Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Thanks!
- Ivan Y. Torshin (22 December 2006)
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Invalid Study?
- B C Gohil (27 December 2006)
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Another Constitutional Difference between Physicians and Surgeons
- A. G. Alias (27 December 2006)
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Weakness of Algebraic Comparison of Photo Assessment
- Martin P. Wedig (28 December 2006)
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The Hen or the Egg?
- Nishith K Singh (28 December 2006)
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Film stars are also taller
- Alejandro Aris, MD, PhD. (29 December 2006)
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Paradox
- Alan Roberts (29 December 2006)
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Interesting
- Eduardo G Salazar (29 December 2006)
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Phenotypic differences between male physicians, surgeons, and film stars: additional conclusions
- Marek Szpalski M.D. (31 December 2006)
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Not surprising
- Iñigo Romon (31 December 2006)
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Some comments and Happy New Year!
- Trilla Antoni, Marta Aymerich, Antonio M Lacy, Maria J Bertran (31 December 2006)
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More than just a pretty face
- David S.Y. Chan, Aaron S.Z. Chan (31 December 2006)
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Phenotypic differences between male physicians, surgeons, and film stars: some more additional conclusion
- RAMON VILALLONGA (2 January 2007)
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Essential careers advice for the tall and beautiful
- Rhys H Thomas (2 January 2007)
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Phenotypic differences between male physicians, surgeons, and film stars
- Eberhard W Lisse (5 January 2007)
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Unique and Interesting study, Prone for bias.
- Ashok Rampurada (5 January 2007)
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The Bold and the Beautiful !!!
- Shachi Pradhan (5 January 2007)
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Phenotypic differences. More research required to establish the real role of external controls
- Carlos - A. Mestres (6 January 2007)
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Anaesthetists excluded
- Pablo Monedero (6 January 2007)
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We must just be unlucky
- Kirsten Hey (19 January 2007)
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Need to show more evidence to make stronger case
- Shirin Kalyan (23 January 2007)
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surgeons might have a better sense of humour
- andrew james (5 March 2007)
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Ivan Y. Torshin, Dir of Bioinformatics Consulting, LLC 125239, Moscow, Russia
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My comment might seem to be trivial but here it is: Authors: thanks for writing this paper. Journal editors: thanks for publishing! Why am I so apparently bubbling is that it's rare when biomedical journals allow themselves to throw aside the false pretences of "objectivity" and "being scientific". As the authors of this paper remind us again, things are not always as they seem... Competing interests: None declared |
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B C Gohil, Uroloy SHO King George Hospital, Essex
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Although this was an interesting read - the fundementals of this research seem flawed through the means of assessing the phenotypic differences. In the methodology - it suggests that the 'assessors' were all female. Has this been done on the basis that the male doctors are all assumed to be heterosexual and more likely to be attactive to the opposite sex? The other major flaw in this study is that it mentions that the 'assessors' all worked at the same hospital. It is not particularly clear whether or not these assessors therefore knew the male doctors prior to the study. Surely there would be some positive or negative bias if for example the assessor worked with the male doctor or the alternative, they are currently or previously in a relationship! Competing interests: Male doctor on F2 rotation. |
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A. G. Alias, Psychiatrist Fulton State Hospital, Fulton, MO 635251
