Research, Teaching, and Textbooks

Update: March 31, 2021

We recently published an infographic outlining the pathology book publishing landscape. Vinay Kumar appeared as the most-published lead author/editor in pathology. As a result, we followed up on our original interview with four more questions about his work in pathology publishing…

You are lead editor of one of pathology’s best-known textbooks, Robbins and Cotran Pathologic Basis of Disease. How did this book become so popular?

Stanley Robbins started his academic career in 1944 at the world-famous Mallory Institute of Pathology. While teaching medical students, he grew dissatisfied by the pathology texts in use at the time because they focused heavily on morphology and not enough on pathogenesis and clinicopathologic correlations. Robbins believed that pathology is the scientific basis of medical practice – so pathology texts should include a robust discussion of the mechanisms of disease. With that in mind, he wrote a new pathology textbook in 1957 that found instant popularity among both students and faculty. In effect, Robbins’ Pathology became the world’s pathology syllabus. After three successful editions, Robbins rewrote the entire text and called it Pathologic Basis of Disease (first published in 1974). He also added a smaller book, Basic Pathology. Over the years, Robbins’ books have been translated into 13 languages and remain the most widely used pathology texts in the world.

When did you become involved?

In 1979, I started working with Stanley Robbins, who invited me to help him revise the third edition of Basic Pathology. It’s now in revisions for the 11th edition, which means that I have participated in nine editions. If you add the many editions of Basic Pathology, Essential Pathology, and the Review Book, I’ve been involved in a grand total of 23 editions. What a ride!

Tell us about Essential Pathology…

Robbins’ Essential Pathology is a new, all-electronic textbook first published in 2020. The book has three integrated components – short texts, cases, and quizzes – that allow for an unprecedented level of interactivity and self-study!

Can we expect any major changes in the next edition of Basic Pathology?

For the 11th edition, we are going back to basics. We will no longer have expert contributors. Instead, the editors are writing the chapters themselves. Expert contributors tend to make the book too complex; we want to simplify it and achieve greater uniformity of style.

Read on for our original interview...

How did you come to contribute so much to Robbins’ pathology textbook – often considered “the bible of pathology?”

I came to the United States in July of 1972 and joined the pathology department at Boston University School of Medicine, having been recruited by Stanley Robbins himself. My primary motivation for the move from India was to pursue my research interests – a bid in which I was successful. In 1974, my colleagues and I published the very first paper describing the anti-leukemic role of a then-unfamiliar cell type – one we all now know as natural killer cells. Two years later, on the strength of that publication and my subsequent work, I obtained my first grant from the National Institutes of Health.

At the same time, my mentor had put me in charge of the pathology course at BU because of my interest in teaching. I worked hard on the course, and I guess he was sufficiently impressed by my dedication and excellence in teaching to offer me co-authorship of Basic Pathology (starting with the third edition, which was published in 1981). Soon thereafter, I was offered co-authorship of another textbook, Pathologic Basis of Disease, by Robbins and Ramzi Cotran. There, too, I worked on the third edition, which we brought to print in 1984. I continued to be the co-author of both books for the next several editions and, in 2000, became the senior author and editor of the seventh editions after Robbins retired and Cotran sadly passed away. It’s a position I am proud to say I still hold, with Basic Pathology now in its tenth edition and Pathologic Basis of Disease in its ninth.

Would Robbins still recognize his original textbook?

Yes, he would! We have not deviated from the principles he laid down – namely, that pathology is the scientific basis of the practice of medicine, and that it is connected to clinical features. Back in 1950, Robbins was the first pathologist to write a textbook that contained more than simply morbid anatomy. He introduced the concepts of pathogenesis and clinical correlations. He also made our discipline more approachable than it had ever been by writing his book in a conversational style. Although the details have changed in the nearly seven decades since the book’s initial publication, we have worked hard to keep its principles intact.

Of course, it’s not only the content that has undergone a transformation; it’s also the way in which we deliver it. Digital options are becoming more and more popular, especially for interactive purposes. We consider electronic and print media complementary, so we use both.

We have also just completed a brand-new Robbins textbook – “Robbins Essentials” – that will be dramatically different. It will be media-heavy. The idea for this book arose in response to the way the teaching of pathology has changed from a standalone course to a part of an integrated, organ-based approach. Faculty felt that, with such a structure, students were losing touch with pathology – in part because there was no time to read books like Pathologic Basis of Disease. My colleagues and I decided to write a new book that contains what we consider core material. Each chapter is linked to several cases in which we focus on the application of science to practice of medicine. The cases are very interactive, with questions, text links, and clickable answers that sometimes contain illustrations (for instance, of the arachidonic pathway to convey how anti-inflammatory drugs act). Similarly, molecular mechanisms underlying cancer are presented in the context of a case. If there was a TP53 mutation in the tumor, then there is a question on how p53 acts. We’ll even have a quiz bank for students to test their knowledge!

You stepped down as chairman of your department to pursue medical education initiatives. What are they?

I am currently involved in setting up a global medical university with the goal of providing excellent education at low cost in the developing world. I also think there is a lot of progress to be made in the developed world!

Medical education has not moved with the times. Our methods have remained largely unchanged for over 100 years. Medical education remains knowledge-based, rather than competency–based; there is too much emphasis on learning facts and not enough on the ability to apply them. But nowadays, vast knowledge is readily accessible via a small, handheld device – so only the core content has to be learned (and taught). At the same time, highly sophisticated simulation platforms can be used to teach and assess competencies.

The bottom line is that technology is a disruptive force that will change how we teach and assess. I am not convinced, though, that artificial intelligence will replace doctors. If I could predict the future, I would not be spending time on this interview!

With all your accomplishments thus far, do you have any as-yet unfulfilled wishes?

I cannot play the piano (yet).