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Academic cardiology at Hammersmith Hospital
249
Academic cardiology at Hammersmith
Hospital SIR,-Reading
your note
on
academic
cardiology
at
the
Hammersmith (Dec 21/28, p 1587), I fmd it difficult to suppress a
feeling of sadness that cardiology at the Hammersmith seems beyond resuscitation. As a cardiologist I have had the privilege, first as a student and later as a lecturer, to take part in quite a few postgraduate courses in cardiology at that hospital. I vividly remember the days of the unforgettable Sir John McMichael, the founding father of invasive cardiology, and Prof John Shillingford, the man who introduced and developed intensive cardiac care. After this, cardiology at the Hammersmith flourished with John Goodwin, Celia Oakley, and Dennis Krikler, clinicians who helped to shape cardiology as it now serves
mankind.
I understand that this whole legacy has been sacrificed for the fata morgana of molecular
genetics and the study of arteriosclerosis without its main target organ, the heart. This news gives me the same sinking feeling I would have if the Dutch Rijksmuseum were to do away with Rembrandt’s Nightwatch to create more space for modem paintings because these are more fashionable or more to the liking of a new director. Britain, the country of Sir Thomas Lewis, James MacKenzie, Sir John McMichael, Peter Sharpey-Schaefer, and Paul Wood, is allowing cardiology at the Hammersmith to die-a black page in the history of medicine.
The failure to consider this diagnosis in presenting symptoms of lethargy, headache, and rhinitis may be because it is virtually absent from general medical books and reports-large textbooks of medicine ususlly devote no more than several paragraphs to the
condition. A MEDLINE search for 1986-90 produced a total of 19 992 articles in the American journal of Medicine, New England journal of Medicine, Annals of Internal Medicine, Archives of Internal Medicine, and Journal of the American Medical Association. Only 10 of those mentioned sinusitis, acute or chronic, as a medical subject heading. Only 1 of the 10 reported original research; the others were brief notes or case reports. I wonder if clinical researchers do not consider chronic sinusitis as a possible cause of sick building syndrome because their exposure to this problem is so slight? The disease may often lack an objective marker, but it is quite real and troublesome. Sales of nonprescription sinus drugs, popular press articles, and television commercials may offer a better clue to doctors about the morbidity of chronic sinusitis than would general medical publications. Department of Medicine, Georgetown University Medical Center, Washington, DC 20016, USA
ALEXANDER C. CHESTER
1. Moss AJ, Parsons VL. Current estimates from the National Health Interview
Survey,
United States—1985 Hyattsville, Maryland: National Center for Health Statistics, 1986. 66-7; DHHS publication no (PHS) 86-1588. (Vital and Health Statistics; series
10; no 160.)
Interuniversity Cardiology Institute of the Netherlands,
Long reports
P0 Box19 258, 3501 DG Utrecht, Netherlands
FRITS L.
MEIJLER
SIR,-In 1990, discussing the future of medical journals, you, Sir, stated that: "the challenges for the next decade will surely be the
SiR,—You draw attention to academic cardiology at Hammersmith Hospital. I would point out that the British (later Royal) Postgraduate Medical School was established to provide an opportunity for the advancement of knowledge of medicine, surgery, obstetrics, and the allied sciences, and to promote the investigation of diseases and their treatment. The fact that cardiology became so prominent at the Hammersmith during the 1940s was due partly to wartime needs (hence the work on shock and haemorrhage) and partly to the introduction by Coumand et al in the USA of the new technique of cardiac catheterisation (which we rapidly adopted and used in our studies of heart failure, congenital heart disease, &c). With each generation new priorities arise, and new techniques are developed for their investigation. The recent appointment to the chair of medicine of Prof James Scott, a noted expert on
apolipoproteins that transport cholesterol and the mechanisms underlying the formation of atheroma, demonstrates that cardiovascular disease remains one of the highest priorities at the Hammersmith. Further support in this specialty will be provided when the British Heart Foundation chair in cardiovascular medicine, currently vacant, is once again filled. Conservatism in medicine has never been the watchword at the Hammersmith ; and I am confident that the School will remain internationally competitive in those areas that seem most ripe for development and where major advances seem most likely to be made. 2 North Square, London NW11 7AA, UK
conflict between information content and readability".1 The challenges seem to have arrived sooner than expected. Though you are to be commended for another British first-publishing the two-part Long Report on the systemic treatment of early breast cancer (Jan 4, p 1, Jan 11, p 71)-many of us will hope that this first experiment will also be the last in a widely read general journal. Rarely can a format have been so reader unfriendly, and rarely can so many other important papers have been pushed aside by such a Behemoth. Most ordinary readers must have got the message over the toast and marmalade, from the daily papers, subsequently supplementing this from your two cogent editorials; experts could have got the detail from a specialist journal. Pluralism, please, for general journals, to be sure, but let us try to solve at least one of the problems of this decade by reserving space for future Long Reports, however important (as undeniably this one was), in such new developments as the electronic journal Current Clinical Trials, due to be launched by the American Association for the Advancement of Science in April. 115 Dulwich
