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Formal MD Thesis Requirement

All students at Yale School of Medicine engage in research and are required to write an MD thesis during medical school. The only exceptions are students who have earned a PhD degree in the health sciences before matriculation and students enrolled in Yale’s MD/PhD program. The YSM MD Thesis is under the governance of the EPCC, which meets regularly to recommend rules, regulations, and deadlines.

Deadlines/Important Dates

Thesis approval process, thesis awards, required formatting and components of the md thesis, examples for reference section formatting, avoiding the risk of copyright violation and liability when submitting your md thesis, instructions for submitting a thesis to the yale medicine thesis digital library, thesis depositors declaration form, evaluations of advisor, student evaluation of thesis advisor.

• Yale School of Medicine Digital Thesis Depositor’s Declaration Form
• Thesis Deadline Extension Request Form

Thesis Deadlines for the 2023-2024 Academic Year

Md students:.

The Office of Student Research, in conjunction with the Dean’s Office, has established the following deadlines for theses submitted in partial fulfillment of the requirements for graduation in May 2024. The deadlines ensure that (1) students have sufficient time to complete their theses; (2) that there is sufficient time for rigorous departmental review and subsequent revision by students before final approval. These deadlines are strictly followed. Students are strongly encouraged to submit their theses well before the Class of 2024 Thesis Deadlines provided below. This timeliness will provide students, advisors, and sponsoring departments sufficient time for useful review and revision. It should be recognized by all concerned that the integrity of the thesis requirement and effective, rigorous review requires adherence to these deadlines. OSR will hold periodic “Thesis Check-in Sessions” via zoom for the Class of 2024 and will send periodic reminder emails with more detailed instructions as these deadlines approach.

*Students missing the August 4th, January 19th, and/or March 29th deadlines will be referred to the Progress Committee to ensure they receive adequate support to make progress towards this graduation requirement. Students missing the January 19th and/or March 29th deadlines will be ineligible for thesis prizes at graduation.

Extensions beyond the above thesis deadlines will be granted only for special circumstances and must have the approval of the student’s thesis mentor/advisor, academic advisor, and the Departmental Thesis Chairperson . Students seeking an extension for the January 19, 2024, deadline must submit a Thesis Deadline Extension Request Form to their Academic Advisor, and the Departmental Thesis Chair, for approval. Students missing the August 4th, January 19th, and/or March 29th deadlines will be referred to the Progress Committee to ensure they receive adequate support to make progress towards this graduation requirement. In the event of an extension, if granted, the following ABSOLUTE Class of 2024 Thesis Extension Deadlines will apply:

*All late theses require an extension. The student must submit the Thesis Deadline Extension Request Form before January 19, 2024.

MD/MHS Students:

Consistent with degree requirements, MD/MHS students must present their thesis to their three-person committee prior to the January 19th deadline. Students are encouraged to start arranging the date of this committee meeting in the fall to avoid unanticipated delays.

MD/PhD Students:

A different process applies to students in the MD/PhD program. For students enrolled in the combined MD/PhD Program, the dissertation submitted to and approved by the Graduate School will satisfy the MD thesis requirement. Therefore, MD/PhD students who have already defended their dissertation and received their PhD should provide this information to OSR via email as soon as possible.

To ensure compliance with YSM graduation deadlines, MD/PhD students in the class of 2024 who have not defended and submitted their dissertation to the Graduate School by the October 1, 2023, deadline will need to submit a copy of their dissertation directly to OSR via the MD/PhD Box Upload Link by March 15, 2024. OSR will convene a committee to review the dissertation, obtain feedback, and provide approval for graduation. Please note that MD/PhD students must also defend and submit their dissertation to the Graduate School no later than March 15, 2024, to meet the Graduate School spring degree deadline for conferral of the PhD degree. MD/PhD students who have not yet defended their dissertation should provide this information to OSR. If there are any questions about the process, please contact the MD/PhD Office.

Financial support is not provided for writing the thesis.

Thesis Preparation and Approval

Preparation for thesis submission begins in the summer of the fourth year with the OSR leadership. At this time, timeline and practices are distributed via email and reviewed with students in class meetings. Because thesis approval is a lengthy process involving three levels of review, students are encouraged to manage their time well and start writing their first draft early in the fall semester of their final year of medical school. A suggested timeline is provided below.

July : Thesis deadlines are distributed via email to all students in the graduating class and an informational session is held. Students should be on track to complete their thesis research by mid-fall. Any student anticipating a challenge in this regard should contact the OSR as soon as possible. All students expecting to graduate in May of a given year must, provide the OSR with information regarding their thesis title and mentor/advisor. Students will receive an email from the OSR containing a Medtrics link requesting this information. The OSR will contact all thesis mentors/advisors to confirm this role and to provide information and expectations regarding the thesis process.

August – December : Students should be finalizing research and writing their thesis draft. As the semester progresses, activities should shift from the data generation/analysis to the writing of the actual thesis. Students should do their best to complete the first draft of the thesis by mid-late December. Because students are also involved in the residency application and interview process, they are discouraged from starting new projects at this time.

December – January : This period is devoted to reviewing and editing of thesis draft that is ultimately approved by their thesis mentor/advisor and submitted by the student to the Thesis Chair of their sponsoring department. The YSM thesis mentor/advisor will be asked to complete a thesis assessment that evaluates the student’s mastery of YSM’s research-related educational objectives and provides formative summative feedback to the student.

January – March : The Departmental Thesis Chair coordinates thesis review by external reviewers. An “external reviewer” is defined as an individual who is not directly involved in the project. This individual may be a Yale faculty member internal or external to YSM or may hold a faculty appointment at an outside institution. This reviewer is required to complete a thesis assessment and provide formative summative feedback, as well as recommendations for any required changes, to the thesis. Departmental Thesis Chairs review assessments, notify students of departmental approval, and transmit these approvals to the OSR.

March : Theses and their associated assessments undergo school-level review by the OSR. Students receive YSM approval of their thesis along with summative feedback obtained during the review process. Students incorporate any required changes into their thesis and upload to the Yale Medicine Digital Thesis Library/Eli Scholar via the ProQuest platform (see below).

April : The OSR confirms that theses have been deposited into the Yale Medicine Digital Thesis Library and the registrar receives the names of students who have completed the thesis requirement.

