What defines a good drug?

good drug NNT

Most people will naturally assume that when a doctor prescribes them a drug, it’s because the doctor thinks they will receive a meaningful benefit from it. Most people have never heard the term NNT, which stands for Number Needed to Treat, or to put it another way, the number of people who need to take a drug for one person to see a noticeable benefit. It’s a bit of a counterintuitive concept for people outside medicine, since most people probably assume the NNT for all drugs is 1, right? If I’m getting this drug, it must be because it is going to help me. Well, wrong.

Before we move on, I want you to perform two small thought experiments:

Say you were suffering from depression, and there was a drug that could potentially improve your mood. But it’s not certain that the drug will work for you. And there’s a catch – the drug has side effects, which you are likely to experience regardless of whether you get the benefits of the drug or not. This particular drug causes a reduction in sexual desire and increased difficulty achieving orgasm during sex.

It also causes subtle changes to your personality, making you more prone to take risks, less emotional, and less empathic. It increases your tendency to engage in addictive behaviours, and it’s been known to cause addictions to alcohol and gambling. Additionally, withdrawal is common, so many people have trouble getting off the drug once they’re on it.

How good would the NNT for this drug need to be for you to be willing to take it? Would you want absolute certainty that it would end your depression, considering the harms? or would 50:50 odds be enough? Or even less?

Keep whatever odds you decide on in mind. If you, for example, think one in two odds are good enough, then that gives an NNT of 2 (you need to treat two people to get a noticeable benefit in one of them).

Ok, next scenario. Say you’d had a heart attack, and there was a drug that could decrease your risk of another heart attack. But just as with the previous drug, there are no certainties that you will actually get any benefit from taking this drug. And this drug also has side effects. Many people who take the drug develop chronic aches and pains. The drug also causes noticeable cognitive impairment in a proportion of those taking it, and some even end up being diagnosed with dementia – how big the risk is unfortunately isn’t known, because proper studies haven’t been carried out that could answer that question. Additionally, the drug causes blood sugar levels to rise, resulting in type 2 diabetes in around 2% of those taking the drug – it is in fact one of the most common causes of type 2 diabetes.

How good would the NNT for heart attack prevention need to be for you to take this drug?

Again, keep the number in mind.

As many of you have probably guessed, the first drug I described is an SSRI (examples of this type of drug are sertraline, citalopram, and fluoxetine). Currently, around 15% of adults in western countries take an SSRI every day.

So, what is the actual NNT for SSRI’s when used as a treatment for depression?

It’s seven.

In other words, you need to treat seven people for one to experience a noticeable effect on their depression. The other six just get the side effects but no benefit. And when I say “effect”, I don’t mean that the depression resolved in the one person lucky enough to see a benefit. Far from it. I mean that on a certain numerical rating scale (MADRS, if you must know), they experienced an improvement in mood that was just big enough to be detectable using statistical methods.

What NNT number did you choose? Are 7:1 odds good enough for you to take an SSRI if you get depressed, knowing the harms?

When a doctor prescribes an SSRI to a depressed patient, they (hopefully) know that the odds of the patient benefitting even slightly are only 1/7 (or 14%). Which doesn’t seem like a very good deal to me. Yet SSRI’s are widely considered to be an “effective” drug.

The second drug, as many of you have probably also guessed, is a statin (examples include atorvastatin, simvastatin, and pravastatin). More than a quarter of adults over the age of 40 take a statin every day in western countries.

So, what is the NNT for statins?

Well, if you’ve already had a heart attack, i.e. you’ve already been established to be at high risk for heart attacks, then the NNT over five years of treatment is 40. In other words, 39 of 40 people taking a high dose statin for five years after a heart attack won’t experience any noticeable benefit. But even if they’re not the lucky one in 40 who gets to avoid a heart attack, they’ll still have to contend with the side effects.

What NNT did you decide on personally? Are 40:1 odds good enough for you to decide the benefits of a statin outweigh the harms?

Of course, patients rarely get presented with this type of information, and are thus rarely able to make an informed choice of their own. I once sat in on a conversation between a cardiologist and a patient who’d recently had a heart attack. The patient was skeptical about statins. He said that he’d read on the internet that they had side effects, and he wasn’t sure he wanted to take one.

The cardiologist gave the patient a long, withering stare, and then responded that there’s a lot of misinformation on the internet, and that the statin was the number one most important thing he could do if he wanted to not die prematurely.

Which I thought was a bit arrogant. Why?

Because the probability that the statins would prevent a future heart attack, let alone premature death, was in the low single digits, and the patient might quite reasonably have felt that that marginal benefit was outweighed by the various harms (which the cardiologist incidentally hadn’t mentioned at all – and which the patient thus wouldn’t have even known about if he hadn’t read “misinformation” on the internet).

Doctors have been conditioned by the pharmaceutical industry to think that drugs that provide very low probability of benefit are effective. An NNT of 10 is often considered good, and an NNT of 5 is considered excellent. Even an NNT of over 100 is often considered acceptable! Patients are rarely informed that the odds of them getting any benefit from the new drug they’re being prescribed are far less than 50:50. And they’re rarely informed about what the harms are, and how likely they are to experience them.

Just in case you think I’m picking on a few particularly ineffective drugs with my two examples, I’m not. NNT’s of five or worse are typical for many of the most commonly prescribed drugs.

What that means is that the average 70 year old who is on five drugs continuously will probably at best only benefit in any measurable way from one of those drugs. The other four are not providing any benefit, they’re just contributing to side effects (which become increasingly likely, and increasingly deadly, the older you get). Things get even worse when you consider that drugs interact in unpredictable ways to increase the risk of side effects, so the risk of harms increases exponentially with each additional drug added. Which is why it used to be considered bad form to have a patient on more than five drugs simultaneously.

The number of drugs the average person is on has increased massively over the last few decades. Polypharmacy (people taking multiple different drugs continuously) is now one of the top five leading causes of death in the western world – which is a little ironic when you consider that people are taking all those drugs in order to live longer. The best way to avoid becoming another polypharmacy death statistic is to be careful about which drugs you take, and only take those for which it’s clear that the benefits outweigh the harms.

From my perspective, a good drug is a drug for which the benefits clearly outweigh the harms. I’m not saying that all drugs with high NNT’s are inherently useless. A drug with an NNT of 40 might be worth taking, if the risks of harm are sufficiently low and the outcome is sufficiently important. Only the patient can make that decision.

Whether a drug is good for you as an individual is clearly context specific. The decision whether or not to take a certain drug requires a deep understanding of the drug (provided by the physician) and a deep understanding of personal values and wishes (provided by the patient). It requires a holistic perspective and a meeting of two minds that is literally the opposite of what doctors are asked to practice today, where we’re continuously pestered with various treatment guidelines and targets that turn physicians in to unthinking automatons and patients in to featureless blobs.

PS. I’m genuinely curious to know what you, dear reader, think would have been reasonable NNT’s for the two examples discussed above. Please post in the comment section, along with your reasoning.

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203 thoughts on “What defines a good drug?”

  1. Excellent information. Confirms my worst suspicions regarding the prescribing of drugs. But what does a doctor say to someone desperate for a remedy for their condition?

    1. Yes, it’s hard to be a doctor sometimes. But withholding information because it’s hard to tell a patient the full truth is unethical. I think the problem is doctors don’t actually know/understand the full truth about how a drug may or may not be beneficial to any specific patient. The cost/benefit to each patient is what the doctor needs to know. The FDA and drug companies can settle for an NNT number. It takes time to analyze the benefit to a specific patient and even then any “conclusion” is problematic. The patient and doctor need to decide these things together. But that’s not going to happen because doctors don’t have time and patients don’t have the statistical tools and medical knowledge.

      1. I must say that I’m really tired of people saying doctors ‘don’t know, don’t understand, don’t have the time, etc.’. These sound like excises, rather than reasons.

  2. Keep up the good work. I enjoy your medical advice/insights.
    Being very sensitive to any drug, had a brain chemistry psychiatrist tell me my ‘issue’ was either in the brain or the liver and that 1 in 10 people had my sensitivity to drugs. I’m thankful…a little goes a long way. I’m a 74 year old female.

  3. This is an excellent entry about an important and overlooked aspect to drugs.

    According to https://www.thennt.com/nnt/statins-for-heart-disease-prevention-without-prior-heart-disease-2/ Statin Drugs Given for 5 Years for Heart Disease Prevention (Without Known Heart Disease):

    Benefits in NNT
    None were helped (life saved)
    1 in 104 were helped (preventing heart attack)
    1 in 154 were helped (preventing stroke)

    Harms in NNT
    1 in 50 were harmed (develop diabetes*)
    1 in 10 were harmed (muscle damage)

  4. Really interesting post, thank you. Everyone needs to know this. If there are undesirable side effects, I’d want an NNT of 2 or less – and that would be subject to review. I’d be prepared to dump the drug if it made me feel less good.

  5. I taught graduate applied statistics years ago so i have some understanding of multivariate statistics. Using various statistical methods statins appear to have almost no effect on all cause mortality for primary prevention. Mendelian statistical methods, however, do show a benefit. In other words there are certain genetic profiles for which statins have a benefit. The marker apo B does seem to predict when statins are a benefit.

    I would appreciate a response from someone with knowledge of the validity of Mendelian statistical methods.

      1. Steve Kirsch has calculated that number. I thought it was 22,000. But in the process you would kill 10,000 with the side effects.

      2. I can’t remember the actual numbers of the original Pfizer trial (and my stats usage was a few decades ago) but I think they were somewhere over 100 in those testing positive with no jab compared to under 10 or 20 in the jabbed. Whatever the numbers were they gave a RELATIVE reduction of 95% and and ABSOLUTE reduction of around 1%. Each arm of the trial had 30 or 40k participants I think. Let’s say it was 30k and the positives were 100 less in the jabbed arm (no pun intended). So you need to treat 30k to get a 100 reduction so that gives a NNT of 30,000/100 = 300. This is a great number if you are a Pharma company making loads of money from the jabs but maybe not so great if you are a jabbee. This is not taking into account any possible side effects to the jab (which of course don’t happen do they?)

      3. It’s extremely poor. And remember, 99.98% of everyone has no problem with this virus. The trials are bogus bc out of 22,000 in the trial arm, only 104 even got the virus. Of those in the “vaccine” arm, only 8 did. So what’s the point?? Your chances of getting the virus are less than 1%, and IF you do get it, your chances of surviving are close to 100% naturally anyway! So who cares if the drug is 95% effective? Who cares?!

