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EDITOR'S CHOICE: Fiona Godlee Think again BMJ 2008; 336: 0 [Full text]

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It is amazing how complete is the delusion that beauty is goodness!

BM Hegde   (14 April 2008)

It is amazing how complete is the delusion that beauty is goodness! 14 April 2008
BM Hegde, Retd. Vice Chancellor Mangalore-575 004, India Send response to journal: Re: It is amazing how complete is the delusion that beauty is goodness!	Dear Fiona Godlee, I went through the recent study in great detail as also your connected editorial (1, 2). Thank God, the former was free on line! The timing of this study is vital to the points I am going to make below. As there were a few good studies indicating the futility of bisphosphonates in the treatment of this universal disease, osteoporosis, this new study appears on the horizon! Firstly, osteoporosis, as defined now, leads to virtual disease mongering as the reference standard for bone density is the bone density of teen age girls’ bones. Any one, screened above that age, must proportionately be osteopaenic, if not osteoporotic, qualifying for treatment. There are two preventive measures viz: regular exercise and salt low diet for all ladies which would make genuine osteoporosis a rarity. Calcium therapy might result in calcium induced calcium loss in the distal tubule, resulting in negative calcium balance at the end of the day! Coming to the science behind this study I wish to make three points. a) It is retrospective and case record based; as such loses much of its sheen, b) atrial fibrillation, for a long time, could remain paroxysmal, and might not appear in the discharge diagnoses list and c) I could not find if the controls were age and sex matched. One of the important confounding factors is alcohol. Early presentations of alcoholic cardiomyopathy could only be isolated paroxysmal atrial fibrillation- a little beyond the stage of the so called “T-P phenomenon” in the ECG where the T wave of the previous complex almost merges with the P wave of the succeeding complex without an isoelectric line in between complexes. I missed to see any particular mention to alcohol intake in the two groups as also the ECG predictors of AF. Another confounding factor could be coronary artery disease prevalence in the two groups studied. Lastly, almost all the authors seem to have had close connection with the manufacturers of the drug in question. I don’t think that makes any difference as we all take the Hippocratic Oath to follow the highest ethical standards when we start our professional life, anyway? The caption is from Leo Tolstoy. Yours ever, Bmhegde Reference: 1) Think again. Fiona Godlee BMJ 2008; 336:0 2) Oral bisphosphonates and atrial fibrillation. Sumit R Majumdar. BMJ 2008 336: 784-785. Competing interests: None declared