Forward from 40: The top healthcare milestones of the past 40 years

In celebration of Modern Healthcare's 40th anniversary, readers were asked to choose the top healthcare milestones since the magazine's founding in 1976. Over 700 respondents to the survey selected their top five picks from each of three categories: healthcare delivery, politics and policy, and science and technology. Read on for the complete list of the 40 most significant developments of the past 40 years.

1. Sequencing the human genome

In June 2000, President Bill Clinton, flanked by Dr. Francis Collins, then director of the National Human Genome Research Institute at NIH, and Dr. Craig Venter, CEO of Celera Genomics, jointly announce the sequencing of the human genome.

2. Magnetic resonance imaging

A team led by John Mallard of the University of Aberdeen in Scotland obtained the first clinical useful image of a patient's internal tissues using MRI imaging on Aug. 28, 1980. Refinements over the next 15 years led to its widespread use by the middle 1990s.

3. The Patient Protection and Affordable Care Act

A Democratically-controlled Congress and President Barack Obama in 2010 pass the largest health insurance expansion in 45 years without a single Republican vote. The law requires citizens to have health insurance and bars insurers from denying coverage. Half the law is devoted to encouraging delivery system reform.

4. Smallpox eradicated

The World Health Organization declared smallpox eradicated on May 8, 1980.

5. First AIDS case identified

In June 1981, the CDC reported a cluster of pneumocystis pneumonia in five gay men in Los Angeles while physicians in L.A. and New York identify an outbreak of a rare skin cancer among gay men. A July 3 article in The New York Times carries the headline: "Rare Cancer Seen in 41 Homosexuals."

6. Health Insurance Portability and Accountability Act

While the 1996 law protects coverage for workers and their families when they change or lose their jobs, and requires national standards for electronic healthcare transactions, it becomes best known for its sections protecting patient privacy.

7. The birth of DRGs

Following a three-year experiment in New Jersey, the Health Care Finance Administration (now CMS) in 1983 established diagnosis-related groups for episodes of care within all hospitals.

8. Electronic medical records

President George W. Bush in his state-of-the-union address in 2004 called for universal, portable electronic health records within a decade. Despite over $30 billion in federal expenditures and tens of billions more by providers, easily transferable EMRs still don't exist in most of the country.

9. Telemedicine

From its beginnings in the NASA space program, telemedicine or telehealth has grown into a booming business with CMS now having over 70 HCPCS/CPT codes to pay for various telehealth services.

10. The growth of nurse practitioners

Fifteen years after the first nurse practitioner program was established in 1965 at the University of Colorado, and five years after the American Nurses Association established a separate council for NPs, their ranks by 1979 had crossed the 15,000 mark. Today, there are more than 205,000 NPs licensed in the U.S.

11. Medicare's prescription drug benefit

The Medicare Prescription Drug, Improvement and Modernization Act, signed into law by President George W. Bush in December 2003, creates Medicare Part D, an unfunded mandate for Medicare to pay for seniors' prescription drugs through private insurance plans.

12. Seat belts

Though the federal government required manufactures to install seat belts in 1969, use enforcement was left up to the states. South Dakota became the last state to enact fines for non-use in 1995. The CDC estimated seat belts saved over a quarter million lives since 1975.

13. Affordable Care Act survives at Supreme Court: Round 2

In a 6-3 ruling, the Supreme Court in King v. Burwell that insurance subsidies were valid in all parts of the country, thus putting an end to the last serious legal challenge to the ACA.

14. Advanced directives or living wills

An advance healthcare directive specifies what actions a person wants from healthcare providers if they are no longer able to make decisions for themselves. The first living will was developed in 1969. In 2009, President Barack Obama became the first president to say he had a living will.

15. Computed tomography (CT) scanning

The first computed tomography scan of a patient took place in England in 1971. This year, an estimated 78 million CT scans will be conducted on far more sophisticated machines.

16. Accountable care organizations

Coined by Dartmouth researcher Elliott Fisher in 2006, the term describes an entity "held accountable" for comprehensive health services for a defined population. Similar to Health Maintenance Organizations (HMOs), ACOs differ in that they are usually run by providers, not insurers, and take on less risk.

17. The Emergency Medical Treatment and Labor Act

EMTALA, Signed into law by President Ronald Reagan, requires hospital emergency departments provide appropriate medical care regardless of citizenship, legal status or ability to pay.

18.Vaccines for Children

A federally funded program created in 1994 provides free vaccines to children in low-income families. Vaccines include MMR, flu and HPV.

19. Discovery of AIDS virus

In 1984, research groups led by Dr. Robert Gallo at Johns Hopkins University, Dr. Luc Montagnier at the Pasteur Institute in Paris, and Dr. Jay Levy at the University of California, San Francisco, identify a retrovirus as the cause of AIDS. A global fight over who discovered the retrovirus ensues.

