The Ninth Annual George R. Daicoff Lecture: The morality of innovation: a twentieth century surgical legacy.

I T IS A GREAT HONOUR TO HAVE BEEN ASKED TO deliver the Ninth Annual George R. Daicoff Lecture. I met Dr Daicoff 18 years ago, when I first attended a meeting of the Congenital Heart Surgeons’ Society. He had been one of the sixteen pioneers of congenital cardiac surgery who had founded that organization many years earlier. Some of the earliest contributions of Dr Daicoff date back to an era when congenital heart surgery was truly in its infancy. An example of these contributions is an often cited report published in Circulation by Dr Daicoff and Dr John Kirklin of the Mayo Clinic in 1967 entitled ‘‘Results of Operation for Atrial Septal Defect in Patients Forty-five Years of Age and Older,’’ which established that adult patients have significantly longer survival with closure of their defects. This pattern of innovation and productivity continued as Dr Daicoff imported paediatric heart surgery to Florida. It is in the spirit of honouring this history of innovation that I have chosen the topic of this presentation. As physicians and related health care professionals of the 21st century, we have inherited from our predecessors a legacy of progress and innovation of here-to-for unknown magnitude. To act responsibly as the custodians of this knowledge, we must also be mindful of another legacy – that of the morality of innovation. Morality is kind of a complicated concept: it has to do with our values – the values of our society. And those values have a tendency to change with the times. The dictionary definition of innovation is quite simple: to create something new. But in the fields of medicine and surgery, innovation is conceptually quite different today from what it was in the last century. Today there exist guidelines by which new therapies are evaluated and introduced into clinical practice. During much of the last century, to be an innovator involved not only the discovery or development of new therapies, but also the creation of guidelines, where none existed. In reflecting on the Morality of Innovation, I’ve chosen to share with you an anecdotal account of the life of a twentieth century surgeon. Ernest Amory Codman was born into a family of Boston ‘‘Brahmins’’ in 1869, just after the American Civil War. As a young man, he attended Harvard College and then Harvard Medical School, from which he graduated in 1895. While in medical school, he served as a ‘‘house pupil’’ at the Massachusetts General Hospital, where one of his responsibilities was the administration of ether anaesthesia for surgeries. Codman shared this responsibility with a medical school classmate named Harvey Cushing, who was later to become one of the great pioneers of neurosurgery. Together Codman and Cushing created what they referred to as the ‘‘ether chart’’ – a record with the patient’s name, diagnosis, operation, vital signs and remarks. At the time, such things as medical records were nearly non-existent. Codman and Cushing created a record on paper of the condition of each patient during the administration of anaesthesia and throughout the course of each surgical procedure. When Codman presented to his superiors a thesis on the subject of ether anaesthesia, a senior surgeon at yThe George R. Daicoff Lecture was delivered at The All Children’s Hospital, The Congenital Heart Institute of Florida (CHIF), and The University of South Florida Ninth Annual International Symposium on Congenital Heart Disease with Echocardiographic, Anatomic, Surgical, and Pathologic Correlation (CHD9). Renaissance Vinoy Resort & Golf Club, St. Petersburg, Florida, Friday, February 13, 2009 – Tuesday, February 17, 2009. Lecture presented on Monday, February 16, 2009