A question for Andrew from Hywel Williams: Efficacy in RCTs mean response or spread of response

1
A question for Andrew from Hywel
WilliamsEfficacy in RCTs mean response or
spread of response?
Mean improvement score 5.0 in both groups
Standard Viagra
New Viagra
Improved disease score
Disease better
Mean
5
Disease worse
Which treatment would you prefer? (Performance
vs. predictability)
2
Efficacy in RCTs mean response or spread of
response?
Mean improvement score 5.0 in both groups
Standard Viagra
New Viagra
Improved disease score
Disease better
Mean
5
Disease worse
Id prefer Predictability - it would save time
spent in titration and consultations
3
The question from Charles

• Is pharmaceutical medicine doomed?
• No, but all the actors need to stop focusing
  narrowly on their own expertise and roles be it
  pharmaceutical technology, patent law, clinical
  trials or marketing and become at least as much
  concerned about ends as means, i.e. the social
  and individual contexts in which medicines play a
  part.
• I dont know how that could be achieved or when

4
A question to Andrew from Jeff Aronson

• Drugs are often withdrawn from the market on the
  emergence of serious adverse effects, which
  nevertheless may not affect all individuals. How
  can we ensure that useful drugs can be kept on
  the market to benefit those who are not
  susceptible to their adverse effects, while
  making sure that those who are susceptible are
  not exposed to them?

5
The question from Jeff

• How can we ensure that useful drugs can be kept
  on the market to benefit those who are not
  susceptible to their adverse effects, while
  making sure that those who are susceptible are
  not exposed to them?
• I think wed have to try to identify those who
  are susceptible, both to themselves and to their
  doctors, but it would be very complicated
  to ensure that they are not exposed

6
A question from Trish Greenhalgh

• Could you please tell us about the most
  illuminative story youve heard about an adverse
  drug reaction or indeed any other illness
  story.

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from Trishs question

• The most illuminative story Ive heard about an
  adverse drug reaction or indeed any other
  illness story
• The deepening of the voice that women have
  reported with long-term use of tamoxifen.
  Predictable from pharmacology, not investigated
  properly, not mentioned in warnings/ information,
  largely ignored

8
Anitas question

• How can we push an appropriate agenda for
  examining the significance and impact of drug
  diversity - the tendency of drugs to have
  different effects in different individuals and
  populations?
• The politicians and health policy makers
  responsible to these populations and individuals
  must be made to face this problem education
  must make them aware of it. Where drugs are
  concerned most of us belong to a minority

9
The question from David Menkes

• What advice say, about a new drug - would best
  suit a medical practitioner in the developing
  world - who has the option of sponsored
  pharmaceutical information from a rep versus no
  information at all?
• No information at all wont work, nor will info
  from commercial reps. The provision of reliable
  information is a public and a professional
  responsibility, but training in critical
  appraisal, and practice in using it, are needed
  to reinforce it. So is international support.

10
Sams question

• Andrew, could you please give us an
  unpunishing summary of this meeting, as a pun?
• Thats difficult.
• We tried hard to distinguish between the views as
  as they appear from Kenwood and from Kent Woods
  how far they coincide and
  how they differ.