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Reply to R Granger

Professor of Preventive Medicine, University of Colorado Health Sciences Center, Department of Preventive Medicine, Campus Box C245, 4200 East 9th Avenue, Denver, CO 80262

Dear Sir:

I thank Granger for sharing his views on the importance of consistency. As the author of the statement on selenium (1) and as the Guest Scientific Editor of the supplement (2), I am happy to respond to both the scientific and the editorial criticism. Views are mixed about how to interpret the striking findings of lower cancer rates in the selenium trial by Clark et al (3). I agree with both Granger and Freudenheim (4) that no single study should have excessive influence on judgements of causation or policy, so I agree that skepticism is warranted. I do not, for instance, broadly recommend selenium supplementation, but I do advocate that new trials be conducted as a research priority to test what I regard as potentially the most important observation in cancer nutritional prevention in years (3). What I meant by having been "turned upside down" by the surprising selenium findings is precisely what is now happening: a surge of activity in human clinical selenium trials that otherwise would not have moved forward under the well-reasoned paradigm of standard nutritional science. I therefore believe that it is possible to remain a skeptic but still be somewhat "upside down." I disagree with Granger's call for editorial intervention to standardize the expression of views across papers. This very dialogue provoked by Granger's perception of inconsistency is, itself, a good example of why it would be imprudent to editorialize a consistency of opinion across papers in a set.

REFERENCES

1. Byers T. The role of epidemiology in developing nutritional recommendations: past, present, and future. Am J Clin Nutr 1999; 69(suppl):1304S–8S.[Abstract/Free Full Text]
2. Byers T, ed. The role of epidemiology in determining when evidence is sufficient to support nutritional recommendations: Proceedings of a workshop held in Washington, DC, on October 7–8, 1997. Am J Clin Nutr 1999;69(suppl):1297S–367S.
3. Clark L, Combs G, Turnbull B, et al. Effects of selenium supplementation for cancer prevention in patients with carcinoma of the skin. JAMA 1996;276:1957–63.[Abstract]
4. Freudenheim JL. Study design and hypothesis testing: issues in the evaluation of evidence from research in nutritional epidemiology. Am J Clin Nutr 1999;69(suppl):1315S–21S.[Abstract/Free Full Text]

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