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Enhancement of left ventricular function by glucose-insulin-potassium in acute myocardial infarction
LETTERS* BLIND
REVIEWS
This letter offers a brief comment on your recent statements concerning blind reviews. Although the motivation for impartiality in reviewing scientific manuscripts is well understood, my experience as both an author and a reviewer suppQrts the side of nonblind reviews. The weight of my opinion rests o n o n e crucial point. As an author, it is important to me to make clear to the reader which aspects of my results or my discussion are based on previous work in my or my colleagues' laboratories. I generally attempt to clearly identify for the reader those parts of the discussion that refer to work performed in our institution. The reader needs to clearly understand how much of the case being made has been built up in one environment and how much derives its foundation from various institutions. It is unfair to deny a reviewer that information. Typically, a reviewer would appreciate a clear understanding of the extent of the author's background in the area being investigated and whether methods used or conclusions drawn are founded in well-experienced laboratories. In addition, little effort is required by the reviewer to determine the source of an article even in a blind review. Unfortunately, some reviewers are unfairly prejudiced against a particular investigator o r investigators. However, individuals who apply such partialities will go to the necessary effort to identify the source of a given article. Normally, a brief review of the reference list will clearly identify the source. Therefore, blind reviews will generally not prevent such prejudicial refereeing. The position of editor is a difficult one. For my own work, I will submit my articles clearly identified with their source and will request nonblind reviews. I will also urge my colleagues to do the same. Time will prove that the only means to prevent prejudiced reviews is to clearly document them and to eliminate those reviewers from your list. Your open approach to this problem and the editorial policy that allows contributing authors to choose the manner in which their particular manuscript is reviewed is greatly appreciated. Michael D. Devous, Sr., MD Dallas, Texas
I read of your intention to initiate blind reviews for manuscripts submitted to your Journal. I think this is an excellent idea which not only may offer a greater equity with respect to acceptance of papers but also may allow the opportunity to determine whether reviewer bias exists. If possible, it would be important to submit each manuscript for both a "blind" and a "standard" review. An additional step would * Letters (from the United States) concerning a particular article in the Journal must be received Within 2 months of the article's publication, and Should be limited (with rare exceptions) to 2 double-spaced typewritten pages. Two copies must be Submitted.
be to have 2 "standard" reviewers: i prominent in the field addressed by the author, the other with competence in another area of cardiology. I realize that the review process, at best, is somewhat subjective, requiring a large number of reviewers to be involved before a meaningful conclflsion is reached concerning reviewer bias. However, the volume of manuscripts submitted to the Journal could provide for sufficient numbers if the extra work would not be a great burden. Barry Stimmel, MD New York, New York
Since you asked for comments on this issue, I would point out that as long as the policy for blinded reviews remains optional, there clearly is an advantage for more established and well-known investigators or laboratories to remain identified, while there is an incentive for less well-known and established investigators to remain unidentified. Accordingly, reviewers receiving unidentified manuscripts may have a tendency to presume they come from less well-known centers and thus may grade them more harshly than they would manuscripts from well-known investigators or centers. It seems, therefore, that for the blind review policy to work as intended all reviews must be blinded, and that this cannot be an optional policy on the part of either editors or investigators. Henry Gewirtz, MD Providence, Rhode Island
ENHANCEMENT VENTRICULAR
OF
LEFT
FUNCTION
GLUCOSE-INSULIN-POTASSIUM ACUTE
MYOCARDIAL
Patrick L. Whitlow, MD William J. Rogers, MD Birmingham, Alabama 1. Rogers WJ, Stanley AW, Breinig JB, Prather JW, McDaniel HG, Moraski RE, Mantle JA, Russell RO Jr, Rackley CE. Reductionof hospital mortality rate of acute myocardial infarction with glucose-insulin-potassium infusion. Am Heart J 1976;92:441-454. 2. Prather J, Russell RO Jr, Mantle JA, McDaniel HG, Rackley CE. Metabolic consequences of glucose°insulin-potassiuminfusionin treatment of acute myocardial infarction. Am J Cardiol 1976;38:95-99. 3. Rogers WJ, Russell RO Jr, McDanlel HG, Rackiey CE. Acute effects of glucose-insulin-potassium infusionon myocardial substrates, coronary bloodflow and oxygen consumption in man. Am J Cardiol 1977;40:421-428. 4. Rogers WJ, Segall PH, McDaniel HG, Mantle JA, Russell RO Jr, Rackley CE. Prospective randomized trial of glucose-insulin-potassium in acute myocardial infarction. Effects of myocardial hemodynamics, substrates, and rhythm. Am J Cardiol 1979;43:801-809. 5. Whitlow PL, Rogers WJ, Smith RJ, McDaniel HG, Papapietro SE, Mantle JA, Logic JR, Russell RO Jr, Rackley CE. Enhancement of left ventricular function by glucose-insulin-potassium infusion in acute myocardial infarction. Am J Cardio11982;49:811-820.
