He is director of The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, and chief medical editor of Ophthalmology Times.

Peter J. McDonnell, MD

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By the time I went off to college I had narrowed my career aspirations to 1 of 3 paths: physics, engineering, or medicine. 

The appeal of a life spent in a scientific field was that truth was knowable and although falsehoods and mistaken beliefs might temporarily gain favor, additional experimentation using the scientific method would ultimately prove them false and the bad ideas would be swept aside.

Scientific knowledge does advance. But often this is not the result of a brilliant new paper being published. Rather, as German physicist Max Planck somewhat cynically declared, science advances one funeral at a time. 

Planck noted “a new scientific truth does not triumph by convincing its opponents and making them see the light, but rather because its opponents die, and a new generation grows up that is familiar with it.”

I have witnessed this phenomenon. I was a medical student when a pair of Australian physicians proposed that duodenal ulcers were not the result of acid hypersecretion but were caused by a bacterial infection, only to be ridiculed.

Not because others performed experiments to test the hypothesis and found it to be incorrect but because “everybody knows” ulcers are caused by acid. It took some 20 years, but we came to accept 

Similarly, my chairman during my ophthalmology residency, Arnall Patz, MD, observed while he was an ophthalmology resident that a high percentage of low birth weight premature babies that developed a disease called retrolental fibroplasia (what we now know as ROP) had been given pure oxygen to breathe.

Thinking and rethinking ophthalmology: Are you?


He hypothesized a causal relationship and designed a clinical trial to prove his hypothesis. National Institutes of Health reviewers called him unscientific and blocked the trial. 

When the trial did start, nurses raised the oxygen back to 100% after Arnall had lowered it in some of the babies. 

This was discovered, the study was conducted, and Patz was proven correct. The findings were not accepted, and yet another study confirmed toxicity from pure oxygen.

Anecdotes like these may be interesting to talk about over cocktails, but are there any “scientific” data to support Plank’s idea about funerals? 

Interestingly, there are! In a 2019 paper in 

 Azoulay et al examined whether the premature death of eminent scientists caused measurable changes in the literature of those fields. 

Planning is important — even when “nobody knows nothing”

They found that when the “star” scientist is alive, outsiders are reluctant to challenge their ideas. But the star’s death is followed an infusion of new ideas.

To me, the cautionary tale here is that senior famous people must be on guard that they do not become impediments to progress and the ideas of their junior colleagues. 


1. Coy P. Science advances one funeral at a time. The latest Nobel proves it. 

. October 10, 2017. Accessed February 19, 2021. . Available at: 

https://www.bloomberg.com/news/articles/2017-10-10/science-advances-one-funeral-at-a-time-the-latest-nobel-proves-it

 Nobel prize for H.pylori Discovery.2005 Nov/Dec;152.

 April 19, 2005. Accessed February 19, 2021. Available at: 

https://www.washingtonpost.com/archive/lifestyle/wellness/2005/04/19/establishing-proof/b3bce1bc-0afc-4797-973f-367114e96214/

4. Azoulay P, Fons-Rosen C, Zivin JSG. Does science advance one funeral at a time? 

Articles

A word from Chief Medical Editor Peter J. McDonnell, MD.

Moving forward: Does science progress one funeral at a time?

My electronic devices occasionally send me messages with the apparent intent of helping me. The news they give me is a mix of good and bad.

During the pandemic, I admit to being tempted to stretch out on the couch with a book more than I used to. I have also been trying new recipes on my grill. Some of them have turned out quite well. 

As a result, I have been eating more. Finally, I have a couple of so-called friends who are ardent oenophiles and who send me a photo of the wine bottle they have opened to enjoy that evening. Frequently, I succumb to peer pressure and follow their bad example.

My phone, concerned for my health, has been sending me messages no doubt intended to counteract these bad habits. 

I get reports on how many steps I took that day, the length of my stride, the total distance I traversed, and my speed. I get an alert telling me that this week I am behind in the number of steps compared with last week. 

Succession planning: Following an 'institution' can be tough

It does not come right out and accuse me of being a lazy son of a gun, but it is clear to me that when I am behind the prior week or month, my phone is disappointed in and silently judging me.

The one piece of good news is that my Walking Asymmetry Score is 0%. It turns out (according to my phone) that walking asymmetry is the percent of time that steps with one foot are faster or slower than the other foot, and the lower the percentage of asymmetry the healthier a person’s walking pattern. So not to brag, but my 0% is a perfect score.

But it gets worse. My laptop runs software produced by a different megacorporation than the one that makes my phone, and sends me regular emails that purport to analyze my “well-being.” 

According to this helpful analysis, in the previous month my “quiet hours” (defined as the time outside normal scheduled working hours) were being occupied by meetings (30%) and emails (70%). 

When emails arrive during my quiet hours, I read over half of them within 30 minutes. The report tells me that in the previous month, I had 0 quiet days, defined as days during which my quiet hours were not disrupted. This score of 0 is not perfect but in fact is the worst possible score. 

According to the report, this means I was not “able to disconnect and recharge.”

The implications of my getting the lowest possible well-being score are not spelled out but certainly ominous. 

Probably my lack of quiet time to “recharge” and ponder great issues will result in my head exploding or at a minimum the severe deterioration of my thought processes (the latter coming as no great surprise to those who read these columns of mine). 

Will my perfect 0% score in walking asymmetry counteract my dismal 0% score in well-being, or am I fated to soon shuffle off this mortal coil?

No doubt these megacorporations’ monitoring and reporting on the speed of my feet and the rapidity with which I read and respond to emails on nights and weekends is trying to help people like me. 

But it seems a bit creepy that all of this information about me (and I presume you) is being gathered, stored somewhere, and analyzed. 

