Natural Health:

There are lies, more lies and statistics in the effectiveness of pharmaceutical drugs

The words in the title about statistics are well known, usually in a slightly different version, but I feel it is a little unfair on statistics. However it is true that most of us don’t know how to interpret statistics and even if someone does know it might take a few minutes to sit down and decode what the figures are actually saying about the effectiveness of drugs.

I have spent a good amount of time looking at research articles over the last couple of decades and have become interested in the question of when or whether one should take the drugs recommended by doctors. I have been asking people how effective they expect a drug to be that is prescribed by their doctor. Most of them expect the drug to be 90 – 100% effective, a few drop the figure to 80% or more and only one person has thought that it might be as low as 70%.

This is in stark contrast to the fact where there is often less than 5% effectiveness and drugs with a proven effectiveness of less than 0.4% are regularly prescribed to the tune of billions of dollars a year for the drug companies. Doctors often talk about patients being unrealistic in their expectations. But who is being unrealistic?

A good case in point is a paper I looked at about Herceptin, a much hyped drug for women with hormone positive breast cancer. It sounds absolutely great when the advertising says “the treatment group has only 62% of the risk of recurrence, metastasis or death.” It sounds at a quick reading that things are 62% better.

Well not quite… Not at all in fact.

• The 62% of the risk of recurrence or spread of the disease or death is…
• An improvement of 37% against what it would have been without treatment which means an improvement of 37% of 22% (deaths which could have happened) which is
• An absolute improvement of just over 8% for disease free survival
• But if we look at  overall survival it is only a 0.9% improvement – that is, out of 1000 patients only nine extra survive two years, or less than 1 in 100
• Or if it is averaged out over the life of everyone, an increase of just under 3 months of disease-free survival and four to five months of additional time till death.

Somehow one life saved out of 100 or an extra five months of survival doesn’t sound so great – nothing like the 62% in the advertising. And when you take into account the suffering due to side effects during treatment and the reduction of quality of life during that time you might like to think of much more fun ways to use up the last years of your life.

When a doctor wants you to take some drugs, especially when it is a life and death issue you don’t want to know the advertising figures, you want to know how much disease free survival time the studies show and how much overall survival time there is. And if the doctor waffles on about a few more months, work out whether months of suffering during chemo is worth the few more months that you might or might not get.

So, with all this in mind – is the problem one of statistics? Or is it that the marketers, the drug companies, are just doing the best they can for their shareholders by promoting their products in the best way they can.

One of the problems is that most doctors wear rose tinted spectacles when it comes to interpreting the figures. At best the doctors are intensely caring, want to do the best for their patients and are incredibly busy, too busy caring to delve into the vast swamp of biomedical literature. It is much easier to read the guidelines provided by the drug companies, or their medical associations which are sponsored by the drug companies.

You deserve better than that. You deserve to know the facts of actual effectiveness. As an example, the average survival time for women with breast cancer is 20 years. In Australia and elsewhere in the developed world between 78% and 85% of women survive 5 years (depending on where I get the figures). Chemotherapy only contributes 1.5% to survival at five years. That isn’t a typo. Only 1.5% of the 78% to 85% survival is due to chemo.