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Back in 1973, when I was doing my Residency training in Psychiatry, I was interested in looking for constitutional differences between physicians and surgeons. I noted that surgeons by and large have substantially deeper voices than physicians. I copied voice samples of over 30 each of surgeons and physicians (in the USA, referred to as inernists) from "ADIODIGEST" medical educational tapes. I listened to the voice samples repeatedly. Over 80% of the surgeons had substantially deeper voices than most of the physicians. I rated them on a scale of 1-5, '1' being the highest pitched and '5' being the lowest pitched, and analysed statistically; the difference was p<0.01. I asked others to listen to the voice samples; they all concurred. I included that as just one sentence in a publication (Alias AG. On the psychopathology of schizophrenia. Biol Psychiatry 1974;9:61-72). I tried to get the differences in the "fundamental frequencies" of those voice samples, but was unsuccessful, and drpped the idea of publishing it as a separate paper. Competing interests: None declared |
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Martin P. Wedig, Physician 44627 Herne/Germany
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Trilla et. al. do not give reasons for the criteria of good looking. The "good looking score " is not published under the methods used. We do not know which arithmetic operations may be carried out with the scale of this score. We do not even know the length of the good looking score. The three-armed study with 14 plus 14 picture samples of physicians and surgeons appears to be sick in the number of controls (four filmstars without any physician). Mention that the number of observers (8) is higher than the number of controls. The calculation with two positions after decimal point suggests accuracy of the good looking score. Precision has been suggested in the measurement of height, which is ususally rounded at .5 or .0. Yet height was compared at one position after decimal point. Mann-Whitney-U-test proves independence of two distributions, if one of them was influenced in the study. Trilla "randomly organised the pictures of all surgeons, physicions, and external controls". Therefore no arm of the study was influenced. Differences are incidental. The portraits of the samples do not inform about the height. Why age shows a Gauß' distribution (t-test) and height an unknown distribution (U-test) remains cryptical in the dedicated comparative study. Conclusion: Photo assessment by observers shows impairment, which consigns footprints in the use of methods. If you see the face, you know neither height nor profession. Competing interests: None declared |
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Nishith K Singh, Resident (Internal Medicine) All India Institute of Medical Sciences, New Delhi, 110029
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Lets rejoice!The study , I must say,is a celebration of subjectivity,a statement in aesthetics and a stimulus for a metaphysical debate. But, while the Authors try to answer,"How do surgeons become taller and better looking than physicians"? I see an inherent flaw in the query.As I rephrase the query in a broader sense,I must ask, "What came first, the tall and handsome look or the Surgeon?" Competing interests: None declared |
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Alejandro Aris, MD, PhD., Director. Cardiac Surgery Service Hospital de la Santa Creu i Sant Pau. Barcelona. 08025. Spain
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Trilla et al have proven something that we surgeons already knew. We are taller and more handsome than our medical colleagues. But aside from their conclusions, they failed to report the height of the film stars. I would like to expand their study reporting these data (Thanks, Google). Harrison Ford's height is 185 cm, George Clooney's, 180 cm; Patrick Dempsey's, 179 cm and Hugh Laurie's 189 cm. Thus, the mean height of the four stars is 183,25 cm, 3.85 cm above the surgeons of the study and 10.65 cm above the physicians. Statistical analysis of the results is beyond the scope of this letter. Interestingly, the actors who portrayed medical specialists (Clooney and Laurie) have a mean height higher than those who portrayed surgeons (Ford and Dempsey) (184.5 vs 182 cm). But we all know that this is pure fiction. Competing interests: None declared |
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Alan Roberts, Consultant Physician Royal Hampshire County Hospital SO22 5DG
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This is an interesting piece of observational research which begs as many questions as it answers. The most obvious is 'Why does the opposite phenomenon occur in the United Kingdom?' There are several possible explanations :- It may be a geographical phenomenon.
