Hospital Practice

ISSN: 2154-8331 (Print) 2377-1003 (Online) Journal homepage:

Letters to the Editor M. L. Auerback M. D. , Philip Altus M. D. & M. David Lauter M. D. To cite this article: M. L. Auerback M. D. , Philip Altus M. D. & M. David Lauter M. D. (1992) Letters to the Editor, Hospital Practice, 27:11, 16-21, DOI: 10.1080/21548331.1992.11705517 To link to this article:

Published online: 17 May 2016.

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Letters to the Editor Scheduled for the December 15 Index Issue Liposomes: Realizing Their Promise ALEC D. BANGHAM

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Cambridge, England Since their discovery in the 1960s, "fat bubbles" have proved to be a versatile model of the cell membrane. They have also turned out to have promising practical applications, especially in the delivery of drugs. Liposomes are being investigated for possible roles in gene transfer, as artificial blood, and for joint lubrication. Clinical trials are under way with Uposomal antibiotics, antifungals, prostaglandins, and Uposomal doxorubicin for treatment of Kaposi sarcoma and breast cancer.

Decision Making in Medicine

Palpable Purpura ROBERT W. LIGHTFOOT

University of Kentucky The differential diagnosis of purpura of the lower extremities can tax the acumen of the most able clinician. Is palpability an etiologic marker? Is the cause a bleeding disorder or vasculitis? lf vasculitis, is it local or systemic? lf drug induced, is there an autoimmune component? Treatment decisions (including no treatment) may be no easier. However, careful attention to clinical evaluation, history, physical findings, and wisely selected laboratory tests can provide the answers.

Continuing the Neuromuscular Transmission Series in Physiology in Medicine

Lambert-Eaton Syndrome R. GLEN SMITH and STANLEY H. APPEL

Baylor College of Medicine

Animal ResearchSensibilities and Sense I was touched by Claude Frazier's love for his Himalayan cat, "Sweet Thing" (Letters to the Editor, HP, September 30) and I am glad he enjoys his company. But I am disturbed by his extrapolation of his relationship with his pet to the plea that animals not be used in biomedical research. His arguments that his cat "is intelligent" and can "coerce [Dr. Frazier I into getting up at 6 A.M. to give him breakfast" could also be made for the baby I saw last week who was born with transposition of the great arteries. Unti11965, every baby with this defect was doomed. Because of animal research, the baby I saw last week has undergone the "switch" operation (Jatene procedure), has left the University of California Medical Center, San Francisco, and now has an excellent chance of outliving Dr. Frazier and me by a considerable margin. Animal research, thoughtfully done, with respect and caring, is still one of our major weapons against disease, particularly in infants and children. Don't let sincere feelings of concern for animals blind us to this reality. M. L. AU E R B A c K

, M. D.

Director, Pediatric Cardiology Clinic San Francisco General Hospital

Healtbcareopatby: A Multifactorial Disease The following was addressed directly to Samuel C. Bukantz:

I enjoyed your editorial "Our 16

Hospital Practice November 15, 1992

Healthcareopathy and Its 'Meltdown,"' (HP, October 15). This is clearly a complex problem. At the base of a lot of the problem is money. The problem starts with big loans that medical students incur (on average, $60,000 to $80,000). They then see the primary care physician struggling to make it, while ophthalmologists, radiologists and anesthesiologists quite often make $300,000-plus. Some incomes are over $1 million. Someone needs to say that a cataract is worth $300 and a complex history and physical examination is worth $150. Not all histories and physicals are complex. A serious pneumonia treated in the ICU for four days reimburses less than does interpretation of two to three CT scans. Something is wrong!

Our mind-set that everything needs to be ruled out and the

threat of a malpractice suit add tremendously to the cost of medicine. How many times have you heard "there's a report in the XYZ journal showing that. ... Therefore, we must get tests 1 through 17 to rule out the possibility."? What ever happened to 95% confidence limits and reevaluating the patient? Does every diabetic need a HgbA1c, does every cardiac patient need an echocardiogram and persantine thallium, does every asthmatic need a pulmonary function test at every visit, IgE levels, and eosinophil smears? Or could many suffice with a history plus physical alone? A tough problem, but this is probably more than what you wanted to hear. Bottom line-I (continues)



enjoyed your editorial.

Statement of ownership, management, and circulation

P.S. Don't forget society's impact on the cost of medicine, i.e., crack, violence, IV drug use. P H I L I P A L T U S, M. D.

Professor and Associate Chairman Department of Internal Medicine University of South Florida Tampa

(Required by 39 U.S.C. 3685)

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Animal research--sensibilities and sense.

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