Reviews Minerva


BMJ 2001; 322 doi: (Published 10 March 2001) Cite this as: BMJ 2001;322:624

Doctors should calculate the precise risk of heart disease for each patient before prescribing aspirin for primary prevention, say researchers from Sheffield (Heart 2001;85:265-71). After examining data from four randomised trials, they conclude that aspirin is safe and effective as long as the risk of a coronary event exceeds 1.5% a year. The risk of bleeding outweighs any benefit when risk of an event falls below 0.5% a year. The researchers urge doctors to calculate risks accurately using tables based on Framingham data.

When it comes to making decisions about life prolonging treatments, relatives and doctors are poor at guessing what incapacitated patients really want. But do advance directives help relatives make the right decision? Not according to a randomised trial in Archives of Internal Medicine (2001;161:421-30). Various forms of advanced directive made no difference to an elected surrogate's accuracy, which remained around 70% for a range of conditions and outcomes. Hospital doctors were worse decision makers than relatives in a second randomised trial (pp 431-40), but advance directives made them a little better.

The new editor of Archives of Paediatric and Adolescent Medicine asks authors not to use spurious variables related to race or ethnicity in their analyses (2001;155:119). Unsophisticated groupings based on a …

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