Why the Anatomy Lab Remains a Fixture of Medicine

 For hundreds of years, physicians have been dissecting the dead to learn about the inner workings of the human body.

While the subject matter itself hasn't changed much, the study of anatomy has been steadily advancing — both in terms of the tools available to clinicians and the ways in which educators and students approach the material. Yet amidst these changes, there's no replacement for the hands-on experience of the anatomy lab, physicians say.

Many people think the purpose of the anatomy lab is for students to simply learn the nomenclature for the parts of the body, said Todd Olson, an anatomist at Albert Einstein College of Medicine in New York. This is certainly part of the purpose — "anatomy is the foundation for the language of medicine: the language health-care professionals use for communicating about patients," Olson said. But it's not the only reason. [Image Gallery: The Oddities of Human Anatomy]

Man with hole in stomach revolutionized medicine

A man whose gunshot wound created a window into his stomach enabled scientists to understand digestion.
But the patient, a fur trapper named Alexis St. Martin, also transformed how physiologists studied the body, new research suggests.

People "realized this was a revolutionary approach to doing physiology and medicine. You collect data on the clinical patient and then come to your conclusions," said study co-author Richard Rogers, a neuroscientist at the Pennington Biomedical Research Institute in Baton Rouge, La.

Prior to that, doctors typically decided what was wrong with a patient or how a bodily function worked often based on 1,600-year old medical ideas of Galen before ever setting eyes on them, Rogers said.

The findings were presented Tuesday (April 23) at the Experimental Biology 2013 conference in Boston, Mass.

Gory wound

Physiologist William Beaumont, an army doctor, was stationed in Fort Mackinac in Mackinac Island, Mich., on June 6, 1822, when a fur trapper's gun discharged and accidentally shot 19-year-old trapper Alexis St. Martin in the stomach.

The wound was gory and St. Martin wasn't expected to live out the night.
"He had lung hanging out of his wound," Rogers told LiveScience.
Yet amazingly, Beaumont performed several antiseptic- and anesthesia-free surgeries on St. Martin over several months, and St. Martin eventually recovered.

Window into digestion

St. Martin became fed up with surgery and was left with a fistula, a hole in his stomach through the abdominal wall, which left it open to view. (The strong stomach acid essentially disinfected the wound from the inside out, making it safe to not sew it up.)

Because St. Martin couldn't work as a fur trapper anymore, Beaumont hired him as handyman. The daily task of cleaning the fistula gave Beaumont an idea: perhaps he could watch the process of digestion at work.
So for the next several years, Beaumont recorded everything that went into St. Martin's stomach, then painstakingly described what went on inside. He also took samples of gastric secretions and sent them to chemists of the day for analysis an unheard of task at the time.

His precise observations led him to conclude that the stomach's strong hydrochloric acid, along with a little movement, played key roles in digestion, rather than the stomach grinding food up as some physiologists of the day believed.

"He was the first one to observe digestive processes going on in real time," Rogers said.
He was also the first to notice that St. Martin's digestion slowed when he was feverish, making the first link between digestive processes and disease, Rogers said.
Revolutionary approach

The findings paved the way for modern physiology, where observations guided conclusions, not vice versa, Rogers said.

The study also ushered in some of the first controlled animal experiments by physiologists who realized they could make faster headway by performing fistula operations in animals.
For instance, Beaumont's experiments inspired the famous Russian physiologist Ivan Pavlov to conduct fistula operations in dogs. It was this window into digestion that spurred Pavlov to make his famous conclusions that classical conditioning could spur dogs to salivate on cue, Rogers said.
St. Martin, meanwhile, lived to the ripe old age of 83, going back to fur trapping for a while and eventually becoming a farmer.

Strange Tales From the Frontiers of Resuscitation Medicine

Sam Parnia practices resuscitation medine. In other words, he helps bring people back from the dead — and some return with stories. Their tales could help save lives, and even challenge traditional scientific ideas about the nature of consciousness.

“The evidence we have so far is that human consciousness does not become annihilated,” said Parnia, a doctor at Stony Brook University Hospital and director of the school’s resuscitation research program. “It continues for a few hours after death, albeit in a hibernated state we cannot see from the outside.”

