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On the exoneration of Dr. William H. Stewart: debunking an urban legend.

ABSTRACT:

Background

It is one of the most infamous quotes in the history of biomedicine: "It is time to close the book on infectious diseases, and declare the war against pestilence won." Long attributed to the United States Surgeon General, Dr. William H. Stewart (1965-1969), the statement is frequently used as a foil by scientific and lay authors to underscore the ever-increasing problems of antibiotic-resistant and emerging infections. However, the primary source for the quote has never been identified.

Methods

We undertook a comprehensive search of multiple databases encompassing medical literature, news articles, and congressional records to attempt to identify sources for the quote.

Results

No source of the quote was identified. However, a trail of source documents was identified that clearly serves as the basis for subsequent, incorrect attribution of the quote to Dr. Stewart. In multiple source documents, Dr. Stewart made statements to the opposite effect, clearly recognizing that infectious diseases had not been conquered. The urban legend was created by a combination of lack of primary witnesses to the originating speech, misunderstanding of points made by Dr. Stewart in the speech, and increasing societal concern about emerging and re-emerging infectious diseases.

Conclusions

Attribution to Dr. Stewart of a belief that it was time to close the book on infectious diseases is an urban legend; he never made any such statement. Numerous other verifiable sources, however, confirm that other people in academia adopted this belief. Dr. Stewart should no longer be cited in this regard, and should be replaced with verifiable sources.

SUBMITTER: Spellberg B

PROVIDER: S-EPMC3707092 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundPhysicians may counsel patients who leave against medical advice (AMA) that insurance will not pay for their care. However, it is unclear whether insurers deny payment for hospitalization in these cases.ObjectiveTo review whether insurers denied payment for patients discharged AMA and assess physician beliefs and counseling practices when patients leave AMA.DesignRetrospective cohort of medical inpatients from 2001 to 2010; cross-sectional survey of physician beliefs and counseling practices for AMA patients in 2010.ParticipantsPatients who left AMA from 2001 to 2010, internal medicine residents and attendings at a single academic institution, and a convenience sample of residents from 13 Illinois hospitals in June 2010.Main measuresPercent of AMA patients for which insurance denied payment, percent of physicians who agreed insurance denies payment for patients who leave AMA and who counsel patients leaving AMA they are financially responsible.Key resultsOf 46,319 patients admitted from 2001 to 2010, 526 (1.1%) patients left AMA. Among insured patients, payment was refused in 4.1% of cases. Reasons for refusal were largely administrative (wrong name, etc.). No cases of payment refusal were because patient left AMA. Nevertheless, most residents (68.6%) and nearly half of attendings (43.9%) believed insurance denies payment when a patient leaves AMA. Attendings who believed that insurance denied payment were more likely to report informing AMA patients they may be held financially responsible (mean 4.2 vs. 1.7 on a Likert 1-5 scale, in which 5 is "always" inform, p < 0.001). This relationship was not observed among residents. The most common reason for counseling patients was "so they will reconsider staying in the hospital" (84.8% residents, 66.7% attendings, p = 0.008)ConclusionsContrary to popular belief, we found no evidence that insurance denied payment for patients leaving AMA. Residency programs and hospitals should ensure that patients are not misinformed.