Hi Oliver

Libby is my brother in-laws sister. Very interesting lady to Google

Your post reminds me of the Mt Twain rule - Lies, Dammed lies and statistics
http://en.wikipedia.org/wiki/Lies,_damned_lies,_and_statistics


I have a great faith in "Benfords law" and have used it in auditing waffle
filled accounts of banks, supermarkets and some other large business.
Benfords law is also very useful in cutting the crud out of biased
statistical analyses http://en.wikipedia.org/wiki/Benfords_law

Regards James


-----Original Message-----
From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]
On Behalf Of Oliver Frank
Sent: Tuesday, 26 June 2007 10:55 PM
To: General Practice Computing Group Talk
Subject: Re: [GPCG_TALK] RE: Potentially inappropriate prescribing
amongAustralian veterans

Ken Harvey wrote:

> Roughead EE, Anderson B, Gilbert AL. Potentially inappropriate 
> prescribing among Australian veterans and war widows/widowers. Internal 
> Medicine Journal 2007; 37 (6): 402-405.
> 
> ABSTRACT: This study examined the extent of potentially inappropriate 
> medicine, as defined by explicit criteria, dispensed to Australian 
> veterans using the Repatriation Pharmaceutical Benefits Scheme Pharmacy 
> Claims database.
> 
> Twenty-one per cent of the 192 363 veterans aged 70 years, with an 
> eligible gold card, were dispensed at least one potentially 
> inappropriate medicine in the first 6 months of 2005.

About ten years ago, I attended a seminar at which Libby Roughead 
presented the results of some research that she'd done to see whether 
telling GPs that NSAIDs cause peptic ulcers had reduced the number of 
admissions to hospital with perforated peptic ulcer.  The finding was 
that the number of admissions to hospital with perforated peptic ulcer 
did reduce after the campaign to tell GPs how bad NSAIDs were.  The 
researchers were obviously pleased that they had saved a number of 
people from this serious adverse effect of NSAIDs.

During the question time, I stood up and asked whether the researchers 
had measured or even asked how many arthritic oldies now were lying 
awake at night in pain from their arthritis, how many had stopped 
bowling, how many could not walk to their letter box at all or without 
significant pain, and so on.  The answer was no.  All they had done was 
to measure the number of admissions to hospital with perforated peptic 
ulcer.  They had made no attempt to measure changes in patient's quality 
of life, ability to perform their daily activities or use of other 
medications.

I was not impressed with this study, because I believe that it is 
relatively easy to change GPs' prescribing by telling them that drug X 
or drug class Y can have serious adverse effects.  The hard part is if 
GPs are discouraged from prescribing medications that are useful and 
increase patients' quality of life, it is important to examine the other 
intended and unintended consequences of that change.  I believe that the 
  withdrawal of TGA approval for quinine for the use of cramps falls 
into this category.  Little old ladies (and men) who had taken quinine 
for years and found it top be the only effective treatment were suddenly 
told that it is dangerous and may kill them, and we now have to tell 
them this, but explain to them that this is unlikely to happen after ten 
or twenty years of use.


-- 
Oliver Frank, general practitioner
255 North East Road, Hampstead Gardens, South Australia 5086
Phone 08 8261 1355   Fax 08 8266 5149  Mobile 0407 181 683
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