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“Why Physiology Matters in Medicine”
Anesthesiologist Michael Joyner makes his case in an editorial in Physiology, online journal of the American Physiological Society
Bethesda, Md. (May 16, 2011) – Grasping the fundamentals is essential in any profession but is imperative in fields where lives depend on the skill and knowledge of the practitioner. Before taking the control of a jet plane, pilots must grasp the complex concepts of flight and architects must have a total command of the laws of physics before they set out to build a bridge. Yet somehow the truism about professional education seems to have gotten lost in the teaching at some of our nation’s medical schools according to an editorial in the current edition of Physiology (bitly.com/hg2PaQ).
Medical school courses in physiology, the branch of biology that deals with the functions and activities of life or of living matter (as organs, tissues, or cells) and associated physical and chemical phenomena, have either been discontinued or changed to reflect new disciplines emerging in medicine. Michael J. Joyner, M.D., Professor of Anesthesiology at the Mayo Clinic, in an editorial, “Why Physiology Matters in Medicine,” makes a strong case for why teaching this essential science to tomorrow’s physicians is critical. Dr. Joyner, a member of the American Physiological Society (APS), also explains why the teaching of physiology fell out of fashion, explains how physiology research and concepts have contributed to new advances in medicine and clinical care, and argues on behalf of returning this core science to the medical school classroom.
Why Physiology Went “Out of Business”
According to Dr. Joyner, the belief by many medical educators that physiology was no longer on the cutting edge of medicine and would not lead to new insights into disease was the catalyst for the dismantlement of physiology departments in their schools. This turning point coincided with the 1989 identification of the gene variant associated with the most common form of cystic fibrosis. This discovery spawned the notion that once genetic variations were identified, gene therapy would be available to fix the genes, restore function, and “cure” affected individuals. During this same period, the medical community came to believe that common diseases such as hypertension, diabetes and cardiovascular disease would also be associated with a limited number of genetic variants and that by identifying the variations it would be possible to understand which patients were at risk for which diseases. These events led to a consensus that identifying gene variants would enable early interventions to deal with the molecular causes of disease before manifestation of symptoms, thereby making physiology increasingly less relevant.
Dr. Joyner dismisses that belief, asserting the ability to identify specific genetic markers that clearly identify who is at what risk for what disease has been problematic at best. He cites, for example, where genetic markers have not been successful in early determination of cardiovascular disease and Alzheimer’s. He also points to the fact that Type 2 diabetes, increasing in prevalence, has a higher chance of being predicted by traditional phenotypic risk factors (a specific trait based on genetic and environmental influences) than the findings of a purely genetic risk score.
Premature Death Called for a Vibrant Science
Dr. Joyner offers compelling evidence that decisions made to close shop on physiology departments within medical schools were premature, ignoring physiologically based insights and therapeutic approaches providing vast and significant inroads into clinical medicine. He cites the discovery of endothelial-derived relaxing factor (EDRF) and the subsequent identification of nitric oxide (NO) as the main EDRF as the most notable example of the continued success of physiology as the backbone of medicine. This discovery, made using a less exciting but highly valuable organ bath of isolated blood vessel preparations, led to such advancements as identification of a new family of gas-based biological signaling pathways, new ideas about the role of the vascular endothelium in health and disease, and new treatments for a number of diseases including erectile dysfunction and pulmonary hypertension.
Other transformational therapies based on physiological insights are briefly summarized to support the call for reinstatement of physiology departments where it is now lacking. These therapies include:
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simple oral rehydration solutions based on the fundamental principles of physiological regulation of fluid and electrolyte balance for treatment of diarrheal illness in infants and children; and
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improved glucose control evoked by exercise in type-2 diabetics patients, which has led to a number of insights about insulin-independent glucose transport in muscle and a variety of observations about the physiology of the body’s glucose metabolism.
“What’s Past is Prologue”
Dr. Joyner closes his editorial stating that the nature of medical progress, “inherently nonlinear and sometimes counter-intuitive,“ clouds the crystal ball in predicting how new successful clinical therapies based on physiological principles will emerge in the future. But even though biomedical progress can be unpredictable, past successes in developing new therapies offer a clear illustration on how integrating physiology can aid the clinical research effort by either providing a pathway to a solution or generating new ideas and questions, even when they are counterintuitive.
In an interview Dr. Joyner stated, “Physiology matters in medicine, more than ever.” He believes that marrying classic physiological principles to modern day medical insights will be at the heart of the answers needed for addressing 21st century diseases such as obesity, Alzheimer’s and aging.
He added, “Just as understanding the principles of aerodynamics brought us from the Wright Brothers to the Space Shuttle, and utilizing the concepts of physics transformed our ability to move beyond building simple bridges to the Golden Gate, medicine must also fully incorporate the principles of its past or run the risk of falling short of its future potential. Simply put, “what’s past is prologue.’”
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NOTE TO EDITORS: Dr. Joyner’s editorial can be read in its entirety at bitly.com/hg2PaQ. To request an interview please contact Donna Krupa at dkrupa@the-aps.org or 301.634.7209.
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Physiology is the study of how molecules, cells, tissues and organs function to create health or disease. The American Physiological Society (APS; www.the-APS.org/press) has been an integral part of the discovery process since it was established in 1887. To keep up with the science, follow @Phyziochick on Twitter.
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