        Taking something to prevent a problem when 99.98% of everyone will never have one is asinine. Bc the drug can kill you. Or cripple you. Or give you myocarditis. Or cause all kinds of other problems. It CAN! So why take it UNLESS you are truly at risk? I personally would never take such a dangerous drug with so many known side effects. I’d rather be left alone to die when I die. But that’s me. And if my government tries to force me, FORGET IT!!

      1. Thanks for that great and very thorough reply re COVID stats. I have seen a formerly respectable organization begin ( CFI) all “ anti vac scientists) as bogus medicine. And I cannot ( or have not been allowed to get through) to present the actual science as you have. Thanks again
        Larry W Banyash MD, retired

  6. This is totally new info to me. I assumed that the side effects were only probable, not that the efficiency of the drug was also only probable. A very low probable at that. I’m 70 and have taken 5 drugs daily for years. Some I know are working and my quality of life is better. Others are more difficult to assess. My answer to your first question is that any drug I take should “work” all the time! NNT of 1! The trouble is how can you tell if a drug taken for prevention of disease is worth taking? I have heart disease and type 2 diabetes in my family. I’ve taken a statin for years. My cholesterol levels were never in the high danger zone. Only slightly elevated and probably could have been lowered by diet changes alone. My doctor at the time I started Lovastatin told me that statins should be added to breakfast cereal because everyone should take them.
    Sebastian, thank you for the insight, but damn it, I have too much work to do now deciding what to do about all this new information.

    1. … “added to breakfast cereals”. That is a shocking comment from a doctor. Shocking. I honestly don’t think they know any better and that they don’t know about NNT. We need to understand that our doctors don’t know everything and most often don’t have an interest to continue to learn after their degree.

      1. That is true. Doctors, in the average, after they get their degree, continue their formation by reading Sanitary policies, which are biased towards the pharmaceutical companies.
        That is, their advice is not only useless, it is sometimes a danger to your health. If they knew about health at all, because they haven’t studied anything related to health in their career. The doctors I have bumped into, don’t know about nutrition, workout, stretching or meditation at all.
        My advice would be to not follow their advice, but to start learning about health. Good luck

    2. I’d get off the statins. Do a little bit of reading and you’ll find out they are bad news. You can change your diet but frankly, cholesterol was never the problem. That is a lie. And a mighty lucrative one at that. Again. This is what the drug companies do! And the docs are trained to repeat it. Sorry. Id take the ones you KNOW are working if they are “safe.” These days, almost no drugs are. Ditch the others.

      1. Most people think they get cholesterol from the diet but this is incorrect, 80% of cholesterol is synthesised by the liver.

    3. Suggest you read books by Dr Malcolm Kendrick especially ‘ The Cholesterol Con’ and his latest book ‘The Clot Thickens’. Also Dr Aseem Malhotra’ s book ‘A Statin Free Life’. These will be good starting point to help you decide.

    4. My father’s last 3years were blighted by mysterious muscle pains, he had enjoyed walking,latterly he became quite crippled. It was only after he died that I realised this could have been a side effect of the Statins he was taking. He had been taking them for some years without ill effects, I believe that the side effects can kick years after starting the meds. My advice to you would be cut the Statins, before you get the side effects.

      1. Totally agree as it is the small particle ldl related to coronary disease with “clot” formation. Actual cholesterol level is useless.
        Larry Banyash, MD, retired

    5. Bite the bullet bravely, Rose. Get off that stinkin Med!! NNT way too high. And as Dr Kendrick has stated, as well as many others, cholesterol does NOT cause heart disease.
      Warm regards,
      Larry W Banyash, MD, retired

  7. Great article. I worked on statins and know they are sold on the basis of relative improvement as opposed to absolute improvement. I had to explain to my GP about statistical trickery but he still insisted I take statins, I refused.

  8. I agree, excellent information. The NNT for either scenario for me would depend on the severity and whether there were other approaches that could help my ‘condition’, for example evidence based herbal medicine treatment or good psychological therapy, support networks, spiritual support etc in the case of depression. I actually left my career as a Consultant Psychiatrist 8 years ago because I was expected to follow protocols and guidelines with poor evidence of benefit (NNTs) and high evidence of harm (much hidden by the manufacturers from us as prescribers) and was unable to access other strategies for my patients- I felt I was doing more harm than good everyday and could no longer justify it.

  9. Very interesting, thanks.
    As a 67 year old male with a father who had heart problems and myself having had an N-STEMI & stent and currently on a statin, I am curious about the following:

    How can cognitive impairment (or any other side-effect) be measured if there was no baseline done before. How much impairment is due to the medication or just ageing?
    Same with diabetes. At least sugar levels can be monitored with regular blood tests and reduced (hopefully) by diet & exercise. If it increases, was it the statin or something else?

    Measuring the NNT also seems to be complicated. How do you measure ‘No-benefit’ or something that does not happen?

    Perhaps an analogy would be useful.
    When a client calls me and says that their Windows computer is malfunctioning, the usual (and easy) answer is to reboot and see if the problem goes away. I _can_ diagnose the problem by asking relevant questions and checking certain things… but I also know that restarting the computer will reset most variables that may have caused the problem…

    Prescribing meds seems to be the same. Why spend many hours investigating alternate meds or checking for possible side-effects, if the generic Rx will work for 1 of 40 people?
    Physicians would probably hope that their patient is the 1 of 40 and if there are side-effects, _then_ they can react and deal with the consequences.

    Am I being too complacent?
    How diligent are physicians when prescribing? Do they even know about all the possible side-effects?

    1. Hi Earl, I am 3 years younger than you in the same situation re N STEMI and a stent. I despair that all GPs and Specialists are these days as Sebastian says ‘treatment guideline’ followers. They are dictated to from above as to what they can and can’t do and prescribe. I do have some sympathy for them as firstly they are too busy to chase up every drug NNT and secondly if they don’t follow the guidelines they could easily get into trouble – as has been the case in Australis in the current Pandemic. My Cardiologist prescribed the ‘gold standard’ treatment of blood thinners, blood pressure and stain drugs. If he didn’t and I had another heart attack I imagine he could have been investigated and reprimanded. After six months of minor side effects (aching, loss of muscle bulk, minor memory loss) I developed major ED (in retrospect it had been coming on slowly). The final nail was taking Ezetimibe to get my Cholesterol to lower than the 2.3 that it had come down to. My Cardiologist suggested Viagra as ‘if my heart arteries were narrow then others would be also’. I chose the path of going off the Statins and Ezetimibe because ED was a step too far for me. In addition I got fitter, lost weight and changed my diet (low carb / sugar). While these probably have more benefit long term to me my Cardiologist (who is great by the way) was not happy with me going off the statins. I now look and feel better than I have for decades and after 6 or more months now function normally. (I also take some vitamin supplements including Vit D,C multivit, etc). After making my decision I became much more comfortable with it after reading books by Dr Malcolm Kendrick and articles by Sebastian. I found there is another medical world out there populated by thinking, logical, critical, data based medicos. Knowing what I know now I seriously wonder whether anyone should be on statins and I wouldn’t trust anything the Pharma industry says.

    2. Cognitative impairment and indeed all adverse events are measured in the double blinded Phase3 trials which include a placebo group. That’s how we can say around 2% of people on statins develop type2 diabetes. Phase3 trials will not pick up very rare adverse events as the trials are not sufficiently statistically powered. These rare events are picked up after drug approval in the treatment population

      1. However the phase 3 trials of statins had a “run-in” period which eliminated all the people who found they made them feel bad. In addition, they did not test for cognitive impairment.

        After my husband’s heart attack and revascularization (only 6 years ago), all the doctors were adamant that he needed high dose statins. They absolutely denied cognitive or sexual effects. I found a few case reports in the literature and collated them for our doctor. The only thing he actually believed was when I told him that the cat raked him with claws whenever he tried to pet it. Now, 6 years later it is accepted that statins can cause cognitive impairment, but the cardiologist still thinks he would be better on them.

    3. Yes, I know the side effects! You will know almost immediately if you stop the useless statins and your cognitive skills improve quite quickly. I would stop the kool aid.
      Larry W Banyash MD, retired

  10. Thanks for this is information, I had no idea. I actually thought the NNT would be 2… quite shocking. It’s good to be aware of this. And typical about the 2% that suffer from type 2 diabetes as side effect. Which is in fact then another medical milk cow…
    Health should be less about medicines and more about healthy living and prevention I believe.

    1. Totally agree with you Fran. I had a heart attack ten yrs ago, placed on statins—within one month had severe upper leg myalgias, and legs so weak could not even get into a soccer van without crawling in. Cardio told me that was rare……not rare when it is you. Weak to this day….primary care ordered blood tests and final referred me to Rheumatology—-3 Months Ago!!
      Larry W Banyash MD, retired

      1. Probably statin induced neuralgia. I doubt rheumatologist would be of help. I would suggest a good Acupuncturist or TCM herbalist.

  11. An excellent article – I had suspicions that this might be the case, but had never seen it put down in words. At least one can be armed with some questions to ask ones Doctor should the occasion arise. I start to wonder about a friend of mine who has been struggling with alcoholism for many years, and is prescribed Citalopram for depression… Thanks again.

  12. I think to have a definitive answer to the NNT I’d need to decide to take a particular drug I’d like to have some statistical likelihood of knowing my chances of experiencing the side effects. If my chances of becoming an alcoholic if I take an SSRI are 1 in 50 maybe that 7 NNT looks good. And I’d also have to know how badly I suffered from depression. Or it might look really bad. I’m inclined to the latter view but it’s not clear.

  13. For the two examples you have given: Prozac made me pass out with vertigo and nausea in a queue at the bank 2 days after I started it, years ago now, so I decided depression was preferable and put the tablets in the bin. So as far as anti-depressants are concerned I would want to know they would help the underlying problem (a 1 on your NNT scale) PLUS ALSO the side effects must not be worse than the original condition.
    As regards statins, I would not take them because they are prescribed generically not personally I.e. these are a “good thing” in general, they should be in the water supply or something, they are a preventative, you must take them. Well, what if I don’t have/won’t have a condition that needs preventing? No-one knows or asks, do they? Just tell you to take it anyway. Nope, sorry – not good enough.
    I am not a good patient, Dr Rushworth.

