Understanding That Package Insert

    Package Insert

    Do you ever really pay attention to the 20 pages of small print that comes with your prescription medicine?

    What in the world does all this stuff mean?

    You obviously see what the drug companies want you to see when you get their advertisements.

    But as Donald W. Miller, Jr., MD points out, if you read the package insert you would realize the ad should really look like this:

    In other words, while the drug companies are not lying, they are certainly manipulating the statistics to sell their products.  But it’s up to you to figure out what you are spending your money on.

    It is easy to say, well “if it saves one person, it’s worth it.”  Well, what if 20 of 100 people who took the drug got horrible permanent side effects?  Is it still worth it?

    Or what if the drug was very expensive?

    The US government likes to push the Mediterranean Diet.  But they don’t tell you it is according to their numbers 61 people would need to do this strict diet for five years before one of these people saw a benefit.  The other 60 would get no benefit at all.

    You need to get to know the term Number Needed to Treat (NNT).  This number gets to an important realization, no matter what you do or don’t do:  Some will get better, some won’t, and some will die.

    And what is really difficult to determine is how the drug in question actually created the change.

    And then what are the side effects?  Nearly every drug has some side effect on people.  Some are horrible, some become fantastic.  Viagra was actually supposed to be a heart medicine.  The ED effect was actually a side effect that was positive to most of the men tested.

    These side effects are why doctors sometimes give you a drug for “off-label use.”  This means that a side effect of the drug is actually what you want, not what the drug was originally created for.

    Let’s look at the number needed to treat heart spasms in high-risk patients.

    Your risk of heart attack or stroke is very high if you suffer from nonvalvular atrial fibrillation (AF).

    The doctors wanted to know:  What’s better – aspirin or an anticoagulant medication?

    The results showed:

    • 95% of those studied did not have a heart attack. So, if you do nothing, odds are you will be fine.
    • 6% are going to have a stroke no matter what you do.
    • There were slightly fewer strokes in the anticoagulant group compared to the aspirin.

    But when you look at the NNT you realize that because so few people have a stroke, taking a potentially expensive medicine for a very unlikely event in which you get almost the same effect of taking an aspirin, do you want to spend the money?

    Unfortunately, very few doctors have the time to do this type of analysis on the myriad number of medicines that pharmaceutical reps are pushing.

    And unfortunately, many doctors are paid indirectly for pushing certain medicines.

    So, when your doctor recommends a certain medication, ask him/her “what’s the NNT on that medication?”  There is a very high likelihood that they will have to stop and look it up.

    Then you can have an actual conversation about if this medicine is worth the cost and potential side effects of a drug before you take it.