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December 1991

Which Categories of Patients Are Known to Benefit From Aspirin?-Reply

Author Affiliations

Tucson, Ariz

Arch Intern Med. 1991;151(12):2490. doi:10.1001/archinte.1991.00400120115035

In Reply.—  I am disappointed that Hennekens did not receive the message that I attempted to convey in my article1 on aspirin and cardiovascular disease.I did not state, nor did I imply, nor do I believe that Craven's clinical observations in the 1950s2-4 constituted "conclusive evidence" of aspirin's benefit. "Conclusive evidence" of aspirin's effect in reducing the incidence of initial myocardial infarction awaited the publication of the physicians Health Study Research Group by Hennekens and coworkers in 1988.5I agree with Hennekens that the natural progression by which medical knowledge advances is from clinical observations (such as Craven's) to randomized placebo-controlled clinical trials (such as Hennekens').The point that I wished to convey was accurately received and discussed by Altman in his review of the article in The New York Times (July 9, 1991). The progression from Craven's astute clinical observations in 19502 to "conclusive