LETTER
Dichotomous Disservice
David H. Spodick, MD, DSc
1 December 1997 | Volume 127 Issue 11 | Page 1044
TO THE EDITOR:
"Dichotomy: Division into two parts, groups or classes esp. when these are sharply distinguished or opposed" [1]. Dr. Carlton's perceptive essay [2] makes a major point worthy of this well-known cardiologist and sophisticated thinker. However, I am at a loss as to why, out of the enormous world of medical publication, he has chosen one of my contributions [3] as one of only two examples of "dichotomous thinking." That report, which successfully ended the dichotomous thinking concerning electrocardiographic distinction of anatomically transmural and non-transmural infarction, was anything but dichotomous. The S-T infarction mentioned in the title of my article was subdivided into several electrocardiographic classes with different clinical and prognostic implications. Dichotomous thinking came shortly after when others perverted the article's message into "Q-wave" and "non-Q-wave" infarction.
Moreover, the primary aim of my article was to demonstrate that the electrocardiogram was unreliable for the anatomic transmural extent of the infarct. I examined the original work, reported in several articles over decades, on which the notion of "electrocardiographic transmurality" was based; it was irreparably flawed. In the vast medical literature, surely better examples are available. Incidentally, the loss of R voltage in Dr. Carleton's Figure has more than the single (monochotomous?) explanation given.
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Author and Article Information
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St. Vincent Hospital; Worcester, MA 01604
1. Webster's New World Dictionary. 2d College ed. New York: Simon & Schuster; 1980.
2. Carleton RA. Dichotomous disservice? Ann Intern Med. 1997; 126:589-91.
3. Spodick DH. Q-wave infarction versus S-T infarction. Nonspecificity of electrocardiographic criteria for differentiating transmural and nontransmural lesions. Am J Cardiol. 1983; 51:913-5.
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