AW: [HSF] The fallacy of surgical research

[Ani Anyanwu]

Hal
 
Good research and RCT are not synonymous. The research method needed to answer a question varies from question to question. For a rare and fatal disease like post-infarct VSD, the case report or a small case series will provide the best evidence to guide therapy and is the research method of choice. In your n of 1 study here, provided you are certain you were dealing with an invariably fatal disease (as is the case with VSD) then the fact that the patient is alive is evidence of efficacy of your intervention. The same however does not apply to the majority of operations you do on a day to day basis - for those procedures, you need more than anecdotal observations to demonstrate benefit or measure outcome.
 
Regarding the Nobel, it is an oddity that a Nobel was never awarded for the development of CBP - I suspect because it was difficult to ascribe (the science) to any one particular individual or indeed any few individuals. I am not sure though that Heart transplantation merits a Nobel. While transplantation itself was a significant medical advance (and that credit went to clinicians Murray and Thomas), heart transplantation has had little impact on healthcare or medicine in general, and indeed is arguably a dying field. 
 
 
Ani



> From: Hgrmd at aol.com> Date: Thu, 2 Aug 2007 07:25:53 -0400> Subject: Re: AW: [HSF] The fallacy of surgical research> To: OpenHeart-L at lists.hsforum.com> CC: > > Ani,> Maybe we surgeons aren't as rigorous in setting up our studies as our > medical colleagues. However, we do have the unequivocal satisfaction of truly > helping patients through our mechanical interventions. How often does an adult > oncologist get that feeling when treating solid tumors? That 82 yo man with > the postinfarction VSD, MVR, CABG, TVR that I did last July 4th came to see > me in the office yesterday. He had only mild DOE. Otherwise, he was > completely asymptomatic with no murmurs. When I first met him, he was in shock, > intubated, anuric, with an IABP. Do you need an RCT to determine if we help > patients like that?> I believe Murray definitely deserved his Nobel Prize. It's a damn shame > that Shumway never got his. I also believe Carpentier should get one. All > three of these physicians have, in aggregate, saved countless thousands of > lives through their untiring research, courage, and teaching.> > Hal> > > > ************************************** Get a sneak peek of the all-new AOL at > http://discover.aol.com/memed/aolcom30tour> _______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L at lists.hsforum.com> > To UNSUBSCRIBE, to CHANGE email address, or to view archives:> http://mmp.cjp.com/mailman/listinfo/openheart-l> > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at:> http://www.hsforum.com/listdisclaim> -----------------------------------------
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