It is a great honor, indeed, to receive an invitation to deliver the annual Frederick Douglass Stubbs Lecture. Dr Stubbs was an outstanding surgeon whose career was so unfortunately and cruelly interrupted by his premature death. The list of previous Stubbs' lecturers reads like a Who's Who of Surgery and I thank you for the opportunity to join this distinguished group.
I have chosen to discuss the processes by which surgeons or, for that matter, most physicians formulate their choice of therapy in their common everyday practices. My major thesis is that these practices are frequently driven by dogma, without adequate or rigorous scientific support, and my plea is that we begin to examine more carefully so many things that we accept without question. At the time I decided on this subject, I was unaware that in 1958, Carl Moyers' Stubbs Lecture was titled "A Case for Emphasis on Scientific