Commentary on and reprint of Farber S, Diamond LK, Mercer RD, Sylvester RF, Wolff JA, Temporary remissions in acute leukemia in children produced by folic acid antagonist 4-aminopteroyl-glutamic acid (aminopterin), in New England Journal of Medicine (1948) 238:787–793

The use of methotrexate in rheumatoid arthritis is reviewed. Methotrexate, a folic acid antagonist, is sometimes employed in an attempt to symptomatically control patients whose disease does not respond adequately to conventional therapies. Systemic administration of 7.5–15 mg/wk in a “pulse” fashion appears to be effective without precipitating severe adverse effects. However, concern over potentially serious side effects and a lack of well-controlled clinical trials have limited its use to severe, refractory disease. Further studies are needed before its role in rheumatoid arthritis can justifiably be expanded.

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Combination Chemotherapy: Synergism between a Possible Folic Acid Antagonist and Ethionine on a “Solid” Tumor2

JNCI Journal of the National Cancer Institute ◽

10.1093/jnci/18.2.201 ◽

1957 ◽

Keyword(s):

Folic Acid ◽

Combination Chemotherapy ◽

Solid Tumor ◽

Folic Acid Antagonist ◽

Acid Antagonist

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The Saikewicz Decision: A Medical Viewpoint

American Journal of Law & Medicine ◽

10.1017/s0098858800013010 ◽

1978 ◽

Vol 4 (3) ◽

pp. 233-242

Author(s):

Arnold S. Relman

Keyword(s):

England Journal ◽

Acute Leukemia ◽

New England ◽

Treatment Decision ◽

Next Of Kin ◽

Incompetent Patient ◽

Medical Tradition ◽

The Family ◽

Attending Physicians ◽

Seriously Ill

AbstractIn this Article, Dr. Arnold S. Relman, the Editor of The New England Journal of Medicine, takes issue with the 1977 Saikewicz decision of the Massachusetts Supreme Judicial Court, which addressed the question of whether chemotherapy should be provided to a severely retarded 67-year-old man who had developed acute leukemia. Dr. Relman interprets Saikewicz as requiring that medical treatment decisions involving the life or death of incompetent patients must receive judicial resolution instead of resolution by the patient's family and physicians. This rule, he asserts, violates medical tradition, and its application will result in serious problems, such as the unnecessary prolongation of the suffering of many seriously ill persons. Dr. Relman proposes, as an alternative to the Saikewicz approach, that in such cases judicial resolution should occur only when there is disagreement, concerning treatment, among next of kin, or between next of kin and attending physicians, or when there is a complaint of injury or of wrongdoing. In all other situations, resolution solely by next of kin and attending physicians should be sufficient. Adequate protection of the interests of the incompetent patient could be achieved by a requirement that the physician in charge document in the medical record that the treatment decision received the concurrence of the family and advance approval of a group of the physician's professional colleagues who have no vested interest in the outcome of the decision.

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