Sorting out the doctor's bag

Abstract

It is a p leasure to address this first scientific mee t ing of the Society for Clinical Trials. I congratulate Dr. Roth and the other m e m b e r s of the Board of Directors on hav ing founded , in so t imely a fashion, a new forum for discussion of impor t an t p rob lems . I r e m e m b e r our surpr ise at the popular i ty of the Nat ional Conference on Clinical Trials Methodo logy [1] held at NIH in 1977, and that, in his closing remarks at that meet ing , Dr. Roth emphasized the need for just such a society as this. The general re la t ionship of clinical trials to the organiza t ion of the doctor ' s bag is obv ious , and my title was chosen to allow me to sample a full range of ideas. First, t h o u g h a s I see so m a n y young faces in the aud ience 1 w o n d e r if e v e r y o n e knows what a doctor ' s bag is? In ancient t imes when doctors went on house calls, they carried black satchels conta in ing most of wha t was useful: d iagnost ic ins t ruments , bandages , and nos t rums. In m a n y cases, any th ing that could be done anywhere could be done in the home with the contents of the bag. Times have changed. The CAT scanner, the Anger camera, or the cardiac catheter izat ion labora tory cannot be c r a m m e d into a bag. Nor is there room for all the poten t drugs now useful in t reatment . The bag has become the medical center , replete with e q u i p m e n t tended by a corps of special ized technic ians . There are consu l tan t special is ts of eve ry type , shelves of medic ina l p repara t ions that dwind le into the dis tant dep ths of the pharmacy, and endless ancil lary services. The m o d e r n d o c t o r i n the u rban set t ing at l e a s t n o longer carries his bag. He moves a round inside it, and feels insecure w h e n ou t s ide its walls. It is no w o n d e r that house calls are becoming a rare recollection of ano ther age. Another consequence of the bu rgeon ing content of the doctor ' s bag is that medical costs are rising. They are r ising fast enough to have become a major focus of a t ten t ion in recent years. When it becomes technically poss ib le to do more for the pat ient , we feel compel led to do more, regardless