If it is the third reason will the MMC changes make a difference? This sounds like a major project. Will MRC funding be made available? alan roberts Competing interests: None declared |
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Eduardo G Salazar, General Surgery Resident Lima 01
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This article let us have a break in the daily work with sense of humor and fun. Personally, i`m pleased with the results found. Best regards! Competing interests: None declared |
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Marek Szpalski M.D., Chairman, Department of Orthopaedics Hôpitaux IRIS Sud, 142 rue Marconi, B-1190 Brussels, Belgium
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Dear Editor, The paper by Trilla et al.(1) is a fascinating study comparing heights and good looks of different medical specialists. Such studies clearly show how Evidence Based Medicine allows to demonstrate fundamental findings. Of course, in the present case, those findings are quite obvious and have already been suggested by some earlier ABM (Admiration Based Medicine) and NBM (Narcissism Based Medicine) works. However, a careful metanalysis of the litterature, available in this major field, enables us to stretch the conclusions a bit further. In a seminal study, Fox et al.(2) have showed that the hands of orthopaedic surgeons are bigger than those of abdominal surgeons (but smaller than those of gorillas). We can safely assume that hand size is reasonably correlated to overall body height. Since it has now been demonstrated that, within medical professions, height is linked to good looks (1), we can therefore conclude that orthopaedic surgeons are even more handsome than the general surgeon population. Only jealous physicians or bitter general surgeons would argue that this reasoning is pure sophism. The bad news, of course, is that gorillas are even better looking. 1. Trilla A,Aymerich M, Lacy AM, Bertran MJ Phenotypic differences between male physicians, surgeons, and film stars: comparative study BMJ 2006;333:1291-1293 2. Fox JS, Bell GR, Sweeney PJ. Are orthopaedic surgeons really gorillas ? BMJ 1990;301:1426-6 Competing interests: None declared |
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Iñigo Romon, Quality Manager Blood and Tissues Bank of Cantabria, Santander, SPain 39008
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The findings reflect what most people in medicine already know: surgery is the better half of our profession. If, as popular knowledge says, "the face is the mirror for the soul", this reflects the higher spiritual well being of the general surgery population. This emanates from early in their education, when: - They soon learn that they are the only ones who actually SAVE lives. - They are the only expeditive, no-nonsense members of the medical profession. - They soon learn that they are in command, not only in the surgery but also in the cafeteria. - They are called for higher destinies than the rest of doctors. This derives in an attitude of self-assurance which can do a lot for your self - steem and consequently for your good looking score: - You become more non-chalant and more easy going than internits. - A surgery resident can be mistaken for a senior consultant by a freshman hematology intern, however, he will not show any sign of easy camaraderie (call him Thou, Sir or Doctor). - Staff in the cafeteria always have a small favours for surgeons: a good steak with salad hidden away, roast chicken after hours, etc. - Bad manners are better tolerated if you work in surgery by the rest of the staff. All together, one should congratulate our surgical colleages on their general good-lookingness, which without doubt emanates from a feeling of true superiority. I would suggest to expand the study to female medical staff and to nursing staff. And possibly could we double blind it? Competing interests: None declared |
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Trilla Antoni, Director of Preventive Medicine and Epidemiology Unit Hospital Clinic - University of Barcelona. 08036-Barcelona (Spain), Marta Aymerich, Antonio M Lacy, Maria J Bertran
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We thank all the rapid responses and comments posted after publishing our Christmas research paper. Many other surgeons and physicians has sent us e-mails with several interesting alternative or additional explanations to our findings, like the one posted by Ivan Y. Torshin. Eduardo Salazar and A.G. Alias. We’ll work on that. Two comments questionned the study methods: a) B.C. Gohil points the possibility of some bias among the observers. As stated in the methods, we decided to avoid (for the time being) male observers, because of potential bias. On the Discussion, we clearly stated that “the members of thee valuating Committee know all the study subjects well”, and because of the anonymity in the scoring system (the Committee’s membership was unknown to the study subjects), we do not believe that any (known) influence has been overlooked. b) Martin P. Wedig says that the GLS is not published in the methods, while in fact it is, and it is also discussed in the “limitations and future studies" section. The height was separately recorded. We do agree in his final statement: “if you see the face, you know neither height nor profession”: however, that was not the aim of our study. Nothwhistanding, if you see some colleague dressed in green scrubs and wearing a surgical cap, the odds that he or she is a surgeons seems to be somewhat higher. We agree with Nisith K. Singh that the fundamental question remains open: “What came first, the tall and handsome look or the surgeon?”