Panacea or Placebo?-Reply

In Reply.—  Two points need to be made about Dr River's comments. I have no doubt that a select number of seriously ill patients with peptic ulcer diathesis should be treated "prophylactically" during times of increased stress (such as chemotherapy), especially if such stress has, in the past, led to reactivation of the ulcer. These cases should be decided on an individual basis and with the knowledge that we do not yet know whether prevention of ulceration and/or its complications is efficacious with cimetidine. A second point is more important. There is very little evidence that corticosteroid therapy is in fact associated with peptic ulcer. In a thoughtful and thorough review of this subject,¹ no increased incidence of peptic ulcer was observed in double-blind randomized studies. The incidence of patients taking high-dose corticosteroids, including those with hematologic and oncologic diseases, was no higher (1%) than those not receiving steroids.