<International Circulation>: : Part of the problem is that we don’t have a standard set of characterizations?
　　Dr Bairey Merz: Correct. We don’t yet have a Bible. So when an investigator in Japan says variant angina， it may or may not be the same as Dr Lanza in Italy and it may or may not be the same as what we have been describing in the United States in the WISE (Women’s Ischemia Syndrome Evaluation) study.
　　<International Circulation>:  Why do you think we haven’t been able to agree on a set of standards so far? Is it because there are not enough events or because it is not considered to be a big enough problem?
　　Dr Bairey Merz: I would say two things. Number one is that the ergonovine testing was decided to be too dangerous in the US and perhaps for the right reasons and perhaps for the wrong reasons， many physicians shied away from the provocative testing in the US whereas they continued to test in Japan and Korea and Italy and the UK and Germany. It is our problem. We have just actually published a paper coming out in JACC Intervention， which will speak to the safety of acetylcholine testing. One problem was the testing was believed to be unsafe and particularly thought to be not safe due to another wrong piece of information which is that these patients do not have risk and that this condition is benign; that it never causes heart attacks and never causes death. That is also not true and Dr Lanza presented their ten year data where they had one death in 42 patients. If you want to annualize that and extrapolate it to a hundred or a thousand patients， it is not so dissimilar to what we have seen in the WISE which is 2.5%. This is a much higher risk than cigarette smoking for instance or even having a high cholesterol level. This is an unacceptable death rate.