Send letter to journal:
Re: Post-Hoc does not Equal Ad-Hoc

Two surveys have been published almost simultaneously in the US (SPINE) and your journal on the consistency with which the high dose methylprednisolone protocols arising out of the NASCIS trials are followed by various professionals in the US and UK. Regrettably, although both surveys reveal that a majority of professionals use steroids, the articles take on a biased and ambiguous tone against the practice. This stance is based on an extremely superficial analysis of alleged flaws in the NASCIS trials. One of those flaws is the fact that a subgroup was identified, and a post- hoc analysis performed. Surely one can analyze real data obtained ethically and professionally so as to identify any trends and subgroups. It is ridiculous to contend that such data should be discarded. Therefore, the post-hoc accusation is not valid when we are talking about the one and only medical treatment available to minimize the devastating effects of this catastrophic injury.

Detractors fail to recognize other studies where steroid use is consistently found to be associated with better outcomes by minimizing secondary injury to the cord, for example by reducing cell apoptosis. The authors in SPINE go as far as to declare that even minimal improvements in neurological recovery can mean huge functional gains for the SCI patient, yet they conclude their paper by suggesting (albeit ambiguously)that physicians should not use steroids, or that they are using them based only on medicolegal concerns.