Tomorrow's healthcare professionals, tomorrow's medications & reductionism

[nightflyer]

1. Is it likely that traditional doctors (having been schooled in biology and chemistry) will be replaced my medical physicists in the future? Will the life sciences of today move more and more into physics, meaning that any healthcare professional will need to have fundamental training in physics?

2. To me it seems like the medications we have today are often very ineffective, and come with a wide range of unwanted side effects. Taking a reductionist view I guess there is hope that more effective treatments will be developed once we understand biology on a more fundamental level, by means of physical and mathematical models. Or could the human organism be too complex a system to be understood on this fundamental level? Paul Davies, among others, seems to think so (he is often writing about the dangers of reductionism in biological system, and emergent properties that might not be reducible to physics).

It would be very nice to hear your views on these topics. Also, feel free to post any links that might be relevant. Thanks!

 

[gravenewworld]

1. Is it likely that traditional doctors (having been schooled in biology and chemistry) will be replaced my medical physicists in the future? Will the life sciences of today move more and more into physics, meaning that any healthcare professional will need to have fundamental training in physics?

Not likely. I highly doubt you would ever solve a differential equation in med school or as a practicing physician (an academic physician maybe, but that is stretching it still). Show me a practicing physician that actually knows on a theoretical level how a MRI works and I will give you 1 million dollars.

2. To me it seems like the medications we have today are often very ineffective, and come with a wide range of unwanted side effects. Taking a reductionist view I guess there is hope that more effective treatments will be developed once we understand biology on a more fundamental level, by means of physical and mathematical models. Or could the human organism be too complex a system to be understood on this fundamental level? Paul Davies, among others, seems to think so (he is often writing about the dangers of reductionism in biological system, and emergent properties that might not be reducible to physics).

As a medicinal chemist, I say physical and mathematical models are just that--models that don't represent the real thing. Could an economist ever come up an equation that would perfectly predict the economy for all time? Most likely not. Models help, but every model comes with a set of assumptions that are made to simplify things, but the assumptions themselves don't reflect reality. In what ways are medicines today "ineffective"? Drugs are foreign chemicals that are put into the body for a desired result. Anytime you do that there will be side effects.

 

[Gokul43201]

Two decades ago... http://www.iupac.org/publications/pac/1988/pdf/6002x0277.pdf

And abstracts from the last conference on Structure-Based Drug Design : http://barryhardy.blogs.com/cheminfostream/2006/09/structurebased_.html

http://www.lifesciencesexpo.com/2006/sbd/index.asp

Of course, using quantum/statistical mechanics to design/understand drugs/diseases is one thing; having a physician utilize physics on a patient-to-patient scale is a whole different ball game.

 

[Moonbear]

1. Is it likely that traditional doctors (having been schooled in biology and chemistry) will be replaced my medical physicists in the future? Will the life sciences of today move more and more into physics, meaning that any healthcare professional will need to have fundamental training in physics?

Medical students are already required to have some fundamental training in physics. Advanced training is more for certain areas of diagnostics (i.e., radiology), but the physicians don't need the in-depth knowledge of how the machines work; that's the job of the scientists developing the machines. The radiologists do need a functional knowledge, enough to know what to adjust and how to interpret the results.

2. To me it seems like the medications we have today are often very ineffective, and come with a wide range of unwanted side effects. Taking a reductionist view I guess there is hope that more effective treatments will be developed once we understand biology on a more fundamental level, by means of physical and mathematical models. Or could the human organism be too complex a system to be understood on this fundamental level? Paul Davies, among others, seems to think so (he is often writing about the dangers of reductionism in biological system, and emergent properties that might not be reducible to physics).

Why resort to an oversimplified model when there's the real thing? Modeling is only as good as the data you have for developing the model.

The problem with side-effects isn't because we don't understand a lot of details about how different systems work, it's because biological systems have a lot of redundancy, so the same drug will act on more than one place. Molecular biology is a very reductionist approach already in use, but if you forget about the interactions of all the systems in the organism (physiology), you're not going to make much useful progress, and are more likely to develop drugs with unintended side-effects.

 

[edward]

Off the topic a bit, but why is it that medical Doctors can't read each others hand writing?

