Sunday 26 April 2015

Anatomy? So yesterday.

Years and years ago, maybe in 1972, I read an article in New Scientist that critically evaluated the then current medical school curriculum.  Why in hell, the author asked, do students still spend the whole of first year carefully dismembering cadavers and quizzing each other to name every knob and dip and muscle attachment on the bones of their personal half-skeleton? In those days you'd buy a half-skeleton because the full one was more expensive and medical students would rather spend the extra £100 on beer.  The author said "still spend the year", because he'd been through the same mill a generation previous and the curriculum was unchanged. IRC his argument was that all sorts of other necessary skills and knowledge were absent entirely from the curriculum because they didn't seem important to Professors of Anatomy in 1872: things like ethics and how to talk to the relatives of your mistakes. CAT scans, MRI and DNA sequences were still a long way in the future but they would have been on the 'missing in anatomy'  list.  Clearly you can't keep adding to the syllabus because the students would be on their pensions before they qualified - something had to go and it was suggested that anatomy was for the chop.  Any doctors who really needed anatomy, orthopedic surgeons for example, could pick it up later or take an advanced course.

I doubt that an article in New Scientist was sufficiently heeded to have changed the face of medical school but it seems to have been prescient.  10 days ago, I was having pre-dinner drinkies in the Senior Common Room of Trinity College Dublin before going into the Dining Hall for Commons and later to attend a symposium on the State of the University.  Blimey, it was hard work.  I'm not stupid and had a very expensive education, but it was difficult to keep up my end of the dialogue which roamed from 20th century Genetics to 12th century Genoa and out to γ-Centauri without missing a beat.  Luckily, I'm old enough and stupid enough to not mind being wrong or asking foolish questions. One of the chaps was a visiting anatomist from The Other University TOU UCD.  At one point he asked, with a rhetorical flourish, how many Professors of Anatomy did I suppose still occupied a Chair in the UK?  The question only made sense if the number was low, so I plunged at "Three", to be told that the answer was One.

He then went on to explain that Anatomy is making a come-back.  It is now the sexiest area in medicine because of computers and nano-technology.  This assertion fell on fertile ground because one of our students presented an amazing paper at Journal Club a few weeks ago: why every MRI research group should have a low-budget 3D printer.  The student pushed that paper because it was right on topic for his own project. MRI machines are set up for humans but what if you want to do some imaging on the head of a mouse to develop a therapy before starting in on human brain surgery. You'll need something to hold the mouse's head still and a 3-D printer can print a snug fitting head-cradle about 15mm across from the analysis of a set of photographs of the mouse's head. You can make another for the next mouse or if you change to rats - the technology is scalable.  The details are impressive: you can load your printer with MRI-transparent plastics for example. And the economic argument is compelling: an MRI machine costs somewhere north of €250,000;  modern 3D printer can be had for less than €1,250 [0.5%] and the consumable materials can be bought for less that €25 a pop. The peripherals and consumables are dirt cheap so it is easier to make optimum economic use of your fancy big instrument. This is why TV commercials often have such high production values; the company is paying half a mill for a 10 second broadcast slot so their ad had better look really slick.

You don't need a skeleton anymore because the human body has been entirely digitised in a scalable fashion: you can zoom into the inner ear and print out the incus, malleus and stapes and see how they articulate.  If dealing with three bones that are each about 4mm long is too fiddly, you can print out a 10x sized model and work with that for, say, teaching purposes.  They have working models of human muscles, that don't have soft-parts made of proteins but are functionally equivalent, the same size and made of little rods, pistons and cam-shafts. You can print a generic human heart!  But then starts the catechism:
Q. Who is going to inform the boffins about all the anatomical variants in which the human heart is fashioned? [* footnote]
A. Someone who has a life-time's experience in looking at them.
Q. Where might you find such an expert?
A. In the Yellow Pages.
Q. Would you be looking for a Professor of Anatomy?
A. Sorry, the last one in England just passed on and his vacated chair has not been filled because the old chap never developed any marketable intellectual property.

[25% of adults have a persistent leak between the right and left atria of the heart because their foramen ovale failed to snap shut at birth].

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