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Charles H. Hennekens, MD, DrPH; I-Min Lee, MBBS, ScD; Nancy R. Cook, ScD; Patricia R. Hebert, PhD; Elizabeth W. Karlson, MD; Fran LaMotte; JoAnn E. Manson, MD, DrPH; Julie E. Buring, ScD
Harvard Medical School and Brigham and Women's Hospital Boston, Mass

JAMA. 1996;276(2):103.

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In Reply.

—Ms Karns and Ms Cullison erroneously suggest that we failed to consider an important point—the possibility of biased selection into the study of only the healthiest women. This is incorrect, because only about 10% of the approximately 400 000 participants in the Women's Health Study are also participating in the Women's Health Study randomized trial of aspirin and vitamin E and signed a consent to avoid taking aspirin or other platelet-active drugs for the duration of the trial. They correctly suggest that the observed 24% increase may be an underestimate, but fail to consider that an overestimate is also plausible.¹ Specifically, among women with breast implants, physicians may be more likely to diagnose and participants may be more likely to report connective-tissue diseases.

Dr Romano raises the issue of the importance of considering atypical connective-tissue diseases such as fibromyalgia, an issue that had not been hypothesized when the Mayo Clinic . . . [Full Text PDF of this Article]

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