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The Pharma Career Ladder · The medical rep · Step 3: Knowing the science · Lesson 5

Number needed to treat

A number a doctor can actually use

By Ahmed El Menshawy · 20 years in pharma, from medical rep to country manager in the UAE. Founder of RepPharma. LinkedIn
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Most trial slides hand the doctor a percentage. The best reps hand him a number of patients.

The number needed to treat was introduced in 1988 in the New England Journal of Medicine by Laupacis, Sackett and Roberts, to turn trial results into something a clinician can picture. It answers one simple question: how many patients do I need to treat for one extra patient to benefit?

The four numbers worth knowing for your key trial:

  • Absolute risk reduction: the difference in event rates between the two arms.
  • Number needed to treat: one divided by the absolute risk reduction.
  • Time frame: how long those patients were treated. Every NNT belongs to one.
  • Number needed to harm: patients treated for one extra to have a side effect.
  • How to read them:
  • A lower NNT means more patients benefit.
  • An NNT without its time frame means nothing.
  • Put the NNT beside the NNH. The doctor weighs both, so show both.

And never line up NNTs from different trials as if they came from one study.

“Doctors treat patients, not percentages. Give them the number of patients.”
Number needed to treat: A number a doctor can actually use

Lesson 5 of 11 in Step 3: Knowing the science, with the full guide and a checklist for this week.

More lessons in step 3: Knowing the science

Lesson 1Learning the science properlyHow to study a product like a professional, not a parrotLesson 2Reading a clinical paperFour steps from the abstract to the limitationsLesson 3Relative vs absolute riskThe number that misleads doctors and reps alikeLesson 4What p < 0.05 does not meanStatistical significance in plain wordsLesson 6Talking about side effectsHonesty that builds trust instead of losing the callLesson 7Off-label questionsThere is only one correct answerLesson 8Head-to-head or nothingComparing across trials is not comparingLesson 9Guidelines are your allyPositioning your product inside the treatment guidelineLesson 10The mechanism slideWhen it helps the call and when it bores the doctorLesson 11Answering a medical question properlyEscalating to medical affairs without losing the doctor

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