The central role of the medical student thesis is to assess student’s performance on the YSM’s research-related educational objectives. As such, all students are expected to produce an excellent piece of scholarly work. In recognition of these achievements, the OSR has worked to develop an award process that celebrates the wonderful research being done by our students without creating a competitive atmosphere surrounding the thesis. Hence, thesis awards are based on competency-based assessments submitted by thesis mentors/advisors and reviewers during the approval process, and internal review of the final thesis that was deposited into the Yale Medicine Digital Thesis Library. Consistent with all other graduation prizes, YSM MD Thesis Awards will remain confidential until they are announced in the YSM Commencement Program on May 20, 2024. While some departments may elect to confer thesis “honors” based upon their own internal review, this recognition is distinct from YSM graduation prizes and is not under OSR’s purview.

Read about the required formatting and components for the thesis .

See helpful examples for reference section formatting.

Read about avoiding the risk of copyright violation and liability when submitting your MD Thesis.

Learn more about submitting a thesis to the Yale Medicine Thesis Digital Library .

Learn more about the Thesis Depositors Declaration Form.

Learn more about evaluating your experience with your thesis advisor .

Apply for a Thesis Extension

Read about the required formatting and components for the thesis.

Yale Journal of Biology and Medicine

Learn more about the journal or submit a manuscript.

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Home > Medicine > Medicine Thesis Digital Library

Yale Medicine Thesis Digital Library

Starting with the Yale School of Medicine (YSM) graduating class of 2002, the Cushing/Whitney Medical Library and YSM Office of Student Research have collaborated on the Yale Medicine Thesis Digital Library (YMTDL) project, publishing the digitized full text of medical student theses on the web as a valuable byproduct of Yale student research efforts. The digital thesis deposit has been a graduation requirement since 2006. Starting in 2012, alumni of the Yale School of Medicine were invited to participate in the YMTDL project by granting scanning and hosting permission to the Cushing/Whitney Medical Library, which digitized the Library’s print copy of their thesis or dissertation. A grant from the Arcadia Fund in 2017 provided the means for digitizing over 1,000 additional theses. IF YOU ARE A MEMBER OF THE YALE COMMUNITY AND NEED ACCESS TO A THESIS RESTRICTED TO THE YALE NETWORK, PLEASE MAKE SURE YOUR VPN (VIRTUAL PRIVATE NETWORK) IS ON.

Theses/Dissertations from 2023 2023

Radiomics: A Methodological Guide And Its Applications To Acute Ischemic Stroke , Emily Avery

Characterization Of Cutaneous Immune-Related Adverse Events Due To Immune Checkpoint Inhibitors , Annika Belzer

An Investigation Of Novel Point Of Care 1-Tesla Mri Of Infants’ Brains In The Neonatal Icu , Elisa Rachel Berson

Understanding Perceptions Of New-Onset Type 1 Diabetes Education In A Pediatric Tertiary Care Center , Gabriel BetancurVelez

Effectiveness Of Acitretin For Skin Cancer Prevention In Immunosuppressed And Non-Immunosuppressed Patients , Shaman Bhullar

Adherence To Tumor Board Recommendations In Patients With Hepatocellular Carcinoma , Yueming Cao

Clinical Trials Related To The Spine & Shoulder/elbow: Rates, Predictors, & Reasons For Termination , Dennis Louis Caruana

Improving Delivery Of Immunomodulator Mpla With Biodegradable Nanoparticles , Jungsoo Chang

Sex Differences In Patients With Deep Vein Thrombosis , Shin Mei Chan

Incorporating Genomic Analysis In The Clinical Practice Of Hepatology , David Hun Chung

Emergency Medicine Resident Perceptions Of A Medical Wilderness Adventure Race (medwar) , Lake Crawford

Surgical Outcomes Following Posterior Spinal Fusion For Adolescent Idiopathic Scoliosis , Wyatt Benajmin David

Representing Cells As Sentences Enables Natural Language Processing For Single Cell Transcriptomics , Rahul M. Dhodapkar

Life Vs. Liberty And The Pursuit Of Happiness: Short-Term Involuntary Commitment Laws In All 50 US States , Sofia Dibich

Healthcare Disparities In Preoperative Risk Management For Total Joint Arthroplasty , Chloe Connolly Dlott

Toll-Like Receptors 2/4 Directly Co-Stimulate Arginase-1 Induction Critical For Macrophage-Mediated Renal Tubule Regeneration , Natnael Beyene Doilicho

Associations Of Atopic Dermatitis With Neuropsychiatric Comorbidities , Ryan Fan

International Academic Partnerships In Orthopaedic Surgery , Michael Jesse Flores

Young Adults With Adhd And Their Involvement In Online Communities: A Qualitative Study , Callie Marie Ginapp

Becoming A Doctor, Becoming A Monster: Medical Socialization And Desensitization In Nazi Germany And 21st Century USA , SimoneElise Stern Hasselmo

Comparative Efficacy Of Pharmacological Interventions For Borderline Personality Disorder: A Network Meta-Analysis , Olivia Dixon Herrington

An Examination Of Honor Society Membership, Mistreatment, And Discrimination By Medical Student Demographics , Katherine Ann Hill

Factors Influencing Decision For Contralateral Prophylactic Mastectomy Versus Unilateral Mastectomy , Julian Huang

Beta-Catenin Nuclear Transport In Wnt Signaling: Kap-Beta2/transportin Mediates Nuclear Import Of Beta-Catenin Via A Py-Nls Motif In A Ran Gtpase Dependent Manner , Woong Y. Hwang

Perspectives On Emergency Department-Initiated Buprenorphine Among Clinical Pharmacists , Marissa Justen

Examination For Independent Predictors Of Seasonality Of Birth Across Forty-Nine Low- And Middle-Income Countries: Analyses Of The United States Agency For International Development Demographic And Health Survey Data , Jehanzeb Kayani

Pediatricians, Social Identity, And The Law In The Early-Twentieth-Century United States , Christopher R. Keys

Single Neuronal Firing Dynamics In A Mouse Model For Absence Seizures , Waleed Khan

The Impact Of Cannabidiol In Patients With Early Psychosis: A Randomized Controlled Trial , Sreeja Kodali

Renalase Agonist Therapy And The Cardiac Response To Pressure Overload In Chronic Kidney Disease , Govind Krishna Kumar Nair

Sociodemographic And Insurance Disparities In Urologic Oncology Care Access And Surgical Outcomes , Folawiyo Laditi

How Ethics Committees Deliberate Resource Allocation For Undocumented Children, A Qualitative Analysis , YuKyung Lee

Mental Health Service Use Among Immigrant And U.S. Born Asian American Pacific Islanders , Hieronimus Loho

Severity And Operative Age In Metopic Synostosis: The Association With Neurocognitive Outcomes , Aaron Samuel Long

