Data were selectively used

EDITOR—Skolbekken is guilty of the same accusation he makes against others—selective use of data.1 After stating that his purpose is to shed some light on the presentation of facts from clinical trials such as the Scandinavian simvastatin survival study (4S) (a secondary prevention study), he then proceeds to concentrate almost exclusively on the West of Scotland coronary prevention study (a primary prevention study). 2 3 Clearly, the absolute benefit of treatment is never going to be as large in low risk primary prevention patients as it is in high risk secondary prevention patients.

To emphasise his negative message, Skolbekken also adopts exactly the tactics of which he accuses others. For example, he concentrates exclusively on mortality as a benefit of statin treatment. Of course the 4S results do not look so good if they are presented as showing the need to treat 33patients for 5years to prevent one death; presenting them as 11patients to prevent one major clinical event (death, infarction, stroke, etc) changes the picture completely.2 Myocardial infarctions, strokes, bypass operations, and hospital admissions matter greatly to patients and their families. This selective use of data applies equally to the comparison between men and women, especially in the light of the long term pravastatin in ischaemic disease study and the airforce/Texas coronary atherosclerosis prevention study.4

Nobody would disagree that the way we present results to patients matters, and that individual risk is an important consideration. Most practising clinicians caring for patients with ischaemic heart disease would, however, present the same data from 4S in a more patient friendly and meaningful way—for example, “this trial tells us that your best chance of being alive and well in 5years' time is if you take a statin.” This is …