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The article by Holmes et al¹ builds logically on a framework already proposed by Stevenson et al² with the following 3 elements common to both: understanding the person's prognosis, the initial intention of a therapy (prevention strategy), and the time until realizing benefits (or burdens). The contribution of a concept of "time until benefit" by Holmes et al¹ is crucial if clinicians are to match prognosis with prescribing, while accounting for changes in people's bodies at the end of life.³

An issue highlighted by both frameworks is the challenge of using number needed to treat (NNT) to assist in ceasing medication therapies rather than simply initiating them.⁴ The original concept of NNT and number needed to harm (NNH) omits a denominator for time but adjusts for baseline risk.⁵ Risks and benefits quantified by NNT or NNH shift as a person experiences cachexia. Entry points to studies at different times change . . . [Full Text of this Article]

AUTHOR INFORMATION
David C. Currow, MPH, FRACP; Amy P. Abernethy, MD

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Reconsidering Medication Appropriateness for Patients Late in Life
Holly M. Holmes, Déon Cox Hayley, G. Caleb Alexander, and Greg A. Sachs
Arch Intern Med. 2006;166(6):605-609.
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