How well does the evidence on pioglitazone back up researchers' claims for a reduction in macrovascular events?

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Abstract
Last month, members of the steering committee of the prospective pioglitazone clinical trial in macrovascular events (Proactive) presented the results at the European Association for the Study of Diabetes meeting in Athens.1 The audience, which overflowed from the meeting room, heard John Dormandy, chair of the steering committee, conclude that the trial had shown that pioglitazone, “Reduces the composite of all cause mortality, non-fatal myocardial infarction, and stroke.” He commented: “We have now shown for the first time that oral glucose lowering medication can prevent macrovascular events.” The audience seemed excited by these results and a consensus emerged that the results would change practice. The presentation was certainly positive and upbeat (as readers may judge for themselves from the webcast made available with the support of the study sponsors, Eli Lilly and Takeda1). Unfortunately, these conclusions are not based on robust standards for the interpretation of evidence from clinical trials.