SIR,-Many of your readers will have welcomed your decision
to allow the results of the ISIS trial (July 12, p 57) to be presented within
the context of a formal overview of all previously reported trials of early
beta-blockade in acute myocardial infarction. Other reports of trials published
by The Lancet1 would have been much strengthened had
they included data derived from such overviews.2
It is clear from a comment in your editorial accompanying the
ISIS paper that you feel ambivalent about your decision to allow the inclusion
of a "lengthy tailpiece". Your ambivalence probably reflects a
concern that such reviews could take up an unacceptable amount of space in the
journal. I can well understand that you might be reluctant to publish an
overview as detailed as that in the ISIS paper next time you print a report of
a trial of early beta-blockade in acute myocardial infarction. Even so I hope
that you would accept a less lengthy tailpiece, showing how the results of the
latest trial influenced the estimates of treatment effects derived from the
ISIS overview.
The updating of trial overviews as new information becomes
available may be a task for which electronic publishing has something to offer.
Next year the Oxford Database of Perinatal Trials3 will
be published by Oxford University Press in electronic form. Besides registers
of published4 and unpublished trials and trials in progress or
planned, the data base will include a library of trial overviews which will be
updated when new data become available.
Oxford Database of
Perinatal Trials,
National Perinatal Epidemiology Unit,
Radcliffe Infirmary,
Oxford OX2 6HE
IAIN CHALMERS
1. Leveno KJ, Klein YR, Guzick DS, Young DC, Hankins GDV, Williams ML.
Single-centre randomised trial of ritodrine hydrochloride for preterm labour. Lancet
1986; i:1293-96.
2. King JF, Keirse MJNC, Grant A, Chalmers I. Tocolysis-the case for and
against. In: Beard RM, Sharp F, eds. Preterm labour and its consequences.
Proceedings of the 13th Study Group of the RCOG. London: Royal
College of Obstetricians and Gynaecologists, 1985: 199-208.
3. Chalmers I, Hetherington J, Newdick. M, et al. The Oxford database of
perinatal trials: Developing a register of published reports of controlled. Controlled
Clin Trials (in press).
4. National Perinatal Epidemiology Unit. A classified bibliography of
controlled trials in perinatal medicine 1940-1984. Oxford: Oxford University
Press, 1986.