HMX Faculty Perspectives

Program instructors Kevin S. Bonham, PhD and Ole-Petter (“OP”) Hamnvik, MB BCh BAO, MMSc share their thoughts on the importance of biochemistry. 

Why do you think it’s important for health care professionals to learn biochemistry?

Kevin: All biological processes, including those that are necessary for health and those that lead to disease, are governed by the chemical interactions of molecules. Life itself is made possible by enzymes – biological catalysts that can control the rate of chemical reactions. This means that in order to truly understand biology, you have to understand biochemistry.

More practically, because our health is rooted in our biology, everything about the practice of medicine, from diagnosing disease to the drugs we use to treat it, is also based on chemistry.

OP: To be able to provide effective medical care to patients, health care professionals need to first understand how the human body functions in health and in disease. To truly gain this understanding, you need to master what happens at the smallest functional units of the body – the cells and the molecules within them – and how these small units aggregate into a functional human body. In a way, biochemistry is the core of medicine; health care providers rely on an understanding of biochemistry in most of their routine tasks.

What do you want students to take away from this course?

Kevin: Because biochemistry touches every aspect of biology, there’s no way to cover everything in a single course. But there are a small number of key principles that show up again and again, and that’s what I want students to take away from this course.

There’s no need to memorize enzyme names like phosphofructokinase, but understanding conceptually how enzymes work, and how the regulation of enzymes alters the behavior of a cell and of the whole body, will help students make sense of the rest of biology. Students won’t need to do complex calculations or derive the equations of thermodynamics, but understanding how energy is extracted and consumed will deepen their understanding of metabolism and human disease.

OP: The course illustrates the important idea that biochemical principles – while describing events that happen at a microscopic scale or smaller – has real implications on patients and the practice of medicine. For example, understanding the biochemistry of carbohydrate metabolism allows the students to understand how the body can deal with fasting and with the sudden influx of nutrients after a meal, and also provides a good understanding of diseases such as diabetes mellitus. The molecular events cause discernible clinical effects.

Learn more about the Biochemistry course.

Program instructors Christine DeGennaro, PhD, Robert C. Green, MD, MPH, and Carrie Blout, MS, CGC, LGC, share their thoughts on the importance of genetics. 

Why do you think it’s important for health care professionals to learn biochemistry?

Christine: As DNA sequencing becomes cheaper and more readily available, the role of genetics in medicine is expanding. With our increasing understanding of the variation in the human genome, we can start to predict how specific changes in DNA sequence will affect an individual’s health. Human genetics is extremely complicated, but it is apparent that many human diseases are influenced by genetics. From a medical perspective, this includes everything from rare DNA sequence variants that drastically increase risk of a disease, to common variants that lead to small changes in risk.

Historically, genetics specialists have helped patients to navigate these situations, but genetics is beginning to permeate medicine as a whole. This means that health care professionals across many fields are faced with new questions. When do you recommend genetic testing to a patient? What kind of testing will provide the most conclusive results? How do you help the patient to understand those results, and use them to make decisions about his or her care? Moving forward, an understanding of the principles of genetics and an ability to apply them in today’s medical landscape will be an enormous asset for any health care professional.

Carrie: Genetics is really a subspecialty of all specialties. The more we understand the genetic basis of biology, the more we will understand human health and disease. Having a strong background in genetics will be important as genomic technologies continue to expand and are implemented more and more into clinical care. Understanding how to look for patterns of disease and when to refer a patient to other specialists is an important tool for every health care provider, and as more patients have genetic results in their medical records, having the ability to understand how this is or is not important to your patients’ medical care will be of the utmost importance. Overall a global knowledge of genetics will help you to provide better care to your future patients.

What do you want students to take away from this course?

Christine: Even outside of medicine, genetics has a very important presence in our world today, so, fundamentally, what I would like students to take away from this course is a level of genetic literacy that will allow them to navigate the questions and decisions that they will face in their own lives.

Direct-to-consumer genetic testing now allows everyone to learn about their own genetics; these tests can potentially include information about health and disease risk and ancestry that have significant impacts for individuals and their families. When making decisions about genetic testing, it is important to be informed about exactly what you will learn and what the consequences of the results might be down the line. In this course, we put the fundamental principles of human genetics into the context of the world today, which will provide students with the tools and resources to ask the right questions and make informed genetic decisions.

