Wednesday, October 15, 2014

3 Questions to Always Ask Your Doctor (or Pharmacist)


Chances are, at some point in your life, you’ve seen the inside of a doctor’s office (or pharmacy) while seeking medical care for a health issue. We are human after all, living inside a human body, and our bodies eventually break down.

Even the most health-conscious individual will end up needing medical care at some point in their life. If this weren’t the case then we’d all live to infinity, without a worry in the world, living in perfect health. But that’s not how the world works. People get sick, accidents happen, and individuals find themselves in the waiting room of their doctor or hospital.

So now what? What do you do when a problem arises? How do you figure out what’s the best treatment option for you? Where do you turn for answers?


No matter whom you choose to seek medical care from (physician, PA, ARNP, naturopathic doctor, alternative medicine practitioner, chiropractor, pharmacist, dietitian, etc.) there are three questions you should always ask your healthcare professional. Doing so will put you in the best possible position to make an informed decision regarding your future health.

A lot is at stake here. You’re only given one life to live and one body to live it in, so it’s important to know what to ask and where to look when facing a disease or illness.

3 Questions to Always Ask Your Healthcare Professional


Question #1 – What is the Absolute Risk Reduction (or Numbers Needed to Treat) for This Particular Treatment Option?


To put this more simply: How well does this treatment work doc?

Your doctor or pharmacist or other healthcare provider is likely to offer you various options to address your medical problem. Maybe there’s a medication you can try, maybe there’s a procedure or surgery that can be performed, or maybe there’s a supplement or natural remedy to cure your ailing woes. Whatever it is, you need to know how well it works.

That’s where absolute risk reduction (or numbers needed to treat) comes in. Let’s take a closer look at this because it’s important.

Absolute Risk Reduction/Numbers Needed to Treat


When you listen to commercials on television or the radio it’s quite common to hear “Drug X reduces a person’s risk of a heart attack by 50%!” or “Drug Y reduces risk of stroke by 60%!” But does it really? What do these numbers actually mean? And how do they come up with them?

Here’s what’s happening in the above scenario:

Two hundred people enroll in a study to receive either Drug X or a placebo. They are split up into two groups, each containing one hundred people. After a set period of time (maybe six months), the group taking Drug X has a total of two patients who experienced a heart attack, while four patients in the placebo group experienced a heart attack.

Drug X – 2 out of 100 experience a heart attack over 6-month period
Placebo – 4 out of 100 experience a heart attack over 6-month period

So what is the reduction in risk of having a heart attack for Drug X? It’s 50% right? Two is half of four, so that equals 50%. It’s a 50% reduction. This is what pharmaceutical companies want you to hear, and it’s what they proclaim in their television ads. “Our drug reduces heart attacks by 50%!”

However, this is in terms of relative risk reduction, not absolute risk reduction. It’s important to understand this difference. What is absolute risk reduction then?

Absolute risk reduction measures the actual decrease in real-life heart attacks (or whatever outcome you’re testing for) over the period of time you’re testing for it. In the above study, the absolute risk reduction is 2% over the six-month period.

Four patients out of one hundred in the placebo group experienced a heart attack during the study. That’s 4% of patients in this group. Only two patients out of one hundred in the Drug X group experienced a heart attack during the study. That’s 2% of patients in this group.

Drug X – 2% (2 out of 100) experienced heart attacks
Placebo – 4% (4 out of 100) experienced heart attacks

Absolute risk reduction is the difference between these two values – 4% minus 2%. This equals 2%. The absolute risk reduction is 2%.

In other words, only 2% of actual patients who took Drug X (compared to doing nothing, which is the same as taking a placebo) benefited in real life by avoiding a heart attack.

What about numbers needed to treat? How does this fit into the picture?

Well, that’s easy. The numbers needed to treat is simply the number of patients needed to take a particular treatment (medication, supplement, procedure, surgery, etc.) in order to prevent one of the particular outcome being tested for (i.e. heart attack).

Using our example above, the number needed to treat for Drug X is 50. You need to treat 50 people with Drug X over a six-month period to prevent one heart attack. This is just another way of saying Drug X produces a 2% absolute risk reduction in heart attacks because 1÷50 = 0.02. If you multiply 0.02x100 you get 2%.

If you want more of an explanation of absolute risk reduction and numbers needed to treat then I encourage you to visit the following website - http://theNNT.com/thennt-explained. It was created by a group of medical doctors to help patients and healthcare providers understand this concept so they could accurately decipher and evaluate the scientific evidence behind various medical or nonmedical treatments.