    1. Yes, you *are* a good patient! Years ago, being a good patient was indeed defined as always following doctors orders. Sadly, that is no longer the case. Now, you must think for yourself, in a critical way. And that’s just what you are doing!

  14. Thank you for this article!
    Sometimes doctors makes one feel like a complete idiot when one is refusing certain drugs… and then deny help with drugs one wants. In my case bioidentical estrogen and progesterone. I was told I didn’t have typical menopausal issues so it would be dangerous to get hormones but they did without hesitance offer me SSRI. (Every 4th American woman in the age of 45-55 are prescribed SSRI, when what they lack is a very potent hormone.) And discussing pros and cons often result in comments similar to what you mention above “don’t believe all you read on the internet”. But if one can’t get full information from the doctor, where else but the internet to get it?

  15. First, thank you for this fantastic information. I feel the risks outweigh the benefits in both scenarios.

    The NNT for both SSRIs and Statins is not worth the side effects. Treating the real underlying causes

    make much more sense to this layperson.

  16. Excellent essay.

    A problem with using NNT in this way though is that drugs don’t really have “an NNT”. They can potentially have several. The calculated NNT for any drug will depend on the population and environment in which NNT was determined; thus at best it represents an “average NNT”. And within a population each individual will have a personal NNT that might be vastly different from the NNTs of their neighbors. So the really important information we need about about a drug before prescribing it for our host is: How many Sebastian Rushworths at a given age, health status and environment need to be treated to see benefit (the “Rushworth NNT”).

    At least this is the underlying presumption of the precision medicine movement.
    Do you think that this movement has the potential to dramatically decrease (i.e improve) the NNT for drugs?

    1. Clinical Phase3 trials try to include a mixed demographic so that efficacy for say Caucasians, asiatic and people of colour can be determined. Such demographic analysis is carried out by drug researchers. For certain drugs which exhibit so called polymorphic metabolism the NNT may differ across racial demographics

  17. I changed my GP practice at the age of 65. The nurse gave me a checkup on entry into the new practice – she said that it was very unusual for a man of my age not to be on any medication. I don’t like tablets & would avoid any ‘regular’ tablet if at all possible.

    1. In the UK I read that 7% of over-65s take no medication. I’m one of the 7%.

      I take 3,000 IU/day of vitamin D, having discovered in 2018 and by a few subsequent tests that I become pre-diabetic without quite a high blood level. Of course the NHS doesn’t want to know how to prevent pre-diabetes, most GPs just put you on drugs.

      I obtained benefits from St. John’s Wort for mild/moderate depression 18 years ago.

      Moreover, a lot of the useful medicine seems to be old, out of patent pills. No money in those, even if drugs like metformin or HCQ are pretty useful.

      1. Berberine is a tested supplement, safe, and acts almost exactly like metformin. I’m on it along with diet and Jason Fung’s intermittent fasting protocol. Most docs, imho nowadays, love to stigmatize bout anything that’s not cookbook.
        Larry Banyash MD, retired

  18. I presume that many people keep on taking a number of medicines for years, without any proper evaluation of them is done. (This may be even more true in a country such as Sweden, were long term family doctors are rare – instead we keep on getting new doctors at the local clinic, at least that’s my impression. ) It is one thing to try a medicine, and if there is no clear effect it should be cancelled, shouldn’t it? Or, since many of them are prescribed to treat life style diseases, there is no medical reason to stop taking them, or?

  19. I’ve tried to discuss NNT for statins with many doctors, but it always ends with an unpleasant atmosphere in the room. They’ll do anything to avoid the subject.

    1. Indeed how true. My doctor tried to convince me until I told him I was involved in statin discovery and clinical development. He wasn’t happy meeting someone who knew more than he did. Most people think statins prolong life, they done

      1. David,
        I am on a statin as a preventive and I am in the process of stopping this all together I have no discernible side effects. I am in the process of reading the book suggested in a previous post, “The Clot Thickens.” I am always endeavoring to get clear and concise information on the pros and cons on medications. Dropping this statin looks to be in my future.

    2. I have to agree with you. I’ve been trying to talk about this with doctors on my parents behalf but am being met with “there are some proven benefits..”. They both have a lot of amalgam fillings, both on statins, one have a beta blocker and both on blood thinners. Both normal weight and been jabbed with the 4th. 77 resp 83 years old. To me it seems that a toxic overload is the main cause of their health problems but no doctor would listen or feel tempted to investigate in this. They’re both now diagnosed with Alzheimers now and my father’s problems started after the first jab and has increased shortly after each while between the 3rd and 4th he seemed to be recovering and now worse again. He cleared the brain scans last autumn but a couple of weeks ago he did not.
      It’s frustrating not being listened to and now I can’t decide for them due to their diagnosis.

  20. I’m 68 years old. I am very fit and do not take any internal prescription medications at all. I am also very educated health-wise, and have repeatedly turned down ‘offers’ from my doctor to go on such as statins etc. [Indeed, when I asked a young member of the ‘team’ at my university-based clinic about the numbers on the cholesterol test, e.g. ‘sub-fractions of LDL’ etc, the doctor didn’t even appear to know what I was talking about. They only stopped their ‘appeals’ when I pointed out that my triglyceride to HDL ratio was in the ultra-low range, i.e., 0.5]

    As for psychiatric drugs, I once – I am independent journalist – wrote a scathing critique of the latter in 2001 entitled, ‘Prescription for Scandal: Biological Psychiatry’s Faustian Pact’. It went a tad viral, and so I append below a link below for those who might be interested.


  21. This post is particularly good in that it is particularly horrifying, but many of your readers -by self selection- are horrified by the medical establishment on a regular basis. Even my “great doctor” who is wise and thoughtful and follows through every possibility of a scenario in benefits vs risks, gets to a point in our discussions where he says, “Well, it’s great that you’ve lost all that weight and started exercising and cut your risk of heart attack by 75% without going on meds, BUT the heart doctor is not going to be happy with your cholesterol level so he will really want you to go on statins…” It’s like no one in the medical/pharmaceutical business wants to offend each other, and you as the obstinate, curious patient are some sort of professional embarrassment.
    Thank you for continuing to post well research, person-oriented information that doesn’t (seem to) have a financial driver behind it.

  22. The maximum NNTs I would required for the SSRI is 3 and for statins 5. I stopped taking statins for secondary prevention for this reason after realizing how much they were harming me. I also stopped taking low-dose Aspirin, which has a one-year NNT of over 1,600. Instead, I adopted a low-carb lifestyle and do annual Coronary CT scans which are examined closely by a preventive cardiologist to verify there is no progression of calcification.

    1. Vit k2 MAY help with ectopic soft tissue calcification. Use your good judgement. Diet programs using almost any good foods along with intermittent fasting are showing good success, and way more natural. Just think about YOUR life.
      Larry W Banyash MD, retired

  23. Many years ago for reasons I still don’t know, I became run down, weak, tired, no energy. I worked out every day, but suddenly no longer could. After the doctor couldn’t determine what was wrong he sent me to the shrink. She told me I was depressed. I told her, maybe I was, because I couldn’t do what I normally do. She told me my symptoms were because I was depressed and prescribed Paxil. I left her office, never filled the prescription and eventually got better. Glad I didn’t take that drug.

  24. I am appalled by this information even though it comes as no surprise. Thank you for revealing it. More than ever, I’m determined to avoid the medical profession as much as possible. Things are even worse than I thought. Of course there are the honourable exceptions but the chances of of meeting one are very slim- you’re a long way away!

    1. People don’t realise drug treatment is a numbers game. For example suppose the NNT for statins is 50 (it’s actually 40 but 50 makes the calculation easier). Therefore 50 people need to be treated to prevent 1 heart attack therefore 100 treatments prevent 2HA ie 2%. Suppose one million take the statins that means 20,000 ie 2% do not get heart attack. Of course the 98% who aren’t helped May suffer with adverse effects. But 20,000 people is a lot of people to help. This is how it works it’s a risk benefit equation but most people don’t know the reality. Of course it depends on the drugs eg antibiotics are highly efficacious and should be taken but CNS drugs ie antidepressants far less so around 7 NNT

      1. I am curious about the NNT of 40 for statins in secondary prevention. Do you have a link? I ask because I remember Dr Kendrick talking about the NNT of 300. Unless he was talking about primary prevention and I got them mixed up…


      2. It’s not really a question anymore—cholesterol does not cause heart disease. Period. It. Does. Not.

        You have a good mind and judgement…. Do what is finally right.
        Larry Banyash MD, retired

  25. I am a little confused by your article, inasmuch as you appear to be using “odds” and “probability” interchangeably. I thought that 7:1 odds would correspond to a probability of 1/8 (i.e.: 12·5%), since I read 7:1 as signifying “for every 7 people **for whom the intervention did not work**, there is one person for whom the intervention worked” (and *not* “for every 7 people who received the intervention, it worked for one person”). Does NNT follow a different convention/usage?

    Of course, I agree that the underlying point you make is excellent, and certainly something that must be taken more seriously. And I think you are right to emphasise the importance of greater transparency (and humility) among practitioners when discussing an intervention with a patient. Presumably, side-effects could also be measured on a similar NNT principle (Gøtzsche seems to use such an approach to discuss serious side-effects in his recent book on vaccines), and thus enable patients and those advising them to arrive at something resembling a risk-benefit ratio… although the problem remains that some types of outcome are far harder to measure reliably than others (due to factors such as under-reporting, lack of identifiable symptoms, sensitivity of the test being used, &c.).

  26. I don’t trust doctors at all ! Tablet for this and that ! I dont take anything stronger than a ibrufen. Antidepressants nearly killed my mam ! It dropped her sodium down to 20. A few years later they put her on them again and luckily i stopped them as she was going downhill. Diet and natural supplements cure everything even cancer, but doctors follow the pharmaceuticals and make them richer. Ive followed you for nearly 2 years and i was very impressed until you said the covid jab was safe ! Not sure wether you agree now after all the data that is coming out about the deaths and side effects. I’d like to know the NNT of the covid jabs ? What puzzles me, for years we’ve went to doctors and they say its viral and it will pass. Sars2 is a virus yet they want the whole world to take a jab, when in the past doctors wouldn’t give anything for a virus. I trust my immune system and I’m well.

    1. I too would like to know if there is a valid NNT for the COVID vaccine, and so also, in particular for ivermectin as both preventative and treatment.

