How Do You Know if the Treatment Your Doctor Prescribes is Good for You?
According to an article published in the NY Times on February 2, 2015, far fewer people benefit from medical treatment than we're led to believe from our doctors, advertisements such as direct to consumer TV ads, ads in medical journals, and even in medical journal articles, and far more suffer from side effects than we imagine.
What the NY Times suggests is that Big Pharma should be required to present the benefits and side effects from medications in a more clear way so you can get the best treatment possible. One way to accomplish this is to present the number of people who need to be treated (NNT) to obtain the primary benefit from a drug as well as the number needed to cause harmful (NNH) side effects. It is not unusual for the NNT to be above 10 or even 100, and the NNH to be far lower. Many chemotherapies are good examples of this.
Another good example is the NNT for aspirin to prevent one heart attack over two years. Quite shockingly, this number is 2,000! This means that less than 0.1% will benefit! Is this what you thought? Aspirin's NNH is 3,333 when it comes only to considering major bleeds such as a stroke, hemorrhage in the eye and GI bleeds. This number does not include other dangers such as Reyes syndrome, anaphylactic shock, kidney damage, etc.
In the case of mammograms, according to the NY Times it takes 13 years of screening to prevent one death from breast cancer in 1,477 people! In addition, for every 333 women screened one person will have an unnecessary lumpectomy or mastectomy, and for every 390 screenings one will undergo an unnecessary course of radiation. This doesn’t include the fact that there will be one additional cancer caused by the radiation in this group!
In the case of treating an ear infection with an antibiotic, pediatricians now know that it will not prevent serious complications or reduce pain in the first 24 hours. However, one in twenty will have somewhat less pain from day 2-7, but one in fourteen will develop nausea, vomiting, diarrhea, or a rash. The NNT is 20 and the NNH is 14. Yet try to convince worried parents that an antibiotic is not a good idea!
It is time to for the FDA to create rules that require the pharmaceutical industry to present their data about the NNT and NNH honestly so we can make intelligent decisions in getting the treatment we need from our doctors.
