Poetry in Medicine

I made a delicious find today. In an article by R Brian Haynes and Graeme A Haynes, "What does it take to put an ugly fact through the heart of a beautiful hypothesis?" published in Evidence Based Medicine 2009;14:68-69 (you know, light reading), the authors cite a poet! They quote Samuel Johnson, "the chains of habit are too weak to be felt until they are too strong to be broken." They also cite physicist Max Planck, "A new scientific truth does not triumph by convincing its opponents and making them see the light, but rather because its opponents eventually die and a new generation grows up that is familiar with it."

I enjoyed this article because it entertains a poet when I just spent a week immersed in poetry, and because the quotes are fascinating. Why are we so stubborn? The article discusses the fact that multiple large randomized studies have shown tight glucose control in patients with long-standing type 2 diabetes is not beneficial. Does that surprise you? It surprised me; I've had so many clinicians focus on hemoglobin A1c that I was shocked to find that the evidence is not there. In the ACCORD, ADVANCE, and VADT trials, tight control did not lower overall mortality, CV-related mortality, stroke, amputations, or clinical (as opposed to surrogate) microvascular endpoints. Hemoglobin A1c doesn't matter as much as most people think it does! We should instead be focusing on cardiovascular risk factors. Sadly despite overwhelming evidence, things are so slow to change.