Mayo Clinic College Of Medicine Research Articles

Drugs, Addiction, and the Law: Policy, Politics, and Public Health

Mayo Clinic College of Medicine, Rochester, Minnesota. berge.keith@mayo.eduDrugs, Addiction, and the Law: Policy, Politics, and Public Health. By Peter J. Cohen, M.D., J.D. Durham, NC, Carolina Academic Press, 2004. Pages: 412. Price: $40.00.This remarkable book is the creation of an author uniquely qualified to comment on the multiple facets the “drug problem.” Dr. Cohen has spent much of his career as an academic anesthesiologist with an interest in assisting addicted physicians. Later in his career, Dr. Cohen attended law school. This book represents an approach to a problem altogether too familiar to anesthesiologists, but from a completely different orientation than is the norm. This book is not about the “medicine side” of drugs; rather, it is about the legal past and present of drug laws. It provides an exhaustive look at the societal challenges created by drugs of abuse and how the legal system predicated upon such principles as “Life, Liberty, and the pursuit of Happiness” has responded during the past century and a half to address these complicated issues—that is, the tension between an attitude of “live and let live,” the desire to prevent harm to others, and the desire to “legislate morality.”The author uses the very useful and engaging device of phrasing multiple questions in the opening of many of the chapters. In doing so, he forces the reader to question many of their preconceptions and biases. For example, in chapter 12, “Crack, Powder, and Justice—Illegal Drugs and Sentencing,” the author provides this list of questions:Having thus “laid the table,” the author then goes on to provide historical context and precedents in an effort to define how the current laws evolved. These discussions are accompanied by extensive quotation from actual court rulings; often, the cases have sufficient complexity that they have risen to the level of the U.S. Supreme Court.This book is clearly an effort to present the dizzying complexity of U.S. drug laws in a format that will be approachable to nonlawyers. Although it is understandably heavy on legal concepts and phraseology, the author makes a valiant attempt to help the reader understand the more arcane aspects of the laws. It is, again understandably, at times quite a dry read, mostly during the lengthy quotations from court rulings. These quotations are essential, however; mere paraphrasing would do a disservice to the reader, and the author has wisely chosen to provide them in appropriate places.As one who viewed the recent right-to-life case in Florida as the most impressive civics lesson in my lifetime, I thoroughly enjoyed this book. As one who has often wondered whether a policy of drug legalization might be preferable to the chaos of our current “war on drugs,” I found this book helpful in shoring up arguments both pro and con. In this light, I was struck with the incredible complexity merely unwinding the tangled threads and layers of existing drug laws would involve if legalization were attempted.In summary, this book is superb. It informs, challenges, educates, and demystifies our system of drug laws. I came away with deep respect for the monumental challenge faced by the author and for the excellence of his final product.Mayo Clinic College of Medicine, Rochester, Minnesota. berge.keith@mayo.edu

Assessing Professionalism in Early Medical Education: Experience with Peer Evaluation and Self-evaluation in the Gross Anatomy Course

Introduction: As today’s healthcare model moves toward more streamlined and corporate industrialism, it is our responsibility, as doctors, to ensure the integrity of medicine’s foundation in professionalism. The erosion of professional values not only creates a climate of animosity, but reverberates negatively to impact the development of students, who model their behaviour after those they most respect. This hazard has spurred an evaluation of medical school curricula, with a new emphasis on professionalism in the philosophy of medical education. Courses such as Gross Anatomy that, in the past, offered “pure content,” are now being used to teach and evaluate professionalism. The goal of this study was to determine if peer evaluation and self-evaluation used in conjunction and implemented early in the medical curriculum, can serve as useful tools to assess and provide feedback regarding professional behaviour in first-year medical students. Materials and Methods: From 1999 to 2003, students at Mayo Clinic College of Medicine evaluated themselves and their peers during the Gross and Developmental Anatomy Course. Numerical evaluations and written comments were statistically analysed within established categories of professionalism and correlated with academic performance, gender, and peer rating and self-rating. Results: The majority of written comments pertained to inter-professional respect, responsibility, and excellence. Students who gave higher peer evaluation and selfevaluation scores provided more positive comments, and students performing well in the course provided more positive comments about their peers and themselves than did those struggling academically. Students consistently rated their peers higher than themselves, and male students rated themselves higher than did female students. Conclusions: Implementing peer evaluation and self-evaluation early in the medical curriculum is a valuable exercise in teaching first-year medical students assessment skills when evaluating their behaviour, as well as the behaviour of their colleagues.