GERONTOLOGIC
BY IN
INFARCTION
I read With great interest the report, "Enhancement of left ventricular function by glucose-insulin-potassium in acute myocardial infarction," by Whitlow et al. I consider the report excellent, but an injustice is evidently manifested. No reference is made to the work of Demetrio Sodi-Pallares, a pioneer in the investigation of glucose-insulin-potassium solutions. Sodi-Pallares demonstrated a marked improvement in reduced myocardial contraction at the center of a recent myocardial infarction with glucose-insulin-potassium solutions. The study was performed in 1964 with the strain gauge method (Brodie bridge) and was described in the book, "Ischaemic Heart Disease and Polarizing Treatment. New Metabolic and Thermodynamic Bases," published by Tampa Tracings in 1976. David Contreras, MD Juarez, Mexico
REPLY: We are certainly cognizant of the pioneering work of Demetrio Sodi-Pallares and his colleagues in the investigation of glucose-insulin-potassium infusion. Indeed, at our institution, interest in glucose-insulin-potassium infusion began after a lecture
1041
on the subject here by Dr. Sodi-Pallares. His work has been referenced in many of our previous publications on this subject, 1-4 all of which were included in our manuscript. The lack of direct reference to the work of Dr. Sodi-Pallares and his colleagues in our most recent report in this Journal 5 was certainly not a comment on the quality and importance of their work. We certainly share their enthusiasm in the use of glucose-insulin-potassium infusion in the setting of acute myocardial infarction.
PHARMACOLOGY
We would like to hring to the attention of the scientific research community a recent report 1 of a workshop on gerontologic pharmacology and of a National Institute on Aging Pharmacology Program announcement 2 based on its recommendations. It has been widely reported that the elderly have a greater incidence of adverse side effects of drugs and of drug interactions than do young adults. Evidence has been reported of altered patterns of drug distribution and responsiveness in the elderly. Because drugs are generally tested in young adults and dosage adjusted to their needs, it is not surprising that the elderly may respond differently. Much research is needed to determine where age-related alterations in drug responses exist and, when found, to determine their cause or causes. Studies are encouraged in both clinical and basic research areas. The addition of cohorts of elderly to ongoing studies may be an appropriate means of detecting significant differences, and special National Institute on Aging programs are available for the performance of pilot studies. George M. Steinberg, PbD Bethesda, Maryland 1. Steinberg GM, Schneider EL. The National Institute on Aging's Second Workshop on Pharmacologyand Aging, June 4-5, 1981. Pharmacologist 1982;24:65-67. 2. Pharmacology Program, National Institute on Aging. National institutes of Health Guide for Grantsand Contracts 11, No. 5.42-44, April 23, 1982.
REVIEWS
This letter offers a brief comment on your recent statements concerning blind reviews. Although the motivation for impartiality in reviewing scientific manuscripts is well understood, my experience as both an author and a reviewer suppQrts the side of nonblind reviews. The weight of my opinion rests o n o n e crucial point. As an author, it is important to me to make clear to the reader which aspects of my results or my discussion are based on previous work in my or my colleagues' laboratories. I generally attempt to clearly identify for the reader those parts of the discussion that refer to work performed in our institution. The reader needs to clearly understand how much of the case being made has been built up in one environment and how much derives its foundation from various institutions. It is unfair to deny a reviewer that information. Typically, a reviewer would appreciate a clear understanding of the extent of the author's background in the area being investigated and whether methods used or conclusions drawn are founded in well-experienced laboratories. In addition, little effort is required by the reviewer to determine the source of an article even in a blind review. Unfortunately, some reviewers are unfairly prejudiced against a particular investigator o r investigators. However, individuals who apply such partialities will go to the necessary effort to identify the source of a given article. Normally, a brief review of the reference list will clearly identify the source. Therefore, blind reviews will generally not prevent such prejudicial refereeing. The position of editor is a difficult one. For my own work, I will submit my articles clearly identified with their source and will request nonblind reviews. I will also urge my colleagues to do the same. Time will prove that the only means to prevent prejudiced reviews is to clearly document them and to eliminate those reviewers from your list. Your open approach to this problem and the editorial policy that allows contributing authors to choose the manner in which their particular manuscript is reviewed is greatly appreciated. Michael D. Devous, Sr., MD Dallas, Texas
I read of your intention to initiate blind reviews for manuscripts submitted to your Journal. I think this is an excellent idea which not only may offer a greater equity with respect to acceptance of papers but also may allow the opportunity to determine whether reviewer bias exists. If possible, it would be important to submit each manuscript for both a "blind" and a "standard" review. An additional step would * Letters (from the United States) concerning a particular article in the Journal must be received Within 2 months of the article's publication, and Should be limited (with rare exceptions) to 2 double-spaced typewritten pages. Two copies must be Submitted.
