I AM MOST grateful to the Academy for naming me as the recipient of an E. Mead Johnson Award for 1958 and pleased beyond measure by this great honor. I cannot allow this moment to pass without acknowledging with pleasure my debt of gratitude to Dr. Richard Day, who first awakened in me a curiosity about the meaning of proof for a clinician and to Dr. John W. Fertig for his patience as teacher, critic and collaborator.
This decision of the Awards Committee has given me cause for reflection. I interpret it to signal approval of and benevolent interest in the use of the planned trial as a device to help answer questions at the clinical level. I am encouraged to think that the rules of evidence that have applied in the laboratory are now increasingly consulted on ward rounds. Mr. John W. Gardner, president of the Carnegie Corporation, recently commented upon the difficulties that result from the acceptance of a double standard of excellence at different levels of human activity; he stated that, ". . . The society which scorns excellence in plumbing because plumbing is a humble activity and tolerates shoddiness in philosophy because it is an exalted activity will have neither good plumbing nor good philosophy. Neither its pipes nor its theories will hold water."
F. H. K. Green has recently been quoted as saying, ". . . when the value of a treatment, new or old, is doubtful, there may be a higher moral obligation to test it critically than to continue to prescribe it year-in, year-out with the support merely of custom or of wishful thinking." I am encouraged to believe that we have arrived at a point in time when this moral obligation may be included as one of our clinical responsibilities.
We were required to consider our responsibility very closely in this regard about 8 years ago when confronted with the challenge of retrolental fibroplasia. As we watched the early vascular changes of this condition develop, we reasoned that these proliferating vessels might be halted by the then newly available hormone, adrenocorticotropin (ACTH). We gave this substance to an infant when, from the appearance of the ocular fundi, it was clear that the disease was progressing. The fundi of this infant returned to normal. This sequence of events was repeated following the treatment of many infants during the next year.
- Copyright © 1959 by the American Academy of Pediatrics