[HSF] Why others market and I treat

[Tea Acuff]

There is a lot of discussion questioning the validity of alternative treatment strategies and programs. Usually suspicions of lack of evidence, marketing in a pejorative sense, surgeons clinging to comfort zones in the face seemingly better options are the causative factors for questionable treatments from the observers view. Alternatively just multiple regional differences in choices of treatment are used as marker of likely intellectual medical malfeasance. 
 
Undoubtedly the use and meaning of the word "evidence" is a part of the problem. We banter the concept around as much as we do the holy grail complete revascularization with a specific explanation of the factors that define either.
 
But let's go back to the surgeons that are suspected of ignoring "obvious" evidence. Is there an underlying characteristic of the surgeon as opposed to the evidence that makes us seems so ill formed for the evidence? Why can we not fit the evidence like a glove?
 
I think it is because we have it backwards. At least this is part of the problem. We are trying to put on an ill fitting glove, which is the evidence or proper practice seen from other perspectives. The hand on which we try to place this ill fitting glove is not perfect, but for a imperfect world it is probably one of the better possible characteristics: fear of adverse events, the more proximate the more fear. This avoidance, I propose, might better explain our failures than other fault lines. It also has the advantages for those of us that are surgeons as being a rather noble trait and affirm an imperative with which there can by much agreement as opposed to the other negative assertions often cited. 
 
I am not trying to be polyannish, but in the imperfect environment in which we labor it may not be necessary to have both such cynical understandings of whom we are and have our eyes open to our failures. As we think about other ways if which we could be grounded, other senarios could work out much worse. While avoidance of adverse events might not be the fastest road to new opportunities, it quite likely is one of the least morbid characteristics that we could as a group engender.
 
The last factor that makes this dance that we observe understandable and illuminates why it seems so backwards from other perspectives (especially the universal one) is a characteristic of our imperfect world. Standards like justice are primarily local if they are to be fair. I presented the other side of this arguement in the past with the study concerning penetrance of new technologies in clinical practice. For most of us local thought leaders and experiences are those that judge us most and are to which we are most held accountable. Local standards of valve repair, off pump or arterial grafting begat a tendency to the same. Not always and by everyone, but more than somewhere else with less of the same.
 
All of this in general while confusing to outside observers is, I think, largely a good thing.  If it is a good thing we should be more quick to acknowledge its benefits and praise the same.To the universalist or lover of reason it is a maddening thing. I will talk more about this and this tension when I try to illuminate "evidence" at a later time. 
 
Am I mad?
 
tea