Dear all,
There is an excellent book by Gerd Gigerenzer ³Simply Rational² that shows
how people think and what makes sense to them, intuitively they know all
the uncertainties but canıt conceptualize easily. If patients have an idea
of what works for others they use that to reflect on how it might work for
them. Hilda Bastion did a great blog on this as well and suggests natural
frequencies and taking the time to explain risk as you have pointed out
http://www.medpagetoday.com/Blogs/ThirdOpinion/50273. I think it is
important to explain basics well and take away all the noise rather than
dumb down and confuse people with something that is going to leave them
with more questions than they started with. I also think it is hard to go
back and understand what it was like to come from the knowledge point of
zero.
Best
Amy
On 11/6/15, 10:34 AM, "Evidence based health (EBH) on behalf of Richard
Saitz" <[log in to unmask] on behalf of [log in to unmask]>
wrote:
>John
>I agree with you.
>At the risk of disagreeing with the praises of NNT, I have never seen
>how they are useful for individual patients. As a patient why do I
>care how many people you need to treat to get benefit for me? I just
>want the benefit. Also it is NNT for some specific outcome during a
>specific time frame which is often hard to weigh.
>
>But absolute risk tells me what i need to know. What is my chance that
>something will occur. I realize the math is identical of course but
>from a patient perspective I have never found NNT to be useful.
>
>Best
>Rich
>
>Sent from my iPhone
>
>Richard Saitz MD, MPH
>Editor, Evidence-based Medicine
>
>Professor of Community Health Sciences and Medicine
>Boston University
>
>> On Nov 6, 2015, at 8:30 AM, John Epling <[log in to unmask]> wrote:
>>
>> (#2015-93)
>> Mime-Version: 1.0
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>>
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>> properly handle MIME multipart messages.
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>>
>> =20
>> Helen, This is a bit of a cheeky response, but I don't mean anything
>>bad =
>> by it... Why would you want NNTs for public health? NNTs were invented
>>to =
>> translate epidemiological concepts to the practicing clinician, whose =
>> sense of magnitude comes from how many patients they'll see with a
>>given =
>> condition in a given time frame. Public health has available to it =
>> attributable risk, population attributable risk, and just plain old =
>> absolute risk reductions to get at the magnitude of intervention
>>effect, =
>> much more applicable statistics that NNT for population health uses.
>>Just =
>> curious...I probably just don't understand how you would be using them.
>>=
>> John
>>
>> John Epling, MD, MSEd Chair, Department of Family Medicine SUNY Upstate
>>=
>> Medical University Syracuse, NY (sent from my phone)=20
>>
>> -------- Original message --------
>> From: "EVIDENCE-BASED-HEALTH automatic digest system
>><[log in to unmask]
>> UK>" <[log in to unmask]>=20
>> Date: 11/05/2015 19:11 (GMT-05:00)=20
>> To: =20
>> Subject: EVIDENCE-BASED-HEALTH Digest - 4 Nov 2015 to 5 Nov 2015
>>(#2015-93)=
>> =20
>>
>>
>>
>> Date: Thu, 5 Nov 2015 15:21:11 +0000
>> From: Helen Outhwaite <[log in to unmask]>
>> Subject: Numbers needed to treat and public health
>>
>>
>> Please let me know if you have any suggestions about searching (terms, =
>> strategies, filters, sources) for numbers needed to treat (NNT) and
>>public =
>> health?
>> This could be already calculated NNT or risk/ incidence of outcome =
>> with/without the intervention.
>>
>> for example:
>> blood pressure control to prevent heart failure or end stage kidney =
>> disease
>> stopping smoking to prevent heart failure or stroke or CKD
>>
>> I have run some searches on Cochrane, Medline, NHS EED and looked at
>>the =
>> following:
>> The NNT http://www.thennt.com/home-nnt/
>> EBM Toronto http://ktclearinghouse.ca/cebm/toolbox/nnt
>> NNT and public health interventions
>>(http://www.nwph.net/Publications/NNT_F=
>> INAL.pdf )
>>
>> Any further help will be appreciated.
>>
>> Helen
>>
>> Helen Outhwaite
>>
>> Knowledge and Evidence Specialist
>> Local Knowledge and Intelligence Services Yorkshire and Humber, North
>>East =
>> and North West
>> Public Health England
>>
>>
>>
>>
>>*************************************************************************
>>*
>> The information contained in the EMail and any attachments is
>>confidential =
>> and intended solely and for the attention and use of the named
>>addressee(s)=
>> . It may not be disclosed to any other person without the express =
>> authority of Public Health England, or the intended recipient, or both.
>>If =
>> you are not the intended recipient, you must not disclose, copy,
>>distribute=
>> or retain this message or any part of it. This footnote also confirms =
>> that this EMail has been swept for computer viruses by Symantec.Cloud,
>>but =
>> please re-sweep any attachments before opening or saving.
