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May 16, 2011 at 8:09 pm #140325JaxKeymaster
This caught my eye today so I went to the website that attempts to explain how effective different types of medications actually are. It’s a little scary, a little enlightening, and more than a little disconcerting how little we know about health. I’m linking to the page that explains it. Then just look around. This knowledge may save you some trouble some day.
In my exploring I found another site which has more information. It’s not an easy read but it’s better than nothing to me.
http://www.cochrane.org/cochrane-reviewsMay 16, 2011 at 9:41 pm #159872jdmcowanParticipant
Very interesting. Thanks for sharing those, Jax.
I found the NNT page a little misleading, though. Statistically, it is an interesting and, I think, useful way to look at treatment outcomes. But it still leaves out large amounts of information about expense, other detriments, and treatment benefits. Let’s assume, for the moment, that StopAttack3 had no to few side effects or interactions and was very inexpensive. Even with a NNT=50, wouldn’t you rather take it just in case you were that 1 in 50 that could be saved by it. Now, let’s add some drug interactions that your physician and pharmacist make sure aren’t a concern for you. And lets add some minor side effects like dizzyness and stomach upset. And lets jack the price up, but you have an insurance that’s going to cover 90% of it. Wouldn’t you still prefer to cover yourself in case you are that 1 in 50? At what cost point (in money and in possible detrimental effects) do you become willing to risk that you could be that 1 in 50? The NNT also leaves out information about just what the dangers are for not taking it. As in the example above, death is such a serious outcome that you’d need a pretty high NNT and some pretty serious costs before it is not worth doing. But what about changing cast time on a broken bone from 8 weeks to 7 weeks? A NNT of 50 with a high expense and big side effects just to reduce healing time by 12%? Maybe not.
Like I said, I still think the NNT is valuable and worth using, but still just one small piece out of many that are needed to decide if a medication is appropriate for a particular patient.May 16, 2011 at 9:49 pm #159873JaxKeymaster
It would probably help a little if I posted the article that led me to these sites. lol http://medicalconsumers.org/2011/05/15/most-drugs-dont-work/Quote:For the Cochrane review entitled, “Using different statistical formats for presenting health information,” the authors identified the 35 best studies designed to evaluate how well people understood the different ways of expressing the same study results. This review came down in favor of absolute risk reduction rather than relative risk reductions (RRR), as described below:
“You read that a study found that an osteoporosis drug cuts the risk of having a hip fracture in the next three years by 50%. Specifically, 10% of the untreated people had a hip fracture at three years, compared with 5% of the people who took the osteoporosis drug every day for three years. Thus 5% (10% minus 5%) less people would suffer a hip fracture if they take the drug for 3 years. In other words, 20 patients need to take the osteoporosis drug over 3 years for an additional patient to avoid a hip fracture. ‘Cuts the risk of fracture by 50%’ represents a relative risk reduction. ‘Five per cent less would suffer a fracture’ represents an absolute risk reduction. ‘Twenty patients need to take the osteoporosis drug over 3 years for an additional patient to avoid a hip fracture’ represents a number needed to treat.”
To people without statistical training—and that includes most physicians—the “cuts your risk by 50%” RRR example appears more impressive. And too often this is the sole way drug study results are described in medical journals, as well as ads aimed at physicians and the general public. Rarely is it explained that the 50% simply represents the difference between the treated and the untreated.
Here’s a real world example: Your doctor says, “You have mild hypertension and should go on a blood pressure lowering drug for the rest of your life because it will cut your risk of stroke by 50%.” Sounds good, maybe even worth the risk of sexual dysfunction and depression—two common side effects of anti-hypertensives. But here’s the other side of the story: A person with mild hypertension has only an infinitessimal chance of having a stroke, so the drug will reduce that infinitessimal risk by 50%
The common usage of RRR comes from the biostatisticians and the methodologists whose job it is to determine whether studies are conducted rigorously and results reported accurately. The fact that the Cochrane Collaboration’s own biostatisticians and methodologists are concerned enough to have produced this new review signals some recognition that it’s time for a change. (Long overdue, given that the sole use of RRR serves the pharmaceutical industry’s interest.) The Cochrane Collaboration itself has produced too many drug reviews with results expressed solely as RRR. Here’s one improvement under consideration because it is better understood: 100 of 1,000 untreated people will have a hip fracture in the next three years; 50 of 1,000 people taking an osteoporosis drug will have a hip fracture in the next three years.June 1, 2011 at 10:32 am #160292Kol DrakeModerator
First week of my college statistics class was the instructor showing “how to lie with statistics'” — by manipulating samples, or changing graph increments (the TV talking heads LOVE this one… it can make a minor variation look like a stock market crash) and other means used to skew how data may be used.
In another post I speak of a presentation by Dean Radin, PhD speaking on verifiable test result for ‘psi’ experiments which had better ‘above average’ percentage results (sometimes as high as 2 to 5 times higher) then the low percentages deemed ‘acceptable’ for recommending aspirin ‘to prevent a second heart attack’… and the scientific community readily accepts the minimal percentages for aspirin results and yet, scoffs at the much higher percentages in the the psi testing results.
Here is a snippet from an article in Newsweek – January 29, 2010 by Sharon Begley
The Depressing News About Antidepressants
Studies suggest that the popular drugs are no more effective than a placebo. In fact, they may be worse.
