Serum Glutamic Oxalacetic Transaminase in Acute Myocardial Infarction
Authors: H. A. Dewar, N. R. Rowell, A. J. Smith
Journal: BMJ (1958)

BDIBTJSHRNAL 1121 undergoing collapse therapy.The records from the proposed patients were examined centrally and the cases classified into three main groups and seven subgroups and allocated at random to the two methods of treatment to be compared.(3) Reports of progress were received at one month, two months, three months, and six months from the beginning of the trial.The speed with which this trial achieved its objective is one of its most impressive features.In February, 1952, preliminary announcements were made in the American press indicating the effects of isoniazid on clinical tuber- culosis.The Medical Research Council trial was initiated the same month and treatment begun on March 29, 1952.The preliminary report of the trial was published the same year (M.R.C., 1952), and it established that isoniazid alone was not superior to a combination of streptomycin and P.A.S.During this time 173 patients had been treated with 200 mg. of isoniazid daily, and 158 with 1 g. of streptomycin plus 20 g. of P.A.S. daily.Improvement in general condi- tion was rather better on isoniazid alone, but radiological changes did better on the combination.Acquirement of bacterial resistance to isoniazid was a severe problem, and occurred in 11 % of cases at the end of the first month, 52%O at the end of the second month, and no less than 71% at the end of the third month.The trial was therefore modified to compare the results of 1 g. of streptomycin daily plus 200 mg. of isoniazid daily with those of strepto- mycin and P.A.S.It was concluded that the degree of radiographic improvement was essentially the same on streptomycin and isoniazid as on streptomycin and P.A.S., and better in either than on isoniazid alone.Improvement in general condition and conversion of positive to negative culture were more frequent with streptomycin and isoniazid than with streptomycin and P.A.S. Thus it seemed that a combination of streptomycin and isoniazid was in general the most effective treatment known for pulmonary tuberculosis.In this account I have omitted many details of method and of the knowledge achidved, and I would refer those interested to the article by the late Dr. Marc Daniels (1951), to whose personal qualities so much of this success was due.But I do want to say that I cannot conceive how so much and so exact a knowledge of the relative efficacies of these drugs could have been got so quickly and with so little expenditure of human life and suffering in any other way.Imagine the fate of the tuberculous patients if these drugs had been prescribed without plan or purpose and their assessment left to " clinical judgment."When I reflect on this I am amazed, stupefied, and I confess rather horrified that some of my colleagues, of unquestioned integrity and of no mean intelligence, adopt the attitude they do to controlled therapeutic trials.I would also like to add that the controlled clinical trial is to my mind the most important new method introduced into clinical science in recent years.It should not only tell us what drugs can do, but if only the practical details can be overcome it could tell us, for example, whether or not overindulgence in fat, or in a particular kind of fat, is a contributing factor in the pathogenesis of ischaemic heart disease.Patients must be treated, and it would seem only sensible that treatment should be designed so that the results shall add to knowledge and help us in the prevention and control of disease, so long as the trial is not against the best interests of the patients.