Nace On Drugs

Question 1

Although there has been a shift towards including more female mice in early drug trials, there still may be a bias towards males in humans. Why?

Answer 1

• Although the female mice could account for hormonal effects, Human Women have much different practices when it comes to medicine than men.
  e. g. They take More prescriptions, and they go to the Doctor more

Question 2

Suppose you are given two treatments that show 100% increase in efficacy in new drugs over preexisting drugs. How do you decide which is better?

Answer 2

Look at the Number Needed to Treat (NNT) and the Number needed to Harm (NNH)

**The lower the NNT, the better

Question 3

What factors drive up the NNT?

Answer 3

A high number needed to treat may mean the drug is treating a condition where therapeutic intervention wasn’t that effective anyways

Question 4

T or F: NNT is only a relative measure.

Answer 4

False, it must be compared to some other drug, treatment, or non-treatment BUT it must also into account how effective that standard of care was in the first place

Question 5

What is the NNH?

Answer 5

Number Needed to Harm - tells you how many patients you can treat with the drug before you see an adverse event

Question 6

Taking the NNH/NNT as a ratio has been considered. How might this misrepresent data?

Answer 6

• It depends on what the harm was (if your curing cancer with the side effect of a headache then a low ratio wouldn’t be as bad as it first seems)

Question 7

T or F: you want the NNH to be less than the NNT

Answer 7

False, you want to NNH to be higher, this means you were able to treat more patients without seeing an adverse event.

Question 8

T or F: real world NNTs are often higher than those seen in studies.

Answer 8

True, in the real world people who aren’t fit for a medication they are receiving so it is even less effective than it was in the trial.

Question 9

Compare Surrogate Outcomes to patient outcomes that matter.

Answer 9

Surrogate Outcomes:
- Look at Factor that is a Risk Factor for a condition, but is not the actual condition itself

POEMS:
- How well did the medicine prevent the Adverse event that the risk factor may lead to

e.g. High cholesterol is a surrogate measure while MI is a PEOMS (you care about having the heart attack, not the amount of cholesterol in the blood)

Question 10

What should you take note of when looking at the comparison group for a drug?

Answer 10

Was it compared to a placebo or a shitty drug as opposed to the gold standard drug

Question 11

How should you as a physician determine whether a drug is fit for a patient?

Answer 11

• How well does the patient compare to the population that the drug was used on in the study

Question 12

What do you need to keep in the back of your mind when reading a very positive report about a drug?

Answer 12

Positive Outcome Reports way outnumber negative outcome reports because companies don’t benefit from downing their own product

Question 13

Pay attention to whether a disease is being treated or a risk factor is being treated

Answer 13

Pay attention to whether a disease is being treated or a risk factor is being treated

Question 14

What is the main problem with relative measures?

Answer 14

Two drugs may be 50% more effective the but the NNT for one is 1000 while the other is 10.

Question 15

What are the Pros and Cons of the NNT?

Answer 15

Pros:

• Good to use when talking to pts. about drug impact
• Combines Estimate of the relative benefit of a treatment to the background risk

Cons:

• Can only be used for one specific comparison it does NOT measure absolute clinical Benefit
• Depends on when the outcomes were counted
• Can ONLY be used for Binary outcomes (hospitalized or Not etc.)

Question 16

What factors must you still consider when looking at an NNT?

Answer 16

• Severity of Outcome
• Cost
• Ease of Application
• Side Effects

**if something is cheap and low risk then why not use it