Genetic modification of vascular endothelial function as therapeutic strategy in heart failure

in patients with chronic heart failure, endothelial dysfunction contributes to increased systemic vascular resistance, decreased exercise tolerance, and reduced tissue perfusion. One of the better-characterized mechanisms responsible for endothelial dysfunction is the increased production of

A Tribute to a Neuropathologist, Robert D. Terry

Alzheimer's & DementiaVolume 1, Issue 1 p. 74-76 Policy Forum A Tribute to a Neuropathologist, Robert D. Terry Dennis W. Dickson, Corresponding Author Dennis W. Dickson dickson.dennis@mayo.edu Neuropathology Laboratory, Mayo Clinic College of Medicine, 4500 San Pablo Road, Jacksonville, FL, USA Corresponding author. Tel.: 904-953-7137. E-mail address: dickson.dennis@mayo.eduSearch for more papers by this author Dennis W. Dickson, Corresponding Author Dennis W. Dickson dickson.dennis@mayo.edu Neuropathology Laboratory, Mayo Clinic College of Medicine, 4500 San Pablo Road, Jacksonville, FL, USA Corresponding author. Tel.: 904-953-7137. E-mail address: dickson.dennis@mayo.eduSearch for more papers by this author First published: 01 July 2005 https://doi.org/10.1016/j.jalz.2005.06.012Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume1, Issue1July 2005Pages 74-76 RelatedInformation

Mild cognitive impairment: Useful or not?

Alzheimer's & DementiaVolume 1, Issue 1 p. 5-10 Perspective Mild cognitive impairment: Useful or not? Ronald C. Petersen, Corresponding Author Ronald C. Petersen peter8@mayo.edu Alzheimer's Disease Research Center, Mayo Clinic College of Medicine, Rochester, MN, USA Tel.: 507-538-0487; fax: 507-538-6012 E-mail address: peter8@mayo.edu.Search for more papers by this author Ronald C. Petersen, Corresponding Author Ronald C. Petersen peter8@mayo.edu Alzheimer's Disease Research Center, Mayo Clinic College of Medicine, Rochester, MN, USA Tel.: 507-538-0487; fax: 507-538-6012 E-mail address: peter8@mayo.edu.Search for more papers by this author First published: 01 July 2005 https://doi.org/10.1016/j.jalz.2005.06.013Citations: 2 This study was supported by grants from the National Institute on Aging: P50 AG16574, U01 AG06786, and U01 AG10483. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Citing Literature Volume1, Issue1July 2005Pages 5-10 RelatedInformation

Mild Cognitive Impairment: Where Are We?

From Mayo Clinic College of Medicine, Rochester, Minnesota. This work received support support from the National Institute on Aging Grants U01 AG06786 and P50 AG16574. Neither Dr. Petersen nor his family own stock or has equity interest (outside of mutual funds or other externally directed accounts) in any pharmaceutical or biotechnology company. Dr. Petersen consults to Elan Pharmaceuticals and GE Global Research. Dr. Petersen is not on any speaker's bureaus but has given talks for national organizations and universities or medical centers through unrestricted educational grants from Pfizer, Inc., Eisai, Inc., Novartis, Inc., and Janssen, Inc. Reprints: Ronald C. Petersen, PhD, MD, Professor of Neurology, Cora Kanow Professor of Alzheimer's Disease, Research Director, Alzheimer's Disease Research Center, Mayo Clinic College of Medicine, 200 First Street SW Rochester, MN 55905 (e-mail: [email protected]).

