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Tramer et al [1] present strong evidence that postoperative
antiemetics should be tested against placebo. While accepting their
scientific argument, and to some extent altering my previous view [2], I
am nonetheless dismayed that it is so. Tramer's conclusion will provide
support for the drug companies' reluctance to test their new antiemetics
against established drugs. I suggest that trials of postoperative
antiemetics should always have three arms: placebo, test drug and control
drug. This design provides the internal index of sensitivity asked for by
Tramer, and the comparative data that clinicians need when they prescribe.
I note Tramer's comment that the "widely held view that use of
droperidol is limited by adverse reactions was not supported". I do not
imagine that this will prevent the almost universal habit of investigators
putting forward "the high incidence of serious side-effects" of the older
antiemetics as a rationale for their studies on ondansetron and the later
5-HT3 antagonists. It is an indictment of our systems and funding of the
testing of drugs that, as Tramer writes, we still do not know the efficacy
or optimal doses of the older and far less expensive antiemetics.
Neville W Goodman
Consultant Anaesthetist
Southmead Hospital
Bristol
BS10 5NB
1. Tramer MR, Reynolds DJM, Moore RA, McQuay HJ.
When placebo controlled trials are inadequate. BMJ
1998;317:875-80.
2. Aspinall RL, Goodman NW. Denial of effective treatment
and poor quality of clinical information in placebo controlled trials of
ondansetron for postoperative nausea and vomiting: a review of published
data. BMJ 1995;311:844-846.
Placebos and postoperative vomiting: we still need active
Tramer et al [1] present strong evidence that postoperative
antiemetics should be tested against placebo. While accepting their
scientific argument, and to some extent altering my previous view [2], I
am nonetheless dismayed that it is so. Tramer's conclusion will provide
support for the drug companies' reluctance to test their new antiemetics
against established drugs. I suggest that trials of postoperative
antiemetics should always have three arms: placebo, test drug and control
drug. This design provides the internal index of sensitivity asked for by
Tramer, and the comparative data that clinicians need when they prescribe.
I note Tramer's comment that the "widely held view that use of
droperidol is limited by adverse reactions was not supported". I do not
imagine that this will prevent the almost universal habit of investigators
putting forward "the high incidence of serious side-effects" of the older
antiemetics as a rationale for their studies on ondansetron and the later
5-HT3 antagonists. It is an indictment of our systems and funding of the
testing of drugs that, as Tramer writes, we still do not know the efficacy
or optimal doses of the older and far less expensive antiemetics.
Neville W Goodman
Consultant Anaesthetist
Southmead Hospital
Bristol
BS10 5NB
1. Tramer MR, Reynolds DJM, Moore RA, McQuay HJ.
When placebo controlled trials are inadequate. BMJ
1998;317:875-80.
2. Aspinall RL, Goodman NW. Denial of effective treatment
and poor quality of clinical information in placebo controlled trials of
ondansetron for postoperative nausea and vomiting: a review of published
data. BMJ 1995;311:844-846.
Competing interests: No competing interests