Hospital Practice
ISSN: 2154-8331 (Print) 2377-1003 (Online) Journal homepage: http://www.tandfonline.com/loi/ihop20
Letters to the Editor Joel K. Kahn M.D., A. R. Feinstein M.D. & Sharon Grundfest M.D. To cite this article: Joel K. Kahn M.D., A. R. Feinstein M.D. & Sharon Grundfest M.D. (1992) Letters to the Editor, Hospital Practice, 27:9, 14-14, DOI: 10.1080/21548331.1992.11705478 To link to this article: http://dx.doi.org/10.1080/21548331.1992.11705478
Published online: 17 May 2016.
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Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ihop20 Download by: [Monash University Library]
Date: 03 July 2016, At: 08:52
Letters to the Editor
Downloaded by [Monash University Library] at 08:52 03 July 2016
1be Equivalence of Antithrombolytic Agents I enjoyed the excellent reView HThrombolytlc Therapy: A State of the Art ReView," (HP, June 15) by Claude R. Benedict and colleagues. However, I was struck by your cover and felt that it deserved comment. There has been much discussion about the role of the pharmaceutical industry in the selection of thrombolytic agents by physicians. Indeed, there has been much pressure to recognize tissue plasminogen activator as the drug of choice for patients with evolVing myocardial infarction. However, several large randomized international trials have recently demonstrated the equivalence of the thrombolytic agents. There has been a significant trend toward streptokinase in the United States because of its significantly lower costs and equal efficacy. I was, therefore, struck by your cover, which shows, specifically, plasminogen activator being infused after myocardial infarction. This would seem to be out of line with the balanced reView in the magazine. To me, it appears that the patient is twisting away from the infusion, probably because of the high cost of the drug! I would suggest a more thoughtful approach by your art department-that it give as much attention to detail as do the articles themselves. JOEL
K.
KAHN, M.D.
Ann Arbor, Mich. As the article by Drs. Benedict, Mueller, Anderson, and Wilierson notes, plasminogen can be activated by various endoge14
Hospital Practice September 15. 1992
nous or exogenous agents. All such agents are thus plasminogen activators. The cover illustration was intended to be nonspeciflc.-ED
Startling Statements I am not sure I grasped the point of Kathryn Montgomery Hunter's long excerpt ''A Case for Narrative" in the June 15 issue of HP. About halfway through, however, I was startled to find myself mentioned. I was even more startled to discover that she regarded me as a "historiographer" and that my Clinical Judgment book was an Hepistemology of clinical data." As someone Htrained in literature," Hunter is probably quite familiar with fiction and certainly can have artistic license for whatever interpretations she imagines. When she makes presumably factual statements, however, one might hope that she will perceive reality and distinguish it from her own fancy or literary exuberance. Contrary to her statements, my Clinical Judgment book was not aimed at "applying the principles of epidemiology to the care of patients" and I have never engaged in any "appeals to mathematics as the foundation of scientific knowledge." In fact, I have regularly said that clinical knowledge is the basis of biostatistics and of any other applications of mathematics to clinical medicine. Clinical Judgment was intended to make clinicians respect the humanistic and scientific challenges of their craft, articulate their observations and eVidence, avoid the inappropriate models
offered by laboratory investigation, and develop an artful science of their own. Clinicians can learn a great deal from the humanities and from other sciences, but the basic principles of patient care should be rooted not in reductionist biology or in literary creations but in what is learned from patient care. A. R.
FEINSTEIN, M.D.
Sterling Professor ofMedicine and Epidemiology Yale University School of Medicine
Past and Present I am writing to you to tell you how much I enjoyed the recent articles on Margaret Sanger and on Rita LeVi-Montalcini by Elmer Bendiner ("Margaret Sanger's Crusade-What Every Woman Should Know," HP, March 15, and "Rita LeVi-Montalcini and the Unveiling of Growth Factors," HP, April 30). I had the great pleasure of meeting Dr. LeVi-Montalcini at MIT when she was kind enough to share her experiences with a group of women students there. We were all very impressed and touched by this remarkable woman. I also had the good fortune to be a medical student under Dr. Grant Sanger at Columbia-Presbyterian Medical Center in New York. He was a dedicated teacher in charge of the breast clinic, and his instruction had an indelible impact on my career. I remember that he spoke quite highly of his mother. Please keep up the good work. SHARON GRUNDFEST, M.D.