      Reason: we are still being stigmatized and lumped as antivaxxers, when one of the principal co-founders of the recent Together trials of COVID, came out in writing that he was recanting his previous negative statements re ivermectin, and that the trial did indeed show a very real tendency for benefit if more people had been enrolled in the trial. (Dr Mills, McMaster Univ)—so does NNT then impact these trials also?

      1. Dr Mills at McMaster recanted? Can you provide a reference for that please?

  27. Thank you! I take a statin which is supposedly preventive. Before statin it ranged from 108-120 depending on how well I watch what I am eating. My LDL is less than 100 and hovers around 75-65 with the statin. I’ve been contemplating stopping it, because I don’t have a family history of heart disease or heart attack. I didn’t have any side effects that I can discern and no cognitive issues given cholesterol is important in brain function and precursor to hormones. I’ve read numerous articles on the usage and it’s been frankly a mixed bag. My focus has always been to optimize my health and well-being (stay out of the hospital) and I am on a sustainable track through exercise, nutrition, supplementation, sleep and stress reduction. Retired, but there are those challenges in life that one must contend with. Oftentimes I am can confused and frustrated with the supposed recommendations on health related topics. Eat this, but don’t eat that etc…. Everything I practice is in moderation, so I suspect I am on the right track. Time will tell. I could get hit by a bus tomorrow or be called home by God. Your article suggests that the benefit is not there, although there are no discernible side effects. I am going to read the book you suggested, “The Clot Thickens.”

    1. Good comment. I am uncertain that statins actually affect the actual count of the small dense particles—which actually is the presumed culprit. PCSK9 inhibitors do seem to lower that sob group, although unclear as to why…

    2. I found it when I googled the Together Ivermectin trial on my IPHONE. His statement was enclosed in a black box. It did not come up on my laptop—only on my IPhone. Verified by his secretary per phone call ( I hope she was) …..I’ll try to find it again and figure how to load on this site.
      Dr Larry

    3. to Dave S.
      tried to send a hyperlink to the actual statement, but experienced great difficulty with actually uploading and sending……went to Sebastion’s site to explain and sent the hyperlink to him, but do not know if it came through

      larry banyash md, retired

  28. I do understand NNT & NNH, but what would be more useful, for instance with statin, would be the NNT for say older women with no prior heart disease and only slightly elevated cholesterol. I am guessing it would be a rather high number compared with the NNH.

  29. My wife takes anastrozole post-lumpectomy. The side effects are horrible. I am now wondering just what the NNT is for this drug and whether her oncology can provide an answer. She has been on it for 2.5 years and 2.5 years to go. The previous oncologist suggested a 10 year term. My wife said no way given the side effects she has experienced since starting. The fatigue, insomnia, weight gain and bone pain suggest the side effects outweigh the benefits when it was suggested that without anastrozole there was a 30% of reoccurrence. Not to be cruel, but perhaps a lumpectomy and possibly radiation is a better course of action. My wife will bring this article to her attention.

  30. I am grateful for your explanation of NNT. At last, a simple question that I can ask, that I will understand the answer, and that is very revealing of which drugs need a lot more scrutiny than patients and doctors usually give them. I will be able to remember to ask “what is the NNT?” when my doctor wants to prescribe something. That will tell me something about that doctor, as well. Thank you, Dr. R.

    1. Most GPs will not know the NNT for a drug category I’ve had the discussion, should say I’m a drug discoverer/developer

  31. I used to work with someone in a night shelter, who frequently said, ‘Bless your cotton socks!’.
    Bless your cotton socks, Sebastian, for speaking out to us as fellow human-beings on everything, including today’s ‘NNT’. It has taken me four decades to slowly identify the multiplicity of hidden agendas within General Practice that most patients are completely unaware of (or refuse to believe).
    I am so grateful to all the doctors who have at last decided that they have, in all conscience, to speak out. I am at end-of-life but at least am not being physically harmed in any way by medical self-interest/s.
    Apropos Statins, Dr. Kendrick’s first book told me almost everything I (then) needed to know. My husband however was persuaded his own GP knew better. Six months on Lipitor set him on the road to ill-health.

  32. Interesting. For the SSRI’s i reckon they are worth trying even if only 1 in 7 chance. If they work, great as long as you can put up with the side effects. If they don’t work, stop taking them.
    For the statins, its not as easy as the benefits and side effects are much longer term and not readily apparent.

    1. The SDRIs work best in people with severe depression for mild depression they are less effective.

  33. I am 74 and was doing no meds ever. Now am on Norvasc because the MD had a fit with my bp of 150/70, sometimes 160/70. He says high bp wrecks kidneys. My lifestyle is perfect regarding bp; slender, naturally athletic, live conservatively etc. – there is nothing else I can change to lower it. I am unhappy and suspicious of taking this pill. I do not trust taking this pill forever. I am colossally sensitive to medicines that’s why I’ve never taken any. I looked up the NNT on internet:
    In Summary, for those who took anti-hypertensives: Benefits in NNT
    1 in 125 were helped (prevented death)
    1 in 67 were helped (prevented stroke)
    1 in 100 were helped (prevented heart attack*)
    Harms in NNT:1 in 10 were harmed (medication side effects, stopping the drug)
    I know, Sebastian, you’d say that I have to decide based on the NNT. But I sure wish I could discuss this with someone rational and objective and knowledgable, rather than all alone. Given my sensitivity to drugs.

    1. jag undrar hur man kan sluta med blodtrycksmedicin efter ha tagit piller sedan 1981? Kan någon tala om det för mig vore jag tacksam till tusen.

  34. With those hit lists of side effects – and after having watched my own father suffering from dementia after years of taking statins etc. – I would say that my NNT is 1.

  35. This is shocking to read. I think we live in a time where people in general aka most of us think that medicines work just like magic – for all of us – and that the top priority for our medicine companies is our health. Of course it’s not. It’s to make money, just like any other company. We need to remember that. I’m not on any medications and my goal is to stay that way for the rest of my life.

  36. I thought an NNT of 1 would be required to get me to take either of these drugs, and maybe not even then, but I don’t suffer from depression and haven’t had a heart attack. I might have rated them differently if I were an actual sufferer.

    I find the NNT concept useful, but how does one get that number for any particular drug that a doctor proposes taking?

  37. Another interesting article Sebastian, thank you for all your “Sound Information”

    I personally think that the NNT should be 1. Or could I present it like this, “The person prescribed the medication should notice a benefit in the condition that they are taking the medication for”

    It is very unfortunate, but we appear to have lost our way. Can you imagine the NNT for a “bullet proof vest” was less than one. I don’t think they would sell very well. But yet it would appear that we happily place the paitient in the line if fire daily.
    I see it like this the first issue is we do not fully understand the cause of the conditions, and the second we do not fully understand the treatment that we provide. Yes there is a lot of unknowns there and I think we should go back to basics. May I say treat the cause and not the symptoms. That may sound a little over simplified but it is not wrong to say, ” I do not know”

    Sebastian, your articles are always excellent and informative and most of all they have been transparent.
    There must be more transparency in way drugs sold , but I fear that is a very big ask.
    Thank you.

  38. Excellent article, the extent to which we are being pharmed is mind-numbing. My husband had 3 hospital admissions for (very messy) nose-bleeds whilst on statins, without any clinician treating him looking at the pharma leaflet for said statin, where it’s listed as a side-effect. Bleeds stopped when he came off statins. He has AF & LVF, for which he takes other medication, but has managed to chug along into his 80’s after nearly 2 decades without statins. I have arrhythmia & asthma; struggle to breathe without my daily use of steroid inhaler, but get by on half the prescribed dose. Ditto for the verapamil for arrhythmia, but here a third of prescribed dose. Have resisted invitations to escalation (statins, anti-coagulants etc). Both my prescribed drugs have main effects at those reduced doses, but side-effects are minimal. Suspect that many side-effects could be rendered more manageable if pharma & clinicians stuck to the principle of minimum effective dose.

  39. Not even an NNT of 1; no thank you.
    Instead, most of my health (and life expectancy) odds reside within the mantra I borrowed from Hyppocrates; “Let food be thy medicine, and let medicine be thy food.”, and I do my best to avoid stress, breath clean air and drink pure water;
    oh yea, and avoid MDs and our so-called health system, which I believe is an out-of-control, despicable racket.
    cheers 🙂

  40. Another insightful article. And another new term (NNT) I’d been blissfully unaware of. While reading the article I wondered who in their right mind would take a drug with a NNT of 100. Then it struck me. Probably the vast majority of patients.

    And the reason for my conclusion. Because here in the UK, and across much of the developed world, patients rushed to have a drug administered for a virus that had less than a 1% (overall) chance of killing them. And it would be hard to argue this critical information was suppressed, although admittedly it was drowned out by the overwhelming message to do the “right” thing for society at large. But nevertheless the information was widely shared and knowingly ignored.

    I suspect our tendency towards herd species behaviour together with respect for authority (especially medical) are much stronger drivers than individual accumulation of knowledge. On this basis, it is the doctors – like Dr Rushworth – who will need to bring about any change, more so than the patients. Change will come, but because it will need to be primarily from within the medical establishment, it will be a long, slow process.

    Keep up your excellent work and I look forward to your next article.

  41. What an interesting post! On mention of those side effects, no NNT however good would persuade me to take those drugs. But, I am a person who always used to get side effects ++ and I am now lucky enough to understand and have confidence in basic good health (diet, exercise, sleep, supplements etc). At 70 I regard myself as a Quality Outcome Framework escapee, don’t take any meds and haven’t needed to see my GP since 2013. I am very angry at the way my generation and older is over medicated. Only 7% of us are medication free.

  42. Tack Sebastian för ett mycket informativt inlägg. NNT var för mig helt okänt och det förvånar mig att man kan vara nöjd med NNT 5 (med de biverkningar som kan följa med).
    Om NNT för statiner är 40 så är jag mycket glad att jag tackade nej till förslaget om statiner ifrån min husläkare. Och det tackar jag Lars Bern för. Han är tydlig med statinernas nackdelar.
    Praktiker som jag är ställer jag frågan: Om du har ett missljud i kraftöverföringen i din bil och åker till verkstaden för att få hjälp, skulle du acceptera att betala för verkstadens åtgärder om oddsen är 1-5, eller 1-40, att de får bukt med problemet, och dessutom riskera att bromsarna slutar att fungera?
    Är vi så rädda att vi går med på det mesta utan några som helst funderingar?

  43. Thank you for this excellent, concise article.
    I would want NNT less than 2 before taking either of these medications.

