Breaking the Wave of Enthusiasm?

The natural history of all substantial innovative medical procedures generally follows the same archetype. A new, potentially revolutionary treatment approach for a certain disease is introduced and initial first-in-men, feasibility, and safety studies are conducted by expert operators in highly specialized centers and selected patients. Given promising initial results, this triggers a wave of mounting enthusiasm and a flurry of activity in this field with transfer into the real world until previously unanticipated or not reported problems or complications are recognized that may act as wavebreakers, resulting in a deceleration or even decline in the stream of exuberance. Such complications usually lead to a change of mood and a state of reconsideration with calls for caution and for training programs, the enthusiasm settling down to a healthy, realistic steady state. Necessarily, problems are addressed and techniques refined, taking the procedure to the next, matured level.