Question of the Week 36

by | May 16, 2023 | Journalism, Question of the Day, Question Of the Week

Last Week’s question: In the context of pharmaceutical drugs, what does “NNT” stand for?

  1. Non Normal Testing (procedure)
  2. Number Needed to Treat
  3. Normal Number Tested
  4. “N” Number Trials
  5. Normal Number Treated

The answer is “B”: NNT stands for Number Needed to Treat to achieve the intended (or advertised) outcome. With a little on-line searching, you can find the NNT for most drugs that are prescribed to treat a condition or prevent an adverse event. The next time you are considering taking a drug, I suggest you do some research. For example, the use of penicillin to treat conjunctivitis has an NNT of 12. That means that for 11 out of twelve people the conjunctivitis will likely go away without penicillin therapy. Personally, I think I would take the penicillin and put-up with the side effects. On the other hand, the NNT for Trulicity is much higher, as high as 327 according to one source! That means 327 people would need to take Trulicity for three years to prevent one heart attack. I would skip that drug and spend my money on beer. I think the biggest scam people are buying into could be blood pressure meds. Below is a short read that might change your mind about taking these pills too. The last paragraph is should be the prime take away for all drug therapies: It is up to YOU to ask your doctor the right questions and then it is up to YOU to decide what is best for YOU.

Antihypertensives for cardiovascular disease (this comes from a medical journal whose audience is medical professionals)

As we know, blood pressure medications help prevent stroke and heart attack. In people receiving antihypertensive therapy for 5 years, the NNT to prevent 1 death is 125. Additionally, the NNT to prevent heart attack is 100, and to prevent stroke, 67.

But what about people with mild hypertension (systolic blood pressure of 140-159 or diastolic blood pressure of 90-99) without preexisting cardiovascular disease? Do blood pressure medicines prevent cardiovascular events in these patients?

The answer is no. After up to 5 years of follow up, people with mild hypertension taking blood pressure medicine experienced no differences in mortality, cardiovascular events, coronary artery disease, or stroke, according to the authors of a review on TheNNT. That is, there is no NNT—or, rather, the NNT is infinite.

Not incidentally, 1 in 12 patients experienced side effects from the medication.

Ultimately, NNT is useful to consider, but it’s not gospel. Every patient’s treatment must be considered individually, with the understanding that any patient seen in your office may not react the same to a drug as members of a study sample. Furthermore, NNT changes with baseline risk. Finally, even a drug with a high NNT may prove useful if it has few adverse effects and is cheap. Likewise, a drug with a low NNT may be inadvisable if dangerous and expensive.

This Week’s Question:

Three years ago, when Maine was gripped by COVID hysteria, Gov. Mill issued her infamous mask mandate. During the week preceding her mask order, the Maine CDC reported 166 cases of COVID in Maine. Now politicians and media have declared that “the epidemic is over”. According to the Maine CDC, about how many Mainers per week are still testing positive for COVID?

  1. None, there is no more COVID. It is OVER!
  2. Only one or two per day so about 15 per week
  3. About the same as three years ago, about 160 per week
  4. About 250 per week
  5. About twice as many as when Gov Mills issued her mask order, over 300 per week
  6. Almost 400 per week

Randall Poulton


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