Village,
STEPHEN LOCK
London SE21 7BJ, UK
1. Fox R. Pluralism please. In: Lock S, ed. The future of medical journals. London: British Medical Journal 1991: 62-66.
Undergraduate teaching on chronic wound care
JOHN MCMICHAEL
are under constant pressure to and reduce costs. There is a vast knowledge base on the prevention and management of chronic open wounds and this, together with rapidly rising costs, means that procedures have to be assessed critically. That process of evaluation will need an input from doctors-yet these wounds (mainly leg ulcers and pressure sores) are usually perceived by doctors as a preserve of nurses.1 This narrow-minded approach will have to change, for many reasons-including the huge numbers of such wounds,z the need for a multidisciplinary approach, the enormous cost of treatmentand the spectre of litigation.’ To see how tomorrow’s doctors might fare in such an altered setting I have done a survey of what medical students are being taught about chronic open wounds.
SIR,-Health-care professionals
assess
Sick
building syndrome and sinusitis
SiR,—Your Dec 14 editorial on sick building syndrome lists the major complaints, "lethargy, headache, blocked or runny nose..." but fails to consider the usual cause of these symptoms-chronic sinusitis. The most common disease in the USA, affecting 31-2 million people, sinusitis is virtually ignored in general medical publications, as well as in the differential diagnosis of medical problems.’ Sinusitis is clearly caused in some cases by pollution, indoor or outdoor, and should be regarded as a possible cause of sick
building syndrome.
treatments
Academic cardiology at Hammersmith
Hospital SIR,-Reading
your note
on
academic
cardiology
at
the
Hammersmith (Dec 21/28, p 1587), I fmd it difficult to suppress a
feeling of sadness that cardiology at the Hammersmith seems beyond resuscitation. As a cardiologist I have had the privilege, first as a student and later as a lecturer, to take part in quite a few postgraduate courses in cardiology at that hospital. I vividly remember the days of the unforgettable Sir John McMichael, the founding father of invasive cardiology, and Prof John Shillingford, the man who introduced and developed intensive cardiac care. After this, cardiology at the Hammersmith flourished with John Goodwin, Celia Oakley, and Dennis Krikler, clinicians who helped to shape cardiology as it now serves
mankind.
I understand that this whole legacy has been sacrificed for the fata morgana of molecular
genetics and the study of arteriosclerosis without its main target organ, the heart. This news gives me the same sinking feeling I would have if the Dutch Rijksmuseum were to do away with Rembrandt’s Nightwatch to create more space for modem paintings because these are more fashionable or more to the liking of a new director. Britain, the country of Sir Thomas Lewis, James MacKenzie, Sir John McMichael, Peter Sharpey-Schaefer, and Paul Wood, is allowing cardiology at the Hammersmith to die-a black page in the history of medicine.
The failure to consider this diagnosis in presenting symptoms of lethargy, headache, and rhinitis may be because it is virtually absent from general medical books and reports-large textbooks of medicine ususlly devote no more than several paragraphs to the
condition. A MEDLINE search for 1986-90 produced a total of 19 992 articles in the American journal of Medicine, New England journal of Medicine, Annals of Internal Medicine, Archives of Internal Medicine, and Journal of the American Medical Association. Only 10 of those mentioned sinusitis, acute or chronic, as a medical subject heading. Only 1 of the 10 reported original research; the others were brief notes or case reports. I wonder if clinical researchers do not consider chronic sinusitis as a possible cause of sick building syndrome because their exposure to this problem is so slight? The disease may often lack an objective marker, but it is quite real and troublesome. Sales of nonprescription sinus drugs, popular press articles, and television commercials may offer a better clue to doctors about the morbidity of chronic sinusitis than would general medical publications. Department of Medicine, Georgetown University Medical Center, Washington, DC 20016, USA
ALEXANDER C. CHESTER
1. Moss AJ, Parsons VL. Current estimates from the National Health Interview
Survey,
United States—1985 Hyattsville, Maryland: National Center for Health Statistics, 1986. 66-7; DHHS publication no (PHS) 86-1588. (Vital and Health Statistics; series
10; no 160.)
