108 e-Letters

  • Gate control pain modulation theory invalidates the control groups used in these RCTs
    Stavros Saripanidis

    Dear Editors,

    The dorsal horns are not merely passive transmission stations but sites at which dynamic activities (inhibition, excitation and modulation) occur. [18]

    Via a series of filters and amplifiers, the nociceptive message is integrated and analysed in the cerebral cortex, with interconnections with various areas. [1]

    The processing of pain takes place in an integrated matrix throughout...

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  • Accurate, but is it patient-centred?
    Rodger C Charlton

    Although the accuracy of a mercury sphygmomanometer can be debated, automatic and semi-automatic devices which inflate the cuff often do so to well above the systolic pressure and can cause patients considerable discomfort even when an appropriate cuff size has been used. These devices frequently re-inflate for a variety of reasons, but out of control of the operator who is waiting for a reading.

    Anecdotally, I...

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  • Do not discard your mercury sphygmomanometers, yet.
    Yehia Y. Mishriki

    It would not be surprising to find that the "error" rate in blood pressure determinations with the "old fashioned" sphygmomanometer was due, in part, to a faulty technique by the individuals taking the blood pressures. Remarkably, little or no time is spent in teaching medical students the proper technique for blood pressure determination including the appropriate cuff size to use, the various audible phases, etc. One ca...

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  • Qualitative reasoning by elimination
    Huw Llewelyn

    Dear Editor,

    Bayes theorem can only be applied properly when considering a single diagnosis or its absence e.g. the presence or absence of asymptomatic diabetes mellitus, hypothyroidism, hyperlipidaemia, cervical cancer, breast cancer, etc. These asymptomatic situations are very important in the clinical setting and also in the community. It is in these situations that the reasoning described in this paper can be...

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  • What is 'transparent' EBM?
    Huw Llewelyn

    Dear Editor,

    Different individuals have adapted and adopted the principles of EBM to different degrees and in vastly different ways [1]. There is yet another approach to EBM, which goes back a long way in terms of verbal justification on ward rounds but which has not been put in writing and taught in that way until recently [2]. It involves specifying the 'evidence' obtained from the patient that was used for ea...

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  • Editor's reply to "Conflicts of Interest"
    Richard Saitz

    I agree with Dr. Tomedi's assertion that one might question the credibility of a commentary written by someone who has received pharmaceutical industry support, or for a number of other reasons. It is for this reason that BMJ Group policies ask authors to acknowledge and openly state any competing interests (1), and as a result of this policy, Dr. Tomedi could become aware of them and consider them in reading the commenta...

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  • Conflicts of interest
    Angelo Tomedi

    Dear editor,

    The important influence of pharmaceutical manufacturers on the medical literature, and the positive "spin" placed on results and conclusions, has been well documented. Given this pervasive problem, readers may question the credibility of the commentary of an EBM reviewer who has "received consulting fees from MSD, Schering, Novartis and GSK and received honoraria from Altana, Astra Zeneca, Boehringer Inglehi...

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  • Is Rosiglitazone a safe drug?
    Chris Williams

    Dear Editor,

    I was surprised to see the assertion by Philip Home that rosiglitazone is a "particularly safe drug." Given its withdrawal from public use (the current prescribing ban recommended by MHRA in the UK, the European Medicines Agency and the FDA in the United States) due to concerns over increased cardiovascular risks, it would seem that our health authorities see it as anything but a safe drug.

  • Re:This commentary could be more helpful to me: Editors Note...
    Richard Saitz

    We are making some changes going forward to the Commentaries such that they are more structured and contain key features related to critical appraisal of the evidence: http://ebm.bmj.com/content/15/4/103.full. Some of what Dr. Bossano refers to (e.g. the use of absolute versus relative risks will be addressed by such changes.


    Richard Saitz, Editor.

    Conflict of Interest:

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  • This commentary could be more helpful to me:
    Davud Bossano
    Dear Editor

    It's quite a while since I read EBM but I received an eTOC today and was pleased to discover I could read it via my NHS Athens login. I couple of abstracts caught my including this one, because as a GP, LUTS and concern about PSA are relatively commonly seen. The commentary seemed to have a lot of detail about prostate disease, which was interesting but perhaps not entirely relevant to the paper it was comm...

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