Advising women on which pill to take

The informed user should be the chooser

Rarely can an editorial in the BMJ have been so difficult to write. The warning about oral contraceptives containing desogestrel and gestodene that was sent to all British doctors and pharmacists on 18 October by the Committee on Safety of Medicines1 was based on three as yet unpublished epidemiological studies. Scientific etiquette forbids those of us who have seen drafts of the papers from commenting in detail, if only because the peer review process is not complete and the articles may be considerably altered before publication. For most doctors, who do not have access to the relevant data, advising patients is particularly difficult.

Despite important questions about the biological plausibility and validity of the findings (see p 1112), three studies in different populations with two different methodologies show results that are congruent and generally statistically significant. If we do not like the message we should not shoot the messenger (though legitimate questions may be asked about the timing of the announcement, procedures for circulating information to doctors, and the detailed content of the committee's letter). And, given that the letter now exists and will (however sound its basis proves to be) …