Half-life of surgical truth in general surgery

Abstract

Introduction Karl Popper’s hypothetico-deductive model contends that an assertion is true if it agrees with the facts, and that science progresses via paradigms held to be true until replaced by better approximations of reality. Our study aimed to estimate the half-life of surgical dogma. Methods The first 15 general surgery articles at 5-year intervals were extracted from the British Journal of Surgery since its inception in 1913. A statement summarising each article’s conclusion was formatted, and non-conducive articles were excluded (n=22). A total of 293 article statements were reviewed and marked as true or false by a cohort of 15 senior general surgeons, with a majority positive response denoting a true statement. Regression analysis of the relationship between perceived truth and time was performed. Results Median reviewer positive response rate was 49.5% (range 35.8–64.2%), with over 80% of responders in total agreement regarding 151 statements (51.5%) and deeming 137 (46.8%) currently true. Publication year correlated with percentage of true responses (rho 0.647, p=0.002). Linear modelling of true responses related to 5-year intervals (R2=0.398, p=0.002) estimated the annual rate of loss of truth to be 0.25%, equating to a half-life of 200.0 years. Conclusions Contrary to popular belief, it appears THAT surgical dogma does not lose its lustre for some seven generations. Regression line extrapolation is contentious but would suggest that the current era of surgical knowledge extends from 1769 – the days of John Hunter, the ‘father of modern surgery’ – to 2176, although relative rates of innovation may accelerate and move the nexus point.