KLG, who as you may recall is a professor of medicine, sent this note from a long-standing colleague:
From my postdoctoral mentor, who was the first woman to get tenure in a Hopkins Basic Science Department:
There is some rather sad news from Hopkins. The Department of Biological Chemistry will be shut down on June 30th, as part of a consolidation (basic science extinction) plan. All the faculty (even emeriti) who have to have an appointment in the department were reassigned to other departments. I am now in Cell Biology. Biophysics in the medical school was merged with Biophysics at Homewood (main undergraduate campus). Physiology and Pharmacology were combined. I’m not sure whether the faculty kept their lab space in the department or whether that has been “rearranged.” Past graduates of Biological Chemistry should still list the Department of Biological Chemistry as their affiliation. I know, it’s the pits.
The Department of Biological Chemistry in the Johns Hopkins University School of Medicine was established as the Department of Physiological Chemistry in 1908. We had our 100th anniversary in 2008 with an international 3-day event. And when I say “we” I mean it. This is not a trivial thing. It will have repercussions the bean counters and other cowards will never feel. Just another brick falling out of the wall.
IM Doc’s reply put this development in the context of the ongoing devolution in medical education:
They have finally joined the crowd. This has been going on for the past 5 years at both of my alma mater. The anatomy and biochemistry dept were closed in med school in 2022 – and both closed at residency program or at least severely curtailed in 2023. Medicine is basically dead. The kids will never learn how to take care of patients.
https://www.nejm.org/doi/full/10.1056/NEJMp2414384
This is from this week NEJM. It describes what you mentioned. It seems to me this whole movement to minimize basic education started about 15 years ago – where else but Harvard Medical School.
No longer we’re students doing gross anatomy, biochem, pathophys etc.
Rather, they did rotations where all the various components of an organ system were done at once. So the courses suddenly became known as THE HEART, THE LUNGS, etc. The anatomy, phys, Pharma, etc for each organ system were all done at once during these rotations.
Very stupid idea. It is very difficult to discuss universal things like chemo and inflammation among many others in this type of system. I mark the decline in curiosity, knowledge base, etc to the past 10-15 years when this became widespread and whole departments were canned or subsumed.
With this, the EMR, and UpToDate, a kid in medical school could not even have a chance to be what clinicians of yesteryear were. And we can all tell. I have conversations with them every day. The knowledge base is profoundly limited. The foundation is cluelessness. We old guys just sit in the lounge every day and shake our heads.
I hate to be this negative, but it is indeed really that bad. The NEJM and others have realized the impending disaster largely caused by shit like this they have been pushing. Their screaming about it now is hilarious and tragic but far too late. The die has been cast.
US-based readers take warning.
I am lucky enough that the US doctors I still see when I visit are over 40 but not over 60, and in independent practices. That means they are old-school well-trained and probably have at least 5 and maybe 20 years more of professional life (they have also set up their practices so as to reduce interaction with insurers, so they are less likely to retire early due torture by corporate or insurance bureaucrats).
I infer very few Americans are in that boat. And in addition to lower medical competence among recent MD is the problem of nearly all doctors being in some sort of corporatized medical practice, and those are increasingly shoving diagnostics on to wildly low-skill nurse practitioners. This ought to be a crime. Why it isn’t is beyond me.
We do not give medical or financial advice, Nevertheless, I strong suggest, if you have the energy to travel, to start exploring medical tourism options. There are many procedures for which the cash pay price overseas plus travel is cheaper than a US copay. This is also true for extensive dentistry. And you don’t have the risk of surprise charges, which are stressful even when you prevail in beating them back. Better to have pre-identfified some alternatives in case you have an urgent but not emergency need for intervention, than necessarily go the inertial route of US care.
My inner Cynic has been warning me for a long time that The Jackpot is not just a fictional plot device. I have been “reading between the lines” that one of the major ‘drivers’ of world overpopulation has been the emergence of efficient public health programs. The basic tool of achieving that outcome has been a large and well trained medical cohort. Playing Devil’s Advocate, one can argue that the best way to “rebalance” the world’s population would be to stop and then reverse the advances in public health world wide. To achieve that, one would simply degrade the public health apparat.