Comparison Of The Bone Bruise Patterns In Contact And Non-Contact Acute Anterior Cruciate Ligament Injuries , Jay Thomas Moran

Multi-Omic Differences Between Right And Left Sided Colorectal Cancer Liver Metastases , Montana Tremaine Morris

Almajiri Health; A Scoping Review On Disease, Health Literacy And Space For Participatory Research , Muzzammil Imran Muhammad

Investigating Effects Of Glycolysis Inhibition On Metabolism And Extracellular Ph In A Mouse Model Of Hepatocellular Carcinoma , David Nam

Applying Deep Learning To Identify Imaging Biomarkers To Predict Cardiac Outcomes In Cancer Patients , Aishwarya Kishore Nene

Incarcerated Patients Have Higher Mortality After Trauma: An Unreported Healthcare Disparity , Harry NewmanPlotnick

The Association Between Social Needs Care Coordination And Social Needs Status Amongst Patients In A Federally Qualified Health Center , Autumn Nobles

Diagnosis Of Polycystic Ovary Syndrome And Non-Hispanic Black Race Are Predictive Of Hypertension In Reproductive Age Women -Analysis Of Real World Electronic Medical Record Data , Nyerovwo Okifo

Utility Of Shear Wave Elastography In Breast Cancer Diagnosis: A Systematic Review And Meta-Analysis , Aishwarya Pillai

“I Was Reaching Out For Help And They Did Not Help Me”: Mental Healthcare In The Carceral State , Anna Grace Preston

Associations Of Frailty With Tumor Characteristics & Longitudinal Outcomes In Patients With Meningiomas , Hanya M. Qureshi

A Single Nucleotide Polymorphism In An Rgs6 Enhancer Regulates Heart Rate Variability And Parasympathetic Modulation , Namita Ravi

Firearm Injury Prevention Strategies In Children And Young Adults , Christopher Schenck

Assessing Quality Of Oral Cancer Care Across A Health System And Region: Opportunities To Improve Care , Hemali Parimal Shah

Single-Cell Transcriptomic Atlas Reveals Molecular Drivers Of Human Inner Ear Development , Amar H. Sheth

More Than Meets The Eye: Improving Recognition Of Child Abuse In Emergency Departments , May Shum

A Novel Smarcc1-Mutant Bafopathy Implicates Epigenetic Dysregulation Of Fetal Neural Progenitors In The Pathogenesis Of Congenital Hydrocephalus , Amrita K. Singh

Baseline Skin Cytokine Profiles Determined By Rna In Situ Hybridization Correlate With Response To Dupilumab In Patients With Eczematous Dermatitis , Katelyn Singh

Barriers To Identifying Learning Disabilities: A Qualitative Study Of Clinicians And Educators , Lauren Stone

"Come On. I Need An Answer." A Mixed-Methods Study Of Barriers And Disparities In Diagnostic Odysseys , Zeyu Tang

Cognitive Impairment And Long-Term Health Outcomes In Patients With Coronary Microvascular Dysfunction , Abriana Tasillo

Family Dyads, Emotional Labor, And The Theater Of The Clinical Encounter: Co-Constructive Patient Simulation As A Reflective Tool In Child And Adolescent Psychiatry Training , Isaiah Thomas

Comparative Effectiveness Of Digital Breast Tomosynthesis For Breast Cancer Screening In Older Women , Akhil Upneja

Analysis Of Prices And Outcomes For Common Hospitalized Conditions In 2021 , Lina Vadlamani

Recording Multiunit Activity Of The Locus Coeruleus In An Awake Mouse Model Of Focal Limbic Seizures , Marcus Valcarce-Aspegren

Improving Cancer Classification With Domain Adaptation Techniques , Juliana Veira

Soil-Transmitted Helminthiases And Deworming Response In School-Aged Children In Retalhuleu, Guatemala , Rebeca Esther Vergara Greeno

The Synergy Between Physiologic Dendritic Cells And Mrna-Loaded Lipid Nanoparticles And Its Potential As A Cellular Immunotherapy , Brian Myles Wei

Lipid Profiles Help Explain Protection From Atherosclerosis In Ascending Aortic Aneurysm Patients , Gabe Weininger

The Impact Of Peer Interventions On Physical Activity For Individuals Living With Mental Illness , Julia Wolfe

Perioperative Outcomes In Patients With Systemic Sclerosis: An Analysis Of A Large Case Series , Luying Yan

Engineering And Evaluating Biodegradable Bioadhesive Nanoparticle-Encapsulated Sunscreens , Beverly Xi Yu

Theses/Dissertations from 2022 2022

Contested Spaces, Stigmatized Treatment: Methadone In 1970s New York, Boston, And New Orleans , Zoe Miranda Adams

Comorbid Pad And Mvd: A Retrospective Nrd Analysis Of Trends, Outcomes, And Readmissions , Miguel Algara

Epidemiology Of Domestic Violence-Related Ocular Injuries Among Adult Patients , Joana E. Andoh

Longitudinal Modeling Of Early Hiv Burden In The Central Nervous System , Victor Diego Armengol

Generating Clinical Evidence Using Real World Data And Personal Digital Devices , Victoria L. Bartlett

Incidence And Prognosis Of Cranial Neuropathies In Children With Covid-19: A Systematic Review And Meta-Analysis , Priyanka Bisarya

A Deep Dive In Head & Neck Cancer: Machine Learning Applications In Diagnostic And Prognostic Evaluations , Alexandra Tan Bourdillon

A Serological Survey Of Sars-Cov-2 Infection In Casino Employees , Julian Campillo Luna

The Real Cause Of The Broken Rib: Developments In Pediatricians' Approach To Child Abuse; 1960 - 2020 , Sofia Charania

Identification Of A Novel Link Between Adiposity And Visuospatial Ability , Herbert Alexander Chen

Predictors Of Very Late Onset Infection In Kidney Transplant Recipients At Least Ten Years Post Transplant , Harry Cheung

Deep Learning Algorithms For Predicting Response To Neoadjuvant Chemotherapy For Breast Cancer , Rachel Choi

Testing Ictal Conscious Awareness: Responsiveness Versus Recall Of Experiences During Seizures , Violeta Contreras Ramirez

Mechanisms Of Progestin Resistance In Reproductive-Age Women With Atypical Endometrial Hyperplasia , Katherine Mcmaster Cooke

Biomarkers Of Egfr Decline After Pediatric Cardiac Surgery In The Assess-Aki Cohort , Christina Anne-Josiane De Fontnouvelle

