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APPENDIX D 27 APPENDIX D TESTIMONY STATEMENT BY IRWIN M. ARIAS, M.D.1 Based upon a unique and productive experience of the past seven years, I submit the following commentary in response to your inquiry of March 3rd. Bridging the continuing rapid advances in basic biology with human disease is, in my view, the greatest challenge to biomedical research and offers the most promise in solving human disease. The gap has become logarithmic and, like a huge suspension bridge, requires many types of wire, struts, and cable. Most efforts to train biomedical scientists are traditionally directed toward physicians and M.D./Ph.D. graduates. Ph.D. graduates are not trained to appreciate pathobiology and, in most medical centers, it is difficult to recruit outstanding basic scientists into clinical departments primarily because, as one of my students succinctly stated, âYou work for physicians and not with them.â Students graduating from basic science departments in medical schools should be important components of the bridge; however, this is infrequent. These students enter programs in medical schools because they wish to work on problems related to human disease. Invariably their academic program, research, and career choice are no different from what would have taken place had they been 100 miles away from a medical center. Approximately six years is spent in the shadow of a great medical center, but the student rarely knows what goes on there. More importantly, brilliant students know little about inflammation, fibrosis, necrosis, and other disease mechanisms. The students reflect the orientation of their mentors and, upon graduation, infrequently seek careers which primarily influence human health. As the number of physician-scientists declines, basic scientists who are sufficiently trained to demystify human pathobiology find exciting and productive careers in clinical departments. These departments have adjusted to changing times by solving academic problems which restrict basic scientists in such departments. In the past seven years, we have trained 63 predoctoral students, 22 postdoctoral fellows, and 6 Ph.D. faculty in the hands-on pathobiology of 20 major human diseases. Our students see patients, handle pathology, and are exposed to every major diagnostic and therapeutic facility in a modern hospital. The program is detailed in a New England Journal of Medicine article (for which we have received over 1200 reprint requests) (Arias, 1989). The Macey, Rockefeller, and Markey Foundations support this program which has graduated 22 students, 16 of whom work in biomedical science research. Our experience prompts the following suggestions: 1. Training appropriations, plans, and programs should include demystifying disease for basic science students and fellows. 2. Institutional solutions to time-honored problems of the Ph.D. in a clinical department should also be encouraged and supported. Summary Bridging basic science with medicine requires many components. The academic physician scientist is a critical player; however, Ph.D. students who demystify disease are major but neglected components. Programs which train basic scientists who can work 1 Testimony presented by J. Frederick Dice, Department of Physiology, Tufts University School of Medicine.