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Dr. Phan Xuan Trung
MEDIC Medical Center
254, Hoa Hao Street, District 10
Ho Chi Minh City
Webmaster, ykhoanet.com
Email:
phanxuantrung@gmail.com
April 29, 2008
Dr. Jean-Marc Olivé
Chief Representative of WHO in Vietnam
63 Tran Hung Dao
Ha Noi
Email:
who@vtn.wpro.who.int
Re: Enquiry of cholera outbreak data
Dear Dr. Olivé,
Thank you for
your letter dated April 28, 2008 in response to our enquiry. We
appreciate your response. However, we do feel that a number of
issues we raised in our letter have not been addressed. We
would like to take this opportunity to reiterate some of our
earlier concerns as follows.
In your comment
to Bloomberg.com, you state that dog-meat is linked to a 20-fold
increase in the risk of cholera. We want to know where was this
figure come from. We specifically would like to know how many
individuals were studied, what pathogens were tested in dog meat
(and other meats or vegetables), and what was the magnitude of
association (i.e., odds ratio and confidence interval) between
these potential risk factors and cholera.
Moreover, as we
understand from the popular media, 194 samples of shrimp sauce
have been tested for V. cholerae and all were negative
for the bacterirum. We are therefore curious to find out the
basis for the following statement: “Contaminated shrimp sauce
caused at least 157 cholera cases in November and December,
Vietnam's health ministry said last year.”
We are also
concerned that since your study was designed as a case-control
investigation, it is not possible to make any inference on the
cause-and-effect relationship between any of the risk factors
examined and cholera risk. However, the terms “cause” and
“link” have been reported in various media outlets, and this has
unfortunately generated considerable confusion in the public.
We are afraid
that we have a different understanding of the Ingelfinger Rule
from you. In simplest terms, this Rule states that no medical
research information is to be communicated to the public if it
has not been published in a peer-reviewed scientific journal
(see Relman, N Engl J Med 1988). Now, you have stated in
the international media about the “link” between dog meat and
cholera, and yet the study you mentioned in your letter has so
far not been published in any peer-reviewed scientific journal.
We thus consider that this clearly represents a breach of the
Ingelfinger Rule which is strictly followed by the scientific
and medical research community.
We consider that
the Vietnamese public is entitled to be informed of important
information of the current cholera outbreak. However, it is
equally important that the public is not misinformed as is
likely to occur in the absence of published comprehensive
evidence. We are sure you understand that in medical research
the real news is the scientific evidence, not the public claim.
Once again, we
thank you for taking time to answer our enquiry. However, we
are still looking for more specific information and/or data that
we do hope you can provide at your earliest convenience.
Yours sincerely,
Dr. Phan Xuan Trung
Dr. Nguyen Dinh Nguyen
Dr. Nguyen Van Tuan |
