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Evangelists and Snails
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•Type with double-spacing
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Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
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IN RESPONSE:
Dostoevsky reminded us that faith makes miracles, rather than the other way around. And while I agree with Dr. Sullivan that both judgment and faith enter substantially into the perspective of the cholesterol “evangelists,” it is only fair to point out that judgment and faith enter into the “snail” position as well. More generally, it is true that data by themselves, even the best data on a problem, are never enough to serve as the basis for medical action. To start with, physicians must find the problem interesting (important to them); then they need to believe in the data (it has to be credible); they need to be assured of their own understanding and their ability to translate the information into action (they must have confidence); and finally, the actions need to “work” for them and their patients (the outcomes need to be satisfying) [1]. My point in the editorial [2], therefore, was that even in medicine, where the basis for action is assumed to be principally scientific, feelings and beliefs are universal-and essential-elements in the process. This reality is intrinsically neither good nor bad; the problems arise when the emotional and moral aspects of a problem aren't openly recognized and dealt with.
Dr. Atkins and his colleagues submit that there is plenty of preventive work to do even if we implement only the most basic and generally accepted measures. This position seems right on the mark. Curiously enough, both the American College of Physicians guidelines [3] and Dr. LaRosa [4] seem to agree on this general point; where they disagree is on the specifics of those basic interventions.
Frank Davidoff, MD
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