. That was the basic research question that prompted us to conduct the study. We have now several offers to conduct a complete genetic analysis of the study subjects, but we put that on hold until next Christmas. Incidental observations about the new generations of surgeons and physicians point out that genetic diversity, if any, is fading. The GLS Committee of our study clearly stated that many younger physicians and surgeons have, by far, a better look that the study subjects (as time goes by...). Prof. Alejandro Aris provide us with very interesting and valuable additional information about the height of film stars. We avoid performing this comparison because all of them are from UK and the US (with higher mean population heights than the Spanish one for the study age group). The trend suggested by Aris (actors playing physicians are taller than actors playing surgeons) give some of us (the physicians)hope. Finally, we are happy to note that perhaps we are contributing to discover a new paradox: the "UK beauty paradox", as mentioned by Alan Roberts. Certainly, we will be please to serve as external reviewers for any project he plans to submit for MRC funding, or even to start a "Research Network of Excellence", funded (heavily, we expect) by the EU, including many other countries as partners (but with coordination meetings held only in Barcelona, the French Riviera, the Toscana or the Greek Islands, please). Happy New Year! Competing interests: None declared |
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David S.Y. Chan, Medical Student School of Medicine, Cardiff University, Cardiff, Wales. CF14 4XN., Aaron S.Z. Chan
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The implications of this highly amusing article [1] are potentially far reaching. With the odds stacked against the pursuit of a surgical career in the UK (surgery being a highly competitive field [2] and more recently, for international medical students [3]), this study leads to another question which male students and junior doctors who have an interest in surgery wish to have answered: ‘Does being tall and good looking help secure a training post in surgery?’ Not surprisingly, these attributes are not listed in the person specifications for application into specialist training in general surgery [4]. Candidates are selected based on the quality of their application form, references, successful completion of the necessary courses and examinations and an interview. Being tall and good looking would therefore only be ‘measured’ during the interview as the UK adopts a pictureless application system. We can thus rephrase the question: ‘Does being tall and good looking help in a surgical interview?’ Poor personal presentation may adversely affect the outcome of the interview [5] but can the best clothes make an ugly man better looking? Height and looks are genetically predetermined and cannot be modified, or can it? Perhaps we can never answer these questions with simple comparative studies due to the numerous confounding factors. For now we can just relish the conclusions of this light hearted study. References: 1. Trilla A, Aymerich M, Lacy AM, Bertran MJ. Phenotypic differences between male physicians, surgeons, and film stars: comparative study. BMJ 2006; 333: 1291-1293. 2. BMJ Careers. Junior Posts Competition. http://www.bmjcareers.com/cgi-bin/section.pl?sn=juniorcomp#. 3. Bonner J. Troubled times ahead for IMGs. BMJ Career Focus 2006; 332: 123-124. 4. Person Specification 2007 – Application to enter specialty training at ST1: Surgery in general. http://www.mmc.nhs.uk/pages/specialties-personspecs. 5. Burnett S. Dressing the part. BMJ Career Focus 2005; 331: 67. Competing interests: DC is short (164 cm), not very good looking (mean score of 2.75 on the same Likert scale [1] , assessed by eight non-random female acquaintances) and hoping to pursue a career in surgery. AC on the other hand is taller (173cm), better looking (5.50) and hoping to pursue a career in endocrinology. However, we are still contemplating on exchanging career interests due to the possibility of AC’s easier admission into surgery due to his good looks. And vice versa. |
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RAMON VILALLONGA, RESIDENT SURGEON UNIVERSITARY HOSPITAL VALL D'HEBRON. BARCELONA. SPAIN
