看了看老外的答复，和各位的想法有类似之处啊！
http://www.bmj.com/cgi/eletters/333/7582/1291Marek Szpalski M.D.,
Chairman, Department of Orthopaedics
Hôpitaux IRIS Sud, 142 rue Marconi, B-1190 Brussels, Belgium
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Re: Phenotypic differences between male physicians, surgeons, and film stars: additional conclusions
Dear Editor, The paper by Trilla et al.(1) is a fascinating study comparing heights and good looks of different medical specialists. Such studies clearly show how Evidence Based Medicine allows to demonstrate fundamental findings. Of course, in the present case, those findings are quite obvious and have already been suggested by some earlier ABM (Admiration Based Medicine) and NBM (Narcissism Based Medicine) works. However, a careful metanalysis of the litterature, available in this major field, enables us to stretch the conclusions a bit further. In a seminal study, Fox et al.(2) have showed that the hands of orthopaedic surgeons are bigger than those of abdominal surgeons (but smaller than those of gorillas). We can safely assume that hand size is reasonably correlated to overall body height. Since it has now been demonstrated that, within medical professions, height is linked to good looks (1), we can therefore conclude that orthopaedic surgeons are even more handsome than the general surgeon population. Only jealous physicians or bitter general surgeons would argue that this reasoning is pure sophism. The bad news, of course, is that gorillas are even better looking.
1. Trilla A,Aymerich M, Lacy AM, Bertran MJ Phenotypic differences between male physicians, surgeons, and film stars: comparative study BMJ 2006;333:1291-1293 2. Fox JS, Bell GR, Sweeney PJ. Are orthopaedic surgeons really gorillas ? BMJ 1990;301:1426-6
Competing interests: None declared
Carlos - A. Mestres,
Consultant Cardiovascular Surgeon
Hospital Clinic, Barcelona 08036 (Spain)
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Re: Phenotypic differences. More research required to establish the real role of external controls
Dear Dr Trilla,
I just read with great interest your recently published contribution at BMJ 2006; 333; 1291-1293 doi:10.1136/bmj.3095.672373.80 on the phenotypic differences between male physicians, surgeons and film stars: A comparative study. I must congratulate you for this nice piece of research work that calls upon the attention of the public to a somewhat neglected issue like how critical phenotype could be in clinical practice. I have carefully gone through your paper and found very important information from my own colleagues. I fully agree on how problematic choosing independent female observers could be at our Institution. Blinded observers were problably a tough business for you as their eventual contributions could have definitely been biased towards the lack of observation. Therefore I agree with you that real world pictures observed by highly trained female observers were the right choice. Age matching among eligible candidates and those who actually responded to the female observers probably avoided some additional biases in terms of the actual consideration of handsomeness by younger female observers in current times. The choice of the external controls was really optimal considering the variety of specialties but in your case you contributed with a good balance among medical and surgical specialties. Then, I congratulate you and your colleagues because your methods section cannot be negatively criticized at all, a very important point in peer review as you perfectly know.
On the other hand I fully agree with you in your thorough analysis of the potential limitations of your study. Being myself a 183 cm tall surgeon 27 years after graduation despite a heavy surgical load I was wondering in my own ability to manipulate pictures in the event I had been called upon to participate in your study. However, it is true that in our own environment such a practice could have proven disastrous. I think your point of using someone else's picture could have easily been caught by the evaluating panel. And finally, we may eventually make the proposal in 2007 of requesting from the Ministry of Health and regulatory bodies to consider the inclusion of mirrors in the device public tender, at least at our Institution.
Regarding future studies, it happens that by chance I am conducting a similar study at the Department of Cardiovascular Surgery trying to ascertain the possible phenotypic differences between senior staff and junior trainees focusing more on anthropometric data to theorize about the impact of regional food supply and consumption on residents coming from different autonomous regions in Spain. I have found some trends (sample size has to be increase in any way) that may lead to some differences among trainees but this needs careful confirmation in the future. Due to the scarcity of senior female counterparts in Cardiovascular Surgery, a fact that has been highlighted by you in your section on limitations, we perhaps need to propose a multicentered prospective randomized trial to further investigate this. I am sure that the Ethics Committee/Institutional Review Board will welcome a properly designed trial and it is my belief that they would strongly endorse such activities. What is sure is that more substantial research is required.
Last but not least, let me congratulate you and your co-authors for this fine study that will fill a gap in our knowledge on the anthropometric profile of this selected sample of doctors. I would suggest if you will be able to share your experiences with Drs. Kimble, Ross, Dempsey and House by e-mailing them a PDF copy of your paper.
Please do convey my best wishes for a Happy New Year 2007 to the distinguished co-authors Aymerich, De Lacy and Bertran.
Very sincerely,
Carlos-A. Mestres MD, PhD, FETCS Consultant Department of Cardiovascular Surgery Hospital Clinic - University of Barcelona
Competing interests: Conflict on height with Drs. Kimble, Clooney and House. More conflicts on handsomeness as rating behind all authors and controls