Echocardiography as a Noninvasive Swan-Ganz Catheter

Diwan and co-investigators report in this issue of Circulation that the interval between onset of mitral E and annular early diastolic velocity (Ea) by tissue Doppler, TE−Ea, can be used to estimate left ventricular (LV) filling pressure in patients with mitral valve disease.1 Garcia and colleagues were the first to report that the onset of Ea occurred 7.5±3.5 ms after peak mitral inflow velocity in 7 patients with restrictive cardiomyopathy, whereas Ea started 22±19 ms earlier than did E in the normal group.2 Subsequently, TE−Ea has been shown to correlate with the time constant of LV relaxation (τ) demonstrated by Hasegawa and associates in their elegant animal experiment.3 With worsening of heart failure by rapid pacing, Ea progressively decreased in velocity and delayed in onset. Mitral E occurred coincidently with the termination of the early diastolic left arterial (LA) and LV pressure gradient at baseline and all stages of heart failure. In contrast, with increasing heart failure, Ea was progressively delayed after LA to LV pressure crossover, and TE−Ea was related to τ. Rivas-Gotz, Nagueh, and their associates also demonstrated that TE−Ea was prolonged after constriction of the circumflex coronary artery in dogs.4 In patients with heart failure, LV myocardial relaxation and compliance are decreased. See p 3281 Although LV filling is initiated and enhanced by augmentable myocardial relaxation in healthy individuals, it is driven by high filling pressure in patients with heart failure because myocardial relaxation remains reduced, not being sensitive to preload. Myocardial relaxation also affects the isovolumic relaxation time (IVRT). As relaxation becomes abnormal, LV pressure falls more slowly and the opening of the mitral valve is delayed, resulting in a longer IVRT. IVRT, however, becomes shorter as LA pressure increases; hence, IVRT∝τ/LA pressure. Because TE−Ea∝τ, …

Transient Left Ventricular Apical Ballooning

Letters19 April 2005Transient Left Ventricular Apical BallooningKevin A. Bybee, MD and Charanjit S. Rihal, MDKevin A. Bybee, MDFrom Mayo Clinic College of Medicine, Rochester, MN 55905.Search for more papers by this author and Charanjit S. Rihal, MDFrom Mayo Clinic College of Medicine, Rochester, MN 55905.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-142-8-200504190-00027 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:We thank all of the correspondents for their interest in our review. Ibanez and colleagues report that intravascular ultrasonography detected plaque rupture in the left anterior descending coronary arteries of 5 patients presenting with transient left ventricular apical ballooning (1). These patients had coronary arteries that appeared normal on angiography and a large recurrent distal segment of the left anterior descending coronary artery. These findings are interesting but seem an unlikely pathophysiologic explanation for most cases of transient left ventricular apical ballooning. First, angiographically detectable intracoronary thrombus in the left anterior descending coronary artery would be expected more ...

