Clearing Away the Smoke and Mirrors: Response to Dr O’Reilly

Abstract

The arguments made by Dr O’Reilly are largely smoke and mirrors, with facts taken out of context to buttress his position. We are told that studies of CTOs have exceeded 4000 subjects, but Dr O’Reilly does not mention that only 416 subjects have completed RCTs. Dr O’Reilly also fails to men-tion that the benefits of CTOs largely disappear when people are compared with randomly or appropriately matched con-trol subjects. This finding includes preliminary results from Ontario comparing patients on ACT and CTOs with patients on ACT alone—results showing no additional benefit from CTOs (1). Regarding the assertion that CTOs improve com-pliance with follow-up, our initial argument also dealt with the fallacy of relying on outpatient contacts to evaluate CTOs. The NNT is useful in summarizing the effects of RCTs. Depending on how the NNT is calculated, it would take up to 100 CTOs to avoid a single admission and 500 to avoid an arrest, although these figures are lower, but still unacceptable, with intention-to-treat analyses (2).