Correspondence
on Hispaniola; the collaboration to to minimise waste and inefficiencies
tackle neglected tropical diseases in the
Americas; the around-the-clock work
required for the prevention and control
of influenza, including preparing
countries for the next outbreaks; the
success of accelerated tobacco control
and the prevention of chronic diseases;
and collaboration to debunk the false
reports of a link between measles–
mumps–rubella vaccine and autism, to
name a few.
It is my view that CDC has been a
model partner, and its leadership has
been visionary in the use and develop-
ment of the best available science and
experience to save more lives more
quickly globally. What more can one
ask for? Hopefully the appropriate
mechanisms for investigating allega-
tions and protecting whistleblowers
will help the CDC to come out stronger.
We all need our gold standard col-
laborating partner for the improve-
ment of global health. We hope that,
in the future, The Lancet will cover
such issues more fairly.
PAHO receives technical and financial support
from the CDC.
Mirta Roses Periago
rosesper@paho.org
Pan American Health Organization, WHO Regional
Office for the Americas, Washington, DC 20037, USA
1 Horton R. Offline: Is CDC a science-based
organisation? Lancet 2012; 379: 788.
There were two major reasons
why I found the publication of
Richard Horton’s Offline piece1 on the
US Centers for Disease Control and
Prevention (CDC) concerning.
First, the piece contains serious
allegations but is lacking compelling
data or supporting details. The Lancet
is respected for publishing first-rate
science and research, which makes the
omissions more striking. Of the many
partners working on behalf of the Center
for Global Health (CGH) at the CDC, how
many of them are doing “a less than
desirable job?” Is a significant portion
of the total budget of CGH consumed
by “wasteful” spending? If so, I hope
that Horton’s comments spurn the CGH
1586
myocardial infarction and stroke in
as much as reasonably possible.
Second, the anonymity provided to
the employees who were quoted raises
important questions. How familiar
are they with the inner workings of
the CGH? Are they qualified to assess
the work done? Do they have any
significant conflicts of interests?
Given these two major caveats, I
am not sure what your typical reader
or I can reasonably conclude from
Horton’s comments.
I have friends, including my girlfriend, who are
employed by the CDC.
Marek Ma
marek_ma@yahoo.com
125 South 31st Street, Suite 1200, Philadelphia, PA
19104, USA
1 Horton R. Offline: Is CDC a science-based
organisation? Lancet 2012; 379: 788.
Does aspirin really
reduce the risk of colon
cancer?
I was surprised to read the conclusions
of the CAPP2 Investigators (Dec 17,
p 2081)1 and the accompanying Com-
ment.2 The study is neutral on its
primary outcome and therefore any
conclusions drawn should be guarded.
Moreover, the previously published
primary analysis3 had appropriately
been interpreted as showing no
benefit with aspirin. Repeated analyses
increase the chances of a false-positive
result. The distribution of events also
seems distinctly odd, with an apparent
gross excess of tumours only in the
11th and final year, by contrast with
possible benefit confined to the first
18 months in the first report. A further
few years’ follow-up are required to
determine whether these late effects
are just the play of chance.
In their earlier report,3 the CAPP2
Investigators report two strokes and
a myocardial infarction in patients
assigned to aspirin, compared with
none in patients on placebo. Baron
and colleagues4 also reported more
patients taking aspirin for colonic
polyps, which they also interpreted
as the play of chance. Many studies
of primary prevention5 suggest that
aspirin could do more overall harm
than good.
Clearly, these results are intriguing
and deserve further scrutiny and follow-
up. However, to base firm conclusions
on such weak data is dangerous
because it could raise false hopes
among patients and physicians and
mislead scientific research. To quote
Thomas Jefferson: “he is less remote
from the truth who believes nothing
than he who believes what is wrong.”
It is a great shame that misleading
conclusions have been shared with the
public without any word of caution.
I declare that I have no conflicts of interest.
John G F Cleland
j.g.cleland@hull.ac.uk
Department of Cardiology, Castle Hill Hospital,
University of Hull, Kingston-Upon-Hull HU16 5JQ, UK
1 Burn J, Gerdes AM, Macrae F, et al, on behalf of
the CAPP2 Investigators. Long-term effect of
aspirin on cancer risk in carriers of hereditary
colorectal cancer: an analysis from the CAPP2
randomised controlled trial. Lancet 2011;
378: 2081–87.
2 Chan AT, Lippman SM. Aspirin and colorectal
cancer prevention in Lynch syndrome. Lancet
2011; 378: 2051–52.
3 Burn J, Bishop DT, Mecklin JP, et al. Effect of
aspirin or resistant starch on colorectal
neoplasia in the Lynch syndrome. N Engl J Med
2008; 359: 2567–78.
4 Baron JA, Cole BF, Sandler RS, et al. A
randomized trial of aspirin to prevent colorectal
adenomas. N Engl J Med 2003; 348: 891–99.
5 Cleland JG. Aspirin in the primary prevention
of vascular disease. Lancet 2009; 374: 878.
The study by John Burn and
colleagues1 is unquestionably a superb
piece of work that opens the door to
formalised chemoprevention in young
carriers of Lynch syndrome. However,
setting aside the fact that the primary
intention-to-treat analysis was not
significant, there is a need to address
whether these data are applicable to
others at need of chemoprevention.
Specifically, the study included a
predominantly young population
with a mean age at recruitment in
the early 40s and a mean follow-up
www.thelancet.com Vol 379 April 28, 2012