Ethics in Medicine

Numbers Needed to Treat

Kristen Sparrow • August 12, 2020

Numbers Needed to Treat

Numbers needed to treat.  This is a crucial concept.  It illustrates brilliantly the concept of First, Do No Harm, which also happens to be the title of the first chapter of my writing project “Deep Resilience”.  This graphic comes from this excellent article  with the even more excellent title when evidence says no but doctors say yes which we covered here.

The diagram shows the results of prescribing a sleep aid to an elderly population.  It’s described as a sedative hypnotic, so it’s likely to be on the order of trazadone.  What this shows in a simple way, is how paltry the positive responses are in comparison to the negative.  And also, how the vast majority of people won’t have a response of any kind. Some of the negatives are mild, such as a “hang over” the next day, others are severe such as memory loss and falls.

This sums up my mantra of “risk/benefit”.  This is where, as practitioners, we need to be laser focused.  Or as Gracian says ”

It takes a wise doctor to know when not to prescribe.  Gracian, The Art of Worldly Wisdon 1647