REPLY
Evangelists and Snails
Frank Davidoff, MD, Editor
15 December 1996 | Volume 125 Issue 12 | Page 1012
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.
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Author and Article Information
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Editor.
1. Davidoff F. Heart and head: feeling and thought in the teaching of medicine. In: Who Has Seen a Blood Sugar? Reflections on Medical Education. Philadelphia: American College of Physicians; 1996:152-7.
2. Davidoff F. Evangelists and snails redux: the case of cholesterol screening [Editorial]. Ann Intern Med. 1996; 124:513-4.
3. American College of Physicians. Guidelines for using serum cholesterol, high-density lipoprotein cholesterol, and triglyceride levels as screening tests for preventing coronary heart disease in adults. Ann Intern Med. 1996; 124:515-7.
4. LaRosa JC. Cholesterol agonistics. Ann Intern Med. 1996; 124:505-8.
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