VOLUME 63, No. 2, FEBRUARY 2002

Editorial Comment

Poetry and Science

When asked to interpret their poetry, poets might say, “My meaning is not only different from yours, it is less important. You bring so much of your life to a poem; so many personal evocations. You filter it through your being. That’s what the poem really says. That’s the real interpretation.”

Science, however, is not like poetry. We analyze hard data, and, within pa- rameters, draw similar conclusions. In science, we have methodology, statisti- cal tests, and a historical background to help us reach a reasonable, justifiable understanding of the data.

The article in the Special Populations section of this issue of the journal seems to differ from this paradigm. Bendersky et al accomplished one of the most difficult objectives in a randomized, controlled trial-they found signifi- cant differences between 2 active medications-yet they did not trumpet their results and broadcast them to the world. These Argentinian investigators dem- onstrated differences between amlodipine and enalapril with regard to their ability to reduce seated and standing blood pressure. In their study, the percent change in seated and standing blood pressure with amlodipine was significantly higher than with enalapril at both 4 and 8 weeks after treatment initiation. This was a valid end-point measure because it accounted for baseline blood pres- sure. However, the authors chose to say in their conclusion that both amlo- dipine and enalapril can be used to treat isolated systolic hypertension in an elderly population, with a relatively low incidence of adverse events. Why did these investigators not focus on any of the several end points for which amlo- dipine was found to be significantly better than enalapril? Why did they not discuss the apparent superiority of amlodipine?

First, the percent change in systolic blood pressure was not the main end point of this study, although it could have been. Second, there were issues about the study design. An open-label study such as this trial can be criticized based on the possibility of manipulation of participants’ blood pressure rec- ords, adverse event reports, and even study entry criteria. Moreover, the trial was done in a small number of patients. During the study, 1 patient died (al- though not as a result of treatment), decreasing the sample size further and creating a slightly larger imbalance in the sizes of the 2 groups. The study was also short (8 weeks). In a longer study, the statistically significant differences between the drugs might have disappeared.

The authors realized that they had shown differences between active medi- cations, but seem to have understood the limitations of their study as well. They decided, for these and other reasons, to conclude that physicians could

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CURRENT THERAPEUTIC RESEARCH~

choose either medication, expect similar results, and help elderly patients choose between these medications based on adverse-event profiles.

Thus, in some ways, poets and their stanzas are not too different from in- vestigators and their patient populations. The work of each must be interpreted by the reader based on his or her life experiences, education, and personal input.

Michael Weintraub, MD Editor-in-Chief

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