949 e-Letters

  • Uncontrolled study proves little about value of therapy received
    Tom P. Kindlon

    This paper (1) includes data on two separate (but related) issues: (i) the prevalence of diagnosed and undiagnosed Chronic Fatigue Syndrome/Myalgic Encephalomyelitis ("CFS/ME") (NICE criteria (2)) in children aged 11-16 and (ii) information on how they fared when they received therapy at the CFS clinic. The relative rigour that is brought to the first set of data may mean some may miss that many questions remain about th...

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  • Research is not convincing
    Des Spence

    I am concerned by the level of coverage this article has received. For this is a service provision descriptive pilot involving a tiny group of just 23 children. It is short , non randomised, has no controls and interventions completely unblinded. There is also an issue around commissioning bias , for the investigating group clearly believe that CFS is underdiagnosised in children. The Radio coverage presented considera...

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  • Re:Oral contraceptive use is not associated with prostate cancer
    David Margel

    We are thankful for Dr Cherrie`s astute observations. After careful review of our data it appears that we indeed miscoded several points in our data set, which have resulted in an error in the analysis. We therefore decided to make sure our hypothesis is in reality supported by the data. We re-analyzed the correlation between mode of contraceptive use and prostate cancer (PCa)- using data from all countries available on t...

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  • Oral contraceptive use is not associated with prostate cancer
    John W. Cherrie

    Margel and Fleshner (1) present results from an ecological study of associations between oral contraceptive (OC) use and prostate cancer. They hypothesize that men inadvertently ingest OCs or their by-products, passed from female urine into the environment or drinking water, and that the consequent increased low-level oestrogen exposure causes prostate cancer. The authors used data from a stratified random sample of countr...

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  • This ecological study overlooked well known prostate cancer risk-modifying factors
    William B. Grant

    The paper by Margel and Fleshner reporting a direct correlation between oral contraceptive use and prostate cancer incidence and mortality rates1 is interesting and there may be an effect of oral contraceptive use on risk of prostate cancer. However, the study was not conducted according to the general rules for such studies. While ecological studies are a very useful approach for determining links to cancer (e.g., Ref. 2),...

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  • Cost analysis of prescribing analogue insulin should take into account the bigger picture of diabetes treatment prescribing cost
    Iskandar Idris

    Dear Editor,

    We read with interest the article 'Evaluation of the incremental cost to the National Health Service of prescribing analogue insulin'(1). The stated aim of this study was to characterize the pattern of insulin prescriptions dispensed between 2000 and 2009 in UK and to evaluate the financial cost to the National Health Service (NHS) of using analogue insulin instead of its equivalent human insulin p...

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  • Letter to the editor
    Oliver Sch?ffski

    Dear Editor of BMJ open,

    last week I read the above mentioned article by Holden et al. and I was quite astonished. The authors write (page 5-6) "The purpose of this study was to calculate a monetary value to raise awareness of the cost implications (...) rather than to suggest an exact percentage of patients with diabetes who could be equally well treated with human insulin instead of analogue insulin." In other...

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  • Association, surely not the same as risk factor
    Peter M English
    The authors conclude "Unhealthy substance use is a risk factor for not receiving all appropriate preventive health services". To my mind, a risk factor is something which is causally associated with something - it increases the risk. It is not the same as a marker for an increased risk. Surely the authors meant: "Unhealthy substance use is associated with not receiving all appropriate preventive health services"...
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  • Re:Lessons Learnt - The 'Big Five' in South Africa
    Kirsten Duckitt

    Whilst acknowledging the previous comment's valid concerns over what constitutes an international survey, I wanted to correct the assumption that all elective deliveries must be Caesarean sections. Most elective deliveries prior to term are likely to be inductions of labour as per the HYPITAT study. This may still not be relevant for the South African setting but it is very different concept than suggested in the respons...

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  • Smoke-free regulations and AMI mortality declining: Do babies come from Paris?
    Jose A. Delgado

    Dear Editor,

    This paper from Villalbi and colleagues use a before-after design without control group to analyse deaths due to Acute Myocardial Infarction (AMI) in Spain from 2004-2007 and concludes "the extension of smoke-free regulations in Spain [came into force in January 2006] was associated with a reduction in AMI mortality, especially among the elderly". While we are clearly in favour of this law, their imm...

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