Pesticide self-poisoning: thinking outside the box

(5-year incidence of major vascular events 9%) infl ates the estimate of absolute benefi t from 1·5% (our estimate) to 2·5%. The CTT collaborators have primary prevention outcome data that can resolve the issues we raise. Subpopulations of particular interest include: men, women, men aged 70 years or older, women below the age of 70 years, people with diabetes mellitus, 20% of people with the lowest bodyweight, people taking more than fi ve drugs, and tertiles of cardiovascular risk at baseline. The following are the outcomes that would be most informative: total mortality, total SAEs, total incidence of cancer, and total cardiovascular events. This analysis would answer the key outstanding questions. First, do the data on primary prevention confi rm that there is no overall benefi t in adult women of any age and in men aged 70 years and older? And, second, is there signifi cant heterogeneity between the statin treatment eff ect in primary prevention subgroups compared with that in secondary prevention subgroups? If the answer to both these questions is yes, the assumption that the benefi ts for secondary prevention populations can be extrapolated to primary prevention populations is false and the cholesterol treatment guidelines based on this assumption should be revised. JMW declares no confl ict of interest. JA is an expert consultant to plaintiff s' attorneys on litigation involving the drug industry, including Pfi zer for its marketing of atorvastatin. 1 Third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood pressure in adults (adult treatment panel III) fi nal report: table II. 5 Cholesterol Treatment Trialists' (CTT) Collaborators. Effi cacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90 056 participants in 14 randomised trials of statins. Healthy lifestyle factors in the primary prevention of coronary heart disease among men: benefi ts among users and nonusers of lipid lowering and antihypertensive medications. Eff ectiveness and effi ciency of diff erent guidelines on statin treatment for preventing deaths from coronary heart disease: modelling study. Self-poisoning with pesticides is a major global public-health problem, with estimates of 300 000 deaths a year in the Asia-Pacifi c region alone. 1 WHO now estimates that pesticide ingestion is the most common method of suicide worldwide, and has responded by launching a global Pesticides and Health Initiative. Several approaches have been proposed to reduce the high morbidity and …