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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
prompt 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.
1. In your comment to
Bloomberg.com, you state that “dog-meat is linked to a 20-fold
increase in the risk of cholera. We would like
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.
2. 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.”
3. 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.
4.
We are afraid that we have a different understanding the
Ingelfinger Rule from yours. 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;318: 1125-1126,
Kassirer and Angell, N Engl J Med 1994; 330:1608-9 on the
“Violations of the Embargo and a New Policy on Early
Publicity”). 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 had not been published in any
peer-reviewed 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 |
