PHAROS of ALPHA OMEGA ALPHA SPRING 2009 HONOR MEDICAL SOCIETY the PHAROS of Alpha Omega Alpha Honor Medical Society Spring 2009
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THE PHAROS OF ALPHA OMEGA ALPHA SPRING 2009 HONOR MEDICAL SOCIETY THE PHAROS of Alpha Omega Alpha honor medical society Spring 2009 ´"YJP7XKFMF ´ ˆJOUPV7` BMHP´ VOUB7ˆ Alpha Omega Alpha Honor Medical Society “Worthy to Serve the Suffering” Founded by William W. Root in 1902 Officers and Directors at Large Editor: Edward D. Harris, Jr., MD Rae-Ellen W. Kavey, MD Editor Emeritus: Robert J. Glaser, MD President Associate Editor and Managing Editor Bethesda, Maryland (in memoriam) Edward D. Harris, Jr., MD Helen H. Glaser, MD Executive Secretary Menlo Park, California Managing Editor Art Director and Illustrator Donald E. Wilson, MD Debra M. Lancaster Jim M!Guinness Vice President Baltimore, Maryland Administrator Designer Ann Hill Erica Aitken C. Bruce Alexander, MD Secretary-Treasurer Birmingham, Alabama Robert G. Atnip, MD Editorial Board Hersey, Pennsylvania N. Joseph Espat, MD Jeremiah A. Barondess, MD Lawrence L. Faltz, MD Eric Pfeiffer, MD Providence, Rhode Island New York, New York Sleepy Hollow, New York Tampa, Florida David A. Bennahum, MD Faith T. Fitzgerald, MD Richard C. Reynolds, MD Ruth-Marie Fincher, MD Albuquerque, New Mexico Sacramento, California Gainesville, Florida Augusta, Georgia John A. Benson, Jr., MD Daniel Foster, MD William M. Rogoway, MD Douglas S. Paauw, MD Omaha, Nebraska Stanford, California Dallas, Texas Seattle, Washington Gert H. Brieger, MD James G. Gamble, MD, PhD Shaun V. Ruddy, MD Baltimore, Maryland Stanford, California Richmond, Virginia Don W. Powell, MD Richard Bronson, MD Dean G. Gianakos, MD Bonnie Salomon, MD Galveston, Texas Stony Brook, New York Lynchburg, Virginia Deerfield, Illinois John C.M. Brust, MD Jean D. Gray, MD John S. Sergent, MD Joseph W. Stubbs, MD New York, New York Halifax, Nova Scotia Nashville, Tennessee Albany, Georgia Audrey Shafer, MD Charles S. Bryan, MD David B. Hellmann, MD Medical Organization Director Columbia, South Carolina Baltimore, MD Stanford, California Marjorie S. Sirridge, MD Robert A. Chase, MD Pascal James Imperato, MD John Tooker, MD, MBA Kansas City, Missouri Stanford, California, and Brooklyn, New York American College of Physicians Jaffrey, New Hampshire Clement B. Sledge, MD Elizabeth B. Lamont, MD Marblehead, Massachussetts Henry M. Claman, MD Chicago, Illinois Councilor Directors Denver, Colorado Jan van Eys, Ph.D., MD Kenneth M. Ludmerer, MD Nashville, Tennessee Eric P. Gall, MD, MACP, MACR Fredric L. Coe, MD St. Louis, Missouri Chicago, Illinois Abraham Verghese, MD, DSc Chicago Medical School at Rosalind James B.D. Mark, MD (Hon.) Franklin University of Medicine Jack Coulehan, MD Stanford, California Stanford, California and Science Stony Brook, New York J.Joseph Marr , MD Steven A. Wartman, MD, PhD Chicago, Illinois Ralph Crawshaw, MD Broomfield, Colorado Washington, DC Portland, Oregon Stephen J. McPhee, MD Gerald Weissmann, MD Amy Goldberg, MD Peter E. Dans, MD San Francisco, California New York, New York Temple University School of Medicine Baltimore, Maryland Robert H. Moser, MD David Watts, MD Philadelphia, Pennsylvania Scott K. Epstein, MD Madera Reserve, Arizona Mill Valley, California Boston, Massachussetts Edmund D. Pellegrino, MD Anne Mancino, MD Washington, DC University of Arkansas School of Medicine Little Rock, Arkansas Student Directors Natalia Berry Dartmouth Medical School Manuscripts being prepared for The Pharos should be typed double-spaced, submitted in triplicate, and conform to the format outlined in the manuscript submission guidelines appearing on our website: www.alphaomegaalpha.org. They are also available Kara Maria Cavuoto, MD from The Pharos office. Editorial material should be sent to Edward D. Harris, Jr., MD, Editor, The Pharos, 525 Middlefield Road, University of Miami Suite 130, Menlo Park, California 94025. Cason Pierce Requests for reprints of individual articles should be forwarded directly to the authors. University of Texas Southwestern Medical The Pharos of Alpha Omega Alpha Honor Medical Society (ISSN 0031-7179) is published quarterly by Alpha Omega Alpha Honor School Medical Society, 525 Middlefield Road, Suite 130, Menlo Park, California 94025, and printed by The Ovid Bell Press, Inc., Fulton, Missouri 65251. Periodicals postage paid at the post office at Menlo Park, California, and at additional mailing offices. Copyright Administrative Office © 2009, by Alpha Omega Alpha Honor Medical Society. The contents of The Pharos can only be reproduced with the written 525 Middlefield Road, Suite 130 permission of the editor. (ISSN 0031-7179) Menlo Park, California 94025 Circulation information: The Pharos is sent to all dues-paying members of Alpha Omega Alpha at no additional cost. All