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EDITORIALS: Jocalyn Clark and Richard Smith Dr Foster case notes BMJ 2004; 328: 362 [Full text]

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All that glisters is not gold

adam j pringle   (22 February 2004)

All that glisters is not gold 22 February 2004
adam j pringle, general Practitioner Lawley Telford TF4 2LL Send response to journal: Re: All that glisters is not gold	Dr Foster's admission data shows a mortality difference in stroke between units that carry out scans within 48hrs and those that do not. The authors state this matches the benefit from early scans in clinical trials, and so claim that this is evidence of a comparable benefit in clinical practice. My view is that the data provided prove the opposite, as no allowance has been made for selection bias, which explains some, and possibly all, of the perceived benefits. (Palliative patients will not be referred to regional scanning units, while those with a good prognosis will be) The differences in mortality data may be the same size, but it is poor science to assume that they have the same cause, without considering alternative hypotheses. Competing interests: None declared