  44. As you and others I now follow educate me I am saddened.
    I believed in my healthcare system pre 2020. Yes, I knew pharma had influence but I naively trusted NICE, and the wisdom/knowledge/ethics of our primary care GPs. I trusted the people in positions of healthcare power.
    I now truly believe that our primary care system is fatally flawed, and that healthcare delivery has been taken over by protocols and a centralised drug prescribing culture. GPs, who may well be people of good ethics, are part of a corrupt and profit-driven system from which it is very very difficult to extract themselves or go against the flow.
    I’ve personal friends who are GPs and during the last 2 years they have been unable to answer my critical questions on the policies they are implementing.
    They are blindly following orders and we all know what history has delivered when people did this.
    I think I want to remain positive as as a lot of good has come from this global scandal. Many people have become aware yeah and and that is the beginning of change.
    In the case of the antidepressants and the statins for me it would be a one-to-one ratio.
    Thank you as ever for you good energy and shared wisdom

  45. Very good article overall with excellent and probing questions into various valid tangents

  46. To be subjected to the mentioned side effects I wouldn’t be willing to take any drug with an NNT larger than 2. After the last two years I came to the conclusion that there’s a huge collusion/corruption between doctors and big pharma. My current trust in the system is zero, to me it’s the biggest scam of all ages.

  47. I never had a doctor who would mention nnt. Most of the time they are busy scaring you of the horrible consequenties of not taking a med or treatment. I lately asked dentist who wanted to try on me some invasive treatment about some evidence. She did not know even how its called in english (in the netherlands).

  48. NNT is a concept most applicable to drugs given to prevent a future occurrence (e.g. statins, anti-hypertensives) or when the effects are idiosyncratic (e.g. SSRIs).

    It is not really applicable to many other drugs which have a clear dose-response relationship. Morphine is a good example, as are all anaesthetic and ICU drugs, in which the effects ramp up from the first molecule and are similar in all patients.

    The problem with all drugs is the inter-individual variability between patients is large. Generally, for any drug given by any route, there is an 8-10 fold variability in both the pharmacokinetic effects (how the body handles the drug) and the pharmacodynamic effects (what the drug does to the body). Outside of anaesthesia and ICU, where I used to work, and the drugs are titrated to effect, the ‘dose’ prescribed is an average, and probably is not the optimal dose for most people.

    1. This is correct a huge amount of work goes into understanding drug genetic polymorphisms in drug discovery. For a number of years we have had screening tests to identify Cyp450 isozymes mediating pharmacokinetic polymorphisms these enable the identification of an optimal drug and dose for patients. Alas most GPs know little of these technologies

  49. I think this question: “[What] would have been reasonable NNT” does a little bit of hiding the real problem under the rug. What we need is better — more precise — ways to tell if you are one of the people who is getting the benefit from taking medication X for problem Y. Then the NNT number doesn’t matter in the same way. We give 100 patients drug X, and 2 get a benefit and are very grateful for it. We stop giving the drug to the other 98, and have to find some other way to treat them. We don’t want to end up in a situation where the only drugs we have are those that work on most people who suffer from common ailments — which would be a different way to fail than stuffing so many people with drugs where they are receiving no benefit.

  50. “Morphine is a good example, as are all anaesthetic and ICU drugs”

    Appreciated your answer. Analgesics fit in here, too, I think.

    “The problem with all drugs is the inter-individual variability between patients is large.”

    E.g., if a patient has some variety of FLD, then supplementing with D3 may have little impact on 25OHD levels. And patients with a high BMI require more D3 to affect their 25OHD levels than patients with low BMI. You’d think that recommendations would be on the basis of IU of vitamin D/kg (or pound). 100 IU per kilo is my napkin estimate

    Isn’t it strange that most doctors won’t even consider recommending calcifediol for supplementation to their patients? I mean, there’s a point where it makes sense to be conservative, and a point at which caution becomes ridiculous.

    One doctor looked at the cautions for calcifediol and rejected it, all the while prescribing 300k units of D3, which must have taxed the liver and produced the same amount of calcifediol as if a supplement had been taken.

    With calcifediol you needn’t worry about FLD, BMI, IBS, or many other three letter conditions which would come into play with D3.

    Of course, I’d supplement K2 with calcifediol just as I would with D3.

    Then there are David Grimes and Sunil Wimalawansa who both know quite a lot about vitamin D research who recommend calcifediol without reservation (barring zebras, of course).

  51. First—FLD?
    Second—on calcifediol two tabs daily
    Serum vit d—OH one month
    Third—on ivermectin weekly as well
    As some elderberry gummies
    Daily. All over a one year
    Span to date.
    No Vax. Doing well. Only share in this group due to great negative feedback if even shared with my colleagues. (OH vit D cheap from Amazon)
    Still to date lots of stigmatization and humiliating remarks if I even suggest as therapy.
    Dr Larry, retired

      1. Why do you take ivermectin a drug used to treat parasites and a drug that has never shown activity against Covid in double blind trials?

      2. Warfarin is used to poison rodents, yet is used in humans as an anticlotting agent.

        Didn’t you know that drugs can have multiple purposes?

        Do you know of any well-designed, well-executed double-blind trials of ivermectin? Please, enlighten us.

  52. I fly a plane. Imagine this. I am at 10 000 feet. Plane catches fire. Wings fall off. I jump out with my parachute. Halfway down the manufacturer calls on my cell phone and tells me the parachute’s NNT is 40.

    1. To the asdgamer:
      There is the recent Together trial of ivermectin, but with a small population count for study. One of the co-founders of the trial has stated in writing —after the trial, that the study clearly showed a favorable result for ivermectin, but not statistically significant —DUE to the small population size. He also put in writing that he was withdrawing all previous negative comments re ivermectin. That was Dr E Hill, Mc Master Univ, Canada. Only RCT that I could find. A journalist, before Dr Hill made his comment, jumped on it saying in essence “see, the anti vac people lose again—writing for the CFI, of all organizations supporting logic and reason…..
      Hope this helps. I double checked his statement with a phone call to his secretary. It was deemed quite truthful
      Larry W Banyash MD, retired

      1. You can Google this trial and the Conclusion states that Ivermectin had no effect on the rate of hospitilisations of ivermectin versus control groups.
        That’s what it says

      2. David,

        The stats on time to treat are missing from the TOGETHER trial…somehow.

        What is reported is the time between symptom onset and randomization, iirc.

        There’s a 72 hour treatment window from symptom onset for any antiviral to be used against covid to prevent premature death (assuming the patient isn’t on his deathbed when infected). There might possibly be benefit if given later, but within 72 hours of symptom onset is best correlation with lowest mortality.

        Shame on me. I have a nasty habit of ignoring conclusions and looking at the data for myself.

  53. I would not accept any NNT greater than 1, because such a level means the doctor and the people who made the drug dont have enough information about me or the problem they are trying to fix. The drug must produce a measurable, beneficial effect in a chemical and biological way, even if it is only a small effect over a period of time. I would weigh the beneficial effect against the harmful effects, which must have mitigations or time-limited expiry to even consider the drug.
    Wine, for example, fits this definition.

    1. To David,
      Again, read the comment on the trial by one of the two cofounders of the Together trial—irregardless of ?final conclusion. I believe it speaks for itself!
      Larry W Banyash , MD

  54. Is there any way you can determine if the odds are higher given a specific condition in the patient? Like on average the NNT is 50 but if the patients don’t suffer from condition X it is 25?

    1. We can characterise patients for genetic polymorphisms relating to the clearance of the drug, this is routinely done in discovery. This gives an indication as to whether a drug will work or will not work in patients with the identified polymorphism. Example many antidepressants are cleared (removed from body) by an enzyme called 2D6 which is polymorphically expressed in 8% of Caucasians. If you are are so called poor metaboliser the drug will achieve toxic concentrations and give rise to adverse side effects ie it’s not the drug for you

  55. Dear Sebastian,

    To answer your question, for the anti-depressant no NNT would seem adequate to compensate for the side-effects. I’d rather try to treat depression through behavioural modifications, say exercise or decreasing my alcohol consumption. I should note that I was once prescribed an SSRI when I went in for a sore shoulder and trouble sleeping. I have not idea why, but the doctor was used to treating academics and probably assumed I was depressed. The only side-effects I remember were increased regularity in my bowel-movements and a more persistent and hard erection, both of which were okay with me. Didn’t help with my shoulder or sleep though, so I discontinued after a month.

    For the heart attack, I think I would require an NNT of 1 or 2. I am highly skeptical of statins and of most of the medicines that doctors have tried to prescribe for other chronic conditions such as high blood pressure. At times I have let a doctor convince me to take them, but I was fortunate to have an allergic reaction both times – a good excuse to stop taking a medication. If there are no drugs that can guarantee at least a 50:50 chance of preventing another heart attack in the next 5 years, then I would eliminate carbohydrates from my diet, lose weight and maintain a good exercise regime. A magic pill would be nice, but I don’t think there is one.

  56. For me, it has to be at least a 50/50 chance of benefit, bare minimum, before I will take any medicine. The problem is, when in need of help we tend to grasp at any hope & defer to what we hope is good advice. Often tho, I think it’s simply convenient advice as we get shunted along the conveyor belt of care.

  57. Thank you Sebastian for bringing another interesting subject to light 🙂
    Depression – I wouldn’t take any drug to decrease a depression even if the NNT was 1 as long as there are any risk for side effects. Instead I would try to work with the root cause.
    Heart attack – If NNT was 2-3 I would consider taking a statin as long as the markers was alarming, but if higher I would focus on changing my lifestyle and fixing the root causes. Which I would even if I was taking a statin, with the goal to be able to quit taking statins as soon as possible.

    1. There is no such thing as a 100% safe drug never has been and never will. Taking drugs against a disease is always a risk/benefit equation but most people don’t realise this.

  58. And then there is the issue of haptens. Most drugs are haptens and all haptens can cause auto-immune-type responses.

    Haptens are defined merely as molecules that have a small size, such that they are not immunogenic. However, once inside the body, they (or a metabolite of the drug) may easily combine with an endogenous protein. That hapten-protein complex or adduct (you always have to learn an entirely new language to research anything these days) will then look foreign to the immune system and antibodies will be formed against it. Three things can then happen: Antibodies can attack the (drug) hapten, some area where the hapten and protein attach, or they can attack the host protein. In the latter case, you’ve now got your own immune system attacking one of your own proteins. NOT a good thing!

