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Clarity of Language–2
LETTERS TO THE EDITOR
Clarity of Language To the Editor: Bravo to Dr Esther for his letter published in the September 2005 issue of Mayo Clinic Proceedings, in which he called for more clarity of language in our profession and ridding ourselves of the redundant term past in past medical history. I would like to add the redundant term coronary heart disease that so many people are afflicted with these days. I assume the term refers to coronary artery disease. However, we never use the terms hepatic liver disease or renal kidney failure for example. Why coronary heart disease is used is anyone’s guess. Tim Laird, MD Private practice Melbourne, Fla Editor’s note: Dr Sanders’ correspondence was but one of several the journal received that addressed the same issue: recommended replacement terminology for past medical history. This letter was selected from the group because of its date of submission, brevity, and clarity. To the Editor: Regarding Dr Esther’s letter on using precise language, I wonder what phrase or words he believes physicians should use to replace the term past medical history. Samuel Sanders, MD Sutter County Clinic Yuba City, Calif In reply: I appreciate the responses to my letter. It is nice to know other physicians also care about the use of language and its effect on our ability to care for our patients. For clarification, in the second paragraph of my original letter, I suggested medical history as a less redundant term to replace past medical history.
surface strength of 192 G, yet there was no attempt to measure magnetic flux penetration into the foot by a standardized Lakeshore 420 gaussmeter2 or other devices as described by Blechman et al.3 Only one third of the foot was being addressed. What about individuals with foot pain secondary to heel spurs, tarsal tunnel syndrome with calcaneal branch compression, spinal stenosis at L5-S1, etc? The fact that a heterogeneous population was used intentionally is also a major weakness because the authors did not know what condition was being treated, and more specifically they did not know the target tissue, ie, nerve, muscle, tendon, articular joints, bones, etc. Of note, this device was removed from the market 2 years ago and was ineffective in a prior study with a similarly flawed design by these same authors.4 The study cohort was primarily women (79%), and it would be interesting to know how many subjects had other somatic symptoms compatible with a diagnosis of fibromyalgia. Did any of the subjects have depression? The authors used intention-to-treat analyses, and it would be of interest to learn how many subjects had missing data. Because pain fluctuates throughout the day and only evening pain and morning pain were mentioned, it is not clear whether these individuals also tabulated their pain while working. Table 1 shows that the mean number of hours standing or walking per day was 8.4 to 9.6. Thus, this information is pertinent. In conclusion, it is important to be skeptical about any new treatment, and the use of a rigorous randomized, double-blind, placebo-controlled design is the best approach to determining efficacy.5 However, it is critical to know what condition is being treated so as to appreciate not only the natural history but also identify target tissue, ie, with an homogeneous cohort. One cannot allegedly treat one third of the foot less than 10% of the time and make any valid conclusions. I am surprised and perplexed that the Mayo Foundation Institutional Review Board approved this design and protocol with these major flaws and that Mayo Clinic Proceedings published this study.
Robert J. Esther, MD Mayo Clinic College of Medicine Rochester, Minn
Magnetic Insoles To the Editor: The article by Winemiller et al1 published in the September 2005 issue of Mayo Clinic Proceedings contains numerous methodological flaws and a faulty hypothesis. Thus, it is not surprising that the magnetic insoles were ineffective. The study cohort used the active and sham insoles for 4 hours daily, 4 days per week, for 8 weeks. This calculates to 16 hours per week or 128 hours of a total of 1344 hours, representing 91/2% exposure to reverse chronic pain present constantly for up to 20 years. Magnets are not magical. If one tests a hypothesis for treating chronic pain, one should use not only strong penetrating devices but also apply them constantly to the entire foot. The specific magnetic insole used has a magnetic foil pad located only under the proximal arch of the foot. It has a weak 264
Mayo Clin Proc.
•
Michael I. Weintraub, MD New York Medical Center Valhalla, NY 1. Winemiller MH, Billow RG, Laskowski ER, Harmsen WS. Effect of magnetic vs sham-magnetic insoles on nonspecific foot pain in the workplace: a randomized, double-blind, placebo-controlled trial. Mayo Clin Proc. 2005; 80:1138-1145. 2. Gaussmeter probe selection: MMT-6J04-VH. Magnet-Physics, Inc. Elk Grove Village, Ill. 3. Blechman AM, Oz MC, Nair V, Ting W. Discrepency between claimed field flux density of some commercially available magnets and actual gaussmeter measurements. Altern Ther Health Med. 2001;7:92-95. 4. Winemiller MH, Billow RG, Laskowski ER, Harmsen WS. Effect of magnetic vs sham-magnetic insoles on plantar heel pain: a randomized controlled trial [published correction appears in JAMA. 2004;291:46]. JAMA. 2003; 290:1474-1478. 5. Weintraub MI. Magnetotherapy: historical background with a stimulating future. Crit Rev Phys Rehabil Med. 2004;16:95-108.
To the Editor: A colleague called my attention to the interesting article by Winemiller et al,1 and I want to address a few issues in that article.
February 2006;81(2):262-264, 266-268
•
www.mayoclinicproceedings.com
For personal use. Mass reproduce only with permission from Mayo Clinic Proceedings.
