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A rush of blood (Editorial)

Not what, but whom
Electronic Bandolier

A rush of blood

There are some topics that are damaging to your health. We try out several this month, in something of a rush of blood to the head. By far and away the most difficult topic is the old chestnut of whether indirect comparisons are valid. If we have tested treatment A against treatment B, and tested treatment C against treatment B, are we able to say anything about the relative merits of A and C?

Some would simply tell us that we could not. Others would suck their teeth like plumbers of old and tell us how tricky it would be even to think about it. A few will just have a go. So Bandolier this month has a feeble stab at trying to put some sort of sense to it. Highly qualified, because it's so tricky, but there's light at the end of the tunnel.

Not what, but whom

We also have a look at prediction rules, importantly about which men to treat with symptoms of BPH. It all comes down to the size of the prostate and the serum PSA as a surrogate for this. Men who, at randomisation, were given placebo, and who had a serum PSA of 3.3 ng/mL or above, had high rates of spontaneous acute retention (about 8% over four years). They look like the best candidates for treatment, and more complicated algorithms help only a bit better. It's also one reason to measure PSA.

What is marvellous is that this comes from an analysis of randomised trials. The trouble is that it has taken all these years after finasteride has been available to get us this information. More please from all those pointy heads in the pharma companies, and soon.

Electronic Bandolier

Just before Christmas Bandolier Internet had 150,000 visitors in one week. Usually it is a bit lower than that, but it has been growing rapidly in recent months. Much has changed, and for the better. The site is in the final stages of an overhaul to make things easier to find, especially for people using Internet search engines.

In 2002 we have several plans. First is to expand the essays available, and a new one is there on cannabis and flying . This was a spin-off from a planned survey of papers on cannabis and multiple sclerosis that will appear when all papers are in. And in 2002 we plan to develop a resource centre on gout. Few systematic reviews for gout, we have found, though a large Cochrane review is ongoing. We'd like to know what questions you want answered.

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