Editorial

Is the “Golden Age” of Internal Medicine Dead? Revisiting a Conversation with Frederic C. Bartte

Authors: Charles C. Bittle, Jr., MD

Abstract

In addressing the question as to why students are not choosing careers in internal medicine at rates seen in the past, I was reminded of a conversation I had with my mentor1 Frederic C. Bartter, MD (FCB) in May of 1982 one year before his death,2 just days before I chose to become an internist. FCB had recently retired as director of the hypertension-endocrine branch of the National Heart, Lung and Blood Institute at the National Institutes of Health. He was famous for his descriptions of Bartter's syndrome3 and the syndrome of inappropriate antidiuretic hormone hypersecretion (SIADH).4 FCB stated that “The golden age of internal medicine is dead, because fame is no longer a part of clinical medicine. The scientific community has decided not to name new syndromes of illnesses by the names of the persons who first describe or discover them. Further, the syndromes of illness which many mistakenly call diseases have been numbered. The ‘golden age’ of medicine is dead because bureaucrats instead of clinicians will soon control medical practice. It will affect how and what is taught in medical schools, how medicine is practiced, and what is funded in research.”

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References

1. Bittle CC Jr, Molina DJ, Bartter FC. Salt-sensitivity in essential hypertension as determined by the cosinor method. Hypertension 1985;7:989–994.
 
2. Wilson JD, Delea CS. Frederic C. Bartter: September 10, 1914–May 5, 1983. Biogr Mem Natl Acad Sci 1990;59:3–24.
 
3. Bartter FC, Pronove P, Gill JR Jr, et al. Hyperplasia of the juxtaglomerular complex with hyperaldosteronism and hypokalemic alkalosis. A new syndrome. Am J Med 1962;33:811–828.
 
4. Schwartz WB, Bennet W, Curelop S, et al. A syndrome of renal sodium loss and hyponatremia probably resulting from inappropriate secretion of antidiuretic hormone. Am J Med 1957;23:529–542.
 
5. Record J. Major concerns about internal medicine: insights from program directors. South Med J 2010;104:89–94.