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Letters to the Editor
February 2005

On the Use of Clusters to Determine Environmental Influence on Disease—Reply

Arch Neurol. 2005;62(2):331-332. doi:10.1001/archneur.62.2.331-b

In reply

Hutchinson and Lebedev have chosen to ignore an essential paragraph on page 1058 of our article. With respect, we quote part of it here again: “It is difficult to demonstrate directly that a group of individuals constitute a cluster in time and space with respect to a disease. In addition to the obvious problem of ascertainment bias associated with the retrospective identification of such groups and the difficulty of defining a suitable control framework for the purposes of comparison, there is a major logical barrier to our attempt to prove the hypothesis that the group constitutes a meaningful cluster.”

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