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  • Title: Concerning the British data.
    Author: Doll R, Inman WH, Vessey M.
    Journal: JAMA; 1969 Feb 10; 207(6):1150-2. PubMed ID: 12332015.
    Abstract:
    The relationship between oral contraceptive use and development of thromboembolism is discussed by Doll, Inman and Vessey who explain the differences between the results of Drill and Calhoun, and other studies on the basis that statistical comparison failed to be based on the same criteria; that deductive reasoning was misapplied due to the lack of a control population and the small number in the sample; and that the risk among women with predisposing conditions as opposed to the control group, was indeterminable because presumably their use of oral contraceptives would be less than that in the general population. In reply, Drill and Calhoun maintain the lack of association between oral contraceptive use and thromboembolic disease by making the following points: 1) inherent problems in controlling the sample and how it grows, e.g., whether the doctor knows if the patient is taking the pill before recommending hospital admission, 2) the significance of accepting the idea of predisposing conditions and the likelihood of their increasing the tendency to produce an effect, 3) comparison of the vital statistics of England and Wales failed to reveal any differences in thromboembolic disease mortality before or after the introduction of oral contraceptives, and 4) the British studies are statistical-epidemiological projections based on oral contraceptive use, with few patients under selected controls. An editorial by C. Seltzer, follows in which the English study (Doll, Inman and Vessey) is considered highly reliable due to its matched case/control approach to disease diagnosis, and because it represents a segment of the English population. The American data (Drill and Calhoun) consists of incidence data from compilations of the literature. However, epidemiological data also is insufficient for concluding a cause and effect relationship.
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