Carrie: I hope students are able to grasp some of the basic concepts about genetics and to understand why it is a vital part of medical care. I hope that this background knowledge will be useful to them if and when they care for patients who come to them with a genetic test result, a family history of genetic disease or a presenting genetic diagnosis. I hope this course excites them about the concept of genetics and genomics and encourages them to want to learn more as their career progresses.

Why are you interested in genetics and genomics?

Robert: Genomics is inherently exciting, and you can see that because of its relationship to forensic law enforcement, reproduction, ancestry, cancer and all sorts of medical developments, and all of the controversy related to direct-to-consumer genetic testing.

The skeleton of genetics is sequencing, and people are building on that – with gene expression, proteomics, metabolomics. So there are multiple layers of knowledge and exploration that are generating tremendous excitement in the world, and motivating enormous investment – scientifically, educationally, financially, and entrepreneurially. So the question isn’t really why I’m interested in genomics, the question is why isn’t everybody interested in genomics because it’s so fabulously interesting.

Learn more about the Genetics course.

Program instructors Kate McDonnell-Dowling, PhD, and James P. Rathmell, MD, share their thoughts on the importance of pharmacology. 

Why do you think it’s important for aspiring health care professionals to learn pharmacology?

Kate: In order to really understand the treatment of disease, you have to understand the basics of how a drug acts in the body. When a clinician is choosing a treatment for a patient, they are considering many pharmacological parameters such as the properties of the drug, the dose of the drug to give, how often the drug should be given, the age, weight, gender, and race of the patient, the disease itself, and the stage of disease. Eventually, without even knowing it, the clinician is processing all this information and all of these basic concepts of pharmacology in order to decide on the most efficient and beneficial treatment for the patient. To get to this point, and to be able to treat and prevent various conditions, knowing the fundamental concepts of pharmacology is vital.

James: Regardless of where a career in health care takes you, understanding how drugs interact with the human body in health and disease is essential. Effective use of drugs to improve health and understanding how and when drugs become toxins relies on mastering the basic principles of pharmacology.

What do you want students to take away from this course?

Kate: Pharmacology does require a knowledge of many other subjects such as anatomy, physiology and biochemistry, so it can be difficult to try and bring all of these together in order to understand pharmacology as a single subject. But although this is challenging this is also what makes pharmacology exciting, being able to bring all of this information together to truly understand what happens when a drug enters the body and what exactly the drug does to all the different systems within the body.

It is often thought that pharmacology is just memorizing drug names and chemical pathways, but when you dig deeper you see that this subject is built on top of a few simple concepts. We’ve put together this course to help the student learn those concepts, to show how they apply on a cellular level and then also how they apply at the patient level, to the treatment and prevention of disease. In this course, we always relate these fundamental principles back to the patient, so the student can see the bigger picture and how the basic concepts are applied in the practice of medicine. 

Learn more about the Pharmacology course.

Program instructor Richard M. Schwartzstein, MD, shares his thoughts on the importance of physiology.

Why do you think it’s important for aspiring health care professionals to learn physiology?

Richard: Physiology is truly the science of how the body works at a macro level. It helps us understand how all the organ systems are integrated and, when we are healthy, are seamlessly monitoring and responding to multiple unconscious inputs every moment of the day and night to keep us functioning well. It is also the foundation for studying and making sense of the impact of disease states, which invariably alter the normal physiology and lead to symptoms. The body’s response is invariably to activate counterbalancing physiological effects to try to restore function as close to normal as possible.

What do you want students to take away from this course?

Richard: Our philosophy with this course, as with most of my work with students, is to “teach what you can’t Google.” While there is important factual content in the course, my primary goal is to convey key concepts which provide a framework for how the body works and to help the learner gain an appreciation for the thinking process that doctors use to work through problems when the answer is not immediately apparent. In addition, I believe that curiosity is a keystone for being a good doctor, both humanistically and scientifically. I hope that the course will stimulate curiosity in those who tackle it and encourage them to continue their learning beyond the specifics of the course.

Learn more about the Physiology course.

Program instructors Andrew Lichtman, MD, PhD, and Shiv Pillai, MD, PhD, share their thoughts on the importance of physiology.

Why do you think it’s important for aspiring health care professionals to learn immunology?

Andrew: Over the past several decades, there has been an enormous increase in the scientific evidence for a central role of the immune system in a wide range of common human diseases, including those that cause the most morbidity and mortality worldwide. Many of these disorders had traditionally not been viewed through the immunology lens, such as cancer and cardiovascular disease, but that is all changing now. Therefore, a basic understanding of the components, functions, and mechanisms of the immune system is really an essential foundation for anyone planning to train for a career in health care.