Equally cynical observers can comment that my scenario is well-nigh unto “clinical” paranoia. My counter argument will be that old chestnut: “Ideation ceases to be paranoia when one realizes that “they” really are out to kill you.” Whether this outcome is the result of greed, stupidity, systemic evil, or Social Darwinism run amuck, the end result is the same; World population is going to drop. Reading as far back as the Club of Rome papers on population (1972), such has been the ‘optimal’ outcome all along.
See: https://en.wikipedia.org/wiki/The_Limits_to_Growth
I would love to be proven wrong, but a lifetime of observing the American Empire from the inside has hardened my “intellectual” arteries.
Stay safe, wherever you are.
I’m sorry, but not surprised, to read of this. I have no direct evidence (my clinically trained friends all being aged 50+ like me) but have suspicions that this change in teaching methods has been creeping into UK medical training too. I think of it as having the square cake no longer being cut “vertically” with each strip being anatomy, biochem, etc, but “horizontally” with strips being the organs (as you point out).
The reason I suspect this has been going on in UK is the increasingly prevalent lack of ability among younger clinicians to think holistically and utilise out-of-the-box thinking. Their whole stock of knowledge is a bunch of “siloes” and this has been very much demonstrated when it came to COVID diagnoses. Only the senior partner at my General Practice “joined the dots” sufficiently with me to get me into the Long COVID service. As I noted in last few days, my opthalmologist (who I’ve known since teenage years) also knew all about COVID and its multi-organ modus operandi.
Sadly I don’t see any solutions to this as a patient, other than to shop around for clinicians who are in the age range you mention, and in UK, find out things like “if a practice’s Nurse Practitioner and their Practice Pharmacist have good records in terms of joining the dots between any multi-factorial issues you might have”. Which in many parts of UK is easier to do than the average US resident who, as you say, may have to look abroad to do this. It’s a sad state of affairs but thanks for the details in the post.
I think the rot started long ago. In 2009 I had a long conversation with an Indian student who was studying to be a pediatrician at Harvard. It was an unforgettable conversation. About room mates studying finance who were on psycho pills since their early teens but destined to become “masters of the Universe” in Wall Street. And most memorably that statistics were showing that kids were starting to walk later and later in the US and that it was concerning pediatricians all over the country. So I said surely Harvard was raising the alarm. No, he replies. They just hiked the average and then told pediatricians that all was ok. I was profoundly shocked. As an aside I might mention that Harvard had been an eye opener for this Indian who back in his homeland had idolized the US. Only the money is better he had summed it up.
Time was when American medical care was used as a soft power. That you had the wealthy and the elites of the world flying into America to receive the best surgeries and treatments on offer. It brought a lot of good will and gratitude. Going forward? It may be used as a threat to captured terrorists. I can see it now-
‘Tell us what we want to know or we’ll fly you into the US for incarceration in an American hospital. One full of Harvard-trained doctors!’
‘You monsters!’
The only way that I can understand this is if there is the idea that doctors will be able to rely on an AI to fill in all the gaps on their knowledge because they never learned the basics. Yeah I know that this is a stupid, unworkable idea but the only alternative will be to suggest that doctors will just have to learn on the job – but who will in any case rely on an AI on their mobile to bail them out. And I can see that in action now as a surgeon prepares to crack open a patient-
Surgeon: ‘Hey, MediAI. How many chambers does a human heart have?’
MediAI: ‘The human heart has five chambers. There are two upper chambers called the right atrium and left atrium, two lower chambers called the right ventricle and left ventricle, and one at the bottom called the lower vestibule.’
So long ago for me now as a semi-retired Internist. But in Med School 1972-6, I was an Independent Study student. And one of my main study methods was exactly as described by IM Doc, by reading Monographs. Of course that was not all I did with studying back then, but I did test well as compared to my colleagues.