Amd3100 Administration For The Treatment Of Asherman’s Syndrome In A Murine Model , Pablo Antonio Delis

Fracture Callus Evaluation In The Setting Of Breast Cancer Metastasis And Rescue Of Healing Via Inhibition Of Erk1/2 , Christopher Dussik

Primary Care Characteristics And Medication Management Among Patients Receiving Office Based Opioid Treatment With Buprenorphine , Xinxin Du

Factors Impacting Trauma-Specific Quality Of Life Following Injury: A Multi-Center Assessment In Lebanon , Ali Elreichouni

Consciousness: Mechanisms And Neuropsychiatric Outcomes , Isaac Gilbert Freedman

Investigation Of Outcomes Following Cervical Spine Surgery In Patients With Pre-Existing Non-Spinal Neurological Conditions , Anoop Raj Galivanche

Medical Students’ Experiences, Knowledge, And Perceptions Of Patients With Substance Use Disorder , Sophia Francesca Gamez

“people Fall Through The Cracks”: Prolonged Lengths Of Stay Beyond Medical Necessity , Lucy Gao

Housing As Healthcare: The Role Of Homelessness In Patient Characteristics And Retention In Outpatient Medication For Opioid Use Disorder Treatment , Marina Gaeta Gazzola

Sleep Apnea In Veterans With Schizophrenia: Estimating Prevalence And Impact On Cognition , Stephen Edward Ghazikhanian

Self-Injurious Behavior And Problematic Video Gaming In Adolescents With Problematic Shopping , Norman Robert Greenberg

Importance Of Social Support In Older Adults After Hospitalization For Acute Myocardial Infarction , Yaakov Green

In-Vivo Nanoparticle Delivery To Fetal Mouse Pancreas And Liver , Mary Elizabeth Guerra

Characteristics Of Inpatient Behavioral Health Services And Hormonal Treatment Decision-Making In Transgender/gender-Expansive Youth , Justin William Halloran

Preferential Utilization Of Resident Physicians To Care For Patients With Medicaid And Persons Of Color At Us Academic Health Centers , Samer Hassan

Atypical Presentation Of Hereditary Hypophosphatemic Rickets With Hypercalciuria Due To Digenic Mutations , Bryan Bo-Ran Ho

Gender Differences In Outcomes Of Coordinated Specialty Care For Early Psychosis , Seong Im Hong

Resident Physician Thriving And The Residency Experience During The Covid-19 Pandemic: A Qualitative Study , Joshua Hyman

Early Experience With The Fda’s Breakthrough Devices Program And Potential Payment Mechanisms , James Johnston

Page 1 of 31

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6.11: Writing a Thesis Statement

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• Lapum et al.
• Ryerson University (Daphne Cockwell School of Nursing) via Ryerson University Library

Readers always want to know “What is the big idea?” Every type of non-fiction writing – from a short essay to a 10-page term paper to a lengthy thesis or dissertation– needs a controlling idea as a “spine” that holds the paper together (see Figure 6.6 ). Look at Table 6.3 : Topics and Thesis Statements for a comparison of topics and thesis statements.

Table 6.3: Topics and thesis statements: A comparison

Figure 6.6: Thesis skeleton

Begin by writing a working thesis statement. You will need this working thesis statement when you begin to outline and organize your assignment. As you continue to develop your paper, you can limit the working thesis statement if it is too broad or expand it if it proves too narrow for what you want to say. Each draft of the thesis statement will bring you closer to the exact wording that expresses your controlling idea.

Student Tip

The Controlling Idea

The controlling idea should be broader for a longer piece of writing than for a shorter piece of writing. Make sure the controlling idea is appropriate for the length of the assignment. How many pages it will take to explain and explore the controlling or main idea in detail? Be reasonable with your estimate. Then expand or trim the controlling or main idea to match the required length.

Attribution statement

Content from this page was remixed with our own original contented and adapted, with editorial changes, from:

Writing for Success 1st Canadian Edition by Tara Horkoff is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License , except where otherwise noted. Download for free at: https://opentextbc.ca/writingforsuccess/

Melbourne Medical School

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Writing a thesis

A thesis is a written report of your research, and generally contains the following chapters: introduction, methods, results, discussion and conclusion. It will also have a list of references and appendices. Check with your faculty/department/school for degree-specific thesis requirements. You may also find it helpful to look at published theses (in your department) to see how they are structured. (Internationally, the ‘thesis’ may be referred to as a ‘dissertation’).

• Gruba, P., & Zobel, J. (2014). How to write a better minor thesis . Melbourne, Australia: Melbourne University Publishing.
• Stoddart, K. (1991) Writing Sociologically: A Note on Teaching the Construction of a Qualitative Report. Teaching Sociology (2), 243-248.
• Mullins, G. and M. Kiley (2002). It’s a PhD, not a Nobel Prize: how experienced examiners assess research theses. Studies in Higher Education . 27(2): 369-386 .
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Writing a medical thesis: tips for post-graduate students.

What is a medical thesis?

A medical thesis is the written work resulting from an original research in the field of Medicine, Nursing, Pharmacy, and other health and life sciences. It is submitted by the students in order to obtain a higher degree from the University.

However, keep this in mind! The purpose of submitting a medical thesis is not limited to the achievement of a doctoral or post-graduate degree. It is a medium to organize the scientific knowledge in a way to make further progress in the field.

That’s the reason why the experts in  medical thesis writing  stress on the importance of choosing the right topic for your thesis. You must be able to address a genuine problem or series of problems through your medical thesis. Choose a topic that aligns with your interest and where you can offer a fresh perspective through your research study.

Writing your medical thesis

After choosing the topic for your research study, collaborate with your supervisor to design your research study and its goal. Collect all the information and data pertaining to your research before proceeding with your clinical trials.

Now, you are ready with your research data and clinical findings. You just need to pen down your findings in your medical thesis.

That sounds easy, isn’t it?

In reality, it’s not so. But, you need not worry!  Writing a medical thesis  becomes easy and fun if you follow the given steps with competence:

1.Outline the structure of medical thesis

Prepare an outline of the thesis in accordance with the following sections:

• Introduction: Why did you start your study?
• Methods Used
• Results of the study
• Discussion of results

List the major sections and chapters in each. Do a section at a time. Assemble all the figures and tables and organise them into a logical sequence.

2.Writing a title of the thesis

The title reflects the content of your thesis. For writing a perfect thesis title:

• Be concise and accurate. The title must neither be too long nor too short
• Avoid unnecessary words and phrases like “Observation of” or “A study of”
• Do not use abbreviations
• Avoid grammatical mistakes

3.Writing an Introduction

The purpose of writing an Introduction is to provide the reader with sufficient background information on the topic and help him understand and evaluate the results of the present study, without needing to refer to the previous publications on the topic.

