Title: A question for Andrew from Hywel Williams: Efficacy in RCTs mean response or spread of response
1A 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)
2Efficacy 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
3The 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
4A 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- Drugs are often withdrawn from the market on the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?
5The 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
6A 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.
7from 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
8Anitas 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
9The 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.
10Sams 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.