COMMENTARY

It’s Time to Replace Organic Chemistry with Nutrition

as a Pre-med Requirement
Success in an undergraduate course in organic chemistry is risk factor, among the top 17 studied, for premature death
one of the master keys needed to unlock the door to medical and disability in the US.11 A rigorous course in nutrition
school. would bring together contemporary molecular biology,
Organic chemistry became a requirement for admission physiology, epidemiology, behavioral sciences, and other
to allopathic medical schools in 1930.1 In 2015 it continues important disciplines with which a physician should be
to be required by 84% of allopathic medical schools and is familiar.
recommended by an additional 11%.2 It is required for In contrast to organic chemistry, it is clear that knowl-
admission to all 34 osteopathic medical schools3 and for edge of nutrition should play a crucial role in the practice
admission to the majority of accredited physician assistant of medicine. Diet plays a critical role in the etiology and
training programs.4 prevention of cardiovascular disease,12 as well as some
But is performance in organic chemistry the best way to types of cancer12,13 and many other conditions.
determine which of the many applicants for medical school And with our current understanding of the connection
would be the best physicians? between nutrition and health, replacement of organic chem-
Many have questioned the relevance of organic chemis- istry as a pre-med requirement with a course in nutrition
try to the practice of medicine.1,5-7 would be more useful for future physicians . and society?
It is widely acknowledged that organic chemistry is used If nutrition education replaced organic chemistry as a
to “weed out” applicants to medical school.8-10 Is there pre-med requirement, there would be an added bonus for
evidence that failure to excel in an undergraduate course in pre-med students who ultimately chose a different career
organic chemistry identifies applicants who are not fit to path. Wouldn’t an undergraduate course in nutrition be more
practice medicine? likely to contribute to their future health than the knowledge
In a study of students who chose to forgo a medical gained in organic chemistry?
career due to concerns about scholastic performance, 78%
James E. Dalen, MD, MPHa
identified organic chemistry as the specific course that
Stephen Devries, MDb
caused them to change their career plans.10 Surely there
Joseph S. Alpert, MDa
were some potentially excellent physicians among this
Walter Willett, MDc
group who were culled needlessly. a
Department of Medicine
Although organic chemistry traditionally has been cited University of Arizona College of Medicine
as a foundational course necessary to tackle biochemistry, Tucson
this rationale has been called into question, with some b
Division of Cardiology
advocating for less emphasis on organic chemistry in favor Gaples Institute for Integrative Cardiology
of education that emphasizes the integration of information Northwestern College of Medicine
across disciplines, with a “tighter focus on science that Chicago, Ill
c
‘matters’ to medicine.”7 Department of Nutrition
Few topics in medicine are as ripe models for interdis- Harvard Chan School of Public Health
ciplinary study, nor as integral to human health, as nutri- Boston, Mass
tion. A recent analysis shows that poor diet is the leading
References
Funding: None. 1. Dalen JE, Alpert JS. Premed requirements: the time for change is long
Conflict of Interest: None. overdue! Am J Med. 2009;122:104-106.
Authorship: All authors had access to the data and played a role in 2. Association of American Medical Colleges (AAMC). AAMC Official
writing the manuscript. Guide to Medical School Admissions, 2015. Available at: https://
Requests for reprints should be addressed to James E. Dalen, MD, www.aamc.org/students/applying/requirements/msar/faq/180172/when_
MPH, Department of Medicine, University of Arizona College of Medicine, purchase_msar.html. Accessed May 28, 2015.
5305 Via Velazquez, Tucson, AZ 85750. 3. American Association of Colleges of Osteopathic Medicine. Osteo-
E-mail address: jdalenmd@gmail.com pathic Medical College Information Book, 2015. Available at:

0002-9343/$ -see front matter Ó 2015 Elsevier Inc. All rights reserved.
http://dx.doi.org/10.1016/j.amjmed.2015.06.002
Dalen et al Commentary 1049

http://www.aacom.org/docs/default-source/cib/2015cib_dmu-com-pdf? under-represented minority undergraduate students. Acad Med.

sfysn¼2. Accessed May 28, 2015. 2008;83:503-511.
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Arch Intern Med. 1987;147:633-634. 11. Murray CJ, Atkinson C, Bhalla K, et al; US Burden of Disease Col-
6. Emanuel EJ. Changing premed requirements and the medical curricu- laborators. The state of US health, 1990-2010: burden of diseases,
lum. JAMA. 2006;296:1128-1131. injuries and risk factors. JAMA. 2013;310(6):591-608.
7. Dienstag JL. Relevance and rigor in premedical education. N Engl J 12. Dalen J, Devries S. Diets to prevent coronary heart disease 1957-2013:
Med. 2008;359:221-224. what have we learned? Am J Med. 2014;127:364-369.
8. Barr DA, Gonzalez ME, Wanat SF. The leaky pipeline: factors 13. Devries S, Dalen JE, Eisenberg DM, et al. A deficiency of nutrition
associated with early decline in interest in premedical studies among education in medical training. Am J Med. 2014;127:804-806.