Testing 1-2-3. Is this drug working?

By Bryce Boyer, for Comedy Works (Wikipedia:Contact us/Photo submission) [CC BY-SA 3.0 (http://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons

By Bryce Boyer, for Comedy Works (Wikipedia:Contact us/Photo submission) [CC BY-SA 3.0 (http://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons

Tests. The word alone may have just sent shivers down your spine, and memories of final exams may be flooding back. How many times have you walked out of a test -- an assessment of how much you know about something -- and felt like you really did know more, but the test couldn’t capture it. You understood the big picture of the forest, but the test was only asking questions about the trees. If you failed this one test, would it mean you were going to fail the whole class?

In healthcare, tests play a similar role in how doctors measure your health -- but they can miss the bigger picture of how you’re really doing. Cholesterol-lowering drugs like Statins may help you lower your cholesterol, but why should you care? More than just getting better numbers at your next doctor's appointment, it's important to know if Statins can prevent something bad like a heart attack or stroke.

Here are some questions to ask:

  1. How important is this drug's benefit to my overall health?  Does taking a drug just give better test results, or does it result in fewer symptoms or lessen the risk of death?  

For example, will an osteoporosis drug not only improve bone-density on an x-ray, but will it actually prevent hip fractures?  

  1. How big will the effect of the treatment be?  Do better test numbers equal beneficial changes in my life or the life of a loved one?  

For example, if Alzheimer’s patients score marginally better on a cognitive test while taking a drug, does it mean that this will make a true difference in day-to-day living?  
 

Whenever you take a drug whose benefit is measured with a test, such as for cholesterol or bone-density, it’s important to realize this is only a surrogate outcome, a number that may or may not have an effect on your chance of something bad happening.  Unfortunately many surrogate outcomes don’t reliably translate into things you can directly feel - for example, there are drugs that improve cholesterol levels but do not reduce the chance of heart attack. Look to see if drugs improve patient outcomes, things you can feel or experience like weight loss or fewer overall deaths.


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Karen Lubell

Karen Lubell is a writer living in the Hanover, NH area. She holds degrees from Dartmouth College as well as New York University, where she taught writing while pursuing doctoral work in English Literature. She has worked as a writer and researcher in many different fields, including a stint at the New York Times as the language researcher for William Safire. Her special interest in the health sciences began four years ago with a health scare, which led her to the work of Drs. Schwartz and Woloshin. She is very excited to be a part of the Informulary team, and help with their mission to make data about prescription accessible to all. She lives in Norwich, Vermont with her husband, two children, and one very old cat.