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To the Editor.—
Prior to 1966, I studied many patients having a history of frequent and often severe spontaneous epistaxes, easy bruising, and complete normal laboratory findings except for a prolonged bleeding time. For such cases I made what then seemed the most logical diagnosis, von Willebrand disease. After I1 discovered in 1966 that aspirin increased the bleeding time in presumably normal subjects and increased the bleeding tendency in certain patients with established hemostatic defects, I1,2 developed the aspirin tolerance test, which enabled me to recognize individuals who had this sensitivity to aspirin. This sensitivity may be regarded as a hereditary trait that is clinically silent and nondetectable without the provocative agent, which is aspirin. This state is not von Willebrand disease, but a manifestation of the aspirin intolerance trait. Nevertheless, when the term "von Willebrand disease" gets into the patients' medical records, they are apt to pay
Quick AJ. Trait vs Disease. JAMA. 1975;233(12):1260. doi:10.1001/jama.1975.03260120022011