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PERSPECTIVES IN BIOLOGY AND MEDICINE Volume 26 ¦ Number 2 ¦ Winter 1983 INVAUDITY OF USING SO-CALLED STARUNG CURVES IN CUNICAL MEDICINE MARK D. ALTSCHULE* I. Introduction More than 2 centuries ago Samuel Johnson wrote, "An ignorant age has many books. . . . Compilers and plagiaries are to give us again what we had before, and grow great by setting before us what our own sloth had hidden from our view." Although Johnson's words apply to the present era in some ways, there are differences. Today's review articles and books are deemed essential because, as Virchow pointed out in 1854, doctors cannot keep up with the flood of publications. (Virchow recommended that physicians who felt the need for continuing education at that time need only take his basic science lectures on microscopical pathology to be brought up to date in clinical medicine.) The situation is worse today because we now have floods of data (many of them pseudodata) spewed out by purchasable machines, threatening to drown those who seek usable knowledge. To them the review article is a snorkel that permits We and limited function under restricted circumstances. After a few years, the current reviews are superseded by newer models made distinguishable, perhaps, by the names of different authors, by arrows that instead of pointing one way now point another, and by references that bear recent dates. The physician who reads such reviews is doing what he believes to be his duty. However, the physician who accepts verbatim what he reads in them is abdicating his critical functions , since many medical reviews today are little more than uncritical ?Francis A. Countway Library of Medicine, Harvard Medical School, Boston, Massachusetts 02115.© 1983 by The University of Chicago. All rights reserved. 0031-5982/83/2602-0323J01.00 Perspectives in Biology and Mediane, 26, 2 · Winter 1983 \ 171 annotated bibliographies of material the physician was too busy, too puzzled, or too disinclined to read. In this sense modern medical reviews fit Johnson's description. Physicians need critical reviews. They need them not to learn about what some experts believe about a currently popular theory but to learn how some aspect or other ofclinical practice developed out of a body of physiologic data. Basic questions that constantly arise involve whether the clinical use of the new scientific data is valid and whether the clinical interpretations actually grow out of the scientific measurements. These considerations clearly apply to the way that Starling's Law ofthe Heart is used today in clinical medicine. The current applications involve not only the interpretation of resting values of cardiac function but, more often, the purported evaluation of the effects of some stress on the heart. Discussing the heart as a pump began centuries ago, but it was not until about 100 years ago that the heart's pump function has come under intensive study. Ernest Starling gave his lecture on the Law ofthe Heart in 1915 [1], and its name has endured to the present. The name itself was derived from the greatly admired A. V. Hill's Law of Muscle. The content of Starling's lecture was also derivative in that it was based on observations made on the heart-lung preparation that had been previously devised by Newell Martin (later the first professor of physiology at The Johns Hopkins Medical School). The idea behind Starling's law was born many years before he gave his now famous Linacre Lecture on the Law of the Heart in 1915. Like all far-reaching, or perhaps far-fetched, generalizations, it was a product of a particular Zeitgeist. It had its formal origin in Otto Frank's 1895 discussion in ZeitschriftfürBiologie [2]. The paper was 67 pages in length, for in those days German publishers guaranteed their readers a certain number of pages per year. The time was after the Franco-Prussian War. Germany, out to prove that it was not-a nation of barbarians, was pouring large sums of money into its universities. Unlike Grlat Britain and France, Germany had just experienced an Industrial Revolution and hence was suddenly made aware of the possibilities of mechanization. Germany had not had an Age ofEnlightenment like that ofEngland and France. Instead, in...


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