Most of us trust, or at any rate hope, that the benefits of a drug our doctor prescribes will outweigh the side effects. Why else would we take it? We would probably be shocked to learn that most drugs don’t do anything good for the majority of the people who use them. That’s probably because we picture a simple cause-and-effect relationship, like antibiotics curing an infection.
“But most chronic diseases involve a complex chain of biochemical interactions,” says Dr. Jonathan St. George, assistant professor of emergency medicine at Weill Cornell Medical College. “The idea that you’re going to take one drug that affects one pathway and dramatically change the course of the illness is just pie in the sky.” The statistical measure that crystallizes this inconvenient truth is the NNT, or “number needed to treat” – that is, the number of people who have to take a drug in order for one person to benefit. There are plenty of popular drugs with NNTs over 50, and a drug with an NNT of five or fewer might fairly be considered a wonder drug – for instance, sumatriptan for migraines or steroids for kids with croup. “But if I told my patients that the drug I was prescribing them had only a 20 percent chance of working,” St. George says, “they’d look at me like I was crazy.”
The reason you’ve probably never heard of the NNT is that the pharmaceutical industry ignores it when marketing its wares to the public. According to Newman’s website, thennt.com, which crunches the best available research data to arrive at NNTs for common tests and therapies, statins have an NNT of 60 – meaning 60 people would have to take a statin drug for five years to prevent one person from having a nonfatal heart attack. Not one heart attack death would be prevented.
Picture a similar effect this way: a study in which a control group of 1,000 people taking no heart medication suffered 24 heart attacks over a five-year period, while the group on statins suffered 16. Because these numbers are small, even relatively minor differences between the incidence of heart attacks translate into an impressive-sounding difference, when you measure it as a percentage – the so-called relative risk. Now you’ve got the makings of a pharmaceutical ad campaign: “Statins reduce heart attacks by 33 percent.”
It gets worse. Stanford epidemiologist John Ioannidis got the medical world’s attention in 2005 with a journal article titled “Why Most Published Research Findings Are False.” In it he notes that 80 percent of published drug studies are funded by the drug industry, and that some 30 percent of all drug studies are never published, presumably mostly the negative results that never enter into the final cost-benefit reckoning.
Read the full article here.
It’s important to keep in mind that while we criticize and critique our health care system, we should not minimize the value of the persons who have dedicated themselves to the study of medicine. When we or one of our love ones are sick we are often beholden to the artful and skilled physician. However, as a patient or concerned loved-one asking good questions should always be encouraged.
The Men’s Health article Drugs, Effective for the Few, Prescribed to the Many is worthy of your review.
Contact Steven G. Cosby, MHSA with questions or to request more information and to schedule a healthcare plan evaluation, savings analysis or group plan solution for your company.
