tionalcompartmentalization of the medical education process and for the existence of specificadministration units that assume primary responsibility for the individual components. It should also be recognized that in view of the increased diversity of the premedical training and backgrounds of entering medical students, now more than ever we have an increased burden of responsibility to ensure that all students are provided with the opportunity to obtain a sound foundation in an orderly and logical manner. Only with this approach can we be reasonably confident that they possess an up-todate factual base of knowledge and understand the fundamental principles that are requisite for an intelligent and informed evaluation of their patients. In summary, I would emphasize that we should not be too hasty to discard the current system with its proven record of success. Rather, let us strive to improve it by the application
of innovative and creativenew approaches made
Dear
Perhaps it is not really important; but it is hard to be credible on the subject of medical education while unconsciously putting on a dunce cap fashioned by an old detractor.
Dr.
Whelan:
It is very discouraging medicine” in an article
to see the words “schools of allopathic on medical education (1). “Allopathy” was an entirely fictitous medical doctrine invented over 100 years ago by the homeopath Samuel Hahnemann, and falsely attributed to the regular medical profession in an attempt to place regular medicine on a level with homeopathic medicine. This was bitterly resisted by the medical profession (2), which has never accepted any such doctrine. The word has been kept alive over the years by non-medical practitioners who want to suggest that medicine is just one among several more or less equal alternatives, and by numerous celebrities and literary people with more fame than judgment. The usage has always been false and misleading. Medicine is a science and does not espouse “allopathy” or any other unproven doctrine; it is either ignorant or dishonest, and in any case offensive, to suggest otherwise. Unfortunately, Dr. Estabrook has plenty of company. Apparently, a number of physicians, educators, and others tend to parrot polysyllabic words without much attention to what they might actually mean. The usage has appeared in Peterson’s Guides (3), and even the New England Journal of Medicine seems to consider it a matter unworthy of editorial attention (4-6). (One can imagine how this would strike the 19th-century Boston fathers of medicine, so often and ostentatiously reverenced.)
Author’s
Reply
Dear
Whelan:
Dr.
Response to Dr. L. C. Navar Thank you for your thoughtful comments. I attempted to summarize in my editorial the recommendations we (The Robert Wood Johnson Foundation Commission on Medical Education) hoped would achieve “continuous improvement and upgrading of educational approaches and techniques:’ as stated in your letter. It is extreme to suggest we recommended a path to “destroy:’ “require upheaval and total restructuring:’ and “discard” all aspects of the present system of medical education. We examined many changes in the process of science education now under way at a number of medical schools and we recognized the value of these changes to the learning environment for the student. Central to our report was the theme of integration of science education. The figure included with your letter illustrates to me the importance of learning the sciences of medicine in an integrated curriculum. I fail to see how this scheme “illustrates that there is a clear sound rationale for the traditional compartmentation of medical education.” I applaud your call to
possible by new and developing technology and by incorporation of those aspects that have not received adequate attention. Most important, let us at least apply a modicum of scientific judgment to the reform process lest we rush headlong into modified apprentice-like approaches that expose unprepared students to a tangled spidery web of apparently unconnected and unrelated pieces of patient data before they have an adequate foundation. In closing, I would suggest to my colleagues that it seems important to determine if I am expressing isolated opinions or if they are shared by the silent majority. Now is the time to speak out! L. Gabriel Navar, Ph.D., Chairman and Professor, Department of Physiology, Tulane University Medical Center, New Orleans, LA 70112, USA
C. Dennis Thron, M.D., cology, Dartmouth 03755-3835, USA
Professor Medical
of Pharmacology and School, Hanover,
ToxiNH
REFERENCES 1. Estabrook, R. W. (1992) Fractures in Flexner’s foundation: recommended changes in medical education. FASEBJ. 6, 2887-2888 2. King, D. (1858) “Quackery unmasked: or a consideration of the most prominent empirical schemes of the present time, with an enumeration of some of the causes which contribute to their port.” pp. 297-298, New York, S.S. and W. Wood 3. Graduate Programs in Business, Education, and Health and Law,
Ed (book 6) 1991 Princeton, 4. Mainzer, E. (1986) Allopathy 314, 187
sup-
26th Guides, Inc. homeopathy. N EngL j Med.
N.J., Peterson’s versus
5. Thron, C. D. (1986) More on reducing medical school classes. N Engl. J Med. 314, 322-323 6. Hughes, R. G., Barker, D. C., and Reynolds, R. C. (1991) Are we mortgaging the medical profession? N Engi. J Med. 325, 404-407
others to speak out and express their opinions. One purpose of an editorial is to present ideas that will serve as a format for further dialogue. Response to Dr C. Dennis Thorn. Your comment criticizing me for use of the words “schools of allopathic medicine” in my editorial was unexpected. I merely quoted the location of those individuals surveyed for their perception of medical education, as originally reported in thej Am. Med. Assoc. article identified. I claim no expertise or knowledge of differences in the educational process providing the sciences required for homeopathic medicine. I quote Webster’s Third New International Dictionary of the English Language. Unabridged (1976): “allopathy-a system of medical practice that aims to combat disease by use of remedies producing effects different from those produced by the special disease treated;” “homeopathya system of medical practice that treats a disease by the administration of minute doses of a remedy that would in healthy persons produce symptoms of the disease treated?’
R.
