The structure of cardiological revolutions. James B. Herrick Lecture.

Abstract

Four revolutions are transforming the cardiology of our day. The first is a social revolution. It has resulted in plummeting esteem for the medical profession reflecting disenchantment coupled with the rapid emergence of the recognition that health care is a right rather than a privilege. The second revolution, interventional cardiology, has provided powerful therapeutic tools demanding technical as well as cognitive expertise. The third, the revolution in molecular and cellular biology, is transforming our understanding of mechanisms underlying disease. Because of the seminal importance of progress in basic science to advances in clinical cardiology, features of these three revolutions are being synthesized in a fourth, a revolution transforming cardiology itself. Novel approaches are needed for optimal training of clinicians with diverse areas of interest, investigators in fundamental and clinical research, house staff, and students; for optimal use of clinical and research resources; and for optimal responsiveness to the needs of patients. They must be developed with cognizance of and fidelity to our clinical and scientific heritage.