Retiring the Learning Curve

Excerpt

Tom Chalmers was a great American advocate for the power of metaanalyses and the adjudication of doubt through randomized controlled trials. He was famous for his admonition to randomize with the first patient in a trial and for his abhorrence of the learning curve in clinical therapeutics. A scientific icon, Dr. Chalmers was an internist, a gastroenterologist, a NIH researcher, a department head, a medical school dean, and a hospital president. His distaste for the learning curve principle was universal and not limited to surgery. He often stated that if a physician or surgeon believed that his first cohort of patients undergoing a new procedure would have a higher mortality and morbidity than his/her subsequent patients, the doctor was obligated to share that perception with those first patients and to tell them that his care of them will be more filled with hazard than he hopes his subsequent efforts will be. …