On the Origins of Therapies: Innovation, Imagination, and the Evolution of Coronary Artery Surgery, 1910-1970

论治疗的起源：冠状动脉手术的创新、想象力和演变，1910-1970 年

• 批准号: 9144861
• 负责人: David Shumway Jones
• 金额: $ 4.84万
• 依托单位: HARVARD MEDICAL SCHOOL
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-09-15 至 2018-09-14
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9144861
• 关键词: Angina Pectoris; Blood flow; Books; Boston; Cardiac Surgery procedures; Collection; Coronary Angiography; Coronary Arteriosclerosis; Coronary Artery Bypass; Coronary artery; Creativeness; Decision Making; Decision Theory; Evidence Based Medicine; Evolution; Future; Heart; History of Medicine; Imagination; Intervention; Learning; Light; Literature; Maps; Measures; Medical; Medical center; Medicine; Methods; Modeling; Nature; Operating Rooms; Operative Surgical Procedures; Outcome; Patients; Physicians; Procedures; Process; Publishing; Randomized Clinical Trials; Reader; Reading; Recording of previous events; Research; Science; Source; Surgeon; Techniques; Testing; Therapeutic; Time; Tissues; Treatment Efficacy; Vascular blood supply; Work; coronary angioplasty; design; innovation; insight; interest; mortality; operation; skills; success

 DESCRIPTION (provided by applicant): Medical treatments constantly change over time, and the changes are usually for the better. How does this happen? It is possible to study the history of therapeutic change to gain insight into the nature of innovation in medicine. This insight can contribute not just to a future of continuing innovation, but also to medical decision making today. On the Origins of Therapies will analyze the history of cardiac surgery, focusing on the treatments of coronary artery disease. In 1968 surgeons developed coronary artery bypass grafting, one of the most important operations of the twentieth century. Inspired by this example, cardiologists developed a related technique, coronary angioplasty. Doctors did not develop these techniques from scratch. Instead, over the preceding fifty years, they had made amazingly creative attempts to design surgical treatments for coronary artery disease, either by increasing the supply of blood to the heart or by reducing the heart's need for it. Patients and doctors believed that many of these techniques worked, even ones that surgeons would now dismiss. Understanding how and why this happened is a major challenge for the history of medicine, and one that sheds light on the faith we now have in therapies today. On the Origin of Therapies will be grounded in extensive research, including a thorough review of thousands of articles from the published medical literature and careful analyses of rich archival collections that survive at prominent medical centers in Boston, Montreal, Cleveland, and Houston. It will focus on three sets of questions. First, it will examine the interplay between surgical imagination and bodily constraint, mapping the sources of creativity and innovation in surgical practice, as well as the limits of what could safely be done to bodily tissues. Second, it will explore the tensions that exist among different modes of assessing therapeutic efficacy, for instance how surgeons weighed the relative value of restored blood flow, decreased angina, and prolonged survival. Third, it will probe the impact of the pervasive rhetoric of progressive therapeutic evolution in the medical literature: faith in ongoing and inevitable progress gave surgeons the confidence to test daring techniques and a justification for downplaying the dictates of evidence based medicine. On the Origins of Therapies will be a major contribution to the literature on the history of medicine and will be essential reading for anyone interested in th processes of therapeutic change.

 描述(由申请人提供)： 随着时间的推移，医疗方法不断发生变化，而这种变化通常是向好的方向发展。这是怎么发生的？研究治疗变化的历史是可能的，以洞察医学创新的本质。这种洞察力不仅可以为未来的持续创新做出贡献，也可以为今天的医疗决策做出贡献。《关于疗法的起源》将分析心脏外科的历史，重点是冠状动脉疾病的治疗。1968年，外科医生开发了冠状动脉搭桥术，这是20世纪最重要的手术之一。在这个例子的启发下，心脏病学家开发了一种相关的技术--冠状动脉成形术。医生们并不是从零开始发展这些技术的。相反，在过去的50年里，他们做出了令人惊叹的创造性尝试，通过增加心脏的血液供应或减少心脏对血液的需求来设计冠状动脉疾病的外科治疗方法。患者和医生认为，这些技术中的许多都有效，甚至连外科医生现在都不会考虑使用这些技术。对于医学史来说，理解这种情况是如何发生的以及为什么会发生，是一个重大挑战，也是我们今天对疗法的信念的一大亮点。 关于疗法的起源将以广泛的研究为基础，包括对已发表的医学文献中数千篇文章的彻底审查，以及对波士顿、蒙特利尔、克利夫兰和休斯顿等著名医疗中心保存下来的丰富档案收藏的仔细分析。它将集中在三组问题上。首先，它将研究两者之间的相互作用 外科想象力和身体约束，绘制了外科实践中创造力和创新的来源，以及对身体组织所能做的安全的限制。第二，它 将探索不同评估疗效模式之间存在的紧张关系，例如外科医生如何权衡恢复血流、减少心绞痛和延长生存期的相对价值。第三，它将探索医学文献中关于渐进治疗进化的普遍修辞的影响：对正在进行和不可避免的进步的信念给了外科医生测试大胆技术的信心，并为淡化循证医学的指令提供了理由。《治疗的起源》将是对医学史文献的一大贡献，也是任何对治疗变化过程感兴趣的人的必备读物。