Clarity of Language To the Editor: Bravo to Dr Esther for his letter published in the September 2005 issue of Mayo Clinic Proceedings, in which he called for more clarity of language in our profession and ridding ourselves of the redundant term past in past medical history. I would like to add the redundant term coronary heart disease that so many people are afflicted with these days. I assume the term refers to coronary artery disease. However, we never use the terms hepatic liver disease or renal kidney failure for example. Why coronary heart disease is used is anyone’s guess. Tim Laird, MD Private practice Melbourne, Fla Editor’s note: Dr Sanders’ correspondence was but one of several the journal received that addressed the same issue: recommended replacement terminology for past medical history. This letter was selected from the group because of its date of submission, brevity, and clarity. To the Editor: Regarding Dr Esther’s letter on using precise language, I wonder what phrase or words he believes physicians should use to replace the term past medical history. Samuel Sanders, MD Sutter County Clinic Yuba City, Calif In reply: I appreciate the responses to my letter. It is nice to know other physicians also care about the use of language and its effect on our ability to care for our patients. For clarification, in the second paragraph of my original letter, I suggested medical history as a less redundant term to replace past medical history.
surface strength of 192 G, yet there was no attempt to measure magnetic flux penetration into the foot by a standardized Lakeshore 420 gaussmeter2 or other devices as described by Blechman et al.3 Only one third of the foot was being addressed. What about individuals with foot pain secondary to heel spurs, tarsal tunnel syndrome with calcaneal branch compression, spinal stenosis at L5-S1, etc? The fact that a heterogeneous population was used intentionally is also a major weakness because the authors did not know what condition was being treated, and more specifically they did not know the target tissue, ie, nerve, muscle, tendon, articular joints, bones, etc. Of note, this device was removed from the market 2 years ago and was ineffective in a prior study with a similarly flawed design by these same authors.4 The study cohort was primarily women (79%), and it would be interesting to know how many subjects had other somatic symptoms compatible with a diagnosis of fibromyalgia. Did any of the subjects have depression? The authors used intention-to-treat analyses, and it would be of interest to learn how many subjects had missing data. Because pain fluctuates throughout the day and only evening pain and morning pain were mentioned, it is not clear whether these individuals also tabulated their pain while working. Table 1 shows that the mean number of hours standing or walking per day was 8.4 to 9.6. Thus, this information is pertinent. In conclusion, it is important to be skeptical about any new treatment, and the use of a rigorous randomized, double-blind, placebo-controlled design is the best approach to determining efficacy.5 However, it is critical to know what condition is being treated so as to appreciate not only the natural history but also identify target tissue, ie, with an homogeneous cohort. One cannot allegedly treat one third of the foot less than 10% of the time and make any valid conclusions. I am surprised and perplexed that the Mayo Foundation Institutional Review Board approved this design and protocol with these major flaws and that Mayo Clinic Proceedings published this study.
Robert J. Esther, MD Mayo Clinic College of Medicine Rochester, Minn
Magnetic Insoles To the Editor: The article by Winemiller et al1 published in the September 2005 issue of Mayo Clinic Proceedings contains numerous methodological flaws and a faulty hypothesis. Thus, it is not surprising that the magnetic insoles were ineffective. The study cohort used the active and sham insoles for 4 hours daily, 4 days per week, for 8 weeks. This calculates to 16 hours per week or 128 hours of a total of 1344 hours, representing 91/2% exposure to reverse chronic pain present constantly for up to 20 years. Magnets are not magical. If one tests a hypothesis for treating chronic pain, one should use not only strong penetrating devices but also apply them constantly to the entire foot. The specific magnetic insole used has a magnetic foil pad located only under the proximal arch of the foot. It has a weak 264
Mayo Clin Proc.
•
Michael I. Weintraub, MD New York Medical Center Valhalla, NY 1. Winemiller MH, Billow RG, Laskowski ER, Harmsen WS. Effect of magnetic vs sham-magnetic insoles on nonspecific foot pain in the workplace: a randomized, double-blind, placebo-controlled trial. Mayo Clin Proc. 2005; 80:1138-1145. 2. Gaussmeter probe selection: MMT-6J04-VH. Magnet-Physics, Inc. Elk Grove Village, Ill. 3. Blechman AM, Oz MC, Nair V, Ting W. Discrepency between claimed field flux density of some commercially available magnets and actual gaussmeter measurements. Altern Ther Health Med. 2001;7:92-95. 4. Winemiller MH, Billow RG, Laskowski ER, Harmsen WS. Effect of magnetic vs sham-magnetic insoles on plantar heel pain: a randomized controlled trial [published correction appears in JAMA. 2004;291:46]. JAMA. 2003; 290:1474-1478. 5. Weintraub MI. Magnetotherapy: historical background with a stimulating future. Crit Rev Phys Rehabil Med. 2004;16:95-108.
To the Editor: A colleague called my attention to the interesting article by Winemiller et al,1 and I want to address a few issues in that article.
February 2006;81(2):262-264, 266-268
•
www.mayoclinicproceedings.com
For personal use. Mass reproduce only with permission from Mayo Clinic Proceedings.