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Sunday, April 3, 2011

Feeding my NNT fedish

I came across another interesting blog on the Efficient MD site -http://efficientmd.blogspot.com/2010/06/number-needed-to-treat-from.html?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+efficientmd+%28The+Efficient+MD%29&utm_content=Google+Reader

Nothing absolutely earth shaking but this piece reinforces the concept that present practices, particularly relating to recommended interventions which MAY prevent some future event, do not make sense to apply universally. Should patients be placed upon statin drugs? If the options are presented in a truly unbiased fashion, what percent of specific patient groups should be buying in and what percentage should be declining the intervention?

This has relevance to the newly announced ACO rules. Within the long list of quality measures is one for mammography screening for women age 40-64. Didn't the US Preventative Services group come out with the position that starting screening of all women at 40 was not justified on the basis of risk/benefit assessment? This is a contentious arena where there is no real consensus on whether women this young actually benefit from mammography. However, physicians are to be provided with financial incentives to nudge (coerce) women to have screening starting at age 40. What percentage of appropriately informed women would elect to forgo such screening if presented with the relevant NNT data?

The list of preventative health measures is likely to grow, driven not by the science but by the politics of medicine. What is a doc to do when the NNT numbers are less convincing than the $$$ numbers?

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