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“Double blind”, indeed!
EDITORIAL CORRESPONDENCE
Editorial correspondence is subject to critical review and to current editorial policy in respect to publication in part or in full. Preference is given to letters.related to articles published in ThE JOURNAL, but letters on topics of current interest m a y be accepted if space is available. Letters are restricted to 300 words or less, and 3 supporting references.
"Double blind," indeed! To the Editor: W e have a question regarding the methods used by DiSessa, et alI in their recent article on the cardiovascular effects of dopamine in the severely asphyxiated neonate. W a s it necessary to use a double-blind protocol? Perhaps they were concerned that informing the asphyxiated neonates as to whether they were receiving dopamine or placebo would bias their results. Studies have shown (references upon request) that neonates, and asphyxiated neonates in particular, are rather apathetic to the type of intravenous infusate they receive. Retrolental fibroplasia notwithstanding, a single-blind study would have sufficed. S. Berman, M.D. C. Eckhoff, M.D. I. Parness. M.D. A. Rabinowitz, M.D. Pediatric Houseofficers Brookdale Hospital Medical Center Brooklyn, N Y 1I212 REFERENCE 1.
DiSessa TG, Litner M, Ti CC, Gluck L, Coen R, and Friedman WF: The cardiovascular effects of dopamine i n t h e severely asphyxiated neonate, J PEOIArR 99:772, 1981.
individual. This suggested to us that we should allow the term to remain as it is written, and this we did. After we determined that it is not possible to trust these little buggers (references upon request), we should have proceeded to a consideration of the second item; we did not do this until receipt of the letter from Dr. Berman. Now we can report that our panel has been reassembled and we can present the following results: we agree that the use of the word blind or any of its derivatives is probably not appropriate in this context because of the obvious double meaning so clearly indicated by Dr. Berman and friends. In seeking a substitute term, the word naive was considered but rejected. It was pointed out that naive carries an implication of innocence and one of our clergymen exercised his single peremptory veto on that basis. He kept muttering something about Original Sin. Also considered was the term ignorant, but it also offended members of the panel, in spite of general agreement that some of what is printed and much of what is submitted seemingly reflect this state. Tentatively we finally settled on the word aware, and have extended the hope that authors might write something like "Neither the physician nor the patient was aware of the capsule content." The disadvantage here is that the word is short, clear, and almost never misspelled, "More work needs to be done," but we thank Dr. Berman et al for the stimulus to proceed thus far. R.E.M.
Reply The letter offered by Dr. Berman and associates was gratefully received because it allows us to comment on the two issues raised therein. The use of the term double-blind in the paper by DiSessa and colleagues gcnerated considerable discussion within the editorial offices so that wc were constrained to recruit a panel of experts to debate whether the infants under study were mature enough to appreciate what was going on. Quickly the topic broadened to consider at what age such awareness emerges. Our experts included the Surgeon General of the United States, an ethicist, two clergy of somewhat disparate persuasions, and a former member of the local municipal sanitary service. After extended discussion it was concluded that an infant can develop significant appreciation of current events any time from the moment of conception to entry into the first grade, depending upon the
Decomposition o f TPN solutions exposed to phototherapy To the Editor: The article of Bhatia et alI has indicated the breakdown of some components (specifically amino acids) in hyperalimentation solutions when exposed to light. In their study, intense phototherapy lamps (flux = 800 to 1,000 W / c m 2 / n m ) were used as the light source. On the basis of their observation, they have recommended that hyperalimentation solutions, when used in the nursery, should be protected from light. It is unclear, though, whether such precaution should be taken when bottles containing hyperalimenration solution are exposed to regular lighting conditions in the nursery, since it has been argued that the irradiance is not as
TheJournalofPEDlATRICS
669
Editorial correspondence is subject to critical review and to current editorial policy in respect to publication in part or in full. Preference is given to letters.related to articles published in ThE JOURNAL, but letters on topics of current interest m a y be accepted if space is available. Letters are restricted to 300 words or less, and 3 supporting references.
"Double blind," indeed! To the Editor: W e have a question regarding the methods used by DiSessa, et alI in their recent article on the cardiovascular effects of dopamine in the severely asphyxiated neonate. W a s it necessary to use a double-blind protocol? Perhaps they were concerned that informing the asphyxiated neonates as to whether they were receiving dopamine or placebo would bias their results. Studies have shown (references upon request) that neonates, and asphyxiated neonates in particular, are rather apathetic to the type of intravenous infusate they receive. Retrolental fibroplasia notwithstanding, a single-blind study would have sufficed. S. Berman, M.D. C. Eckhoff, M.D. I. Parness. M.D. A. Rabinowitz, M.D. Pediatric Houseofficers Brookdale Hospital Medical Center Brooklyn, N Y 1I212 REFERENCE 1.
DiSessa TG, Litner M, Ti CC, Gluck L, Coen R, and Friedman WF: The cardiovascular effects of dopamine i n t h e severely asphyxiated neonate, J PEOIArR 99:772, 1981.
individual. This suggested to us that we should allow the term to remain as it is written, and this we did. After we determined that it is not possible to trust these little buggers (references upon request), we should have proceeded to a consideration of the second item; we did not do this until receipt of the letter from Dr. Berman. Now we can report that our panel has been reassembled and we can present the following results: we agree that the use of the word blind or any of its derivatives is probably not appropriate in this context because of the obvious double meaning so clearly indicated by Dr. Berman and friends. In seeking a substitute term, the word naive was considered but rejected. It was pointed out that naive carries an implication of innocence and one of our clergymen exercised his single peremptory veto on that basis. He kept muttering something about Original Sin. Also considered was the term ignorant, but it also offended members of the panel, in spite of general agreement that some of what is printed and much of what is submitted seemingly reflect this state. Tentatively we finally settled on the word aware, and have extended the hope that authors might write something like "Neither the physician nor the patient was aware of the capsule content." The disadvantage here is that the word is short, clear, and almost never misspelled, "More work needs to be done," but we thank Dr. Berman et al for the stimulus to proceed thus far. R.E.M.
Reply The letter offered by Dr. Berman and associates was gratefully received because it allows us to comment on the two issues raised therein. The use of the term double-blind in the paper by DiSessa and colleagues gcnerated considerable discussion within the editorial offices so that wc were constrained to recruit a panel of experts to debate whether the infants under study were mature enough to appreciate what was going on. Quickly the topic broadened to consider at what age such awareness emerges. Our experts included the Surgeon General of the United States, an ethicist, two clergy of somewhat disparate persuasions, and a former member of the local municipal sanitary service. After extended discussion it was concluded that an infant can develop significant appreciation of current events any time from the moment of conception to entry into the first grade, depending upon the
Decomposition o f TPN solutions exposed to phototherapy To the Editor: The article of Bhatia et alI has indicated the breakdown of some components (specifically amino acids) in hyperalimentation solutions when exposed to light. In their study, intense phototherapy lamps (flux = 800 to 1,000 W / c m 2 / n m ) were used as the light source. On the basis of their observation, they have recommended that hyperalimentation solutions, when used in the nursery, should be protected from light. It is unclear, though, whether such precaution should be taken when bottles containing hyperalimenration solution are exposed to regular lighting conditions in the nursery, since it has been argued that the irradiance is not as
TheJournalofPEDlATRICS
669