Opioids misuse and money

[Hezekiah]

There was an interesting programme on BBC Radio 4 last night - File on 4, Opioids: A Painful Prescription. Here's a link to it.

bbc.co.uk/sounds/play/m00050s0

It raised loads of interesting topics, but I'd just like to reference one really - clinical trials and what happens afterwards.

Dr Cathy Stannard says (about 7 minutes in to the programme) "how clinical trials and published evidence can lead us down a wrong path". And she says "When we look at the conduct of these clinical trials, and in particular how medicines are used in real life, we realise that the clinical trials really didn't give us any useful information at all and in fact they probably misled us. "

So, I would say, I wouldn't want to do away with clinical trials BUT.....they ain't perfect. The number of variables in the real world is phenomenal... every patient is a different chemical bundle...re-runs of trials seem to sometimes show a lot less effectiveness in the treatment than the original trials showed...money talks, and expensive drugs make shedloads of it....there's something to be said for anecdotal evidence..and the old days when doctors tested medicines on themselves.

[Mmrr]

Yes, and the trails even though run double blind, cannot get away from subjectivity in terms of recipients of the drugs self rating how they feel, the placebo effect and social desirability bias to name but a few. The p level of acceptance is sometimes very small in whether a new drug is accepted as useful or not.

Then there is the side effects of which most of us on this site know all about, often we are trading in one set of problems for another. Side effects are often underplayed by the manufacturers.

It's kinda like the information you get about the performance of a new car, all trials are undertaken in perfect conditions and whilst not strictly telling fibs, are unachievable under normal circumstances.

But, where would we be without MTX , biologics and other drugs ?

[Hezekiah in reply to Mmrr]

I had to look up Social Desirability Bias, which I vaguely knew about already and could fairly easily understand, and also p level but I found that much more difficult. Doubt if I understood it really.

[Mmrr in reply to Hezekiah]

It's the probability that something has happened by chance/random/unaccounted for factors ...or a real change due to.....in this case the drug. Drug companies tend to work to small margins that it is indeed the drug and not something else that has caused the change.

[Hezekiah in reply to Mmrr]

Thanks Mmrr