Although the year is young, it has already brought my first moral dilemma. In early January a friend mentioned that his New Year’s resolution was to beat his chronic depression once and for all. Over the years he had tried a medicine chest’s worth of antidepressants, but none had really helped in any enduring way, and when the side effects became so unpleasant that he stopped taking them, the withdrawal symptoms (cramps, dizziness, headaches) were torture. Did I know of any research that might help him decide whether a new antidepressant his doctor recommended might finally lift his chronic darkness at noon?
The moral dilemma was this: oh, yes, I knew of 20-plus years of research on antidepressants, from the old tricyclics to the newer selective serotonin reuptake inhibitors (SSRIs) that target serotonin (Zoloft, Paxil, and the granddaddy of them all, Prozac, as well as their generic descendants) to even newer ones that also target norepinephrine (Effexor, Wellbutrin). The research had shown that antidepressants help about three quarters of people with depression who take them, a consistent finding that serves as the basis for the oft-repeated mantra “There is no question that the safety and efficacy of antidepressants rest on solid scientific evidence,” as psychiatry professor Richard Friedman of Weill Cornell Medical College recently wrote in The New York Times. But ever since a seminal study in 1998, whose findings were reinforced by landmark research in The Journal of the American Medical Association last month, that evidence has come with a big asterisk. Yes, the drugs are effective, in that they lift depression in most patients. But that benefit is hardly more than what patients get when they, unknowingly and as part of a study, take a dummy pill—a placebo. As more and more scientists who study depression and the drugs that treat it are concluding, that suggests that antidepressants are basically expensive Tic Tacs.
So, as time goes by, we have to wonder — how much is it the medicine ‘helping’ as much as the ‘idea’ of the medicine being the catlyst for our mind/body to do the healing? Plenty of other examples where placebo did as well or better then the medicine being tested. Just read of one instance where folks were given morphine — a MAJOR pain killer — or a placebo. Many who were given the placebo but were told it was morphine showed all the pain reduction as those given morphine itself. And those given morphine but told it was ‘just a placebo’ still had pain…. so, the mind can be a pretty powerful thing to deal with.
Not counting those tests that showed doctors can also influence how much or little a medicine can ‘work’ by how much or little THEY believe in it’s potential for healing. Crazy world.
Not to mention the variations in ‘normal’ human biochemistry and genetic dispositions toward how they act/react/metabolize food and medicines. It is all ‘similar’ but totally different for each person. Hence another ‘thing’ which can vary how much or little medicine can ‘help’ any given person.June 1, 2011 at 1:49 pm #160293JaxKeymaster
Yet there are times when a person doesn’t even know they are getting medication and they feel the affects. Medication cannot just be a placebo affect. However, there is a flip side to the placebo idea. If a person takes anti-depressants and hasn’t addressed the cause of the depression (or any other disease) then no medication may work because their body and spirit is trying to tell the mind that something is wrong and no bandaid will fix it. So it’s possible the drugs are doing what they’re supposed to do but the person is subconsciously blocking it.
There have been times when my wife subconsciously blocked her medication from going to where it needed to go. The reasons were complicated and not important, but in that case it wouldn’t matter if you gave her more, it just wasn’t going to the brain. I’m sure she’s not the only person on this planet who can do it. And often those that struggle with mental illness have greater non-physical abilities than the ‘normal’ person so it’s possible they are blocking somewhat as well and don’t know they are doing it.
And yes, then there’s all the human variation physically and our lack of options to see what’s actually happening when a person takes a drug. Right now it’s basically just check how much is in the blood, look for behavioral or physical change, and quantify it. It’s a rather crude system which can only improve over the years.
Because we’re basically blind when it comes to medicines we’re missing out on why things work and why they don’t and that’s the biggest piece of the puzzle in my opinion.June 2, 2011 at 11:27 am #160312SetanaokoParticipantJune 2, 2011 at 10:09 pm #160323Kol DrakeModerator
Setanaoko’s post also pointed to this more comprehensive article in Wired.
Gives examples, the history and points to the evidence that the placebo ‘effect’ is getting stronger. And then goes on to report on studies trying to figure it all out. Shape, color, and ‘excitement in presentment’ can all make a sugar pill work better then a pharma product — depending on the factors noted. (plus location and more)
Worth the read even for being a bit long.
Here is the last paragraph…Quote:Ironically, Big Pharma’s attempt to dominate the central nervous system has ended up revealing how powerful the brain really is. The placebo response doesn’t care if the catalyst for healing is a triumph of pharmacology, a compassionate therapist, or a syringe of salt water. All it requires is a reasonable expectation of getting better. That’s potent medicine.
The mind/body can do some amazing things!June 2, 2011 at 10:22 pm #160324JaxKeymaster
Perhaps what that’s really telling us is that most symptoms aren’t actually physical. Many medical intuitives teach that most symptoms and ailments are just a symptom of a spiritual issue. If a person believes they are taking medicine that is enough to address the issue for them. Clearly we don’t know enough about this. lol
What I’d like to see instead is a two part trial. First, figure out who responds to the medicine using the standard double blind thing. Then, take the group of people who didn’t respond to placebo and those who did respond to the medication and switch them (without telling them – assuming this is safe. I wouldn’t advocate taking a dying person off life saving medication). If the people who were helped by the medication cease to be helped by placebo you have a drug that does something (still needing to be checked for safety of course). If the placebo folks find benefit that’s another strong indicator of the drug doing something.
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