Abstract
In Reply.— I would like to thank Dr Spodick for his comments concerning our article. However, the question he raised cannot be addressed because, as stated in the article, patients were asked to guess their treatment group assignment at the conclusion of the trial. Therefore, only survivors were questioned. With respect to Dr Morgan's editorial, some additional comments may be made. First, concerning the issue of unblinding and a possible placebo effect, no trial is completely blinded. The use of an unambiguous outcome (such as mortality) diminishes the chance of bias. Moreover, with respect to the β-Blocker Heart Attack Trial, there was no evidence of differential follow-up behavior between those patients who correctly guessed their treatment group assignment and those who did not. Second, the issue of noncompliance was recognized before the β-Blocker Heart Attack Trial began and the sample size was substantially increased (from 2,200 to 4,000) to account
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