Survival Value of Bypass Surgery

To the Editor.—  The otherwise well-documented report by Miller and Dodge ("Benefit of Coronary Artery Bypass Surgery," Archives 137:1439-1446, 1977), is marred by the unwarranted conclusion that this form of surgery has been shown to extend survival. For symptomatic left main coronary disease, appropriately designed studies have indeed shown this. However, the authors' conclusion that this is true for any other kind of coronary lesion is not supported by adequate studies. It is curious that they explicitly recognize the superiority of prospective randomized clinical trials, yet that spurious conclusion is based on their review of nonrandomized, nonprospective, noncontrolled trials. Retrospective matching simply will not do. It is an odd coincidence that this paper is juxtaposed with William Crosby's brilliant think-piece "Alvarez' Complaint," which deals with inexplicable practices in medicine (labeled less kindly as "decerebrate"). It is inexplicable how the distinguished authors can justify an important conclusion on the basis of