10 Questions

​I guess the first list of 10 were the 10 Commandments.
​
I remember David Hiebert’s list of 23 unsolved mathematical problems (1900), which kept 20th Century mathematicians busy for many years. Two are still unsolved (one of which is the Riemann Hypothesis, that the zeta function* has zeros only at negative even integers and complex numbers with real part ½). Prestigious medals are awarded to those who lead in mathematics, science and social advancement (eg. Fields, Copley, Nobel). It got me to thinking, what 10 questions would I like answered about medicine? After a long career dealing with medical quandaries, I thought I’d list 10:

i) Why is the hallux PIP the commonest joint to be affected by gout?
Is it because it is a ‘cool’ joint, distant from the heart, that allows uric acid
crystals to form?

ii) What is it that generates ‘clubbing’ in patients with chronic sepsis of cancer of
the lung?

iii) What do we understand about the initiating cause of multiple sclerosis?

iv) Why can half a liver regenerate, half a kidney does not?

v) If the appendix is ‘redundant’, what was its function originally?
Is it a storage site for bacteria – when we need to reboot our gut?

vi) Do we really lay down a protein for every memory – if so, why do some last,
some don’t?

vii) Why do some people with gluten sensitivity get sore joints?

viii) What is happening when a schizophrenic patient has an auditory or visual
hallucination?

ix) Cachexia of malignancy is caused by what, exactly?
​
x) What is going on in polymyalgia rheumatica, and what causes it?
Is it really an inflammatory response to a viral trigger?

Some readers will know the answers to some of these – do share. And if you have a list of 10 questions for the practicing clinician, add them.
In the realm of Global Public Health, you could tackle the Gates Foundation list, which lists the following grand challenges (GC) -
To improve childhood vaccines:
GC 1: Create effective single-dose vaccines that can be used soon after birth;
GC 2: Prepare vaccines that do not require refrigeration;
GC 3: Develop needle-free delivery systems for vaccines.
To create new vaccines:
GC 4: Devise reliable tests in model systems to evaluate live attenuated vaccines;
GC 5: Solve how to design antigens for effective, protective immunity;
GC 6: Learn which immunological responses provide protective immunity.
To control insects that transmit agents of disease:

GC 7: Develop a genetic strategy to deplete or incapacitate a disease-transmitting
insect population;
GC 8: Develop a chemical strategy to deplete or incapacitate a disease-transmitting
insect population.
To improve nutrition to promote health:
GC 9: Create a full range of optimal bioavailable nutrients in a single staple plant
species.
To improve drug treatment of infectious diseases:
GC 10: Discover drugs and delivery systems that minimize the likelihood of drug-
resistant microorganisms.
To cure latent and chronic infections:
GC 11: Create therapies that can cure latent infections.
GC 12: Create immunological methods that can cure chronic infections.
To measure disease and health status accurately and economically in poor countries:
GC 13: Develop technologies that permit quantitative assessment of population
health status.
GC 14: Develop technologies that allow assessment of individuals for multiple conditions or pathogens at point-of-care.

Interesting Reading:
a) 10 Greatest Discoveries in Medicine,
M Friedman and G Friedland (1998) ISBN 9780300075984
b) 10 Days in Physics that Shook the World
Brian Clegg (2021) ISBN 1785787489

*zeta function