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Throughout the history of medicine,
eminent authorities e.g. designing surgical procedures made major contributions
that stood the test of time. At times advice given by some authority figures
lacked scientific proof. This has led to delay in true progress in optimizing
patients’ outcome. I will give two examples of such delay from the field of
obstetrics. Firstly, the use of prenatal steroid administration to mothers at
risk for delivering prematurely to minimize neonatal respiratory distress
syndrome (RDS) was reported in the late 1960’s. By 1982, there were enough
randomized controlled trials supporting the beneficial effects of such therapy,
yet in the mid 1980’s a narrative (not systematic) review by an authority
figure was published warning against the use of prenatal steroids to reduce (RDS).
It was not until 1989 that a systematic review of all available trials was
published and concluded that the evidence is overwhelming in favor of the
beneficial effect of steroid therapy. How many neonates were denied such an
effective therapy? The second example of delay in optimizing maternal/fetal
outcome due to an authority figure advice that lacked scientific proof is in the
treatment of eclampsia. The North American school used magnesium sulfate and
will swear by it and condemned the use of diazepam on the ground of efficacy and
neonatal hypotonia. The European school swore by diazepam and condemned
magnesium sulfate on the ground that it is a very dangerous drug that can lead
to maternal respiratory arrest. This attitude of both schools is a manifestation
of the effect of professional expert authorities advice. It was not until the
late 1980’s that the treatment of eclampsia was evaluated through the
scientific approach of Randomized Controlled Trials (RCT’s). The conclusion of
these trials was that magnesium sulfate is superior to diazepam in reducing
recurrence of eclamptic fits. What a scandal that we had to wait 70 years for
the answer".
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