BMJ  2003;327:E59 (4 October), doi:10.1136/bmjusa.01090005 (published 5 September 2002)

BMJ USA: Education and debate

COMMENTARY

This article originally appeared in BMJ USA

The June 23rd issue of the BMJ included five papers and an editorial on apoptosis, one of which appears above. Below we reproduce Richard Smith's "Editor's choice" column from that issue. He comments on apoptosis and also refers to an editorial on racism in medicine in that same issue of the BMJ, which we republish in this issue of BMJ USA (BMJ USA p 437)—EDITOR

Apoptosis and racism: a long time coming and a long time going

Research in apoptosis—programmed cell death—"has become one of the hottest fields of biomedical research" (BMJ USA p 466). This theme issue explores what apoptosis means and will mean for clinicians, but for me it evokes fond memories and reflections on the vagaries of time.

I worked on apoptosis in 1972-1973 while doing a degree in pathology in Edinburgh, UK. Two of the three authors of the 1972 paper that introduced apoptosis—Alastair Currie and Andrew Wyllie—had just come to Edinburgh from Aberdeen, UK. Currie was the head of department, son of an Islay baker, and capo di tutti i capi of the Glasgow mafia that ran pathology. I liked him very much, although he never forgave me for deserting the seriousness of research for the frivolity of editing. Wyllie was a bright young thing who had a hundred ideas a minute. You could never hope to keep up.

Apoptosis had the simplicity and clarity of an important idea. Why should cell death be a random disorganised event? God was cleverer than that. Apoptosis is to cell death what mitosis is to cell division. Look carefully down a microscope and you can see it. Now we know that apoptosis is important in physiological processes like embryogenesis, organ development, and aging; and in the disease processes of AIDS, neurodegeneration, autoimmunity, cancer, and many other conditions.

As I read these papers on apoptosis I wondered whether anybody yet had had his or her life saved by the discovery of apoptosis. Almost 30 years after the discovery, the answer seems to be no. But drugs that affect apoptosis are being developed and coming close to clinical trial. Our editorialists predict that "this promising youngster will show many achievements by its 50th birthday." Maybe it will be just in time to stave off my dementia, so encircling my intellectual life. What the story does illustrate is the long period between discoveries in basic science and the appearance of new treatments.

While apoptosis has taken a long time to come, racism is taking a long time to go. Raj Bhopal, who was also a medical student in Edinburgh in the early days of apoptosis research, writes about his experiences (BMJ USA p 437). "As a child, being called ‘darkie’ or ‘Paki’ was a daily event. . . . At university some friends regularly enjoyed racial banter at my expense. ‘You’re a black bastard Raj.'" These memories make me think of growing up in South London in the 1950s, when "wog" was an everyday word. Medicine is behind some other sectors with exorcising racism, and I fret that apoptosis will have delivered before racism has gone.

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