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Up Front | Feb 2016


Pessimism: a Rebuttal

The following letter is in response to “Cleaning out the Garage,” an editorial by Robert J. Weinstock, MD, that appeared in our January 2016 edition.

I enjoyed reading Dr. Weinstock’s recent editorial. In it, he describes his storeroom filled with outdated ophthalmic technologies. He wonders at the practice patterns of those “pessimistic” physicians who have resisted, or failed to share, his commitment to continuing practice innovation, improvement, and advancement—out with the old machines and procedures, in with the new.

Poor Luddite souls. That is one way to see the storeroom.

An alternative view could be suggested. The room is filled with technology that did not reflect successive advances. The technology might represent repeated advances down blind paths. The room might be filled with technologies that were not advanced through demonstrated scientific benefit for patients but that were popularized via hype, industry advertising, and advocacy by professional shills who endlessly threaten conservative physicians that they will be left in the dust of medical history by “new paradigms” if they fail to jump onboard.

In fact, one can even imagine technologies now gathering dust that not only failed to provide improvement but that actually were shown over time to be of clinical harm. One can imagine expensive technologies whose main benefit was providing increased revenue for physicians and increased sales to ophthalmic manufacturing companies. One can imagine technologies that gave marketing opportunities for early adopters but that did not show improved clinical outcomes when adopted into real-world practice.

One can imagine technologies marketed before they were proven of worth.

I have been in practice for 24 years. I have never needed to rent a storeroom to fill with old equipment, gathering dust, left behind. I have unfortunately never been the first one on my block to bring new ideas and benefits to my patients. I have fortunately never been the first to bring new avenues of harm.

I guess that is one definition, eager to avoid bringing harm to my patients—a “pessimist,” I mean.

Mark Johnson, MD
Venice, Florida

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