    Everyone should know about haptens. Since most drugs are haptens.


    1. Potential drugs are tested for immunogenicity potential during preclinical investigations. I did once work on a drug called Practolol which gave rise to sclerosis peritonitis in only one in 10,000 people. You can only detect such rare toxic events once the drug has been launched

      1. The ability to detect rare events depends on the size of the treatment population. The trial size should should be designed so as to discover rare events appropriate to the population size.

        In the case of covid vaccines, trial size should have been at least a million and should have gone on for three years.

        Is there anyone here who still doesn’t see the covid vaccines as a disaster?

        We see sky-high non-covid excess mortality in working age populations in several western countries of which a large portion is likely due to vaccines.

  59. Drug trials are designed to produce measures of statistical significance for efficacy assessment and the Covid trials met these criteria. Blinding can be broken once hospitilisations numbers reached the level to assess statistical efficacy. Your comments on trials should contain a million and last 3 years show you don’t understand clinical trial design. Your last paragraph is simply wrong. Should say that I have worked on drugs and trials for 40 years and it’s clear so many people have little idea about drugs/vaccines and their discovery

      1. As I said you have no idea how drug trials are designed so you really shouldn’t comment. I’ve been involved in drug trials for 40 years, you should take this opportunity to ask questions of someone who has actually helped discover major innovative drugs

      2. David, I understand the standard pharma marketing spiel that you run up the flagpole. Minimal evidence to show efficacy and maximum evidence to show harm. Same ol’, same ol’.

        I’m quite capable of reading and understanding the literature. I also understand pharma’s strategy quite well.

        If you have something useful to contribute, I’m all ears. You haven’t mentioned any particular expertise, other than time working for pharma. Could be marketing for all I know. Yeadon has quite a different take than you do about the covid vaccines and he has considerable experience working for Pfizer in a technical capacity. But I still do my due diligence and don’t rely on Yeadon.

        The very short term Pfizer covid vaccine trials were based on a dodgy test with a high false negative rate. The efficacy data from the trials is useless. (Pfizer probably had data about the rate of decline of antibodies and hid it.)

        Considering some billion vaccine doses have been rolled out, one might have expected a bit larger number than 42,000 trial participants. It’s almost like the size of the trial was designed to prevent excess mortality numbers from reaching statistical significance. As it is, the significance is high enough that the null hypothesis isn’t to be preferred. That must have been concerning to Pfizer. The FDA must have had a discussion about that.

        Unlike other vaccines, there were no long term studies using animal models.

      3. Who besides Yeadon has experience working for pharma? Robert Malone. And what does Robert Malone have to say about his work for pharma? Malone now questions the value of his entire life’s work and whether it ended up doing more harm than good.

        Geerd vanden Bosche is another pharma person who questions the covid vaccines–especially the timing.

        David, perhaps you could elaborate about harms in the drug development process that you see based on your experience and systematic errors in the drug development process that lead to a lack of discovery of adverse effects from drugs.

        If your expertise is drug discovery, would this perhaps lead to a strong bias to not see drug harms?

    1. for David and the asdgamer: enclosed my reference by Dr Ed Mills, McMaster univ re ivermectin. only brought up here because David so (it seemed)quickly dismissed this study and comment by one of the cofounders of the Together study without actually looking at his comments, or, the actual study showing incredibly large study problems.Re: Reis: Effect of Early Treatment with Ivermectin among Patients with Covid-19.


  60. Hi Sebastian, thank you for the article.

    I would never take a pharma drug prescribed by a western physician because their model of health and disease is wrong.

    Heart attacks are a great example. Hearts don’t attack us, we attack them with crappy food, including toxic seed oils like rapeseed, and suppressed sad emotions. No wonder they keel over in agony.

    1. it is my hope that from David no bias exists–as would seem in his reply to me re the actual co-founder of the Together trial , Dr Ed Mills, of McMaster Univ. it just seems he gave little credence to his comment in deference to the supposed “final” findings of the study……which Dr. Mills has clearly implied being flawed.
      larry w banyash, MD, retired

      1. We can attempt strategies to mitigate bias, but it can never be eliminated.

        The problem with pharma is that its strategies are wholly aimed at pushing its products and minimizing its liability, which means pretty much carte blanche.

        What happens to pharma whistleblowers? They get fired. What happens to doctors who speak out against pharma products? They get censored and/or fired and/or lose their medical licenses and/or are investigated for malpractice and/or have to undergo psych evaluations.

  61. Here’s good example that many of us need to think about. My physician recently recommended a Shingrix vaccination. Current advertising claims that 1 in 3 of us will get shingles and we know how nasty that can be. The overall risk statistics are: 91.3% relative risk reduction, 3.10% absolute risk reduction and NNT of 32 (over 3 years). Side effects have been reported but mostly not very serious. If I only saw the ads or the RRR, I would be inclined to take the vaccine. But looking at ARR and NNT, I’m not so sure.

    1. Relative risk is always used by Pharma as absolute risk is by definition a lot smaller. You have to bear in mind that a NNT of eg 20 still represents a large number of people being helped with disease. The big issue is the adverse event profile. If the AEP is minimal it’s worth going for NNT of 20 if the disease is serious enough. Don’t forget many areas of drug administration have NNT of 1 eg anaesthetics

      1. So 19 people out of 20 get no benefit but have to pay for products that don’t benefit them and risk side effects, some of which only surface long term, in order to benefit the one person.

    2. I got shingrix before I knew how effective vitamin D was at improving my immune health. There are a surprising number of things that contribute to immune health, including vitamin A, vitamin C, magnesium, selenium, zinc, etc.

      Long term cadmium poisoning will undermine immune health because cadmium is a zinc competitor. Cod, squid, and mussels seem to have high levels of cadmium.

      Mercury is in the same column as zinc, so I would expect it to also compete with zinc to some extent. You find mercury primarily in the flesh of predatory fish like tuna and swordfish.

  62. Read my reply again. It depends on the disease if their is a NNT of say 30 and you have a serious disease then a 1 in 30 chance of gaining relief provided the AEP is low is probably worth taking. People need to understand drug risk/benefit . I should probably post something about pharmacogenomics and why drugs don’t work in all people, perhaps I will

    1. Yes, risk/benefit depends on the disease, but that isn’t the only factor.

      Let’s take hydroxychloroquine as an example. There’s a very, very low NNT for lupus. Millions of doses have been taken for years, including by people with Q-T prolongation. It’s considered a very safe drug. There are maybe a handful of case reports on cardiac issues in the literature for this drug at clinical dosing. However…

      HCQ is known to cause retinopathy in a small percent of cases, beginning at seven years of chronic dosing. I think that it’s a common sense guess that HCQ poisons people very slowly, with the effect showing up in the retina of some small percent. And we know that HCQ raises the pH of endosomes, which means that there will be some endosomal dysfunction in cells, resulting in various metabolic issues. So, we must consider not only risk for drugs, but also long term toxicity. Almost all drugs are toxic to some percent of people when taken chronically. And maybe toxic to all to some degree, with most having vague problems that can’t be diagnosed.

      So, we have to consider risk/benefit, of course, as well as cost/benefit. With great risk of disease, then greater risks may be taken wrt side effects. But we must consider not only relative risk, but also absolute risk when we are looking at dosing hundreds of millions of people. Even a small absolute risk can have a huge impact with hundreds of millions of doses being given. Side effects may be 580 per million, which means 580 x 200 people may be impacted by a side effect. 116,000. Let’s pretend the side effect is myocarditis. That means that a _huge_ number of people are living with a Sword of Damocles suspended over their heads. But it gets better.

      The 580 per million rate for myocarditis is only for old men. Myocarditis as a side effect is likely much higher in young men. Maybe 1 in 2,000. And myocarditis is often subclinical, which means that we have underestimated the problem.

      But nobody is really too interested in looking very hard at this problem. The studies I have looked at have all played games with adjusted data and withhold the raw data. The CDC could have looked at sampling troponin levels after vaccination in some limited locale, but didn’t. Diaz, et. al., looked at hospital records to find their estimate of myocarditis in young men. They found a higher incidence than the CDC, but we have no idea what incidence occurred in outpatients. And even that number may be low because myocarditis is often subclinical.

      Why would myocarditis in old men be found more often than in young men? Because old men are more likely to have their troponin levels checked. Myocarditis in young men is more likely to be missed than in old men.

      A _few_ pediatricians are testing their patients’ troponin levels before releasing them for sports.

      Myocarditis is subclinical until it’s not. Which may be in the middle of intense sporting activity where the first indication is cardiac arrest.

      1. A shift from NNT to adverse events….extremely important, and for the effect profile a superb post—however, I honestly wished I could remember when either my primary care or specialist spent that quality time….but that is a whole mother post…. A fill in doc for my cardio came in ( bout month ago) kept looking at computer, said I looked good BY LAB and got ready to go. I asked him to wait a minute to ask me the question. He said “what question?” I replied, for starts: how are you today, Doc B?………it just never ceases to amaze our change through the years talking one with another. Sorry for the length of this post…..and thanks for a place for a quite studious exam of almost any medical/SCIENTIFIC issue.
        Dr Larry

  63. Dear Sebastian please comment on the recent increase in cases of acute hepatitis among children in some countries. What is the likely explanation? Is there an increase in cases in Sweden as well? Can we rule out the Covid19 vaccines ?
    Some headlines “CDC Warns About Severe Hepatitis Cases in Children” (Yahoo, April 22).
    “Update: Hepatitis of unknown origin in children” ecdc.europa.eu/en/news-events/update-hepatitis-unknown-origin-children

    1. Reply to asgamer…
      If you are sincere, feeling well. Thanks.

      Otherwise have I missed something?
      Dr Larry

      1. Well, your cardiologist forgot to ask, but I remembered even though I’m not a doctor (. And why do we ask each other how we’re feeling? Maybe because we have a little compassion and may be able to offer assistance if needed?

        Two things that PC docs should do wrt physicals: 1) ask patients to prepare a list of supplements they take and 2) ask patient to prepare a list of health issues they’ve noticed. In the moment, people often forget–at least I do.

