Whirly, hope you get this message after your hols, when hopefully your blood pressure should be at its lowest !
And I do wonder how many GPs could actually tell me the answer to that?
Well, probably quite a few actually, to a certain extenct !
The clinical decisions your GP makes will usually be based on clinical trial data, which usually includes a measure of NNT - numbers needed to treat. From what I gather, and perhaps my more learned friends could correct me if nedded, these are the number of patients, from a certain population, (eg males aged 50-60 with a bp >160), which need to be treated, by an intervention, (eg. a blood pressure drug), to prevent an adverse incident, (eg a stroke).
However there are certain problems with this approach.
a) your GP will have to generalise the trial data to his population, or to the patient sat in front of him....do you share the same characteristics as the patients used in the trial ? Most of my patients do not !
b) Some adverse outcomes, (eg. death), are very carefully monitored by the trials. However, the "softer" adverse effects, eg. is this drug going to make me impotent/tired tend to be less rigourously monitored.
c) Some would say that because of the massive amount of money involved in treating hypertension, then we can never really trust the data of the drugs companies. Remember only the positive stuff usually gets published !
d) GP's have to make decisions based on the trial data, which may not be generalised to you. The drug in question may may have worked for 4300 of the 5000 people it was tested on, but it may not actually work on you.
e)GP's are very busy people, treating a number of different conditions which affect their population. There are about 12,000 journals published annually - even the most diligent GP would be unable to keep up with every single article published regarding hypertension ! They rely on secondary sources of information to make clinical decisions. Some of these secondary sources have a low element of bias, eg recommendations from the British Hypertensive Society, others are more questionable, eg, young pretty drug company representative with flashy car, glossy mag and free clock for office.
I guess the question you are asking, is can we accurately balance risk against benefit, on your behalf. Well perhaps not with 100 % accuracy, but we use the best tools to hand, the clinical trial data.
Cheers, David.