• Give this background information in brief in the first paragraph
• Include the importance of the problem and what is unknown about it in the second paragraph
• State the purpose, hypothesis, and objective of your study in the last paragraph

Cite the research papers written on your research topic

• Include unnecessary information other than the problem being examined
• Include the research design, data or conclusion of your study
• Cite well-known facts
• Include information found in any textbook in the field

4.Writing the section of “Methods Used”

This section must be so written that the reader is able to repeat the study and validate its findings.

Write a detailed exposition about the participants in the study, what materials you used and how you analyzed the results

• Give references but no description for established methods
• Give a brief description and references for published but lesser known methods
• Give detailed description of new methods citing the reasons for using them and any limitations if present
• Include background information and results of the study
• Refer to animals and patients as material
• Use trade name of the drugs; instead, use their generic names
• Use non-technical language for technical statistical terms

5.Writing your Results

Keep in mind the objective of your research while writing the “Results” section. The findings of the research can be documented in the form of:

• Illustrative graphs

Use text to summarize small amounts of data. Do not over-use tables, figures, and graphs in your paper. Moreover, do not repeat information presented in the table or figure in the text format. Text must be a summary or highlight of the information presented in tables or figures.

6.Discussing your Results

Good medical theses have a targeted discussion keeping it focused on the topic of the research. Include:

• Statement of the principal findings. Make it clear to show that your thesis includes new information
• Strengths and weaknesses of your study
• Strengths and weaknesses in relation to the other studies
• A take-home message from your study for clinicians and policymakers
• Any questions that are left unanswered in your study to propose new research

How to conclude your medical thesis?

The conclusion of your research study must comprise of:

• The most important statement or remark from the observations
• Summary of new observations, interpretations, and insights from the present study
• How your study fills the knowledge gap in its respected field?
• The broader implications of your work
• How can your work be improved by future research?

However, avoid any statement that does not support your data.

With these tips, write your thesis like a pro and don’t let it delay your doctoral award!

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Importance and benefits of the doctoral thesis for medical graduates

Affiliations.

• 1 University of Freiburg, Medical Faculty, Office of Student Affairs, Centre for Evaluation of Teaching in Medicine Baden-Württemberg, Freiburg, Germany.
• 2 University of Freiburg, Medical Faculty, Department for Medical Biometry and Medical Informatics, Freiburg, Germany.
• 3 University of Freiburg, Medical Faculty, Department for Medical Psychology and Sociology, Freiburg, Germany.
• 4 University Basel, Medical Faculty, Office of Student Affairs, Basel, Switzerland.
• PMID: 26958656
• PMCID: PMC4766933
• DOI: 10.3205/zma001007

Abstract in English, German

Introduction: The majority of medical graduates in Germany complete a doctorate, even though a doctoral degree is not necessary for the practice of medicine. So far, little is known about doctoral candidates' view on the individual benefit a doctoral thesis has for them. Consequently, this is the subject of the present investigation.

Method: Data from surveys with graduates of the five medical faculties of Baden-Württemberg from the graduation years 2007/2008 (N=514) and 2010/2011 (N=598) were analysed.

Results: One and a half years after graduating 53% of those interviewed had completed their doctorate. When asked about their motivation for writing a doctoral thesis, participants answered most frequently "a doctorate is usual" (85%) and "improvement of job opportunities" (75%), 36% said that an academic career has been their primary motive. Less than 10% responded that they used their doctoral thesis as a means to apply for a job. The proportion of graduates working in health care is equally large among those who have completed a thesis and those who have not. Graduates who pursued a thesis due to scientific interest are also currently more interested in an academic career and recognise more opportunities for research. An implicit benefit of a medical thesis emerged with regard to the self-assessment of scientific competences as those who completed a doctorate rated their scientific competencies higher than those who have not.

Discussion: Although for the majority of physicians research interest is not the primary motivation for completing a doctorate, they might nevertheless achieve some academic competencies. For graduates pursuing an academic career the benefit of completing a medical thesis is more obvious.

Einleitung: Die Mehrheit der medizinischen AbsolventInnen in Deutschland promoviert, obwohl der Titel nicht zur ärztlichen Berufsausübung notwendig ist. Zur Frage, welchen individuellen Nutzen die Doktorarbeit aus Sicht der Promovenden hat, ist bislang nur wenig bekannt. Sie ist daher Gegenstand dieser Untersuchung. Methode: Analysiert wurden Daten aus Absolventenstudien der Abschlussjahrgänge 2007/2008 (N=514) und 2010/2011 (N=598) der Medizinischen Fakultäten Baden-Württembergs. Ergebnisse: 53% der Befragten haben 1,5 Jahre nach Studienabschluss ihre Promotion abgeschlossen. Die stärkste Zustimmung zu Beweggründen, eine Doktorarbeit anzufertigen, erfahren die Motive „Promotion ist üblich“ (85%) und „Verbesserung der Berufschancen“ (75%). Dem Motiv, eine akademische Karriere anzustreben, stimmten 36% zu. Weniger als 10% der Befragten setzen ihre Promotionsarbeit als Strategie bei der Stellensuche ein. Der Anteil der AbsolventInnen, die in der Krankenversorgung arbeiten ist unter den Promovierten praktisch genauso groß wie unter den Nicht-Promovierten. Diejenigen, die für die Promotion stärker wissenschaftliche Motive angeben, sind auch aktuell stärker an einer akademischen Karriere interessiert und sehen für sich mehr Möglichkeiten wissenschaftlich zu arbeiten. Als impliziter Nutzen zeigte sich, dass die promovierten AbsolventInnen ihre wissenschaftlichen Kompetenzen signifikant höher einschätzen, als ihre nicht promovierten KollegInnen. Diskussion: Obwohl die meisten MedizinerInnen eine Promotion nicht in erster Linie aus originärem Forschungsinteresse anstreben, erweitern sie dadurch dennoch ihre wissenschaftlichen Kompetenzen. Einen offensichtlicheren Nutzen hat die Promotion für diejenigen, die eine wissenschaftliche Karriere anstreben.

Keywords: Doctorate, medical; Evaluation; Graduate survey; Methods, academic; Motivation.

