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May 15, 1987

Analgesic Use, Agranulocytosis, and Aplastic Anemia-Reply

JAMA. 1987;257(19):2591-2592. doi:10.1001/jama.1987.03390190068012

In Reply.—  Dr van Dijke's suggestion that the inclusion of drugs other than dipyrone results in underestimation of the real risk would only be true if the simultaneous effects of causal drugs other than dipyrone were not controlled in the analysis. This was done.He suggests that the reference category for dipyrone users should have consisted of those not exposed to any drug. This would have necessitated the exclusion of most dipyrone-exposed cases and controls, as they were also exposed to many other drugs. Further, our purpose was to evaluate dipyrone as it is used in everyday life; for that purpose, an excess risk derived from a restricted comparison would have been uninformative.He argues that, in Budapest, dipyrone use was so common that an association was undetectable. This is not so: the association between smoking and lung cancer, for example, is demonstrable where smoking is common and where it