Also, she claims that drug litigation is not about lawyer profits, but about “empowering” the little guy, if that is the case, then why do they take a fee at all?

Theoretically, the placebo group would give the background rate but only if the placebo group is representative. One of the pieces of “damning” evidence used against Vioxx was a surprising reduction of incidents in the placebo group about midway through the study while the incidence rate among Vioxx users continued unabated and unchanged. The only reasonable conclusion is that there was something wrong with the placebo group. Guess how it was presented though.

DA: “No placebo trial could be done with patients presenting with indications for avandia.”

True but presumably some study was done. I’m not so cynical to assume EB’s claim is entirely baseless. You still need to know the background rate for the general population though — because it’s possible that other treatments may have similar (but different) effect. Any attempts to derive it from the experiment groups would likely hopelessly skew it.

Seems to be skating on thin ice.

VMS may have meant this, but its not the general population’s rate of heart attack we need. We aren’t handing out avandia to the general population. It would be the heart attack rate in people where avandia is indicated… btw, significantly elevated.

Just had a patient with serious COPD in for a followup for hospitalization for COPD exacerbation – patient was given a great drug for quitting smoking two weeks ago, and told me she had stopped taking it and did not plan to restart supposedly secondary to seeing an ad by a local lawyer that scared her about side effects… wonder how those side effects stack up to continued smoking in a patient with significantly advanced COPD. This is a recurring theme. These ads have population health consequences… and they are not positive. Frustrating!

When will we get a class action for the negative effects of this BS publicity about side effects?

Disclaimer: I don’t know what kind of studies have been done re: Avandia and do not know whether any such studies have been conducted.

Welcome to the world of Bayes’ theorem and conditional probabilities. See http://en.wikipedia.org/wiki/Bayes'_theorem (example 2 therein).

See also the prosecutor’s fallacy http://en.wikipedia.org/wiki/Prosecutor%27s_fallacy

Many legal (and medical) errors are made due to a misunderstanding of conditional probabilities, and I see it all the time in real life and on the legal blogs and in medical testing. For example, on a recent blog criticizing the jury’s deliberation in 12 angry men, one commentator wrongly stated that if each piece of evidence proved guilt by 70% then with 4 pieces of such evidence he is guilty to a certainty of 99.2% =(1-.3**4).

In order to prove or disprove a relation between taking Avandia and having a heart attack, one would need the missing information to plug into the Bayes equation, namely the incidence of heart attacks in the general population. That also goes for proving (or disproving) a relation between seeing Erin Brokovich and having a heart attack.

Rarely in medicine are diagnostic signs pathognomonic. Rather, a diagnosis is made by a probabilistic analysis where Bayes’ theorem should come into play. Almost all tests have a finite probability of a false positive and a false negative.