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An other point made by Ralph Moss in his essay is concerning the potential under reporting of heart side effects when the population of patients using Herceptin is extended beyond the limits of the criteria for admission to the clinical trials.
The accepted women were relatively young & without cardiovascular problems.
This may not be the result of a devious design to show improved outcomes.If the women had been admited with debilitaing heart preconditions the observed side effects of Herceptin could have been "messed up" by confounding factors.
However,as the use of Herceptin is extended to either older or heart weakened women the rate of ocurrence of heart side effects is likely to rise.
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