Reflective teaching: the value of e-mail student journaling

Context and setting Early clinical encounters during the first 2 years of medical school place students with limited knowledge and skill in contact with sick patients, often without the support of the team that traditionally accompanies inpatient clinical clerkships. Why the idea was necessary Course chairs struggle to keep in touch with students' experiences, an essential component of developing and maintaining a student-centred curriculum. Students, in turn, need support and guidance as they start their clinical encounters. Existing pre-clinical curricula lack the social support system that comes with the inpatient care team. Timely insights into students' experiences and struggles during their first exposure to sick, hospitalised patients may provide opportunities for course chairs to connect with and counsel students. What was done At Mayo Clinic College of Medicine, all Year 2 medical students, in groups of 12–14, are required to take an 8-week, on-campus internal medicine course (Med2), a pre-clinical course following the Year 1 Introduction to Clinical Medicine. During Med2, students complete 8 comprehensive histories and physical examinations on hospitalised patients, followed by written and oral case presentations, and participate in weekly physical examination rounds. Beginning in 2001, the students were required to write weekly e-mails to the course director. The students were given 5 questions to promote self-reflection, but were told that they might write freely. The course chair responded to the e-mails, allowing for sharing of experiences and reflections. The journals were not graded. In 2003, the students' attitudes towards the required e-mails were assessed by an anonymous survey at the end of the course. Evaluation of results and impact All students participated and wrote an average of 6 e-mails over 8 weeks. The course chair spent 1 hour per week reading and responding to 10–11 e-mails, each between half and 1 page in length. While the quality varied, the majority of the e-mails provided insight into the students' struggles with detecting abnormal physical examination findings, encountering issues of death and dying, and dealing with patient−learner relationships. There were also remarks of affirmation, teacher effectiveness and insights into the learning process. In 2003, all 39 students (of that year's class) completed the anonymous survey. Twenty-six (66%) considered the e-mails helpful, 3 (7%) found them somewhat helpful and 10 (25%) found them unhelpful. The majority (66%) indicated that the e-mail system was a good forum for expressing their struggles and concerns. Twenty-eight (72%) of the students thought they benefited from the course chair's responses to the e-mails. While candour was encouraged and the course was assessed on a pass/fail basis, an obstacle for honesty and disclosure in the e-mails for some students may have been the lack of anonymity. The benefits of individualised e-mail responses versus complete anonymity should be evaluated. Consideration should also be given to the frequency of e-mails as some students felt it became tedious. While our experience is that e-mailing has been beneficial, adaptations (such as e-mail facilitators) will need to be made to implement this at larger medical schools.

Vancomycin

Dr. McNamara is Instructor of Medicine, Mayo Clinic College of Medicine, Rochester, MN. Dr. Steckelberg is Professor of Medicine, Mayo Clinic College of Medicine. None of the following authors or the departments with which they are affiliated has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article: Dr. McNamara and Dr. Steckelberg. Reprint requests: Dr. Steckelberg, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905.

47-Year-Old Man With Fever and Headache

RESIDENTS’ CLINIC*Resident in Internal Medicine, Mayo Graduate School of Medicine, MayoClinic College of Medicine, Rochester, Minn.†Adviser to resident and Consultant in Primary Care Internal Medicine, MayoClinic College of Medicine, Rochester, Minn.See end of article for correct answers to questions.Individual reprints of this article are not available. Address correspondence toKris G. Thomas, MD, Division of Primary Care Internal Medicine, Mayo ClinicCollege of Medicine, 200 First St SW, Rochester, MN 55905 (e-mail: thomas.kris@mayo.edu).© 2005 Mayo Foundation for Medical Education and Research

State-of-the-Art Imaging With 64-Channel Multidetector CT Angiography

During the past decade, computed tomography angiography (CTA) has become a standard noninvasive imaging method for the depiction of vascular anatomy and pathology. The quality and speed of CTA examinations have increased dramatically as CT technology has evolved from single-channel spiral CT systems (circa 1990) to multichannel (4-, 8-, 10-, and 16-slice) spiral CT systems (circa 1998 through 2001). In 2004, 64-slice multichannel CT technology became available in the United States, with the first installation occurring at the Mayo Clinic College of Medicine. We describe our initial experience using this state-of-the art technology, focusing on examinations that illustrate the increased diagnostic resolution of vascular anatomy and pathology, and the effectiveness of 2-and 3-dimensional postprocessing using a 64-channel CT system. Future applications of 64-channel technology for preoperative and postoperative vascular surgery and endovascular techniques are also described.

