5 ms·

Perhaps the difference of our reading can be down to a difference in our interpretation of "average". It is unhelpful and imprecise allowing a variety of interp

by keanzu 7y ago

Perhaps the difference of our reading can be down to a difference in our interpretation of "average". It is unhelpful and imprecise allowing a variety of interpretations. I have interpreted it to be an average with a high variance - perhaps as much as 3 months. Thus some of the drugs decrease survival on average. It seems that maybe you are considering a smaller variance with all the drugs tightly clustered around the 2.1 month average where the central question becomes - what's the cutoff and who decides? As to who decides where the line should be drawn in the US it is the patient and in the UK it is the government (NHS). Ideally the patient should give informed consent for a treatment regime, that means realistic assessments of likely outcomes sans hype.

DanBC 7y ago
> As to who decides where the line should be drawn in the US it is the patient and in the UK it is the government (NHS). No, this is wrong. UK patients have the same access to private healthcare as Americans.
- keanzu 7y ago
  Terminally ill boy denied 'potentially life-saving' treatment by NHS 'would be given it in any US hospital' https://www.telegraph.co.uk/news/2017/04/03/terminally-boy-denied-potentially-life-saving-treatment-nhs/ https://www.telegraph.co.uk/news/2017/04/03/terminally-boy-d... The NHS decides what's necessary care and what's not, then they're supported by the courts. The illusion of "same access as the US" was shattered by Charlie Gard when reality collided with our ideals.
  - DanBC 7y ago
    In the UK: The doctors come up with a plan. The parents disagree. The doctors need to go to court to get a ruling. In the US: The doctors come up with a plan. The parents disagree. It is the parents who need to go to the courts to get a ruling. Charlie Gard's case has absolutely nothing to do with cost. In the UK children are humans and humans have rights, and those rights are protected by the courts. Parents do not get to own children as possessions. The courts will focus on the child's best interests, because of the Paramountcy Principle which flows from Article 3(3) of the EU Treaty and Article 24 of the Charter of Fundamental Rights of the European Union, which flows from the UNCRC article 3(1). Charlie Gard's case is about someone who cannot make a choice for themself, and the courts focussing on that person's best interests, not on the interests of that person's relatives. Charlie Gard had RRM2B MDS. This has fewer than 50 cases worldwide. There is no cure. There is no treatment. The discussion is whether to allow him to die with pain relief, or allow medical experimentation that has no hope of success but which will cause pain. Unsurprisingly the courts decided it was in his best interests to be allowed to die with pain relief. http://blogs.bmj.com/medical-ethics/2017/07/07/never-let-an-ill-child-go-to-waste/ http://blogs.bmj.com/medical-ethics/2017/07/07/never-let-an-... You may wish to read the judgments, because almost everything written by the US press was wrong. https://www.judiciary.uk/judgments/great-ormond-street-hospital-v-yates-and-gard/ https://www.judiciary.uk/judgments/great-ormond-street-hospi... https://www.judiciary.uk/judgments/great-ormond-street-hospital-v-yates-and-gard-24-july-2017/ https://www.judiciary.uk/judgments/great-ormond-street-hospi...
mft_ 7y ago
(Apologies for the delay in replying to you.) I was able to access the paper in question, and of the 71 trials included in their analysis, two trials reported a negative overall survival (OS) outcome (-0.3m and -0.6m) and one trial reported exactly 0m overall survival gain. There were also 23 trials (I think - quick eyeballing) where the overall survival gain wasn't available or reported. Everything else had a positive overall survival benefit reported. In most cases (2/3 cases with a negative or null survival benefit reported, and a majority of the cases where no survival benefit was reported) there was a positive improvement reported in progression-free survival (PFS). So with the exception of a single case (Premetrexed, approved in 2008 for 1L NSCLC with 0m PFS benefit and -0.3 OS benefit - maybe it was better tolerated than the comparator??) there's seems to be a positive benefit to be found somewhere, small as it may have been in some cases. And yes, it's essentially a data-set with a lot of clustering of OS benefit around a low single-digit number of months, with a few higher outliers. EDIT: FWIW, it would also be very uncommon (as borne out by the dataset) for FDA to approve a drug which didn't offer a clear statistically-significant improvement in (usually) OS or (more rarely) PFS.

