In this week’s Telegraph, Annabel Fenwick Elliott reported she took a pill to help fix her drinking problem, “It’s the magic drug for hard drinkers that has an 80 per cent success rate – so why is this drug so under-prescribed?”
Boyd Brogan asked us to look into this latest claim, so we did.
Annabel seems to be a travel writer, but at a minimum, we might expect her to check out her evidence for the magic 80% success rate. Annabel refers to success in clinical trials; however, the link for the trial result in the article takes us to the Sinclair Method website.
The Sinclair Method for Alcohol Use Disorders involves taking the FDA-approved prescription medication Naltrexone on an as-needed basis at least one hour before drinking alcohol.
The success rate of 78% can be found in the Cure for Alcoholism book—there is no mention of the trial. We did a little digging and found out a trial was done in 2001. The 78% appears on multiple websites and seems to have been documented in Dr. Roy Eskapa's book, The Cure for Alcoholism.
Finally, we found the study: Evidence about the use of naltrexone and different ways of using it in the treatment of alcoholism. It’s not a trial; it's a review of the evidence, and in there, Sinclair states the results of a Finnish open-label naltrexone trial done in 1997 by Sinclair: “Of the 147 patients who had completed enough treatment to be classified, 115 (78%) were considered successful.” it seems that the trial was only reported in a conference abstract.
So, did Annabel take the trouble to look for the original research, or did she take it as read?
If she wanted to know whether Naltreoxne was any good, she could have checked out the latest systematic review evidence.
The Cochrane Review of Naltrexone and nalmefene for alcohol-dependent patients found 50 studies with 7,793 participants. Most studies reported treatment over three months - not quite the overnight pill.
Patients who took naltrexone were able to reduce the amount and frequency of drinking compared to a placebo. On average, one out of nine patients was helped by naltrexone. Hmm, not quite 80%.
For the second opioid antagonist, nalmefene, the evidence is still too sparse to allow conclusions to be drawn.
But that’s not all; we wondered where Annabel got her prescription. Other evidence to refer to is the NICE guidance on Alcohol-use disorders.
Oral naltrexone has been licensed for alcohol dependence, and NICE recommends” “For harmful drinkers and people with mild alcohol dependence who have not responded to psychological interventions alone, or who have specifically requested a pharmacological intervention, consider offering acamprosate or oral naltrexone in combination with an individual psychological intervention.” (see recommendation 1.3.3.3). It also recommends use after a successful withdrawal for people with moderate and severe alcohol dependence.
But here’s the catch that Annabel forgot to mention: before starting treatment with oral naltrexone, conduct a comprehensive medical assessment (baseline urea and electrolytes and liver function tests. In particular, consider any contraindications or cautions (see the SPC) and discuss these with the patient.
Annabel went to a private clinic. Dr Janey Merron, one of the first doctors to join Sinclair Method UK, prescribed her the meds. The Sinclair Method - Option 1 (the Most Popular) costs £399. However, the medication cost is not included and must be paid separately; currently, £100 per 28 tablets.
Overall, the article reads like an advert: Annabel should have indicated that the treatment is currently available on the NHS. Indeed, Naltrexone has been around since 1963. Annabel seems to think “the NHS might be motivated to take another look at its approach to this medication.” Beyond NICE, what approach is she referring to? Also, the article misleads readers about the effect size. Perhaps that's the magic she is referring to. But getting the facts right in modern-day journalism doesn’t seem to be part of the job.
This post was written by two old geezers who like a drink and like to get their facts right.
Firstly, the study states ““Of the 147 patients who had completed enough treatment to be classified” which suggests there was a number of patients who did not complete treatment”. So, the way I read it is that the initial sample was very small and there may have been a significant number of patients who did not complete treatment for whatever reason. Secondly, doesn’t the Telegraph article classify as misinformation albeit not intentional? If so, then surely the fact checkers should be all over articles of this nature. I know from my work in pain management that an overemphasis on the efficacy of interventions can lead to some very negative consequences, including reinforcing a sense of hopelessness and the potential blaming of those trying to help. I’ve now got to the stage where I think that the constant pushing of new, improved “miracle” medications without sufficient scrutiny is both raising unfulfilled expectations and actively damaging health care provision. Okay…rant over (for now).
"Getting the facts right in modern day journalism doesn't seem part of the job".
The problem is that any science/medical journalist who did get their facts right, ie by checking sources, reading round the matter whilst applying even a modicum of critical thought wouldn't have a job for very long.
Even before Clown World began 4 years ago they were often just useful idiots for pharma.
I've lost count of the number of wonder drugs, miracle medical breakthroughs, and the human genome being cracked which would lead to a cure for, well, every disease known to man.
Gene tec has been the new kid on the block for a couple of decades now but precisely what has it done save create fortunes for the likes of you know who. - not forgetting mmRNA.
It's a bit complicated innit, especially when the genetic engineers appear to know the square root of F all about precisely how the immune system actually works.
No matter though - step forward AI which is the new saviour of mankind for matters medical. I read it somewhere.
It must be true, our science correspondents say so.