Metabolic Acidosis due to Propofol Infusion

Mayo Clinic College of Medicine, Rochester, Minnesota. johnson.michael@mayo.eduI appreciate the interest of Dr. Farag et al. in the recent case report of asymptomatic metabolic acidosis in a patient receiving prolonged propofol infusion in the absence of any likely cause of the acidosis except propofol.1I agree that an occult mitochondrial disease is a possible etiology. The anecdotal reports of Dr. Farag et al. on the effects of propofol in patients with mitochondrial disease are interesting, and I encourage them to publish details in a more systematized form.However, their letter makes unsupported assumptions about propofol infusion syndrome that might adversely affect the level of vigilance for and detection of this complication. It is not true that “hundreds of thousands of adult patients have received propofol without experiencing this complication.” To the best of my knowledge, no large-scale study of acid–base balance on thousands of patients receiving high-dose, prolonged propofol infusion has been reported. The subject of the case report by me and my colleagues was completely asymptomatic and was detected only because concern about respiratory depression under deep sedation caused arterial blood gases to be checked.1It is possible that mild forms of propofol-induced acidosis are much more common than appreciated, and it is also possible that they are as rare as suggested by Farag et al. We simply do not have the data at this time. A large-scale study is needed to answer the question.It is also important to note that propofol infusion syndrome is so far defined only clinically, with metabolic acidosis being the invariant common factor, usually accompanied by circulatory collapse.1Although propofol can have adverse effects on mitochondria in vitro ,2there are multiple potential pathways to the clinically defined syndrome besides mitochondrial disease. Pharmacogenomic variability in propofol metabolism and nonmitochondrial sites of propofol action could cause accumulation of propofol or unusual propofol metabolites,3,4or loss of the cytoprotective effects of propofol,5–8which might otherwise mask harmful effects of propofol. The recommendations of Farag et al. for anesthetizing patients with mitochondrial disease are reasonable and appropriate. However, anesthesiologists should still be vigilant for propofol infusion syndrome in patients without mitochondrial disease.Mayo Clinic College of Medicine, Rochester, Minnesota. johnson.michael@mayo.edu

Treating Hypertension

What do we really know about sympathetic outflow and blood pressure in humans? For example, in healthy normotensive young subjects, baseline sympathetic outflow can vary 2-fold to 3-fold.1,2 We also know that in healthy aging subjects, baseline sympathetic outflow can be increased dramatically with only a modest impact on vascular resistance and little or no impact on blood pressure.1 Additionally, there is no clear evidence for dramatic increases in baseline sympathetic outflow in “garden variety” essential hypertension.1 If we stop here, a position of “nihilism” about sympathetic outflow and blood pressure seems reasonable. However, when the sympathetic nervous system is destroyed by disease or surgery, blood pressure is highly labile.3 We also know that many “stressors” that evoke a pressor response also evoke marked sympathetic activation, and that the magnitude of these pressor responses can be a harbinger of future hypertension.4,5 Finally, in disease states like congestive heart failure, excessive sympathetic activation is a “bad thing.”6,7 If we emphasize these points, sympathetic vasoconstriction seems more important to blood pressure and perhaps survival. …

Chemokines as Attractive Targets in Liver Carcinogenesis

Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota Reprint requests and correspondence: Lewis R. Roberts, M.B., Ch.B., Ph.D., Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA. Received September 05, 2004; accepted September 21, 2004.

