Notes of a Medical Maverick

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Contents

1. Why "Maverick"?.........................................................................................12. The Phoenix Phenomenon in Medical Research..............................................................53. In the Service of the IRS...............................................................................174. The Elusive Clot: The Controversy Over Coronary Thrombosis in Myocardial Infarction.....................255. Confessions of Creeping Obsolescence....................................................................436. On First Looking Into Jarcho's Leibowitz: The Clinician as Medical Historian............................517. Names...................................................................................................638. Drawing The Line........................................................................................699. The First Heart Operation: The Surgical Treatment of Mitral Stenosis....................................7710. Absolutely the Last Word on Physical Diagnosis. Not!....................................................9311. Noble, Not Nobel: How Not to Win the Most Prestigious Prize in Medicine.................................10112. Dreamwork...............................................................................................12913. The UMDNJ Debacle: A Scandal in Academia................................................................13514. Greek, Latin, English and All That: The Languages We Live In............................................14715. A Fond Farewell to the Foxglove ? The Decline in the Use of Digitalis...................................16116. I Was a Mole in an IRB..................................................................................17117. A Skeleton in Obama's Medical Closet: The Doctor Dilemma................................................18118. Publishing Without Perishing............................................................................189About the Author: Allen B. Weisse, M.D......................................................................203

Chapter One

In my other life, that of an academic cardiologist, I came to a fork in the road fairly early in the game. In 1963 I had just been appointed an instructor of medicine at the medical school where I would remain for the rest of my career and had to decide which professional path I would follow. To the left lay the path of super specialization; I could select a rather abstruse cardiovascular condition and devote myself unremittingly to it until I had a good chance of becoming one of the world experts on it. There was the risk, however, as some cynics might postulate, of getting to know more and more about less and less until I knew all there was to know about nothing at all. To the right lay the path of uncertainty; I could let my efforts wander in whatever direction my curiosity led them. Although I might have to settle on becoming a jack of all trades instead of a master of one, there was the compensation that "jacks," after all is said and done, might have a lot more fun than "masters."

I deliberately veered to the right and never really looked back. The expectation of never becoming a world class expert was certainly fulfilled, but I was rewarded with the opportunity to explore fields far beyond clinical and experimental cardiology while still maintaining credentials required for my day job as a member of our medical faculty. Ethics, philosophy and especially history, a great love of my life, were given free rein in my writings often flavored by large dollops of humor.

As a result of this, although many of my efforts fell into the conventional modes of medical publishing, others found it difficult to find a home within the pages of learned or even popular journals. If an article touched on an aspect of medical history the historical journals were more than likely to reject it. Oftentimes the reviewers would remark on its interest and literary quality, but the final judgment would be "not for us." Medical journals, cardiological and otherwise, would come up with the same decision. My penchant for humor was particularly self-defeating. Although laughter is supposed to have a healing quality, it rarely finds its way into serious repositories of professional medical writing. So it is that although some of the essays appearing here have previously been published in scholarly journals many of them have remained in limbo until appearing here for the first time.

The term "maverick" has been overused as of late, especially in politics in describing some of its practitioners and probably should be given a rest. However, it so neatly describes what I have often been about that I could not resist using it to describe what is contained within these pages.

You may be interested to learn that the term harks back to a living person. Samuel Augustus Maverick (1803-1870) was a Texas lawyer, politician and rancher who refused to brand his cattle, probably because he was not all that interested in this aspect of his life. The term "maverick" came to be used to describe the independently minded although I prefer to think of it more metaphorically; his cattle had no brand to mark them and therefore could not be identified or categorized as part of any group. Thus each retained its uniqueness and individuality.

Proceeding within this Western context of the term I look upon much of my work as unbranded stock that may wander far beyond the local spread. Since you, dear reader, have already gotten this far along the way I hope that your interests, like mine are far ranging. I trust that you will not be inclined to ride off into the sunset but choose rather to saddle up and join me on this trail of discovery, surprise, and inspiration enjoying an occasional chuckle along the way.

Chapter Two

SOME YEARS AGO IT was suggested that "The Phoenix Phenomenon" might be a term suitably applied to ideas in science and medicine that, although presented as original concepts, actually had been proposed in the past, rejected and forgotten until now arising again like the mythical bird, the Phoenix, from its own ashes. Some recent readings however suggested that this term might even be better applied to instances in which some investigator may have suffered some devastating loss – critical data, the ability to reproduce results, one's personal health or special knowledge – despite which he or she was able to overcome this debacle and move on to ultimately achieve the treasured final goal.

Stimulating this revised conception were retellings of two instances of this kind, one not actually involving medicine; the other more appropriately described as being within the general field of biology.

The first concerns the Scottish essayist and historian ThomasCarlyle (1795-1881) and the writing of his masterpiece, a history of the French Revolution (1837), which established him as a major figure in Victorian England. An intriguing aspect of this massive effort concerns its near derailment at an early stage in its production.

When Carlyle had completed a draft of the first volume of what would become a three volume account of the events leading up to, occurring during and then at the...