 

[Moonbear]

Off the topic a bit, but why is it that medical Doctors can't read each others hand writing?

Same reason I can't read the handwriting of quite a lot of students...laziness in penmanship! Though, it's not really as bad of a problem as people joke. More of it is that there are a lot of standard abbreviations used in writing prescriptions that are based in Latin, so the average patient hasn't a clue how to read what's written on their prescription sheet, but the pharmacists do. I force my med students to improve their penmanship if it's really illegible...they have to write a lot on the board in the class I facilitate, and get dinged on communication skills if their penmanship is atrocious.

 

[edward]

You are doing a good job Moonbear. Ironically few people receive instruction on pensmanship after grade school.

But the problem is not just with pharmacist. Nurses and clinicians have the same problem.

Death By Handwriting
Interpreting physicians' orders can be as confusing as deciphering hieroglyphics--with the potential for serious patient injury or death.
By Maureen Glabman
Wednesday
October 5, 2005

Saints Memorial Medical Center nurses attended to hundreds of details, preparing to dazzle a team from the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). When the team arrived for a January inspection at the Lowell, Mass., hospital, the nurses had checked fire procedures, conducted mock patient tracers and scrutinized charts for forbidden abbreviations.

Saints' Web site boasts "an exceptional 95 percent" on its last examination in 2002, and administrators fully expected a similar assessment. But after surveyors left, stunned executives learned Saints was cited twice for a pervasive problem rarely addressed a decade ago in the nation's hospitals--illegible physician penmanship. The hospital was given 90 days to correct the deficiency.

http://www.trusteemag.com/trusteemag_app/hospitalconnect/search/article.jsp?dcrpath=TRUSTEEMAG/PubsNewsArticleGen/data/2005/0510TRU_FEA_Handwriting&domain=TRUSTEEMAG

It is still an ongoing problem. A number of states have even passed laws requiring prescriptions to be legible.

 

[Moonbear]

It is still an ongoing problem. A number of states have even passed laws requiring prescriptions to be legible.

One of the solutions to this is computerizing prescription writing. But, med schools have recognized this problem. I've seen the criteria used at another medical school for assessing their students in a similar course to the one I teach in, and they also specifically mention penmanship in their evaluation criteria. You don't have to have beautiful script that would make your third grade teacher proud, just be legible. It's pretty easy to get the point across if someone writes something completely illegible by asking them, "What do you call it when a physician scribbles something on a chart that nobody else can read?" When they look at you with the "I have no idea" look, the answer is, "malpractice." We've recently begun evaluating students on a number of other "professionalism" criteria as well.

 

[Curious3141]

Not likely. I highly doubt you would ever solve a differential equation in med school or as a practicing physician (an academic physician maybe, but that is stretching it still).

Wrong. Enzyme kinetics (Michaelis-Menten and Hill kinetics) and pharmacokinetic theory use differential equations to get the basic stuff done. I can reproduce the derivation even now (more than a decade after that point in med school).

Far more involved differential equations (including partial d.e.s) are frequently involved in my pet interest of mathematical epidemiology.

Show me a practicing physician that actually knows on a theoretical level how a MRI works and I will give you 1 million dollars.

You'd lose your bet. I know how an MRI works at a theoretical level (and I'm a practicising physician, although most of my work is in the lab). I was involved in a functional MRI project (which started with me reading a lot of basic NMR theory) in my elective project in med school.

 

[nightflyer]

Thank you for all the replies!

I wrote this post because I can not make up my mind about whether to go into university studying traditional life sciences and become a medical doctor, or study physics and specializing in biophysics or medical physics, and maybe get involved in research instead of working with patients directly. I think I am a reductionist at heart, but obviously I know way too little to know what relevance physics might have in understanding disease. But to me it seems like mathematical models have been tremendously successful in describing the workings of the physical world, so it is easy for me to imagine how these models could also give us at least partial understanding of how biological systems work.

 

[Schrodinger's Dog]

One of the solutions to this is computerizing prescription writing. But, med schools have recognized this problem. I've seen the criteria used at another medical school for assessing their students in a similar course to the one I teach in, and they also specifically mention penmanship in their evaluation criteria. You don't have to have beautiful script that would make your third grade teacher proud, just be legible. It's pretty easy to get the point across if someone writes something completely illegible by asking them, "What do you call it when a physician scribbles something on a chart that nobody else can read?" When they look at you with the "I have no idea" look, the answer is, "malpractice." We've recently begun evaluating students on a number of other "professionalism" criteria as well.

