Mandrola Chooses a Favorite Academic Article

Emerson once urged academics to think publicly, clearly, and not influenced by tradition or history. I have found such a modern article, but are these principles possible now?

Words that pop into my head when thinking about the academic literature: vast, insipid, repetitive, Sisyphus.

Then I found this:

Ultimately, our success as a profession will depend on our ability to engage in debate, acknowledge different opinions, and seek answers through science.

This sentence came seven years before social media and a virus shredded our norms.

In 2012, outgoing editor-in-chief, Dr. Harlan Krumholz, titled this essay in Hitchens-esque fashion:

A Note to My Younger Colleagues…Be Brave.  

If such a piece could be written now, its title might read something like, A Note to My Younger Colleagues…Be Super-Brave.

I loved this piece before the pandemic. But our polarized censorious climate elevates this 7-minute read into a classic.

Every paragraph overflows with relevance. And…no collection of words available on PubMed better explain what we strive for here at Sensible Medicine.

Let’s review the piece and then a recent example of how hard it is to be brave in our current medical climate.

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First a note on Dr. Krumholz. He had grown the once small Circulation--Cardiovascular Quality and Outcomes into a prominent journal in the academic cardiology space.

I was delighted that he invited me to give cardiology grand rounds at Yale. We held similar values on over-diagnosis, over-treatment, and reducing low-value care.

Here is his lede:

In some ways, our best hope to reveal our follies lies with those new to the field. It is your fresh eyes, unbridled enthusiasm, optimism about what is possible, and commitment to the highest ideals of the profession that can reveal what those who have longer tenure in medicine may have trouble discerning.

Like all good ledes, there is a lot to break down.

Our best hope… Yep, I agree, medical science is in trouble.

Those new to the field…(the young)…with their optimism, enthusiasm, and commitment to the highest ideals of the profession…(those not yet tarnished with cynicism)…can reveal what those who have longer tenure in medicine may have trouble discerning (think sclerosis of the old guard).

Krumholz then urges young people to speak truth to power. But notes, of course, that our profession does not often welcome those who question dogma. (emphasis mine)

If we are to accelerate innovation in medicine, eliminate wasteful practices, and improve the depth and effectiveness of how we care for patients, then there must be room to question traditional approaches and to introduce new and better ways of prevention, diagnosis, and treatment.

He recognizes the challenge:

Those who ask difficult questions or challenge conventional wisdom are often isolated. He warns that this could have career implications…

And that’s where bravery comes in.

Krumholz appreciates those who stand up and speak—despite the risks and efforts to silence them. He is drawn to this bravery because “promoting the best science and advocacy sometimes entails risk.”

He emphasizes real life:

If you take the path toward clarity, I guarantee you that you will occasionally find people who will disparage you. They may seek to undermine you, find ways to marginalize you, and try to incriminate you.

And get this.