It’s critical that you grasp the ideas behind these concepts. There’s a big difference when trying to make an informed decision on whether or not to go ahead with a treatment option if you’re told that it results in a 2% versus a 50% risk reduction.

Another important note, there is no way of predicting whether or not you’re going to be in the 2% of patients that benefits from taking Drug X in our example. Maybe you will, and Drug X saves your life. But maybe you won’t, and Drug X causes side effects, does nothing for you, and is a waste of money. There’s just no way of predicting either scenario.

Question #2 – What Are the Possible Risks (Side Effects) Associated With This Particular Treatment Option? What Are the Absolute Risks (or Numbers Needed to Treat) of Experiencing One of These Potential Side Effects?


As I just mentioned, you could experience side effects from taking Drug X. Possible harms and risks can happen with any potential treatment you choose to proceed with, whether it’s drugs, surgery, over-the-counter supplements, certain diets, alternative medical treatments, or what have you. This doesn’t mean you shouldn’t consider these options. It just means there are potential pros and cons to evaluate before picking your path.

It would be wise to know what these potential adverse effects are, don’t you think? Just like there is an absolute risk reduction of a particular treatment working or not working, there is also an absolute risk of a particular side effect happening or not happening.

In our example with Drug X, let’s say study investigators found that ten people experienced dizziness while taking Drug X while only seven people experienced dizziness while taking placebo. The absolute risk of experiencing dizziness is 3%.

Drug X – 10% (10 out of 100) experience dizziness while taking
Placebo – 7% (7 out of 100) experience dizziness while taking

Your overall chances of experiencing dizziness due to Drug X is the absolute risk of this side effect occurring. This equates to 10% minus 7%, which is 3%. You have a 3% absolute risk of experiencing dizziness while taking Drug X. Dizziness is not considered a major side effect. Maybe you don’t even care about this. However, it could be bothersome nonetheless.

Now, what if investigators found that Drug X led to an increase in absolute risk of 3% in suicidal thoughts or bleeding ulcers or even death? Would that be worth knowing? I hope so. I think it bears repeating that it’s important to know what you’re getting into.

Once again, there is no way to predict whether or not you’ll be in the 3% experiencing an adverse effect. This is just information you should use to make an informed decision on going forward.

Question #3 – What is the Worst Thing That Can Happen to Me if I Do Nothing?


Often times when a health issue arises we automatically think we must do something about it. Both patients and doctors (and pharmacists too) in our current culture and mindset are hardwired to reach for the pill bottle or rush to surgery or undergo fancy testing to remedy the situation.

Sometimes this is the right thing to do, like when you’re facing a life-threatening case of sepsis due to the superbug MRSA. Powerful intravenous antibiotics are a must to avoid death in this situation. But other times doing something may not be the best choice.

Did you ever hear of watchful waiting for slow growing prostate cancer? Many times men in this scenario will die of something else before they die of prostate cancer.

This particular cancer type is heavily influenced by diet and lifestyle. Dean Ornish, MD proved this when showing he could halt, and partially reverse, cases of slow growing prostate cancer in men after putting them on a whole foods, plant-based diet.1 There were no side effects from this diet by the way.

An alternative to this approach is surgery to remove the prostate gland. In conventional medicine we call this a radical prostatectomy. Yes, I did use the term radical, and it’s not because I came up with the term. It really is termed radical by Western medicine. Anyway, there is much debate as to whether or not this radical surgery decreases prostate cancer death rates or not.2 Available studies are either too small in size or not meet the rigorous, high-quality standards needed by Western medicine to solidify the answer.

One thing is for sure, though, radical prostatectomies have been shown to cause urinary incontinence and erectile dysfunction in up to 28% and 36% of men, respectively, who underwent them.2 This information is well worth knowing if you’re a man trying to make a decision on how to treat a slow growing prostate cancer.

When evaluating whether or not to proceed with a particular treatment the question you really need to ask yourself is: Is the treatment worse than the disease? This should help you put things into perspective when evaluating potential adverse effects.

Summing It Up


We will all experience an accident, disease, or illness at some point in our life requiring medical attention. When this happens we’ll be faced with a lot of questions. I’ll admit, it’s scary walking into your doctor’s office not knowing what’s wrong with you. The possibilities of different diagnoses can drive you crazy. It can be even more terrifying trying to decide what to do when you do figure out what’s wrong with you.

