Chronic fatigue syndrome and the biopsychosocial model.

I completely concur with Dr Des Spence: Big Pharma is manipulating doctors and exploiting patients, and Big Medicine is neglecting its role to protect patients.1 I can remember, shortly after becoming a GP Principal in 1987, a drug representative trying to persuade us to prescribe evening primrose oil capsules for itching in eczema. The glossy presentation and neurolinguistic programming attempts to persuade failed because of my training. A study of n = 20 can prove anything. So how did it get a licence? Of course, after many years its licence was withdrawn as there was no evidence of positive effect. Later I asked drug representatives two questions: What is the number needed to treat (NNT)? And what is the number needed to harm (NNH)? The response was mostly gobbledygook, or I’ll get back to you, which they never did. Looking at this more seriously, if referees and journal editors insisted on NNT and NNH figures in research/review papers, instead of relative risk everybody would understand the results more easily. It is depressing that many health media correspondents do not know the difference between actual risk and relative risk, and so misinform the public on the effectiveness of treatments. Unfortunately this is unlikely to happen as even NICE refuses to adopt NNT and NNH as a type of outcome description.