Introduction

Enough is known at present about the biochemistry of disease to securely link this science to medicine. Biochemistry
and physiology are foundations of medicine. Pharmacology, the practice of which generates medicines, can be defined
as the biochemistry of drug action. As most medical students, who encounter biochemistry, cell biology, molecular biol-
ogy, and genetics in the first year of medical school, thirst for training and experience in medicine, it behooves instruc-
tors of biochemistry in this setting to establish firmly the interconnection between biochemistry and disease. Otherwise,
students tend to separate this science from medicine and often wonder why they are taking a course that would seem
remote from medicine and disease. This book, which introduces the basics of biochemistry, emphasizes the connection
between biochemistry and disease so that the student is aware of the basic information supporting our current knowl-
edge. Accordingly, relevant diseases are introduced in each chapter that relate to the principles explored in the chapter
and extend the understanding of the disease often to the level of molecules.
The biochemical information is up to date. At the end of each chapter, a summary appears. In addition, each chapter
has supporting online materials, including a set of review questions in the form of USLME (United States Medical
Licensing Examination) examinations serving to familiarize the student with this type of testing. These questions cover
the major points of the chapter and emphasize the central principles. Furthermore, the online support supplements each
chapter with a case presentation that would incorporate the principles of the chapter in a clinical context. This is becom-
ing a favored mechanism for the deductive diagnosis of a set of symptoms by a small group under the direction of a
mentor. The experiential nature of this exercise serves to incorporate basic information into the thinking of the student
so that he/she may retain useful information for a long period compared to rote memorization, recapitulation during
testing and forgetting the information after the test is over. This technique facilitates the capability of a student to solve
problems and introduces the technology for gathering relevant information, a prescription for the lifelong learner.
In all, this book contains 19 chapters that cover the essential information in a basic course in medical biochemistry.
Importantly, the stress is on the integration of biochemistry, disease and medicine. The chapters are ordered so that a
discussion of proteins and enzymes comes first. In my view, all succeeding information depends upon knowledge of
enzymes that allow chemical reactions to occur under bodily conditions. I realize that all instructors may not agree with
this order and might prefer to introduce the subject of nucleic acids at the outset. In that case, one can begin with
Chapter 8, Glycolysis and Gluconeogenesis, leaving Chapters 4 and 5 for later introduction.
There are many figures in this book. They are used to provide pathways and overall views of mechanisms of action.
There are some figures showing three-dimensional structures. These are used only when they shed light upon a mecha-
nism or interaction of a macromolecule with a ligand, to show protein protein interactions or to graphically demon-
strate an enzymatic action. The use of such figures is limited to increasing the understanding of a particular mechanism.
Clinical case-based exercises are developed by individuals familiar with this technique. Likewise, the USMLE type
questions are developed by separate experts. General references are included for further reading at the end of each
chapter.
The first three chapters are introductory. In Chapter 1, Organ Systems and Tissues are discussed the organ systems
and tissues, including aspects of tissue development. Chapter 2, The Cell focuses down to the cell and its composition
with particular reference to organelles and subcellular particles. In Chapter 3, Water, pH, Buffers and Introduction to
the General Features of Receptors, Channels, and Pumps, there is a discussion of water, pH, buffer systems, and general
features of receptors and channels. These are basic concepts that a student should learn at the outset. The chapters intro-
duce physiology and cell biology as larger contexts of biochemistry which focuses on molecules but has become misci-
ble with cell—and molecular—biology.

xv
xvi Introduction

At the end of the book is a Glossary, explaining specific names and abbreviations, an in depth index and
Appendices giving the names of amino acids, their abbreviations, and some characteristics, the genetic code, and
weights and measures.
Studying the basic information in this book should provide a format for lectures, if they are used, and as well a
source of information for small group study and reference during the exercise of case- or problem-based learning.
Gerald Litwack