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J Thorac Cardiovasc Surg 2007;134:562-564
© 2007 The American Association for Thoracic Surgery

Editorial

The seven stages of an idea

Departments of Cardiac Surgery, Erasme Academic Hospital and Tivoli University Hospital, Brussels University, Brussels, Belgium.

Received for publication February 28, 2007; revisions received March 22, 2007; accepted for publication March 29, 2007.

^_* Address for reprints: D. de Cannière, MD, PhD, Professor and Chief, Departments of Cardiac Surgery, Erasme Academic Hospitaland Tivoli University Hospital, Brussels University, 1070 Brussels Belgium and 7100 La Louvière Belgium. (Email: didier.decanniere@ulb.ac.be).

The first 300 words of the full text of this article appear below.

Norman Shumway, recalling the pioneering days of heart transplantation, described the seven stages the idea went through before it eventually entered the field of routine clinical practice:

1 Initial stage: "Won’t work; been tried before."

2 After successful experiments in animals: "Won’t translate to man."

3 After 1 successful clinical patient: "Very lucky; doubt if patient really needed transplant."

4 After 4 or 5 clinical successes: "Highly experimental, too risky, immoral, unethical; I understand they have had a number of deaths they are not reporting."

5 After 10 to 15 patients: "May succeed occasionally in carefully selected cases but very few patients really need an operation anyway."

6 After a large series of successes: "So and so has been unable to duplicate their results. I hear that a number of their patients are now dying late death."

7 Final stage: "This is a very fine contribution. A straightforward solution to a difficult problem. I predicted this. In fact, in 1939 I had the same idea. Of course, we didn’t publish anything. We had no cyclosporin."

The time frame of this evolution took more than 20 years, between 1960 and 1982.

The heroic days of ground-breaking cardiac surgery have long passed, and progress now relies on evidence-based medicine. To enter the field of routine clinical practice, new ideas (including techniques or technologies) need comparison with the established gold standards and demonstration of statistically superior measurable end points. Until prospective, randomized, controlled trials possibly close discussions between the supporters and doubters, who will turn into "early adopters" and "laggards" if the technique becomes the next gold standard, it is desirable and rational to debate ideas and comment on data. Nonetheless, before reading the editorials about robotics, one should recall that . . . [Full Text of this Article]

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