Re: observation
From: art fougner, md (evsono@pipeline.com)
Wed Jan 17 09:02:37 2001
how are you defining/diagnosing "fibrocystic?"
art
At Tue, 16 Jan 2001, Robert J. Woolley wrote:
>
>I've noticed something over the last several years. I'm curious whether anybody
>else has ever noticed the same thing.
>
>It started with one patient perhaps 4 years ago who had--well, there's simply no
>politically correct way to express this--the most gravity-defying breasts I've
>ever seen. What struck me is that she also had just about the most fibrocystic
>breasts I had ever seen.
>
>Since then, it has been quite consistent, I think. The few percent of women with
>the greatest elevation of the areolar complex above the inframammary
>fold--apparently independent of breast size--have all been heavily fibrocystic.
>And, conversely, those with the most ptotic breasts--whether large or
>small--tend to have little if any fibrocystic content. (Nearly all of my
>patients are in a narrow age spectrum of 18-28 or so, and nulliparous, so this
>observation is reasonably independent of age.)
>
>I can convince myself that this makes some sense: relatively more internal
>connective tissue would feel fibrocystic on exam and perhaps also provide more
>resistance to the inexorable effects of gravity. But this is, of course,
>after-the-fact reasoning, which is dangerously susceptible to bias.
>
>And my entire observation of such a trend may be bogus, the result purely of a
>confirmation bias induced by that first patient in whom I noticed the
>association. I may have subconsciouly noticed cases that confirm the hunch, and
>ignored those that don't.
>
>So I ask for the cumulative vast experience of this distinguished group of my
>colleagues. Am I just nuts here, or am I onto something? Would it be of
>sufficient interest to persue objectively? (E.g., make some sort of measurement
>of the degree of ptosis, have a blinded radiologist count the cysts or make some
>other quantitative measurement of fibrocystic content, and look for a
>statistical association.) Would anybody care if it happened to be demonstrably
>true? That is, would it be an observation that would shed any light on the
>nature of fibrocystic change, or how cosmetic breast surgery might be improved,
>or whatever?
>
>--
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>
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>Bob Woolley
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>St. Paul, Minnesota
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>GIC
>
>Some presidents' names become adjectives -- Lincolnian gravity,
>Rooseveltian reassurance, Kennedyesque charisma, Nixonian deviousness,
>Reaganesque leadership. To understand the meaning of "Clintonian," parse
>this from a 1997 news conference: "I don't believe you can find any
>evidence of the fact that I have changed government policy solely
>because of a contribution." ...Clinton is not the worst president the
>republic has had, but he is the worst person ever to have been president.
>
> -- George Will, 1/11/01
>
--
art fougner, md
A series of 1000 cases begins with but a single anecdote.
