Ganesh Rao, MD
President, Congress of Neurological Surgeons
Professor, University of Texas MD Anderson Cancer Center
Residency Program Director, Baylor College of Medicine

The theme of the 69th Annual Meeting of the Congress of Neurological Surgeons is “The Age of Reason for Neurosurgery.” Inspired by American Revolutionary, Thomas Paine, the theme is intended to be a call-to-arms for neurosurgeons, and physicians in general, to stand up for evidence-based practice. As a discipline based on sound scientific methodology, the practice of medicine is subject to change as evidence evolves and studies demonstrate the efficacy of new treatments. However, there has been a major upheaval in how medicine and physicians are perceived. Dubious medical journals are now publishing manuscripts that have undergone minimal if any peer review. A physician’s years of experience are being undermined by non-experts with flashy websites. Patients show up in our clinics with literature suggesting that the latest snake oil can cure their ailment. In years past, we were reluctant to strongly counter misinformation for fear of insulting our patients, but now inaccurate and dangerous advice can harm our patients. Perhaps the most obvious example of this is the recent measles outbreaks affecting the US and Europe. Deliberate distortion of facts linking vaccines to autism has terrified parents across the globe and has resulted in the resurgence of a disease considered eradicated in the US in 2000. More diseases are set to reappear as people lose faith in evidence-based research and fall victim to campaigns of misinformation. Pertussis, diphtheria, and even polio are poised to make a comeback as parents avoid vaccinating children.

We also need to respect that the scientific method requires us to change our ways as new evidence is reported. Medicine, and neurosurgery specifically, requires nuance when it comes to recommending treatment for a patient. As an example, the evidence suggests that the best treatment for a low-grade glioma brain tumor is maximal surgical resection followed by radiation and chemotherapy. However, this strategy may not be appropriate for all patients. At the annual meeting, we will address the management of low-grade glioma in General Scientific Session IV. Another area of controversy is chronic traumatic encephalopathy (CTE). We are familiar with reports that repetitive head trauma leads to the condition prompting many neurosurgeons to be very cautious when recommending participation in contact sports. However, the data may not be as clear as it would seem. CTE will be a topic of discussion during the General Scientific Session I. Finally, is it always necessary to perform a randomized controlled trial (RCT) to determine if a treatment is indicated or not? Is an RCT always ethical? These controversies will be discussed in General Scientific Session III.

“When men yield up the privilege of thinking, the last shadow of liberty quits the horizon.”  Thomas Paine, 1775

These words written on the eve of the American Revolution were meant to inspire action. This year’s meeting is intended to inspire our members to critically evaluate evidence and, when appropriate, change our practices to most effectively benefit our patients. I’m particularly excited about the program this year which has been put together by section representatives and our annual meeting team (Alex Arash Khalessi, MD; Nader Pouratian, MD, PhD; and Brian Vala Nahed, MD). We had over 1,800 abstracts submitted (a record!). Spouses and guests are free before the early registration cut off on September 18, and we’ve even arranged for childcare during important meeting events (for a nominal fee). San Francisco is a perennially popular destination with lots to do for everyone. Register at cns.org/2019.

I look forward to seeing you there!

 

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