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Dear Editor, I have read with interest the article published in BMJ concerning phenotypic differences between male physicians, surgeons, and film stars, but I think some more additional conclusions or observations should be mentioned. First of all, concerning the factors that make the surgeons more handsome, It seems quite important that surgeon's image is that of competence, trust, expertise, and compassion, and also, as the authors mention, they are often practical and fast acting. However, not all surgeons are taller and better looking then physicians, and we do have some experience in our Hospital!! Also, there might be some phenotypic differences between different countries that should be evaluated, and more if we consider the high immigration rates in Spain. Concerning the microtrauma and the “effective anti-ageing device”, it is possible that this could play a role in all this, but surgeons spend a lot of time awake, in late hours of the night in the operating theatre, and I do think this plays an important role after years. I would like to congratulate the authors of the study for taking care of some quotidian aspects of the professionals who work hard and for long time. Competing interests: None declared |
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Rhys H Thomas, Medical SHO Gloucestershire Royal Hospital, GL1 3NN
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My heartfelt thanks to Trilla et al (1) for publishing their novel research. I was within a whisker of dedicating myself to a speciality that I would not be suited to. I had thought that my analytical mind and desire to understand the patient holistically might have made me a physician. However being dashedly handsome and standing proudly at 1.85cm, I discover that I am wholly unsuited to my intended path. I am queasy around blood, faint at the sight of retractors, cannot use a knife and fork, nor tie my own shoe laces. I am allergic to scrubs, terrified of taking consent and more clumsy than any evolved primate should ever be. Should I be a surgeon? Some would say I am over qualified. Flummoxed, I find myself with three viable options. At present I hope that late nights and early ward rounds might take their toll. Although they will certainly wizen my looks, to hope that they make me shorter are far fetched. I am not sure that surgery is ready for me yet. The career of film star however, remains a distinct possibility. References 1. Trilla A, Aymerich M, Lacy AM, Bertran MJ. Phenotypic differences between male physicians, surgeons, and film stars: comparative study. BMJ 2006; 333: 1291-1293 Competing interests: None declared |
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Eberhard W Lisse, Obstetrician & Gynaecologist WIndhoek, Namibia
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Dear Sir, I wonder why the peeress reviewers did not request stratification of sub-specialties, in particular Plastic Surgeons? Never mind Obstetricans. el Competing interests: None declared |
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Ashok Rampurada, SHO, Orthopaedics Doncaster and Bassetlaw NHS Trust, DN2 5LT
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this is a very unique and interesting study. The biggest flaw in this study is having 8 observers from the same hospital and women!!. It is well known that women are attracted to tall men and being tall makes them more handsome to women. The good looking scores might change if the actual person [ surgeon/physian ] came face to face instead of a digital picture!! Competing interests: None declared |
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Shachi Pradhan, Psychiatrist Chertsey,Surrey,United Kingdom.KT1 6OAE
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I am quite enamoured by this article.I am sure it must have been very interesting and fun collecting the data for this study. I was wondering if the results could be generalized to women practitioners versus film stars,where not many women filmstars have portrayed as medicos and usually are serious and not so charming in comparison to actual practitioners. Competing interests: None declared |
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Carlos - A. Mestres, Consultant Cardiovascular Surgeon Hospital Clinic, Barcelona 08036 (Spain)
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Dear Dr Trilla, I just read with great interest your recently published contribution at BMJ 2006; 333; 1291-1293 doi:10.1136/bmj.3095.672373.80 on the phenotypic differences between male physicians, surgeons and film stars: A comparative study. I must congratulate you for this nice piece of research work that calls upon the attention of the public to a somewhat neglected issue like how critical phenotype could be in clinical practice. I have carefully gone through your paper and found very important information from my own colleagues. I fully agree on how problematic choosing independent female observers could be at our Institution. Blinded observers were problably a tough business for you as their eventual contributions could have definitely been biased towards the lack of observation. Therefore I agree with you that real world pictures observed by highly trained female observers were the right choice. Age matching among eligible candidates and those who actually responded to the female observers probably avoided some additional biases in terms of the actual consideration of handsomeness by younger female observers in current times. The choice of the external controls was really optimal considering the variety of specialties but in your case you contributed with a good balance among medical and surgical specialties. Then, I