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Vol. LX, No. 5
March 07, 2008
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History Office Welcomes New Director

On the front page...

In Dr. Robert Martensen’s life there are rivers within rivers, a confluence of the humanities—art, philosophy, history— with the practice of medicine. Now far from triage and trauma resuscitation, he’s reflecting on the experience of illness and his years in the ER, which is where, he says, “the rubber meets the road.”

By the time Martensen came to Bethesda to head the Office of NIH History in October 2007, he had not only earned degrees from Harvard (B.A.), Dartmouth (M.D.), and the University of California, San Francisco (Ph.D.), but also he had practiced emergency medicine for 25 years; held several university appointments, including chair of medical humanities and philosophy of medicine; and received a Guggenheim fellowship to support a book, The Brain Takes Shape: An Early History (Oxford; 2004).

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His latest work, now in press, is A Life Worth Living: A Doctor’s Reflections on Illness in a High-Tech Era. Aimed at general readers, the book “explores what it’s like to be very ill in the United States today,” he says. “It draws on my experience as an emergency physician and also my experience as a historian of medicine and somebody who’s taught bioethics...to try to illuminate some of the strengths and limitations of current approaches to serious disease.”

Martensen’s first immersion in those approaches was during medical residencies in San Francisco: “ERs are inclusive. You’re open to everybody, 24 hours a day...If there’s a multiple trauma from people stabbing and shooting each other, you take care of the person who did the shooting and you take care of the person who got shot.”

This inclusiveness, he says, impressed him: “[The ER] gives one an experience, vertically, of a community in a way most people don’t have any more. I’ve had patients who were fished out of dumpsters, alive, but in serious trouble. And then you have somebody brought in and their driver has double-parked the limo.”

While NIH has its share of M.D./Ph.D.s, Martensen’s doctorate in the history of health sciences places him in the small cohort of physicians who are also medical historians. This is important, since history is more than a timeline: it’s a way of thinking about how patterns connect and form us, and how we contribute to them, too.

In an ER, changes are tracked minute to minute, yet in that narrow timescale, the context—life/death, rich/poor, shooter/shootee—doesn’t get much larger. Questions that occurred to Martensen during emergency room shifts are ones he carried into his study of history.

“We saw lots of people from East Asia, South Asia, as well as people from all over the world...That got me interested in people’s ideas about how their minds and bodies operated. That’s a subject I explored in graduate school.”

Other interests include the origins of neuroscience, the development of nuclear medicine and the scientific transformation of medicine during the Progressive Era (a period of reform from the 1890s through the 1920s).

Why should scientists and physicians worry about history? Take a look at the history of research policy, he says, or at how “findings in one area of science move around; they don’t observe institute walls, they don’t stay in silos...I don’t know how better to do that kind of illumination than through historical analysis.”

Because Martensen is a vivid storyteller, when he describes how the biomedical-industrial complex affects research, or how mathematical algorithms are transforming biology, history comes alive. As for education, he recalls how the great William Osler taught his medical students that “the patient is the text.” Now, medical education has changed so much that “we spend relatively little time with the patient...relying instead on lab profiles, imaging studies and decision trees.”

After World War II, “many, many accomplished physician-investigators were developed out of NIH programs, [people who] led the NIH and medical schools...So there’s a great concern: how do we, American society, replicate physician- investigators?” Martensen hopes to develop a conference on the topic. Other possibilities include a conference on science and the public imagination; a Darwin centenary; and a symposium on genes, behavior and history.

The history office might not be as busy as an ER, but it promises to be lively under its new director. NIHRecord Icon

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