Like this should be any surprise, but it probably will be.
The crucial health stat you’ve never heard of
Sifting through the underlying science reveals that the way in which scientists and drug companies describe the benefits of many medications—by framing the question in terms of “relative risks”—systematically inflates their value. The result is that patients frequently buy and consume medicines that do very little good. An alternative way of describing the benefits of medical therapy could help change that—if doctors and nurses would start using it.
Suppose that 100 people with high cholesterol levels took statins. Of them, 93 wouldn’t have had heart attacks anyway. Five people have heart attacks despite taking Pravachol. Only the remaining two out of the original 100 avoided a heart attack by taking the daily pills. In the end, 100 people needed to be treated to avoid two heart attacks during the study period—so, the number of people who must get the treatment for a single person to benefit is 50. This is known as the “number needed to treat.”
“A statin might help you, or it might not. Out of every 50 people who take them, one avoids getting a heart attack. On the other hand, that means 49 out of 50 people don’t get much benefit.”
But drug companies don’t want people thinking that way; whenever possible, they frame discussions of drugs in terms of relative risk reduction. That’s why the package insert for Pravachol highlights the 31 percent reduction.
Just as onerous is the info on “side effects” they leave up to the physician to dispense. There are a few medications for high blood pressure which induce a physiological dependence. If you stop taking the medication, your blood pressure gets worse than it was before you took it.
My father-in-law is one of those stuck in that endless loop. Through revisions in exercise and diet, he moved to a physical situation where his blood pressure arrived at the lower end of OK. So, he stopped taking the medication. His pressure shot up within a week or two to well above the range that predicated initial use.
He asked his doctor about it — checked up online — and discovered this wasn’t unusual. He has to take it the rest of his life — or die from not doing so. Atenolol.
The result is that patients frequently buy and consume medicines that do very little good.
Just sad! Take a look in the waiting room next time your at the doctors office. I bet half are people(from the drug company) waiting to talk to the doctor wanting them to prescribe their drugs. What a racket!
“A statin might help you, or it might not. Out of every 50 people who take them, one avoids getting a heart attack. On the other hand, that means 49 out of 50 people don’t get much benefit.”
Ok, tell us (beforehand) who those 49 are, and this will mean something. And then move on and tell us who needs car insurance, and who will not have any accidents, and therefore won’t. Etc etc.
That’s a great article, thanks.
#3, xrayspex… thank you for adding common sense to the argument.
As you put it, these types of drugs are like insurance (anticipates/mitigates a possible future event), than other kinds of drugs (antacids, etc), that treat immediate conditions.
That being said, we definitely need to come up with better ways of presenting medical statistics to the public.
Personally, I’ve always wondered whether EVERY death is considered preventable. For example, if a 105 year old smoker dies of lung cancer, does this go into the epidemiological statistics? Seriously, if anyone knows the answer, I’d be curious. TIA.
I do not believe in taking ANY medication because it might prevent a problem that might not even occur. I do believe it’s a personal choice if your own risk factors are high.
Disclosure time: I’ve had the heart attack. I have some of the risk factors. I am on meds now but I wasn’t taking any of them prior. So in my case, the meds are to prevent a re-occurence.
My doctor is one of those who follows the “use only the absolute minimum necessary” rule. And he’s upfront with me about real or pervceived benefits.
#1 moss – If your father-in-law stopped his atenolol ‘cold turkey’, I’m not surprised that he had that kind of reaction. I’m on metoprolol. My current dosage is 1/2 that from when I started it. The actual reduction took about a month to accomplish. As my doctor put it, the gradual reduction was to prevent a shock to the system.
Actually it is crap because there is no magic number for cholesterol or at what point cholesterol contributes to a heart attack and / or high blood pressure. There is a relationship, but the strength is unknown. Remember, out of the 100 person sample, five will die anyway from a heart attack.
Patients want a magic pill that will cure them. Physicians want to make it look like they are doing more for their patients then simply calling on the gods and shaking a rattlesnake tail to rid the evil spirits.
My father-in-law is one of those stuck in that endless loop. Through revisions in exercise and diet, he moved to a physical situation where his blood pressure arrived at the lower end of OK. So, he stopped taking the medication. His pressure shot up within a week or two to well above the range that predicated initial use.
(#1 – moss)
If your father-in-law stopped his atenolol ‘cold turkey’, I’m not surprised that he had that kind of reaction. I’m on metoprolol. My current dosage is 1/2 that from when I started it.
(#6 terry)
Time to give my story. Reached 50 and had Hi BP… took meds and also lost weight (did a LITTLE exercise, such as walking up to the local stores for small purchases instead of driving). Dr. dropped the meds to one QUARTER of the dosage after a few months, then a few months after that took me completely off.
At the same time, I went from mild diabetic to NON diabetic. I take no meds for either at this time.
J/P=?
How much weight did you lose, John P? I’m guessing that was a major cause of your diabetes going away.
The really creepy part is the commercials with some obviously successful boomer telling us all about the scary and disgusting side effects, along with the caution that just because we feel ok doesn’t mean we are and that we should buy and ingest the snake oil just in case the evil little platelets shown piling up in this real strange looking artery are killing us quietly.
Can we expand this beyond drugs. How many lives are saved by seat belt laws? .0001%? How about airline screening? Drug laws?