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
> Content-Type: multipart/alternative; boundary="=__PartD5E2B27D.0__="
>
> This is a MIME message. If you are reading this text, you may want to
> consider changing to a mail reader or gateway that understands how to
> properly handle MIME multipart messages.
>
> --=__PartD5E2B27D.0__=
> Content-Type: text/plain; charset=US-ASCII
> Content-Transfer-Encoding: quoted-printable
>
>
> =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
> **************************************************************************
>
> ------------------------------
>
> 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
> Content-Description: HTML
>
> <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__=--
--
------------------------------
BMJ advances healthcare worldwide by sharing knowledge and expertise to
improve experiences, outcomes and value. This email and any attachments are
confidential. If you have received this email in error, please delete it
and kindly notify us. If the email contains personal views then BMJ accepts
no responsibility for these statements. The recipient should check this
email and attachments for viruses because the BMJ accepts no liability for
any damage caused by viruses. Emails sent or received by BMJ may be
monitored for size, traffic, distribution and content. BMJ Publishing Group
Limited trading as BMJ. A private limited company, registered in England
and Wales under registration number 03102371. Registered office: BMA House,
Tavistock Square, London WC1H 9JR, UK.
------------------------------
|