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2010 Roman Lecturer
Dr Ken Sikaris - "Biochemistry on the Human Scale"
Clinical Biochemistry is the most commonly applied clinical science. It is also probably the most numerical area of medicine. Can we really expect to reduce medicine to mathematics? There is a historical connection between Pythagoras theory, the Fibonacci sequence and the Gaussian distribution that continues into modern medicine. We use it every day in measurement uncertainty and reference intervals.
While humans seem to have almost infinite variations, there are easily recognised ones (eg gender, height, weight, pregnancy and aging), whereas other similarities are more subtle (eg diet or sunlight). Each of these factors can distort the symmetrical Gaussian distribution. Furthermore when asymmetric pulsatile secretion, diurnal variation or half life decay are superimposed, it seems as though all clinical distributions are skewed.
Even after we try to correct for each of these distorting factors, there will still be differences between individuals represented by the width of the reference interval (inter-individual variation) compared to the variations within an individual (intra-individual variation). Ultimately we would prefer to have each patient’s reference as their own status in health so that we could pick up any significant deviations as warnings of early disease.
With increasing variation from an ideal healthy state, there is the increasing risk of disease, morbidity and mortality. This change can be measured as either (i) an absolute shift outside population norms (abnormal results), (ii) a relative shift from the stable population ‘set point’ (multiples of medians) or (iii) an excessive deviation of an individual from their prior state (critical difference). The elucidation of the human genome has similarly lead to the understanding that there are important variations between individuals that can be recognised and reapplied as personalised medicine.
Clinical Biochemistry is often misjudged as an impersonal profession. It is increasingly physically hidden from public gaze in factory like mega laboratories, while our reports are the subject of daily conversation. Each of our measurements leads to powerful predictions for each individual as profound as any fortune tellers. Nevertheless, the important differences between clinical biochemists are not defined by mathematics, physiology or genetics but on professional education and experience. We remain grateful for men like Wadim Roman for establishing these professional opportunities.
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TOUR DATES
| 20th July | Tues | NSW/ACT Branch |
| 21st July | Wed | QLD Branch |
| 27th July | Tues | SA/NT Branch |
| 10th August | Tues | WA Branch |
| 14/15th August | Sat/Sun | TAS Branch |
| 17th August | Tues | VIC Branch |
| 9th September | Thurs | NZ Branch |
