tag:blogger.com,1999:blog-4683970826895755480.post1210107926361595466..comments2024-03-28T16:35:26.665+00:00Comments on Bruce Charlton's Notions: Bruce Charltonhttp://www.blogger.com/profile/09615189090601688535noreply@blogger.comBlogger6125tag:blogger.com,1999:blog-4683970826895755480.post-80809270371124672432013-01-24T15:55:43.561+00:002013-01-24T15:55:43.561+00:00I should interject that NNT statistics are themsel...<i>I should interject that NNT statistics are themselves bogus [etc.]</i><br /><br />Well, I have no trouble believing this...<br /><br /><i>Also, in real life good medical practice, a drug is tried out and if it doesn't work it is stopped, and pretty quickly.</i><br /><br />But not for primary prevention!Samson J.http://samsonsjawbone.wordpress.comnoreply@blogger.comtag:blogger.com,1999:blog-4683970826895755480.post-22934234319991309632013-01-24T14:23:36.720+00:002013-01-24T14:23:36.720+00:00@SJ - I should interject that NNT statistics are t...@SJ - I should interject that NNT statistics are themselves bogus, because they are derived from randomized trials which are almost always misleading/ useless as a guide to clinical practice. <br /><br />http://www.biomedcentral.com/content/pdf/cvm-2-1-002.pdf<br /><br />Also, in real life good medical practice, a drug is tried out and if it doesn't work it is stopped, and pretty quickly.<br /><br />Trials design ignores this good practice, indeed discourages it (because of analysis being based on the random allocation and 'intention to treat'). <br /><br />For example, an antibiotic may be given for a treatment whose exact diagnosis and sensitivity may not be established at the time the course begins. If the bug is sensitive to the drug, there will probably be a cure; but if either the diagnoses turns out to be wrong, or the bug is insensitive then it won't work, or the drug is swiftly stopped due to side effects then it won't work - yet trails average these in with the results of treating the correct disease with the correct drug. <br /><br />A drug may therefore be close to 100 percent effective (NNT = 1) when given to 'the right patient' - yet come out as only modestly effective (with a high NNT) when the matching of drug and treatment is suboptimal (and this matching may be very suboptimal in trials where triallists are striving to include the largest possible number of subjects, perhaps being paid per subject).Bruce Charltonhttps://www.blogger.com/profile/09615189090601688535noreply@blogger.comtag:blogger.com,1999:blog-4683970826895755480.post-28016841864439652112013-01-24T13:55:00.606+00:002013-01-24T13:55:00.606+00:00Very very few drugs are beneficial overall when us...<i>Very very few drugs are beneficial overall when used as primary prevention.</i><br /><br />Roffle. It's a horrifying day in medical school when you learn about "Number Needed to Treat", and realize that the NNT for most drugs is like 50.Samson J.http://samsonsjawbone.wordpress.comnoreply@blogger.comtag:blogger.com,1999:blog-4683970826895755480.post-69687235735920565072013-01-24T11:26:14.753+00:002013-01-24T11:26:14.753+00:00@D - Thanks. My usage is as treatment - not primar...@D - Thanks. My usage is as treatment - not primary prevention. Very very few drugs are beneficial overall when used as primary prevention. <br /><br />@MR - I've tried them. They don't help at all. <br /><br />Bruce Charltonhttps://www.blogger.com/profile/09615189090601688535noreply@blogger.comtag:blogger.com,1999:blog-4683970826895755480.post-30604263544832688702013-01-24T11:12:11.297+00:002013-01-24T11:12:11.297+00:00Krill oil or fish oil might help also, provided th...Krill oil or fish oil might help also, provided the side effects of blood thinning and immune dampening aren't a problem for you.Michael Rnoreply@blogger.comtag:blogger.com,1999:blog-4683970826895755480.post-49015741973294150362013-01-24T10:45:22.244+00:002013-01-24T10:45:22.244+00:00http://cardiobrief.org/2012/06/06/real-world-bleed...http://cardiobrief.org/2012/06/06/real-world-bleeding-risk-of-aspirin-in-primary-prevention-examined/#responddeariemenoreply@blogger.com