Perioperative Mortality

Perioperative Mortality

Wilson Disease—Keeping the Bar for Diagnosis Raised *

We read with interest the article by Ala et al.1 regarding the diagnosis of Wilson's Disease in siblings, both of whom were in their eighth decade of life. We recently diagnosed Wilson's Disease in a 60-year-old woman, underscoring the conclusions reached by Ala et al. This 60-year-old woman was recently referred to us for further evaluation of liver disease. She had no significant past medical history and experienced neither neuro-psychiatric symptoms nor symptoms referable to chronic liver disease. Thus, there was nothing that would warrant further evaluation for Wilson's Disease. An abdominal ultrasound had been obtained to evaluate mild, transient upper abdominal pain and had revealed changes consistent with cirrhosis and portal hypertension. She had essentially normal liver tests, and initial evaluation for causes of chronic liver disease had been negative except for serum ceruloplasmin, which was minimally abnormal. A 24-hour urine copper level was greater that 120 μg/24 hr. She was, therefore, referred to us. Our evaluation confirmed the lack of neurological features, and ophthalmologic examination did not demonstrate Kayser-Fleischer rings. Serum ceruloplasmin and serum-free copper level were normal. The liver biopsy demonstrated steatohepatitic cirrhosis with a negative rhodanine stain. The hepatic copper was quantified at 1,021 μg/g dry weight. To confirm the diagnosis of Wilson's Disease, we performed fluorescent DNA sequence analysis of the ATP7B gene, which demonstrated compound heterozygosity for the H1069Q mutation and the E1064A mutation, an identical genotype to the patients who presented with neurological manifestations recently described by Ala et al. We initiated therapy with trientine. Whereas the H1069Q mutation is the most common mutation found in patients with Wilson's disease, the E1064A mutation has only been described once prior to the report by Ala et al.2 In summary, we diagnosed Wilson's Disease in a woman in her seventh decade of life with no symptoms referable to either liver or neuro-psychiatric disease. This finding underscores the conclusion reached by Ala et al. that the diagnosis of Wilson's Disease should be entertained in patients of all ages who present with evidence of liver disease, neurological disease, or psychiatric symptoms. Roman E. Perri M.D.*, Si Houn Hahn M.D., Ph.D. , Matthew J. Ferber Ph.D. , Patrick S. Kamath M.D.*, * Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, MN, Department of Laboratory and Medical Pathology, Mayo Clinic College of Medicine, Rochester, MN.

38-Year-Old Man With Priapism and a History of Paranoid Schizophrenia

38-Year-Old Man With Priapism and a History of Paranoid Schizophrenia

To open or not to open: that remains the question

This editorial refers to DECOPI (DEsobstruction COronaire en Post-Infarctus): a randomized multi-centre trial of occluded artery angioplasty after acute myocardial †; by P.G. Steg et al. on page 2187 The benefit of prompt reperfusion for ST-segment elevation myocardial infarction (STEMI) using either mechanical or pharmacologic modalities has been convincingly demonstrated. Successful reperfusion salvages myocardium, reduces infarct size, improves left ventricular function (although not uniformly so), and subsequently leads to better survival. This benefit is critically time-dependent within the first three hours after symptom-onset, with sustained but lesser degrees of benefit in the 3–12 h window after symptom-onset.1,2 The benefit of reperfusion in the 12–24 h period after symptom-onset is less pronounced, but likely to be beneficial in patients with signs or symptoms of ongoing ischaemia,3 and likely holds true even after 24 h in such patients. If all eligible patients with STEMI received prompt and durable reperfusion therapy, a debate over the late revascularization of occluded arteries would be moot. However, in reality, many eligible patients with STEMI do not receive primary reperfusion therapy; additionally, thrombolysis, the most widely available reperfusion modality, is often associated with significant residual stenosis, re-occlusion and/or re-infarction even among patients in whom successful reperfusion is achieved initially. Importantly, sustained late patency of the infarct-related artery (IRA) is required for persistent benefit; subsequent re-occlusion of a reperfused IRA is associated with worse outcome than if the IRA remains patent.4 This realization, along with the 'open artery concept', which postulates potential late benefits on the electrical, mechanical, and ischaemic milieu, independent from the time-dependent issue of initial myocardial salvage, has sustained interest in the strategy of angiography followed by revascularization in asymptomatic post-MI patients with occluded IRAs. Although experimental studies have been quite persuasive regarding the late benefits of an open IRA, a … * Correspondence to: Dr. Verghese Mathew, Associate Professor of Medicine, Mayo Clinic College of Medicine, Mayo Clinic, Gonda 5S, 200 First Street SW, Rochester, MN 55905, USA. Tel.: +1 507 538 1469; fax: +1 507 266 9142 (E-mail: mathew.verghese{at}mayo.edu).

