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Harrisons Hematology and Oncology 2nd Edition PDF

Harrisons Hematology and Oncology 2nd Edition PDF

Harrisons Hematology and Oncology 2nd Edition PDF



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Preface

Harrison’s Principles of Internal Medicine has a long and distinguished tradition in the field of hematology. Maxwell Wintrobe, whose work actually established hematology as a distinct subspecialty of medicine, was a founding editor of the book and participated in the first seven editions, taking over for Tinsley Harrison as editor-inchief on the sixth and seventh editions. Wintrobe, born in 1901, began his study of blood in earnest in 1927 as an assistant in medicine at Tulane University in New Orleans. He continued his studies at Johns Hopkins from 1930 to 1943 and moved to the University of Utah in 1943, where he remained until his death in 1986. He invented a variety of the measures that are routinely used to characterize red blood cell abnormalities, including the hematocrit, the red cell indices, and erythrocyte sedimentation rate, and defined the normal and abnormal values for these parameters, among many other important contributions in a 50-year career.
Oncology began as a subspecialty much later. It came to life as a specific subdivision within hematology. A subset of hematologists with a special interest in hematologic malignancies began working with chemotherapeutic agents to treat leukemia and lymphoma in the mid-1950s and early 1960s. As new agents were developed and the principles of clinical trial research were developed, the body of knowledge of oncology began to become larger and mainly independent from hematology. Informed by the laboratory study of cancer biology and an expansion in focus beyond hematologic neoplasms to tumors of all organ systems, oncology developed as a separable discipline from hematology. This separation was also fueled by the expansion of the body of knowledge about clotting and its disorders, which became a larger part of hematology.
In most academic medical centers, hematology and oncology remain connected. However, conceptual distinctions between hematology and oncology have been made. Differences are reinforced by separate fellowship training programs (although many joint training programs remain), separate board certification examinations, separate professional organizations, and separate textbooks describing separate bodies of knowledge. In some academic medical centers, oncology is not merely a separate subspecialty division in a Department of Medicine but is an entirely distinct department in the medical school with the same standing as the Department of Medicine. Economic forces are also at work to separate hematology and oncology.
Perhaps I am only reflecting the biases of an old dog, but I am unenthusiastic about the increasing fractionation of medicine subspecialties. There are now invasive and noninvasive cardiologists, gastroenterologists who do and others who do not use endoscopes, and organ-focused subspecialists (diabetologists, thyroidologists) instead of organ system– focused subspecialists (endocrinologists). At a time when the body of knowledge that must be mastered is increasing dramatically, the duration of training has not been increased to accommodate the additional learning that is necessary to become highly skilled. Extraordinary attention has been focused on the hours that trainees work. Apparently, the administrators are more concerned about undocumented adverse effects of every third night call on trainees than they are about the well-documented adverse effects on patients of frequent handoffs of patient responsibility to multiple caregivers.


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