Abstract
Sometimes, a distinction is made between the art and science of medicine, but these two concepts are closely related. The clinician must act as rationally as possible. A scientific approach to clinical medicine only helps to disclose the importance of the human factor. Medical ethics also belong to the art of medicine. Since the clinician must always aim at doing what is best for the patient and for the community he serves, all clinical decisions have an ethical component [1]. The science of trials has added another dimension to academic research: the ultimate evidence that in clinical medicine, blindness is more helpful than observational skills. A double blind randomized placebo controlled approach has proven to be the only method, able to overcome honorable intellectual biases. It can not be denied that trials are attractive for three more reasons: (1) commercial interests; (2) in large hospitals, it is convenient to enter the patient in a therapeutic trial, as the trial takes over all therapeutic responsibility; (3) better patient follow-up.
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References
Wulff HR, Lennard-Jones JE. Rational Diagnosis and Treatment. Oxford: Blackwell Scientific Publications 1981: 4.
Feinstein AR. An additional basic science for clinical medicine: II. The limitations of randomized trials. Ann Intern Med 1983; 99: 544–50.
Epstein AE. AVID necessity. PACE 1993; 16: 1773–5.
The CAST Investigators. Effect of encainide and flecainide on mortality in a randomized trial of arrhythmia suppression after myocardial infarction. N Engl J Med 1989; 321: 406–12.
Echt DS et al. Mortality and morbidity in patients receiving encainide, flecainide, or placebo—The Cardiac Arrhythmia Suppression Trial. N Engl J Med 1991; 324: 781–8.
The Cardiac Arrhythmia suppression Trial II Investigators. Effect of the antiarrhythmic agent moricizine on survival after myocardial infarction. N Engl J Med 1992; 327: 227–33.
Greene HL, Richardson DW, Barker AH et al. Classification of deaths after myocardial infarction as arrhythmic or nonarrhythmic (The Cardiac Arrhythmia Pilot Study). Am J Cardiol 1989; 63: 1–6.
The CASCADE Investigators. Cardiac arrest in Seattle: Conventional versus amiodarone drug evaluation (The CASCADE Study). Am J Cardiol 1991; 67: 578–84.
Ector H, Rogers R, Rubens A et al. Classification of death in patients under antiarrhythmic treatment. PACE 1993; 16: 2250–4.
The Criteria Committee of the New York Heart Association. Nomenclature and Criteria for Diagnosis of Diseases of the Heart and Great Vessels. Boston: Little, Brown and Company 1973: 286.
Lown B, Wolf M. Approaches to sudden death from coronary heart disease. Circulation 1971; 44: 130–42.
Lown B. Sudden cardiac death - 1978. Circulation 1979; 60: 1593–9.
Lown B. Sudden cardiac death — 1978. Circulation 1979; 60: 1593–9.
Kim SG, Fogoros RN, Furman S et al. Standardized reporting ICD patient outcome: The report of a North American Society of Pacing and Electrophysiology policy conference, February 9–10, 1993. PACE 1993; 16: 1358–62.
Rogers R, Ector H, Rubens A, Timmermans C, Heidbüchel H, De Geest H. Classification of death in patients under antiarrhythmic treatment. In Aubert AE, Ector H, Stroobandt R (eds): Cardiac pacing and electrophysiology. A bridge to the 21st century. Dordrecht, The Netherlands: Kluwer Academic Publishers 1994; 41–8.
Simon SR, Powell LH, Bartzokis TC, Hoch DH. A new system for classification of cardiac death as arrhythmic, ischemic, or due to myocardial pump failure. Am J Cardiol 1995; 76: 896–8.
Ector H. Endpoints and trials: a matter of life and death. PACE 1994; 17: 1079–81.
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© 1996 Kluwer Academic Publishers
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Ector, H. (1996). Endpoints and trials: a matter of life and death. Classification of death in patients under antiarrhythmic treatment. In: Oto, M.A. (eds) Practice and Progress in Cardiac Pacing and Electrophysiology. Developments in Cardiovascular Medicine, vol 183. Springer, Dordrecht. https://doi.org/10.1007/978-94-009-0219-0_1
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DOI: https://doi.org/10.1007/978-94-009-0219-0_1
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