Hi MJ,
Just an addendum re my previous post.
Lest you think I am a skeptic---really, I am not. I don't consider the glass to be half-full, or half-empty. I try to consider it to be half-occupied.
It may be helpful to know that our interest in calcium scanning that began so long ago was based on hope---that we could help people by detecting disease earlier. But eventually, we were forced to admit that our own data did not support this idea.
This was at first both astonishing to me and discouraging, but now I see things much differently, because of what I have witnessed.
The fact is that the halls of clinical medicine are littered with the wreckage of ideas that nearly everyone agreed were good ones that seemed really promising, in terms of helping people. I could write a book on the things I personally have been involved with that began with hope and cutting-edge technology, and ended with discouragement, wreckage and harm that came in many forms..... angioplasty, stenting, directional atherectomy, gamma irradiation, beta irradiation, rotablators, infiltration catheters, excimer laser angioplasty, etc. etc. etc.
Even the script is well-travelled and predictable. A few years ago, somebody showed me an issue of the New England Journal of Medicine. The feature article was a paper showing the first clinical results from drug-eluting stents, which then became the rage. Of course, the first clinical results were astonishingly good. I remembered the many other similar papers in that same journal which also looked so encouraging, on the topics/technologies noted above. I remembered the later papers in that same journal which told a much different story as time and experience accumulated. And I predicted to that person that within two years, we would see a paper in that same journal showing that drug-eluting stents were not the greatest thing to hit medicine since penicillin. I was wrong. It didn't take two years, I think it was more like 12 or 18 months. But suffice it to say that drug-eluting stents, once advertised like so many others on the list above as being the Final Solution to the clinical problem at hand, so far have turned out to be beneficial to some, and either not helpful or harmful to others.
The next step is the wave of technical improvements to the original idea/technology. During this phase, it is always claimed that the "new and improved" technology is superior to anything else available, and that you must disregard previous evidence to the contrary because that was obtained with substandard, primitive technology, but now we have solved all those problems. And now, it is just a matter of verifying that conclusion that we already know is true with confirming clinical data.
But this has never turned out to be the case, as we find out later. The "confirmation" never comes, and we instead refine the approach further, and assume the same thing---that NOW we have solved all the problems, that previous studies with inferior technology must be ignored, and that it is only a matter of time before this is compellingly confirmed.
Finally, the reasons for the failure are compellingly documented, but by then people's attention is taken up by the NEXT "hot new test/technology" that just happens to be the feature article in the New England Journal of Medicine or some similarly prominent venue, and comes accompanied with a host of disciples singing its praises.
So that's why the "mainstream medical profession" seems so hard to convince, and so skeptical. This is the fruit of long, hard experience with lots of dashed hopes along the way. So far, the "mainstream medical profession" with its seemingling stodgy, seemingly ultraconservative, skeptical views and ways that may sometimes seem motivated by self-interest, inevitably has had the last laugh, and has been proven correct, as yet another new approach is abandoned in favor of the latest hot new approach.
But that vindication never makes the lead article in the New England Journal of Medicine..... and so it goes.
So my major motivation and the thing that shapes my thinking and judgement is much less skepticism, much more the prime Hippocratic directive: First, do no harm.
T |
