Three Little Words


It’s the title of a great song from 1930, with Duke Ellington’s version a true classic. Three little words seem to apply to overused and now nearly meaningless vocabulary in medicine and probably the wider world: "robust," "transparency," and "paradigm shift." Admittedly, those are four words, but I’m not alone in miscounting to make a point. Vice President Joe Biden famously once said that "the No. 1 job facing the middle class and it happens to be ... a three-letter word: jobs, J-O-B-S, jobs."

How many times have you seen those words in the cardiology literature or heard them at grand rounds?

Findings in a study are "robust." A new therapy represents a potential "paradigm shift." Justification for an increase in the number of rules and oversight is based on a goal to increase "transparency."

The problem now is that the meanings behind those words have been cheapened and, ironically, we frequently observe that findings labeled as robust (as in a phase II study) often do not pan out. Paradigm shifts are few and far between (our advances are usually gradual and incremental), and transparency is often an excuse used by bureaucrats and political agenda artists to justify more regulation.

I’ll stick with the 1930s original Three Little Words. Look them up and repeat them to someone important in your life. They will have far more resonance than "paradigm shift."

Dr. Paul Hauptman is Professor of Internal Medicine and Assistant Dean of Clinical-Translational Research at Saint Louis University and Director of Heart Failure at Saint Louis University Hospital. He currently serves as an Associate Editor for Circulation: Heart Failure and blogs while staring out his office window at the Arch.

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