How Expeditions Drive Clinical Research 
Matthew Lewin 
(Hearst Expedition Physician) 
California Academy of Sciences, 55 Music Concourse Drive, San Francisco, California 94118 USA. 
Email: MLewin@calacademy.org 
Ever since I can remember I’ve wanted to see the world and have a portable skill. I was amaz¬ 
ingly fortunate because my second grade classmate, Karl Gajdusek, brought his Uncle Carlton to 
school for “show-and-tell” one day shortly after his remarkable discovery of prions was awarded 
the 1976 Nobel Prize for Medicine. He told us about his expeditions to Papua New Guinea, kuru 
and then proceeded to dissect a brain and a heart for the class. I knew exactly what I wanted to do 
when I grew up. 
Combined physician-scientist training programs are long, so it wasn’t until 2003 that I finally 
joined the American Museum of Natural History on expeditions to Mongolia and then, having cut 
my teeth on those expeditions, joined the California Academy of Sciences in 2009. The Mongo- 
lian-American expeditions taught me a lot about the practicalities of expedition life and I published 
several original clinical research papers related to those experiences. Invariably interesting or 
quirky, they were all one-off projects. Nevertheless, each was the product of a practical problem 
encountered in the field [1-9]. 
It is the practical problems of life in the field that drive my research. Contrary to my expecta¬ 
tion that my research would be the product of real-time reactions to crises and experiences, it has 
invariably been the product of preparation. I spend months preparing for expeditions, thinking 
about and researching the areas anticipated to be covered by the expedition. The research in prepa¬ 
ration includes physical, political and medical geography, including disaster management, commu¬ 
nications and evacuation options. This preparation also includes becoming familiar with the crews 
and their medical concerns, past present and future. Much of this effort is geared toward guessing 
the optimal medical kit for any given trip. Considerations for the assembly of the kit includes the 
number of people going, the duration of the trip, likely diseases to be encountered and evacuation 
options. Additionally, I have to anticipate what I will leave with the crews if I am leaving the field 
before they do — I can carry only so much stuff and that which I leave needs to be appropriate and 
safe in the hands of non-medically trained personnel. 
The 2011 Hearst Philippines Biodiversity Expedition was unique in my experience for sever¬ 
al reasons. The sheer size of the expedition was most notable, along with its decentralized stmc- 
ture — crews spread throughout the country in both marine and terrestrial divisions. Fortunately 
for me, Dr. Terry Gosliner sunplified my task by admonishing me to focus on the hazards to be 
faced by the terrestrial group working in the mountains and rainforests of Luzon. 
My general approach to emergency medicine, my chnical specialty, is to simplify the problems 
and this is how 1 approach each expedition’s medical kit. For each situation and each patient 
I encounter in daily practice, I ask myself three questions: 
1. Wliat is hie worst imaginable tiling this could be? 
2. What is the most likely thing? 
3. If I delay or miss the diagnosis, will the patient be harmed? 
For most situations, especially trauma, questions 1 and 2 are quickly resolved. The victim sim¬ 
ply reports what happened. It is the answer to the third question that causes the most angst. Any 
computer, or even most third-year medical students, can tell you what is most likely and what is 
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