Lists of 10

Ten is an interesting number. We all have 10 fingers and 10 toes. All land animals today are descended from pentadactyl ancestors with five toes going back 340 million years. This is true of every mammal, bird, reptile or amphibian—although some species have subsequently fused these fingers into hooves or lost them altogether. It got me to think, what questions would I like answered about medicine? After a long career dealing with medical quandaries, I thought I’d list 10:Why is the hallux PIP the most common joint to be affected by gout? Is it because it is a “cool” joint, distant from the heart, that allows uric acid crystals to form?What is it that generates “clubbing” in patients with chronic sepsis and fibrosis/cancer of the lung?What do we understand about the initiating cause of multiple sclerosis?Why can half a liver regenerate, but half a kidney does not?If the appendix is “redundant,” what was its function originally? Is it a storage site for bacteria when we need to reboot our gut?Do we really lay down a protein for every memory. If so, why do some last and some don’t?Why do some people with gluten sensitivity get sore joints?What is happening when a patient with schizophrenia has an auditory or visual hallucination?What exactly causes cachexia of malignancy?What is going on in polymyalgia rheumatica, and what causes it? Is it really an inflammatory response to a viral trigger?Some readers will know the answers to some of these—do share. And if you have a list of 10 questions for the practicing clinician, add them. I looked on my bookshelf and found a few paperbacks that have tackled interesting science problems in the list format. You may be interested in these.Ten Drugs: How Plants, Powders, and Pills Have Shaped the History of Medicine, Thomas HagerOpiates and opioids (from opium to heroin, methadone to oxycontin, a huge industry with a persistent and lethal problem—addiction)Vaccines (crediting Montague and Jenner’s work on smallpox, and beyond)Chloral hydrate (Julius von Leipzig, 1879, the father of medical chemistry). Chlorpromazine (Laborit and Delay work to make the first antipsychotic, followed in time by tranquillizers and novel antidepressants)Oral contraceptives (Haberlandt in the 1920s and ‘30s, Marker and Pincus in the 1950s, leading to a social revolution)Antibiotics (Salvarsan for syphilis, Erlich in 1929), Sulphanilamide for lethal strep (Domagk and Klarer in 1932) and Penicillin (Fleming 1928 and the Second World War)Erectile dysfunction drugs (Sildenafil in 1988, Cialis and Levitra in 2003)COX2 inhibitors (eg. Celebrex)Statins (Anichkov, Endo and others. Mevacor in 1987, then lookalikes in a boom industry)Monoclonal antibodies (1980s)—eg. the checkpoint inhibitor, pembrolizumabTen Questions You Must Ask Your Doctor, Ray Moynihan and Melissa SweetDo I really need that test?Do I really have that disorder?Do I really need to be screened?What are my options?How well does that treatment work?What are the side effects?Will this operation really help?What is the evidence?Who else is profiting here?What can I do to help myself?Medicine's 10 Greatest Discoveries, Mayer Friedman and Gerald FriedlandAndreas Vesalius' anatomy of the human body (1543), with its presentation of the scientific method William Harvey's description of the functions of the heart, and the circulation of the blood (1628) Anton Leeuwenhoek's use of the microscope, to identify bacteria (1675) Edward Jenner's discovery of vaccination (1796)Crawford Long's development of surgical anesthesia, through the use of ether (1842) Wilhelm Roentgen's discovery of x-rays for diagnostic purposes (1895) Ross Harrison's invention of tissue culture (1907)Nikolai Anichkov's discovery of the role of cholesterol in coronary artery disease (1912)Alexander Fleming's discovery of penicillin (1928)Maurice Wilkins' isolation of a single fibre of DNA (1950-53)I think the process of listing our goals and objectives has great value, personally and professionally. It challenges us to identify where the future might take us. It encourages us to prioritize research directions and galvanizes policy and public understanding. If we, as a species, could learn to communicate better, we might be able to learn what we need to know, and enact the changes necessary to survive well, and peacefully, on the planet Earth.

Lists of 10

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