Letters to the Editor
- The health care system in the United States is capable of both health care excellence and pricing people out of care.1 Key individuals can exert influence on public and private discourse, policies, and actions that are responsible for health care's current state and envision a path forward. Since 2003, the periodical Modern Healthcare has published a yearly ranking of the 100 most influential people in US health care.2 The list is compiled with readership input and vetted by the periodical's editorial board using proprietary criteria; the selection is also opaque as to what (ie, health care or clinical policy and the practice or the business of care) or who (ie, policymakers, employers, payers, clinicians, and patients) is subject to their influence.
- We thank Dr Myerson for his interest in our systematic review. However, we would like to address some of his comments on the relevance of stroke in our article.
- To the Editor: Three months after the introduction of the turbidimetric immunoinhibition assay for hemoglobin A1c (HbA1c) (TINIA, Roche Diagnostics, Indianapolis, Ind) into our clinical practice, Mayo Clinic diabetologists noticed a discrepancy between patient-logged glucose values (above goal levels of 80-140 mg/dL) and lower than expected HbA1c levels (<6%-7%). Given the importance of HbA1c as a guide to glycemic control, the fact that this monoclonal assay is one of the most commonly used measurements of HbA1c in the United States (used in approximately 15% of laboratories reporting in the American College of Pathology Laboratory Survey in March 2006), and concerns that this discrepancy could lead to inadequate clinical care,1 we report further investigations into its performance.
- Before addressing performance characteristics of the ARR as a screening test, our study asked a more fundamental question: Is the assumption underlying its calculation valid?1 Several of the points raised by Stowasser and Gordon serve to further discredit the ARR. Their comment that “no one experienced in this area would have expected to find a simple relationship” between PA concentration and PRA is the essence of the argument against the ARR. The concomitant effects of potassium and corticotropin also underscore the advocates’ disconnect in logic, since they do not propose dividing PA concentration by these other influential covariates.
- To the Editor: We are currently emphasizing the understanding and use of likelihood ratios (LRs) in our teaching of evidencebased medicine to internal medicine residents and medical students.1 However, readers might be confused by the different formulations of the LRs in the literature.