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Definition of thesis noun from the Oxford Advanced Learner's Dictionary

• Students must submit a thesis on an agreed subject within four years.
• He presented this thesis for his PhD.
• a thesis for a master's degree
• He's doing a doctoral thesis on the early works of Shostakovich.
• Many departments require their students to do a thesis defense.
• She completed an MSc by thesis.
• her thesis adviser at MIT
• in a/​the thesis
• thesis about

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Edinburgh Medical School is one of two schools at the College of Medicine and Veterinary Medicine at the University of Edinburgh. The Edinburgh Medical School integrates research and teaching across our three Deaneries: Biomedical Sciences, Clinical Sciences and Molecular,Genetic and Population Health Sciences.

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• v.92(5); May 2002

The McKeown Thesis: A Historical Controversy and Its Enduring Influence

James colgrove.

James Colgrove is with the Program in the History and Ethics of Public Health and Medicine, Division of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY.

The historical analyses of Thomas McKeown attributed the modern rise in the world population from the 1700s to the present to broad economic and social changes rather than to targeted public health or medical interventions. His work generated considerable controversy in the 1970s and 1980s, and it continues to stimulate support, criticism, and commentary to the present day, in spite of his conclusions' having been largely discredited by subsequent research. The ongoing resonance of his work is due primarily to the importance of the question that underlay it: Are public health ends better served by targeted interventions or by broad-based efforts to redistribute the social, political, and economic resources that determine the health of populations?

IN A BODY OF RESEARCH published from the 1950s to the 1980s, the physician and demographic historian Thomas McKeown put forth the view that the growth in population in the industrialized world from the late 1700s to the present was due not to life-saving advancements in the field of medicine or public health, but instead to improvements in overall standards of living, especially diet and nutritional status, resulting from better economic conditions. His historical analysis called into question the effectiveness of some of the most basic and widely applied techniques in the public health armamentarium, including sanitary reforms, vaccination, and quarantine. The “McKeown thesis” sparked the inquiries and shaped the research hypotheses of many scholars and became the subject of an extended controversy.

McKeown's work may be seen in the context of the debate over the relationship between food supply, economic development, and population growth that has engaged the natural and social sciences since the days of Thomas Malthus. McKeown's research also came to play a prominent role in the debate that emerged in the United States and Great Britain following World War II, and that intensified in the 1970s, over the appropriate focus and allocation of medical resources.

Sophisticated analyses in the field of historical demography effectively overturned the McKeown thesis in the early 1980s. Yet it has shown remarkable staying power, continuing to draw support and commentary throughout the 1990s. The purpose of this article is to examine the controversy over Thomas McKeown's work and its ongoing influence on public health research and policy. Even though its empirical foundation and conclusions are now considered flawed, the questions at the heart of the McKeown thesis—What are the most important determinants of a society's patterns of morbidity and mortality? and How should public health practitioners most effectively focus their efforts?—remain as relevant today as when they were first proposed.

HUMAN AGENCY VS ECONOMIC GROWTH

The McKeown thesis attempted to construct a unifying theoretical explanation for the so-called demographic transition, the dramatic growth in the population of the industrialized world from around 1770 to the present. The thesis can be summarized as follows: Population growth was due primarily to a decline in mortality from infectious disease. This decline was driven by improved economic conditions that attended the Industrial Revolution, which provided the basis for rising standards of living and, most important, enhanced nutritional status that bolstered resistance to disease. Other variables that may have been operating concurrently—the development of curative medical interventions, institution of sanitary reforms and other public health measures, and a decline in the virulence of infectious organisms—played at most a marginal role in population change. Put another way, the rise in population was due less to human agency in the form of health-enhancing measures than to largely invisible economic forces that changed broad social conditions.

McKeown came to demographic studies by way of an interest in the historical role of medicine. He had a strong interest in the ways that social factors such as class, income level, and living environment influence health and a passionate belief that the medical profession should move beyond a strict biological paradigm to address these factors. At the time McKeown began investigating past trends in population change, historical demography was a relatively new discipline. 1

McKeown advanced the core tenets of his thesis in 4 seminal articles published between 1955 and 1972 in the journal Population Studies . 2– 5 Each treated various aspects of the demographic transition, weighing the relative effects of various potential contributors to the decline in mortality. Medical treatments were ruled out, because most were introduced long after a downward mortality trend had already begun. Public health advances, McKeown determined, played only a small role, because they influenced water-borne illnesses such as cholera, which were responsible for just a small portion of the mortality decline, but not airborne ones such as tuberculosis, which made up the majority. Declining virulence of infectious agents was rejected as biologically implausible. In a 1962 article, McKeown concluded that “the rise of population was due primarily to the decline of mortality and the most important reason for the decline was an improvement in economic and social conditions.” 3 (p121) Among these conditions, the most significant was improved diet.

In 1976, McKeown published 2 books that summarized and synthesized the arguments he had advanced during the previous 20 years. In The Modern Rise of Population , 6 McKeown once again put forth his view about the primary role of social melioration, led by nutrition, in population growth. The structure of his argument unfolded in successive chapters as he discussed the potential alternative causes for the rise in population. The book was mostly derived from his Population Studies articles and contained little new material.

Published the same year, The Role of Medicine: Dream, Mirage, or Nemesis? 7 was McKeown's most explicitly polemical use of historical data. The book contained a further recapitulation of his now-familiar arguments about the relative contributions of medicine and economic progress to the health of society. It was less a research monograph, however, than a philosophical treatise on the nature of well-being and illness and what he saw as the appropriate role of medical providers. Medicine, McKeown stated, placed far too much emphasis on “cure” and not enough on “care,” in part because of a misunderstanding of history: “[M]isinterpretation of the major influences, particularly personal medical care, on past and future improvements in health has led to misuse of resources and distortion of the role of medicine.” 7 (pxiv) He concluded with a plea for a more humanistic, less technocratic role for the medical profession.

HISTORY AND IDEOLOGY

Elements of the McKeown thesis came under scrutiny in the 1960s and the early 1970s, mostly in academic journals of demographic or economic history. Various historians took issue with McKeown's summary dismissal of the importance of medical intervention and made the case for the importance of, among other measures, smallpox inoculation and the development of hospitals. 8– 10 Nevertheless, the thesis could hardly be described as controversial around that time, either in terms of its influence on other scholars or the criticism it attracted.