Resuscitation medicine grew out of the mid-twentieth century discovery of CPR, the medical procedure by which hearts that have stopped beating are revived. Originally effective for a few minutes after cardiac arrest, advances in CPR have pushed that time to a half-hour or more.

New techniques promise to even further extend the boundary between life and death. At the same time, experiences reported by resuscitated people sometimes defy what’s thought to be possible. They claim to have seen and heard things, though activity in their brains appears to have stopped.

It sounds supernatural, and if their memories are accurate and their brains really have stopped, it’s neurologically inexplicable, at least with what’s now known. Parnia, leader of the Human Consciousness Project’s AWARE study, which documents after-death experiences in 25 hospitals across North America and Europe, is studying the phenomenon scientifically.

Parnia discusses his work in the new book Erasing Death: The Science That Is Rewriting the Boundaries Between Life and Death. Wired talked to Parnia about resuscitation and the nature of consciousness.


Wired: In the book you say that death is not a moment in time, but a process. What do you mean by that?

Sam Parnia: There’s a point used to define death: Your heart stops beating, your brain shuts down. The moment of cardiac arrest. Until fifty years ago, when CPR was developed, when you reached this point, you couldn’t come back. That led to the perception that death is completely irreversible.

But if I were to die this instant, the cells inside my body wouldn’t have died yet. It takes time for cells to die after they’re deprived of oxygen. It doesn’t happen instantly. We have a longer period of time than people perceive. We know now that when you become a corpse, when the doctor declares you dead, there’s still a possibility, from a biological and medical perspective, of death being reversed.

Of course, if someone dies and you leave them alone long enough, the cells become damaged. There’s going to be a time when you can’t bring them back. But nobody knows exactly when that moment is. It might not just be in tens of minutes, but in over an hour. Death is really a process.

Wired: How can people be brought back from death?
Parnia: Death is, essentially, the same as a stroke, and that’s especially true for the brain. A stroke is some process that stops blood flow from getting into the brain. Whether it’s because the heart stopped pumping, or there was a clot that stopped blood flow, the cells don’t care.

Brain cells can be viable for up to eight hours after blood flow stops. If doctors can learn to manipulate processes going on in cells, and slow down the rate at which cells die, we could go back and fix the problem that caused a person to die, then re-start the heart and bring them back. In a sense, death could become reversible for conditions for which treatments become available.

If someone dies of a heart attack, for example, and it can be fixed, then in principle we can protect the brain, make sure it doesn’t experience permanent cellular death, and re-start the heart. If someone dies of cancer, though, and that particular cancer is untreatable, then it’s futile.

Wired: Are you talking about bringing people to life days or weeks or even years after they’ve died?

Parnia: No. This is not cryogenics. When you die, most of your cell death occurs through apoptosis, or programmed cell death. If your body is cold, the chemical reactions underlying apoptosis are slower. Making the body cold slows the rate at which cells decay. But we’re talking about chilling, not freezing. The process of freezing will damage cells.

Wired: You also study near-death experiences, but you have a different term for it: After-death experience.

Parnia: I decided that we should study what people have experienced when they’ve gone beyond cardiac arrest. I found that 10 percent of patients who survived cardiac arrests report these incredible accounts of seeing things.

When I looked at the cardiac arrest literature, it became clear that it’s after the heart stops and blood flow into the brain ceases. There’s no blood flow into the brain, no activity, about 10 seconds after the heart stops. When doctors start to do CPR, they still can’t get enough blood into the brain. It remains flatlined. That’s the physiology of people who’ve died or are receiving CPR.

Not just my study, but four others, all demonstrated the same thing: People have memories and recollections. Combined with anecdotal reports from all over the world, from people who see things accurately and remember them, it suggests this needs to be studied in more detail.

Wired: One of the first after-death accounts in your book involves Joe Tiralosi, who was resuscitated 40 minutes after his heart stopped. Can you tell me more about him?

