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Case-Control Study, Meta-analysis, and Bouillabaisse: Putting the Calcium Antagonist Scare into Context

Franz H. Messerli, MD
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Ochsner Clinic and Alton Ochsner Medical Foundation New Orleans, LA 70121 Requests for Reprints: Franz H. Messerli, MD, Ochsner Clinic, 1514 Jefferson Highway, New Orleans, LA 70121.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1995;123(11):888-889. doi:10.7326/0003-4819-123-11-199512010-00015
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The recent panic over the use of calcium antagonists in cardiovascular medicine stems from two sources: 1) a presentation of a case–control study at the 35th Annual Conference on Cardiovascular Disease, Epidemiology, and Prevention on 10 March 1995, in San Antonio, Texas, and 2) a meta-analysis purporting to show a dose-related increase in mortality in patients with coronary heart disease who receive treatment with nifedipine, which was presented to the scientific community all over the globe. Unfortunately, numerous inflammatory articles were printed by the lay press, creating much of anxiety among patients—some of whom stopped taking their medications. Physicians were inundated with phone calls and became frustrated by the lack of information. The Washington Post, after first scaring its readers with the headline “Drugs for Blood Pressure Linked to Heart Attacks: Researchers Fear 6 Million Are Imperiled” [1], later conceded that the news media were partially to blame for the inappropriate information: “What was missing—and what caused newspapers to overreact to the story and patients to panic—is what often gets lost when journalists on deadline translate science: context and implications” [2]. By now, both of the papers in question have been published [34], accompanied by critical editorials [58], and can therefore be judged in their proper context. Not surprisingly, the media coverage of these full publications has been less impressive because the newsworthiness and sensationalistic message has vanished.

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