All my prescriptions are usually computerized. Dr prints them out then signs them. In fact if your really lazy since the pharmacy is actually part of the Dr's surgery you can get the pharmacy to pick up your prescription then process it,so you don't have to wait at the chemist, which is nice. Apparently they do it whether the surgery is close or not too. Probably a real boon to the old I would imagine.

 

[Moonbear]

Thank you for all the replies!

I wrote this post because I can not make up my mind about whether to go into university studying traditional life sciences and become a medical doctor, or study physics and specializing in biophysics or medical physics, and maybe get involved in research instead of working with patients directly. I think I am a reductionist at heart, but obviously I know way too little to know what relevance physics might have in understanding disease. But to me it seems like mathematical models have been tremendously successful in describing the workings of the physical world, so it is easy for me to imagine how these models could also give us at least partial understanding of how biological systems work.

You still have time to decide. You don't have to major in life sciences to go to medical school. You can major in physics and just take the few additional pre-med courses required in biology (and chemistry if the physics degree doesn't require that already), which you'd probably need to take if you learned biophysics anyway, and see which direction you'd prefer after you've learned more about the various subjects. If you're an outstanding enough student, you can also do an MD/PhD, which would allow you to attend med school as well as do research and earn both degrees (it's a long process, so you'd really have to have a strong desire to do that to make it worthwhile).

 

[gravenewworld]

Wrong. Enzyme kinetics (Michaelis-Menten and Hill kinetics) and pharmacokinetic theory use differential equations to get the basic stuff done. I can reproduce the derivation even now (more than a decade after that point in med school).

Far more involved differential equations (including partial d.e.s) are frequently involved in my pet interest of mathematical epidemiology.
You'd lose your bet. I know how an MRI works at a theoretical level (and I'm a practicising physician, although most of my work is in the lab). I was involved in a functional MRI project (which started with me reading a lot of basic NMR theory) in my elective project in med school.

When does a physician use this in everyday life to treat a patient? Never. So you use Diff eqs as a physician? Interesting... so why do 100% of US medical schools NOT require any math classes above basic calc/stat then ? probably because they know you won't need to use it in the real world while treating patients. Those heavily involved in PK/pharmacology aren't treating patients, they are busy working in industry or teaching/researching at universities etc. We have heaps of them at my company, I am very familiar with what the do. Like I said before, the only MDs that would ever use theoretical stuff would be those in academia or those in industry, not docs who have hands on with patients.

Anyways...does anyone have an idea as to how long it actually takes to make a drug? Consider this fact, on average it takes 234 FTEs years/DC (FTE=full time employment years, DC=drug candidate)! So you would need 117 people all working on the same project for 2 years full time just to get 1 DC. That isn't even conisdering the fact that the DC still has to pass phase I,II, and III clinical trials before it can even become a drug. Big pharma has armies of computational chemists that do theoretical work with insanely nasty computers, but even with their help finding a drug is like finding a needle in a haystack. Call me a pessimist, but 5-10 years (most companies don't ahve 117 scientists working on a single project but more like 10-20), 234 FTEs, and 100s of millions of dollars just to find a DC? That doesn't sound like the theoretical models that are being employed are that successful (maybe this will actually motivate you to do theoretical work to try to make improvements on this situation). To be brutally honest, none of the bosses at my job take the theoretical work very seriously, they only use it as a rough guide. Nothing substitues for hands on data that came from testing on rats/dogs/monkeys/bioassays etc.

OP medschools don't give a crap what you major in. Major in what ever you want to. However, you will eventually have to decide if you want to have hands on with patients or work in lab for the rest of your life.

 

[Moonbear]

However, you will have to eventually have to decide if you want to have hands on with patients or work in lab for the rest of your life.

Not true. There are physicians in clinical research who do both. Though, if this person has not even begun college, there is plenty of time to figure out what they will do (and no career path is ever terminal...if you really start to dislike something, you can always go back to school to pick up what you need for something different).