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I note the comments made by Sharma and Griffiths that concern our
paper (MacKenzie and Cooke, BMJ
2001; 322: 1334-1335), which I believe warrant a response.
1. Although they suggest that our report, and that by Tufnell
and colleagues (BMJ 322:
1330-1333) have shown that it is safe to deliver the baby within 30
minutes of making the
decision, that is unfortunately incorrect. Neither paper addressed the
issue of maternal
complications and we are anxious that others do not misinterpret the data
and foster
misunderstandings for the future.
2. Neither paper dismissed the 30 minute decision-to-delivery
interval as being
unachievable, and thus unrealistic. The data from both studies shows that
such a delivery
interval is achievable but both challenge the wisdom of striving to
achieve such a deadline except
in a few 'crash' situations. It is important that others do not
misinterpret the data in a
similar way.
3. The conclusion reached by Sharma and Griffiths that babies
born after short
decision-to-delivery intervals are in a poorer condition than those born
at a later stage is
evidence of correct assessment of the urgency of the need to deliver and
is the obvious
conclusion to reach. However, we pointed out that the same improving
trend in neonatal condition
was also observed when delivery was performed for reasons that did not
include fetal distress.
We hope that as a result of their letter others will not overlook
important information contained
in the reports.
4. The issue of conflict of interests is also important. The
expert witness provides an
unbiased opinion for use by the Court and these reports should not be
influenced by those who are
instructing the expert. The suggestion that all clinicians who conduct
clinical research should
include a statement that one or more of the authors is engaged in medico-
legal work must surely be
challenged; an enquiry of my consultant colleagues (in post for 12 months
or more) has shown that
11/12 (92%) of my consultant colleagues provide expert reports for medico-
legal purposes. The
purpose of clinical research is to advance knowledge and understanding,
rather than for the rather
cynical reason implied by Drs. Sharma and Griffiths.
Yours sincerely,
I. Z. MACKENZIE
Nuffield Department of Obstetrics and Gynaecology,
John Radcliffe Hospital,
Oxford
OX3 9DU
Competing interests:
No competing interests
28 June 2001
I Z Mackenzie
Nuffield Department of Obstetrics and Gynaecology, John Radcliffe Infirmary, Oxford
Author's reply to Sharma and Griffiths
I note the comments made by Sharma and Griffiths that concern our
paper (MacKenzie and Cooke, BMJ
2001; 322: 1334-1335), which I believe warrant a response.
1. Although they suggest that our report, and that by Tufnell
and colleagues (BMJ 322:
1330-1333) have shown that it is safe to deliver the baby within 30
minutes of making the
decision, that is unfortunately incorrect. Neither paper addressed the
issue of maternal
complications and we are anxious that others do not misinterpret the data
and foster
misunderstandings for the future.
2. Neither paper dismissed the 30 minute decision-to-delivery
interval as being
unachievable, and thus unrealistic. The data from both studies shows that
such a delivery
interval is achievable but both challenge the wisdom of striving to
achieve such a deadline except
in a few 'crash' situations. It is important that others do not
misinterpret the data in a
similar way.
3. The conclusion reached by Sharma and Griffiths that babies
born after short
decision-to-delivery intervals are in a poorer condition than those born
at a later stage is
evidence of correct assessment of the urgency of the need to deliver and
is the obvious
conclusion to reach. However, we pointed out that the same improving
trend in neonatal condition
was also observed when delivery was performed for reasons that did not
include fetal distress.
We hope that as a result of their letter others will not overlook
important information contained
in the reports.
4. The issue of conflict of interests is also important. The
expert witness provides an
unbiased opinion for use by the Court and these reports should not be
influenced by those who are
instructing the expert. The suggestion that all clinicians who conduct
clinical research should
include a statement that one or more of the authors is engaged in medico-
legal work must surely be
challenged; an enquiry of my consultant colleagues (in post for 12 months
or more) has shown that
11/12 (92%) of my consultant colleagues provide expert reports for medico-
legal purposes. The
purpose of clinical research is to advance knowledge and understanding,
rather than for the rather
cynical reason implied by Drs. Sharma and Griffiths.
Yours sincerely,
I. Z. MACKENZIE
Nuffield Department of Obstetrics and Gynaecology,
John Radcliffe Hospital,
Oxford
OX3 9DU
Competing interests: No competing interests