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One of the best-kept statistical secrets in medicine

time.com — Researchers can gather all the hard-nosed evidence they want about the effectiveness of a particular drug or treatment. But there's one figure doctors don't much talk about despite its importance. It's called number needed to treat, or NNT, a new measure developed in the past 20 years......

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  • anthonymaitz, on 04/17/2008, -7/+3This is absolutely retarded. One in 50 men are spared a heart attack? That's not a couple thousand that's closer to 3 million men. 3 million. This article is ***** stupid.
    • insomniac8400, on 04/17/2008, -0/+2I'd imagine their across the U.S. figure only includes those at risk for heart attacks. Otherwise they would be ignoring their own rant about more realistic data. Of course they don't tell us what that number is, so yes, this article is ***** stupid.
    • WilliamDavis, on 04/17/2008, -1/+2Are you telling me 1 week old baby boys are at risk of heart attack and should take stains? I think you must be a drug company rep.
    • justjoehere, on 04/17/2008, -1/+4One in 50 men who take, TAKE, the drug may have a heart-attack prevented. So the ability to prevent a heart attack depends upon the drug taking population as well. It's not stupid, it just takes some thought to understand.
  • PoopSalad, on 04/17/2008, -3/+14TMNT > NNT
  • robotto, on 04/17/2008, -2/+2This is really stupid. There is no secret about this, it's just a conversion of statistical data. Same data, only differently presented. lol
  • Steinr, on 04/17/2008, -4/+6Drug firms are in the business to SELL drugs and NOT to make people better! Its like specialist Doctors, every time you go to see one he will tell you that you ail from what he "cures".
    • ricksite, on 04/17/2008, -0/+4You are right. Maybe you should stop going to the doctor. I, on the other hand, will never learn so I will continue to see the doctor.
    • quiggibub, on 04/17/2008, -1/+4Wow! So when I go see my kidney doctor, I really don't have kidney failure? You mean I got a transplant that died and went on dialysis for nothing? What a dick!
  • ravenze, on 04/17/2008, -1/+3Good article, however, the same forces that keep this statistic from being published keep it from being presented at all. The doctor that prescribes the medicine, won't know the NNT if they're not told it anywhere. How could they?
    • 2ndEdition, on 04/17/2008, -0/+4more likely, doctors don't read the articles. esp since drug reps already market the drugs with free meals.
  • thoouth, on 04/17/2008, -2/+8Buried due to misleading nature.

    1. Public Health specialists DO focus on NNT - in the UK it supports them in deciding how much treatments are worth.
    2. The 1 in 50 argument does not tell you how effective the drug will be for *you* only what impact it will have on a population level. If the drug works for *you* its certainly worth a lot more. Unfortunately, in terms of heart attacks this is not exactly straight forward.
    3. (well, 2a) 30% reduction in risk is more informative for the individual than 1 attack prevented in every 50 people being treated. The first statement tells you that there is about a 30% chance that this drug will work for you (assuming you fall into the same demographic as those in whom the drug was tested). The second tells public health officials that for every 50 people taking the drug, there will be one less heart attack.
    • diggymow, on 04/17/2008, -0/+110 points for you.
    • murdockat, on 04/17/2008, -1/+0Thanks for saying that... now I don't have to!
    • iamollie, on 04/17/2008, -0/+0you obviously have a good grasp of the concept. Its nice to see people you arent part of the conspiracy that health professionals are keeping life changing secrets from the population
  • hollyminkowski, on 04/17/2008, -0/+1There are these guys called "detail men" and they are always hanging around medical offices.
    They are incorrigible glad-handers with sacks full of 'gifts' and sample medicines they are trying to give away. You have to see them in action to believe it. We must have 1000 trinkets around the house that were handed out by these guys.
  • subterfu9e, on 04/17/2008, -0/+2A NNT of 50 is pretty small when compared to other diseases and as thoouth said, it IS taken into account.
  • phexerian, on 04/17/2008, -0/+6This article is not stupid. It clearly explains one of the major problems in evidence based medicine but it does it in elementary terms. NNT is very important. Of course it might look stupid to someone who knows nothing about statistical evidence and how to run clean, ethical, and valid clinical trials.

