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As an experienced emergency physician, I can assure you that physicians who choose not to use tPA for stroke are not, as characterized in this article, “insufficiently trained or too conservative”. There has been, to my knowledge, no study that has shown decreased mortality with the use of tPA for acute stroke. Most of the emergency physicians I know do their best to treat patients on the basis of the best available evidence and to avoid being caught up by marketing like the brain-attack program that ensnared this story.

Dave Ellison
Pelican Rapids, Minn.

There is a lot of research going on in risk detection and stroke prevention. An example is magnetic resonance imaging to detect unstable carotid-artery plaque, which can rupture, block brain arteries, and cause a stroke. Let’s try to prevent the stroke so that we don’t have to attempt a rescue afterward.

Nayak L. Polissar
Seattle, Wash.