Basic Medical Science and Next Generation Medicine
Mahmoud Bukar Maina
In Nigeria, there is a low level of awareness about the relevance of basic medical science to a successful health system. The position of Physicians is indisputable and their hard work and dedication must be appreciated. However, to have an efficient system that may be able meet future challenges in medicine, we must also understand the importance of basic medical science and how investing in it could enhance health care delivery. The process of disease prevention or treatment is a long one that often starts from the bench (basic science). Basic medical science can be any one of the sciences fundamental to the study of biology and improving human health, and this involves disciplines like Anatomy, Physiology, Biochemistry, Pharmacology, Cell Biology and Microbiology, among others. Most basic medical scientists go into academia to teach and do research towards understanding the biological processes in health and disease. One of the main goal of medicine is to improve health; basic medical research serves as the fundamental unit for improving the human health.
Basic medical research address clinical problems using a reductionist approach. This means working on a biological question or a human disease model in a test tube, cell culture, animal model or system that is not complex, from which one could get an understanding of a complex system like the human body. For example, almost all the drugs that one gets prescribed upon a visit to a physician have gone through a validation process during which its potential as a drug, the right dosage and side effects were tested in cell culture and animal models, before clinical trials and eventual approval for human use. This process is very long and expensive and most often starts when basic scientists learn of a biological target (e.g., a receptor, enzyme, protein, gene, etc.) that is involved in a biological process thought to be dysfunctional in patients with a disease. The process, therefore, starts with the basic scientists and eventually to hospitals where clinical scientists become involved and finally to physicians who use the outcome for patient care. This is an example of driving medical solution from basic science to the clinic.
Discoveries made due to basic medical research has transformed medicine as we know it today. For example, a great deal of understanding regarding the human gene sequence map was developed with the completion of the human genome project in 2003. Genes are pieces of DNA that control our livelihood and passed by our parents but which can be shaped by our environment and experiences. The human genome project is one crucial example of an important contribution of basic research to medicine. It has now resulted in the development of genomic sequencing technologies, with which it is now easy to make a diagnosis, evaluate risks of developing disorders and identify therapeutic targets. Now members of the public can independently pursue genomic data to inform their own health and well-being decisions. In the West, it is becoming easier and cheaper by the day to have one’s genome sequenced, with which one may know his risk of diseases, ancestral history and many more.
Talking about the importance of basic medic research, Professor Jonathan Horowitz of North Carolina State University Center for Comparative Medicine and Translational Research in the United States rightly said: “Every patient treatment, every diagnostic test, and every medical intervention in use today is the result of innumerable biomedical research discoveries”. One example is the discovery of insulin which led to treatment for diabetes and Nobel Prize for Physiology or Medicine to Frederick Banting and John MacLeod in 1921. Discovery of Penicillin – the antibiotic used against bacterial infections (Nobel Prize 1945), yellow fever vaccine (Nobel prize 1951), and Magnetic Resonance Imaging use for diagnosis (Nobel Prize 2003), were all basic research efforts which transformed medicine and patient care. Another powerful breakthrough that could shape medicine is a recent discovery of the CRISPR gene editing system from bacteria. This is proving to be potentially one of the biggest discoveries in medicine of our time. The discovery resulted from research into how bacteria protect themselves from viruses. CRISPR has been used by scientists to make mosquitoes resistant to malaria and potentially treat some human diseases (including HIV, haemophilia and leukaemia). It was also recently used to modify human embryos, leading to claims that designer babies are closed to be being made. In the future, this technology may be used to do many things that current drugs or medical intervention are unable to do. All these potential powers of CRISPR came from basic research!
These discoveries and their impact on medicine are one of the key reasons why we must improve our support for basic medical science and research. According to the American Association of Medical Colleges: “In the absence of information and insights generated from basic research, it is difficult to envision how future advancement in the treatment of disease and disability will occur; physicians would increasingly be in the position of mechanics who do not know how engines work, or programmers who do not understand how computers store and compile information”. In developed countries, it is therefore understood that basic medical scientists and clinicians work together in shaping the health system.
I thought it is interesting to end this article by quoting Professor Horowitz’s words on the importance of biomedical research. He said:
“Let’s try to imagine a world without biomedical research. A world in which emerging deadly microbes are not identified, and vaccines or antibiotics are not discovered. A world in which genes are theoretical rather than tangible bits of information that can be manipulated for our benefit. A world in which all cancers are treated alike and survival is a coin-flip. Do we want to live in that world?
“Let’s take this exercise one step further and imagine a world in which clinical training programs occur in the absence of biomedical research. A world in which youngsters yearning for a clinical career will meet the medical challenges of the future with knowledge based solely on discoveries from the past. Will this suffice? Clinicians are expected to be challenged by an infinitely more complicated future in which patients live longer and require treatment for a plethora of complex chronic ailments, antibiotic-resistant bacteria are the norm, climate change and environmental toxins have affected every species on Earth, and deadly infectious agents are just a plane trip or animal transport truck away. Instead of relying solely on discoveries of the past, wouldn’t we prefer that future clinicians be informed by research insights gleaned today and in years to come? And how will current and future discoveries be made and translated into practical solutions if support for biomedical research continues on its current downward spiral?”
Mahmoud is a Postdoctoral Fellow in Sussex Neuroscience, Serpell Laboratory, studying the cellular and molecular mechanism of Alzheimer’s disease. Connect with him on twitter via @mahmoudbukar