BMJ 2002;324:1581 ( 29 June )

Letters

Alteplase for stroke

    Uncertainty remains about efficacy
    Patients and doctors are being misled by promotional pressures
    American Heart Association explains how guidelines were formulated
    Financial information is needed to ensure objectivity
    Why were these authors of the commentaries chosen?
    Author's reply
    Authors of commentary reply

Uncertainty remains about efficacy

The first 150 words of the full text of this article appear below.

EDITOR---The article by Lenzer and the associated commentary by Saver et al raise many serious issues, among which is the residual state of uncertainty concerning the efficacy of alteplase (tPA) in acute ischaemic stroke.1 Confronted by opposing interpretations of the aggregate data published to date and the now known baseline imbalance in the severity of stroke in the National Institute of Neurological Diseases and Stroke (NINDS) trial, doctors are presented with a conundrum: what action do the data support?

The reported unwillingness of the investigators and sponsor of the National Institute of Neurological Diseases and Stroke trial to provide data for additional analysis is disturbing. Emanuel et al have described seven requirements for the ethical conduct of clinical research, among which is social and scientific value.2 Social value presupposes the public dissemination of research results. I have formulated a standard for the scientific and ethical review of trials . . . [Full text of this article]
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Shooting the messenger
BMJ 2002 324: i. [Full Text] [PDF]

Alteplase for stroke: money and optimistic claims buttress the "brain attack" campaign • Commentary: Who pays the guideline writers? • Commentary: Thrombolysis in stroke: it works!
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This article has been cited by other articles:

  • Hertzberg, V., Ingall, T., O'Fallon, W., Asplund, K., Goldfrank, L., Louis, T., Christianson, T. (2008). Methods and processes for the reanalysis of the NINDS tissue plasminogen activator for acute ischemic stroke treatment trial. Clin Trials 5: 308-315 [Abstract]  
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