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To the Editor: In their meta-analysis, Dr Natanson and colleagues¹ described the hurdles they faced in accessing data from HBOC trials conducted by pharmaceutical companies. Although we agree that more transparency is needed to balance corporate and public interests, we consider it unacceptable to draw definite conclusions based on seemingly incomplete data.

Their review included trials of varying methodologies performed on heterogeneous patients in different settings with various controls. There may not have been statistical heterogeneity, but there was important clinical heterogeneity. For example, a core issue in HBOC trials is the comparator, and it seemed that blood and nonblood controls yielded similar results. However, although 2 large trials^2-3 had mixed blood and nonblood controls, their results were incorrectly pooled with those of the remaining 14 trials in the corresponding subgroup analysis. Some supposedly "nonblood" controls may have received blood and vice versa.

Also lacking is consideration of a possible . . . [Full Text of this Article]

Aryeh Shander, MD
aryeh.shander@ehmc.com

Mazyar Javidroozi, MD
Department of Anesthesiology and Critical Care Medicine
Englewood Hospital and Medical Center
Englewood, New Jersey

Gary Thompson, MD
Saint Luke's Health System
Kansas City, Missouri

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