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The most important study on the placebo effect is Hróbjartsson and Gøtzsche’s Is The Placebo Powerless?,updated three years later by a systematic review and seven years later with a Cochrane review. All three looked at studies comparing a real drug, a placebo drug, and no drug (by the third, over 200 such studies) – and, in general, found little benefit of the placebo drug over no drug at all.
NHS Scotland created a comprehensive site regarding medication management which they refer to as polypharmacy guidance. http://www.polypharmacy.scot.nhs.uk/7-steps/
An example of their content follows. They even have an app for smartphones.
Step1: Identify aims and objectives of drug therapy
Review diagnoses and identify therapeutic objectives with respect to:
- Management of existing health problems.
- Prevention of future health problems.
The National Academies of Sciences, Engineering, and Medicine released the report “The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research.”
Here’s the link.
Despite a lot of rhetoric, current research supports value for three conditions as noted in the following quote.
“There is conclusive or substantial evidence that cannabis or cannabinoids are effective:
- For the treatment for chronic pain in adults (cannabis) (4-1)
- Antiemetics in the treatment of chemotherapy-induced nausea and vomiting (oral cannabinoids) (4-3)
- For improving patient-reported multiple sclerosis spasticity symptoms (oral cannabinoids) (4-7a)”
It’s been my experience that sending written information to prescribers had a greater impact than trying to meet with them face-to-face. This article from Lancet doesn’t compare the two but did show a limited impact of written information.
Here’re the findings from the abstract:
“Between Sept 8 and Sept 26, 2014, we recruited and assigned 1581 GP practices to feedback intervention (n=791) or control (n=790) groups. Letters were sent to 3227 GPs in the intervention group. Between October, 2014, and March, 2015, the rate of antibiotic items dispensed per 1000 population was 126·98 (95% CI 125·68–128·27) in the feedback intervention group and 131·25 (130·33–132·16) in the control group, a difference of 4·27 (3·3%; incidence rate ratio [IRR] 0·967 [95% CI 0·957–0·977]; p<0·0001), representing an estimated 73 406 fewer antibiotic items dispensed. In December, 2014, GP practices were re-assigned to patient-focused intervention (n=777) or control (n=804) groups. The patient-focused intervention did not significantly affect the primary outcome measure between December, 2014, and March, 2015 (antibiotic items dispensed per 1000 population: 135·00 [95% CI 133·77–136·22] in the patient-focused intervention group and 133·98 [133·06–134·90] in the control group; IRR for difference between groups 1·01, 95% CI 1·00–1·02; p=0·105).”
The Healthcare Economist posted some very useful information on this topic. One of the estimates placed the range between $109,000 and $297,000 per year of added life.
No real surprises.
From the abstract:
“Results indicate an increase in overall use of prescription drugs among US adults between 1999-2000 and 2011-2012 with an estimated 51% of US adults reporting use of any prescription drugs in 1999-2000 and an estimated 59% reporting use of any prescription drugs in 2011-2012 (difference, 8% [95% CI, 3.8%-12%]; P for trend <.001). The prevalence of polypharmacy (use of ≥5 prescription drugs) increased from an estimated 8.2% in 1999-2000 to 15% in 2011-2012 (difference, 6.6% [95% CI, 4.4%-8.2%]; P for trend <.001). These trends remained statistically significant with age adjustment. Among the 18 drug classes used by more than 2.5% of the population at any point over the study period, the prevalence of use increased in 11 drug classes including antihyperlipidemic agents, antidepressants, prescription proton-pump inhibitors, and muscle relaxants”