Molecules, Cells, Compassion
Unit 3
This unit explores structure and function in the context of cellular and human lifespans. Aberrations in cellular function, as exemplified by genetic, hematologic and oncologic diseases, are examined holistically to include epidemiological, biomedical, ethical and osteopathic perspectives. Professional identity formation is fostered, while skills in communicating difficult news, compassion, empathy, resilience and self-care are developed. As learners examine local, state and federal health care systems, in the context of inter- and intra-professional health care teams, they make plans to enable patients and their families to access and receive appropriate care. Finally, trends and ethical issues of biomedical research and integrative medicine are evaluated for application for clinical practice.
Rationale
Rudolph Virchow first expressed in 1855 that all diseases are disturbances that start at the cellular level.1 This became the basis of cellular biology and modern medicine. Since Virchow’s time, the amount of information we have gathered about cells has grown exponentially. It is now common knowledge that all cells come equipped with the instructions necessary for life and self-destruction. The instructions for this are written in the sequence of proteins, the structural and functional foundation of the cell, and therefore the human body. Approximately 20,000 protein encoding genes exist in the human genome, and from these instructions the human organism grows from one undifferentiated cell to produce approximately 37 trillion cells of over 200 different cell types.2 When these cells function both individually and collectively, the human body becomes a remarkable machine.
A contemporary of Virchow, Andrew Taylor Still wrote in 1897, “So if the supply channels of the body be obstructed, and the life-giving currents do not reach their destination full freighted, then disease sets in.”3 The osteopathic view of the human body further expanded in 1922 when a consensus statement published by the A.T. Still Research Institute recognized the importance of the relationship between cellular structure to function and the adaptability of cells to changing environments. The consensus statement also integrated the role of the blood in sustaining the cells of the body, with disease symptoms manifesting as a result of an inability of the organism to efficiently deal with an adverse circumstance or other structural abnormalities.4 From this, rational methods of osteopathic treatment are focused on normalization of structural relationships accounting for the interaction between body, mind and spirit.5 Osteopathic medicine is uniquely suited to restore homeostasis by removing obstructions to perfusion through osteopathic manipulation.
Throughout the 20th century, medicine has experienced revolutionary growth in the areas of mechanistics, diagnostics and therapeutics through the elucidation of the central dogma of molecular biology. The molecular biology revolution of the 1970s and early 80s led to a deeper understanding of how and why therapeutics work and ultimately influenced a movement toward the use of evidence-based medicine, or the judicious use of current best evidence in clinical decision making.6 For example, the discovery of oncogenes and tumor suppressors that influence cell growth has allowed for the development of new drugs that target cancer cells, and laboratory testing methods that are useful in diagnosis and monitoring in oncology.7 The Human Genome Project alone has provided abundant information about the underlying causes of human health and disease, and led to birth of the new fields of genomics, proteomics, and subsequently, personalized medicine.8 As such, and in order to best serve their patients, physicians should employ an encapsulated model of clinical reasoning, in which cell and molecular sciences become intertwined with clinical facts and medical humanities in mental representations of disease scripts.9
The conditions that result from genetic and biochemical alterations in cells present particularly difficult challenges to patients and their families. Parents of children born with congenital or genetic disorders may feel overwhelmed or underprepared for the life-long challenges ahead. Patients diagnosed with cancer, and their loved ones, feel worry and fear as they embark upon their journey of uncertainty and hope. Furthermore, patients and family members facing end-of-life care decisions struggle with issues of mortality and loss. Because of this, it is of utmost importance that osteopathic physicians treat these patients, and their communities, with delicate and compassionate care.
References
1Rather LJ translator. Disease, life and man: selected essays by Rudolf Virchow. Stanford (CA): Stanford University Press; 1958.
2Bianconi, E., at al. An estimation of the number of cells in the human body. Annals of Human Biology. 2013; 40 (6).
3Still, AT. Autobiography of Andrew T. Still. New York: Arno Press Inc. Reprint 1972; p. 229.
4Hulett, GD. A Text Book of the Principles of Osteopathy. 5th ed. Pasadena, CA: A. T. Still Research Institute. 1922.
5Rogers, F. Advancing a Traditional View of Osteopathic Medicine Through Clinical Practice. The Journal of the American Osteopathic Association. 2005; 105 (5): 255-259.
6Sackett DL, Rosenberg WMC, Gray JAM, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn't. BMJ. 1996; 312: 71-2.
7Cooper, GM, Hausman, RE. The Cell A Molecular Approach. 7th Ed. Sinaur Associates. 2016.
8Merrill SA, Mazza AM, editors. Reaping the Benefits of Genomic and Proteomic Research: Intellectual Property Rights, Innovation, and Public Health. National Research Council (US) Committee on Intellectual Property Rights in Genomic and Protein Research and Innovation. Washington (DC): National Academies Press (US). 2006; Ch. 2.
9Nesic, O, et al. Four Clinical Concepts: A Template for Cognitive Integration of Clinical and Basic Sciences. Sci.Educ. 2015; 25: 483.