Reform, Drugs, and the NNT

Reform, Drugs, and the NNT
The people and organizations who oppose health care reform are using powerful frames, or stories, to fight it. The stories involve fear and are open to debate. One story can be called "We'll stop using drugs and procedures to keep people alive." Fox News Channel employee Glenn Beck communicated that fearful prospect with great emotion on May 13, 2009, when he responded to a recording of Prof. Stuart Altman of Brandeis University. Prof. Altman was speaking at a Senate Finance Committee Hearing on Health Care Reform, and he mentioned that the current health care system often uses technology to prolong life for a very short time (sometimes as little as a few days) at a very high cost.

"Nazi Germany!" cried Mr. Beck, at the thought of a nonagenarian receiving palliative care instead of high-cost, high-tech treatment for a disease that would end his life very soon either way. "Eugenics!" cried Mr. Beck. Since the situation being discussed had nothing to do with preventing "undesirables" from reproducing (which is what eugenics means), I can only assume that he meant the very idea of considering cost-benefit ratio in regard to patient treatment was a step on the path to eugenics.

Maybe Mr. Beck does not know that medical professionals have been performing cost-benefit analysis for many years. Under health care reform, they would only do it with even more careful consideration of both words: "cost" and "benefit." Mr. Beck might also be unaware of the medical phrase "Number Needed to Treat," or NNT. This is a measure used to assess how many patients must be treated with a drug in order to prevent one instance of disease or death.

The NNT for the popular drug Lipitor is 100. This means that for every 100 people who take Lipitor for several years, there is one fewer heart attack than would be predicted otherwise. One hundred people pay for and take a drug that helps one of them. For more information about this, you (and Mr. Beck) can refer to the article by Martin Sipkoff in the June 2008 issue of Managed Care.

When some people learn about the Lipitor NNT, they opt not to take the drug. But many people, blindly following the advice of their doctor, who has Lipitor sticky note pads all over his office, do pay for and take it. Thanks to them, Pfizer, the drug company that produces Lipitor, made approximately $14 billion dollars in 2006, on Lipitor alone.

One of the things President Obama’s plan seeks to encourage is preventative measures. Drug company critic Dr. Jerome R. Hoffman is quoted in the January 17, 2008 issue of Business Week as saying, "The things that really work are lifestyle, exercise, diet, and weight reduction." He goes on to say that these activities have a high NNT, too. But, given the choice of putting millions of people on drugs in order to save thousands of lives or having millions of people lose weight, eat well, and exercise in order to save thousands of lives, I would choose the latter plan.

But it won’t happen without a fight. For every 100 drug company executives who are greedy, 100 make a profit. That’s an NNT of 1 -- the best possible outcome. Unfortunately, it doesn’t make anybody healthier.

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