Tiresias: One of paths that have brought us here

"Now I have precisely the right instrument, at precisely the right moment, in exactly the right place.”

Patton (1970)

My friends,

Today I have a story which some of my friends may think doesn't particularly relate to Optiscan. Please be patient and indulge your old friend. It is interesting in and of itself and does shed some light on our subject.

This is the story of Archie Cochrane, generally recognised as the father of evidence-based medicine. Archie Cochran was a doctor. He was in WWII and was a prisoner of war in Germany. He looked after the British prisoners of war and there he had had his first epiphany. He realised none of the treatment he was administering had any evidence at all that it was any good, or if it was harmful. After the war he persevered in his quest for evidence-based medicine. As is so often the case in the world, fate took a hand. Archie developed a spot on the back of his hand. His general practitioner cut the spot off, and subsequent histopathology showed it to be a basal cell carcinoma (BCC). The general practitioner also found a small lymph node in his armpit on the same side. Now a BCC spreads by local invasion and almost never metastasises. Nevertheless, his general practitioner referred him to an eminent surgeon. As often happens when doctors become patients, the investigation and treatment is overdone. The “eminent” surgeon was convinced that this was a cancer and excision surgery. At surgery the surgeon decided that this was metastatic breast cancer (which does occur in men, and which is often deadly) and had spread to the axilla. He undertook what was the standard treatment of metastatic breast cancer at the time, super- radical mastectomy, with total clearance of the armpit and excision of several chest muscles. Though frozen section biopsies were available, and had been in use for over 60 years, this was not done at surgery. The surgeon, as is still often the case, “knew” the lump was cancer, didn’t like frozen section biopsies because they were inaccurate, inconclusive, and time wasting, and this is still the case. So, a super-radical mastectomy it was for Dr Archie. Post-operatively, the eminent surgeon sat down beside Archie Cochrane and told the bad news, that he, Archie had metastatic breast cancer, that he had cut it all out, but the prognosis was very poor, and that he had less than a year to live. He could have done a frozen section biopsy and frozen section, but he didn’t believe they were worthwhile, but it would have only prolonged an already long operation for no advantage. Many surgeons now when they operate on breast-cancer still do not use frozen section biopsies for all of the above reasons, but also because they cannot define the edge of the cancer. Well, the pathology results came back three weeks later. The original lump was not cancer. It was just a common inflamed lymph node. Archie Cochran had undergone major radical mastectomy and excision of muscles of the chest wall for no reason to tall. This was Archie Cochrane's second epiphany. He committed the rest of his life to the campaign for evidence-based medicine. The culmination of this was the foundation eponymous Cochrane Library in honour of Archie Cochrane and his fight for evidence-based medicine. Archie Cochrane insisted on evidence-based medicine and the best medicine. The best medicine for diagnosis and treatment of cancers now must include in-vivo real-time AI-assisted Confocal 3-D laser Endomicroscopy, in the clinic and in the operating theatre.