Big Brother is watching: Technology is looking out for me


Gene Bartow was an American collegiate basketball coach. In 1975, he began coaching the varsity team at a university in Southern California. 

In his first season, his team won its conference championship and reached the Final Four in the National Collegiate Athletic Association tournament to select the national champion. 

In his second season, they were again conference champs and again qualified for the national “March Madness” tournament. After 2 years, his team had won 52 games and lost 9.

Bartow’s average winning percentage of .852 placed him among the elite of the coaching pantheon, comparing favorably to the legendary Adolph Rupp (University of Kentucky) at .822, Dean Smith (Michael Jordan’s coach at the University of North Carolina at Chapel Hill) at .776, and Mike Krzyzewski (coach of perennial basketball powerhouse Duke University) at .764. 

Few coaches even reach the Final Four during their entire careers. For Bartow to accomplish this in his first year was quite a feat.

What was Bartow’s reward for this tremendous performance? Despite a remarkable 2-year record, Bartow was shown the door. He was guilty of an unpardonable sin—he was not John Wooden.

Wooden was the legendary basketball coach who preceded Bartow at the University of California, Los Angeles (UCLA), and who ended his career with a remarkable string of victories and national championships. As a result, fans came to expect national championships as their right.

Marques Johnson was a star player for UCLA under both Wooden and Bartow. Johnson said, “[Coach Bartow] was a sensitive person. He was used to being totally embraced as a coach and a person and he was just not ready for the kind of vitriol thrown at him when he took Coach Wooden’s place. He never came to grips with it, and it bothered him more than anything. After 2 years, he was gaunt and pale and he refused to read the Los Angeles newspapers because there was so much negativity. But he was a wonderful human being, a super nice guy, and a great coach.”

Whether Bartow was pushed out or left on his own to avoid a toxic situation may be debated. But no one disputes that he had incredible abuse heaped upon him.

Ironically, Bartow’s win-loss record at UCLA bested that of his revered predecessor. Wooden ended his (albeit much longer) career at UCLA with a winning percentage of .808. Few coaches who followed Bartow would match his winning percentage.

What possible relevance could this tale of 2 coaches hold for ophthalmologists and physicians in general? Just as with coaching jobs, from time to time a transition in leadership takes place in our medical practices, hospitals, departments, and divisions. 

When considering whether to throw one’s hat in the ring for a vacated leadership position, I think the wise ophthalmologist should take stock of the departing leader and any associated “cult” following. 

Like basketball coaches, no 2 medical executives are identical in their personalities, leadership styles, and priorities. As demonstrated in the case of Bartow, objectively demonstrable excellence might not be able to overcome the emotional attachment to a previous longstanding leader. 



1.Henderson M. Gene Bartow, man who followed John Wooden, dies. Patch. January 4, 2012. Accessed March 30, 2021. 

https://patch.com/california/ranchosantamargarita/gene-bartow-man-who-followed-john-wooden-dies

Drew Bledsoe was the first overall pick in the 1993 National Football League (NFL) draft and went on to play in the pros for 14 years. He was voted by his fellow players to 3 Pro Bowls and in 1995 became the youngest quarterback ever to play in the game.

After his football career ended, Bledsoe returned to his home state of Washington and did something quite unusual for a stellar athlete: He became a stellar businessman. 

He found he had an appreciation for fine wine, and the Walla Walla Valley region where he had grown up proved to be an excellent place to grow wine grapes. Working with advisors with knowledge of the winery business, he started a winery, and his first vintage came in at No. 51 of 

 magazine’s 100 finest wines in the world. Bledsoe went on to found 3 successful wine estates. 

, his net worth today is approximately $60 million.

In a recent interview, Bledsoe described a conversation he had with a financial adviser a few years after his retirement from the NFL. He needed to raise money for a business deal and was concerned that might prove difficult. 

The financial adviser told him not to worry, telling him “If we can’t raise it from the banks or the professionals, we can just get the money from athletes and doctors.”

It seemed strange to Bledsoe at first that athletes and doctors were lumped together, especially since “doctors should be the smartest people in the world.” But upon reflection, he decided that doctors and athletes are wired the same way:

> We have God complexes (anything we do, we will be successful).

> We think we know everything, but we often do not know a lot when it comes to investing.

We all know examples of professional athletes who earn incredible sums of money, only to declare bankruptcy a few years after retirement. Similarly, as portrayed in 

, the unscrupulous stock manipulators love to prey upon naive physicians.

I remember my father, a general surgeon, spending all his waking time either working or reading his surgery journals. He would say that “doctors are the worst businessmen,” and he was kind of living proof of that. To make up for this, he relied on a businessman friend for advice. 

Unfortunately, his trust in that man was misplaced.

My own view is that it is not shameful for physicians to think about finances and investing. Surgeons can become disabled or pandemics can appear out of the blue. Financial peace of mind allows physicians and athletes to concentrate on performing their jobs well.

Physicians and athletes classically come out of training and begin receiving large paychecks with little-to-no preparation for how to handle their finances. 

Drew Bledsoe is right; even we ophthalmologists are not gods. 

Those of us who lack the time and/or interest in learning how to save and successfully invest would be wise to seek out and carefully vet competent advisors who do not have conflicts of interest. 


1. Invest Like a Boss. Drew Bledsoe, from pro football to wine estates. 

Published January 26, 2021. Accessed March 3, 2021. 

https://www.youtube.com/watch?v=GE1SUo3d93I

Professionals can often make financial mistakes.

Peter J. McDonnell, MD

Articles

Big Brother is watching: Technology is looking out for me

Succession planning: Following an 'institution' can be tough

Athletes and doctors: not that different

Moving forward: Does science progress one funeral at a time?