I recently gave a lecture to 70 primary care physicians here in Stockholm, titled “should the patient really get the drug?”. The lecture seemed to generate quite a bit of cognitive dissonance among some in the audience, based on the somewhat aggressive discussion that followed the lecture, which suggests to me that much of what I was saying was stuff they had literally never been … Read more
What defines a good drug?
Most people will naturally assume that when a doctor prescribes them a drug, it’s because the doctor thinks they will receive a meaningful benefit from it. Most people have never heard the term NNT, which stands for Number Needed to Treat, or to put it another way, the number of people who need to take a drug for one person to see a noticeable benefit. … Read more
Why sleeping pills are a bad idea
I hate sleeping pills. I really hate them. The negative emotional response I get when I see them in a patient’s chart is much stronger than what I feel when I see pretty much any other drug. In particular, there is one class of sleeping pill that I really hate, and that is the weirdly named “nonbenzodiazepine”, which is basically a benzodiazepine (a highly addictive … Read more
Do drug trials underestimate side effects?
One commonly used trick in drug trials is to exclude any group that might make the drug look worse, such as those that are more likely to experience side effects. A good recent example of this is the covid vaccine trials, which largely excluded people with auto-immune diseases (more likely to develop an auto-immune disease after vaccination), people with allergies (more likely to have an … Read more
Are regular health checks good for you?
Regular health checks (a.k.a routine visits) are probably the bane of many a primary care physician’s existence. I can’t imagine many things more boring than running through a standardized list of questions with a patient who feels absolutely fine, then going through a list of lab values that are almost invariably within the normal reference range, and finally topping it off with a perfunctory physical … Read more
How well do doctors understand probability?
I’m very interested in how doctors think. How do we use the information gained from talking to and examining a patient to reach a reasonable list of likely diagnoses (a so called “differential”)? When we order a test, what specifically are we looking for, and how will we react to the result that comes back? More cynically, I’m curious about the extent to which we … Read more