4 ms·

This study doesn't mention "number needed to treat" - if we give X people this medication we'd expect to prevent Y occurances of this condition. Sometimes X ca

by DanBC 7y ago

This study doesn't mention "number needed to treat" - if we give X people this medication we'd expect to prevent Y occurances of this condition. Sometimes X can be surprisingly high and Y worryingly low. It also doesn't mention the drug company funding provided to some patient campaign groups. It's pretty cynical: you know your medication is not effective enough for the cost, so you give money to dying people and their families to campign to get your med provided by single payer systems and insurance companies.

amelius 7y ago
Can you give this "number needed to treat" for some common medications?
- DanBC 7y ago
  Here's an article that mentions a few of them: http://www.pulsetoday.co.uk/clinical/clinical-specialties/prescribing/nnt-how-many-is-too-many/20033549.article http://www.pulsetoday.co.uk/clinical/clinical-specialties/pr... > For example, for every thousand low-risk patients prescribed statins for primary prevention, only a single stroke is prevented per year. Meanwhile, you would need to treat more than a thousand people with antihypertensive therapy per year to prevent one death. This is a far higher NNT than that of many interventions GPs are advised against prescribing due to lack of efficacy. https://www.bmj.com/content/348/bmj.g3458/rr/761453 https://www.bmj.com/content/348/bmj.g3458/rr/761453 > Enas bases his numbers on a 2013 Cochrane review. Enas reports that NNT equals 167 for low risk (less than 1%) and 67 for intermediate risk (1-2%) individuals. Enas reinterprets this as meaning 1000 low-risk people would need to be treated for five years to prevent six major adverse cardiovascular events. Enas notes the increased risk of type II diabetes from statin use and also estimates that 100 of the thousand people treated would have myopathy (that the same might occur with placebo is irrelevant as I will not be taking a placebo). Enas judged that the benefits of treatment in low risk subjects far outweigh any possible hazards and concluded that early and aggressive statin therapy offers the greatest potential for reducing the continuing epidemic of coronary artery disease among Indians.
  - khuey 7y ago
    The accepted NNT for antihypertensives is around 1 in 100 depending on the exact metric you use (http://www.thennt.com/nnt/anti-hypertensives-to-prevent-death-heart-attacks-and-strokes/ http://www.thennt.com/nnt/anti-hypertensives-to-prevent-deat...).
- deleted 7y ago
  [deleted]
javadocmd 7y ago
And don't forget the related metric: "number needed to harm". Physicians practicing good, Evidence-Based Medicine also weigh how many patients are likely to be impacted by harmful side effects. In an example from The NNT about PSA Screening for Prostate Cancer: http://www.thennt.com/nnt/psa-test-to-screen-for-prostate-cancer/ http://www.thennt.com/nnt/psa-test-to-screen-for-prostate-ca... No benefits were identified to PSA screening, while 1 in 5 will go on to have an unnecessary prostate biopsy (which can itself lead to complications, false-positive diagnosis, and further treatment with associated complications, and so on). (I feel obliged to mention that I'm not a doctor, btw, just sort of a casual fan of medical science and stats.)

by DanBC 7y ago

amelius 7y ago

Can you give this "number needed to treat" for some common medications?

DanBC 7y ago
Here's an article that mentions a few of them: http://www.pulsetoday.co.uk/clinical/clinical-specialties/prescribing/nnt-how-many-is-too-many/20033549.article http://www.pulsetoday.co.uk/clinical/clinical-specialties/pr... > For example, for every thousand low-risk patients prescribed statins for primary prevention, only a single stroke is prevented per year. Meanwhile, you would need to treat more than a thousand people with antihypertensive therapy per year to prevent one death. This is a far higher NNT than that of many interventions GPs are advised against prescribing due to lack of efficacy. https://www.bmj.com/content/348/bmj.g3458/rr/761453 https://www.bmj.com/content/348/bmj.g3458/rr/761453 > Enas bases his numbers on a 2013 Cochrane review. Enas reports that NNT equals 167 for low risk (less than 1%) and 67 for intermediate risk (1-2%) individuals. Enas reinterprets this as meaning 1000 low-risk people would need to be treated for five years to prevent six major adverse cardiovascular events. Enas notes the increased risk of type II diabetes from statin use and also estimates that 100 of the thousand people treated would have myopathy (that the same might occur with placebo is irrelevant as I will not be taking a placebo). Enas judged that the benefits of treatment in low risk subjects far outweigh any possible hazards and concluded that early and aggressive statin therapy offers the greatest potential for reducing the continuing epidemic of coronary artery disease among Indians.
- khuey 7y ago
  The accepted NNT for antihypertensives is around 1 in 100 depending on the exact metric you use (http://www.thennt.com/nnt/anti-hypertensives-to-prevent-death-heart-attacks-and-strokes/ http://www.thennt.com/nnt/anti-hypertensives-to-prevent-deat...).
deleted 7y ago
[deleted]

javadocmd 7y ago

And don't forget the related metric: "number needed to harm". Physicians practicing good, Evidence-Based Medicine also weigh how many patients are likely to be impacted by harmful side effects. In an example from The NNT about PSA Screening for Prostate Cancer: http://www.thennt.com/nnt/psa-test-to-screen-for-prostate-cancer/ http://www.thennt.com/nnt/psa-test-to-screen-for-prostate-ca... No benefits were identified to PSA screening, while 1 in 5 will go on to have an unnecessary prostate biopsy (which can itself lead to complications, false-positive diagnosis, and further treatment with associated complications, and so on). (I feel obliged to mention that I'm not a doctor, btw, just sort of a casual fan of medical science and stats.)