Competencies in premedical and medical education: the AAMC-HHMI report

One hundred years ago, Flexner emphasized the importance of science in medicine and medical education. Over the subsequent years, science education in the premedical and medical curricula has changed little, in spite of the vast changes in the biomedical sciences. The National Research Council, in their report Bio 2010, noted that the premedical curriculum caused many students to lose interest in medicine and in the biological sciences in general. Many medical students and physicians have come to view the premedical curriculum as of limited relevance to medicine and designed more as a screening mechanism for medical school admission. To address this, the Association of American Medical Colleges and the Howard Hughes Medical Institute formed a committee to evaluate the premedical and medical school science curricula. The committee made a number of recommendations that are summarized in this essay. Most important were that competencies replace course requirements and that the physical sciences and mathematics be better integrated with the biological sciences and medicine. The goal is that all physicians possess a strong scientific knowledge base and come to appreciate the importance of this to the practice of medicine. While science education needs to evolve, Flexner's vision is as relevant today as it was 100 years ago.     

A proposal on a contribution of space biological sciences to sexual health in the human space life.

Sexuality is a basic property of the human being and provides an important background for the human life and society. The present situation in the world strongly suggests that the human being will extensively and intensively spread out in space and the population in space, particularly on the space stations in orbit, moon and possibly Mars, will rapidly increase during this century. Therefore sexual health will become a serious issue for the development of space and a better life of the human in the space environment. It is not too early to consider sexuality in the space life and to discuss how to maintain sexual health, how to control it in the space society, or whether it should be controlled. Space biological sciences should be the key and play an important role in studying scientifically sexuality especially the sex, sexual behavior and reproduction in the space environment.     

The Need for Continuing Medical Education

Continuing medical education is an essential feature of the practice of modern medicine since it furnishes the means to maintain the doctor''s ability to provide quality patient care.To ensure that continuing medical education is provided efficiently and in the best quality, and utilized fully, it is necessary that: (1) the medical faculty inculcate in the student the concept of lifelong learning; (2) the practitioner adopt less time-consuming patterns of practice, to free more of his time for learning; (3) community hospital-based clinical teaching be provided universally; and (4) research be conducted to determine the best of current teaching methods and develop better ones. Conflicting efforts to meet these needs by practitioners (whose primary responsibility it is) and by organized medicine, specialty societies, voluntary health agencies and others have led to inefficient use of medical faculty teachers. The key parties in continuing medical education—practitioner and teacher—can learn best in medical school-administered programs, which need be supported by all other interested organizations.     

Outlook for Restrictive Animal Legislation in the 89th Congress

Past records indicate that legislation, be it extreme or moderate in design, will be the goal of the proponents of restrictive animal legislation in the 89th Congress. Bills similar to those introduced in past sessions almost surely will appear again. If the President succeeds in soliciting congressional support for his goals of the Great Society, Congress may have little time for other legislative matters. The medical and scientific forces that oppose the use of federal legislation as a means of upgrading the standards of animal care and improving the validity of the results of biological research can be expected to continue their support of voluntary control through education and research. Continued support of the effective “task forces” and public relations programs that developed during the 88th Congress must come from all segments of the organized health professions.     

Parasitic diseases: opportunities and challenges in the 21st century

The opportunities and challenges for the study and control of parasitic diseases in the 21st century are both exciting and daunting. Based on the contributions from this field over the last part of the 20th century, we should expect new biologic concepts will continue to come from this discipline to enrich the general area of biomedical research. The general nature of such a broad category of infections is difficult to distill, but they often depend on well-orchestrated, complex life cycles and they often involve chronic, relatively well-balanced host/parasite relationships. Such characteristics force biological systems to their limits, and this may be why studies of these diseases have made fundamental contributions to molecular biology, cell biology and immunology. However, if these findings are to continue apace, parasitologists must capitalize on the new findings being generated though genomics, bioinformatics, proteomics, and genetic manipulations of both host and parasite. Furthermore, they must do so based on sound biological insights and the use of hypothesis-driven studies of these complex systems. A major challenge over the next century will be to capitalize on these new findings and translate them into successful, sustainable strategies for control, elimination and eradication of the parasitic diseases that pose major public health threats to the physical and cognitive development and health of so many people worldwide.     

Models of membranes of cerebral cells as substrates for information storage.

The past decade has seen a growing understanding of functional capacities and structural organization of cell membranes. Studies in immunology, endocrinology and neurobiology have led to some unifying concepts about processes of transduction at the membrane surface, and the coupling of surface events to the interior of the cell. My interest in these problems has been directed in no small measure by interactions with Lars Onsager. His kindly tutelage and rigorous criticism have been a source of endless encouragement to those who sought the full measure of his wisdom in the difficult area of the energetics of membrane excitation. Onsager's unflagging interest in mechanisms of ion transportation led him to earnest consideration of a variety of non-classical models of conduction in proteins, always tempered by his deep insight essential aspects of physical chemistry. My discussions with him at the MIT Neuroscience Research Program were a regular stimulus to the experiments which our groups have undertaken in search of answers to questions raised by the models presented here. Above all, Lars Onsager was a kindly, gentle man. In this personal example, he will be as sadly missed as for his broad and imaginative approach to critical questions in the physical and biological sciences.     

