Cole, GD

Francis, DP

English

Darrel P Francis

Graham D Cole

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Authors’ reply to Perry

Spiral - Imperial College Digital Repository

CORONARY ARTERY DISEASE: SCREEN OR TREAT?Authors’ reply to PerryDarrel P Francis professor, Graham D Cole specialty registrarInternational Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, London W2 1LA, UKWe thank Perry for raising the interesting difference betweenresearch trials where both patients and staff are blinded towhether the tablet is really a statin and everyday practice wherepatients and doctors know whether a statin is being taken.1 2 Inthe blinded trials, there are indeed reports of symptoms, but (inthe published data) these are equivalent between statin andplacebo. In everyday practice, there are reports of symptomsbut no blinded comparator group.While in some cases symptoms might be a pharmacologicaleffect that cannot be evaded, the blinded randomised datasuggest that in other cases it might be a non-pharmacological(nocebo) effect. In routine practice patients have no way to findout for themselves which is the case for them individually.We are delighted to report that the British Heart Foundation issupporting a patient centred randomised controlled trial withmultiple blinded segments for each patient (statin, placebo, andno treatment). We expect this to allow patients to judge forthemselves where symptoms are coming from—the statin orbeing on any tablet (even placebo).We invite any UK based doctors with patients who have stoppedstatins because of symptoms to look at the SAMSON website(http://www.preventingheartdisease.org/) and get in touch withus.Together we may be able to move closer to providing what ourpatients most need—a simple, scientifically valid, andpersonalised answer to this vexing question.Competing interests: None declared.1 Perry TL. Ignoring adverse experiences of people taking statins. BMJ 2016;353:i2030.2 Francis DP, Cole GD. Coronary artery disease: screen or treat?BMJ 2016;352:i1395. doi:10.1136/bmj.i1395 pmid:26987757.Published by the BMJ Publishing Group Limited. For permission to use (where not alreadygranted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissionsd.francis@imperial.ac.ukFor personal use only: See rights and reprints http://www.bmj.com/permissions Subscribe: http://www.bmj.com/subscribeBMJ 2016;353:i2031 doi: 10.1136/bmj.i2031 (Published 12 April 2016) Page 1 of 1LettersLETTERS

Authors' reply to Perry.

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Authors' reply to Perry

Authors' reply to Perry

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