University
W
Estabroolc, Ph.D., Department of Texas Southwestern
Harry
Hines
Blvd.,
Dallas,
TX
of Biochemistry, Medical
75235-9038,
Center,
The 5323
USA
Vol. 6 December 1992 University (148.88.67.84) on January 11, 3427 LETTERS TO FASEB THE EDITOR aded from www.fasebj.org by Lancaster 2019. The Journal Vol. ${article.issue.getVolume()}, No. ${article.issue.getIssueNumber()}, pp. 342
of innovative and creativenew approaches made
Dear
Perhaps it is not really important; but it is hard to be credible on the subject of medical education while unconsciously putting on a dunce cap fashioned by an old detractor.
Dr.
Whelan:
It is very discouraging medicine” in an article
to see the words “schools of allopathic on medical education (1). “Allopathy” was an entirely fictitous medical doctrine invented over 100 years ago by the homeopath Samuel Hahnemann, and falsely attributed to the regular medical profession in an attempt to place regular medicine on a level with homeopathic medicine. This was bitterly resisted by the medical profession (2), which has never accepted any such doctrine. The word has been kept alive over the years by non-medical practitioners who want to suggest that medicine is just one among several more or less equal alternatives, and by numerous celebrities and literary people with more fame than judgment. The usage has always been false and misleading. Medicine is a science and does not espouse “allopathy” or any other unproven doctrine; it is either ignorant or dishonest, and in any case offensive, to suggest otherwise. Unfortunately, Dr. Estabrook has plenty of company. Apparently, a number of physicians, educators, and others tend to parrot polysyllabic words without much attention to what they might actually mean. The usage has appeared in Peterson’s Guides (3), and even the New England Journal of Medicine seems to consider it a matter unworthy of editorial attention (4-6). (One can imagine how this would strike the 19th-century Boston fathers of medicine, so often and ostentatiously reverenced.)
Author’s
Reply
Dear
Whelan:
Dr.
Response to Dr. L. C. Navar Thank you for your thoughtful comments. I attempted to summarize in my editorial the recommendations we (The Robert Wood Johnson Foundation Commission on Medical Education) hoped would achieve “continuous improvement and upgrading of educational approaches and techniques:’ as stated in your letter. It is extreme to suggest we recommended a path to “destroy:’ “require upheaval and total restructuring:’ and “discard” all aspects of the present system of medical education. We examined many changes in the process of science education now under way at a number of medical schools and we recognized the value of these changes to the learning environment for the student. Central to our report was the theme of integration of science education. The figure included with your letter illustrates to me the importance of learning the sciences of medicine in an integrated curriculum. I fail to see how this scheme “illustrates that there is a clear sound rationale for the traditional compartmentation of medical education.” I applaud your call to
possible by new and developing technology and by incorporation of those aspects that have not received adequate attention. Most important, let us at least apply a modicum of scientific judgment to the reform process lest we rush headlong into modified apprentice-like approaches that expose unprepared students to a tangled spidery web of apparently unconnected and unrelated pieces of patient data before they have an adequate foundation. In closing, I would suggest to my colleagues that it seems important to determine if I am expressing isolated opinions or if they are shared by the silent majority. Now is the time to speak out! L. Gabriel Navar, Ph.D., Chairman and Professor, Department of Physiology, Tulane University Medical Center, New Orleans, LA 70112, USA
C. Dennis Thron, M.D., cology, Dartmouth 03755-3835, USA
Professor Medical
of Pharmacology and School, Hanover,
ToxiNH
REFERENCES 1. Estabrook, R. W. (1992) Fractures in Flexner’s foundation: recommended changes in medical education. FASEBJ. 6, 2887-2888 2. King, D. (1858) “Quackery unmasked: or a consideration of the most prominent empirical schemes of the present time, with an enumeration of some of the causes which contribute to their port.” pp. 297-298, New York, S.S. and W. Wood 3. Graduate Programs in Business, Education, and Health and Law,
Ed (book 6) 1991 Princeton, 4. Mainzer, E. (1986) Allopathy 314, 187
sup-
26th Guides, Inc. homeopathy. N EngL j Med.
N.J., Peterson’s versus
5. Thron, C. D. (1986) More on reducing medical school classes. N Engl. J Med. 314, 322-323 6. Hughes, R. G., Barker, D. C., and Reynolds, R. C. (1991) Are we mortgaging the medical profession? N Engi. J Med. 325, 404-407
others to speak out and express their opinions. One purpose of an editorial is to present ideas that will serve as a format for further dialogue. Response to Dr C. Dennis Thorn. Your comment criticizing me for use of the words “schools of allopathic medicine” in my editorial was unexpected. I merely quoted the location of those individuals surveyed for their perception of medical education, as originally reported in thej Am. Med. Assoc. article identified. I claim no expertise or knowledge of differences in the educational process providing the sciences required for homeopathic medicine. I quote Webster’s Third New International Dictionary of the English Language. Unabridged (1976): “allopathy-a system of medical practice that aims to combat disease by use of remedies producing effects different from those produced by the special disease treated;” “homeopathya system of medical practice that treats a disease by the administration of minute doses of a remedy that would in healthy persons produce symptoms of the disease treated?’
R.
University
W
Estabroolc, Ph.D., Department of Texas Southwestern
Harry
Hines
Blvd.,
Dallas,
TX
of Biochemistry, Medical
75235-9038,
Center,
The 5323
USA
Vol. 6 December 1992 University (148.88.67.84) on January 11, 3427 LETTERS TO FASEB THE EDITOR aded from www.fasebj.org by Lancaster 2019. The Journal Vol. ${article.issue.getVolume()}, No. ${article.issue.getIssueNumber()}, pp. 342
