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May 12, 1978

The Algorithm in Medicine-Reply

Author Affiliations

Scripps Clinic and Research Foundation La Jolla, Calif

JAMA. 1978;239(19):1957-1958. doi:10.1001/jama.1978.03280460025004

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Sheiner et al write as though my intention had been to patch up their algorithm. It was not. It was to warn against taking seriously "one person's concept of how to play a game." My questions were not intended to imply that routine reticulocyte counts or routine serum iron measurements should be forced on physicians on pain of being zapped by score-keeping clinical pathologists. I intended that they illustrate how unrealistic some of the procrustean requirements appear on paper. Ordering serum folate and B12 determinations in every case of macrocytic anemia with a normal reticulocyte count seems analogous to prescribing folate and B12 determinations for every patient with macrocytic anemia. We should discourage such practices, not give praise.

The authors' reiteration of procedures and intentions changes nothing, even though their three cases of missed iron deficiency anemia became two on retelling, and even though they say