Shiv: The immune system protects us from infections and cancer in a very exquisitely precise way. Most human diseases result from some loss of this precision. Sometimes the immune system is overwhelmed by an infection or a tumor. On other occasions the immune system aberrantly or over-exuberantly responds to innocuous environmental molecules or microbes – or to self-structures – and this results in a loss of immune regulation that results in disease. Understanding immunology has allowed the prevention of infections by the use of vaccines, has helped the medical world develop the ability to transfuse blood making modern surgery possible, has allowed transplantation to become a reality, and has led to rational treatments for allergies and autoimmune diseases, and what are likely the first real cures for cancer. Many of the therapies of the future will likely be derived from an even better understanding of immunology and how the loss of immune regulation leads to specific diseases. No other field of basic science is so intimately connected to the pathogenesis of disease or to treatment.

What do you want students to take away from this course?

Andrew: On completion of the course, students should understand the fundamental ways the immune system protects us, and appreciate how deficiencies, excesses, or mistargeting of immune responses contribute to disease. Furthermore, students should be aware of the many ways the science of immunology has already been successfully translated into clinical medicine. The basic knowledge gained from this course should facilitate students’ continued course-based and self-learning of immunology.

Shiv: Students should understand the underlying concepts of how the immune system works and how knowledge of immunology has already impacted the understanding and treatment of a range of human disorders.

In your HMX Fundamentals Immunology course, students learn about the role of immunology. What does the science behind immunology and infection say about reducing transmission of SARS-CoV-2 (the coronavirus involved in the pandemic)?

Andrew: Reliable community epidemiologic data and in-hospital infection control data accrued over the duration of the pandemic have unequivocally shown that transmission of SARS CoV-2 is significantly reduced by mask wearing and social distancing. Conversely, analyses of the incidence of new cases after social and public events conducted without mask-wearing or distancing clearly show that such behavior significantly increases the risk of infection with SARS CoV-2. The major way mask-wearing works is by protecting other people from viruses released from the mask-wearer, and to a lesser degree protecting the mask-wearer from virus released by others. So mask-wearing needs to be adopted by a majority of people in a community in order to decrease viral spread.

Furthermore, a majority of infectious disease epidemiologists have carefully addressed the question of herd immunity, and agree that the only way to achieve this without disastrous increases in COVID-19 associated morbidity and mortality way beyond the already dire numbers is through a widely adopted vaccination program, and not by intentionally encouraging infection of the general population. We still do not know if SARS CoV-2 infection results in effective long-lived immunity, and several studies of immunological parameters in infected patients suggest that the viral infection actually impairs strong antibody reposes needed for protective immunity. This impairment may be related to systemic inflammatory events that accompany the infection, and this would not likely be a problem for vaccine effectiveness. 

Shiv: Most infections are acquired by breathing a pathogen in, or touching an infected surface, or ingesting something containing a pathogenic microbe. We now know that SARS-CoV-2 is acquired largely by two routes, but primarily by inhaling droplets containing the virus. These droplets could even come from an asymptomatic person opening his or his mouth to speak to you when in close proximity. The other way the virus spreads is by touching a recently infected surface and then touching your face – the virus then gets into you. That is why regular handwashing with soap is important.

The reason why mask-wearing is a socially responsible thing to do is that the chances of an infected but asymptomatic or symptomatic person transmitting the virus dramatically decrease if he or she wears a mask. Although some protection is afforded to the wearer, a mask is not worn primarily to protect the wearer but to protect the people around the wearer! If everyone wore masks, transmission would drop dramatically. Young people may be less likely to get very sick generally with this coronavirus, but they are often the source of virus that is transmitted to older people, sometimes members of their own families, who may not end up doing so well. It is younger people who brought the virus into nursing homes with devastating consequences. So wearing a mask is not just good public health, it is what an informed responsible human being should do. It does save lives.

While getting measles or mumps often results in lifelong immunity, coronaviruses in general provide immunity for relatively short periods of time. There is little likelihood of obtaining herd immunity towards any coronavirus from natural infection – this is NOT like measles! Vaccination, when shown to be effective and safe, will be the only way to achieve herd immunity against SARS-CoV-2, but that will depend on a large segment of the population getting vaccinated. 

Learn more about the Immunology course.