    Take Crestor for example since they have caught lots of flak about this. In their clinical trial, they did not use NNT for heart attacks or myocardial infarctions etc... They used a surrogate endpoint which was cholesterol in mg/dl. They did not show how it reduced mortality in humans on statins. Yet Lipitor clinical trials did show that. Same with pravastatin. Yet detail men go out and market the drug as if its the best thing since sliced bread. When crestor was approached about their misleading marketing and trials, they said basically, "we may have used surrogate end points which aren't as strong, but we used X more people in our sample size which is HUGE!"

    Quite frankly, sample size is good and all, but if you can't say your drug saves lives and your competitor can, you are up the creek without a paddle.

    2nd edition - you are correct, very few doctors ever read these articles anymore. They are trained to look for this stuff. Usually they go by the guidelines which are written by groups of physicians who read the articles and tear them apart. We all generally practice evidence based medicine. Well, at least the younger generation does.

    thoouth - this is not misleading at all. Medicine does focus on NNT, but not all the drug companies do. Read my example above.

    The 1 in 50 statistic does not tell you how effective the drug will be for you. That is correct. However, neither does 30% risk reduction. That only applies if you meat the criteria of the study. I don't think someone who weights 140 lbs and has a HDL of 50 and an LDL of 100 has to worry about heart attacks from cholesterol, therefore, there 30% risk reduction is utter crap.

    And no, 30% RR is not more informative as I have just explained above. The NNT at least gives a clear picture of the sample size which is meant to be based off of the population as a whole. 30% risk reduction does not.

    Phex
    2nd Year PharmD Candidate
  • knulpm, on 04/17/2008, -0/+5Funny nobody mentioned the opposite of NNT, the number needed to harm. Basically, calculated the same way but it focuses on how many people who'd have to take the drug to suffer an adverse event or side effect. However, even that can be confusing.

    For example, take a blood thinner. You might have a lot more people who episodes of heavy bleeding vs. those who prevent a heart attack or a stroke. However, blood is replaceable, heart muscle and brain is not. So it might not tell the whole story.
  • racekarl, on 04/17/2008, -0/+1Isn't this just basic actuarial math? The insurance industry has been using metrics like this since forever
  • iamollie, on 04/17/2008, -0/+0buried since I'm a medical student and we have been taught about. It has little clinical importance, at least here in the UK anyway
  • siktath, on 04/17/2008, -1/+1Thanks Socialists. The extra costs and time that your FDA has put on the drug production process is causing people to die because they aren't economically significant enough to cover the costs. Well done! Thanks for ruining the country for us. You've done a wonderful job with the rest of the world.
    • phexerian, on 04/17/2008, -0/+0Would you rather drugs come out that are 1) harmful to humans 2) worthless and don't give any protection for the relative diseases they treat? but yet come out fast? Or would you rather have the time taken to show that the medicine is an actual good chemical that is beneficial.

      BTW, many people in the medical profession have commented that they would like to see the FDA compare new drugs to drugs currently on the market. Crap drugs that apply would be rejected. This would make the application process even longer, but the market would not be flooded with crap or even dangerous drugs.

      BTW, NNT is not required by the FDA to approve a drug for the market as I explained in my first post with Crestor. It does however, provide another interpretation of statistical data.

      Yes racekurl, this is pretty simple math. NNT = 1 / ARR.
      ARR = CER - EER.
      CER = events / subjects in the control group
      EER = events / subjects in the experimental group

      It is very basic statistics. What people are up in arms about is its clinical significance.

      iamollie, is it really insignificant in england? I know your medicine practice across the pond there is different from us, but last time I checked, I have read some studies from scotland and england that included NNT.

      knulpm, NNH can be confusing but it is basically the opposite of NNT. It basically states how many people need to be exposed to an event (drug) to harm one person that would not have been harmed any other way. It is the inverse of Attributable Risk. It is helpful in determining the benefit-to-risk ratio and is completely relative to the event which NNH or NNT is being applied. It is certainly taken different when using it in GERD patients compared to using it with heart attack patients.

      Before you people comment that this article is stupid, learn a little bit about basic statistics before making an ignorant comment. I certainly would not call an article on the event horizon of black holes stupid unless I actually knew a little bit about black holes and event horizons. It is not like this statistics stuff is complex. This is taught in some basic statistics classes in college and as well at graduate level in MBA and other professional programs.

      Phex
      2nd Year PharmD/MBA Candidate
      • siktath, on 04/17/2008, -0/+1That's awesome!

