Testing treatments

Margaret McCartney

The issue of evidence on the Breastlight breast monitoring product for women has got me thinking about how much evidence one should have before an intervention is declared to work. In an ideal world, there would be continuous monitoring of all interventions so that very late or very rare complications would show up. In the real world that doesn’t often happen and we have to make do with initial studies and then voluntary reporting of problems thereafter.

So the quality of the evidence at the start would seem important. Here’s another Boots product: advanced electronic cold sore treatment which says it ”reduces the duration of the attack and speeds up the healing time”. It’s a good concept, and certaintly cold sores are common and often unpleasant. So does it work?

Margaret McCartney

When we are recommended an operation or healthcare intervention, it’s likely we’re going to want some information about it. Not just who will do it, where and when, but also the chances of whether it could damage, maim or even kill. All procedures – even straightforward ones – entail the risk of complication, so it’s important to be informed.

One way of doing this is to use “calculators” to predict these health risks. Some of these are available online, often targeted at assessing cardiovascular risk. By entering your age, smoking history, blood pressure, family history and diabetic status, a calculation is made projecting risk for cardiovascular disease over the following years.

Continue reading “Plus and minuses”

Margaret McCartney

Is it an unsightly freckle – or a deadly melanoma? To find out, many people now visit private or high-street clinics offering mole checks. Some people say they just want a quick consultation; others seem reluctant to “bother” their doctor. These services have proliferated recently, but how reliable are they?

Dermatology is one of the few medical specialities that still rely, to a great extent, on pattern recognition. Indeed, being able to make a diagnosis from a glance – the role of the consultant during a traditional dermatological assessment – is, I am told, what makes it so satisfying.

Continue reading “Of moles and men”

Margaret McCartney

Old age is often beset by a variety of illnesses and health risks, and we end up taking a large number of pills as a result. But even though the elderly are more likely to need multiple medications, we still do not know enough about the effect these medicines have, since older people are rarely included in trials. As Professor Peter Crome, former president of the British Geriatrics Society, says: “They [the elderly] are less likely than younger people to have clinical trial evidence on which to make decisions about the risk and benefits of drugs and other treatments.” This, he believes, is a form of age discrimination.

One study showed that even though almost 40 per cent of heart attack patients are over 75, only 9 per cent of people taking part in treatment trials for heart attack were in this age group. A new project is trying to correct this distortion. The scheme, PredictEU, is examining the reasons why older people are under-represented in trials across Europe. Using this information, it’s organisers have drawn up a charter for the rights of old people in clinical trials.

Continue reading “The trials of age”

By Rebecca Knight

Most of the time blogging for FT.com’s health section is a lot of fun. I get to write about cool breakthrough technologies and therapies that might change the way our bodies fight disease. I get to learn about the latest studies that could have a practical impact on nutrition, fitness and family health. And plus I get to read comments from readers all over the world about how they view health and wellbeing. It’s not a bad gig.
 
But every once in a while I come across a piece of science news that is rather depressing. That happened this week. 
 

Margaret McCartney

Those of us who prefer Cochrane reviews for our evidence, and who know that the majority of pharmaceutical companies do not publish all of their research, will not be surprised by this publication in the BMJ today: Neuraminidase inhibitors for preventing and treating influenza in healthy adults: systematic review and meta-analysis. The lead author is Dr Tom Jefferson, who we’ve interviewed for the blog. Here’s the conclusion, about the impact of neuraminidase inhibitors oseltamivir and zanamivir :

” Neuraminidase inhibitors have modest effectiveness against the symptoms of influenza in otherwise healthy adults. The drugs are effective postexposure against laboratory confirmed influenza, but this is a small component of influenza-like illness, so for this outcome neuraminidase inhibitors are not effective. Neuraminidase inhibitors might be regarded as optional for reducing the symptoms of seasonal influenza. Paucity of good data has undermined previous findings for oseltamivir’s prevention of complications from influenza. Independent randomised trials to resolve these uncertainties are needed.”

Margaret McCartney

In September this year, a young woman fell ill and died, hours after she was injected with Cervarix, the vaccine intended to prevent cervical cancer.

Several media reports questioned the safety of the vaccine and called for the schools vaccination programme to be scrapped. The batch of vaccine was quarantined until investigations could be completed, but after a postmortem concluded that the schoolgirl had died of a previously unknown tumour, the vaccination programme continued.

I am no great fan of Cervarix, but not for safety reasons. Rather, I am not convinced that doubts about its performance have been adequately addressed by research. The management of this unexpected fatality, however, was faultless. The possible link to the vaccine was instantly spotted and properly reacted to. Deaths in young schoolgirls are uncommon, so the potential danger was easier to identify, and in this case it was relatively easy to rule out.

The remainder of this article can be read here. Please post comments below.

Margaret McCartney

I’m always perversely pleased when research comes out saying that an intervention we previously thought of as useful turns out not to be.

The reason I’m pleased is that is shows that the necessary critical evaluation of what we are doing in healthcare is ongoing: it also means that genuine improvements in care can be made.

I’m not convinced that these kinds of studies get the attention they deserve in either the medical or non-medical press, so here’s a summary of two recent such studies that caught my eye.

Margaret McCartney

So, just because something is statistically significant, doesn’t mean it’s clinically significant

And just because it’s clinically significant, doesn’t mean you should be doing it.

And here is why. In this illuminating article from the New England Journal of Medicine - Lost in Transmission – FDA Drug Information That Never Reaches Clinicians - Lisa Schwartz and Steven Woloshin illustrate how the distillation of evidence that goes into the package inserts of drugs is not always clear or complete.

Margaret McCartney

Links to previous interviews by Margaret McCartney:
Professor David Colquhoun, professor of molecular pharmacology and campaigning blogger

Dr Tom Jefferson and pandemic flu vaccines 

Two things in particular made me want to talk to Richard Bandler, the American co-creator of “neuro-linguistic programming”. The first is that an email arrived from his PR agency in London, entitled “Richard Bandler: Shrinks are a waste of money”. It went on:

“His method is to teach the depressed, stressed or disillusioned to dispose of their poisonous memories, their fears and self-doubt, by exploring how we think, communicate and behave, changing negatives into positives by adopting more successful ways of using the mind. Richard, whose techniques have successfully helped millions of people, including billionaires, sports stars, celebrities and the mentally ill, says: ‘… They come to me in desperation – and often, I only need to see them a couple of times to re-program their thinking and give them a whole new outlook on life, success and happiness.’”

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This blog, part of the FT's health series, is a forum for readers interested in the science, policy, management, technology, business and delivery of healthcare.

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About our regular bloggers

Margaret McCartney is a Glasgow-based GP and FT Weekend columnist. She started writing for the Life and Arts section in 2005 and moved to the magazine in 2008. She also has her own blog: www.margaretmccartney.com/blog

Clive Cookson has been a science journalist for the whole of his working life. He joined the FT in 1987. Clive, the FT's science editor, picks out the research that everyone should know about. He also discusses key policy issues, from R&D funding to science education.

Andrew Jack is pharmaceuticals correspondent, covering the industry and public health issues. He has been a journalist with the FT for 19 years, based in London, Paris and Moscow

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