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Garcia and Gilman make some very good points about the selection biases inherent in hospital and retrospective studies.I do not have enough knowledge about the primary data on this subject to hold a strong opinion. If Garcia and Gilman are right that the natural history of cysticercosis is much more benign than portrayed and if uncertainty remains about the efficacy of therapy, then a randomized, controlled clinical trial would, indeed, be preferable. One would want to make sure, however, that firm stopping rules were in place and that regular monitoring by a safety committee would assure that patients were not being harmed and that the study would not go beyond the point of reasonable certainty about a therapeutic effect.
Hachinski V. Medical Treatment of Cysticercosis: Ineffective vs Effective-Reply. Arch Neurol. 1995;52(10):941. doi:10.1001/archneur.1995.00540340017004
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