Why Organic Chemistry should always be taken (and passed) by pre-meds — part II

Chapter 25 of Clayden is all about synthesis, and as an old Woodward grad student, I loved it.  Ingenuity and elegance on display many times.  Everything in the previous 24 chapters was brought to bear on each problem at hand.  

Just like medicine.

You start in medical school with anatomy and biochemistry, then move on to pathology and pharmacology, then to endocrinology which uses much of the above, then physical diagnosis.  All this in the 2 years before you really get involved with patients.  The handbook for entering med students at Duke is reported to have started with:   “Like to read?  Good, you’ve come to the right place.”

Having spent 2 years reading about the diseases flesh is heir to, at the start of the third year, you are then plunked down in front of a patient to take a history, do a physical exam, come to some sort of understanding about what’s wrong and propose a course of action.  All this to a cynical intern over which stands a even more cynical resident, and above that an attending physician.  

The first few patients take several hours each.  They don’t come with labels saying I’ve got a liver problem, any more than a target molecule says why don’t you try the aldol condensation. Almost invariably, the patients have multiple problems, and you have to be careful that your therapy for one doesn’t adversely affect another — does this remind you of protecting groups?  It should.  

The fact that you have to bring everything you know and have ever studied to bear on an unfamiliar situation is typical of synthesis and medicine.  Even if you’re a specialist, the problems you see don’t necessarily have origins in what you specialize in.  Organic chemistry teaches you to think this way, and if you can’t, you don’t belong in medicine.  For an earlier rumination on this topic see the link at the end.

One example, for any docs reading this.  As a neurologist you get called on to see people who pass out.  One young woman I saw had passed out several times on a hot summer day.  She was thin, but otherwise appeared healthy.   On physical examination (she’d been hospitalized), she had a gorgeous tan.  Moreover, it was all over her body, including the breasts and pelvis.   This was Montana in the 70’s (which was like the US in the 50’s) and there was very little nude sunbathing going on.  That gave the diagnosis away. See the next paragraph for the denouement. I’ve put in some white space so you can think about it before scrolling down.

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She had Addison’s disease and was in adrenal crisis.  Even though it was late evening, I called in an endocrinologist (stat) who drew tons of blood and started treatment immediately.  He told me I’d saved her life.  He said she was on her way out and would have been gone by morning.   She was fainting because she couldn’t maintain her blood pressure when erect.  No intellectual achievement ever gave me satisfaction like this (not even the Woodward seminars). 

For the non MDs:  The total body tan gave things away for the following reason.  To a first approximation, the pituitary gland controls most of the other endocrine glands (adrenal, thyroid, ovaries, testis, but not the pancreas).  It samples the blood to make sure the glands are secreting what they should.  When they aren’t, it pumps out the appropriate hormone (ACTH, TSH, FSH, LH) which tells them to secrete more.  ACTH stands for AdrenoCorticoTrophic Hormone which drives the adrenal cortex to secrete.  However, ACTH is but a part of a larger protein (pro-opiomelanocortin) which contains at least 10 biologically active peptides in its 265 amino acids (ACTH accounts for only 39).  One group is the endorphins, but the clue to the diagnosis is that another peptide contained by both pro-opiomelanocortin and ACTH  is alpha melanocyte stimulating hormone, which makes the pigment cells in your skin (the melanocytes) produce more pigment, darkening the skin (and giving the young woman her great tan).  It doesn’t seem terribly efficient to pump out 10 biologically active peptides when you really want just one, but that’s the way we’re built. 

The link to the earlier rumination

 http://luysii.wordpress.com/2009/09/01/why-organic-chemistry-should-always-be-taken-and-passed-by-pre-meds/

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Comments

  • J-bone  On May 21, 2010 at 9:09 am

    You are one of the few voices of reason I have heard in this debate (although I think that there’s only a small group of people advocating the abolishment of this course, they just happen to be the loud ones).

  • James  On June 12, 2010 at 7:45 am

    Question for you: in medical school, were there any courses that were notorious time sinks that you spent a lot of time on yet never ended up using in your practice as a physician?

  • luysii  On June 13, 2010 at 9:02 pm

    Sorry for the delay in responding. Yes Orgo is hard, but so is medicine, and in exactly the same way.

    James — not really. The courses in the first two years are about theory and facts you much master — without them, medicine is a series of unrelated facts and even less comprehensible than it presently is. Neurologist is a fairly arcane specialty, but I didn’t regret having delivered 100 or so infants when I got called into the delivery room for an emergency consultation. Ditto for the surgical rotation.

    The one thing we didn’t have, and which hopefully med students get nowadays, is a course in statistics or failing that, a course that tells you how to critically analyze data. It’s a pleasure to be back reading the (relatively) hard sciences, without thinking “how are they lying to me?’ which is very necessary in reading the medical literature, where the conclusions don’t always follow from the data, or are presented in a misleading manner.

  • Yonemoto  On July 2, 2010 at 11:40 am

    Holy cow, I should be a doctor. With no medical training I thought it could be one of three things: An inability to degrade tryptophan, a brain tumor, or something wrong with the adrenal glands. The phrase ACTH and “adrenocortical” kept running through my head.

Trackbacks

  • By Is Orgo Hard? « Master Organic Chemistry on June 9, 2010 at 1:39 pm

    [...] Is there any other course like it? Probably not. Organic chemistry is in the middle ground between a fact-heavy course like biology and a highly quantitative course like physics. So you end up getting the worst of both worlds, as far as course difficulty is concerned. It’s a course that tests our memory as well as forcing us to think. And we haven’t even mentioned the labs yet, which add a whole other practical dimension to the course. Can you think of another field of study which involves so much 1) book learning 2) making decisions based on thinking through conflicting data, and 3) working with one’s hands? I can. [...]

  • [...] Is there any other course like it? Probably not. Organic chemistry is in the middle ground between a fact-heavy course like biology and a highly quantitative course like physics. So you end up getting the worst of both worlds, as far as course difficulty is concerned. It’s a course that tests our memory as well as forcing us to think. And we haven’t even mentioned the labs yet, which add a whole other practical dimension to the course. Can you think of another field of study which involves so much 1) book learning 2) making decisions based on thinking through conflicting data, and 3) working with one’s hands? I can. [...]

  • [...] If this doesn’t sound like the problem-solving skills required for being an effective physician, I don’t know what is. Another estimable blogger (and retired neurologist)  has made the same point. [...]

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