by keanzu 7y ago

DanBC 7y ago

> As to who decides where the line should be drawn in the US it is the patient and in the UK it is the government (NHS). No, this is wrong. UK patients have the same access to private healthcare as Americans.

keanzu 7y ago
Terminally ill boy denied 'potentially life-saving' treatment by NHS 'would be given it in any US hospital' https://www.telegraph.co.uk/news/2017/04/03/terminally-boy-denied-potentially-life-saving-treatment-nhs/ https://www.telegraph.co.uk/news/2017/04/03/terminally-boy-d... The NHS decides what's necessary care and what's not, then they're supported by the courts. The illusion of "same access as the US" was shattered by Charlie Gard when reality collided with our ideals.
- DanBC 7y ago
  In the UK: The doctors come up with a plan. The parents disagree. The doctors need to go to court to get a ruling. In the US: The doctors come up with a plan. The parents disagree. It is the parents who need to go to the courts to get a ruling. Charlie Gard's case has absolutely nothing to do with cost. In the UK children are humans and humans have rights, and those rights are protected by the courts. Parents do not get to own children as possessions. The courts will focus on the child's best interests, because of the Paramountcy Principle which flows from Article 3(3) of the EU Treaty and Article 24 of the Charter of Fundamental Rights of the European Union, which flows from the UNCRC article 3(1). Charlie Gard's case is about someone who cannot make a choice for themself, and the courts focussing on that person's best interests, not on the interests of that person's relatives. Charlie Gard had RRM2B MDS. This has fewer than 50 cases worldwide. There is no cure. There is no treatment. The discussion is whether to allow him to die with pain relief, or allow medical experimentation that has no hope of success but which will cause pain. Unsurprisingly the courts decided it was in his best interests to be allowed to die with pain relief. http://blogs.bmj.com/medical-ethics/2017/07/07/never-let-an-ill-child-go-to-waste/ http://blogs.bmj.com/medical-ethics/2017/07/07/never-let-an-... You may wish to read the judgments, because almost everything written by the US press was wrong. https://www.judiciary.uk/judgments/great-ormond-street-hospital-v-yates-and-gard/ https://www.judiciary.uk/judgments/great-ormond-street-hospi... https://www.judiciary.uk/judgments/great-ormond-street-hospital-v-yates-and-gard-24-july-2017/ https://www.judiciary.uk/judgments/great-ormond-street-hospi...

mft_ 7y ago

(Apologies for the delay in replying to you.) I was able to access the paper in question, and of the 71 trials included in their analysis, two trials reported a negative overall survival (OS) outcome (-0.3m and -0.6m) and one trial reported exactly 0m overall survival gain. There were also 23 trials (I think - quick eyeballing) where the overall survival gain wasn't available or reported. Everything else had a positive overall survival benefit reported. In most cases (2/3 cases with a negative or null survival benefit reported, and a majority of the cases where no survival benefit was reported) there was a positive improvement reported in progression-free survival (PFS). So with the exception of a single case (Premetrexed, approved in 2008 for 1L NSCLC with 0m PFS benefit and -0.3 OS benefit - maybe it was better tolerated than the comparator??) there's seems to be a positive benefit to be found somewhere, small as it may have been in some cases. And yes, it's essentially a data-set with a lot of clustering of OS benefit around a low single-digit number of months, with a few higher outliers. EDIT: FWIW, it would also be very uncommon (as borne out by the dataset) for FDA to approve a drug which didn't offer a clear statistically-significant improvement in (usually) OS or (more rarely) PFS.