May 18th, 2012
Standing Up for What You Believe: The Story Behind an Editorial
Harlan M. Krumholz, MD, SM
I had an experience the other week that reminded me that speaking your mind has its challenges. I was approached by someone with influence who asked me to cease my discussions on a particular topic. The reason was oblique – and I was told that people are viewing me negatively because my views are strong and wondering if there are conflicts of interest that are influencing me. In essence, I was told that people are whispering about me – though no names were given.
Now this topic was part of a scientific debate that has strong implications for guidelines and performance measures – and, well, patients. It is a situation where I am questioning conventional wisdom – and the long held beliefs by many individuals. I am trying to do so respectfully – and through the use of evidence – but still it is questioning dogma.
This conversation prompted me to write a message to my younger colleagues urging them to stand up for what they believe – and be willing to speak truth to power. I quote my friend Victor Montori, who eloquently advised a junior colleague about how to manage a concern about whether to express an opinion that was likely to be viewed negatively by her superiors. That person had been told to hold opinions tight until he had more grey hair. Victor starts by saying: ‘I have struggled with this issue for years. Turns out that this is a common struggle for those who find themselves unable to stay silent in the face of waste, error, low integrity, or abuse.’
In any case, take a look. Here is the link:
I would be interested in your thoughts.
10 Responses to “Standing Up for What You Believe: The Story Behind an Editorial”
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This is great. It is also not too different to how junior physicians feel in general about the difficulties in challenging the status quo in terms of best practice.
The history of mankind has shown us how difficult it is to fight dogmas (e.g Galileo Galilei). The problem lies in who will hold the power. Refuted dogma makes those formerly keeping the dogma powerless. Harlan Krumholz´s voice now has strong implications for guidelines and they do transfer into company revenues from statin sales – again loss of power. Yet people are here to have a chance in the pursuit of happiness and truth. They cannot be denied it. In no way can they deny this pursuit to others. How to come out of this? I think it is important to respect others, to tolerate them and to appreciate different opinions, while willing to admit that all of us make mistakes. People are often selfish or self-centered, seeking fame and money. This is philosophy about values. For some it may be true faith, for others faith in the truth. Erich Fromm may help here. It is crucial in these times of big science accompanied by schismatic (i.e. money-chasing and promoting progress at the same time) industry to fight for the truth. That is why persons like H. Krumholz, S. Nissen, U. Ravnskov and many others are so precious. It is the benefit of patients that matters. We all are here for nothing else. (By the way, I think H.K.´s A Note to Younger Colleagues may pertain more to some Elder ones.)
The “Horse Whisperer” was the inspiration behind an acclaimed book and movie. The “Harlan Whisperers” are the inspiration behind a superb editorial and opinion piece.
Dr. Krumholz, thanks for this much needed perspective.
When I was leaving Boston for fellowship, one of my most important mentors told me about the time he had just finished fellowship and, with “fresh eyes, unbridled enthusiasm” challenged an important finding by those with “grey hair”. He said that after that he became persona non grata in cardiology circles for many years and, in hindsight, he should have just stayed quiet instead of speaking his mind.
Building a career in medicine is may be different from many other careers. We spend many hours of many years training (many until our 40s), most of our weekends are spent in the hospital away from our loved ones, and we put our families in a vulnerable financial position. In such a situation, when your career can perish if you upset the wrong person, why do so?
While numerous people who have changed the face of medicine by challenging dogma (and gotten into trouble doing so) come to mind, the case of Werner Forssmann might be particularly relevant. As you know, he was the German physician who performed the first human cardiac catherization. He had quite a bit of difficulty finding a job for many years after his experiment, and even had to change fields.
Should the elders of medicine who have most sway over its culture work on making it less hierarchical and place less stress on conforming? Should there be an accessible form in high impact journals where more junior members of the community are asked to write editorials? Should the entire process of academic promotion and research funding be modified such that there is higher importance is given to thinking outside the box?
The NICE-SUGAR study challenged the dogma of 80-110 glucose control- and saved lives by showing a higher range had 14% lower mortality.The recent RCT on Xigris showed that the drug, costing hundreds of millions annually was ineffective.I often find British and Australians more willing to challenge dogma- and save lives. Thank you so so much for the contributions to the literature
Petty tyrants who stand to benefit from cowering silence will make sure that your speech is never free. But the price of self-censorship is even greater, especially in matters that involve the health and welfare of patients, because you may have to forfeit your essence as a physician and as a moral being. Harlan, I admire your courage. Gossiping whisperers will scatter to their miserable cracks in the wall when the light of truth is shined on them.
Reply: from Richard Seedman, DVM
In an age of increasing public transparency, the challenger may find refuge from establishment sanctions by broadcast.
Now comes the challenge of finding an actual investigative reporter with courage and with a supportive editor. Maybe the internet, with sites like Mercola.com and Life Extension Foundation [internet and magazine]-LEF.org], both of which challenge mainstream medicine on a regular basis, and without apparent restraint or conflict, and with solid, referenced, evidence based fact.
Harlan,
Superb. Thank you! You are doing very important work. So good.
I’m a fan.
Men with integrity and conviction who have stood their ground in the face of objections, threats and reprisals, will be forever remembered, while their power driven critics with big voices and small hearts will be relegated to antiquity by the facts of history and forever forgotten !
Thank you for standing tall, Harlan. Your example is cherished and will serve well to encourage others who dare to defy convention in the name of truth.
We salute men who show their colours despite the risks of academic and professional isolation, and economic sabotage and hardship.
I think of Kilmer McCully, and the price he paid for daring to resist and defy, and whose work has now been vindicated. I think also of Uffe Ravnskov and his continuing monumental contribution to the exposure of hidden truths in studies on heart disease, despite overwhelming opposition from many conventional quarters. There are many other big men who can be named.
The undeniable lesson of history is that TRUTH can never be silenced for too long !
I fully agree with Neville Wilson. Dr Krumholz, I thank you for your courageous and honest stance. Many people will do the same in the near future.