To the Editor:
I appreciated your editorial, “The Answer You Get Depends on the Question You Ask,” in the July 2005 issue of the Journal.
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I was pleased that as editor-in-chief of The American Journal of Medicine, you ask yourself whether the question being asked by an article is important and whether the outcome is predictable. Careful consideration of these issues, as well as of how questions and answers are reported, is critical to a great journal.I was, therefore, surprised to read the article in the same issue by Lee et al entitled, “Low-Dose Aspirin Increases Aspirin Resistance in Patients with Coronary Artery Disease.”
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I thought about “the question” of whether using low-dose aspirin (something now commonplace) might have negative effects in patients with coronary disease. With excitement I read the article, expecting to learn “the answer” that the use of low-dose aspirin somehow desensitizes platelets to cyclooxygenase inhibition by aspirin and produces measurable aspirin resistance. Instead, I read that in a group of patients with stable coronary disease, aspirin dose was directly associated with the prevalence of aspirin resistance. Although intriguing, the study by Lee et al certainly did not prove the cause-and-effect relationship between low-dose aspirin and aspirin resistance suggested by the title.Although I may be in the minority of readers of the Journal who were misled by the title, I believe that “the question you ask” should be reflected in the title, as should the answer to that question. We must recognize that, particularly given the time constraints many practitioners face, readers of medical journals often peruse titles and abstracts and do not read full articles. Although this is disappointing, an article’s title (which appears in references, abstracts and Internet citations) is therefore very important and may be all that a reader recalls. Although a physician who prescribes high-dose aspirin out of concern about causing aspirin resistance based simply on this article’s title is clearly not practicing good medicine or demonstrating the highest standards of professionalism, reviewers and editors of medical journals also bear responsibility for ensuring that the message communicated to the public is clear and precise. We also should recall that summaries of medical articles are frequently made available to the lay public and that patients with coronary disease can draw their own conclusions about what aspirin dose to take to prevent ischemic complications.
I am sure that the commitment to high quality reflected in the July 2005 issue’s editorial
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was impressive to readers of the Journal; I know it was to me. I hope that reviewers of articles submitted to the Journal not only ensure that the question asked is important, but also that the question or the answer is readily apparent… even in the title.References
- The answer you get depends on the question you ask.Am J Med. 2005; 118: 693
- Low-dose aspirin increases aspirin resistance in patients with coronary artery disease.Am J Med. 2005; 118: 723-727
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- Reply to “What is the Answer You got?”The American Journal of MedicineVol. 119Issue 3
- PreviewWe read with interest the letter from Dr. Ziegelstein in response to our publication in the Journal.1 We must reiterate that we sought to investigate the relation between aspirin dose and aspirin resistance as measured by a point-of-care assay only. The title of our article just reflects what we found and has no suggestions for any actions needed for this observation. It is beyond the scope of the present work to examine the mechanistic explanation for this phenomenon. We concur with the position paper of the International Society on Thrombosis and Haemostasis that we need more studies to link the laboratory findings to adverse clinical events and the benefits of altering antiplatelet therapy based on such a finding.
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