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Message from the MGH

The pursuit of paradigm-shifting ideas in medicine.

Spring 2006
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Proto Spring 2006 cover

For every paradigm-shifting medical advance there may be 
hundreds or even thousands of ideas that never make it out of the lab. Still, medicine’s innovative thinkers forge ahead—undeterred by traditionalists who balk at revolutionary, untested ideas, especially when a perfectly adequate alternative exists. In fact, some of the medical world’s most promising technologies have emerged only after risk-takers persevered amid persistent criticism and condemnation.

In this issue of Proto, we consider a nascent technology known as natural orifice translumenal endoscopic surgery (NOTES). Unlike today’s minimally invasive standard, laparoscopy, in which surgeons use tiny incisions to reach the abdominal cavity, natural orifice surgeons would follow a different route: threading a flexible scope into the mouth, down the throat and through a hole cut into the stomach wall to gain access to the appendix, gallbladder and other organs.

As more physicians learn about this idea, some are excited by its promise—of quick recovery, minimal pain and no external scarring. Others remain wary, concerned that the procedure is fraught with unnecessary risk and likely complications. Could natural orifice surgery be one of the paradigm-shifting ideas that eventually enters the medical mainstream? The answer may be years away, as we await results of additional preclinical studies and the possible progress to human trials.

Thirty-five years ago, the idea of treating cancer by shutting off tumors’ blood supply—the subject of another story in this issue—was at a similar crossroads. In the early 1970s, the notion that the growth of new blood vessels, known as angiogenesis, might play a role in cancer was widely ridiculed. Yet Judah Folkman and a few other believers doggedly pursued this hypothesis; their persistence gave rise to a field of research that has begun spawning many promising therapies.

Two other stories in this issue also tell of the dogged pursuit of big ideas. When AIDS emerged 25 years ago, a handful of scientists became, almost by chance, crusaders out to conquer a deadly new disease. Meanwhile, the fight to eradicate a much older disease, polio, may finally be won, though the virus is proving an elusive foe. Central players in both battles describe lessons that have applications beyond those diseases. Their stories, like those of the proponents of natural orifice surgery and antiangiogenic cancer therapies, are ongoing. We’ll keep you posted.

Peter L. Slavin, M.D.
President
Massachusetts General Hospital
David F. Torchiana, M.D.
CEO and Chairman
Massachusetts General Physicians
Organization
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