Interuniversity Cardiology Institute of the Netherlands,
Long reports
P0 Box19 258, 3501 DG Utrecht, Netherlands
FRITS L.
MEIJLER
SIR,-In 1990, discussing the future of medical journals, you, Sir, stated that: "the challenges for the next decade will surely be the
SiR,—You draw attention to academic cardiology at Hammersmith Hospital. I would point out that the British (later Royal) Postgraduate Medical School was established to provide an opportunity for the advancement of knowledge of medicine, surgery, obstetrics, and the allied sciences, and to promote the investigation of diseases and their treatment. The fact that cardiology became so prominent at the Hammersmith during the 1940s was due partly to wartime needs (hence the work on shock and haemorrhage) and partly to the introduction by Coumand et al in the USA of the new technique of cardiac catheterisation (which we rapidly adopted and used in our studies of heart failure, congenital heart disease, &c). With each generation new priorities arise, and new techniques are developed for their investigation. The recent appointment to the chair of medicine of Prof James Scott, a noted expert on
apolipoproteins that transport cholesterol and the mechanisms underlying the formation of atheroma, demonstrates that cardiovascular disease remains one of the highest priorities at the Hammersmith. Further support in this specialty will be provided when the British Heart Foundation chair in cardiovascular medicine, currently vacant, is once again filled. Conservatism in medicine has never been the watchword at the Hammersmith ; and I am confident that the School will remain internationally competitive in those areas that seem most ripe for development and where major advances seem most likely to be made. 2 North Square, London NW11 7AA, UK
conflict between information content and readability".1 The challenges seem to have arrived sooner than expected. Though you are to be commended for another British first-publishing the two-part Long Report on the systemic treatment of early breast cancer (Jan 4, p 1, Jan 11, p 71)-many of us will hope that this first experiment will also be the last in a widely read general journal. Rarely can a format have been so reader unfriendly, and rarely can so many other important papers have been pushed aside by such a Behemoth. Most ordinary readers must have got the message over the toast and marmalade, from the daily papers, subsequently supplementing this from your two cogent editorials; experts could have got the detail from a specialist journal. Pluralism, please, for general journals, to be sure, but let us try to solve at least one of the problems of this decade by reserving space for future Long Reports, however important (as undeniably this one was), in such new developments as the electronic journal Current Clinical Trials, due to be launched by the American Association for the Advancement of Science in April. 115 Dulwich
Village,
STEPHEN LOCK
London SE21 7BJ, UK
1. Fox R. Pluralism please. In: Lock S, ed. The future of medical journals. London: British Medical Journal 1991: 62-66.
Undergraduate teaching on chronic wound care
JOHN MCMICHAEL
are under constant pressure to and reduce costs. There is a vast knowledge base on the prevention and management of chronic open wounds and this, together with rapidly rising costs, means that procedures have to be assessed critically. That process of evaluation will need an input from doctors-yet these wounds (mainly leg ulcers and pressure sores) are usually perceived by doctors as a preserve of nurses.1 This narrow-minded approach will have to change, for many reasons-including the huge numbers of such wounds,z the need for a multidisciplinary approach, the enormous cost of treatmentand the spectre of litigation.’ To see how tomorrow’s doctors might fare in such an altered setting I have done a survey of what medical students are being taught about chronic open wounds.
SIR,-Health-care professionals
assess
Sick
building syndrome and sinusitis
SiR,—Your Dec 14 editorial on sick building syndrome lists the major complaints, "lethargy, headache, blocked or runny nose..." but fails to consider the usual cause of these symptoms-chronic sinusitis. The most common disease in the USA, affecting 31-2 million people, sinusitis is virtually ignored in general medical publications, as well as in the differential diagnosis of medical problems.’ Sinusitis is clearly caused in some cases by pollution, indoor or outdoor, and should be regarded as a possible cause of sick
building syndrome.
treatments