© Photo (not Noa) by Bertie
Our daughter Noa started medical school last month, and she’s elbow-deep in anatomy— quite literally.
I remember the hours spent in those anatomy labs, the indelible smell of formaldehyde in your nose, learning the grammar of arteries and nerves, the syntax of muscles and fascia; but more than anything learning that medicine begins with meticulous attention to the reality of the body and a mountain of facts to memorize.
Anatomy is humbling for that reason. You can’t shortcut an origin–insertion pair or the branches of the brachial plexus; you learn it by looking, naming, repeating, and then looking again. Watching her enter this world reminds me that the craft of medicine still starts with the basics: curiosity, a steady hand, and the patience to learn what’s actually there.
I try to read a journal article every day - a discipline I started in residency - and recently I came across one about using circulating tumor DNA (ctDNA)—tiny fragments of tumor-specific genetic material in the blood—to guide adjuvant chemotherapy decisions in colon cancer.
The results are striking. The ctDNA-guided approach reduced the proportion of patients receiving chemotherapy without compromising outcomes: two-year and five-year recurrence-free survival was non-inferior to the standard arm, meaning fewer people were exposed to toxic therapy with no loss of protection against relapse.
A blood test keyed to an individual tumor’s genetic “signature” becomes the map for treatment intensity, not just population averages or broad staging rules.
When I think about Noa’s future, I see a move away from the current model of evidence-based medicine—powerful, but rooted in actuarial averages—toward evidence that lives inside the individual patient.
Today’s paradigm asks, “What worked for a cohort that looks roughly like this person?” The next will ask, “What will work for this person, given her tumor’s subclonal architecture, pharmacogenomic profile, immune repertoire, microbiome, and real-time physiology?”
Anatomy introduces medical students to the idea that for all every human body has in common structurally, every human being is also unique; genomics teaches this at the molecular level.
One promise of the future in medicine is to harmonize those truths: to treat the patient as an individual not only at the bedside, but throughout the whole process of evaluation and treatment - to fully personalize medicine, both inside and out.
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