- Email: [email protected]
Patrick W Serruys
Perspectives
Historical keyword Crisis The current “financial crisis“ comes hot on the heels of the “energy crisis“ and the “food crisis“—to say nothing of my own “identity crisis“ prompted by a “mid-life crisis“. By thus tagging situations we impart gravity and urgency to them, inherent to which is an understanding that while to do nothing is to court disaster, the opposite course holds out the promise of catharsis and recovery. Crisis is both a danger and an opportunity. More or less, this attribution has been historically constant, but until comparatively recently it was never independent of the discourses of western medicine and its metaphors. Defined as the decisive turning point in the course of a disease, crisis was the moment after which a patient either recovered or died. The concept probably predates Hippocrates, to whom it is often attributed, and may possibly have emerged from observing fever episodes in malaria. Galen, the authoritative voice of medicine until the 17th century, devoted a whole book to the subject and like subsequent authors invested enormous effort in calculating the exact moment of its appearance. Conveniently, miscalculations could be attributed to the belief that one disease easily morphed into another. The notion of crisis was in decline long before modern chemotherapy killed it off completely by arresting the natural course of diseases. A British author commented on the “modern neglect of crisis” as early as 1741. French doctors, though, continued to debate it into the 19th century—animated perhaps by its sensational reappearance in late 18th-century mesmerism where, metaphorically and to some extent literally, crisis became associated with both sexual climax and political revolution. In Victorian Britain the concept’s legacy was in hydropathic medicine, whose therapeutics were explained through it; patients would discuss who among them would next achieve crisis and hence throw off their illness. In a context in which disease was understood as an unnatural condition resulting from the intervention of alien agencies, crisis and laissez-faire economic theory easily joined hands—critical purges “naturally” restoring self-regulating markets. As deployed today, crisis may seem far from its ancient medical origins, but insofar as it is directed to economic purification and regeneration, it is still intimately a part of its foundational metaphor.
Roger Cooter Wellcome Trust Centre at UCL, London, UK [email protected]
www.thelancet.com Vol 373 March 14, 2009
Lifeline Patrick W Serruys is Professor of Medicine with a Chair in Interventional Cardiology at the Erasmus University, Rotterdam, and Head of the Interventional Department, Heartcenter Rotterdam. He received his MD (1972) from the Catholic University of Louvain and his PhD degree (1986) from the Erasmus University. In 2006, he received the highest award of the Clinical Council of the American Heart Association: the James Herrick Award. He is a Doctor Honoris Causa from the University of Athens. What has been the greatest achievement of your career? To have done the first randomised trial on a stent (BENESTENT) and get the device approved by the US Food and Drug Administration.
See Articles page 897
What is the most over-hyped field of medicine? Cell transplantation for regeneration of myocardium. And most neglected? Diet education for children. What inspires you? Being appreciated for making patients better. If you had not entered your current profession, what would you have liked to do? Pure philosophy—by the way, I started with that but quit. Who was your most influential teacher, and why? Paul Hugenholtz: with him, nothing was impossible. What would be your advice to a newly qualified doctor? My motto to them is always the same. If the future is unrealistic, it will remain the future; if the future is realistic, it will become the past fast. How do you relax? Tennis and red wine. What is your greatest regret? Not to have pursued percutaneous coronary intervention in acute myocardial infarction. If you wrote an autobiography what would be the title? Thorax Centre. Which event has had most effect on your work? My first successful intracoronary thrombolysis with immediate disappearance of chest pain and ST elevation. What are you currently reading? A l’écoute du vivant by Christian de Duve. What is your worst habit? To work on Saturday and Sunday. What is your idea of a perfect day? A full day of percutaneous intervention, followed by a game of tennis, followed by a glass of wine. What was your first memory? I forgot.
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Historical keyword Crisis The current “financial crisis“ comes hot on the heels of the “energy crisis“ and the “food crisis“—to say nothing of my own “identity crisis“ prompted by a “mid-life crisis“. By thus tagging situations we impart gravity and urgency to them, inherent to which is an understanding that while to do nothing is to court disaster, the opposite course holds out the promise of catharsis and recovery. Crisis is both a danger and an opportunity. More or less, this attribution has been historically constant, but until comparatively recently it was never independent of the discourses of western medicine and its metaphors. Defined as the decisive turning point in the course of a disease, crisis was the moment after which a patient either recovered or died. The concept probably predates Hippocrates, to whom it is often attributed, and may possibly have emerged from observing fever episodes in malaria. Galen, the authoritative voice of medicine until the 17th century, devoted a whole book to the subject and like subsequent authors invested enormous effort in calculating the exact moment of its appearance. Conveniently, miscalculations could be attributed to the belief that one disease easily morphed into another. The notion of crisis was in decline long before modern chemotherapy killed it off completely by arresting the natural course of diseases. A British author commented on the “modern neglect of crisis” as early as 1741. French doctors, though, continued to debate it into the 19th century—animated perhaps by its sensational reappearance in late 18th-century mesmerism where, metaphorically and to some extent literally, crisis became associated with both sexual climax and political revolution. In Victorian Britain the concept’s legacy was in hydropathic medicine, whose therapeutics were explained through it; patients would discuss who among them would next achieve crisis and hence throw off their illness. In a context in which disease was understood as an unnatural condition resulting from the intervention of alien agencies, crisis and laissez-faire economic theory easily joined hands—critical purges “naturally” restoring self-regulating markets. As deployed today, crisis may seem far from its ancient medical origins, but insofar as it is directed to economic purification and regeneration, it is still intimately a part of its foundational metaphor.
Roger Cooter Wellcome Trust Centre at UCL, London, UK [email protected]
www.thelancet.com Vol 373 March 14, 2009
Lifeline Patrick W Serruys is Professor of Medicine with a Chair in Interventional Cardiology at the Erasmus University, Rotterdam, and Head of the Interventional Department, Heartcenter Rotterdam. He received his MD (1972) from the Catholic University of Louvain and his PhD degree (1986) from the Erasmus University. In 2006, he received the highest award of the Clinical Council of the American Heart Association: the James Herrick Award. He is a Doctor Honoris Causa from the University of Athens. What has been the greatest achievement of your career? To have done the first randomised trial on a stent (BENESTENT) and get the device approved by the US Food and Drug Administration.
See Articles page 897
What is the most over-hyped field of medicine? Cell transplantation for regeneration of myocardium. And most neglected? Diet education for children. What inspires you? Being appreciated for making patients better. If you had not entered your current profession, what would you have liked to do? Pure philosophy—by the way, I started with that but quit. Who was your most influential teacher, and why? Paul Hugenholtz: with him, nothing was impossible. What would be your advice to a newly qualified doctor? My motto to them is always the same. If the future is unrealistic, it will remain the future; if the future is realistic, it will become the past fast. How do you relax? Tennis and red wine. What is your greatest regret? Not to have pursued percutaneous coronary intervention in acute myocardial infarction. If you wrote an autobiography what would be the title? Thorax Centre. Which event has had most effect on your work? My first successful intracoronary thrombolysis with immediate disappearance of chest pain and ST elevation. What are you currently reading? A l’écoute du vivant by Christian de Duve. What is your worst habit? To work on Saturday and Sunday. What is your idea of a perfect day? A full day of percutaneous intervention, followed by a game of tennis, followed by a glass of wine. What was your first memory? I forgot.
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