How Can we Translate Good Science into Good Perinatal Care?


  • David A. Grimes M.D., F.A.C.O.G.

    1. David A. Grimes is Clinical Research Investigator at the Epidemiology Research Branch of the Centers for Disease Control, Atlanta, GA 30333.
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  • This paper was a keynote presentation at the conference “Technological Approaches to Obstetrics: Benefits, Risks, Alternatives V” in San Francisco Feb. 27–28.


ABSTRACT: Scientific skepticism, known more formally as the discipline of epidemiology, can help overcome five obstacles that impede perinatal care: seduction by authority, the false idol of technology, letting sleeping dogmas lie, the pursuit of pedantry, and numerators in search of denominators. When the seduction by authority is strong, epidemiology shows us how to judge data on their own merit and not on the stature of their proponent. Epidemiology teaches us that we need not blindly worship technology; that technology can be our servant, not our master. Epidemiology compels us to rouse those slumbering dogmas and make them prove their merit. Despite the powerful lure of medical pedantry, epidemiology shows us the way out of this multiple-choice mentality. When we are still stinging from our last unpleasant case, epidemiology guides and sustains us through science, reason, and logic—rather than through clinical impression.