20/20: PEER REVIEW FAILURE, HEART SURGEON GENIUS!

Matthew A. Emme emme0002 at gold.tc.umn.edu
Sun Jun 16 10:56:08 EST 1996


In article <Dt3C6t.118 at anasazi.com> Karl Dussik, karl at anasazi.com writes:
>In article <Pine.A32.3.93.960615105858.20101A-100000 at itsa.ucsf.edu> Bert
Gold 
><bgold at itsa.ucsf.edu> writes:
>>
>>The remarkable story on 20/20 last night concerning the new
>>surgical procedure in which enlarged ventricular cavities are
>>removed with propitious consequences for most all patients had
>>an important take-home lesson in it for peer review:
>>
>>Not only was the procedure perfected in a small, jungle hospital
>>by a capable Brazilian heart surgeon faced with legions of
>>parasite infected patients predisposed to the heart enlargement
>>condition (necessity being the mother of invention), but,
>
>Well, let's see how this stands up in controlled studies before
pronouncing
>it a success.  It does look hopeful, though.



That is very true.  No one is talking about the 40% short term mortality
and the almost total lack of follow up in this guys studies.  It will be
great if it works, but I will hold my enthusiasm till some well designed
studies are done. 



>>His national televised explanation of 'sneaking in to a cardiovascular
>>surgery meeting, after numerous REJECTIONS, and presenting
>>a videotape of his surgical technique' to the astonishment, amazement
>>and chagrin of the audience there, should give us pause.
>>
>>It must not be forgotten by those of us in Medicine that
>>Paul Simmelweiss, the surgeon who suggested washing between procedures,
>>died on the street, a penniless pauper, because the members of his
>>profession thought him a fool.


At that time many people still believed in the theory of spontaneous
generation.  In fact before Semmelweis, Dr Alexander Gordon and Dr Oliver
Wendell Homes were saying that it would be a good idea to wash between
patients with puerperal fever to decrease the risk of transmission.  

Even though Semmelweis did not change all of medicine (and he went insane
and died at the age of 47) he did decrease the number of patients with
puerperal fever at his hospital (by having his students wash there hands
after leaving the dissecting room) and his OBSERVATIONS were a base for
more detailed experiments by Lister and Pasteur that did change the way
medicine is practiced.  

Pasteur did the painstaking experiments (not just making observations)
under rigorously controlled conditions that disproved the old spontaneous
generation theory and also found that certain diseases were caused by
micro-organisms.  Lister then applied Pasteur's principles to the
prevention of surgical infections.  To quote Lister, "All efforts to
combat decomposition of the blood in open wounds were in vain until
Pasteur's research opened a new way, by combating the microbes".

You have to do the science, and prove that your observations are correct,
 before people should buy into a new theory.  It is called the scientific
method and it might be slow but it is the best system to filter out the
huge amounts of crap that comes out.



>And don't forget what the Australian (I think it was) doctor went though
>trying to convince the medical community ulcers were caused by a
bacterial
>infection and could be cured - not just treated - with antibiotics.


But now, after lots of good studies have been done to prove this it has
become standard medical thought.  A great success.  

Revolutions in any field of knowledge take time to filter to the main
stream.  Science and medicine are notoriously conservative and need to be
convinced that a given development is more substance than hype.  An
extension of the old saying, "Do not be the first person on the block to
prescribe a new drug, but also do not be the last one to."


---------------------------

Matthew A. Emme     emme0002 at gold.tc.umn.edu

The three mental elements of Golf (and life): 
Belief, Vision and Method.
  
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