Not everything in medicine is well delineated, or well established, or even well thought out; conceptualizations change with time, and many issues remain undecided and unresolved: if it were not so, medical journalism would lose its appeal and much of its purpose. Grand rounds sessions thrive on discussion and argument.
In the midst of our preoccupation with new ideas, it is well to remember that old and seemingly well-established concepts, even clinical and therapeutic dogma, may still be subject to differences of opinion, and in need of periodic reevaluation. And new ideas need skeptics as well as proponents. In The Hope of Progress,1 Sir Peter Medawar reminds us that what distinguishes science from other forms of intellectual endeavor is not creativity or imagination, but rather its inherent posture of criticism. Now controversy is one form of criticism; and controversy allows us to escape the prison of our own ideas.