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  • Title: Balanced view of risks of oral contraceptives.
    Author: Spitzer WO.
    Journal: Lancet; 1997 Nov 29; 350(9091):1566-7. PubMed ID: 9393332.
    Abstract:
    Available studies on the association between the use of combined oral contraceptives (OCs) and the risk of three serious side effects (myocardial infarction, ischemic and hemorrhagic stroke, and venous thromboembolism) were reviewed at a World Health Organization (WHO) scientific group meeting held in November 1997. The group's findings have been published in the November 28, 1997, issue of "WHO Weekly Epidemiological Record." Of concern to the author of this letter to the editor was the exclusion, with no clear criteria, of many lead investigators from closed sessions. Also notable was the tendency of the panel to downplay controversies about the differences between second- and third-generation OCs in the risk of venous thromboembolism. Moreover, the conclusions on myocardial infarction minimize the likely protective effect of third-generation compared with second-generation OCs. Finally, the summary report does not mention possible bias sources or clarify the lack of clinical and public health significance of odds ratios of 2.0 or less for adverse effects that are extremely rare. In the author's opinion, WHO should have given greater emphasis to the continually improving safety of OCs.
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