Author + information
- Valentin Fuster, MD, PhD∗ ()
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
- ↵∗Address correspondence to:
Dr. Valentin Fuster, Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, New York 10029.
In 1687, Sir Isaac Newton published Philosophiæ Naturalis Principia Mathematica, wherein he introduced to the world his laws of motion, the first of which dramatically altered the understanding of mathematics and physics for all future generations. It is this first law—often referred to as the Law of Inertia—that I have been pondering of late, with regard to the field of cardiovascular research: “An object will remain at rest or continue with constant velocity unless acted on by an unbalanced force” (1).
Within the context of inertia as outlined by Newton, medical journals should try to avoid publishing paper after paper reinforcing the same message about the same issues. We must be willing to effect a change of motion by proposing and accepting papers that introduce new concepts and challenge our conventional ways of thinking, in particular if they are reflective of what we witness in our patients. Newton leads us to understand that applying “unbalanced forces” or taking the risks to counteract inertia will lead researchers and clinicians to examine the large variety of cardiovascular observations through different lenses. We, as cardiologists, have gotten incredibly comfortable with our ability to take care of our patients—and there have been tremendous strides in treating cardiovascular disease over the past 40 years—however, we should never become stagnant in our pursuit of finding new pathways.
Two experiences come to mind. One of my mentors, Dr. Simon Dack, who founded JACC and served as its editor-in-chief for more than 30 years, conveyed to me that his early papers about the premonitory symptoms of acute coronary occlusion received multiple rejections in the early 1960s, and the concept did not receive widespread acceptance for many years. Therefore, as an editor, peer reviewer, and educator, he recognized that “most science is a work in progress” (2). Accordingly, I recall his accepting a significant number of papers for publication that were rejected by other journals, when he thought there was a possibility of an eventual breakthrough. I remember the frustration that Dr. John Ambrose and I experienced at not being able to disseminate the concept of the “angiographically small plaque rupture” as a frequent mediator of acute coronary syndromes. Simon Dack found the data appealing enough, due to their possible future impact, to disregard the small number of patients in our research. He published our paper together with 5 subsequent papers from our group and from other groups validating the concept. Simon Dack was one of the “best listeners and risk takers” whom I have known, and no one can question his success as editor-in-chief of the Journal.
The second observation serves as a warning for contrary behavior. How easy it is to fall into “inertia” or “constant velocity” by acting as if our motor engine for curiosity and motivation is turned off. For example, if we set up 1 or 2 conferences per week, delivered by outstanding experts in the cardiovascular field, young fellows who become familiar with such a routine quickly do not feel motivated anymore and consciously or unconsciously find easy excuses to not attend. Perhaps this is human nature, but the talented members of our profession, particularly those of us who are lucky enough to have been able to obtain a university degree, have an obligation to be excited to develop, create, and incentivize our environments. Do not be a passive sponge prone to “cerebral apoptosis.”
Importantly, becoming a part of that progress of science requires humility. I have always admired and shared Newton’s obsessive focus on research, his willingness to take risks, as well as the desire to remain humbled by the path we have chosen. As he said, “What we know is a drop, what we don’t know is an ocean” (3). To continue to learn and move forward or change direction, we cannot become arrogant as a result of our successes. We need to let knowledge, research, and creativity guide us, and to not fall into a sense of security or passivity in our daily obligation as medical professionals or as individuals.
- American College of Cardiology Foundation
- ↵Newton I. Philosophiæ Naturalis Principia Mathematica. 1686.
- ↵(2014) Dust to dust: what lessons can be learned from the presentation of the gravitational-waves story? Nature 514:273–274.
- ↵GoodReads. Isaac Newton quotes. Available at: http://www.goodreads.com/author/quotes/135106.Isaac_Newton. Accessed January 26, 2015.