A question for Andrew from Hywel Williams: Efficacy in RCTs – mean response or spread of response? Improved disease score New Viagra Standard Viagra Mean improvement score = 5.0 in both groups 5 Disease worse Mean Disease better Which treatment would you prefer? (Performance vs. predictability)

Efficacy in RCTs – mean response or spread of response? Improved disease score New Viagra Standard Viagra Mean improvement score = 5.0 in both groups 5 Disease worse Mean Disease better Id prefer Predictability - it would save time spent in titration and consultations

The question from Charles: Is pharmaceutical medicine doomed? No, but all the actors need to stop focusing narrowly on their own expertise and roles – be it pharmaceutical technology, patent law, clinical trials or marketing – and become at least as much concerned about ends as means, i.e. the social and individual contexts in which medicines play a part. I dont know how that could be achieved or when

A question to Andrew from Jeff Aronson Drugs are often withdrawn from the market on the emergence of serious adverse effects, which nevertheless may not affect all individuals. How can we ensure that useful drugs can be kept on the market to benefit those who are not susceptible to their adverse effects, while making sure that those who are susceptible are not exposed to them?

The question from Jeff: How can we ensure that useful drugs can be kept on the market to benefit those who are not susceptible to their adverse effects, while making sure that those who are susceptible are not exposed to them? I think wed have to try to identify those who are susceptible, both to themselves and to their doctors, but it would be very complicated to ensure that they are not exposed

A question from Trish Greenhalgh Could you please tell us about the most illuminative story youve heard about an adverse drug reaction – or indeed any other illness story….

from Trishs question: The most illuminative story Ive heard about an adverse drug reaction – or indeed any other illness story … The deepening of the voice that women have reported with long-term use of tamoxifen. Predictable from pharmacology, not investigated properly, not mentioned in warnings/ information, largely ignored

Anitas question: How can we push an appropriate agenda for examining the significance and impact of drug diversity - the tendency of drugs to have different effects in different individuals and populations? The politicians and health policy makers responsible to these populations and individuals must be made to face this problem – education must make them aware of it. Where drugs are concerned most of us belong to a minority

The question from David Menkes: What advice – say, about a new drug - would best suit a medical practitioner in the developing world - who has the option of sponsored pharmaceutical information from a rep versus no information at all? No information at all wont work, nor will info from commercial reps. The provision of reliable information is a public and a professional responsibility, but training in critical appraisal, and practice in using it, are needed to reinforce it. So is international support.

Sams question: Andrew, could you please give us an unpunishing summary of this meeting, as a pun? Thats difficult. We tried hard to distinguish between the views as as they appear from Kenwood and from Kent Woods: how far they coincide and how they differ.