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There should be, and in the best of cases there is, a synergy
between basic research and patient care. However, this synergy is
hard to develop because the techniques required to be a successful
researcher are so different from the skills required to be an
outstanding physician. Harold R. Roberts, M.D., of the University
of North Carolina at Chapel Hill, is an example of a
physician-researcher who has benefited from having his feet in both
the world of patient care and the world of the laboratory: he has
let clinical problems direct his basic research effort and
conversely has adopted research advances in his care of patients.
Dr. Roberts's long and continuing career has included many research
and clinical advances. He was part of the first group to determine
the amino acid sequence of the important thrombin inhibitor hirudin
and part of the group that prepared the first cryoprecipitates
which were the first alternative to plasma as therapy in hemophilia
A. Dr. Roberts has made significant advances in understanding the
protein chemistry behind hemophilia B; he was among the first
researchers to identify some patients as not being completely
deficient but instead as having measurable levels of protein and
subsequently demonstrated that this protein was dysfunctional. This
important advance led him to a classification scheme for patients
into Cross Reacting Material (CRM) positive, negative, and reduced.
Dr.
"For the blood is the life . . . . "(Deut. 12 :23) " . . . because
the blood, in its value as life, makes atonement" (Lev. 17: 11)
HemoPhilia is a rare disease, severe hemophilia rarer still, yet
the written history of hemophilia extends back over a millennium
and a half. In the ancient Middle East, blood and life were
coupled. Blood was the primary substance necessary for life, given
to God in sacrifice and forbidden as a food to mortals by Levitical
law. Blood was essential for rites of purification and
consecration. But the flow of blood during menstruation or
parturition rendered a woman unclean. The circumcision of a male
child required 33 days of "blood purification" by the mother. '
Circumcision, the visible reminder of the covenant of Abraham
lijith Yahweh, was required of newborn Jewish males. It "connote(d)
suitability for participation in what God is doing. "2 Hence, free
and uncontrolled bleeding of the male child during circumcision,
during the ratification of God's covenant, would be noted with awe
and concern by those of the Jewish faith. It should not be
surprising that the first genetic counseling offered to families
with hemophilia is found in the Babylonian Talmud (compilation of
Jewish law dated to about the third century AD) and concerns the
necessity for circumcision in families with what we would now call
hemophilia.
There should be, and in the best of cases there is, a synergy
between basic research and patient care. However, this synergy is
hard to develop because the techniques required to be a successful
researcher are so different from the skills required to be an
outstanding physician. Harold R. Roberts, M.D., of the University
of North Carolina at Chapel Hill, is an example of a
physician-researcher who has benefited from having his feet in both
the world of patient care and the world of the laboratory: he has
let clinical problems direct his basic research effort and
conversely has adopted research advances in his care of patients.
Dr. Roberts's long and continuing career has included many research
and clinical advances. He was part of the first group to determine
the amino acid sequence of the important thrombin inhibitor hirudin
and part of the group that prepared the first cryoprecipitates
which were the first alternative to plasma as therapy in hemophilia
A. Dr. Roberts has made significant advances in understanding the
protein chemistry behind hemophilia B; he was among the first
researchers to identify some patients as not being completely
deficient but instead as having measurable levels of protein and
subsequently demonstrated that this protein was dysfunctional. This
important advance led him to a classification scheme for patients
into Cross Reacting Material (CRM) positive, negative, and reduced.
Dr.
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