Clinical Chemistry: the Road to N=1
Why we need more chemistry in the clinic if we’re to reach the goal of individualized medicine.
Sixty years ago, as an elementary school student, I was required to complete a physical examination in order to join an athletic team or participate in summer camp. At the time, such exams were fully in the domain of physics. The available tools measured height and weight and included a chilly stethoscope, a blood pressure cuff, a rubber hammer, and a mercury thermometer. There was a little device with a bright light used to peer into my ears, nose and throat (otoscope/auriscope). Virtually no chemical measurements were made beyond looking at the clarity of urine and a semi-quantitative test for sugar therein.
Following a recent morning encounter with my physician, I told a class of premeds that I’d just had a “pchem” exam. I related how a “physical” had become a “physical chemistry” exam, with the doctor showing me tables of numbers on a tablet computer, enabling comparison with reference ranges and my own longitudinal data. Those same data are now available to me anywhere on planet Earth. Clinical chemistry has come a long way in my lifetime, and it is advances in instrumentation that have had the biggest impact on medicine. The microscope and the thermometer got us started, but even these are recent advances considering our history of several hundred millennia.
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