Edward Tabor
Washington, DC, United States

Medical residents who engage in scientific research obtain numerous advantages that may enhance their careers. They acquire analytical skills, refine their critical thinking, and may develop better future training opportunities. Unfortunately, scientific research is often not part of their training, leading to the suggestion that this should change and that some scientific research opportunities should be included in current medical residency programs.¹

There is also the additional potential benefit that by participating in research, students or residents may make important advances in medicine, as shown by a few advances described here.

Cardiac catheterization: Werner Forssmann (1904-1979) was a surgical intern in Eberswalde, Germany, a small town fifty miles from Berlin, when in 1929 he had the idea of introducing a catheter into the heart by way of an antecubital vein, which eventually led to the development of cardiac catheterization. His department chairman refused to give him permission to try this either on patients or on himself. As recounted by Steckelberg et al., he tried it anyway, first on cadavers and then on himself:

. . . after deceiving the surgical nurse into thinking that she would be the subject, and thus gaining access to the necessary sterile instruments, he persuaded her into allowing herself to be tied to the operating table (preventing her from interfering with his plans), anesthetized his own left cubital fossa, advanced the catheter into his right atrium, and then climbed several flights of stairs to the x-ray department to document his achievement.²

One of his fellow residents later recalled, “I remember so well the day when Werner Forssmann came a little later than usual to our luncheon round table . . . Forssmann told us that he was a little bit delayed because he had just put a ureteral [sic] catheter from his left arm into the right ventricle . . .”³ The x-ray of the catheter in his own right atrium was published with a description of the work in Klinische Wochenshrift. However, his findings were not accepted by the medical community; he conducted further studies for two more years but spent the years after 1931 as a surgeon in various undistinguished posts and as a “country doctor.” When he won the Nobel Prize for the catheter work twenty-seven years later (in 1956, with Cournand and Richards), the presentation speech said Forssmann’s work was proof “that—even in our enlightened times—a valuable suggestion may remain unexploited on the grounds of a preconceived opinion.”²

Antibiotics for treating ulcers: Barry Marshall (1951-   ) was a resident in internal medicine in Australia when a supervisor called his attention to twenty patients whose stomach biopsies contained curved bacteria. Marshall and others worked for eight months to culture the bacteria, and within a year had found that these bacteria were present in all patients with duodenal ulcers and in 80% of patients with gastric ulcers. The bacterium was Helicobacter pylori, and this discovery led to the ability to treat gastric ulcers with antibiotics. Marshall experimentally induced gastritis in himself by ingesting the bacteria, and cured it with antibiotics. He subsequently confirmed the findings in controlled clinical trials of antibiotics in conjunction with antacids to treat patients with duodenal ulcers.⁴ He was awarded the Nobel Prize for the work in 2005.

Bromsulphthalein (BSP) clearance test for liver function: Sanford M. Rosenthal (1897-1989) invented the bromsulphthalein (BSP) clearance test for evaluating liver function, based on an idea he had while a medical student at Vanderbilt University. He had read about earlier studies of liver clearance of a dye in which the dye had to be measured in the stool, which was too cumbersome and messy to be clinically useful.⁵ He had the then novel idea that it might be possible to determine clearance by measuring how much of a dye remained in the blood, and thus determine if liver function were impaired. However, he was not able to develop the practical use of the idea until after he completed his internship.^5,6,7 The BSP became the primary test for clinical liver function, and remained so until the development of enzyme tests for liver function in the 1960s.

Discovery of insulin: Charles Best (1899-1978)⁸ was a medical student at the University of Toronto when he and Frederick Banting discovered insulin. For Best, the work began as a summer project just before starting medical school in 1921, assisting Banting in the laboratory of J.J.R. Macleod. He continued to work intensively on the project while a medical student during the following year; the work was publicly presented in December 1921 and published in February 1922 under the names of Banting and Best. Although the Nobel Prize was awarded to Banting and Macleod in 1923, the medical community and history have always correctly referred to the discovery of insulin “by Banting and Best.”

These examples of major medical breakthroughs brought about by scientific thinking and research conducted by medical students and residents provide support for including at least some research opportunities as part of medical school and residency programs.

References

1. Rothberg MB. Overcoming the obstacles to research during residency: What does it take? JAMA 2012;308:2191-2192.
2. Steckelberg JM, Vlietstra RE, Ludwig J, Mann RJ. Werner Forssmann (1904-1979) and his unusual success story. Mayo Clin Proc 1979;54:746-748.
3. Ladewig PP. Nobel laureate Werner Forssmann. Mayo Clin Proc 1980;55:195(lett).
4. Marshall B. Helicobacter pylori & peptic ulcer. In Bynum W and Bynum H, eds. Great Discoveries in Medicine. London: Thames and Hudson; 2011:288-291.
5. Rosenthal SM. An improved method for using phenoltetrachlorphthalein as a liver function test. J Pharmaco & Exper Therap 1922;19:385-391.
6. Rosenthal SM and White EC. Clinical application of the bromsulphalein test for hepatic function. JAMA 1925;84:1112-1114.
7. Tabor CW and Tabor H. It all started on a streetcar in Boston. Ann Rev Biochem 1999;68:1-32.
8. Bliss M. The Discovery of Insulin. Chicago: University of Chicago Press; 1982.