correspondence Telephone: (650) 329-0291 relating to circulation should be directed to Ms. Mara Celebi, Webmaster, 525 Middlefield Road, Suite 130, Menlo Park, California 94025. E-mail: Fax: (650) 329-1618 [email protected] E-mail: [email protected] POSTMASTER: Change service requested: Alpha Omega Alpha Honor Medical Society, Post Office Box 2147, Menlo Park, CA 94026. www.alphaomegaalpha.org Editorial Marat and Harvey, revolutionaries David P. Hill Edward D. Harris, Jr., MD evolution is defined in several ways. One is the forc- writes Will Durant.2 Aristotle observed that life was growing ible overthrow of a government or social order in fa- steadily in complexity and power, with increasingly specialized vorR of a new system. This type of revolution invariably function. Indeed, he was on the verge of deducing the theory occurs over a short period of time. “Marat’s Terror” by Jesse of evolution. Why then was Aristotle not the one to define the Woodard (pp. –) describes the troubled but powerful life physiology of the circulation, that the heart (not the brain) of physician/polemicist Jean-Paul Marat and his role in the pumped blood through arteries, and that blood flowed back French Revolution. His fiery doctrines were quenched sud- to the pump through thinner vessels, the veins? He certainly denly when Charlotte Corday stabbed him while he bathed. had each of the tools—eyes, a brain, and hands—needed to Revolutions in medicine and the medical sciences do this. are less radical and follow a second definition: a dra- William Harvey based his matic and wide-reaching change in the way some- theory of the circulation of the thing works or is organized and in people’s ideas blood on a series of simple ex- about it, a transition from one paradigm to another. periments in which he stud- Today’s physicians and scientists are familiar with ied venous blood flow using this type of revolution. We have experienced the a tourniquet and digital com- discovery of penicillin, streptomycin, and cortisone; pression. His famous book, the development of vaccines against poliomyelitis “Ecercitatio anatomica de motu and other infectious scourges; the definition of the cordis,” published in , illus- structure of DNA, the translation of the genetic trates these experiments and code, and the establishment of methods to synthe- elucidates the observations he size DNA; the initiation and growth of transplant made and deductive reasoning surgery; the technical advances informing CT, MRI, he used to arrive at this theory. microarrays, and stem cell biology; and the slower Traditionalists following in the but no less important revolutions in public health. footsteps of Galen attempted We relish the exploration of the unknown. to reject Harvey’s conclusions, Why did it take more than years, from but uniformly failed to find the first to the seventeenth century, for empiric Courtesy of the National Library of Medicine weaknesses in either his ex- observations to enable understanding of the circu- periments or deductions be- lation? Galen, in the first century AD, adopted the cause to deny a single part of Hippocratic theory of the four humours: blood, phlegm, and Harvey’s theory would be to reject the whole, and this was yellow and black bile, and the importance of having balance impossible. Nevertheless, many tried! among them to ensure good health. Although reported to be The revolution sparked by Harvey’s new paradigm brought conceited, cruel, and vindictive, he cannot be blamed for the much new knowledge from diverse sources. For example, blind allegiance to his teachings that persisted for centuries. Antoine van Leeuwenhoek built an instrument, the micro- Those who followed Galen failed to use the tools they had— scope, that would be a revolution in itself. Leeuwenhoek’s eyes, brain, and hands—for at least two reasons: first, human microscope revealed the presence of red blood cells and, more dissection was prohibited, and second, it was philosophers importantly, the hair-thin anastomoses between the blood and the clergy who for many centuries determined the truths vessels that he named “capillaries,” a discovery that linked the of life for the people. Most significant among those who led veins and arteries to complete the elements of the circulation thought was Aristotle. Bertrand Russell writes that ”it was two that Harvey had outlined. thousand years before the world produced any philosopher Scientific revolutions continue to evolve in both intensity who could be regarded as approximately his equal.” 1 It was and sophistication, combining the resources of eyes, brains, Aristotle who gave science to mankind. He observed, and and hands to bring biological science to the heights it has deduced logical conclusions. Consider his realization that reached today, with more to be ascended tomorrow. no drop of water has been added