Don’t Confuse the Art and Science of Medicine: PCI vs CABG for Left Main Disease

It is often said that medicine is both an art and a science. In an imperfect world this is both inevitable and desirable. But it is extremely important that the two should not be confused with each other. In particular, because the “science” side of the equation has achieved overwhelming prestige and authority, it is often the case that that the “artistic” side seeks to claim the mantle of scientific certainty, Frequently this occurs when “experts” skate over the difference between scientific certainty and uncertainty. Often they do this by the selective use of data, in particular observational data and imperfect or cherry picked instances of non-robust randomized controlled studies that are the hallmark of real and convincing scientific certititude.

The controversy over the uses of PCI or CABG for left main coronary disease is a perfect example of this problem.

In his initial blog post on CVCT CardioBrief Bernard Gersh maintained that the scientific evidence in support of PCI was now sufficient to raise the status of PCI in scientific guidelines. But then Sanjay Kaul pointed out that by strict scientific standards the evidence was weak. The key point I want to highlight here is that in his response to Kaul’s post Gersh does not address the scientific issues raised by Kaul but instead bases his defense on “a clinical perspective.” Gersh illustrates my point…

Click here to read the full post on CVCT CardioBrief.




  1. William E. Boden, MD says

    Excellent perspective as always, Larry. Can you please send me your current best email address?


    Bill Boden

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