INDUSTRY CALLING!—Is There a Doctor in the House?

Medical service is needed in industry by both management and labor as never before. Industry is just beginning to awaken to this need. The medical profession is largely unaware of it. Unless physicians are prepared to heed this call, there is danger that management and labor will come to a bipartisan agreement over the bargaining table which will specify the amount, quality, and price of medical service irrespective of the effects of such an agreement on the practice of medicine. Such agreements should invariably be tripartite—between management, labor and medicine—if we are to continue to strive for medicine''s traditional ideals: The best of medical care for all alike.This situation imposes at least two important obligations on organized medicine at the national level and especially at state and local levels where there is industrial concentration:1. Provision of a strong and competent committee or council whose members are especially interested in occupational medicine and who will make their presence known to management and labor alike, offering to advise with them on all medical problems, to mediate their disagreements or medical questions, and to help them attain a common goal.2. Assisting the members of organized medicine who are interested, to learn more about the medical problems peculiar to occupational health.     

Building capacity in the life sciences in the developing world

The fundamental challenge facing the scientific community is how to devise innovative strategies that will bring all developing countries into the "biological fold" and to do so in ways that will take full advantage of advances in the biological sciences to curb poverty, improve public health, and promote human development.     

系统生物学对医学的影响

系统生物学是21世纪最前沿的科学之一,它是随着生命科学飞速发展而产生的一门新兴生物学分支[1],它综合数学、信息科学和生物学的各种工具来阐明和理解大量的数据所包含的生物医学意义,从而使人们能够从整体上理解生物医学系统并精确、量化地预测生物医学系统的行为。随着系统生物学的发展及其理论的突破,将在疾病诊治、新药开发、预防医学方面发挥重要的作用,有助于弥补传统医学缺陷并促进其发展。     

Evolution and medicine in undergraduate education: a prescription for all biology students

The interface between evolutionary biology and the biomedical sciences promises to advance understanding of the origins of genetic and infectious diseases in humans, potentially leading to improved medical diagnostics, therapies, and public health practices. The biomedical sciences also provide unparalleled examples for evolutionary biologists to explore. However, gaps persist between evolution and medicine, for historical reasons and because they are often perceived as having disparate goals. Evolutionary biologists have a role in building a bridge between the disciplines by presenting evolutionary biology in the context of human health and medical practice to undergraduates, including premedical and preprofessional students. We suggest that students will find medical examples of evolution engaging. By making the connections between evolution and medicine clear at the undergraduate level, the stage is set for future health providers and biomedical scientists to work productively in this synthetic area. Here, we frame key evolutionary concepts in terms of human health, so that biomedical examples may be more easily incorporated into evolution courses or more specialized courses on evolutionary medicine. Our goal is to aid in building the scientific foundation in evolutionary biology for all students, and to encourage evolutionary biologists to join in the integration of evolution and medicine.     

The future of proteomic analysis in biological systems and molecular medicine

Proteomics is the study of proteins and their interactions within complex biological systems. While this field is often associated with mass spectrometry, it is more useful to consider proteomics in the context of an objective: to identify and understand the molecular basis of health and disease at the protein level in vivo. Achieving this objective will require (1) technological developments to resolve current instrument limitations and (2) multidisciplinary integration of biological and protein analysis technologies to answer important questions in both the biological sciences and molecular medicine.     

Biotechnology to improve health in developing countries -- a review

The growing health disparities between the developing and the developed world call for urgent action from the scientific community. Science and technology have in the past played a vital role in improving public health. Today, with the tremendous potential of genomics and other advances in the life sciences, the contribution of science to improve public health and reduce global health disparities is more pertinent than ever before. Yet the benefits of modern medicine still have not reached millions of people in developing countries. It is crucial to recognize that science and technology can be used very effectively in partnership with public health practices in developing countries and can enhance their efficacy. The fight to improve global health needs, in addition to effective public health measures, requires rapid and efficient diagnostic tools; new vaccines and drugs, efficient delivery methods and novel approaches to therapeutics; and low-cost restoration of water, soil and other natural resources. In 2002, the University of Toronto published a report on the "Top 10 Biotechnologies for Improving Health in Developing Countries". Here we review these new and emerging biotechnologies and explore how they can be used to support the goals of developing countries in improving health.     

From Aviation Psychology To Space Psychology

Without doubt, a name such as the aerospace century can be given, along with many others, to the twentieth century. In our country, which is the native land both of aviation and of astronautics, such genuinely humanitarian sciences as aviation medicine and, later, space biology and medicine, of which aviation and space psychology are component parts, emerged and grew simultaneously with technological development.     

