In 1991, much to the chagrin of my cardiology attendings, I published my second research paper in The Journal of the American College of Cardiology (JACC) in as many years.

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My fellowship program was unused to research ideas coming from cardiology fellows in training, let alone publishing more research than the attendings were publishing.

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But in 1989-1990, it became clear to me, after comparing the results of visual qualitative interpretations of coronary arteriograms (cardiac catheterization) with the Quantitative Coronary Arteriography (QCA) measurement data obtained from the cardiac catheterization results of the patients in the Teboroxime study, that the experimental outcomes were different depending upon whether I used the subjective qualitative visual results or the objective QCA measurements.

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In one instance, if I used the subjective qualitative visual results, Teboroxime would be shown to be superior to Thallium-201 (Tl-201) as an imaging agent and I would be assured a place in history; because, Teboroxime - not Tl-201 or Sestamibi would become the imaging isotope agent of choice.

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Or, I could be scientifically honest, and report the objective QCA measurements, which showed Teboroxime was better but NOT STATISTICALLY. I chose the latter. Scientific integrity over fame.

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More importantly, I noticed from the comparisons of the Teboroxime study, there was a pattern in the differences between visual and QCA results.

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The cardiology attendings told me this was unimportant - move on. All the important work had been published in the 1970s when first authors Detre (1975), Zir (1976) and DeRouen (1977) all showed problems with the reported visual interpretations from coronary arteriograms.

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I repeated my call to publish when only a month later, Beauman (1990) published his research showing misreading of coronary arteriograms continued throughout the country - independent of location or academic affiliation.

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As my psychology mentor, Professor Gordon Harrington, used to tell people, "Fleming doesn't suffer fools gladly." So instead of "moving on" I dug in and kept pursuing the data. A behavior that resulted in the attendings assigning me a code name, which they did for everyone; in my instance "bulldog."

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It was with that tenacity that the comparison of 87 coronary arteries became 212 arteries and more (1040) as time went on.

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The results showed, as seen in the following abstract from that published research, that physicians tended to over estimate the severity of coronary artery disease (CAD) when more than half of the coronary lumen was narrowed, while underestimating severity if less than half of the lumen was narrowed, and while CAD and angina is not the direct result of lumen narrowing - as you will see through my published research made available to you on this website - it does play a role in the end result.

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More directly, as shown in this research, these errors in subjective visual interpretations of results meant cardiologists were both (1) over interpreting the results of their angioplasty and stenting and (2) sending patients for bypass surgery who did not actually have triple vessel CAD or left main disease.

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In the end, the research was submitted for publication, not because my attendings suddenly realized it was important; but rather, because they found out that Dr. Eugene Braunwald (editor in chief of one of the two main Cardiology Textbooks) had discovered the same thing. As a result, my call to submit for publication went from a bad idea to mach speed submission - to beat Braunwald, which we did.

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The importance of this publication was several fold:

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1) It exposed the patterns behind these errors and the consequences for patients - clinical flaws,

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2) It exposed the flaws in our medical research, using errors in the subjective qualitative results of one set of tests to determine outcomes of another set of tests, AND

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3) It laid the foundation for the continued work I would do to establish the proprietary equation component of FMTVDM.

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Stenosis Flow Reserve (SFR), Coronary Flow Reserve (CFR); Quadratic Coronary Flow Researve (QCFR). 1-655833951. Started 1 Sept 2011 and effective 16 September 2011. TX 7-451-241.