
Simple System Could Transform American Medicine - sundancekid
http://www.wired.com/2014/10/number-needed-to-treat/?mbid=social_fb
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phren0logy
I teach medical students and residents this method, and use it in my practice.
There are some important caveats that make it more complicated than it looks
at first glance. The primary one is that the NNT is tied to a very specific
outcome; for example: How many patients do I need to treat with a statin to
lower cholesterol? That's a lower number than the number I need to treat go
get the outcome I actually care about: How many patients do I need to treat
with a statin to prevent one heart attack or stroke? And even then, the answer
I actually get is: How many patients do I need to treat with a statin to
prevent a heart attack or stroke in a one year period?

So, I would respectfully submit that it's not so simple as the article makes
it sound, but it adds much-needed empiricism to prior standards for clinical
decision-making.

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danielbarla
I also wonder if the situation isn't further complicated when you consider
accuracy of diagnoses. A snippet from wikipedia: "It is estimated that between
10-15 percent of physician diagnoses are erroneous" [1], which is apparently
attributed to overconfidence.

This would probably have a larger effect in conjunction with treatments having
a higher NNH (number needed to harm).

In any case, I suspect that the push for (a more) evidence-based medical
science will only have positive effects, and thanks for your information!

[1] Berner, E.S., and M.L. Graber. "Overconfidence as a cause of diagnostic
error in medicine." American Journal of Medicine 121 (2008): S2-S23.

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jessaustin
Several close relatives of mine died in similar circumstances, so I especially
appreciated the humane treatment of the elderly stomach cancer patient.
Everyone in medicine should be looking for _anything_ that can reduce abuse
via "heroic measures".

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ics
> In this case, though, the general consensus “among people who care about
> this kind of stuff,” Newman says, is that the antibiotics are unnecessary
> for a simple abscess like this one, even in the age of nasty antibiotic-
> resistant staph infections. Just getting all the junk out and keeping the
> wound clean is usually enough. But Newman isn’t going to pick that fight
> today. He doesn’t want to get in the way of doctors’ plans for their
> patients. If he respects their decisions, they’ll be more likely to respect
> his, after all.

This is something everyone should learn from.

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yzzxy
This statistic seems like a useful tool for doctors and others prescribing
medicine.

However, I don't at all like the insinuations this article repeatedly makes
that doctors are keeping information away from patients that could save their
lives. Doctors go to med school for years so that they can make medical
decisions for the rest of us. It's almost insulting to do armchair
pharmacology and assume you know better than the doctor who's trained for
years. This is the same kind of thinking that brought us vaccine autism scares
and the chronic issue of people not finishing their antibiotic courses.

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Alex3917
> It's almost insulting to do armchair pharmacology and assume you know better
> than the doctor who's trained for years.

Yeah but doctors in the U.S. basically get fake medical training, which is
(partly) the point of this article.

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phren0logy
What are you talking about? Medical training is more rigorous than ever, and
requires constant testing, continuing education, and renewal of board
certification. All while competing groups have sought independent prescribing
privileges with none of these assurances.

~~~
Alex3917
> Medical training is more rigorous than ever, and requires constant testing,
> continuing education, and renewal of board certification.

\- Much of the med school curriculum isn't based on science at all. This
article gives several examples of that.

\- Of the part that is based on science, much of the science is completely
wrong for various reasons.

\- Medical education mostly consists of sponsored content that's paid for by
pharma companies rather than students/doctors, at least for continuing
education.

~~~
adventured
You're making extraordinary claims, with zero evidence to support what you're
claiming.

For example: "much of the med school curriculum isn't based on science at all"

Ok, now show me the proof to back up that statement so I can verify for myself
that you're not just opining.

"Of the part that is based on science, much of the science is completely wrong
for various reasons"

Ok, which parts, and prove that it's wrong. At least support your extreme
claims.

"Medical education mostly consists of sponsored content that's paid for by
pharma companies rather than students/doctors, at least for continuing
education."

More truly massive claims. "Mostly" typically implies majority. You've got a
lot of proving to do.

~~~
Alex3917
So basically it's not your job to read books and become well educated, it's my
job to do your homework for you. Good luck with that.

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tunesmith
The site appears down; TheNNT.com just returns a vanilla wordpress site.

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cwkoss
Yeah, i get barely-formatted content. Something is definitely going wrong

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adventured
I was pretty sad to see this on TheNNT.com at the moment:

"Welcome, Wired Readers! We're glad to have you but you've crashed our tiny,
bare bones website created by hand from a bunch of passionate physicians in
our spare time! Please bear with us while we get back up and running!"

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autokad
maybe other people have different experiences, but i find this article
complete BS.

first off, its nearly impossible to get prescribed antibiotics for something
like bronchitis. Only after 3 doctors visits and a raging fever and cough that
was going on for 3 weeks did they prescribe me antibiotics. of course by that
time I already had pneumonia.

more recently this may, i had a bad cough, fever, and raging sore throat. i
could tell from how my body felt that everything was emanating from a single
spot in the back of my throat, but of course when telling a doctor this they
look at you like you have a 3rd eye, and then send you home (telling you to
drink plenty of fluids and rest) after crawling there and paying a 50$ copay.
its inconceivable to them that we might actually understand our bodies, but i
digress. Even though I had puss nodules on the very spot (my left tonsil) I
felt everything was coming from, I was not prescribed antibiotics because the
strep test came back negative.

note, these are two severe cases where I was REALLY sick and not getting
better. not only did doctors not prescribe antibiotics for these, but for all
general colds and flues that i have ever had - I have never received that as a
prescription. they simply will not do it.

lucky for me, I had a plane jane penicillin script that was never taken.
within an hour of taking it, the sore throat abated as did the fever. by the
next morning, I was nearly better. maybe coincidence, but i seriously doubt
it.

they love to fear monger about over prescribing antibiotics, about creating
super bugs, etc. but the truth is, they do help. even with viruses, because
quite often these diseases wreck your immune system allowing many other things
to take hold. for instance, bacterial ear infections are quite common enough
with these types of infections and antibiotics totally prevents them - and the
good possibility of hearing loss.

however, evidenced based medicine is often set up to prove whatever agenda
they want to pass. a few people with reduced hearing is inconsequential to
their idea of a greater good. especially in the agenda to reduce people
receiving antibiotics - even when evidence has shown that the amount of
antibiotics farm animals are given probably over shadows any lack of
antibiotics given to sick humans trying to get better.

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saurik
It of course depends on the doctor. My experience is that if I go to the local
Sansum Urgent Care with the symptoms you describe (which I have done often) it
is impossible to not leave with a prescription for antibiotics, even if the
doctor and I both agree I probably have something that will get better on its
own and will not likely be helped by antibiotics :/.

A couple weeks ago, I walked into a tree and got a tiny scrape on my forehead,
and just wanted to know if there was anything special I should do to minimize
scarring: the doctor largely ignored my questions (giving me really useless
answers) and instead did a swab to check for staph and then wrote me a script
for an antibiotic that I should take if I saw any changes... and the stuff she
listed was stuff I'm certain many people would just panic and assume were
happening :/.

Hell: I'll up the ante here, and say that if I get this one guy when I go, a
doctor I like to call "Dr. Happy Pills", not only will he try to get me to
start taking antibiotics, he will also try to get me to start taking steroids
(whether oral prednisone or an inhalable version), and will refuse to let me
leave until he's found enough free samples of some random form of steroid in
the office to feel like he's "helped" me :/.