congratulate you and your colleagues because your methods section cannot be negatively criticized at all, a very important point in peer review as you perfectly know. On the other hand I fully agree with you in your thorough analysis of the potential limitations of your study. Being myself a 183 cm tall surgeon 27 years after graduation despite a heavy surgical load I was wondering in my own ability to manipulate pictures in the event I had been called upon to participate in your study. However, it is true that in our own environment such a practice could have proven disastrous. I think your point of using someone else's picture could have easily been caught by the evaluating panel. And finally, we may eventually make the proposal in 2007 of requesting from the Ministry of Health and regulatory bodies to consider the inclusion of mirrors in the device public tender, at least at our Institution. Regarding future studies, it happens that by chance I am conducting a similar study at the Department of Cardiovascular Surgery trying to ascertain the possible phenotypic differences between senior staff and junior trainees focusing more on anthropometric data to theorize about the impact of regional food supply and consumption on residents coming from different autonomous regions in Spain. I have found some trends (sample size has to be increase in any way) that may lead to some differences among trainees but this needs careful confirmation in the future. Due to the scarcity of senior female counterparts in Cardiovascular Surgery, a fact that has been highlighted by you in your section on limitations, we perhaps need to propose a multicentered prospective randomized trial to further investigate this. I am sure that the Ethics Committee/Institutional Review Board will welcome a properly designed trial and it is my belief that they would strongly endorse such activities. What is sure is that more substantial research is required. Last but not least, let me congratulate you and your co-authors for this fine study that will fill a gap in our knowledge on the anthropometric profile of this selected sample of doctors. I would suggest if you will be able to share your experiences with Drs. Kimble, Ross, Dempsey and House by e-mailing them a PDF copy of your paper. Please do convey my best wishes for a Happy New Year 2007 to the distinguished co-authors Aymerich, De Lacy and Bertran. Very sincerely, Carlos-A. Mestres MD, PhD, FETCS Consultant Department of Cardiovascular Surgery Hospital Clinic - University of Barcelona Competing interests: Conflict on height with Drs. Kimble, Clooney and House. More conflicts on handsomeness as rating behind all authors and controls |
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Pablo Monedero, ICU staff Clínica Universitaria de Navarra. 31008 Pamplona (Spain)
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A major flaw in this study is that anaesthetists are not considered as the control group, instead of film stars: everybody knows that anaesthetists are better looking than surgeons (1). Have a happy new year. Reference (1)Royal College of Anaesthetists. http://www.rcoa.ac.uk/ Competing interests: I am an anaesthetist |
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Kirsten Hey, OT Scotland
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How come all of our surgeons are mingers, then? I'm very disappointed the researchers didn't think to include Doctor Mopp from Camberwick Green. Competing interests: None declared |
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Shirin Kalyan, postdoctoral research fellow v5p 1e7
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Given the relatively small sample size, the ambitious investigators of this important study would make their case more convincing if they had shown some of their raw data with digital photographs (with a mimumum 300 dpi resolution). It would also be helpful to give examples of what a typical specimen rated "1" versus a "7" would look like, and the inter- rater variability scores. I look forward to a follow-up investigation conducted on the female half of the species to determine if their is indeed a gender disparity in these results. Competing interests: None declared |
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andrew james, male tea lady Wesley hospital, Brisbane
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Dear Trilla, I would like to know whether you observed any differences in personality between surgeons and male physicians due to their differences in height and good looks. In Australia, the good looking surgeons are generally accompanied by happy co-workers , the muted sounds of merriment and laughter a constant echo in the corridors outside the operating theatres. Given that, as you point out, the atmosphere of the operating theatre is more than likely a direct result of the leading surgeon's personality type it would indicate that these surgeons had a highly developed good sense of humour (GSOH). Furthermore, I would suggest that some of the taller, more ridiculously good looking surgeons also had a deeper sense of well-being than their shorter counter-parts. Competing interests: None declared |
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