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In reply

We agree entirely with Cotter that " . . . cause-and-effect relationships are difficult to prove using observational retrospective analyses . . . ." We state repeatedly in our commentary that the relationship between anemia and a variety of outcomes across disease states is an association. Such associations, however, raise important scientific and clinical questions that need to be answered by prospective studies. Until such studies are available, however, practitioners and patients are caught in a therapeutic dilemma, somewhat analogous to considering evidence in a legal proceeding. That is, are we serving our patients' best interests by waiting to adjust medical practice until proof beyond a reasonable doubt is available for a given intervention or is a preponderance of the evidence sufficient?

We disagree with Dr Jackson that perisurgical transfusion guidelines can only be revised (or even issued, as implied) if and when data are forthcoming from prospective . . . [Full Text of this Article]

Lawrence T. Goodnough, MD
St Louis, Mo

Robert W. DuBois, MD; Allen R. Nissenson, MD
Los Angeles, Calif

RELATED ARTICLE

Prospective Studies Are Required Prior to Revision of Perioperative Transfusion Guidelines
William L. Jackson, Jr
Arch Intern Med. 2003;163(19):2396.
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