It was during the late 1970s and the 1980s, following the publication of The Modern Rise of Population and The Role of Medicine , that the McKeown thesis stimulated a highly visible and often contentious debate, focusing primarily on the contribution of medicine to society's well-being, which spread from the world of demographic and economic history to the realm of medicine and public health. The impact of the 2 works was significant, with many articles of the time describing them as establishing a “new orthodoxy” in historical interpretation. Since neither work contained substantially new material, it is somewhat surprising that the thesis achieved such sudden prominence. Part of the reason is simply that McKeown's opus had much greater impact once it was collected between the covers of 2 books and reached a wider audience than the readership of a specialized academic journal. Part of the answer also lies in the social and political climate of the late 1970s, a time of tension and transition in the field of medicine in which McKeown's diminution of the role of curative technologies struck an especially resonant chord.

The medical profession underwent a profound crisis of confidence in the 1970s, as advanced nations of the world, especially the United States and Great Britain, began to question large expenditures on sophisticated medical techniques that seemed to produce diminishing returns in quality of life. In contrast to the optimism and faith in medicine that had characterized the 1950s, the prevailing attitude toward the profession became one of cynicism, mistrust, and therapeutic nihilism. 11, 12 A spate of books and journal articles in both the popular and academic press questioned the ethics, values, and priorities of the institution of medicine; some of these attacks came from economists, while others were made by left-wing social historians who critically examined the cultural and political status of the profession. 13– 17 One of the most prominent works was Archibald Cochrane's Effectiveness and Efficiency: Random Reflections on Health Services , 13 which claimed that the benefits of many sophisticated and expensive procedures had not been adequately evaluated. Another was Ivan Illich's Medical Nemesis: The Expropriation of Health , 14 a harsh polemic that described medicine as a malign influence that does more harm than good through misguided and often dangerous “treatments.”

McKeown's 2 books were frequently cited alongside these works as part of the same social critique. Although the subtitle of The Role of Medicine: Dream, Mirage, or Nemesis? was an explicit reference to Medical Nemesis , McKeown distanced himself from Illich's ideology; in the introduction to The Role of Medicine , he wrote that it had little in common with Medical Nemesis “except perhaps in the sense that the Bible and the Koran could be said to be identified by the fact that both are concerned with religious matters.” 7 Yet both men shared the view that the increasing emphasis in the second half of the 20th century on hightechnology, curative medical efforts was a misguided diversion of resources away from more environmentally focused health programs. Many like-minded commentators saw McKeown's interpretation of the past as an object lesson about the failings of the present and a guideline for the future.

McKeown's critique of the medical establishment also dovetailed with a newly prominent discourse that was emerging in the United States, Canada, and Great Britain that emphasized the role of individual responsibility for health. In 1974, the Canadian health minister, Marc Lalonde, issued an influential report in which he called for citizens to examine their behavioral and lifestyle choices as the root of illness in society. 18 In an essay in the journal Daedalus , John Knowles, a physician and president of the Rockefeller Foundation, laid the blame for an unhealthy society on the personal habits of individuals and argued that people should stop looking to organized medicine or the government for improvements in health. 19 Both documents, which received wide attention in the popular and academic press, cited McKeown's work—selectively—to buttress claims that government-supported medical services had but a limited role in health. This environment helps explain the prominence that the McKeown thesis achieved. The Role of Medicine alone was cited in more than 130 articles in the decade following its release, primarily in journals of medicine, public health, and health services administration. 20 At least 2 journals, the Milbank Memorial Fund Quarterly and the Journal of Interdisciplinary History , devoted special issues responding to McKeown's claims.

While many scholars found McKeown's ideas persuasive, others took a more skeptical stance, and from his book's publication in the mid-1970s through the end of the 1980s, the 2 volumes were the targets of often scathing criticism focusing on both the substance of his conclusions and the methods by which he reached them. Several distinct though related elements of the thesis were targets of attack: the propositions that the growth of population was due to a decline in mortality rather than a rise in the birth rate, that active human intervention in the form of medical and public health measures had little to do with the fall in the death rate, and that increasing food supplies led to enhanced nutritional status at the population level. The methodological shortcomings for which McKeown was condemned included vaguely and imprecisely defining and categorizing the historical phenomena he was analyzing (such as “medical measures,” “standards of living,” and “food distribution”), failing to subject a hypothesis to rigorous analysis for plausibility, allowing ideological biases to color interpretation of data, and selectively overlooking other relevant scholarship.

A THEORY IS DISCREDITED

It was ultimately on empirical grounds that the McKeown thesis was overturned. The quantitative techniques used by historical demographers grew in sophistication from the 1950s to the 1980s. 21 A group of French scholars at the Institute National d'Etudes Démographiques in Paris developed a technique known as family reconstruction with which they were able to study the period predating the institution of death registration in France in 1792. In England, the Cambridge Group for the History of Population and Social Structure began in the early 1960s to generate a considerable body of influential work on population trends in Britain. 22 The Cambridge Group mined a rich source of data: parish registers dating from 1538 that recorded baptisms, burials, and marriages for the period before the first census in Britain. The group's groundbreaking research gave rise to numerous articles that presented a more complete and nuanced view of population change than McKeown's work had offered. 23, 24 One of the criticisms of McKeown's later work was that he failed to acknowledge and incorporate these more recent findings. He countered that the parish data being used by the Cambridge Group were problematic because of their fragmentary and ambiguous nature; answering his critics in a 1978 Population Studies article, he declared that “few would claim that they [parish records] provide a reliable picture of national fertility and mortality trends before the nineteenth century.” 25

The research of the Cambridge Group culminated in the publication in 1981 of The Population History of England 1541–1871 by E. A. Wrigley and Roger Schofield, which represented perhaps the most significant challenge yet to the credibility of the McKeown thesis. 26 Applying a variety of sophisticated new statistical and analytic techniques to the parish registers to overcome problems of accuracy and interpretation, Wrigley and Schofield produced a comprehensive and authoritative volume that conclusively demonstrated the invalidity of a central feature of McKeown's reasoning—that the growth in population was due to a decline in mortality, not a rise in fertility. Indeed, the book treated the McKeown thesis dismissively, consigning it to mentions in a few footnotes.

Probably the most detailed and thorough critique of McKeown's research came from Simon Szreter in a 1988 article. 27 Szreter claimed that the thesis suffered from conceptual inaccuracy, especially with respect to the catchall term “rising standards of living,” which conflated a heterogeneous group of phenomena, some of them related to economic changes and others to social reforms. More damning, Szreter conducted a new analysis of McKeown's own data on mortality trends in the 19th century and found that McKeown had misinterpreted the death records, confusing tuberculosis, bronchitis, and pneumonia. This misreading led to, among other errors, an incorrect description of the timing of the decline in tuberculosis mortality and an underestimation of deaths from bronchitis and pneumonia, which Szreter asserted played a more prominent role in overall mortality than McKeown had allowed. In Szreter's new interpretation of the data, public health measures such as clean water and milk supplies assumed greater importance, while changing social conditions, to which McKeown had attributed beneficial effects such as improvements in nutrition, were in fact a detrimental influence, resulting in, for example, overcrowded and poorly constructed housing resulting from rapid urbanization.

