The machinery of medicine: how technology influences medical research and clinical care

Since Neolithic humans fashioned the first scalpel out of stone, new machines and methods have changed the way we practice medicine and learn about the human body. Physicians moved on from those early scalpels to stethoscopes, X-rays, and MRIs, the better to understand the workings of the human body. With these new understandings has come translational research that transfers findings from the lab into new, more effective treatments and medicines. Dean Robert J. Alpern, M.D., Ensign Professor of Medicine, discussed basic science and advances in clinical care; technology and patient care; and the role of serendipity in research with Yale Medicine.

What have been some of the key inventions or discoveries that have advanced clinical care and medical research?
In the past 50 to 100 years, there have been so many advances that it’s hard to rank any one above the other. Obviously, some come to mind—the discovery of the structure of DNA, recombinant DNA, electron microscopy, knockout technology. The new gene editing technology, CRISPR, is really going to transform research. It’s important to point out that the major advances in health care have been based on basic scientific findings. DNA technology and the structure of DNA were basic science findings that now drive clinical genetics. The understanding of how cells grow has transformed cancer care. Basic understandings of the immune system have led to immunotherapy for cancer.

How do physicians integrate new technologies into medicine while maintaining the doctor-patient relationship?
Technology is always good for improving what physicians can do, but you run the risk that doctors won’t hone their clinical skills as well as they could because they know that the technology will end up defining the diagnosis. There needs to be a combination of the two. I don’t see technology replacing the need for outstanding clinicians. Technology should enhance clinical skills, not replace them.

How important is serendipity in scientific discovery?
There are stories of serendipity, but the best investigators always appear to have good luck. The best investigators are asking the right questions, the important questions. It’s a matter of staying knowledgeable about all of the technologies, including those from other fields, and thinking about how to apply them to your field. When you ask the right question and use the right technology, serendipity falls upon you.