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Hypnotics' association with mortality or cancer: a matched cohort study
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  • Published on:
    Re:Re:Re:Hypnotics' association with mortality or cancer: bias related to the study design and analysis

    Dr. Hallas, Dr. Andersen, and colleagues give us the very good news that they are working on a study of benzodiazepine-cancer association using the Danish Cancer Registry. Additional data that isolates benzodiazepine agonists and other hypnotics individually will be very welcome, as different benzodiazepine agonists may have different risks. Perhaps they can provide results from time-dependent Cox models. It will be...

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    Conflict of Interest:
    None declared.
  • Published on:
    Re:Re:Hypnotics' association with mortality or cancer: bias related to the study design and analysis
    • Jesper Hallas, Professor
    • Other Contributors:
      • Morten Andersen, S?ren Friis, Anton Potteg?rd

    We appreciate the response from Dr. Kripke, although we are afraid it supports our notion of a bias in their selection of reference cohort rather than reassure us about the opposite.

    In their study, non-users of hypnotics were required to have no hypnotic prescriptions at any time in their entire follow-up. However, in a cohort study, exposure that occurs after an endpoint should not be taken into consideration....

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    Conflict of Interest:
    None declared.
  • Published on:
    Re:Hypnotics' association with mortality or cancer: bias related to the study design and analysis
    Replying to Dr. Andersen and colleagues, we appreciate their very learned statistical comments on our article. First, there seems to be a misunderstanding of our selection criteria. A patient who developed cancer before receiving a hypnotic would not have been included in either the hypnotic-prescribed or the control group, and therefore would not bias the study in regard to hypnotic-associated cancer incidence. Secondly,...
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    Conflict of Interest:
    None declared.
  • Published on:
    Re:Is it hypnotics that kill, or is it psychiatric illness?
    In reply to Dr. Terkelsen and colleagues, I am greatly awed by the extensive literature review which they kindly offered with so much effort. Unfortunately, these colleagues ignored the point which we made in our article: Mallon et al. (reference 7) and Belleville (reference 8) have shown that control for depression does not substantially attenuate the mortality hazard associated with hypnotics. On the other hand, Patten e...
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    Conflict of Interest:
    None declared.
  • Published on:
    Hypnotics' association with mortality or cancer: bias related to the study design and analysis
    • Morten Andersen (1)
    • Other Contributors:
      • Anton Pottegård (2), Søren Friis (3), Jesper Hallas (2)

    In BMJ Open, Kripke et al have presented a study on risks associated with the use of hypnotics (1). In their two-in-one study, the authors report an about fourfold increased risk of death and a 35% increased risk of cancer when comparing users of hypnotics with non-users. The authors present the analyses as a cohort study using a survival analysis model with Cox regression. However, several approaches in both the study d...

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    Conflict of Interest:
    None declared.
  • Published on:
    Is it hypnotics that kill, or is it psychiatric illness?
    • Kenneth G Terkelsen, MD, General psychiatrist, Assistant Director, Behavioral Health Services
    • Other Contributors:
      • James P McGuire, MD and Michael B Friedman

    Is it hypnotics that kill, or is it psychiatric illness? * Kenneth G. Terkelsen, M.D. General Psychiatrist, Assistant Director * James P. McGuire, M.D. Child and Adolescent Psychiatrist Behavioral Health Services Community Health Center of Cape Cod Mashpee, Massachusetts, USA

    * Michael B. Friedman, Adjunct Associate Professor Columbia School of Social Work and Mailman School of Public Health New York, New York, US...

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    Conflict of Interest:
    None declared.
  • Published on:
    Re:Conflict of interest: response to Ms Colella

    Please note that my co-authors have approved our manuscript, but Dr. Langer and Dr. Kline have no previous publications about hypnotic drugs and no affiliation with the www.DarkSideOfSleepingPills.com web site. Some people would think it scientifically proper that I participated in a new study which overcomes some of the limitations of my previous scientific studies, along with co-authors who have no previous biases or...

