In Medicine We Treat Many to Benefit a Few
In medicine we sometimes treat many to benefit a few. In that regard, medicine is practiced like laws are enacted.
We sure have a lot of laws in our society and none of us know what they all are. I have longed felt that for every new law that is passed another law should go out of “business” or sunset. Perhaps, we should have a net neutrality law for laws. There can be only so many laws being enforced at any one time.
Most laws, when you think about it, are enacted to deal with a very small segment of the population which may be engaged in an activity that most of us find wrong. The downside to that is that 100% (unless you are a politician) of us have to comply with law meant for perhaps 1% of the population. Complying with laws results in inconvenience, money, and time depending on the law. Thus, we are all affected by laws even though many of them really will never apply to most of us.
Medicine many times is practiced in the same way especially when it comes to prevention. We sometimes treat many to benefit a few, and there can be negative consequence to those treated, yet who do not benefit from a treatment.
The Number to Treat
We illustrated this in our previous article The Number to Treat: The Most Elusive Number where we discussed the “effectiveness” of the medication Lipitor in preventing heart attacks. The number to treat provides a most useful indication of how likely one will receive the intended benefit of taking a particular drug.
In Pfizer’s study that led to FDA approval of Lipitor for primary prevention, 100 patients (at risk for heart disease) had to take Lipitor to prevent just one heart attack over a 40 month period.
Keep in mind, these are high risk patients and only 1 out 100 benefited from Lipitor over 40 months. So 99 patients were treated “unnecessarily” and were more apt to get side effects plus subject themselves to frequent blood work to monitor the effects of Lipitor on cholesterol and monitor liver function which can be adversely affected by statin drugs like Lipitor.
Is that a fair trade off? What we really need is a better way to determine in advance who is most likely to benefit from a given treatment to narrow down the number to treat so so many are not treated unnecessarily.
Plus, in many cases we do not know fully the long term side effects of many medications including the new COVID vaccines. Pfizer’s COVID mRNA vaccine has a number to treat of 22,000 to prevent a COVID death, for instance, and the long term adverse effects of getting such a vaccine, likely repeatedly, will not be known for several years.
So many times in medicine we over treat the larger population to address or prevent a medical issue that affects a much smaller population. Not everyone gets heart attacks and not everyone will get COVID. The fact that both conditions can kill drives this tendency to treat the masses, yet only a small number will actually die from any condition.
Drugs are not benign and neither are other medical treatments. Several studies over the years show that if you get rid of all the doctors (link here and link here) life expectancy would not change. One reason for that is for every life we safe here with our treatments, we many times hasten the development of another medical condition due to complications from drugs and surgery over there. Plus, deaths due to medical error (drugs and treatment complications) is the number 3 leading cause of death. So we save one life here and “kill” another one there.
Good Health is About Lifestyle
What is the real point to this article?
Most of what happens to you health wise will be the result of the lifestyle decisions you make. It has been estimated that lifestyle accounts for 80% of your health and genetics the other 20% up to age 80. Beyond age 80 genetics becomes a more determining factor. Yet, many look for the quick fix and gravitate to use of medication and surgery when a sensible diet and exercise program prevents and treats many common medical problems.
Focus on diet and exercise to prevent the development of chronic disease. Reduce the odds of you needing a medication or any other medical treatment to achieve good health.