Power of observation, clinic legacy, and
the "c" word

I have three comments about the spring issue of Momentum:

• In the article titled "Burden of Proof," my friend and colleague Bill Weintraub argues for the need for more scientific medicine -- for more clinical trials, as opposed to mere observational data. I agree but would point out that doctoring is for the most part a humanitarian act. Clinical trials themselves are an advanced form of observation. They are superior to individual observation, but they are not science per se. Scientific discovery comes out of laboratories like the one Dr. David Harrison has developed, where he and his colleagues are trying to identify the cause of atherosclerosis. That's science.

  Many randomized clinical trials are initiated because individual doctors observe and wonder. But many conditions and treatments should not be studied in clinical trials. For example, I don't know if surgery-versus- antibiotics to treat acute appendicitis has been analyzed by clinical trial. Surgery is obviously a very successful treatment. Do we discard the observations of generations of doctors who believe this to be true because of a lack of confirmation from clinical trials? Or another example -- should we discontinue our use of antibiotic prophylaxis for endocarditis in patients with heart valve disease because there is no clinical trial to prove its value?

  Randomized clinical trials are here to stay, but they are simply a more accurate method of making an observation -- rarely do they achieve the stature of real science.

• The only thing missing in the account of the birth and development of The Emory Clinic is a detailed description of the emotional upheaval precipitated when the clinic was first created. I remember it like it was yesterday because in the midst of the turmoil, Dean Richardson fired the chairmen of medicine, surgery, and obstetrics, and many other faculty left as well. The dean asked me to chair medicine, and he appointed J.D. Martin to lead surgery, Dan Thompson in gyn/ob, Richard Blumberg in pediatrics, Bernie Holland in psychiatry, John Steinhaus in anesthesiology, Hugh Dudley in pathology, and Phin Calhoun in ophthalmology. Once the team was assembled, the school could move forward. The phenomenal growth we've seen in ensuing years in all these departments and in the school as a whole would have been impossible without The Emory Clinic.

• As I have stated previously, the "c" word [for customer] should not be used in place of the word "patient." The latter reflects more accurately the relationship between a sick person and his or her physician. "Customer" sounds as if the sick person regards the doctor as a clerk in a shoe store, who, I suspect, loses little sleep worrying about the future of the person's feet.

I look forward to reading the next issue of Momentum.

J. Willis Hurst
Consultant to the Division of Cardiology,
Emory School of Medicine
Professor emeritus and former chair,
Department of Medicine
Founding partner, The Emory Clinic

Website for geneRx+

Thank you for including our company in Holly Korschun's article in the Spring 2003 Momentum ("The company line"). We are pleased to be part of Emtech Bio. We did note an error in the listing of our website in Holly's article.

The website for geneRx+, Inc. is http://www.generxplus.com/.

Kristie Sanders
Grants administrator/accounting
and financial reporting manager, geneRx+, Inc.