Does this work for you?

doi:10.1136/bmj.a2281

Published 30 October 2008, doi:10.1136/bmj.a2281
Cite this as: BMJ 2008;337:a2281

Observations

Only Connect

Does this work for you?

Nicholas A Christakis, professor of medical sociology, Harvard Medical School, and attending physician, Mt Auburn Hospital, Cambridge, Massachusetts

christak@hcp.med.harvard.edu

To say a drug "works" is only half the story

The first 150 words of the full text of this article appear below.

Doctors say that a drug "works" if, in comparison with the controlarm of a clinical trial, significantly more people in the treatmentarm respond. Unfortunately, this is a naive oversimplification,and it breeds complacency among patients and physicians alike.

Criticisms of this perspective have been lodged before. Oneis that researchers often pick outcomes that are not patientcentred—patients do not care if a tumour shows "shrinkageupon radiological visualisation" but rather whether they arein less pain. Another criticism is that when side effects ofdrugs are factored in, many patients do not think that a drugworks very well at all, even as the doctor or drug company extolsits virtues; drop-out rates in the active agent arm of trialsoften exceed those of the placebo arm, providing evidence ofpatients’ distaste for the overall effects of a drug.

But one problem that has received far less . . . [Full text of this article]

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