be to have 2 "standard" reviewers: i prominent in the field addressed by the author, the other with competence in another area of cardiology. I realize that the review process, at best, is somewhat subjective, requiring a large number of reviewers to be involved before a meaningful conclflsion is reached concerning reviewer bias. However, the volume of manuscripts submitted to the Journal could provide for sufficient numbers if the extra work would not be a great burden. Barry Stimmel, MD New York, New York
Since you asked for comments on this issue, I would point out that as long as the policy for blinded reviews remains optional, there clearly is an advantage for more established and well-known investigators or laboratories to remain identified, while there is an incentive for less well-known and established investigators to remain unidentified. Accordingly, reviewers receiving unidentified manuscripts may have a tendency to presume they come from less well-known centers and thus may grade them more harshly than they would manuscripts from well-known investigators or centers. It seems, therefore, that for the blind review policy to work as intended all reviews must be blinded, and that this cannot be an optional policy on the part of either editors or investigators. Henry Gewirtz, MD Providence, Rhode Island
ENHANCEMENT VENTRICULAR
OF
LEFT
FUNCTION
GLUCOSE-INSULIN-POTASSIUM ACUTE
MYOCARDIAL
Patrick L. Whitlow, MD William J. Rogers, MD Birmingham, Alabama 1. Rogers WJ, Stanley AW, Breinig JB, Prather JW, McDaniel HG, Moraski RE, Mantle JA, Russell RO Jr, Rackley CE. Reductionof hospital mortality rate of acute myocardial infarction with glucose-insulin-potassium infusion. Am Heart J 1976;92:441-454. 2. Prather J, Russell RO Jr, Mantle JA, McDaniel HG, Rackley CE. Metabolic consequences of glucose°insulin-potassiuminfusionin treatment of acute myocardial infarction. Am J Cardiol 1976;38:95-99. 3. Rogers WJ, Russell RO Jr, McDanlel HG, Rackiey CE. Acute effects of glucose-insulin-potassium infusionon myocardial substrates, coronary bloodflow and oxygen consumption in man. Am J Cardiol 1977;40:421-428. 4. Rogers WJ, Segall PH, McDaniel HG, Mantle JA, Russell RO Jr, Rackley CE. Prospective randomized trial of glucose-insulin-potassium in acute myocardial infarction. Effects of myocardial hemodynamics, substrates, and rhythm. Am J Cardiol 1979;43:801-809. 5. Whitlow PL, Rogers WJ, Smith RJ, McDaniel HG, Papapietro SE, Mantle JA, Logic JR, Russell RO Jr, Rackley CE. Enhancement of left ventricular function by glucose-insulin-potassium infusion in acute myocardial infarction. Am J Cardio11982;49:811-820.
GERONTOLOGIC
BY IN
INFARCTION
I read With great interest the report, "Enhancement of left ventricular function by glucose-insulin-potassium in acute myocardial infarction," by Whitlow et al. I consider the report excellent, but an injustice is evidently manifested. No reference is made to the work of Demetrio Sodi-Pallares, a pioneer in the investigation of glucose-insulin-potassium solutions. Sodi-Pallares demonstrated a marked improvement in reduced myocardial contraction at the center of a recent myocardial infarction with glucose-insulin-potassium solutions. The study was performed in 1964 with the strain gauge method (Brodie bridge) and was described in the book, "Ischaemic Heart Disease and Polarizing Treatment. New Metabolic and Thermodynamic Bases," published by Tampa Tracings in 1976. David Contreras, MD Juarez, Mexico
REPLY: We are certainly cognizant of the pioneering work of Demetrio Sodi-Pallares and his colleagues in the investigation of glucose-insulin-potassium infusion. Indeed, at our institution, interest in glucose-insulin-potassium infusion began after a lecture
1041
on the subject here by Dr. Sodi-Pallares. His work has been referenced in many of our previous publications on this subject, 1-4 all of which were included in our manuscript. The lack of direct reference to the work of Dr. Sodi-Pallares and his colleagues in our most recent report in this Journal 5 was certainly not a comment on the quality and importance of their work. We certainly share their enthusiasm in the use of glucose-insulin-potassium infusion in the setting of acute myocardial infarction.
PHARMACOLOGY
We would like to hring to the attention of the scientific research community a recent report 1 of a workshop on gerontologic pharmacology and of a National Institute on Aging Pharmacology Program announcement 2 based on its recommendations. It has been widely reported that the elderly have a greater incidence of adverse side effects of drugs and of drug interactions than do young adults. Evidence has been reported of altered patterns of drug distribution and responsiveness in the elderly. Because drugs are generally tested in young adults and dosage adjusted to their needs, it is not surprising that the elderly may respond differently. Much research is needed to determine where age-related alterations in drug responses exist and, when found, to determine their cause or causes. Studies are encouraged in both clinical and basic research areas. The addition of cohorts of elderly to ongoing studies may be an appropriate means of detecting significant differences, and special National Institute on Aging programs are available for the performance of pilot studies. George M. Steinberg, PbD Bethesda, Maryland 1. Steinberg GM, Schneider EL. The National Institute on Aging's Second Workshop on Pharmacologyand Aging, June 4-5, 1981. Pharmacologist 1982;24:65-67. 2. Pharmacology Program, National Institute on Aging. National institutes of Health Guide for Grantsand Contracts 11, No. 5.42-44, April 23, 1982.