GLOBAL ADVANCES IN HEALTH AND MEDICINE
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Why Medical Case reports?
Gunver S. Kienle, Dr med
author affiliations edicine is built up of single cases. Individual
Gunver S. Kienle, Dr med,
patients—single cases—are the essence of Case reports
is senior research scientist
what medicine deals with. Every patient is A common thread in healthcare around the
at the Institute for Applied
Epistemology and Medical important, and every case can be a lesson. Clinician, world is that patients receive treatments and
Methodology at the
researcher, and epidemiologist Alvan Feinstein said, these treatments produce outcomes. Reporting
“In caring for patients, clinicians constantly perform guidelines for case reports and their systematic
Freiburg, Germany. experiments. During a single week of active practice, a documentation and publication are an important
busy clinician conducts more experiments than most tool to share information across healthcare sys-
of his laboratory colleagues do in a year.”1 tems. The editors of Global Advances in Health and
Gunver S. Kienle, Dr med
Medicine stretches between the intertwined poles Medicine believe that high-quality, professional
of being developed in the laboratories of the pharmaceu- case reports focusing on a systems approach to
tical industry and in the clinical practice of the “clinical medicine and the global convergence of conven-
Global Adv Health Med.
champions”—the innovative clinician, therapist, nurse, tional and traditional healthcare systems will
or midwife. While the laboratory testing route (pharma- inform the design and implementation of clini-
Key words cology, quality assessment, phase I-IV trials) is well cal trials and in turn improve the delivery of
Case reports, cases,
established, what about the significant clinical observa- healthcare to patients everywhere.
trials, clinical, tions? How can they be presented scientifically?
guidelines, treatment, There is a wealth of case reports in medical jour-
medicine, medical nals and textbooks, and they range from groundbreak-
ing to hardly noticeable. They are a colorful entity in
the world of medical literature, but aren’t they notori-
ously biased? Haven’t they misled medicine for centu-
ries? Don’t they inherently suffer from low method-
ological quality? Aren’t they just singularities and
therefore always nonrepresentative? These questions
reflect widespread convictions, but the issues have
never been systematically investigated, so the answers
Case reports, in fact, do have an important place in
medicine. As “cornerstones of medical progress,”2 they Photographs reprinted with permission from AngelPHACE.com.
often are the first presentation of discoveries: new con-
ditions, novel therapies, new perspectives in pathogen- an Example of a High-impact Case report
esis, inventive diagnostic procedures. Their publica- Propranolol, a generic beta-blocker, was
tion often provokes others to try to reproduce the shown to effectively treat infantile hemangiomas
observation and thus to either confirm or refute the (IH) in case reports published in The New England
initial hypothesis. A recent example is the discovery of Journal of Medicinea in 2008 as a letter to the edi-
beneficial effects of propranolol in severe hemangio- tor. This finding was confirmed in a case series
mas of infancy, which found its way into routine appli- published in 2010 in the Journal of the American
cation after the publication of just a few case reports. Academy of Dermatology.b Propranolol is now rec-
Another domain is side effects. The thalidomide trage- ommended as a first-line therapy for ulcerating
dy was brought to light by a courageous pediatrician IH. The reasonable safety profile for this drug
and geneticist, Widukind Lenz, who analyzed and pre- reduced the need for a randomized controlled
sented numerous cases. About 40% of all side effects trial (RCT), and the lack of compelling alterna-
are uncovered by case reports.3 tives and propranolol’s availability as a generic
Many disciplines find themselves represented drug further reduced the likelihood of an RCT.
mainly in case reports. These include not only the leg-
a Léauté-Labrèze C, Dumas de la Roque E, Hubiche T, Boralevi F, Thambo
endary Sigmund Freud cases, which introduced the era JB, Taïeb A. Propranolol for severe hemangiomas of infancy. N Engl J Med.
of the intense and highly differentiated tradition of 2008 Jun 12;358(24):2649-51.
psychotherapy accounts that form the essence of this b Hermans DJ, van Beynum IM, Schultze Kool LJ, van de Kerkhof PC,
therapeutic artistry. Areas of medicine such as pediat- Wijnen MH, van der Vleuten CJ. Propranolol, a very promising treatment
for ulceration in infantile hemangiomas: a study of 20 cases with matched