Consensus statement understanding health and malnutrition through a systems approach: the ENOUGH program for early life

Nutrition research, like most biomedical disciplines, adopted and often uses experimental approaches based on Beadle and Tatum’s one gene—one polypeptide hypothesis, thereby reducing biological processes to single reactions or pathways. Systems thinking is needed to understand the complexity of health and disease processes requiring measurements of physiological processes, as well as environmental and social factors, which may alter the expression of genetic information. Analysis of physiological processes with omics technologies to assess systems’ responses has only become available over the past decade and remains costly. Studies of environmental and social conditions known to alter health are often not connected to biomedical research. While these facts are widely accepted, developing and conducting comprehensive research programs for health are often beyond financial and human resources of single research groups. We propose a new research program on essential nutrients for optimal underpinning of growth and health (ENOUGH) that will use systems approaches with more comprehensive measurements and biostatistical analysis of the many biological and environmental factors that influence undernutrition. Creating a knowledge base for nutrition and health is a necessary first step toward developing solutions targeted to different populations in diverse social and physical environments for the two billion undernourished people in developed and developing economies.     

THE DEVELOPMENT OF SPECIALIZATION IN ALLERGY—A Historical Review and a View Ahead

Clinical allergy as a special field of practice is a little more than twenty-five years old. The organized efforts of the two national societies for the study of allergy and the many county, state and regional groups of physicians interested in allergic diseases have served to bring all workers in the field together in pursuit of a common objective. However, the foundation stones for the specialty were laid by a number of astute clinical observers during the past hundred years.This historical sketch aims to portray these men and their work, and points out how the introduction of the skin test as a diagnostic method has dominated the clinical approach to allergic diseases during the past half-century—and that the technique is gradually losing some of its significance. This changing emphasis from the older diagnostic procedures to other techniques is the results of the discovery of the new hormones, cortisone and corticotropin (ACTH). These hormones have presented another method of studying the mechanism of allergic phenomena in man. Finally, brief reference is made to the growing recognition of the significance of the psychosomatic factors in the management of the allergic patient and the influence of this and the other additions to knowledge on the training of the future generations of allergists.     

RECENT TRENDS IN PUBLIC HEALTH

Environmental sanitation is experiencing a reawakening with concerted drives at control of water and atmospheric pollution, mosquito and rodent control, and improvement in restaurant sanitation. Communicable disease control efforts are being intensified.With prolongation of life, chronic diseases are assuming increasing importance as public health problems. Maintenance of standards of hospitals and provision for more adequate hospital facilities are also receiving attention. Mental health and chronic alcoholism are being considered as a public health problem.With all these new trends emphasizing prevention of disease, increasing teamwork between physicians in private practice and in public health practice is being manifested. Preventive medicine and public health are now a recognized specialty in medicine.     

Nonlinear systems in medicine

Many achievements in medicine have come from applying linear theory to problems. Most current methods of data analysis use linear models, which are based on proportionality between two variables and/or relationships described by linear differential equations. However, nonlinear behavior commonly occurs within human systems due to their complex dynamic nature; this cannot be described adequately by linear models. Nonlinear thinking has grown among physiologists and physicians over the past century, and non-linear system theories are beginning to be applied to assist in interpreting, explaining, and predicting biological phenomena. Chaos theory describes elements manifesting behavior that is extremely sensitive to initial conditions, does not repeat itself and yet is deterministic. Complexity theory goes one step beyond chaos and is attempting to explain complex behavior that emerges within dynamic nonlinear systems. Nonlinear modeling still has not been able to explain all of the complexity present in human systems, and further models still need to be refined and developed. However, nonlinear modeling is helping to explain some system behaviors that linear systems cannot and thus will augment our understanding of the nature of complex dynamic systems within the human body in health and in disease states.     

The Physician of the Future

The good physician of the future will need to master not only the basic and traditional medical skills but many new concepts and techniques as well. He will need to be, as always, a compassionate and intelligent man. If he is to retain his status as a healer in the eyes of his patients, he will have to be fully aware of what is happening in the social and technological environment, or he will run the risk of being relegated to the position of a high-grade technician.He will have new physical tools and new thinking tools to help him. To understand and use these, and also to understand the technical world of the future, he will need a sound knowledge of the physical sciences and some fluency in the language of modern mathematics.     

Observations on the history of Dutch physical stature from the late-Middle Ages to the present

In the late-Middle Ages and at the onset of the early modern period, the Dutch population was taller than in the first half of the 19th century. This inference is partially based on skeletal evidence, mainly collected by the Dutch physical anthropologist George Maat and his co-workers. A spectacular increase in Dutch heights began in the second half of the 19th century and accelerated in the second half of the 20th century. At the end of the 20th century, the Dutch became tallest in the world.