Cleveland Clinic Foundation
ISSN: 2154-8331 (Print) 2377-1003 (Online) Journal homepage: http://www.tandfonline.com/loi/ihop20
Letters to the Editor Joel K. Kahn M.D., A. R. Feinstein M.D. & Sharon Grundfest M.D. To cite this article: Joel K. Kahn M.D., A. R. Feinstein M.D. & Sharon Grundfest M.D. (1992) Letters to the Editor, Hospital Practice, 27:9, 14-14, DOI: 10.1080/21548331.1992.11705478 To link to this article: http://dx.doi.org/10.1080/21548331.1992.11705478
Published online: 17 May 2016.
Submit your article to this journal
View related articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ihop20 Download by: [Monash University Library]
Date: 03 July 2016, At: 08:52
Letters to the Editor
Downloaded by [Monash University Library] at 08:52 03 July 2016
1be Equivalence of Antithrombolytic Agents I enjoyed the excellent reView HThrombolytlc Therapy: A State of the Art ReView," (HP, June 15) by Claude R. Benedict and colleagues. However, I was struck by your cover and felt that it deserved comment. There has been much discussion about the role of the pharmaceutical industry in the selection of thrombolytic agents by physicians. Indeed, there has been much pressure to recognize tissue plasminogen activator as the drug of choice for patients with evolVing myocardial infarction. However, several large randomized international trials have recently demonstrated the equivalence of the thrombolytic agents. There has been a significant trend toward streptokinase in the United States because of its significantly lower costs and equal efficacy. I was, therefore, struck by your cover, which shows, specifically, plasminogen activator being infused after myocardial infarction. This would seem to be out of line with the balanced reView in the magazine. To me, it appears that the patient is twisting away from the infusion, probably because of the high cost of the drug! I would suggest a more thoughtful approach by your art department-that it give as much attention to detail as do the articles themselves. JOEL
K.
KAHN, M.D.
Ann Arbor, Mich. As the article by Drs. Benedict, Mueller, Anderson, and Wilierson notes, plasminogen can be activated by various endoge14
Hospital Practice September 15. 1992
nous or exogenous agents. All such agents are thus plasminogen activators. The cover illustration was intended to be nonspeciflc.-ED
Startling Statements I am not sure I grasped the point of Kathryn Montgomery Hunter's long excerpt ''A Case for Narrative" in the June 15 issue of HP. About halfway through, however, I was startled to find myself mentioned. I was even more startled to discover that she regarded me as a "historiographer" and that my Clinical Judgment book was an Hepistemology of clinical data." As someone Htrained in literature," Hunter is probably quite familiar with fiction and certainly can have artistic license for whatever interpretations she imagines. When she makes presumably factual statements, however, one might hope that she will perceive reality and distinguish it from her own fancy or literary exuberance. Contrary to her statements, my Clinical Judgment book was not aimed at "applying the principles of epidemiology to the care of patients" and I have never engaged in any "appeals to mathematics as the foundation of scientific knowledge." In fact, I have regularly said that clinical knowledge is the basis of biostatistics and of any other applications of mathematics to clinical medicine. Clinical Judgment was intended to make clinicians respect the humanistic and scientific challenges of their craft, articulate their observations and eVidence, avoid the inappropriate models
offered by laboratory investigation, and develop an artful science of their own. Clinicians can learn a great deal from the humanities and from other sciences, but the basic principles of patient care should be rooted not in reductionist biology or in literary creations but in what is learned from patient care. A. R.
FEINSTEIN, M.D.
Sterling Professor ofMedicine and Epidemiology Yale University School of Medicine
Past and Present I am writing to you to tell you how much I enjoyed the recent articles on Margaret Sanger and on Rita LeVi-Montalcini by Elmer Bendiner ("Margaret Sanger's Crusade-What Every Woman Should Know," HP, March 15, and "Rita LeVi-Montalcini and the Unveiling of Growth Factors," HP, April 30). I had the great pleasure of meeting Dr. LeVi-Montalcini at MIT when she was kind enough to share her experiences with a group of women students there. We were all very impressed and touched by this remarkable woman. I also had the good fortune to be a medical student under Dr. Grant Sanger at Columbia-Presbyterian Medical Center in New York. He was a dedicated teacher in charge of the breast clinic, and his instruction had an indelible impact on my career. I remember that he spoke quite highly of his mother. Please keep up the good work. SHARON GRUNDFEST, M.D.
Cleveland Clinic Foundation
