When a Single Patient Changes Medicine: Case Reports That Matter

Case reports sit at the bottom of medicine’s evidence hierarchy, yet they account for 12% of all PubMed publications. This episode explores why physicians write them (academic currency, naming rights, journal economics) and how humble observations have sparked FDA-approved treatments — from hydroxychloroquine for porphyria to esketamine for depression. We examine the tension between “interestingness” and importance, the role of post-marketing surveillance, and whether the system generates too much noise.