Time for another revolution? The Flexner Report in historic context, reflections on our profession.

The Flexner Report, published in the early 20th century, turned medicine toward a firm scientific foundation and raised standards of education and practice. This corrected many of the profession's deficiencies present at the turn of the century such that medicine became capable of improving the health of humanity. While the focus of education on the sciences suited the needs of the era, the pendulum may have swung too far. As medical schools clamored for funding from wealthy capitalists to achieve new standards, they lost autonomy and adopted unsaid values that were possibly a danger to humanity. This dynamic may have led to the manifestation of medicine's dark history marked by the eugenics movement and the Tuskegee Project. This history demonstrates how medicine can impact humanity detrimentally when the broader scope of the humanities and arts is lost. In spite of this understanding, medical education has been dogmatic and resistant to change. The paper ends with a description of the crisis in modern medicine that is on par with the problems it faced in the early 1900s and concludes that it is indeed time for another revolution.

Matched-control retrospective study of the acute and late complications in patients with collagen vascular diseases treated with radiation therapy.

BACKGROUND: Controversy surrounds the potential complication rate of patients with collagen vascular diseases (CVD) after radiation. We assess the acute and late complications (based on Radiation Therapy Oncology Group criteria) by a matched-control retrospective study. PATIRNTS/METHODS: The charts of 12,000 patients treated with radiation therapy at the University of Louisville from 1982 to 2001 were reviewed for CVD. A total of 38 patients with documented CVD were compared with a matched-control group of 38 patients without CVD. Median follow-up for patients with CVD was 35 months. The patients were matched on the basis of site treated, age, dose, date of treatment, sex, treatment goal, follow-up, tumor site and histology, therapeutic technique, and general treatment method. The patients with CVD included 21 patients with systemic lupus erythematosus (55%), two with scleroderma (5%), four with Raynaud's phenomena (11%), three with fibromyalgia (8%), three with polymyalgia rheumatica (8%), three with Sjögren's syndrome (8%), and two with polymyositis-dermatomyositis (5%). Twenty-nine patients received curative doses, and nine patients received palliative doses. RESULTS: No difference was observed in the incidence of acute or late complications between the two groups. For CVD and matched-control patients receiving curative doses, the incidence of acute reaction for grade II was 49% versus 58% and for grade III was 7% versus 7%, respectively. The incidence of late reactions for patients with CVD and the matched control patients for grade I was 3% versus 7%, for grade II was 7% versus 3%, and for grade III was 7% versus 7%, respectively. The patients treated with palliation had a similar incidence of acute reaction in the CVD and the matched-control groups. No patients in the CVD or matched-control group had fatal complications. Only patients with scleroderma had a slight increase in acute and late complications. CONCLUSION: This is the largest matched-control study thus far in the literature. In the comparison between the patients with CVD and the matched-control patients, there was no significant difference in the incidence of acute or late complication. However, there was a higher incidence of radiation complications in patients with scleroderma. Importantly, no fatal complication was noted in any of the patients with CVD.