Correspondence
The Journal and SI Units
N Engl J Med 1993; 328:1040-1041April 8, 1993
- Article
To the Editor:
On behalf of practicing physicians, I want to thank the editors for reviewing the entire issue of Systeme International (SI) units (July 2 issue)1 and for using common sense to reach a decision to abandon their use.
The attempts by the bench scientists to convert American clinicians to an unintelligible system of laboratory communication were unnecessary from the outset. As five years of effort have proved, it is certainly unnecessary for excellent patient care and communication between physicians. Finally, I want to thank you for the SI Unit Conversion Guide that you have made available to those of us who read foreign journals.
1 ReferencesThomas J. Schneider, M.D.
Palm Beach Medical Group, West Palm Beach, FL 334071
Campion EW . A retreat from SI units. N Engl J Med 1992;327:49-49
Full Text | Web of Science | Medline
To the Editor:
I believe your announced retreat from SI units is timely and proper, and I hope other journals will follow. Although I make my living in academic medicine and research, the change to the use of SI units for clinical measures has been slow and painful for me. A plasma glucose level of 8.33 mmol per liter will never mean as much to me as a level of 150 mg per deciliter; it will always be easier for me to recognize abnormality in a serum calcium value of 11 mg per deciliter than in one of 2.74 mmol per liter. I fully agree with your correspondents that SI units are propounded by laboratorians not occupied with the daily realities of clinical practice. Overall, communication through articles in the Journal and among physicians caring for patients will be best served by the use of conventional units alongside SI units. Will we ever switch completely to SI units? After I have retired, I hope.
Hunter Heath, III, M.D.
University of Utah School of Medicine, Salt Lake City, UT 84132To the Editor:
As one of many thousands of physicians outside the United States who have come to admire and depend on the Journal, I am amazed that you have chosen to indulge the conservatism of doctors in the United States who have chosen to isolate their practice from that of the rest of the world. The apparent basis for this is the slow pace with which American laboratories and physicians have converted to the use of SI units in their daily practice of medicine. I speak as someone who was educated in the conventional units and had to become accustomed to new units 8 to 10 years after graduation. Like most of my colleagues, I felt uncomfortable at the time, but the adjustment period was short. As a diabetologist and general physician, I am indeed comfortable, as are my colleagues, students, and patients, in dealing with the serum creatinine, glucose, and cholesterol levels referred to in your article and, conversely, would be very uncomfortable dealing with their “conventional” counterparts. The adjustment was swift and painless and has been totally incorporated into the language of clinicians and researchers. Medicine and medical science are international. I consider it incredibly backward-looking and parochial that you should choose at this stage to reject their international language.
Richard Larkins, M.D., Ph.D., F.R.A.C.P., F.R.C.P.
Royal Melbourne Hospital, Victoria 3050, AustraliaTo the Editor:
During my studies at Basel University, in Switzerland, and at the beginning of my postgraduate training we used conventional units. Then one day the units were changed to SI units, and laboratory sheets contained only the new values. In a very short time, everyone got accustomed to the new units. Later, I moved to a more conservative region in Switzerland where the old units were still used. So I had to change again. A few years later the whole of Switzerland moved to SI units on governmental order. From then on, all the laboratory data were given in the new “currency” without mention of the old values. Pocket-sized cards were distributed containing the old and the new values for comparison. The patients also got accustomed to the new units very easily.
SI units are very convenient, not only for daily use but also for publications. It is not only common sense, but also a matter of cooperation and goodwill, to adopt SI units.
Urs Meili, M.D.
2504 Biel/Bienne, SwitzerlandTo the Editor:
I simply wish to register my complaint at the retrograde step adopted by the Journal on SI units. However, I realize I am just a single voice in the dark. I feel most strongly about the issue, because I have had the good fortune to work on both sides of the Atlantic and therefore realize the difficulties of having separate systems in different parts of the world.
William M. Bennet, M.D.
Hammersmith Hospital, London W12 ONN, United KingdomTo the Editor:
In the beginning of the 1970s, SI units were introduced throughout the Netherlands without major problems and without dual reporting. We regret your decision to retreat from SI units. We in Western Europe can hardly believe that American doctors are not sufficiently capable of learning new things, such as these units.
W.M. Haasbroek, M.D.
Gelderse Vallei Hospital, 6720 GA Bennekom, the NetherlandsTo the Editor:
A return to conventional units for weight in an internationally authoritative journal such as yours encourages medical insularity and is regrettable. It will prolong the inconvenience and potential confusion of the dual-unit system. Having been force-fed molar units after a “conventional” training and with my reflex responses now SI, it will become increasingly difficult to assimilate data in the Journal. Mass units discourage the maximal use of simple laboratory data through the anion and osmolal gaps, and the rationale for going SI with alcohols and ethylene glycol disappears. Ensuring maximal readability of the Journal in the United States is certainly not without cost.
William P. Tormey, F.R.C.P.I.
Beaumont Hospital, Dublin 9, IrelandTo the Editor:
It was a great disappointment to read that the Journal now requires authors to express all measurements in conventional units instead of SI units, as has been done for the past five years. Since most scientists believe that the adoption of SI would be a major advance in scientific communication and since the decision has been made by a journal that is reputed to be at the highest levels of clinical research, the disappointment is even greater. Furthermore, this is happening when doctors in Europe and other parts of the world are beginning to get used to the SI in their laboratories and clinical departments. . . .
A double system is an important obstacle to scientific communication at the international level.
Angelo Rosolen, M.D.
Luigi Zanesco, M.D.
University of Padua, 35128 Padua, ItalyAuthor/Editor Response
Editor's reply:
Medicine and the Journal are unquestionably international, but for now we are stuck with two different systems of units. In the United States SI units are not being used in clinical practice, and the majority of our readers are in this country. Hence the Journal's change in policy. Some of our international readers are offended and seem to have misunderstood the new policy. We continue to print both sets of units, but with conventional units first and SI units in parentheses. There will be some inconvenience, since figures and tables can rarely show both sets of units; conversion factors are now included with figures and tables. Manuscripts with either set of units are accepted for consideration.
No solution to this problem can please everyone, and in this language war there are strong feelings on both sides. We will do everything within reason to accommodate our many international readers. Our current policy on SI and conventional units provides an approach that all should be able to live with, including those who do not agree with the policy.
Edward W. Campion, M.D.
- Citing Articles (1)
Citing Articles
1
Michael Mayer, David Chou, Ted Eytan. (2001) Unit-Independent Reporting of Laboratory Test Results. Clinical Chemistry and Laboratory Medicine 39:1, 50-52
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