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）： 医疗治疗会随着时间的流逝而不断变化，并且通常会变得更好。这是怎么发生的？可以研究治疗理论的历史，以深入了解医学创新的本质。这种见解不仅可以为持续创新的未来做出贡献，还可以为今天的医疗决策做出贡献。关于疗法的起源，将分析心脏手术史，重点是冠状动脉疾病的治疗方法。 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。受这个例子的启发，心脏病学家开发了一项相关技术，即冠状动脉成形术。医生没有从头开始开发这些技术。取而代之的是，在过去的五十年中，他们通过增加对心脏的血液供应或减少心脏的需求来设计出令人惊讶的创造性尝试来设计冠状动脉疾病的手术治疗方法。患者和医生认为其中许多技术都起作用，即使是外科医生现在也会解雇的技术。了解这种情况是如何以及为什么发生的，这是医学史的主要挑战，并且阐明了我们现在对疗法的信念。 关于疗法的起源，将基于广泛的研究，包括对已发表的医学文献中数千篇文章的彻底审查，以及对在波士顿，蒙特利尔，克利夫兰和休斯敦的著名医疗中心生存的丰富档案收藏的仔细分析。它将集中在三组问题上。首先，它将检查 手术的想象力和身体限制，绘制了手术实践中的创造力和创新来源，以及可以安全地对身体组织采取的措施的局限性。第二，它 将探索评估治疗效果的不同模式之间存在的紧张局势，例如，外科医生如何权衡恢复的血流的相对值，减少心绞痛和延长生存率。第三，它将探讨进步治疗进化在医学文献中的普遍性言论的影响：对正在进行的和不可避免的进步的信念使外科医生有信心测试大胆的技术，并有理由淡化基于证据的医学指示的理由。关于疗法的起源将是对医学史的文献的重大贡献，对于对理论变化过程感兴趣的任何人来说，这都是必不可少的阅读。