| Summary: | In the early 1970s physicians engaged in fierce debates over the most appropriate method
of evaluating the efficacy of coronary artery bypass grafting (CABG). With millions of
patients and billions of dollars at stake, CABG sparked fierce controversy. Skeptics demanded
that randomized controlled trials (RCTs) be performed, while enthusiasts argued
that they already had visual proof of CABG's efficacy. When RCTs appeared, they did
not settle the controversy. Participants simply reasserted their preconceptions, defending
a trial's strengths or exploiting its flaws. The debate centered on standards of knowledge
for the evaluation of therapeutic efficacy. Specifically, cardiologists and cardiac surgeons
struggled to assess the relevance of different measures of therapeutic success: physiological
or clinical, visual or statistical. Many factors contributed to participants' decisions, including
disciplinary affiliation, traditions of research, personal experience with angiography,
and assessments of the history of cardiac therapeutics. Physicians had to decide
whether angiography provided a meaningful representation of the disease and its treatment
or whether demonstrations of therapeutic success could come only from long-term statistical
evaluation of mortality data.
|
|---|