Not necessarily ...

doi:10.1136/bmj.39465.508634.3A

BMJ 2008;336:174 (26 January), doi:10.1136/bmj.39465.508634.3A

Letters

The treatment paradox

Not necessarily ...

The first 100% of the full text of this article appears below.

Spence says that an individual patient, despite many years ofinvestment in taking statins, gets virtually nil health benefit.¹This is not necessarily so. Clinical trials cannot determineif the benefit is confined to a few individuals or distributedamong many. Statins might prevent (or delay) cardiovasculardeath in a handful of those who take them, or they might slightlyreduce the risk in everyone who takes them.

To use an analogy, wearing thermal underwear in winter mightprevent death due to hypothermia in only a few, but the benefitof keeping warm would be felt by many.

No conflict of interest is declared, as I do not take statinsor wear thermal underwear.

Norman R Williams, clinical trial co-ordinator

¹ Clinical Trials Group of the Department of Surgery, UCL Archway Campus, London N19 5LW

n.williams@ctg.ucl.ac.uk

Competing interests: None declared.