Académie royale de Médecine de Belgique

|

Résumé Joseph Murray, membre honoraire étranger

(Séance du 23 mai 1992)

THE ROLE OF SURGEON-SCIENTISTS IN MEDICAL PROGRESS       

by Joseph MURRAY (Prix Nobel), membre honoraire étranger.

All knowledge is basic, whether derived at the bedside or the bench.  Some individuals imply erroneously that “pure” research is nobler, and more intellectual and difficult than “applied” research.  A statement made by Pasteur denies this conception : “No category of science exists to which one could give the name of applied science.  Science and the application of science are linked together as a fruit is to the tree that has borne it”.

Accepting Pasteur’s holistic view, the bioscientist, whether surgeon or internist, has a major advantage over the scientist confined to the laboratory projects.

To study new problems, the surgeon-scientist needs to have only “curiosity, drive, and persistence”.  But one cannot do it alone.  Seldom, if ever, is one person responsible for medical progress.  No clinician can be completely proficient in biochemistry, genetics, immunology, embryology, endocrinology, or whatever discipline is required to investigate a specific biological problem.  But most surgeons understand the need for team play and therefore can fit comfortably into any research project, as productive and innovative members.   

In today’s technological world it is easy to understand that team play is essential; but we sometimes forget that it has always been so.  In his Nobel prize address en 1902, the legendary carbohydrate, purine, and protein chemist Emil Fischer observed that scientific progress was no longer determined by brilliant personal achievements but rather through planned collaborations with teams of workers.  There are many examples of surgeon-scientists who have contributed in fundamental ways to transplantation, cardiac and vascular surgery, nutrition and metabolism, gastrointestinal and endocrine surgery, to mention only  a few.

In the early 1930s, when I was a high school student, Alexis Carrel’s book “Man the Unknown” was immensely popular.  Reading it then strengthened my nascent interest in science and medicine.  His classic papers on vascular suture and the transplantation of blood vessels and organs, for which he won the 1912 Noble prize, remain exciting and stimulating.  Carrel, with his coworker Guthrie, transplanted organs in animals in a variety of ingenious ways, even producing a two-headed dog.

Conceptually, the surgeon and bench scientist differ in three ways :

1.  The scientist knows that he doesn’t know, whereas the surgeon is expected to know.

2.  The scientist can wait for all the data to become available, whereas the surgeron must make a decision based upon the available date.

3. The scientist deals with mass date, whereas the surgeon,  deals with an individual patient.

Acnowledging the differences, is it possible for a surgeon, or any clinician, to be a scientist ?  The answer of course is yes.  It is a difficult role to assume, but nevertheless it is absolutely essential for our patients welfare that dedicated physicians and surgeons understand and work with scientists of other disciplines.