Number Needed to Treat

nnt

How many people do you need to treat with this ___________ (medication, treatment, operation) to save one life?   The NNT or number needed to treat is something that I drilled into me since medical school.   It is a statistical equation that applies to real life.  Unfortunately, we are not given that information many times or it changes or it is distorted by third parties.  Well, the video I put up the other day mentioned this site thennt.com and I have to say it is impressive and it is NOT funded by drug companies.  Here is what they say:

We only use the highest quality, evidence-based studies (frequently, but not always Cochrane Reviews), and we accept no outside funding or advertisements.

I highly recommend you check it out.  For example, how about taking cholesterol medication without any prior history of heart disease?  Here is what they come up with:

In Summary, for those who took the statin for 5 years:

Benefits in Percentage

  • 98% saw no benefit
  • 0% were helped by being saved from death
  • 1.6% were helped by preventing a heart attack
  • 0.4% were helped by preventing a stroke

Benefits in NNT

  • None were helped (life saved)
  • 1 in 60 were helped (preventing heart attack)
  • 1 in 268 were helped (preventing stroke)

Harms in Percentage

  • 1.5% were harmed by developing diabetes**
  • 10% were harmed by muscle damage

Harms in NNT

  • 1 in 67 were harmed (develop diabetes*)
  • 1 in 10 were harmed (muscle damage)

So, the same amount of people who were helped were actually harmed.   It makes you rethink the way we use statins for someone especially someone who is young, healthy, eats well, not overweight and exercises but whose cholesterol is a little high.   Oh, wait, that’s right, we can’t think.  The quality indicators and bonuses by the gov’t/insurers called pay-for-performance demand we get our patients’ numbers in the right boxes.  In other words, we are motivated to use drugs.   The statin issue above once again proves why this concept is wrong.

Anyway, please check out the site and use it for yourself or if you are a doctor, for you patients.

 

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  2 comments for “Number Needed to Treat

  1. Madelyn Sieraski
    November 6, 2013 at 1:35 pm

    Guess I should stop my crestor.

  2. DrHockey
    November 6, 2013 at 9:39 am

    This seems to be an apropos time to mention that in residency I was taught the following definition:

    Harvard death: All the lab values are normal.

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