Fear is usually always the result of not knowing what to expect in life. Are you going to be ok? Is disability in your future? Are you going to die? Who’s going to take care of your family?

The best thing you can do about this is to become an educated consumer. When you walk into your doctor’s office (or pharmacy), you are, quite literally, making lifesaving or life-threatening decisions that can have a major impact on the rest of your life. You owe it to yourself to do your homework. You’d never buy a house or choose a career path or move to a far-away city without knowing what you’re getting yourself into. You shouldn’t make random choices about your health either.

By taking the time to ask the right questions, and to get second opinions (unless it’s truly a medical emergency), you’ll put yourself in the best position possible to make an informed decision regarding your health and your future. You’ll feel better because of it, and likely experience better outcomes as well.

If your doctor or healthcare provider cannot answer your question(s) off the top of their head, then ask them to get back to you. It’s our job as healthcare professionals to be there for you in your time of need. Asking legitimate questions that can play a major role in your future wellbeing is important. Your healthcare provider should take it seriously.

(Note: There are times where your questions may not have answers. While there is a plethora of scientific literature available in today’s world, not every treatment option or medical condition has had a study done to analyze absolute risk reduction on it. If your doctor or healthcare provider returns to you with an answer that there isn’t any data available to the best of his/her knowledge then be understanding. Or better yet, try and search for this information yourself. For example, you can do so by typing in “Aspirin and heart attacks absolute risk reduction pubmed” or whatever it is that you are interested in using Google. This will pull up studies from the National Library of Medicine. You can also use TripDataBase.com which is a search engine primarily for scientific and medical journal articles. Another option is to visit theNNT.com or search for review studies via www.Cochrane.org/cochrane-reviews.)

Most doctors and healthcare providers are good people who entered the field of medicine to make a difference. They would love to have a patient who takes a proactive role in their own care. If you have the unfortunate circumstance of this not being the case then look for a new doctor or other healthcare provider who may be a better match for you. Make it a team effort. You’re bound to get better results this way. 






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by Dustin Rudolph, PharmD
Clinical Pharmacist

Check out Dustin Rudolph's book The Empty Medicine Cabinet to start your journey towards better health. This step-by-step guide leads you through many of today's common chronic diseases (heart disease, obesity, diabetes, cancer, and more), giving you the facts on foods versus medications in treating these medical conditions. The book also contains an easy-to-follow guide on how to adopt a whole foods, plant-based diet as a part of an overall lifestyle change, producing the best possible health outcomes for you and your family. Hurry and get your copy today!

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Photo credits: Freedigitalphotos.net

References:
1 Ornish D, Weidner G, Fair WR, et al. Intensive lifestyle changes may affect the progression of prostate cancer. J Urol. 2005 Sept;174:1065-1070.

2 Chou R, Croswell JM, et al. Screening for Prostate Cancer: A Review of the Evidence for the U.S. Preventive Services Task Force. Ann Intern Med. 2011 Dec;155:762-771.

3 comments:

  1. I have read your book and loved it! I recommend it to others, as well as put it in my
    Amazon Associates page on my new blog, along with a few other books I have read. For my issues, I'll first try to find a Plant-Based Doctor, a plant-based dietitian or a plant-based Pharmacist!
    My blog is still new; though I hope to attract those who relate to my writing and style. I am not a polished writer as Mr. Rudolph, though I may link occasionally to this and other blogs.
    http://www.plant-strong-health-blog-by-gary.com/

    ReplyDelete
  2. Great article. Will definitely share this with clients.

    One question: in the dizziness example, isn't the risk of dizziness 10%, regardless of how much is attributable to placebo? After all, if I'm told that one of the side effects of the med is dizziness, then I may experience dizziness. If I don't take the med at all, I have zero chance of experiencing drug-induced dizziness, regardless of whether it's attributable to placebo or active ingredient.

    It seems to me that absolute risk of side effects do not require adjusting for placebo effect. Your thoughts?

    ReplyDelete
    Replies
    1. Sometimes we can find side effects in absolute terms being reported in the medical literature. This is referred to as numbers needed to harm (NNH) and is calculated in the same manner as numbers needed to treat (NNT). By using NNH you would be getting a true sense of exactly what the percentage of people experiencing a side effect is due to the active ingredient in the drug. A more detailed explanation of the process can be found here - http://www.psychiatrist.com/JCP/article/Pages/2015/v76n03/v76n0313.aspx.

      Great topic though to think of when taking any medication or pill.

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