Parnia: I wasn’t involved in his care when he arrived at the hospital, but I know his doctors well. We’d been working with the emergency room to make sure they knew the importance of starting to cool people down. When Tiralosi arrived, they cooled him, which helped preserve his brain cells. They found vessels blocked in his heart. That’s now treatable. By doing CPR and cooling him down, the doctors managed to fix him and ensure that he didn’t have brain damage.

When Tiralosi woke up, he told nurses that he had a profound experience and wanted to talk about it. That’s how we met. He told me that he felt incredibly peaceful, and saw this perfect being, full of love and compassion. This is not uncommon.

People tend to interpret what they see based on their background: A Hindu describes a Hindu god, an atheist doesn’t see a Hindu god or a Christian god, but some being. Different cultures see the same thing, but their interpretation depends on what they believe.

Alternative Medicine May Help Control Costs

Use of complementary and alternative (CAM) treatment strategies has become a recognized option for many medical and mental conditions.

For chronic illness, CAM is often blended with traditional medical care as people believe the therapies help them better manage their lives.

A new major Nordic research project has scientifically mapped the use of alternative treatment among multiple sclerosis patients.

Researchers from five Nordic countries find that CAM users are often affluent, younger, and more educated than the general population. Also, young women often use CAM as a reflection of lifestyle choices.

As health care costs skyrocket across the world, expanded use of CAM potentially provides a cost-effective option for better care management.

Researchers found that in the case of multiple sclerosis (MS), people use alternative treatments such as dietary supplements, acupuncture and herbal medicine to facilitate their lives with this chronic disease.

“What we see is that patients do not usually use alternative treatments for treating symptoms, but as a preventative and strengthening element,” said Lasse Skovgaard, Ph.D., who has been involved in conducting the questionnaire-based study among 3,800 people with MS in Denmark, Sweden, Norway, Finland and Iceland.

Multiple sclerosis is a chronic disease which attacks the central nervous system, and which can lead to a loss of mobility and sight. Multiple sclerosis, as any chronic illness, is often accompanied by depression and anxiety.

The incidence of MS is increasing across the world with Denmark experiencing a high prevalence of the disease. Together with researchers from the five other Nordic countries, Skovgaard has spent three years gathering the new data.

“Within the field of health research, it is often a question of studying the extent to which a particular type of drug affects a particular symptom. However, it is equally as important to look at how people with a chronic disease, for example, use different treatments to cope with their situation.

“Here, MS patients offer valuable experience. Their experiences constitute a knowledge bank which we must access and learn from,” he says.

“There is a lot of talk about ‘self-care competence’, in other words patients helping themselves to get their lives to function. Here, many people with a chronic disease find they benefit from using alternative treatments, so we should not ignore this possibility,” said Skovgaard.

Furthermore, learning why patients choose particular treatments is important in relation to improving patient safety because of the possible risks involved in combining conventional and alternative medicine.

According to a 2010 Health and Sickness Study from the Danish National Institute of Public Health (NIPH), one in four Danes say that they have tried one or more types of alternative treatments within the past twelve months.

Among MS patients, the use of alternative medicine has been growing steadily over the past 15 years. In the researchers’ latest study, more than half of the respondents say that they either combine conventional and alternative medicine or only use alternative medicine.

“We cannot ignore the fact that people with chronic disease use alternative treatments to a considerable extent, and that many of them seem to benefit from doing so. It doesn’t help to only judge this from a medical point of view or say that alternative treatments are nonsense – rather, we must try to understand it.”

The study shows that, among MS patients using alternative treatments, there is a significantly bigger proportion of people with a high level of education compared to those who do not use alternative treatments. There is also a larger proportion of highly paid people and of younger women.

“Some critics are of the opinion that when alternative treatments are so popular, it is because they appeal to naïve people looking for a miraculous cure. But our results indicate that it is primarily the well-educated segment that is subscribing to alternative treatments. And that using alternative treatments is part of a lifestyle choice,” said Skovgaard.

He hopes that the new knowledge will improve communication regarding how the chronically ill use alternative treatments in combination with conventional medicine.

