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(Circulation. 1995;91:1901.)
© 1995 American Heart Association, Inc.

Articles

Integrative Physiology

Remember the Big Picture

Claude Lenfant, MD

	Introduction

Top Introduction

 
When resources for biomedical research are scarce, the natural competition that exists between different investigative interests often intensifies. Given the current fiscal climate, it is not surprising that one overhears much discussion in the scientific community about the respective contributions that newer versus more traditional disciplines are likely to make toward our understanding of human health and disease. Although the promise of subcellular and molecular techniques is widely appreciated, there is much debate about their relative importance in the "big picture." These new technologies have been hailed by many as the final keys to unlock nature's mysteries—the ultimate path to future advances—and because they are in their infancy, they are being nurtured vigorously. At the same time, more traditional scientists tend to be wary of reductionist approaches and to view enthusiasm for these new technologies as symptomatic of a "tunnel vision" that will ultimately set back science.

It is time to bring it all together.

The great potential of the new technologies is so fascinating, so innovative, and, yes, so glamorous (as has been said) that it is impossible to overlook. With their simple yet powerful techniques, these new approaches can provide the instructions that specify the very structure of biological molecules and help us understand where natural processes go awry and how we can correct them. The implications for a variety of interventions—from gene therapy to rational drug design to tailored risk assessment—cannot be overemphasized.

Nonetheless, the determinism of genetics, for example, has its limits. Although information encapsulated in the nucleus of the recently fertilized egg is enough to generate and sustain the course of events that leads to the development of a complex adult organism, much happens along the way that cannot be ascribed to the independent properties of the primary products of the genes. To paraphrase an eloquent colleague, it is as in music: the heavenly harmony of the choir can never be appreciated by listening in turn to each chorister, however accomplished, singing independently.

It should be clear that the full realization of the implications of this new knowledge will not occur without the concurrent and inspired efforts of scientists who apply this information to the larger organism and use it in the context of the vast knowledge already assembled about living creatures. The goals and importance of such efforts are reflected in the new term "integrative physiology" that is now being used to describe this function. The discovery of a new gene, adhesion molecule, gap junction, or intracellular process is not an end but rather a new beginning in the time-honored process of sorting out the nature of living things.

Thus, far from being left behind in the modern scramble for meritorious research ideas, the physiologist is at the threshold of an unprecedented scientific era. To him or her will fall the task of making sense of the bits and pieces of new knowledge that are so rapidly accumulating. The whole is more than the sum of its parts, but an intimate appreciation of the parts is needed to assemble a coherent whole. This is the challenge—and the privilege—of today's integrative physiologist.

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