Doctors talk amongst themselves about patients' unrealistic expectations about the effectiveness of drugs. Quite often this conversation is done with shaking of heads and often sarcasm in their voices. However it is time that we ask the question: Just who is being unrealistic? Why should the patient (or the country where socialized medicine pays or subsidizes the cost) pay for a drug that has a very low level of effectiveness? When you go to the doctor and the doctor prescribes a drug, what level of effectiveness do you expect this drug to have? Do you expect it to be 100% effective? Or 98% or 90%, or 80%? Or would you take the drug if the doctor told you that it might reduce your chances of a bad outcome by 4%? Or what about 1% or even less? This is a question I have been asking for the last couple of months. I ask anyone I come across - people in the bus queue, shop assistants, colleagues in the staff room at work, and even medical students. The consistent response has been that most people expect drugs to be 90% effective, with a few dropping as low as 80%. Even one of the medical students said, very honestly, "Well I'm a trained pharmacist, so I know how effective they are but when my doctor gives it to me I expect it to be 90% effective." I am a health researcher and one of the things I do is to go and search the medical literature to find out what works to improve health. I bury myself deep in the literature. When I went searching deep into the literature about the use of cholesterol lowering drugs, statins, I was staggered to find out just how low the effect was. When I looked at the actual results of the drug trials I found that the results often didn't match what was conveyed by the title of the journal article and certainly not in the drug company advertising. For example, women had no improvement in overall survival when taking statins. For men who had no history of heart problems only one life was saved out of 250 men when taking the drugs for five years. That is a 0.4% effectiveness. For those who had had a previous heart attack the figures were 1 in 25. That is 25 men had to take the drug for 5 years to save one life - that is a 4% effectiveness - a long, long way away from the 90'100% effectiveness that most people look for. Some time later I came across a paper looking at the effectiveness of chemotherapy on cancer. Now I don't know about you, but I have always had the assumption that with the horrendous side effects of the treatment one could at expect a 90% increase in survival times, or at least 50%. That is, I would expect that it would cut my risk of dying at least by half, and that I could then go and live a full length of life. A paper published in 2004 in the cancer journal Clinical Oncology paints an altogether different picture. Morgan and colleagues found the contribution of chemotherapy to the five year survival in adults was only 2.3% in Australia and 2.1% in the USA. As the five year survival rate for cancer is now 60% you can see how little impact chemo has on the overall outcomes. For breast cancer the rates are 1.4% and for prostate cancer the rate is 0%, that is zero effect. How can this be? Surely that can't be right? I couldn't believe it and so I started asking the doctors I work with. They all agreed the effectiveness was much lower than almost everyone expected but they didn't realize that the rates were as low as mentioned in the article. One oncologist just wouldn't answer me, but also didn't say the paper was wrong. She just kept saying, "We must ask the patients' what they want." But how can patients make an informed decision if the doctors aren't honest about the effectiveness of the drugs? Now there will be the occasional person who wants to use every drug available in the hope of gaining a few extra days or weeks to be with their family. But I believe there would be many, many more who would forgo the months of agony from side effects if they realized just how poor the results were. If instead of being told you were at grave risk of dying you were told that the average survival time was 20 years (as in women with breast cancer), and that the chemotherapy would add an average of 5 months to survival time, then would you take it? I would suggest that a great many people would be interested in the research which shows that in many cancers people who exercise at least three hours a week have much better cancer outcomes than those who don't. It seems that those with breast cancer have an improved survival of 7-10% which is six times better than chemo but I have never heard of a doctor who prescribes exercise for cancer. Other possible improvements could be had through eating lots of bright green, yellow, orange, red and purple vegetables several times a day and cutting back on sugar consumption. The big problem is that doctors have been brainwashed to only accept treatments proven by randomized controlled trials. We can never prove that exercise or vegetables can improve life expectancy to the same level of proof because we can never use the same research methods. We cannot stop people from exercising or eating fresh vegetables to do the research as that would be unethical when we already know how good they are. So as we can never prove exercise and vegetables are better than the chemo using exactly the same research methods; the drug companies win, and the patients suffer from side effects. It is time we became a bit more discriminating and started to learn to ask better questions about the research assumptions that underpin the methods they use. Or alternatively, just go natural - do what your body intended: eat as close to nature as possible, move regularly throughout the day and have an enjoyable family and social life.
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