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Now do some simple math. The numbers in that sentence mean that for every 100 people in the trial, which lasted 3 1/3 years, three people on placebos and two people on Lipitor had heart attacks. The difference credited to the drug? One fewer heart attack per 100 people. So to spare one person a heart attack, 100 people had to take Lipitor for more than three years. The other 99 got no measurable benefit. Or to put it in terms of a little-known but useful statistic, the number needed to treat (or NNT) for one person to benefit is 100.
Compare that with, say, today's standard antibiotic therapy to eradicate ulcer-causing H. pylori stomach bacteria. The NNT is 1.1. Give the drugs to 11 people, and 10 will be cured.
A low NNT is the sort of effective response many patients expect from the drugs they take. When Wright and others explain to patients without prior heart disease that only 1 in 100 is likely to benefit from taking statins for years, most are astonished. Many, like Winn, choose to opt out.
Plus, there are reasons to believe the overall benefit for many patients is even less than what the NNT score of 100 suggests. That NNT was determined in an industry-sponsored trial using carefully selected patients with multiple risk factors, which include high blood pressure or smoking. In contrast, the only large clinical trial funded by the government, rather than companies, found no statistically significant benefit at all. And because clinical trials themselves suffer from potential biases, results claiming small benefits are always uncertain, says Dr. Nortin M. Hadler, professor of medicine at the University of North Carolina at Chapel Hill and a longtime drug industry critic. "Anything over an NNT of 50 is worse than a lottery ticket; there may be no winners," he argues. Several recent scientific papers peg the NNT for statins at 250 and up for lower-risk patients, even if they take it for five years or more. "What if you put 250 people in a room and told them they would each pay $1,000 a year for a drug they would have to take every day, that many would get diarrhea and muscle pain, and that 249 would have no benefit? And that they could do just as well by exercising? How many would take that?" asks drug industry critic Dr. Jerome R. Hoffman, professor of clinical medicine at the University of California at Los Angeles.
In many other countries, dumpster divers like Mr. Brylla would be written off as eccentrics. In Germany, he's just a normal 36-year-old graphic printer brought up to look down on wasting money on new things when sturdy old stand-bys are there for the taking.
"Consumption is nothing good," says Mr. Brylla. "It brings evil into the world."
Germans like Mr. Brylla are the retail trade's worst nightmare. They make enough money to buy the latest wares but choose to live in a free-of-charge economy. People who don't want stuff put it on the sidewalk. People who like it take it home.
"It's the culture here in Germany," says Dora Fecske, a Frankfurt businesswoman. "Why trash something if it's still good?" She recently found a large wooden dining table in the street and carried it several blocks to her home with help from friends.
... The trend is stubborn, with deep roots in history. Germans save their money partly because war and economic disasters during the last century make them think the future will bring more rainy days.
Today, even though the German economy is growing solidly and unemployment is falling, consumer spending is in the doldrums.
In recent weeks, news that hogs are being specially raised to feed the athletes at the next year's Beijing Olympics has spurred an outcry on the Internet. The pigs are reportedly being fed an organic diet and getting daily exercise, treatment that has China's bloggers variously mocking, lamenting and raging online.
"I would rather be a pig for the Olympics than a human in a coal mine!" wrote a blogger who calls himself Shiniankanchai, referring to the reported deaths of thousands of workers in China's mines so far this year.
Shiniankanchai's sentiments soon spread to other blogs and to Tianya, the biggest Chinese-language Web forum. They reflect a growing frustration among ordinary Chinese with tainted food, dangerous or inhumane work environments and corrupt officials -- a frustration that is being expressed with increasing frequency.
It's "just ridiculous!" said Jane Xun, a 24-year-old employee of a Shenzhen logistics company, in an interview after she posted her own online objections to the pig-rearing program for the Olympics. "It actually shows how serious the food-safety problem is. What am I going to eat?"
... But a program to raise pigs specifically to feed the Olympic athletes, both the Chinese and those from other countries, is seen by many citizens as a sign of mad excess and pandering to foreigners.
Pigs are such an important commodity in China that the nation has a strategic pork reserve, a little like the U.S. Strategic Petroleum Reserve, to stabilize prices. China's pork reserve releases frozen meat and live hogs in a supply emergency. A recent jump in the price of pork after an outbreak of blue-ear disease among pigs played a part in pushing up China's inflation rate to 6.5% in August -- a serious concern for a government worried about an overheating economy, asset bubbles and a disgruntled rural populace.
Coming in the wake of reports of tainted Chinese food and toys, news of the Olympic-pig project are adding fat to the fire for some citizens. The special pigs "show how serious our food safety issue is," Shiniankanchai commented in an Internet posting. "While the government is devoted to solving the athletes' pork-eating problem, common people are asking: How about the food safety problem for people living in this country?"
The Olympics pork supplier, Qianxihe Food Group, or Lucky Crane, as the company brands itself in English, held a press conference in Beijing in August to announce the project. According to reports in the Chinese press, which widely covered the press conference, the company said its aim is to provide athletes with the purest of meat, free of any substances that could cause them to fail doping tests.
" ... the 34-year-old engineer has pioneered the city's first permitted micro–wind project, a six-foot-tall cylindrical turbine that currently sits on his roof and sends juice into the energy grid ... (it) generate(s) between 300 and 600 kilowatt hours of energy per year, or about 10 percent of a typical home's energy needs. ... A one-turbine system will cost around $5,000, though Pelman estimates that rebates will reduce the price by $1,500."