  64. The WHO report does not say the Covid vaccine is to blame it says adeno viruses are circulating and it’s unknown whether these have some effect. The role of the vaccine is unknown, if it has any effect. The rest of the report you link too is full of so much nonsense it’s difficult to know where to start. May I just say don’t believe everything you read and let the experts do their work

    1. In that I’m a retired physician, and a scientist of sorts, why should we even be giving a “vaccine” with “ unknown effects “ from a study too fraught with errors?? It is though blatantly obvious that it is not a safe medicine, irregardless of any NNT (open Vaers.com). We continue to argue merits, when the hard end point of drug induced DEATH cannot be minimized…. Is this not a type of insanity? And now I must be punished because of vax refusal due to legitimate concerns re it’s very safety, ie, passports etc.

    2. To asdgamer,
      Man,am I older or what? Thanks for asking as a very old mentor told me long ago: if we listen to a patient long enough, they will tell you their diagnosis. However, your added ideas are a very good addition to the initial history! Have a good Sat . Sunshine and 75 here today.

    3. Did you look at one of the referenced studies? “Autoimmune hepatitis developing after coronavirus disease 2019 (COVID-19 vaccine): causality or casualty?”


      It seems that tests for the normal viral agents that cause hepatitis are negative.

      I ask my vascular surgeon buddy about clotting issues he sees. Some look to be due to covid and some to vaccines. And maybe to vaccine-enhanced-risk covid. (You _do_ know that people who get covid while in the 14 day waiting period after vaccination aren’t counted as breakthrough cases by the CDC, right? So maybe vaccinations added to risk during the waiting period but the risk was “mistakenly” added to the unvaccinated column because of the CDC’s definition of “vaccinated”.)

      I think that it’s a matter of months before the CDC starts releasing 2021 data about increased novel onset conditions in 2021 categorized by age. There will be great perplexity about what caused the sudden increase. Eventually, maybe after a court case, vaccines will be blamed for most of the increase, while covid will be blamed for about a third. And if people are clever, they will look at breaking down the covid statistics by vaccine-waiting-period, but I think that that will be difficult and require unusual techniques–at least in the US. Those statistics are available for UK data.

  65. The Japanese study in the report is a bio distribution study using radiolabelled material probably tritium. The 27,900 unequal/g is not mRNA spike it is radiochemical equivalents in fact if tritium was used it could be water. These biodistribution studies are routinely undertaken, I’ve done scores of them. You are not measuring unchanged drug or vaccine. The author of this report doesn’t understand the science. A body of toxicology studies in animals was undertaken on the vaccines you can find the full listing on line. Some people are at risk from the vaccines eg young males aged 19-35 have a slightly increased risk of cardio toxicity. The risk of eg blood clots is way higher in unvaccinated people than in vaccinated who catch the Covid virus.

    1. Blood clots can be prevented with simple ASA from the illness. Death , once it occurs from the vaccine, can no longer be prevented.

      But thanks anyway for the update.
      Dr Larry Banyash

    2. “Some people are at risk from the vaccines eg young males aged 19-35 have a slightly increased risk of cardio toxicity.”

      Lol at claiming knowledge about a mostly subclinical condition which has _huge_ risk. Or have you found someone checking troponin levels after vaccination? Myocarditis is a veritable Sword of Damocles hanging over the heads of young, active people. Including young women who engage in strenuous sports. Young men are more likely to do strenous sports, so myocarditis shows up more in young men than women. Cardiac scar tissue can go undetected for years.

      1. If you care to read my comment it related to a biodistribution study and my critique of that study. I pointed out the problems with the study and why it was not presenting conclusions appropriate to what the author claimed. I made no comment on clinical consequences did I? Perhaps you can point to my clinical comments? If you wish to personalise these discussions I’ll play the game. I have a PhD in chemistry and 40 years experience of drug discovery in preclinical and clinical trials. I am an author in premier journals relating to drug metabolism and pharmacokinetics. I could go on but you get my point. Who are you?

      2. “Some people are at risk from the vaccines eg young males aged 19-35 have a slightly increased risk of cardio toxicity. The risk of eg blood clots is way higher in unvaccinated people than in vaccinated who catch the Covid virus.”

        So the unvaccinated who have recovered from covid have a higher risk of novel onset of clotting issues than the vaccinated who catch covid? I don’t think this is true. Or are you comparing the unvaccinated who catch covid with the vaccinated who may not have caught covid? By this time, we have all been exposed. Vaccination is non-sterilizing and seems to add to risk. In old men (VA patients), the incidence of myocarditis was 0.00037 for the unvaccinated who caught covid and 0.00058 for the vaccinated who caught covid. RR for the vaccine for myocarditis is 58/37. 1/2000 for the vaccinated. That’s for old geezers. Maybe a bit higher risk for young men active in sports.

        “I have a PhD in chemistry and 40 years experience of drug discovery in preclinical and clinical trials.”

        If you truly had done your work, you wouldn’t be pulling the credentials trick. People who have done the work can recognize when others have done the work. You obviously haven’t, since you don’t recognize that I have done the work.

    1. Hey guys,
      I only have 45 years clinical experience in general and aerospace medicine, only one of those years in actual clinical research…so it’s hard to compare me to most of you guys… but my point is you only need to say it once. We catch on rather quickly. So let’s enjoy the science, as it should be ( more so than any burning bush that some old guy saw and wanted to take his son on a long morose walk to see also) you just cannot know how much I respect ALL you gize!! Thanks. Good Sat to you.
      Dr Larry

      1. I’m still no MD–just some random geeky bozo on the interwebz who happens to read a _lot_ of research articles in a _lot_ of different specialties, which I’m sure you can tell. My undergrad degree was in chemistry when I was premed, but I counted the cost of medicine (as regards commitment) and didn’t figure I could pay it. So I earned a master’s in physics, with thesis in classical optics.

        In the last two years I have read a lot of articles by pharma and the blogs of David Healy, Meryl Nass, Malcolm Kendrick, and, of course, our host’s articles. Why are those blogs important? Because they consider adverse effects carefully, which is a blind spot when you read pharma’s articles. (Yes, we all know that pharma has ghost writers for their articles. Or we should.)

        Healy was involved in SSRI research and was an expert witness in the SSRI lawsuit brought against Glaxo Smith Kline. Nass was involved in fighting the horrific anthrax vaccine used on American military personnel. Kendrick is an MD who likes to research stuff he finds interesting. I think that I found Kendrick first. Kendrick helped me see the big picture of covid. But don’t blame him for my mistakes.

        I can discuss general principles of masking wrt evaporation of droplets, because that falls generally within my field. I can discuss classical optics, because I did research in that field, with implications for medical diagnostic equipment as well as space exploration (medium-IR absorption spectra derived from reflectance spectra for organic compounds). (The technology could be used to map out IR absorption spectra of organic molecules. It was exciting way back when, but not much has been done to use the technology in medicine, although it’s being used by NASA. The cool part is that samples are unnecessary if you can just reflect a beam off of a surface. Potentially that could be done with blood vessels of the eye or ear to look for levels of various chemical compounds.)

    2. Now proven by the recent RCTs from the university of South Denmark
      Larry Banyash MD, retired

  66. Thanks for that very knowledgeable update. Tried to send a hyperlink to Dave S earlier showing Dr Ed Mills actual private retraction statement from the Together ivermectin study.
    Hope you guys got it.

    Again thanks for the impressive bio!

  67. Some of you may be wondering about the impact of false negatives on Pfizer’s data in support of efficacy. Let’s look at that now.

    I looked at the Pfizer study (yet again) as regards its protocol and as regards its testing data for covid in the supplemental appendix. The protocol is important to find out how Pfizer tested for covid and how many times it tested one symptomatic individual. It’s also important to know how many people were tested in each arm so that we can figure out the impact of false negatives on the results.

    Pfizer’s protocol specified a single test for symptomatic individuals, which could be NAAT or LAMP. Pfizer didn’t publish the number of individuals it tested for covid in each arm. (Is that weird or what?) But Ok, we can still run a couple of hypotheticals to see what impact false negatives _could_ have.

    Let’s start with the basic number of people diagnosed with covid:

    placebo arm: 19

    vaxx arm: 1

    Now let’s figure out the false negative rate. Early on, a Hopkins review study reported a low of 20% on day eight of the infection, 67% on day two, and the rest above 20% inclining upwards from day two. But that was old data. The newer data has a flat 12% as the false negative rate, so let’s use that.

    Let’s suppose that 100 symptomatic people tested for covid in the vaxx arm and 200 people in the placebo arm. Then the false negatives would be as follows:

    placebo: 24

    vaxx: 12

    That brings the number of covids to:

    placebo: 24 + 19 = 43

    vaxx: 1 + 12 = 13

    So, the efficacy would be (43 – 13) / 43 = 70% That’s for the total testing numbers where 100 are in vaxx and 200 are in placebo.

    Now let’s look at false negative probable results for 50 testing in vaxx and 100 testing in placebo:

    placebo: 12

    vaxx: 6

    So total covid would be as follows

    placebo: 12 + 19 = 31

    vaxx: 6 + 1 = 7

    So efficacy for these numbers is (31 – 7) / 31 = 77%

    Huh, fewer total test numbers = better efficacy.

    So, the more symptomatic people who get tested, the bigger the impact of false negatives.

    Now if a second covid test had been run, then false negatives would have been in the range of 1% or so, but more covid cases would have been caught.

    Does it make sense why things were done the way they were in Pfizer’s clinical trial protocol and why certain raw data isn’t published?

  68. And do you not see how corrupt your field has become?

    I have only recently been introduced to Terrain Theory after at least 25 years of suppression.

    Terrain Theory explains, pretty much, everything wrong with Western “medicine.”

    Of course, the entire field of virology is a fraud. No wonder the genocide is kicking into high gear. Kill those who suspect anything and muzzle the rest with fear. Look what they’ve done to Assange.

    When will “doctors” speak out about the fraud?

    When will the “medical” establishment stop being pimps for Big Pharma.

    It will be a cold day in hell before I go to another doctor, or hospital (euthanasia centers) for that matter.

    You should be ashamed to be associated with such sociopaths.

    1. Like many things, there is some truth to Terrain Theory and some garbage. Ditto allopathic medicine. But people seem to be keen on ditching the baby with the bath water.