Finally, Szreter turned his attention to what he viewed as a crucial weakness that underlay McKeown's research: that McKeown had allowed his a priori assumptions about the limited value of medical intervention and the need for social reform to predetermine his analytic categories, thus biasing his interpretation of evidence. Szreter concluded his critique with a biographical sketch of McKeown, examining the ideology that influenced the research.

McKeown's professional and political battle was primarily directed against those who argued for ever greater diversion of the new National Health Service resources into curative technical medicine—invasive surgery and biochemical “treatments”—at the expense of preventive, humanistic medicine—efforts to understand and modify the health implications of the environment in its widest sense. . . . McKeown's exploration of the historical record was fantastically effective in these professional, political terms, thoroughly puncturing the inflated claims to importance, on the grounds of a supposed long history of life-saving achievements, of the medical “technocrats.” 27 (p33)

Szreter was not alone in pointing out the way that this political bias had influenced McKeown's writing. In a scathing critique of the thesis, S. Ryan Johansson accused McKeown of dissembling by presenting The Modern Rise of Population as a detached scholarly investigation when instead it was a piece of advocacy for a current policy. 28 “It is clearly an abuse of persuasive methods for any scholarly text to present itself as detached, when it is in fact an applied text presenting a skewed interpretation of the past designed to recruit support for a present policy,” Johansson wrote. 28 (p125)

As Johansson's essay implies, the policy implications of the McKeown thesis were controversial. Two courses (at least) may follow from the claim that targeted health interventions had not produced gains for populations: either refocus efforts on programs designed to change broad social conditions, or eliminate government involvement in health altogether, since a rising economic tide will lead, however indirectly, to improved health at the population level. As Johansson noted, the McKeown thesis could be (and was) interpreted as a model that “subverted the germ theory/public health orthodoxy and marginalized the role of the state as the key agent of reform in modern mortality history.” 28 (p106)

Commenting on the work of McKeown and Archibald Cochrane, one historian noted, “it is thus a sad irony that McKeown's historical work and Cochrane's advocacy . . . gained popularity during a period of growing concern over the costs of health services in the United States, Great Britain and other Western societies, for both these bodies of work have been used as a way of containing costs and providing a rationale for doing so, without at the same time sharing the concern of the authors for humane and equitable care.” 12 (p262)

THE CONTINUING RESONANCE OF THE MCKEOWN THESIS

The consensus among most historians about the McKeown thesis a quarter century after it first stirred controversy is that one narrow aspect of it was correct—that curative medical measures played little role in mortality decline prior to the mid-20th century—but that most of its other claims, such as the assessment of the relative contributions of birth rates and of public health and sanitation measures to population growth, were flawed. A new historical orthodoxy, however, has not taken its place. The complex interrelationships between economic changes, social trends, and professional medical and public health activities remain refractory to simple or sweeping explanations. Much of the problem in arriving at unifying theories of change, as Gretchen Condran has noted, is that “competing explanatory variables were changing simultaneously.” 29 (p119)

Inquiries into all of the variables continues, stimulated in large measure by McKeown's iconoclastic interpretation. 30– 32 In particular, many historians of public health and medicine have used McKeown's ideas as a starting point to reexamine and reassert the value of various sanitary reforms, which he had discredited. For example, Gretchen Condran, acknowledging the McKeown thesis, examined the influence in Philadelphia of public health and sanitary measures such as improvements in the milk and water supplies and in child care practices and concluded that “intervention as against economic growth was a major source of the decline in mortality in American cities.” 29 (p121) A 1991 volume of essays included several that explicitly and implicitly responded to the McKeown thesis, examining topics such as the declines of cholera and tuberculosis and the effects of social and sanitary factors such as improved housing conditions and pasteurization. 33 More recently, Amy Fairchild and Gerald Oppenheimer made the case that McKeown had insufficiently explored the effect on tuberculosis rates of 2 public health interventions, quarantine of infected people and eradication of the bovine form of the illness (responsible for transmission through contaminated milk). 34

The ongoing interest in McKeown's ideas, not only among historians but also among policymakers addressing contemporary issues, is striking. What accounts for his work's remarkable durability? Why has the influence of the McKeown thesis persisted even after its conclusions were discredited? In part, his writing continues to generate responses because many scholars believe that although McKeown's analysis was flawed, his underlying ideas regarding the effects of poverty and economic well-being on health were essentially correct. More broadly, McKeown's influence has continued to be felt because his research posed a fundamental question that has lost none of its relevance in the decades since he began writing in the post–World War II era: Are public health ends better served by narrow interventions focused at the level of the individual or the community, or by broad measures to redistribute the social, political, and economic resources that exert such a profound influence on health status at the population level?

Although McKeown's formulation of this question achieved unusually wide visibility, for the reasons discussed above, he was not the first to raise it. His work represented a reframing of a much older debate, dating to the latter part of the 19th century, between sanitary reformers devoted to improving social conditions in the broadest sense and germ theorists dedicated to controlling disease through the sophisticated tools of bacteriology. Far from fading in prominence, the questions he raised have assumed new salience at the beginning of the 21st century, especially in debates about how best to confront health threats such as AIDS, tuberculosis, and malaria in the developing world. For example, commenting on the recent initiative to provide AIDS drugs in poor nations, a health activist based in Nepal summed up the 2 sides of this debate when he noted, “There has been an overemphasis . . . [on] drugs. The lack of drinking water is a much bigger priority in most countries than anti-retroviral treatments.” 35

A large and growing body of research suggesting that broad social conditions must be addressed in order to effect meaningful and long-term improvements in the health of populations has validated the underlying premise of McKeown's inquiries. 36– 39 This research challenges public health professionals to view targeted interventions and social change, not as dichotomous or opposing choices, but rather as essential complements to each other, and to find ways to integrate technical preventive and curative measures with more broad-based efforts to improve all of the conditions in which people live. These concepts, which lie at the heart of the McKeown thesis, account in large measure for its continuing resonance in the field of public health. McKeown's work, empirically flawed though it may have been, placed before a wide audience a set of practical and ethical challenges with which policymakers in the United States and internationally will continue to grapple in the coming decades.

Acknowledgments

The author thanks Ronald Bayer and Amy Fairchild for their comments on an earlier version of this paper.

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