Art vs Science
Jason S. Slakter, MD
Over the years, we have all heard the terms �the art of medicine� and �the
practice of medicine.� Decades ago, these terms were probably more accurate in
their depiction of clinical medicine. In the 1800s, physicians learned medicine
from apprenticeships with other physicians, thus gaining experience through
�practice.� Although anatomy and physiology was understood, therapeutic
treatment strategies were often employed through a trial-and-error process. The
physicians who were leaders in the field often made discoveries and advanced
treatment through innovative techniques � and occasionally through serendipity.
These were the so-called leaders or �artisans.�
As science advanced, medicine began to rely more and more on hard data for
determination of diagnostic and, more importantly, therapeutic approaches.
Results of rigorous scientific inquiry into the efficacy and safety of
treatments have led to the introduction of therapeutic modalities that have
changed all of our lives. The cornerstone to this objective approach to
analyzing treatment outcomes is the clinical trial. As physicians, we rely upon
the integrity of the trials and a full presentation of the data to understand
the safety and potential benefits, or occasionally lack thereof, for a
particular treatment strategy. Transparency in clinical trials therefore, is
crucial, and steps have been taken to introduce regulations that require
registration and presentation of clinical trials. I am pleased to direct your
attention to the guest editorial by Andrew Schachat, MD, editor-in-chief of
Ophthalmology, who addresses this issue in depth.
Of course, not all of our practice patterns are determined by randomized trials.
The clinical trials of ranibizumab for exudative AMD, the results of which are
summarized and discussed in this issue, are excellent examples of well-designed
studies with clear, comparative endpoints. On the other hand, there are many
treatments that have evolved based upon collective experience in the medical
community without such clinical trials. Such is the case with the treatment of
macular holes. Initially, no controlled clinical trials were conducted, yet
physician-reported experiences in the treatment of this condition resulted in
one of the most successful vitreoretinal surgical procedures to date. The
�macular hole story� is eloquently discussed by William Smiddy, MD, in this
issue as well.
Maintain a Balance for Individualization
As we go about our daily practice, we carry with us the �science� gained from
clinical trial data and pooled clinical experience from other retinal
specialists. When dealing with a single patient, however, we often find
ourselves basing our treatment decisions upon a combination of these data along
with our own personal experience and expectations for that particular
individual. Thus, although we have entered a new millennium, medicine remains a
clear balance of art and science.
Retinal Physician, Issue: July 2006