        Hey! Are people still dieing from bad drugs? Yes!
        FDA=ineffective.
        Hey! Are people dieing who wouldn't, actuarially speaking, be otherwise if they had access to drugs? Yes!
        FDA=harmful
        Hey! Are people having to pay much more, as a percentage of their income, to pay for medicine than they otherwise would because of all of the costs the FDA has put on drugs? Yes!
        FDA=costly
        Are there any benefits from the FDA? No! All drugs that have made it to the market would have had a higher chance to make it to the market without the FDA being in the way.
        FDA=bad
        • phexerian, on 04/18/2008, -0/+0FDA is ineffective in certain areas. When it comes to safety they are generally ok with it. When it comes to efficacy they are not, IMHO. They let drug companies take things too far.

          Yes people are dieing from not having access to drugs. I assume that is what you were trying to type in that sentence. It is not because of the FDA, it is because of high drug prices and no programs to get it out to poor people. It is because america is one of the few countries to put limits on drug pricing where as canada and france do, as well as others.

          Yes the FDA requires clinical trials. This costs the drug companies money. About 1 billion per clinical trial. Would you rather the drugs become created and not be safe and effective? Sounds like you want to go back to a time when anyone who puts something in a bottle can make a claim that it works and that it is safe. Think about the implications a little more. Besides, if you studied medicine, you would realize that a good chunk of the funding that goes to the FDA comes from drug companies, not taxes. Of course one could argue we pay for it in the end.
          Do you really think if we got rid of the FDA, the drug companies would lower costs of their medicines? Besides, how would we regulate drugs? You think of terms in black and white and not the gray area in between.

          I refer you to my previous comment above about learning a little bit about the subject before commenting on it.

          Phex
          2nd Year PharmD/MBA Candidate
    • siktath, on 04/17/2008, -0/+1Phex,

      Nice move, trying to hijack the data in the article. I love how you leftists do that. It's like religious people claiming nature as proof that their religion is true. You superstitious people are so funny!

      That guy
      The one who knows a whole of a lot more about economics than you will about anything and who will most likely be more like the one firing you than working beside you.
      • phexerian, on 04/18/2008, -0/+0How did I hijack the data? I was explaining what the data was and explaining its importance in the world of clinical trials. If you think I am hijacking it, then apparently 98% of the pharmacists, physicians, nurses, and medical PhDs must be too. Got some good reasoning to go with that ham buddy?

        I am a leftist? Pff.. Ignorance. I am not a liberal or a conservative. I am an independent. I swing towards the left or right depending on the issue. If anything, you should have guessed that I was conservative since most of my pharmacy profession leans that way.

        "It's like religious people claiming nature as proof that their religion is true. You superstitious people are so funny!" You are comparing evidence based medicine to religion? Last time I checked, one couldn't refute that X number of patients had a myocardial infarction in a study. I could say that many people have said the bible is bollocks. And the bible has no defining proof that its events actually happened. Unlike religion, there are witnesses to the events that lead to the outcomes of these events. Don't think so? Go ask the ER physician that watched a patient die in a clinical trial due to an experimental drug while he tried to save him. I don't think anyone witnessed jesus rise from the grave on the third day and then provide real proof that it happened. Where are all the people that watched it? Did they watch it and then all report it in the bible and just say that god wrote the bible? You are comparing apples to oranges. It actually almost sounds like you are claiming the medical community is nothing but a bunch of religious nut jobs whose dogma is based in synthetic chemical compounds and years of research in pathophysiology. But I digress with that statement. You are claiming that.

        The guy who knows more about economics than me is gonna be my boss and fire me? You did see the "2nd Year PharmD/MBA" at the end of the post right? What do you think an MBA entails? ::gasp:: money, economics, financing, etc...

        Besides your sentence doesn't make sense. I am honestly not sure what you are saying.

        "you will about anything" What the hell is will about me anything? Is "you will about anything" an action verb/phrase? Is it close to sodomy? ::Shivers:: (reminisces about that year in the pen). Does it involve transexual rodeo clowns on a leash with a big black boyfriend named bubba from boise buckville who bitches little boys in the bottom? ::spooge::

        Next time try to not sound like a complete ***** douche bag.

        Phex
        2nd Year PharmD / MBA Candidate
  • Pout, on 04/17/2008, -0/+0Its not about economic significance, its about the marketed health scare. 50 people have to needlessly take the drug. That is far far far more statistically accurate than the other figures given. 1 in 50 in billions is nothing.
    This article raises a very valid point.
  • LinkinParkSucks, on 04/17/2008, -0/+0this isn't a secret, i read a huge ***** article in consumer reports a month ago about this
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