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    Conflict of Interest:
    None declared.
  • Published on:
    Conflict of interest

    Dear Editor: I appreciated and read Dr. Kripke's manuscript with interest. He and his co-authors present many considerations healthcare providers should acknowledge when prescribing hypnotics. Hypnotics, like all medications, have inherent risks. I was disappointed however, to read about Dr. Kripke's affiliation, or hosting, of the website www.DarkSideOfSleepingPills.com. In my opinion, this affiliation casts a signi...

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    Conflict of Interest:
    None declared.
  • Published on:
    Propensity score matching to minimize confounding by indication
    The authors made a concerted effort to control for confounding in the design and analysis phase of this paper, and correctly stated that unmeasured confounding is a limiting feature of the results. Given the understandable concerns about confounding by indication, another approach the authors may wish to consider is propensity score matching for the analysis. Indeed, they should be able to show that a given hypnotic user had some...
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    Conflict of Interest:
    None declared.
  • Published on:
    Response: "Hypnotics' association with mortality or cancer: a matched cohort study"

    Dr. Daniel Kripke,

    Thank you for you article entitled "Hypnotics' association with mortality or cancer: a matched cohort study," I enjoyed reading it and found it to be especially interesting. Nonetheless, I have a few comments and questions related to your research area and your article. Firstly, I thought the research design you choose was suitable for the nature of the research. The matched cohort study was...

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    Conflict of Interest:
    None declared.
  • Published on:
    Re:Hypnotics and mortality: A time for action

    We apologize if we created confusion by saying we "adjusted" for prior cancer. Indeed, our method of adjustment was to exclude all patients with any diagnosis of major cancer prior to the interval of observation. Similarly, when examining non-melanoma skin cancers, we excluded patients with prior skin cancers.

    Unfortunately, only dichotomous responses concerning whether patients used alcohol were available in...

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    Conflict of Interest:
    None declared.
  • Published on:
    Need for accessible non-drug treatments
    As these distinguished authors write, efforts should be made to improve the accessibility of non-drug treatments for insomnia such as cognitive-behavioral approaches. By reducing the use of hypnotics, such treatments might be life-saving.

    Conflict of Interest:

    Please see our BMJ Open article

    Conflict of Interest:
    None declared.
  • Published on:
    Insomnia in the UK: who cares?
    • Colin A Espie, Director, University of Glasgow Sleep Centre
    • Other Contributors:
      • Kevin Morgan, David Nutt, Niroshan Siriwardena, Derk-Jan Dijk, Brian McKinstry, June Brown, John Cape, Sue Wilson, Maureen Tomeny, Andrew McCulloch, Neil Douglas

    Insomnia is twice as common in the UK as anxiety or depressive symptoms(1). Indeed, chronic insomnia is a risk factor for the development of such mental health problems(2). Yet in a week when new research shows that the prevalence of insomnia is increasing in England(3), and that even occasional hypnotic drug use continues to be associated with excess mortality(4), it is disappointing that after 21 months of waiting for a...

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    Conflict of Interest:
    None declared.
  • Published on:
    Hypnotics and mortality: more evidence is needed
    • Victor Vallejo-Garcia, Medical Student
    • Other Contributors:
      • Pilar Toledano-Valero, Javier Feito-Sancho, Joao Modesto-Santos

    Dear Editor:

    We have read with great interest the recent article by Kripke DF, Langer RD and Kline LE that assessed the risk of all cause mortality and cancer incidence in patients using benzodiazepines or zolpidem. The article poses relevant questions about the use of these drugs and it is likely to have a very large influence on the decisions that health care practioners take, particularly because of the larg...

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    Conflict of Interest:
    None declared.
  • Published on:

    Why weren't people with insomnia who didn't take hypnotics included in the control group-could insomnia and not hypnotics be the factor causing excess death???Is the dose relationship just an indication of the severity of insomnia?

    Conflict of Interest:

    None declared

    Conflict of Interest:
    None declared.