Paradigm paralysis in the management of neuromuscular disease

Abstract

Paradigm paralysis is the misplaced certainty we hold in often unjustified and unjustifiable ideas. It results from lower brain, that is, basal ganglia and limbic system nuclei, inhibiting prefrontal cortex consideration of any information that runs counter to the ideas it already holds unless there is immediate benefit to the individual in considering them. In medicine this has resulted in 4,500 years of physicians being paid for bleeding patients despite several 100 years of evidence that the bleeding was at best useless, delays in adopting aseptic labor techniques that resulted in tens to hundreds of thousands of deaths of mothers and their newborns, and today, in morbidity and mortality in patients with neuromuscular disorders.