The concept of initial attachment could be viewed as the "Holy Grail" of endometriosis. Find it and you might prove Sampson's theory and convince skeptics like me that it is true. But it should have been found long before now. Those who have studied microscopic endometriosis have not found evidence of initial attachment. There are only two possible reasons for the continuing lack of evidence of initial attachment:
- Those favoring Sampson's theory have not looked for it.
- Initial attachment does not occur because Sampson's theory is incorrect.
Sampson's theory leads to a sense of hopelessness among patients and physicians alike. But this is about more than just scientific uncertainty concerning the origin of a disease. This sense of futility can have a direct effect on surgical treatment of the disease. If a surgeon is convinced that the disease will "just come back" after surgery, (s)he may not try as hard to get all of the disease out, resulting in persistent disease which is its own self-fulfilling prophecy of "recurrence."
If a surgeon burns only the top of endometriosis with laser or electrocoagulation, but believes that all of the disease has been destroyed, persistent disease can be blamed as "recurrence" due to Sampson's theory.
Medical therapy can be similarly influenced. Although no one has ever bothered to do a study proving that pregnancy or menopause eradicate endometriosis, all medical therapy is based on duplicating the assumed beneficial effects of these two hormonal states. We know that medical therapy does not eradicate the disease, but if a physician believes that it does, then "recurrence" after medical therapy can also be blamed on Sampson's theory. How much more perfect could this be?
With Sampson's theory as a foundation, failure of medical or surgical therapy is never due to ineffectiveness of the medicine or the surgery, it's due to the fact that the pelvis is re-seeded again next month, and the month after. It's not the fault of the system, it's the nature of the disease.
Physicians don't have to be introspective about their treatment methods, since failure is explained and predicted, and it's not their fault. In my view, Sampson's theory is actually Sampson's excuse for our time.
In all of this discussion, I am not blaming John Sampson for anything, and I don't want people to think I am disrespectful of him. He was an excellent student of endometriosis, and he did the best he could in developing his theory of origin with the evidence of the time. If he knew what we now know about endometriosis, I'm certain he would not have arrived at the same theory.
The problem lies in the human trait of accepting things from the past without question, and this continues to be our problem today. We need more healthy questioning of authority.