BMJ  2006;333:550 (9 September), doi:10.1136/bmj.333.7567.550-b

Letter

Strange things happen when we never qualify the frequency

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

EDITOR—Aronson illustrated that the definition of frequency qualifiers cannot be taken for granted.¹ However, we often omit them completely as we condense complex research findings into terse one liners. This can dramatically distort our perception of risk.

For example, nobody would disagree that non-steroidal anti-inflammatory drugs (NSAIDs) are an important cause of avoidable iatrogenic mortality in elderly patients, largely through ulceration and perforation of the upper gastrointestinal tract. These ideas profoundly influence prescribing: doctors may avoid their use altogether or co-prescribe prophylactic measures.

Reputable studies show that, for NSAID users over the age of 75, the annual risks for serious gastrointestinal bleed and death are 1 in 110 and 1 in 650, respectively, and that there is one episode of ulcer bleeding in elderly people for every 2823 NSAID prescriptions.²³ At least 83 patients need misoprostol prophylaxis to prevent one NSAID-related gastrointestinal bleed, although a subsequent systematic review . . . [Full text of this article]

Katharine House Hospice, Adderbury, Oxfordshire OX17 3NL dr.ch@mbers.info

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