Risk of gastrointestinal effects with COX-2 inhibitors and NSAIDs: What does evidence from randomised trials show about celecoxib?

doi:10.1136/bmj.331.7530.1474-c

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Jonathan L Underhill, assistant director, education and development (jonathan.underhill@npc.nhs.uk)

National Prescribing Centre, The Infirmary, Liverpool L69 3GF

EDITOR—With reference to Feczko's comments (first letter in this cluster), Hippisley-Cox et al's study was an observational study.1 This occupies a lower place on the hierarchy of evidence than large, prospective randomised controlled trials measuring outcomes that are important to patients (patient oriented evidence that matters, or POEMs).

The only POEM evidence for …