Controversies in Therapeutics [antikvár]

PrefaceA perverse characteristic of the human race is its preference for spurious simphcity as opposed to truthful complexity. Doctors are not immune to this virus, and indeed they are often inoculated with large quantities of it in their medical education by well meaning pedagogues who try to ease student anxieties by "not making the practice of medicine too complicated." Nor is this teaching principle devoid of meritit often seems easier to build upon a solid bedrock of general (and generally valid) principles than to start with a foimdation shot full of caveats and exceptions.But sooner or later departures from the party line must be incorporated into one's medical thought if the magnificent richness of patient complaints, syndiomes, and therapies is to be adequately encompassed. A wise physician once said that doctors have to learn to live with ambiguity. They need not (and indeed cannot) resign themselves to diagnostic or therapeutic paralysis, but it is surely better in the long run to acknowledge the fact that one does not know for certain what is the "right" thing to do, even as one makes the best judgment possible at any given time.This book tries to convey the disagreements that characterize some of society's most pressing therapeutic questions. A good course in therapeutics could certainly be organized around the opposing positions taken by men of good will and expertise in the pages that follow.Some readers may recall the delightful (but now defunct) television program called "Omnibus," hosted by the urbane and witty Alastair Cooke. One such program featured a playlet by William Saroyan about an old lady and a necktie salesman. These parts were playedif memory serves correctlyby Helen Hayes and Burgess Meredith. At one point the lady asks the salesman whether he wouldn't think it splendid to die for something in which he truly believed. "No, " he replied, "I might be wrong."As I get older, I find myself thinking more and more like the necktie salesman and less and less like the old lady. Not that I have lost my passion for vigorous