Do no harm: Not even to some degree

摘要

We are grateful to Dr. Bianchi and colleagues for summarizing questions about our recent paper associating hypnotics with excess mortality and cancer.1 We are grateful to the Journal for this opportunity to provide organized answers to these questions. In the absence of adequate randomized trials extending for years, it is clinically important to assess the long-term risks and benefits of commonly prescribed hypnotics, using the best data now available and employing the most conservative analytic strategies possible. We have done that. Dr. Bianchi and colleagues asserted that we confused correlation with causality. We did not. We took pains to be clear that ours was an observational study and that some residual confounding was likely. Nonetheless, the robust associations of hypnotics with mortality and cancer that we found, increasing stepwise with increasing exposure, and virtually unchanged with multiple strategies for control, command attention and reassessment of common practice.