> Yes to all three questions. My point is that a few individuals respond
> better than predicted by aggregated trial data. It would be unfair to deny
> the drug to the responsive minority because of the majority experience.
The problem, as you say, is that the few individuals who respond
amounts only to about 10% of those treated (from trials where 25% of
treated and 15% of placebo achieved 'clinically significant'
responses in ADAS-cog or global function). Until this small
proportion can be identified prospectively, it's difficult to say
whether these drugs should be used at all. Of course, even if there
is improvement, you don't know whether or not it's due to the drug.
Some patients on placebo in trials had similar improvement to
those on drug.
Finally, my impression was that the MMSE score was inappropriate
for measuring the *outcome* of treatment but I could be wrong ?
Mark Campbell
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