Bandolier

The argument made in the issue of Bandolier that the evidence for a specific effect of third generation pills on DVT is devoid of biological plausibility is vacuous. Too often biological evidence is criticised and dismissed by some - but that is not sufficient to render the logical extrapolation implausible. The use of the word 'absent' biological plausibility is, I am afraid, just illegitimate !

In this case the article you review, by Walter Spitzer, comes from a series of systematic attempts , essentially funded by the pill manufacturers (Schering and Akzo-Nobel in his case) , to discredit the epidemiological evidence by recourse to arguments of bias and selection. Again some of this argument is possible but in my opinion nowhere nearly enough to conclude with any certainty that there is no specific causative effect of third generation pills.

The evidence here is tricky and complex and Bandolier should in my view be a good deal more skeptical about this evidence knowing, as it must, that the research effort dedicated to pursuing a particular hypothesis is a direct function of the funds available. This, in turn, it would not be too fanciful to argue, is likely to be proportional to the commercial interests involved.

Yours

Klim McPherson

Professor of Public Health Epidemiology

Cancer and Public Health Unit

0171 927 2059

fax +44 171 436 4230