It was once said, in the distant past, that an adolescent son should be advised to seek entrance to the profession of medicine if his morals were too malleable for the clergy, his stamina too fragile for the military and his arithmetical skills too rudimentary for the world of accounting. The character lapses underlying the choice of a profession such as medicine, however, are rarely documented, except perhaps in Gilbert and Sullivan operettas or the wellsprings of Jewish humor.
Most 21st century medical school graduates undertake an average of three or more post-MD years to learn the rudiments of their contemplated clinical specialty. They sit for their specialty Board examinations at about age 31 and then venture forth into clinical practice, armed with a young family, a sprinkling of grey hair, a profound sense of professional inadequacy and an educational debt in excess of $100,000.
A small fraction of medical graduates, however, elect to enter the nebulous field of academic/research medicine. These pioneers tend to be self-selected; being a research physician, after all, is an insecure state; at best their feet are firmly planted in mid-air. Salaries are so low that when the subject of remuneration arises at the tenth anniversary medical school class reunion, the medical investigator talks only of the merits of Zen Buddhism or the mystical roots of Kabbalah. To be called a researcher, remember, is to be relegated to an ignoble form of academic vagrancy with no licensure, occupational cachet or visible means of livelihood.
The elements of modern science have become so elaborate, so complex, that an individual untrained in the field is unlikely to understand the dimensions of the confronted problem, let alone envision an answer. Self-trained, unschooled physical scientists such as Davy, Faraday or Edison – lone dreamers armed with pencil, an empty pad and a vivid imagination – are long past. And, more often than not, the lone investigator of cinematic nostalgia is now replaced by a team of unsmiling research scientists.
In the world of the natural phenomena, Thomas Jefferson’s self-evident truths become neither self-evident nor patently simple. Indeed, they are frequently counter-intuitive, denying what our senses tell us. It requires a trained yet open mind to observe the sun traversing the heavens from east to west, and then affirm that it is the undetected rotation of the earth that yields the erroneous impression of solar migration.
Imagine now a research physician who aspires to become an interpreter of life’s great mysteries. This young scientist then chooses a problem to work on; generally, a problem is assigned to him by a mentor. This investigator’s professional activity is thus voluntarily narrowed to a miniscule segment of human endeavor. It is much like a literary scholar declaring that he will confine himself solely to translating 13th century Mongolian poetry into medieval Yiddish. It will then be this young scientist’s genius to envisage the broader implications of his “small problem” of beholding the unimaginable treasures in the detritus of his assignment.
In general, who gravitates toward medical research? Certainly cerebral types rigorously trained in the disciplines of applied biology do; also those endowed with a bundle of contradictions have interest in the field. They are often quite shy yet fulsomely articulate in their particular field of study, humble in most of life’s endeavors but immensely self-assured, perhaps even arrogant, in believing that they are worthy enough to seek answers to questions as yet unanswered.
While they do not deny the extent of their own ambitious motives, they readily, willingly seek out the thoughts of competing colleagues and eagerly publish their findings for all to criticize. Paranoid scientists hovering over their secret discoveries are confined to 19th century fiction.
The compelling need to explain phenomena in the basic medical sciences, to clarify their underlying dynamics, is not a pastime for sissies or something to be engaged in on alternate Wednesday afternoons while playing golf. It is a nervous state of mind compelled by the need to upset prevailing beliefs currently held in reverence; to replace intellectual comfort with discomfort; to be, in the world of abstract thinking, an irreconcilable revolutionist; and to be burdened with an abiding need for skepticism, tenacity, courage to stay in an intellectual minority; and, above all, burdened by a goal-oriented passion. To witness a Watson or a Crick gabble about their discoveries regarding the molecular structure of DNA is to see passion at its greatest intensity, exhibiting an eagerness matched only by an adolescent’s most prurient emotions.
It is doubtful that the medical scientist ever thinks of himself as a martyr, a Dr. Arrowsmith, on the sacrificial altar of basic research. This scientist pays his taxes as other citizens do, groans when the Red Sox lose to Tampa, votes each November and dislikes broccoli. But, as Mozart was not “just another composer,” so too that small enclave of gifted scientists who lessen our ills and lengthen our lives, must represent a precious assemblage of rare talents to be admired by the rest of us as though they were an endangered species.
STANLEY M. ARONSON, M.D. (firstname.lastname@example.org) is dean of medicine emeritus at Brown University.