“We see that so many people are combining conventional medicine with alternative treatment that it should be taken seriously by the health service. Until now, there hasn’t been much focus on the doctor-patient dialogue in relation to the alternative methods used by the chronically ill to manage their lives,” says Skovgaard.

Additional research will assess how patients perceive the risks associated with using alternative medicine and explore why some patients turn their backs completely on conventional medicine.

X-ray vision: how a chance discovery revolutionised medicine

Katie Maggs of London's Science Museum and Liz Parvin of the Open University discuss how a German physicist called Wilhelm Roentgen stumbled upon a completely unknown form of electromagnetic radiation in 1895 … and why they believe the X-ray machine was such a worthy winner of the museum's 20th Century Icons public vote. Few discoveries can have brought such far-reaching benefits for humanity as X-rays, not just in medicine but also molecular biology, materials and astronomy. The device on display at the museum was built by Russell Reynolds in the UK just months after Roentgen's discovery

Regenerating the future of medicine

Regenerative medicine is poised to dramatically alter conventional methods of treatment, shifting the focus away from symptoms and targeting the specific causes of different defects.

Within this field, adult stem cell research has already established itself as a concrete option for curing several diseases and researchers are excited by the possibilities opening up before them.

Professor Silviu Itsecu, founder and CEO of Mesoblast, a regenerative medicine company, expanded on the potential opportunities: “We’re developing products now based on the stem cells that could allow them to be delivered very simply by an intravenous injection, taking advantage of the properties that they will home (take back) to this specific damaged tissue that we’re trying to target.”

He gave a couple of examples: “An inflamed joint in patients with rheumatoid arthritis, these cells will find themselves going to the inflamed joint and selectively treating that joint. Otherwise, we’re looking at lung disease. So in certain inflammatory lung diseases the cells from simple intravenous injection will find their way straight to the inflamed lung and be able to do their thing (their job) locally, without actually getting to other healthy tissues where we don’t want them to go.”

And yet, whilst the prospect of cell replacement is increasingly acknowledged, its current limitations are also worth noting. Sir John Gurdon, the 2012 Nobel prize winner for Physiology or Medicine, has been one of those eager to stress this point;

“Where people need one kind of cell type, I think that’s a very good promise. It’s quite another thing to say ‘We will replace a whole heart or a whole brain’, that’s complicated, but to replace individual cell types seems very good prospects,” he told euronews.

One party keen on progress, is the Catholic Church, which controversially championed the new technology as an ethical alternative to embryo stem cells research.

"Dirty" Cancer Fighter: Medicine's Next Big Thing?

A single cell causes it and it kills millions of people around the world every year

We have a lot of ways to treat cancer once it forms, but there might be a new way to prevent it.

It's most famous for its statues, "called Moai," but a drug discovered in the dirt among the Easter Island icons back in the 70's, could be the answer to preventing cancer.

"This drug has had a lot of lives," said Z. Dave Sharp, PhD, Professor of Molecular Medicine at the UT Health Science Center at San Antonio.

Dr. Dave Sharp says rapamycin was first used as a fungicide. Now it's used as anti-cancer therapy and an immunosuppressant.

"It can prevent transplant rejection," Dr. Sharp said.

A few years ago, he got the idea it might help extend life too.

"And everybody said oh that's a crazy idea," Dr. Sharp explained.

However, studies showed mice given the drug had their lives extended by up to 30 percent.

"They look younger. They act younger. They're more mobile," Dr. Sharp said.

On top of that Tyler Curiel, MD, MPH, Professor of Medicine at the UT Health Science Center at San Antonio, told ABC30, "The mice that got rapamycin appeared to have their cancers prevented."

Now they're giving mice cancer-causing chemicals. The idea is to find out if the drug is boosting their immunity, so their immune systems can kill cancer cells as soon as they appear.

"There's a lot of evidence that it boosts your immunity," Dr. Curiel said.

If it really does prevent the disease in these guys, "Perhaps eventually people will be able to take this drug," Dr. Sharp explained.

A two year, 450 thousand dollar grant from the National Cancer Institute is helping fund the work. Dr. Curiel says if the drug does prove to prevent cancer in mice, human trials could start in about two years.