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—We appreciate Dr Renner's thoughtful comments. It is curious to us that many cardiologists view medical therapy as noninterventional; hence, proceeding to coronary bypass surgery or angioplasty becomes an activist solution to what is perceived by some patients and physicians as a "stand there" philosophy.Dr Fribourg raises a number of important and as yet unanswered issues. Our study of second opinions reported an experience that was bound to create the type of dialogue raised in Dr Fribourg's letter. We do not profess to know what is best for every patient, nor do we provide a formula or recipe guiding the management of every patient. We hope that our observations encourage other physicians when they choose a conservative method of managing coronary artery disease.In response to Dr Bogart's letter, our intent was not to add new knowledge about coronary artery surgery. We emphasized in the article the
Thomas B. Graboys, Charles M. Blatt, Steven Lampert, Bernard Lown. A Second-Opinion Program for Coronary Artery Bypass Graft Surgery-Reply. JAMA. 1988;259(2):215. doi:10.1001/jama.1988.03720020016014