20. The Stark law

This 1989 law bars physicians from referring Medicare patients to hospitals, labs and other doctors with whom they have financial ties (except in some circumstances). Many providers sued under the Stark law criticize its complexity.

21. FDA approves direct-to-consumer advertising

The FDA decision in 1997 made the U.S. only one of three countries in the world where DTC advertising is legal. The flood of television and print advertising for pharmaceutical products continues to this day.

22. Genetically-targeted cancer therapies

The FDA approves the first targeted cancer therapy, imatinib or Gleevec, in 2001 for chronic myelogenous leukemia. In 2015, President Obama announces a precision medicine initiative.

23. Statin drugs

The FDA approved lovastatin for prevention of heart disease in 1987. Marketed by Merck as Mevacor, it was the first drug in a class that would become the best-selling drugs in U.S. history.

24. In-vitro fertilization

Louise Brown, the first test tube baby, was born on July 25, 1978 at Oldham General Hospital in the UK. Her parents, Lesley and John Brown, had been trying to conceive for nine years.

25. The Children's Health Insurance Plan

President Bill Clinton signed CHIP into law in 1997 as part of the Balanced Budget Act. By 2015, more than 8 million children received health insurance coverage under the program.

26. Percutaneous coronary interventions (PCI)

The first coronary angioplasty was performed in Zurich on Sept. 16, 1977, by Dr. Andreas Gruntzig. The procedure spread quickly to the U.S. after he moved to Emory University in Atlanta. By the mid-1980s PCI had become the leading procedure for treating coronary artery disease.

27. The HIV/AIDS triple cocktail

The Food and Drug Administration's approval of the first protease inhibitors in 1996 enabled three-drug combination therapy, which turned a fatal disease into a manageable condition.

28. COBRA

The Consolidated Omnibus Budget Reconciliation Act, passed by Congress in 1985 and signed into law in 1986, required employers to offer partially subsidized health insurance to employees who lost their jobs.

29. Framingham heart study

Begun in 1948, this ongoing epidemiological study that began with over 5,000 Massachusetts men and women discovered the links between elevated levels of heart disease and smoking (1960), high cholesterol and blood pressure (1961), psychosocial factors (1978), and atrial fibrillation (1998).

30. Nutrition Labeling and Education Act

In a major breakthrough for dietary health, this 1990 law required nutrition information on all packaged foods and regulated the use of health claims on labels.

31. Coronary stents

In 1986, Drs. Ulrich Sigwart and Jacques Puel implanted the first coronary stent in a human at a hospital in Lausanne, Switzerland

31. United Network for Organ Sharing

Congress passed the National Organ Transplant Act to coordinate the allocation of organs in 1984. UNOS was incorporated in March of that year and received its initial contract in 1986.

33. Oregon's Death With Dignity Act

Oregon became the first state in the country to pass a law allowing terminally ill individuals to end their lives with lethal medication prescribed by a doctor. Since 1997, five other states have also legalized the practice.

34. The orthopedics revolution

By the early 1970s, surgeons had developed effective replacements for arthritic knees and hips. By 2010, an estimated 7.2 million Americans have undergone total knee and total hip arthroplasty. Women accounted for over 60% of the operations.

35. Affordable Care Act survives at Supreme Court: Round 1

In a 5-4 decision, the U.S. Supreme Court in NFIB v. Sebelius upholds most of the ACA when it declares the penalty levied on people who didn't buy insurance a tax. The high court also allows states to opt out of expanding Medicaid.

36. Patient-centered medical homes

An American Academy of Pediatrics statement in 1992 defines a medical home a family-centered, comprehensive, continuous and coordinated care for infants and children. The American College of Physicians in 2005 encourages their use with all patients.

37. Fighting healthcare fraud and abuse

The Department of Justice and HHS Secretary in 2009 create the Health Care Fraud Prevention and Enforcement Action Team, which focuses on preventing and reducing Medicare and Medicaid fraud. Since then, the DOJ has recovered more than $16.4 billion in healthcare fraud cases.

38. Health Savings Accounts

Part of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, HSAs were designed to offer a tax-advantaged account to pay for out-of-pocket costs under high-deductible health plans.

39. Massachusetts healthcare reform

The 2006 law, signed by future GOP presidential candidate Mitt Romney, mandated residents buy health insurance and employers with 11 or more workers offer coverage. The law became the model for the Affordable Care Act.

40. Artificial hearts

The first artificial heart, developed by Dr. Robert Jarvik, was implanted Dr. William DeVries of the University of Utah on Dec. 2, 1982. Seattle dentist Barney Clark lived another 112 days.