The case of the missing data

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Capital Good analysis:

 

BMJ 2002;325:1490-1493 ( 21 December )

The case of the missing data

 

James Le Fanu<nretainer general practitioner. 

Mawbey Brough Health Centre, 39 Wilcox Close, London SW8 2UD

 

" Is there any point to which you would wish to draw my attention? "

 

 

 

" To the curious incident of the dog in the night time. "

 

 

 

" The dog did nothing in the night time. "

 

 

 

" That was the curious incident, " remarked Sherlock Holmes.

 

 

 

Sir Arthur Conan Doyle. Silver Blaze<A

HREF= " http://bmj.com/cgi/content/full/325/7378/1490#B1 " >1</A>

 

 

 

" The term `non-barking dog' refers to a species of anomalydetail that could

reasonably have been expected to appear in evidential text but which, for

whatever reason, is absent. "

 

 

 

Eric Shepherd. Non barking dogs and other odd species. Med Sci Law 1999<A

HREF= " http://bmj.com/cgi/content/full/325/7378/1490#B2 " >2</A>

 

 

(It is the morning of 26 February 2000. The famous detective Sherlock Holmes

has just been joined in the breakfast room of his flat at 221b Baker Street

by the ever reliable, if unimaginative, Dr Watson.)

Holmes: Why, Watson, you don't seem your usual cheerful self this morning.

Something preying on your mind? Out with it, man. I don't want my day ruined

by one of your black moods.

Watson: I am, as you so astutely observe, much vexed. You will know I have

been much persuaded by those distinguished members of my profession who claim

I would avoid the misfortunes of suddenly dropping dead from a heart attack

were I to adopt what they like to call a " healthy lifestyle. " <A

HREF= " http://bmj.com/cgi/content/full/325/7378/1490#B3 " >3</A> So now I start

the morning with a brisk walk round Regent's Park, have controlled my tobacco

addiction with those marvellous nicotine patches, and have given up the

pleasures of bacon and eggs for breakfast and of Mrs Beeton's powerful

puddings.

It must be said the value of such measures has not been confirmed by

clinical trials<A

HREF= " http://bmj.com/cgi/content/full/325/7378/1490#B4 " >4</A>indeed, there is

even a rumour that heart disease may be a

biological phenomenon caused by a newly identified strain of bacterium<A

HREF= " http://bmj.com/cgi/content/full/325/7378/1490#B5 " >5</A>but I

have always been impressed by how our American cousins have been rewarded for

their self denial by a precipitous decline in the number of coronary deaths.<A

HREF= " http://bmj.com/cgi/content/full/325/7378/1490#B6 " >6</A>

Or that at least is what I believed until I picked my copy of the Lancet this

morning. It reports the results of a massive WHO-Monica study of trends in

heart disease in 27 countriesa major enterprise indeed. These trends, it

turns out, " fit poorly " with the lifestyle risk factors.<A

HREF= " http://bmj.com/cgi/content/full/325/7378/1490#B7 " >7</A> So it's scarcely

surprising I am a trifle upset....

http://bmj.com/cgi/content/full/325/7378/1490