Evidence and medicine do not always run together

I didn’t get an answer from the cardiologist about the NNT. Perhaps this was because imaging was ordered to investigate the aches and pains. It turned out the statin wasn’t the problem. The man’s pain was from multiple bony secondaries of a previously undiagnosed cancer. 

During my second recent flirtation with evidence-based medicine, I avoided the same mistake. I already knew this patient had cancer.  

She was worried because her oncologist wanted to start chemotherapy. I didn’t know the statistics to give adequate counsel on this, so I gave her a letter. In it, I asked the oncologist to discuss the NNT and NNH of chemotherapy with her.

Yesterday, I saw her again. She looked much more relaxed. She said the oncologist had decided against chemo.

Every prescription or procedure should be dictated by its NNT and NNH yet doctors mostly work without knowing them. Try asking for the NNT and NNH of your treatments, then sit back and observe the response!

In the future, doctors should be able to rattle off these figures for any treatment and be prepared for the reply, “Huh? There’s only one chance in fifty this will help me, there’s some chance it’ll harm me and on top of that, it’s expensive? Forget it, doc!”

Hopefully Yogi Berra was right. “The future ain't what it used to be.”