10 No. 4
The Long and Winding Road
Tenure and the Presidential Advisory Committee
Presidential Advisory Committee
“I get a lot of files to read for the PAC, and I start reading and say, Why am I spending my time? This is clearly someone there is no question about.”
“I think [the PAC has] helped to elevate the aspirations of the various units, to create a more uniform scholarly work culture. ”
Grady at the Crossroads
So are faculty
Pattern and Symmetry in the Human Body
A simpler side of complexity for teaching and learning
Why not buy lottery tickets?
Beyond "you can't win if you don't play"
From fertilized egg, by cell divisions
There is growth and form without decisions.
It should be no surprise, to observant eyes
That hidden within our human anatomy
Is the indelible stamp—that is symmetry?
Why might Viagra cause a stuffy nose? How is the thyroid like the ovary? Why is a sneeze like an orgasm? Why is smoking a risk factor for both lung and kidney cancer?
Medicine needs synthesis. The growth of knowledge in the medical sciences has led us to break up the wholeness of the patient into isolated parts and organ systems—it doesn’t occur to us to connect the thyroid and the ovary, the lungs and the kidneys, or the feet and the pelvic floor. Rather, academic medicine rewards and privileges those who focus their interests more and more towards less and less. Each specialty area within medicine contains sub-specialties, and each has its own unique language and methods of practice. This narrow focus excludes our view of larger patterns and symmetry in the human body and does not encourage the broad perspective we may need to address some unresolved problems in medicine.
Pattern and symmetry are everywhere. In biology there is obligatory economy that creates simple repetitive fractal forms and symmetries. When we look for symmetry, we find it in all systems. And exploring it opens a new window for teaching, learning, and research.
Windows and mirrors
In medicine, the classical perspective of the human body has been from the front. We meet face to face. The early anatomists saw symmetry on the left and right of the outer body, so they looked logically for order in the internal structures. They looked from the front; for one thing, it is easier to open and dissect on the soft underside. This perspective of the organ systems presents the heart on the left and the liver on the right. There is no symmetry to be seen. Likewise, today’s medical students dissect the cadaver always from the abdominal surface, just as the ancients did.
Modern imaging techniques, however, allow us new windows. Technology eliminates barriers and opens our view. When we look from the back, we see a striking pattern of internal symmetry. Above the diaphragm, for example, the paired lungs offer a mirror image of the paired kidneys below. The respiratory system and the urinary tract develop in the embryo at exactly the same moment as outgrowths from the gut tube on the twenty-eighth day after conception. Both grow as branching forms with highly similar design of structures and functions. Is it possible that there is simple symmetry within the human body just as there is in our external form and features?
Not only is it possible, it is absolutely inescapable. Nature offers a limited number of designs for organ systems and uses the same signaling mechanisms and construction plans that are common to the simplest of living organisms. Nature finds a way of creating and repeating with minor modifications to achieve different ends.
Simple patterns produce forms within forms that create orderly shapes and symmetries in the human body. The bones of the human arm are similar to those of the leg, but that same pattern is present in the limbs of a horse or an elephant and in the flippers of a porpoise or the wings of a bat. There are changes in scale and form for specific functions, but at the heart of it there is a simple universal pattern of limb design.
Our internal structures also employ simple forms. As we begin to recognize patterns in the internal organ systems, we see a simpler order. These patterns offer both a new framework for examining existing knowledge and exciting opportunities for medical study and research.
Symmetry and synthesis
For physicians, scientists, and students, pattern and symmetry allow synthesis instead of division. They emphasize the shared aspects among human organ systems and suggest new reasons for the nonrandom associations that are so much a part of medical diagnosis.
Pattern also offers a powerful way to organize and retain new information. Medical teaching has always presented the individual organ systems as separate, unique structures. We emphasize the differences and challenge students to learn disparate accounts that miss their remarkable similarities. And today’s students must assimilate and retain more data in a shorter time. The task seems easy for some. For others, new information is piled in a cognitive heap that buries and conceals what has been acquired before.
Today’s medical residents are unable to recall important anatomical knowledge that was bedrock for previous generations of physicians. But an integrated framework would make it easier to acquire, retain, and apply knowledge in clinical settings. Studying these larger patterns would enable students to explore the human body by comparing elements of one system with the corresponding elements of another. It becomes easy to see that organ systems have simple repetitive structure and design. This awareness would help students apply knowledge from one area to another. Patterns provide visual templates that are easy to acquire and effortless to retain.
This perspective will also resonate in medical care, from patterns of developmental anomalies of the newborn to degenerative conditions and cancer. It will offer powerful clues for wellness and predictive health.
Seeing the patterns
Why might Viagra cause a stuffy nose? Just as a key can turn a lock, so a drug can turn on a chemical change and promote a physiological response. Viagra is targeted to help dilate the blood vessels of the penis for erectile function, but all vascular structures are the same. There are blood vessels in the nasal passages and Viagra will dilate those also, which gives rise to a sensation of nasal stuffiness and congestion for some patients.
How is the thyroid like the ovary? The thyroid gland is to the airway as the ovaries are to the genito-urinary tract. Both are endocrine or hormone-secreting glands that control growth and development. Both consist of follicles sensitive to stimulating hormones and regulated by feedback from the anterior pituitary gland. Thyroid-stimulating hormones and follicle-stimulating hormones are remarkably similar. Both glands regulate biological cycles and biorhythms. With pregnancy, both the thyroid and the ovary increase in size. With slowing of the ovaries in menopause, the thyroid often becomes underactive.
Why is a sneeze like an orgasm? Consider the elements of a sneeze. Gentle repetitive stimulation of the nose may induce a sneeze. An aura might precede the event. With the sneeze there is an emission of a small volume of fluid at some velocity. Sneezes can be single or multiple. The act is associated with coordinated muscle contractions, and in the moment all else is excluded. A sneeze might be associated with urinary leakage. After the sneeze there may be a feeling of release and a sense of tranquility.
Why is smoking a risk factor for both lung and kidney cancer? Cigarette smoking is well known to promote an increased risk of lung cancer. The connection is clear: inhaled smoke contains tar and carcinogens that can irritate and cause malignant transformation of the lining of the bronchial tree. Some of the inhaled carcinogens are absorbed by the lungs and excreted by the kidneys. Just as the lining of the respiratory tract is vulnerable to malignant changes, so too is the lining of the urinary tract.
More examples abound. Tuberculosis also has a particular propensity to infect not only the lungs of a victim but also the kidneys. Cystic fibrosis is a chronic disease that results in excessive phlegm in the airways and stones in the urinary tract. All the tubes in the body share the same characteristics—the kidney tubules are each a miniature form of the gastrointestinal tract. This similarity is so strong that the gut can be used to treat patients with kidney failure: enteral dialysis as a substitute for the more common hemodialysis. And since the lungs and kidneys are both organs of excretion, a state trooper might ask an intoxicated driver to take a Breathalyzer test or provide a urine specimen: alcohol is actively excreted both on the breath and in the urine. The nerves that control the muscles of the feet and toes are immediate neighbors of those that control the pelvic floor. Patients with significant imperfections in the form and function of their feet are likely to have similar imperfections in the pelvic floor.
These patterns are natural constructs that can bridge systems. They provide a complementary perspective that can integrate and synthesize knowledge, teaching, and research. And they could offer a new compass that could lead Emory in a dynamic and creative direction.
Angus and James Galloway are the sons of Professor Niall Galloway. Angus holds a B.A. from Emory and an MFA from Georgia State University and is an artist, and James, also an Emory College graduate, recently completed an M.D. at St. Matthews Medical University and a master’s of health administration at St. Joseph’s College.