

Personalized medicine: Time for one-person trials - michaelmachine
http://www.nature.com/news/personalized-medicine-time-for-one-person-trials-1.17411

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mlinksva
> Every day, millions of people are taking medications that will not help
> them. The top ten highest-grossing drugs in the United States help between 1
> in 25 and 1 in 4 of the people who take them (see 'Imprecision medicine').
> For some drugs, such as statins — routinely used to lower cholesterol — as
> few as 1 in 50 may benefit. There are even drugs that are harmful to certain
> ethnic groups because of the bias towards white Western participants in
> classical clinical trials.

Those are stunningly small proportions. What is the explanation? People try
out lots of drugs and stop taking those that seem not to be working?

The graphic in the article says the proportions are related to the
[https://en.wikipedia.org/wiki/Number_needed_to_treat](https://en.wikipedia.org/wiki/Number_needed_to_treat)
but I think I'll have to read that article several times to understand. :) Not
clear what reference in the article (the Nature one) provides the proportions
or NNT data, but the nearest footnote is paywalled anyway.

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mlinksva
Read again, the 'proportions' are literally 1 in NNT, I think. NNT is the
number needed to treat in order to make a positive difference for 1 patient,
vs control group with no treatment. NNT between two studies not directly
comparable if they are of different durations.

I'm still curious then how such high NNT drugs are blockbusters. Restating
what I wrote above, I guess it is worth trying many of these, even with
potential side effects, for a 1 in 4 chance the drug will help (seems entirely
plausible) to even a 1 in 50 chance (less so).

I suppose then that precision medicine could largely have people trying fewer
drugs, as for people similar to the patient, the NNT might be lower
(indicating a definite try) or higher -- but OTOH if people are taking a 1 in
50 chance now, what odds will actually make them bypass a drug?

