Lies, Damed Lies and Statistics

Tuesday, May 1, 2007

There should be a cookbook for medicine. How hard could it be? Strep throat equals penicillin, unless you’re allergic, then it’s doxycycline. Not if you’re 8 or younger because that drug stains maturing teeth. So it’s erythromycin, except that may cause significant nausea and vomiting.

Yesterday, I attended a lecture about the use of anti-coagulation in the treatment of heart attack. Usually, lectures are meant to inform and educate. Today, I’m just more confused.

Myocardial infarction, the fancy name for heart attack, occurs when one of the blood vessels to the heart gets clogged with a blood clot and part of the heart muscle, deprived of its blood supply, dies. Technology can reopen the blood vessel with a heart catheterization to find the blockage, an angioplasty to open the vessel and a stent to keep the vessel open.

Then are emergency treatments that occur while the patient gets to the cath lab. Everybody agrees about most of the drugs. Nitroglycerin dilates blood vessels, Beta blockers slow the heart and make it beat more efficiently, Aspirin makes platelets in the blood less sticky and less likely to clot. But what blood thinners? Controversy rages as the old standby, heparin, is being challenged by a variety of other drugs that offer potentially incremental benefit. So which one to choose? Lovenox, Angiomax and Fragmin are some of the latest entries into the market.

The lecture that tried to unmuddy the waters for me, did just the opposite. After an hour of PowerPoint graphs, studies and statistical analysis, I learned that if in specific situations if I used one drug over another, I could decrease mortality (a good thing) by up to 20%. But that may mean having only 4 deaths instead of 5 in a population of 50,000. So the statistics say the newer drugs are better, but the cost difference is huge as well.

Would we be better served if we spent the extra money on education and prevention? To answer question, we would need another study and more statistics. I leave you with this research result:

The premature deaths of smokers has economic benefits, according to a controversial report commissioned by a leading US cigarette manufacturer. The report, drawn up for tobacco giant Philip Morris Inc, found that the Czech Republic saved about $147m in 1997 through the deaths of smokers who would not live to use healthcare or housing for the eldery. Compiled as a cost-benefit analysis and delivered to the Czech Government, the study weighted the savings against the income tax lost and cost of caring for smokers before they died. In a statement, Philip Morris said it “deeply regrets” suggestions of the beneficial economic effects of smoking. The study “was part of an ongoing debate about the economics of cigarette excise tax policy in the Czech Republic,” said a company spokesman.
-BBC News July 17, 2001

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