  69. Very good Sebastian.
    The best part is:- ‘Doctors have been conditioned by the pharmaceutical industry’.
    I was put on statins for no other reason than that I had reached a certain age. I think it was 60yrs. Some years later another doctor had another attempt.
    I more or less volunteered for a S.S.R.I.. Or rather, I wanted an anti depressant and that was the only sort on offer.
    Virtually the only effect I noticed was ‘taking stupid risks’ when driving. Then the long drawn out withdrawal period.
    To answer your main question:-
    Unfortunately, the risks are so great nowadays, that the only sensible course is to avoid all prescribed drugs for as long as possible.
    77yrs. now and I have gone back to Trelegy steroid inhaler for my chronic bronchitis.
    As usual, I really can’t decide whether it is benefiting me at all.
    I also get vitamin D3 free from our N.H.S.
    Otherwise, I use my common sense and buy from Amazon.

  70. I would like to see a NNT of 1 for both.

    That doesn’t look to possible so I would probably try the medicine for a while and see if it helped and if it didn’t then I would stop taking it.

    If the long term benefits are not measurable in the short term I’m not sure what I would do. Probably look for traditional alternatives that have been around longer.

  71. What is going on with relatively high rates of covid among the fully vaccinated?

    Boosters. Why boosters?

    It’s because of how numbers are counted. If you get your first shot and are in the 2-week waiting period, you are counted as unvaccinated. After your first shot, you are counted either as as not-fully-vaccinated or as singly-vaccinated. If you get your second shot and are in the 2-week waiting period, you are counted as not-fully-vaccinated or singly-vaccinated. Once you clear the waiting period after your second dose, you are counted as fully vaccinated. But suppose you get a booster. During two weeks after the booster you are especially susceptible to infection, so if you get covid, you will be counted as fully-vaccinated.


    If the stats only discern between two categories, fully-vaccinated and unvaccinated, then the not-fully-vaccinated will be counted as unvaccinated and any covid infections which might have been caused by vaccines will be counted against the unvaccinated.

    1. These injections simply do not work. No real surprise. Rushing out a new delivery platform and method to treat infection that never under went thorough testing and evaluation and using this pandemic as justification to provide cover to these pharmaceutical companies was a mistake and a failure. Moreover, demonizing off-label drugs and adherence to government dictates as to what is deemed appropriate treatment, hence approved treatment according to these health professional tyrants masquerading as bona fide public health professionals lead to deaths and untold tragedy across society. These tyrants have burned their bridges and the trust level in these supposed “experts” has been thoroughly tarnished. It will take years, if ever to regain trust in our institutions. The next pandemic I’ll be tuning these dimwits and control freaks out.

  72. Jag som inte vill ta statiner har blivit starkt ifrågasatt av läkare.
    Har precis haft en hjärtinfarkt, fått ett stent. De ser ingen ingen skada på hjärtat, vilket förklarats med att det bildats nya kärl för att understödja delen där stoppet (99,5%) var
    De tror att jag har familjär hyperkolestromi (värde 6,7) och menar att jag är tvungen att äta statiner livet ut.
    Jag äter sen två veckor bakåt i tiden, men har fått halsbränna och känningar i musklerna. De har behandlat mig mot heloibacter för att undvika magsår.
    Jag hade även högt kolestrol (7,2) 1916 då jag förskrevs statiner. Jag tog dem inte. Lade om kosten och fick ner värdet till 2,5, vilket förundrade min läkare.
    Senare har jag örjat slarva med kosten, men tänker nu ta tag i detta. Läkarna säger att det inte går med att endast förändra kosten om jag har familjär hyperkolestromi. Farfar och alla hans åtta syskon dog unga i hjärtproblem, utom de två sista som fick hjärtoperation. Vet inte den egentliga orsaken. Det ska utredas närmare nu. Har en mormor som dog (64 år) trots behandlad hjärtsjukdom. Vet att hon hade högt kolestrol och förstorat hjärta
    Jag är nu frågande gällande statiner. och vill höra din syn på saken.

    Jag har också sagt ifrån Brillique 90 mg eftersom jag fick stora blödningar under huden, smärta och svindelskänslor.
    Jag ifrågasatte maxdosen också då jag bara är 154 cm och väger 60 kg. Men det var samma för alla.
    Clopidogrel 75 mg skrevs ut trots stark avrådan från läkare att sluta med Brillique.
    Äter även Trombyl

    Jag har aldrig tidigare ätit medicin, förutom antibiotika kanske tre gånger i livet. Äter aldrig smärtlindrande. Har IBS och en muskelsjukdom i släkten (på mammas sida) som vi aldrig får någon diagnos på. Hårda spända muskler, smärta och muskelryckningar. Jag, min syster, hennes och mina barn och barnbarn har även detta i större eller mindre omfattning. En son med mycket svåra problem, men ingen läkare eller prover kan påvisa orsaken.
    Han har dock börjat testa med glukasomin som han tycker har gjort förändring. Han är inte lika längre lika stel utan i kroppen.
    Därför vill jag inte heller äta statiner.
    Tålde aldrig p-piller och äter heller aldrig smärtlindrande (jo, möjligen en Ipren/år om myskelsmärtan blir för svår.)
    Så som sagt hur ser du på saken?
    Glad om du tar dig tid att svara.


    1. this is what comes out of google translate:

      Ann-Margret Ellström Forsgren says:
      1 May, 2022 at 09:57

      I who do not want to take statins have been strongly questioned by doctors.
      Just had a heart attack, got a stent. They see no damage to the heart, which is explained by the formation of new vessels to support the part where the stop (99.5%) was
      They think I have familial hypercholesterolemia (value 6.7) and think I have to eat statins for life.
      I have been eating for two weeks back in time, but have had heartburn and feelings in the muscles. They have treated me against heloibacter to avoid stomach ulcers.
      I also had high cholesterol (7.2) in 1916 when I was prescribed statins. I did not take them. Changed my diet and reduced the value to 2.5, which amazed my doctor.
      Later I have been careless with the diet, but now I intend to tackle this. Doctors say that it is not possible to change the diet only if I have familial hypercholesterolemia. Grandfather and all his eight siblings died young of heart problems, except the last two who underwent heart surgery. Do not know the real cause. It will be investigated further now. Has a grandmother who died (64 years) despite being treated for heart disease. Know that she had high cholesterol and an enlarged heart
      I’m now questioning about statins. and want to hear your views on the matter.

      I have also stopped taking Brillique 90 mg because I had heavy bleeding under the skin, pain and dizziness.
      I also questioned the maximum dose as I am only 154 cm and weigh 60 kg. But it was the same for everyone.
      Clopidogrel 75 mg was prescribed despite strong advice from doctors to stop taking Brillique.
      Also eats Trombyl

      I have never taken medicine before, except for antibiotics maybe three times in my life. Never eat painkillers. Have IBS and a muscle disease in the family (on the mother’s side) that we never get a diagnosis of. Hard tense muscles, pain and muscle twitching. I, my sister, her and my children and grandchildren also have this to a greater or lesser extent. A son with very severe problems, but no doctor or tests can prove the cause.
      However, he has started testing with glucosomine, which he thinks has made a difference. He is no longer as stiff as in the body.
      That’s why I do not want to eat statins either.
      Never tolerated birth control pills and also never eats painkillers (yes, possibly an Ipren / year if the muscle pain becomes too severe.)
      So as I said, how do you see the matter?
      Glad if you take the time to respond.


      1. Thank you for the translation Dave S. With that history and Kendrick’s heart clot hypothesis, don’t know if statins are indeed proper here—esp with a muscular dystrophy TYPE disorder, among other reasons.

    2. Larry I think you have my email please email me and I’ll step you through google translate, it is easy and very useful

  73. I would want preferably 1:1 but would except 2:1 if the result of taking the drug outweighed the harm of not taking it.

  74. Should NNT be information the doctor would\should know and tell us if we ask?

    If not, how do the non medical folks find out the NNT for a particular drug?

  75. It’s worth noting that Jessica Rose found huge mortality increases of the “injected” (which includes both the partially and fully vaccinated). The game is to push the blame for risk on the unvaccinated by lumping the partially vaccinated in with the uninjected when counting deaths.

    Rose normalized deaths to account for divergence in numbers of the partially vaccinated from the uninjected. However, she didn’t stratify by age, so the Feb. figures are questionable. The April figures are solid, though, because when vaccinations were occurring in March, the highest risk 80+ group had already been heavily vaccinated. Rose calls those fully and partially vaccinated “the injected,” and I will use her term.

    So, for April, in Sweden, the uninjected deaths were 40 per million and the injected deaths were 156 per million using Rose’s data. That’s about a 300% increase in mortality for the injected. It looks like the greatest risk is for the partially vaccinated group.

  76. Good grief Charlie Brown. When does this nonsense stop?
    Larry Banyash, MD, retired

  77. Bra! Så tänker även jag och har redan slutat med statiner. Jag åt i tre veckor men lade då samtidigt om min kost. Efter tre veckor hade värdet sjunkit från 6,7 till 1,7, detta trots att läkaren sa att det skulle vara svårt för mig att få ner värdena. Jag har ju dock för några år sen fått ner värdet på fyra veckor, från 7,4 till 2, 4 bara med koständringar och lite mer motion, då jag vägrade statiner. Denna minskning förvånade min läkare. Tyvärr började jag slarva, men tänker nu hålla mig till strikt diet. Hellre det än statiner.
    Nämnas ska också att jag denna gång fick muskelkramper i ansiktet, detta gissar jag var biverkning av statinerna. Jag har aldrig haft muskelkramper tidigare, även om jag haft muskelproblem i många år.

    1. Good! I think so too and have already stopped taking statins. I ate for three weeks but then changed my diet at the same time. After three weeks, the value had dropped from 6.7 to 1.7, despite the doctor saying that it would be difficult for me to bring the values down. However, a few years ago I reduced the value to four weeks, from 7.4 to 2.4 only with dietary changes and a little more exercise, when I refused statins. This reduction surprised my doctor. Unfortunately I started to be careless, but now I intend to stick to a strict diet. Better that than statins.
      It should also be mentioned that this time I got muscle cramps in the face, I guess this was a side effect of the statins. I have never had muscle cramps before, even though I have had muscle problems for many years./////good!! I can relate to the muscle discomfort….I have gotten lost in this post and cannot find the original NNT for statins—can you or anyone advise. thanks
      larry w banyash, MD, retired

  78. from the article, “So, what is the NNT for statins?

    Well, if you’ve already had a heart attack, i.e. you’ve already been established to be at high risk for heart attacks, then the NNT over five years of treatment is 40. In other words, 39 of 40 people taking a high dose statin for five years after a heart attack won’t experience any noticeable benefit. But even if they’re not the lucky one in 40 who gets to avoid a heart attack, they’ll still have to contend with the side effects.”

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