I did research in the latter part of my career because there are so many gaps in evidence for why we do what we do. One stands out: my patient with decompensating cirrhosis was found to have a gallbladder polyp now measuring 10 mm. Doing his own research and seeing in the surgical literature that there was a higher risk of cancer, he talked a surgeon into operating, despite my pleas to get followup measurements. After bleeding complications left a scarred-in liver, he later died of the inability to do further surgery. This led to a study of 20 years of Kaiser data, showing overall no higher risk of gall bladder cancer with a polyp than without, and that even with growth to 10 mm cancer was exceedingly rare. So much of what we do is habit, clinical questions led to research: why are we doing colonoscopies-endoscopies on asymptomatic premenopausal women with iron deficiency? Do people with hepatitis C have an increased risk of liver flare when they receive chemotherapy? Is there really a high risk of seeding if one biopsies liver cancers? Do those with hepatitis B die in old age of hepatitis B, or of the usual heart disease-cancer causes?
In medicine as in life, “the unexamined life is not worth living”.
So, is there an academic institution where the clinical training is considered excellent that is or might be willing to publicly take a two-pathway approach to residency or fellowship: (1) the "long" path with significant research time OR (2) the shorter, all-clinical path without research? Could such a place even exist?
“Then they care mostly about the exit and not about helping people. You can have a great financial exit for a failed product. Being acquired is the goal.“ - in every single start up, not just medicine. The “Sephora” method.
So Dr. P- Did the FDA advisors do enough research to begin the loosening of compounding peptides? Is there any good research on this? Or is this just political research?
There’s an inherent disconnect between the management of patent-worthy ideas and the executive management that decides on who exhibits the best potential for those innovations for disruptive discovery.
And it’s precisely at that intersection that the system is broken.
There are rules (academic freedom and the like) in place to give disruptive innovators rein to run on there own, and yet they are still bound by and to preselected controlling executives, who are given the right/privilege/license to shoot down a runaway thoroughbred who is making disruptive discovery that rises above the existing standard.
The question at this intersection boils down to whether the world loses any gain of importance when Secretariats are sacrificed?
"runaway thoroughbred who is making disruptive discovery that rises above the existing standard."
just bitterness or is there good supporting evidence for this, even anecdotal?
One sees what looks like disruptive innovation in discrete sites throughout the American medical landscape and notes, it doesn't look any less prevalent than the 20/80 [in this situation, 20/80 of 20/80] rule would tend to produce.
If we're talking about innovation that does away with allopathic medicine, ok sure we can posit that, but in that case the reason for "shooting down" a "thoroughbred" isn't because their efforts "rise above the existing standard" but because they directly threaten an existing site of capital investment.
I did research in the latter part of my career because there are so many gaps in evidence for why we do what we do. One stands out: my patient with decompensating cirrhosis was found to have a gallbladder polyp now measuring 10 mm. Doing his own research and seeing in the surgical literature that there was a higher risk of cancer, he talked a surgeon into operating, despite my pleas to get followup measurements. After bleeding complications left a scarred-in liver, he later died of the inability to do further surgery. This led to a study of 20 years of Kaiser data, showing overall no higher risk of gall bladder cancer with a polyp than without, and that even with growth to 10 mm cancer was exceedingly rare. So much of what we do is habit, clinical questions led to research: why are we doing colonoscopies-endoscopies on asymptomatic premenopausal women with iron deficiency? Do people with hepatitis C have an increased risk of liver flare when they receive chemotherapy? Is there really a high risk of seeding if one biopsies liver cancers? Do those with hepatitis B die in old age of hepatitis B, or of the usual heart disease-cancer causes?
In medicine as in life, “the unexamined life is not worth living”.
So, is there an academic institution where the clinical training is considered excellent that is or might be willing to publicly take a two-pathway approach to residency or fellowship: (1) the "long" path with significant research time OR (2) the shorter, all-clinical path without research? Could such a place even exist?
“Then they care mostly about the exit and not about helping people. You can have a great financial exit for a failed product. Being acquired is the goal.“ - in every single start up, not just medicine. The “Sephora” method.
So Dr. P- Did the FDA advisors do enough research to begin the loosening of compounding peptides? Is there any good research on this? Or is this just political research?
"Consider becoming a primary care physician in a large hospital system with many quality metrics."
Ouch
I have never been so offended by something so completely true... ;)
It's fun.
There’s an inherent disconnect between the management of patent-worthy ideas and the executive management that decides on who exhibits the best potential for those innovations for disruptive discovery.
And it’s precisely at that intersection that the system is broken.
There are rules (academic freedom and the like) in place to give disruptive innovators rein to run on there own, and yet they are still bound by and to preselected controlling executives, who are given the right/privilege/license to shoot down a runaway thoroughbred who is making disruptive discovery that rises above the existing standard.
The question at this intersection boils down to whether the world loses any gain of importance when Secretariats are sacrificed?
Serious question here: is this
"runaway thoroughbred who is making disruptive discovery that rises above the existing standard."
just bitterness or is there good supporting evidence for this, even anecdotal?
One sees what looks like disruptive innovation in discrete sites throughout the American medical landscape and notes, it doesn't look any less prevalent than the 20/80 [in this situation, 20/80 of 20/80] rule would tend to produce.
If we're talking about innovation that does away with allopathic medicine, ok sure we can posit that, but in that case the reason for "shooting down" a "thoroughbred" isn't because their efforts "rise above the existing standard" but because they directly threaten an existing site of capital investment.
🤣