To the Editor.—
Dr Lance Gould's editorial entitled "Coronary Reperfusion: Medical, Surgical, or Not at All" (1982;248:1362) is the kind of carefully written and well-expressed piece one would expect of its distinguished author. He raises serious questions about controlled clinical trials but cites no decisive objections. The absence of control groups almost always makes data tenuous. Moreover, despite the desirability of laboratory criteria in some cases, randomization should balance laboratory results that would emerge from sufficiently large patient groups. In this context, the author advocates "some physiologic measure of myocardial viability" but states later that there are "currently no adequate techniques that determine myocardial viability." The beauty of the controlled clinical trial is that it asks what the end point is, ie, what happens to the patient? If the standard (perhaps "gold" standard) is the fate of the patient, one need not get into the thicket of sometimes questionable laboratory
Spodick DH. Controlled Clinical Trials. JAMA. 1983;249(11):1434. doi:10.1001/jama.1983.03330350016007
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