Tuesday, October 24, 2006

How magic happens

The magic of academic medical centers occurs at the intersection of clinical care, basic science research, and clinical research. The excerpt below is from an article written by Dr. Jerome Groopman and printed in The New Yorker this past July. If you have chance to read the whole thing, you will find a wonderful story of how a young scientist, working in collaboration with others in the hospital, developed a theory that might end a disease.

The Preeclampsia Puzzle (The New Yorker)
In June, 2000, Ananth Karumanchi, a thirty-one-year-old kidney specialist at Beth Israel Deaconess Medical Center, in Boston, read an article in Nature about preeclampsia, a poorly understood disorder that affects about five per cent of pregnant women. In the developing world, preeclampsia is one of the leading causes of maternal death; it is thought to kill more than seventy-five thousand women each year. In the United States, where treatment is more readily available, few women die of the disease, but complications -- including rupture of the liver, kidney failure, hemorrhage, and stroke --can cause lasting health problems. (In rare cases, patients with preeclampsia develop seizures or lapse into a coma; this is called eclampsia.) The only cure is delivery. "If a woman develops preeclampsia near term, then she is induced to have a delivery or undergoes a Cesarean section," Benjamin Sachs, the chief of obstetrics and gynecology at Beth Israel Deaconess, told me. "In most cases, as soon as she is delivered we know she will get better. But, if preeclampsia develops early in the pregnancy, then we have a huge challenge, because we have two patients: the mother and the baby. If you deliver the baby early to spare the mother, then you put the baby at risk for the complications of prematurity; if you wait, then the mother can have severe complications and go on to eclampsia."
http://www.newyorker.com/printables/fact/060724fa_fact

4 comments:

Jeff Miller said...

Magic or miracles happen because one man had an itch he couldn't scratch and kept at it until he could. This read was poignant, since the causes or contributing factors of pre-/eclampsia has been so poorly understood for so long, and since after thalidomide nobody wants anything to do with studying pregnancy related conditions.

Paul said...

You write, "The magic of academic medical centers occurs at the intersection of clinical care, basic science research, and clinical research."

I understand where you are coming from, but I strongly disagree with this statement. As a physician working at an academic medical center, I can honestly say that the magic in my life, at my job, the magic that keeps me going to a job at a medical center that I don't always find that magical - this magic comes from what is happening as we train young physicians to be the great, passionate and dedicated physicians of tomorrow.

EDUCATION and clinical care (not research) is what will make a difference in our lives. These are the individuals that are destined to care for you and for me in our latter years. We need to make sure that they are not only book-smart but also find inspiration and balance in their future practice.

Unfortunately, our hospital administrators (you might be an exception) too often focus on clinical care and research at the expense of education. This is because clinical care and research bring in the dollars (and perhaps the reputation). Education, on the other hand, costs money and doesn't necessarily bring acclaim. However, I would argue it really is at the heart of what we do. If we sacrifice education for dollars, we will all suffer in the coming years.

Paul Levy said...

I think it is all three! But I recognize each person has his or her own priorities and loves. We do try to support all three.

Paul said...

I also think it is all three. However, I argue for education because it seems to be the one always getting the proverbial short end of the stick. It is obvious that good patient care is the cornerstone of all that we do. Research gets both the glamour and brings in the dollars (grants, etc.) - so researchers, in essence, pay their own salaries.

Educators, on the other hand, are rarely encouraged or recognized and even more rarely find a way to pay their own way. We've got to make special efforts to treat education as an equal in the "tripod" of patient care, research and education that is the foundation of what we do.