>>http://www.gov.uk=
>> /PHE
>>
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>> ------------------------------
>>
>> End of EVIDENCE-BASED-HEALTH Digest - 4 Nov 2015 to 5 Nov 2015
>>(#2015-93)
>>
>>*************************************************************************
>>
>>
>> --=__PartD5E2B27D.0__=
>> Content-Type: text/html; charset=US-ASCII
>> Content-Transfer-Encoding: quoted-printable
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>>
>> <html><head><meta http-equiv=3D"Content-Type" content=3D"text/html; =
>> charset=3DUTF-8"></head><body>=0A =0A<div>Helen, <div
>>dir=3D"auto">=
>> This is a bit of a cheeky response, but I don't mean anything bad by
>>it... =
>> Why would you want NNTs for public health? NNTs were invented to
>>translate =
>> epidemiological concepts to the practicing clinician, whose sense of =
>> magnitude comes from how many patients they'll see with a given
>>condition =
>> in a given time frame. </div><div dir=3D"auto">Public health has =
>> available to it attributable risk, population attributable risk, and
>>just =
>> plain old absolute risk reductions to get at the magnitude of
>>intervention =
>> effect, much more applicable statistics that NNT for population health =
>> uses. </div><div dir=3D"auto">Just curious...I probably just don't
>>=
>> understand how you would be using them. </div><div
>>dir=3D"auto">John</=
>> div></div><div><br></div><div><br></div><div
>>id=3D"composer_signature"><met=
>> a http-equiv=3D"Content-Type" content=3D"text/html;
>>charset=3DUTF-8"><div><=
>> div>John Epling, MD, MSEd <div>Chair, Department of Family
>>Medicine&nb=
>> sp;</div><div>SUNY Upstate Medical University </div><div>Syracuse,
>>=
>> NY </div></div><div>(sent from my
>>phone) </div></div></div><br><b=
>> r>-------- Original message --------<br>From: "EVIDENCE-BASED-HEALTH =
>> automatic digest system <[log in to unmask]>"
>><LISTSERV@JISCM=
>> AIL.AC.UK> <br>Date: 11/05/2015 19:11 (GMT-05:00) <br>To:
>><br>Subject=
>> : EVIDENCE-BASED-HEALTH Digest - 4 Nov 2015 to 5 Nov 2015 (#2015-93) =
>> <br><br><div><br dir=3D"auto"><br dir=3D"auto">Date: =
>> Thu, 5 Nov 2015 15:21:11 +0000<br dir=3D"auto">From: =
>> Helen Outhwaite <[log in to unmask]><br
>>dir=3D"auto">Subject:=
>> Numbers needed to treat and public health<br dir=3D"auto"><br
>>dir=3D"auto"=
>>> <br dir=3D"auto">Please let me know if you have any suggestions about =
>> searching (terms, strategies, filters, sources) for numbers needed to =
>> treat (NNT) and public health?<br dir=3D"auto">This could be already =
>> calculated NNT or risk/ incidence of outcome with/without the
>>intervention.=
>> <br dir=3D"auto"><br dir=3D"auto">for example:<br dir=3D"auto">blood =
>> pressure control to prevent heart failure or end stage kidney
>>disease<br =
>> dir=3D"auto">stopping smoking to prevent heart failure or stroke or
>>CKD<br =
>> dir=3D"auto"><br dir=3D"auto">I have run some searches on Cochrane, =
>> Medline, NHS EED and looked at the following:<br dir=3D"auto">The =
>> NNT http://www.thennt.com/home-nnt/<br dir=3D"auto">EBM Toronto =
>> http://ktclearinghouse.ca/cebm/toolbox/nnt<br dir=3D"auto">NNT and
>>public =
>> health interventions (http://www.nwph.net/Publications/NNT_FINAL.pdf
>>)<br =
>> dir=3D"auto"><br dir=3D"auto">Any further help will be appreciated.<br =
>> dir=3D"auto"><br dir=3D"auto">Helen<br dir=3D"auto"><br
>>dir=3D"auto">Helen =
>> Outhwaite<br dir=3D"auto"><br dir=3D"auto">Knowledge and Evidence =
>> Specialist<br dir=3D"auto">Local Knowledge and Intelligence Services =
>> Yorkshire and Humber, North East and North West<br dir=3D"auto">Public =
>> Health England<br dir=3D"auto"><br dir=3D"auto"><br dir=3D"auto"><br =
>>
>>dir=3D"auto">************************************************************
>>**=
>> ************<br dir=3D"auto">The information contained in the EMail and
>>=
>> any attachments is confidential and intended solely and for the
>>attention =
>> and use of the named addressee(s). It may not be disclosed to any other
>>=
>> person without the express authority of Public Health England, or the =
>> intended recipient, or both. If you are not the intended recipient, you
>>=
>> must not disclose, copy, distribute or retain this message or any part
>>of =
>> it. This footnote also confirms that this EMail has been swept for =
>> computer viruses by Symantec.Cloud, but please re-sweep any attachments
>>=
>> before opening or saving. http://www.gov.uk/PHE<br
>>dir=3D"auto">***********=
>> ***************************************************************<br =
>> dir=3D"auto"><br dir=3D"auto">------------------------------<br
>>dir=3D"auto=
>> "><br dir=3D"auto">End of EVIDENCE-BASED-HEALTH Digest - 4 Nov 2015 to
>>5 =
>> Nov 2015 (#2015-93)<br
>>dir=3D"auto">***************************************=
>> **********************************<br dir=3D"auto"></div></body></html>
>>
>> --=__PartD5E2B27D.0__=--
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