Usual Interstitial Pathologist

In my previous post, I suggested a central dogma for students of pathology. After injury, a physiologic response maintains homeostasis without loss of function while a pathologic response leads to reduced function, even if a new homeostatic set point is reached.  With that in mind, let us turn to the first figure in the textbook that most of us consider the “standard of care” for pre-clinical instruction, Robbin’s textbook of pathology. The first figure is an opportunity for pathology to state the central dogma of the field.  Unfortunately, this figure is terrible.  The figure lists various names such as cell injury and death, homeostasis and adaption, reversible and irreversible injury. The relationship of these to each other seems arbitrary, ignoring definitions or time course. At most, one learns that some how a cell at rest maintains homeostasis, but that the cell can be injured, that sometimes this injury is mild and can be repaired, sometimes there is something call...

 Pathology has been a central pillar of allopathic medicine since the dawn of scientific medicine. However, with respect to medical education, pathology no longer is a stand alone course.  Pathologists must therefore make the underlying message of pathology as clear as possible or get lost in the firehose of information that medical students are subject to from their first day of classes. The central dogma of molecular biology as enunciated by Crick in 1958 is that information required to run an organism flows from DNA to RNA to protein. It represents the entire field as a flow of information, rather than as a series of molecular interactions. For the student, this is a very attractive proposition, rather than considering molecular biology as a series of endless organic chemistry reactions.  Pathology needs something similar or will forever be viewed at random (uninterpretable) histologic images. I was taught that “all disease occurs as a response to injury”. Unfortunatel...