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Should Organic Chemistry Be a Premed Requirement?
1-quack-4-malpractice writes "For the second time, the Wall Street Journal health blog has questioned whether premed students should be forced to suffer through organic chemistry. Dozens of doctors weighed in with comments, and many of them seem to think that the wry subject is an almost useless rite of passage. Wired Science points out that there are not enough doctors who do research in addition to seeing patients, and they are the ones who benefit most from a thorough grounding in basic sciences like organic chemistry."
Reminds me of the classic joke:
A college physics professor was explaining a concept to his class when a pre-med student interrupted him.
"Why do we have to learn this stuff?" he blurted out.
"To save lives," the professor responded before continuing the lecture.
A few minutes later the student spoke up again. "Wait-- how does physics save lives?"
The professor responded. "By keeping idiots out of medical school."
Speaking as a current medical student, I absolutely think that Organic Chemistry is an appropriate pre-med subject. While the material covered isn't particularly useful beyond establishing a solid basis for understanding the chemistry of biochemical pathways, the value of O-Chem is that it's usually the first time an undergrad student is hit by a tidal-wave of information. O-Chem, just like a lot of the stuff in med school, isn't necessarily difficult stuff; the challenge lies in assimilating information and understanding relationships at a high rate. O-Chem was an excellent primer for the drinking-from-a-firehose atmosphere of medicals school, as well as a good tool to test scientific critical thinking on the MCAT.
P.P.S. I'm doing Science and I'm still alive.
I have a doctor who couldn't pass organic chemistry. We call them "nurse practitioners". Sure, they aren't formal doctors, but they'll see me.
Here are some great follow-up examples:
Why on earth should engineering majors study optics, when so few will work with optics?
Why should a computer science major study operating systems, when scant few of them will actually work on an operating system?
Why should English majors study poetry, when so few will become poets?
Why should Business majors study economics, when so few will actually become economists?
Why should a home owner buy fire detectors, when so few will have their house burn down?
Why should people buy the Journal, when it publishes such stupid crap?
Actually, what you need are more mid-level providers. Physician Assistants, Nurse Practitioners, and the like are probably the future of front-line medical care, while doctors will provide an increasingly overseer role. Hell, as a future doc, I'm not particularly happy about that, but it's the reality. I'd rather see fewer but better doctors surrounded by an army of trained nurses and PAs, than the converse.
P.P.S. I'm doing Science and I'm still alive.
This is precisely my argument in favor of forcing medical students to learn ochem. If you don't understand this stuff, you really shouldn't be prescribing drugs. We understand fairly little (or nothing) about the way many drugs work as it is. To not have some idea at least about how they will interact is simple incompetence through ignorance.
On the other hand, as the sibling AC comment points out, most doctors are just going to prescribe whatever their sales rep is pushing that month. It is a sad reality of patent-protected medicines that when a drug is no longer covered by patent, a new drug will be pushed to the patients both directly and through unscrupulous physicians even if the new drug is less effective than the old one - which is often the case.
As others have pointed out the future is most likely to include more medical practitioners, and fewer actual doctors. This is probably for the best - I think we've all received incompetent medical care in the USA; for most of us it is probably the norm. I know that is the case for me.
Incidentally, I am not a "computer scientist", yet I am able to learn new skills. I wouldn't hire me for any kind of substantial programming job or anything, but this is really more about a mindset than anything else. Then again, I know far more about the inner workings of the computer than the average "tech" (whatever the hell that means) and that does help quite a bit.
"You're right," Fisheye says. "I should have set it on 'whip' or 'chop.'"
As an chemist (pharmaceutical development, so mostly analytical on small organic molecules) who sat through many an o-chem class with pre-meds, I am of course biased towards the subject, one of the most useful things I have ever learned. That being said, while I will argue for the importance of organic chemistry to medical professionals, it seems clear to me, from what I heard in my education and from what I see from the comments here, that the lessons o-chem can impart are not being absorbed.
Organic chemistry is the basis of pharmacology. Organic chemistry is the basis of molecular biology. From the future doctor's point of view, that should make it required reading. Do you want to know what makes some drugs orally active and others parenteral only? Do you want to know why one drug has a thousand times the activity, or a thousand times the metabolic clearance, of another drug in the same class? Do you wish to know the mechanisms underlying lipid storage disorders, protein misfolding, or genetic mutation? Is it conceivable you might ever want to develop pharmaceuticals alongside your old /. pal reverseengineer? Organic chemistry lays the groundwork for all of these things. I don't think it's asking too much for doctors who plan on treating diseases based on proteins, DNA, and sugars to know the basic chemistry of amino acids, nucleotides, and carbohydrates, as well as a basic notion of the reaction mechanisms. There's a sweet spot of knowledge here: I don't care if my physician can tell me the products of the Hell-Volhard-Zelinsky reaction, but knowing the difference between an aldose and a ketose would be helpful.
Here's the rub: the mechanisms are really the key to knowing o-chem. Unfortunately, it wasn't until my third semester of orgo, when it was up to orgo for the people who genuinely enjoyed it, that I really saw this. If you know what the electrons will do, and why they will do it, you understand organic reactions, and you don't need to memorize everything. This is where I think organic chemistry education is really falling short. At my alma mater, in particular, there are two levels that most chemistry courses are taught at. Being a chemistry nerd, I took the accelerated track all the way (adv. p-chem was like chewing glass). Only the most ambitious and self-confident pre-meds followed this track; the rest followed the regular sequence.
The problem with the way "normal" organic chemistry is taught to pre-meds is that in order to "make it easier," it tends to get abstracted into meaninglessness. Pre-meds in orgo are often like Searle's Chinese room: they can give you the right answers, but they don't understand them. The whole thing's backwards: advanced organic students are taught the basics, the essence, the very point of organic chem while basic students suffer with their fat deck of flashcards and wonder if a C is going to keep them out of Hopkins.
If I were to fix this, I would keep o-chem a requirement for pre-meds, but it would be a quarter-length course at most, or folded into the start of a decent biochemistry course. It would focus hard on functional groups found in biological molecules- amines and carbonyl compounds especially- and discussion of the physiological consequences of reactions. More time drawing arrows showing electron flow. More time learning about equilibrium and kinetics. No time spent memorizing different ways to do electrophilic aromatic substitution reactions. What I want physicians to really know about benzene is that it is poisonous.
"FDA staff reviewers expressed concern about the number of patients who were left out of the study because they died."