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Communicating risk reductions

BMJ 1999; 318 doi: (Published 27 February 1999) Cite this as: BMJ 1999;318:602

This article has a correction. Please see:

Data were selectively used

  1. J McMurray, Consultant cardiologist
  1. Medical Research Council Research Initiative in Heart Failure, Wolfson Building, University of Glasgow, Glasgow G12 8QQ
  2. Department of Metabolism and Genetics, St Bartholomew's Hospital, London EC1A 7BE
  3. Imperial College School of Medicine, Charing Cross Hospital, London W6 8RP
  4. Department of General Practice, University of Wales College of Medicine, Llanedeyrn Health Centre, Cardiff CF3 7PN
  5. School of Health Policy and Practice, University of East Anglia, Norwich NR4 7TJ
  6. Department of Psychology, University of Tromsø, 9037 Tromsø, Norway

    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

    View this table:

    Benefits of cardiovascular treatments. Adapted with permission from McMurray5

    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 …

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