Metabolomics: Have doctors lost their bedside manner?

Written by Tony Harris, August 11, 2016

Have doctors lost their bedside manner?

The appropriate bedside manner is actually addressed in the Hippocratic Oath. The original version went on to state that ‘Gravity signifies breadth of experience’. Of course without all the drugs and remedies available today, there was little else that doctors could offer, other than a bedside manner. Do not misunderstand me, I am not in any way attempting to belittle the Hippocratic Oath with respect to its importance then or today. I’m just saying they didn’t really have any good drugs back then!

Have you ever wondered how all the drugs that doctors have at their disposal today were discovered? In 1928 Alexander Fleming discovered penicillin; by his own admission, it was in part serendipitous. Certainly we can’t sit around and wait for mold to grow in the hope that another new medicinal cure materializes. Likewise we can’t just shove chemicals in sick people to see if there is anything that makes them better.

You’ll be glad to hear that we do have a scientific approach. It is called metabolomics. Metabolomics is the study of cell metabolism or more accurately the study of metabolites which are the products of metabolism. So what the heck does all that mean anyway? Let’s start with metabolism; it is just a fancy word used to describe the chemical reactions involved in maintaining the living state of the cells and the organism. So; you and me for example! As the chemical reactions take place, keeping you and me alive, there are products and by-products of these reactions. These are called metabolites.

The color, smell and even, unfortunately, taste of urine has been used to detect certain medical conditions since the Middle Ages and before. Urine is a rich source of metabolites, but it was not until the 1970’s that the analysis tools really started to come into their own. It was then they could become looked upon as a chemical fingerprint. So if we see the presence of a particular metabolite in a sample, we can use that as evidence to diagnose a condition in the patient.

The study of metabolomics and analysis of metabolites are increasingly being used to diagnose disease, understand the underlying mechanisms of disease and to identify novel drug targets. This leads to customized drug treatments.

In 2005 the first database of metabolites was founded at the Scripps Institute in San Diego with 10,000 metabolites and the associated mass spectral data. My nephew, Dr. H. Paul Benton, of the institute tells me that today, there are over 240,000 mass spectrometry signatures of metabolites in their database.

This certainly opens up avenues to enable us to further our understanding of disease and to formulate drugs to target said disease.

So have doctors lost their bedside manner and is it relevant anyway today? I am not sure. One does feel, however, that even with a collection of snake oils at the ready, a little empathy would not have gone amiss on Hugh Laurie’s character, Dr. House.

Tony Harris

August 2016