This Article Full Text Full Text (PDF) All Versions of this Article: 35/9/2211    most recent 01.STR.0000138024.30064.71v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Warlow, C. Search for Related Content PubMed PubMed Citation Articles by Warlow, C. Pubmed/NCBI databases Compound via MeSH Substance via MeSH Hazardous Substances DB ACETYLSALICYLIC ACID Medline Plus Health Information Stroke Related Collections Acute coronary syndromes

(Stroke. 2004;35:2211.)
© 2004 American Heart Association, Inc.

Comments, Opinions, and Reviews

The Willis Lecture 2003: Evaluating Treatments for Stroke Patients Too Slowly

Time to Get Out of Second Gear

From the Department of Clinical Neurosciences, Western General Hospital, Edinburgh, UK.

Correspondence to Dr Charles P. Warlow, Department of Clinical Neurosciences, Western General Hospital, Crewe Road, Edinburgh EH4 2XU, UK. E-mail cpw@skull.dcn.ed.ac.uk

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

	Introduction

 
Thomas Willis was born in 1621, received his classical education and then medical degree from Oxford in 1646, became a highly successful and prosperous physician, and, in 1660, was appointed Professor of Natural Philosophy at the University of Oxford.¹ Although at that time there were no neurologists as such, he coined the word neurology in his Cerebri Anatome:²

"We should deliver an exact neurology, or doctrine of the nerves" and "without the perfect knowledge of the nerves the doctrine of the brain and its appendix would be left wholly lame and imperfect."

Of course, his pharmacopoeia was primitive in the extreme and he had no reliable way of proving that any treatment interventions worked, unless they had a very obvious and immediate effect. But these days we have the most remarkable tool to evaluate our interventions, the randomized controlled trial, although it is not yet 60 years since the first trial in the modern era was published in the BMJ on October 30, 1948, of streptomycin for pulmonary tuberculosis³ (Figure 1). It was conducted in the UK just after World War II when the supply of the antibiotic was so limited that Austin Bradford Hill, the statistician, was able to persuade clinicians to use randomization between the new treatment and control as a form of fair rationing and to construct 2 groups of patients who were so similar in their prognosis at baseline that any definite difference in their outcome must be because of the new treatment.

View larger version (36K): [in this window] [in a new window]   . . . [Full Text of this Article]

This article has been cited by other articles:

				J. S. Elkins, T. Khatabi, L. Fung, J. Rootenberg, and S. C. Johnston Recruiting Subjects for Acute Stroke Trials: A Meta-Analysis Stroke, January 1, 2006; 37(1): 123 - 128. [Abstract] [Full Text] [PDF]