The Scientific Infrastructure of Medicine
Medicine is not a science, but a profession that encompass medical science learning as well as well personal, humanistic and professional attributes. Nonetheless, the delivery of Western medicine depends totally on science and the scientific method. Since Flexner issued his famous report on the subject in 1910, American medical education has strived to develop a strong scientific ba as an integral part of medical education at every level: premedical, medical, residency, and continuing medical education. Biomedical science is fundamental to understanding dia, making diagnos, applying new therapies, and appreciating the complexities and opportunities of new technologies. The process of becoming a physician and being committed to lifelong learning requires that one posss the scientific ba not only to acquire and appreciate new knowledge but to e new ways for applying it to patient care as well. The physician顶岗教师
must be able to understand reports of current rearch in the medical literature in order to grasp and evaluate the newest and latest approaches, no matter how complicated the field may become. That is why this textbook of medicine strongly emphasizes how things work, how they go amiss when pathol
ogic process ensue, and what effect a given therapy can be expected学生自评
to have in correcting abnormalities. We ek to create in our readers a yearning for a greater depth of understanding and a continuing commitment to stay at the frontier of scientific knowledge throughout their professional lives.
Medicine has advanced to an outstanding degree in the past half century. The 100 years from 1850 to 1950 were characterized -- with the important exceptions of the discovery of penicillin, sulfonamides, and insulin -- by the application of chemistry and physics to biologic materials, e. g. blood and urine, or to the body, e. g. roentgenography and sphyghmomanometry, and by the empirical u of medicinal chemicals. The advances of the last 50 years have come at the most fundamental levels of science and have reflected the general explosion in scientific knowledge worldwide. Much of this explosion has been stimulated by the 'strong influence of the American National Institutes of Health (NIH) and their programs of intramural rearch and extramural rearch support. Thanks to the NIH and a variety of public philanthropi牛肉干制作
es, since World War II uni头衔怎么设置
versities throughout the nation have become deeply engaged in biomedical science at levels that l
ong precede applications to specific dia. What has come from the basic discoveries, however, has been the very substance of new technologies to understand and cure dia.
True understanding of dia process depends on levels of scientific knowledge which are just being discovered. For example, when one learns how proteins are synthesized, fold into their native conformation, and express their various physical properties, one gains an understanding of why erythrocytes sickle when the -chain of hemoglobin undergoes a Glu to Val change at amino acid number 6. One becomes able to understand the deposition of protein casts in multiple myeloma; the complexities of amyloid formation and how it influences organ function; the nature of protein aggregation as a fundamental process of Alzheimer's dia; and the importance of protein-protein interaction in transmitting messages across cell membranes, within the cytoplasm, and to the nucleus of cells. Once a student understands that way G-proteins function, he/she understands how membrane transport events take place and messages transfer from the outside to the inside of cells. Furthermore, he/she gains an understanding of how microbi
al toxins operate, hormones influence cell action, and cells respond to external stimuli and are regulated in their respon. When a student has knowledge of the basic process of DNA synthesis, mutation, and somatic alteration of gene expression, he/she is in a position to understand inherited dias as well as tho that have their fundamental process expresd in continuous pattern of somatic alteration within a given individual. Understanding such pathogenic process and events is the esntial first step in being able to identify and apply appropriate therapeutic maneuvers. Fundamental science is crucial as a knowledge ba for any member of our profession. Fortunately, for a physician studying and learning in this complex environment, medical science has become so fundamental that understanding of a few fundamental and critical process can provide insights into a whole variety of dias.
A list of major clinical achievements in any particular branch of medicine reveals that more than 60% of the enabling discoveries ari from the category of very basic science and that the discoveries were made without any particular notion of how they might be applied to human dia. Our repertoire of breakthroughs in infectious dias, the reg
ulation of blood pressure, fundamental immunology, fundamental genetics, and metabolic regulation by hormones reprents milestones in the cour of medical history that now provide the tools to help unravel the intricacies of human dia. In spite of unbelievable success, many dias remain for which we still have no absolute answers. The include cancer, Alzheimer's dia, autoimmune dias such as rheumatoid arthritis and lupus erythematosus, psychiatric dias including manic-depressive psychosis and schizophrenia, and many othe梅花的作用
rs. Nonetheless, the clues now being ferreted out at the molecular level anticipate solutions of even the disorders, realistically filling our future expectations with excitement and anticipation.
The scientific infrastructure that we appreciate today is the springboard for the future in which most of the readers of Cecil Textbook of Medicine, 20th edition, will practice. Throughout most of the recorded history of medicine, diagnos and therapies have not been bad on scientific fact, and the degree of certainty with which physicians worked was inexact, if not totally flawed. But this has entirely changed. By 150 years ago things were beginning to change and by the 20 years spanning the turn of the century, the first f
undamental lights began to illuminate the “golden age of microbiology." During this period, Pasteur, working in Paris, and Robert Koch, working Berlin, began to unravel the intricacies of infectious dias. To define microorganisms, to understand how they cau infection and transmit dias, and to understand the host respon reprented a real turning point and forever established the scientific method as the basis for understanding and treati恨字开头的成语
ng dia. It is an amazing experience to read the scientific papers from Paris and Berlin at that time becau in relatively short period tho two schools of thought t us on a pathway from which medicine can never depart -- that of demanding precision, of requiring experimental proof, and of building confidence by accumulating irrefutable data.
