Letters

The PROGRESS trial three years later: Evangelism is understandable

BMJ 2004; 329 doi: https://doi.org/10.1136/bmj.329.7479.1404-a (Published 09 December 2004) Cite this as: BMJ 2004;329:1404
  1. Peter Ward (pwward{at}blueyonder.co.uk), general practitioner principal
  1. Gateshead NE8 1NR

    EDITOR—I think the reasons for the evangelical tone of the last paragraph of the commentary by MacMahon et al on the PROGRESS trial are that the authors are academic specialists in medicine.1 They have a clear view from their hill over the confused swampy lowlands of everyday practice and believe they can help guide us poor souls groping about in it.

    To help my patient decide if he or she wants to risk the adverse effects of antihypertensive drugs and whether he or she can be bothered to take several tablets a day for the rest of his or her life, it would be nice to have some decent information with which to help him or her to make a decision. This information is slowly emerging, but is far from clear as yet.

    Even if patients can understand the concepts of numbers needed to treat and the like, they will often say “No thanks, I would rather not” when confronted with their NNT of 20 or whatever to prevent a stroke over five years.

    A lot will say yes to please their doctor, then collect the prescription regularly but not take it (it will probably be free on the NHS), and a lot will take it when they feel a bit unwell in the morning, for whatever reason.

    Others may actually take it regularly and see it as a reason why they can carry on smoking and drinking too much as the medicine the nice doctor gives them “reduces risk” and balances out their bad habits a bit.

    Others will conscientiously take it and acquire exemplary lifestyles and so get the life preserving benefits the authors are extolling, to die on average a few months later of some other major “preventable” disease. This last group, in my inner city practice, is rather small.

    Footnotes

    • Competing interests None declared.

    References

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