Intracranial bypass surgery for cerebral arterial disease and the responsibility of the practicing physician.

IT IS SOMETIMES HARD to know whether to applaud with amazement the rapid progress of science — exemplified by such diverse but important achievements as travel to the moon, enzymic dissection, and replication of the gene — or to decry the pedestrian pace at which the medical scientist provides the practicing physician with the best present answer to pressing therapeutic problems. This dichotomy in achievement rate is due neither to an absence of talented scientists in medicine and biology nor to an unwillingness of these individuals to attack pertinent problems, although one does hear these complaints from rominent politicians, from puzzled and frustrated lay individuals, and even from physicians themselves. Some element of truth can usually be found to support almost any criticism, and a balanced perspective on such problems is very hard to achieve, even after thoughtful investigation of the facts. It might thus be more fruitful to consider the unique nature of our perplexing problems in medicine and in the process to attempt to discover constructive ways to aid in their solution rather than wring our hands in distress at the absence of one. In a recent important article which should be read by all physicians, Thomas R. Dawber addressed several important factors that bear on the relationship of science, the scientific method, and the practice of medicine. Even when rigorous scientific results are not available, the methods of science are employed by the medical practitioner. Dawber notes that the medical practitioner possibly does not envision himself as an investigator; nevertheless, he tests a "best working hypothesis" every time he undertakes an unproved therapy. He runs frequent and serious risk either of accepting prematurely an assumption that a given therapy works or, equally likely, of rejecting an effective therapy because of a chance run of "bad luck" in his own early personal assessment. There are numerous examples. Many of them involve therapies for major diseases affecting large