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(Stroke. 2003;34:372.)
© 2003 American Heart Association, Inc.

Advances in Stroke 2002

Controversy: The Essence of Medical Debate

Geoffrey A. Donnan, MD, FRACP Stephen M. Davis, MD, FRACP

From The National Stroke Research Institute (G.A.D.), Austin and Repatriation Medical Center and the University of Melbourne, and the Department of Neurology (S.M.D.), Royal Melbourne Hospital and the University of Melbourne, Australia.

Correspondence to Geoffrey A. Donnan, National Stroke Research Institute, Level 1, Neurosciences Bldg, 300 Waterdale Rd, Heidelberg West, Victoria 3081 Australia. E-mail gdonnan@unimelb.edu.au

Key Words: controversy • imaging • stroke • therapy • thrombolysis

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Experience is fallacious and judgement difficult.

— Sir William Osler, 1904 1

Why does controversy exist? We have always known that it is human nature to enjoy the cut and thrust of debate. Subjective opinion is the essence of personality and is often based on singular experiences, which may have a disproportionate impact on clinical judgment. In the time of Osler,¹ the opinions of senior physicians, based on experience, were regarded as the gold standard on which clinical management was based. When we trained as neurologists, this system was still very much in place. Even with the dramatic change in practice with the introduction of evidence-based medicine,² controversies exist, because the evidence may not be well disseminated or may be of dubious quality. Furthermore, experts may disagree on the generalizability of the accumulated evidence or the relevance to an individual clinical problem.

So far in our Controversies Section, we have tried to address issues that are common to practicing physicians. By doing this we feel that most readers of Stroke are more likely to be personally engaged. Issues of this magnitude tend to ignite passions; this adds color to the text and has been a feature of the controversies covered to date.

A very large number of trials in acute stroke have generated a substantial evidence base in relation to thrombolysis, anticoagulation, neuroprotection, and the role of imaging in selection of patients for therapy. No issue has caused greater controversy than the view that intravenous tPA should be a standard . . . [Full Text of this Article]