Letters The treatment paradox

Pills in the sky

BMJ 2008; 336 doi: https://doi.org/10.1136/bmj.39465.477373.3A (Published 24 January 2008) Cite this as: BMJ 2008;336:174
  1. L Sam Lewis, general practitioner
  1. 1Newport, Pembrokeshire SA42 0TJ
  1. sam{at}garthnewydd.freeserve.co.uk

    How right Spence is—the marginal individual benefits of much modern medicine appeal only to population doctors and left the individual patient behind years ago, when we started treating “mild hypertension” (with a number needed to treat (NNT) of 800).1

    With such a NNT, and a life expectancy of 20 years, how many of us will be eating “pills in the sky, in the sweet buy-and-bye” (to paraphrase the American working man’s hymn).

    May I again propose this new statistic, pill in the sky, representing the total cost of treatment taken by those who will not benefit, to rank alongside numbers needed to treat and numbers needed to harm?


    • Competing interests: Cost versus benefit.


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