To what extent is cadaver dissection necessary to learn medical gross anatomy? A debate forum

In this Olympic year of 2004 in Athens, Greece, which is considered the birthplace of modern Olympics, controversy was inescapable. Whether it was the points awarded by the judges for gymnastics, Paula Radcliffe dropping out of the women’s marathon, or drug-testing scandals, controversy swirled. So, too, we find there is controversy within the arena of anatomical education for medical students. Athletes performed their tasks “just in time”; anatomical sciences educators, however, may have the luxury of time to contemplate the controversial issues they face today or they may have change thrust upon them—administratively, or through the fiat of best medical education practice. The controversial issue for this year’s educational debate is to what extent is cadaver dissection necessary to learn medical gross anatomy. One of the moderators (G.D.G.) proposed a debate on whether dissection is necessary for learning medical gross anatomy for publication in The Anatomical Record (Part B): The New Anatomist. The question was refined to our current title. We bring this debate to the anatomy community through the pages of this journal and also through an online virtual issue on dissection and medical education, available at www.wiley.com/anatomy/ dissection. The format of this debate forum was designed to be similar to a formal debate. The moderators invited several anatomists to present and defend their positions on the topic. There were two proponents: one pro, arguing that dissection is necessary to learn medical gross anatomy, and one con, arguing that dissection is not necessary to learn medical gross anatomy. The proponents stated their positions independently. There were also two rebuttal debaters, one pro and one con. The rebuttal writers had the opportunity to review the proponent papers for each position and then present a response supporting their own position. The authors were allowed only limited space to make their arguments and were encouraged to provide data and references in support of their positions. Dr. Noelle Granger, from the University of North Carolina School of Medicine, was the proponent for the pro position and presented arguments based on her and her students’ experiences (Granger, 2004). Her position was supported by many references. Dr. John McLachlan from the Peninsula Medical School (Plymouth, U.K.), where cadaver dissection is not part of the anatomical education program, supported the con position and described the rationale for their institution’s gross anatomy teaching program (McLachlan, 2004). The rebuttal for the pro aspect was coauthored by Dr. Wojciech Pawlina, from the Mayo Clinic College of Medicine, and Dr. Nirusha Lachman, of the Durban Institute of Technology in South Africa. Pawlina and Lachman (2004) expanded on some of the ideas discussed in the proponent papers and drew a link between dissection in the gross anatomy laboratory and the acquisition of clinical skills, as well as the development of professionalism and professional attitudes for medicine. Dr. Kimberly Topp, from the University of California, San Francisco, authored the rebuttal for the con aspect. Topp (2004) made a pointby-point rebuttal to the pro arguments presented by Granger (2004) and indicated where she believed cadaver dissection may not be necessary in medical education. It is worth noting that anatomy is not only the study of morphology or the structure and function of the members of the zoological or botanical kingdom, but also the geography of a biological entity. In this case, the human anatomist is actually a geographer of the human body. As geographers of the human body, we use atlases to find our way around. Many of us use exploratory learning such as dissection with other clinical resources like images generated by medical imaging modalities both to teach anatomy and to expand the anatomical knowledge base. After a number of visits, we become familiar with the places we have visited, just like one becomes familiar with a new town once one has driven around it. Value judgments aside, it is inescapable that the extent we experience hands-on and personal or emotional aspects of this educational journey directly affects not only howwe teach the geography of the human body but also how andwhat our students learn. This also affects the knowledge they take with them into clinical practice as physicians. Dr. Guttman is a moderator of this forum and a member of the journal’s Panel of Reviewers. Drs. Drake and Trelease, both moderators of this forum, are members of this journal’s Editorial Advisory Board. We encourage reader feedback. Please direct all responses and comments to the editors at newanat@ wiley.com and be sure to add “debate forum” to the subject line.