To the Editor: The study of the efficacy of cyclophosphamide in the treatment of multiple sclerosis (Jan. 27 issue)* has four major flaws. First of all, the assessment of the response to therapy was based on subjective impressions of the patients and investigators, who were aware of the type of treatment received. Both groups of observers would be expected to have a vested interest in the success of the experimental protocol, which would bias their reporting. This failure to use an accepted double-blind technique needs a better explanation. Even complete scalp alopecia could be masked, so that an unbiased observer.
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