June 25th, 2013
What Will We Count in 30 Years?
From the perspective of today, cardiology 30 years ago was full of wrong ideas and practices. What will cardiology today look like in 30 years? In a paper published in the American Journal of Cardiology entitled “What We Counted,” Robert Rosenthal remembers practices that were once considered dogma but were later proven to be either incorrect or even harmful. He then speculates about which current practices will be judged in the future to have been misguided. James de Lemos interviewed Dr. Rosenthal for Cardioexchange.
de Lemos: Dr. Rosenthal, I thoroughly enjoyed reading your paper in the Am J Cardiol. I think it provides a great temporal context for “modern” cardiology. What prompted you to write this piece?
Rosenthal: I have always been interested in hearing how life was “back in the day”, stories told at first by my elderly relatives and recently by my patients, especially those who served in World War II. As a medical student, I was able to sit down with some great medical legends like H. Houston Merritt and Franz Ingelfinger, who enjoyed being asked what it was like for them to practice medicine when they were young. So I wanted to pick out some stories that I would tell if I was asked.
de Lemos: You seem to focus on history. What practical information can a young cardiologist learn from studying past practices in that field?
Rosenthal: No matter what field, cardiology or otherwise, I think you are at a disadvantage if you can’t place yourself in the context of time and appreciate what was understood and undertaken 20, 30, 40 years before you. As a specific example, all we had in our day were M-mode echos. Now, we don’t even perform or teach M-mode echo at our hospital. It is regarded as obsolete. But M-mode provides a more precise measuring and timing tool than current techniques. It will become a lost art like phonocardiography, which is a shame because both provide distinctive insights. Most current cardiology fellows would not even know what a phonocardiogram was.
de Lemos: When you look at contemporary cardiology, what are the current practices that you think we will look back on as useless or even dangerous?
Rosenthal: Of course, we don’t know now what will be looked on years hence as harmful or we wouldn’t be doing them, but I think we can be pretty certain that some of the things we do fall into that category. I did give examples in my article of practices that I think may become obsolete. I think we are seeing some of that evolve pretty rapidly in the field of lipids and so maybe 20 years from now people will be astonished to hear that doctors around the year 2000 actually focused on measuring and trying to raise the HDL. There are certainly a lot of fashions that come and go: coronary spasm and silent myocardial ischemia were very fashionable topics for a while, but now you don’t hear them spoken of much. Today’s fashions may be fractional flow reserve or diastolic dysfunction.
To our readers: Which of today’s practices or paradigms do you think will be looked upon in the future as folly?