I have been reflecting on the changes in clinical practice over the 30+ years since I graduated from medical school. So many interesting ideas have now become accepted wisdom. For example, as I graduated, the first streptokinase studies into clot lysis for acute myocardial infarction were just starting in Australia. Discussions among my clinical leaders at that time were fairly evenly divided between the ‘cautious’, those sceptical of new and as yet unproven developments, and the ‘early adopters’, who were excited to embrace the future. Needless to say, the trials were a success and were soon followed by an apparently endless succession of new investigations, medications and treatment modalities that have changed the face of cardiovascular disease management to what we see today.