Medicine (MED)

Lecturer: Julian E. Asher

Julian E Asher graduated magna cum laude from Harvard University and attended medical school in the United States. He is now in the third year of a PhD in neurogenetics as part of a joint MD-PhD programme with the Department of Psychiatry at the University of Cambridge and the Wellcome Trust Centre for Human Genetics at the University of Oxford. His research focuses on synaesthesia, a neurological condition affecting approximately 1 in 2000 people where patients perceive a sensation in one sense when another sense is stimulated – for instance, hearing sounds can evoke colours. Julian’s research focuses on the genetics of synaesthesia, with the goal of finding gene(s) linked to the condition. Previous research experience includes the genetics of absolute (perfect) musical pitch and issues faced by marginalised and underserved patients. Julian teaches neurobiology for the Cambridge MB-BCh course at Trinity Hall, Peterhouse, and Magdalene Colleges. He is a Fellow of the Cambridge Philosophical Society, a Cambridge Overseas Trust Scholar and the holder of an Overseas Research Studentship.

Syllabus

Medicine is a subject of immense scope, and this course will of necessity only scrape the surface of a discipline of almost infinite variety. Rather than attempt to cram the science of medicine into the short time we have, we will focus on the essence of medicine, where science meets art to become something more than the sum of its parts.

The readings have been chosen for their intelligibility to the non-medic, and will hopefully be as interesting as they are informative. In cases where only a very small portion of a book is used, it will be included in a course reader distributed to you on arrival. You will be expected to purchase the two required texts (see reading list) and to do the reading prior to each seminar.

You may wish to purchase a small medical dictionary, such as the Oxford Concise Medical Dictionary (Oxford University Press, 2003), to assist with some of the technical terms, though this is by no means necessary.

Seminar 1: The Doctor-Patient Relationship

The unique relationship between doctor and patient lies at the core of the practice of medicine, and will form the core of this course as well. We will begin with an examination of the doctor-patient relationship from both theoretical and first-hand perspectives, incorporating viewpoints from philosophers as well as physicians. How do doctors relate to patients? How should doctors relate to patients?

READINGS:

· *Bedside Stories, ‘Medical House Officer’ and ‘Casualty’

Seminar 2: A Chance to Cut is a Chance to Cure — Surgery

For centuries, doctors were forbidden to perform surgery, as it violated the primary Hippocratic injunction: ‘First, do no harm.’ Even now, doctors divide themselves into ‘medics’ and ‘surgeons’ — those who don’t cut and those who do. The surgeon’s perspective is fundamentally different from that of the non-surgeon, for crossing that forbidden line and taking up the scalpel redefines the relationship between doctor and patient. We will explore the surgical perspective and its unique dilemmas.

READINGS:

· Mortal Lessons, ‘The Exact Location of the Soul,’ ‘The Surgeon as Priest,’ ‘Lessons from the Art,’ ‘Bone,’ ‘Liver, ‘Stone’, and ‘The Knife’

· Confessions of a Knife, ‘Sarcophagus;’

· Bedside Stories, ‘Surgical House Officer’

· Raising the Dead, ‘A Modern Lazarus’ and ‘Kidney for Sale’

Seminar 3: Care Beyond Cure — HIV Medicine

For all that medical science has accomplished, there remain all too many problems we cannot solve. What is the doctor’s role when there is no cure? What can medicine offer those whose bodies cannot be healed? In this seminar we will examine the doctor’s role in the treatment of chronically ill patients and patients at the end of life.

READINGS:

· Mortal Lessons, ‘The Corpse’

· AIDS Doctors, ‘The Dark Years’ and ‘Travel Agents for Death’

· Dreamsnake, Chapter 1

Seminar 4:

This seminar will cover two topics — please do the reading for both topics.

The Double-Edged Helix — Medical Genetics

The completion of the Human Genome Project heralds a new era, in which genetics will play an ever-larger role in the practice of medicine. Bespoke drugs, designer babies, and pre-diagnosis at birth of diseases that may affect a person in old age — all this and more hovers on the horizon. What will this new information mean for the practice of medicine?

READINGS:

· DNA, ‘Gene Hunting: The Genetics of Human Disease’ and ‘Defying Disease: Treating and Preventing Genetic Disorders’

Speaking in Tongues — Cross-Cultural Medicine

Healing traditions and beliefs vary widely across cultures, and the increasing ethnic and cultural diversity of 21^st century society will make cultural competence as important as medical competence for physicians. Even ‘mainstream’ patients are increasingly supplementing their medical care with ‘alternative’ therapies such as herbs and acupuncture. How will the increasing use of other healing methods affect the practice of medicine?

READINGS:

· The Spirit Catches You and You Fall Down, ‘Take as Directed’ and ‘High-Velocity Transcortical Lead Therapy’

· Mortal Lessons, ‘The Twelve Spheres’