Hopes of easing pain by numbers

The Journal of Theoretical Medicine

May 7, 2004

Judged by W. F. Bynum and Roy Porter's Companion Encyclopaedia of the History of Medicine , which devotes the bulk of the first of its two volumes to theories of life, health and disease, the whole medical edifice has been raised on ephemeral theories. Given this varied and often colourful background, it was tantalising to anticipate what a journal of "theoretical medicine" might have on offer.

A glance at the affiliations of the editors and associate editors quickly put paid to further speculation; four out of six are based in departments of mathematics. And although they state that the objective of the journal is to promote interdisciplinary collaboration between those interested in the theoretical and clinical aspects of medicine, they go on to say that it aims to foster and encourage the application of mathematics to problems arising from the biomedical sciences. A browse through the early volumes, filled with pages of dense formulae and arcane figures, leaves the general reader in no doubt that this is a journal of biomathematics and not of "theoretical medicine" in its wider sense.

Following the completion of the human genome project, mathematics will play an increasingly important role in biology and medicine. Hitherto, epidemiology and other numerate aspects of medical research have managed to get by with relatively straightforward statistical treatments: the analysis of disease at the cellular and molecular level and its application in the clinic will require much more sophisticated approaches.

The editors call for papers across the spectrum of medical research, ranging from cell kinetics and pharmacokinetics, through wound healing, to cardiovascular dynamics and neurobiology. The bulk of the papers in the early editions deal with different mathematical approaches to disease and therapy, including an entire issue on modelling and simulation of different aspects of cancer growth. So far, most of the papers are restricted to modelling and retrospective analyses of how a model fits with previously observed data. For the most part they tackle relevant problems, although physicians who have had experience of caring for the elderly may wonder about the value of a complex model that sets out to show how the failure of one organ may be the prelude to multi-organ dysfunction and demise.

This well-produced journal has undoubtedly appeared at a propitious time.

But considering the importance of its rapidly evolving field, and, incidentally, of educating both present-day doctors and those of the future in a broader appreciation of biomathematics, it is surprising that it does not yet aspire to any review articles aimed at the non-expert. Reflecting the breadth and complexity of present-day biomedical science, the trend in top-line journals is towards a mixture of original articles and short reviews or editorials that clarify the significance of their research papers; several recently published accounts of the practical implications of evolutionary modelling of epidemics of infectious disease are excellent examples of this genre. A development along these lines in The Journal of Theoretical Medicine would undoubtedly be essential for many research workers in the biomedical sciences who, by virtue of their limited education, are ill equipped to cope with even their income-tax returns.

A good start, therefore; if the journal takes a broader approach to presenting its material this journal will undoubtedly play a significant role in the rapidly moving world of the biomedical sciences. But of course the real test of the relevance of its complex field is whether, in the long term, it has a major impact on day-to-day clinical practice. The jury may be out for a long time.

Sir David Weatherall is emeritus regius professor of medicine, Oxford University.

The Journal of Theoretical Medicine

Editor - Brian Sleeman and David Cameron
Publisher - Taylor and Francis, Quarterly
Price - Institutions £175.00 Individuals £72.00
ISSN - 10 3662

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