All the news this week amongst diabetic patients in my small town has been the news about the medication
Avandia .
Everyone's thinking, "Oh no, here's
Vioxx again!" While this week's headlines may eventually take us down that path, I'm telling my patients to not to panic just yet.
The big to do is over a meta-analysis published in the
New England Journal of Medicine which showed a significant risk of heart attacks in those taking
rosiglitazone , or
Avandia . Now a meta-analysis is really a study done on paper only. The authors look at all of the other data from earlier studies on
Avandia and convert that into one
uber -result. By combining all of small experiments into a large one, the number of patients studied increases dramatically, often from a few hundred to many thousands. This increase allows researchers a better opportunity to discern small differences between control and experimental groups. This creates what in the statistical world is known as "power".
The downside to the meta-analysis is that they are better at showing an
association which may or may not be a
causal relationship. In other words, those patients on
Avandia may have had more heart attacks for some other reason than the authors controlled for when designing their meta-analysis. Only a large randomized controlled trial really can show that one thing causes another.
Now while study design and statistical considerations are interesting to some of us, most of my patients just want to know what they should do about the
Avandia they are taking for their diabetes. Here's what I'm telling my patients. Most importantly, don't stop the medication unless we are going to replace it with something else!
Avandia may be bad, but out of control blood sugars is really, really bad. Then the conversation I'm having with my patients is to either wait for another month or two to see where all of this
controversy is headed and see what the FDA is going to do about it; or switch over to another diabetic medication at least for the time being such as
Actos , or
pioglitazone .
Actos is in the same class of medication as
Avandia , but has no reports of the risk of heart attacks that
Avandia has had...yet.
One mentor during my residency told me that the medical literature is like a conversation. One study, even a meta-analysis, only gives one statement of the conversation. Looking at just that one statement can be misleading and incomplete. One needs to wait for the reply and then the
rebuttal to the reply to truly understand where the conversation is going.
The Country Doctor
The big to do is over a meta-analysis published in the New England Journal of Medicine which showed a significant risk of heart attacks in those taking rosiglitazone , or Avandia . Now a meta-analysis is really a study done on paper only. The authors look at all of the other data from earlier studies on Avandia and convert that into one uber -result. By combining all of small experiments into a large one, the number of patients studied increases dramatically, often from a few hundred to many thousands. This increase allows researchers a better opportunity to discern small differences between control and experimental groups. This creates what in the statistical world is known as "power".
The downside to the meta-analysis is that they are better at showing an association which may or may not be a causal relationship. In other words, those patients on Avandia may have had more heart attacks for some other reason than the authors controlled for when designing their meta-analysis. Only a large randomized controlled trial really can show that one thing causes another.
Now while study design and statistical considerations are interesting to some of us, most of my patients just want to know what they should do about the Avandia they are taking for their diabetes. Here's what I'm telling my patients. Most importantly, don't stop the medication unless we are going to replace it with something else! Avandia may be bad, but out of control blood sugars is really, really bad. Then the conversation I'm having with my patients is to either wait for another month or two to see where all of this controversy is headed and see what the FDA is going to do about it; or switch over to another diabetic medication at least for the time being such as Actos , or pioglitazone . Actos is in the same class of medication as Avandia , but has no reports of the risk of heart attacks that Avandia has had...yet.
One mentor during my residency told me that the medical literature is like a conversation. One study, even a meta-analysis, only gives one statement of the conversation. Looking at just that one statement can be misleading and incomplete. One needs to wait for the reply and then the rebuttal to the reply to truly understand where the conversation is going.
The Country Doctor