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To the Editor: We believe that the approach used in the meta-analysis of mortality in randomized trials of antioxidant supplements by Dr Bjelakovic and colleagues¹ erred in several important ways, probably resulting in biased conclusions.

First, the Linxian General Population Nutrition Intervention Trial (NIT)² was misclassified as a "trial with high risk of bias." This double-blind placebo-controlled trial of 29 584 persons contained all the attributes described by the authors as defining trials with low risk of bias: more than 60% of the target population was enrolled and computer-randomized, and participant characteristics were virtually identical across all supplement groups (no selection bias); all pill bottles were masked throughout the trial (adequate allocation concealment and blinding); all participants were visited monthly to assess adherence and ascertain end points (no performance or detection bias); and follow-up and endpoint ascertainment were essentially complete, with only 0.2% lost to follow-up (no attrition bias). Indeed, the . . . [Full Text of this Article]

Philip R. Taylor, MD, ScD
ptaylor@mail.nih.gov

Sanford Dawsey, MD
Division of Cancer Epidemiology and Genetics
National Cancer Institute
Bethesda, Maryland

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