I had the good luck recently to pick up a book called
"Medicine’s
10 Greatest Discoveries" by Drs. Friedman and Friedland. To tell the
truth, I expect a boring 10 minutes of reading before I put down the paperback,
but instead I got sucked into a series of well written stories about the
great medical scientists of the western tradition, their scientific problems,
and their love lives. It inspired me to write down what I thought were
the most important medical issues for our generation of students and young
physicians. I've listed my "Top Three" here - but this is a personal list
and you might disagree. If you've got others to put on the list, please
share them with us on our revamped discussion
board or send them to us by e-mail at: PerpetualStudent@studentdoc.com
(if there is enough interest, we'll publish them in an upcoming newsletter).
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AIDS. Without a doubt, this is the most socially charged and frightening
epidemic that our generation of Americans and Europeans has seen. For Africa,
"socially charged" and "frightening" would be huge understatements of the
problem. AIDS has turned modern medicine on its ear - forcing us to a learn
a whole new type of medicine. Along with the immuno-suppression of AIDS
weave seen many of the "old" (like TB) or "rare" (like Kaposi’s Sarcoma)
diseases strike with a vengeance. It forced modern-day politicians and
policy makers to realize that they are in large part responsible for public
health - few will forget how President Reagan basically ignored AIDS because
it struck a subpopulation of Americans that he did not want to acknowledge.
In addition to changing how we think about personal responsibility in the
context of a global epidemic, HIV has forced us to develop, really for
the first time, a series of pharmacological treatments for viral infections.
In the long run, that is, when AIDS as a disease is controlled world-wide,
we will be left with the legacy of a new understanding of viral illness
and how to treat it.
For
an excellent piece on the 20 years of AIDS, see the San Francisco Chronicle's
and SFgate.com's "AIDS at 20".
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The human genome project. The completion of the human genome project
has been compared to landing men on the moon - but practically speaking,
I think this is going to have a much larger impact than that truly amazing,
yet mostly symbolic, achievement. In fact, it's not just the "human" genome
that will transform our understanding of normal physiology and disease,
it's that we will soon be sequencing the entire genome of at least one
species a year. This will give us tremendous insight into what is common
to life on earth, and what is unique to humans, to family groups, and to
the individual. As students of medicine, it will change how we learn about
the body. Comparative anatomy will yield ground to comparative genetics,
family history will yield ground to 10 minute single-chip genetic screens,
and family planning will take on a whole new dimension.
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Cloning and germ-line modifications. While some technical hurdles
still exist, there is little doubt that a human being can be cloned sometime
in the next 10 years. Combined with the ever-increasing ability to change
genes in germ lines, this means that the days of genetic engineering of
humans are right around the corner. This presents one of the biggest challenges
to our generation of physicians and medical scientists - to develop a set
of moral and ethical codes to regulate genetic engineering. There is no
doubt that this technology will be used by someone, somewhere - so we won't
have the luxury of just burying our heads and saying "it's wrong, let's
ignore it."
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