Future of Health CareMedical Decision-MakingResearch
March 6, 2019

If Not Now, It’s Too Late: Clinical Science Is Futile If We Study the Wrong Population

In 1936, the Literary Digest, a respected national magazine, undertook a public opinion poll. Who would win the race between Republican Alfred Landon, governor of Kansas, and Democratic incumbent Franklin D. Roosevelt? Mock ballots were mailed to 10 million Americans. About 2.4 million responded—one of the largest survey samples ever created. Their prediction? Landon would carry the day. They were wrong—by a landslide for FDR. That’s because respondents were biased toward Landon and did not accurately represent the distribution of presidential preferences across all voters. Notably, George Gallop accurately predicted FDR’s victory using a smaller representative sample of about 50,000…
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Consumers & PatientsFuture of Health CareMedical Decision-MakingResearch
February 13, 2019

If Not Now, It’s Too Late: Clinical Science Needs Fixing

In 1967, the year I graduated from high school, my family’s television required “rabbit ear” antennae with perched aluminum foil. Our farming family had little time to watch TV, but when we did, the ritual included a side trip to reset the antennae’s angle to ensure good reception. Today, I watch a clear picture on myriad devices, no antennae needed. In the 1980s, my trips to a library to find medical literature were few. A single trip to the library would take hours and net only a small number of papers. Now, I obtain articles on any topic in a…
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Consumers & PatientsMedical Decision-MakingValue-Based Health Care
December 12, 2018

Conflict of Interest in Medical Practice Is Hardwired: Unless We Acknowledge It, Nothing Will Change

In philosophy class, we were asked to choose which of two children falling out of a boat, unable to swim, should we save. Kant believed all people share the same moral equivalency, and a choice cannot be made to save one or the other based on morality. They must be treated the same. This question was paired with a second question forcing a choice between sacrificing one to save others, or many to save one. Tough moral questions. However, both questions were moot if the one being saved or sacrificed was your child. No matter what moral principle studied, whether…
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Consumers & PatientsFuture of Health CareMedical Decision-MakingResearchValue-Based Health Care
October 17, 2018

Wise Patients Really Can Make Medical Decisions

“The numbers in this blog are hard to believe. Why is the medical profession recommending shingles vaccine? It is one thing to say that patients should be their own advocates. But why would medical professionals recommend a vaccine to their patient that has such a paltry risk/benefit outcome? After all, we go to doctors because we presume that they know more about medical conditions, prevention and treatment than we do. If they don’t, what’s the point?” A wise patient reading my blog on the shingles vaccine made the above comments. The adjective “wise” has been defined as “able to make good judgments.”…
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Consumers & PatientsMedical Decision-MakingResearch
August 8, 2018

Why Randomized Clinical Trials Are Essential to Informed Medical Decisions

I am not a card-carrying philosopher, although I did study philosophy as my undergraduate major. What I enjoyed most was epistemology, the theory of knowledge. We debated, hotly, from the standpoints of social interaction and humanism, “What is knowledge? What constitutes knowing?” But such philosophical debates are not relevant in medical care. Medicine is not a philosophical province. By that I mean that when we are ill, we are philosophically the same; debating differences is a waste of time. We have equal value; have the same rights to the same efforts and same actions to get us better. The essential…
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Consumers & PatientsMedical Decision-MakingResearch
June 20, 2018

Deciphering Outcomes: Thirty Percent More of Nothing Is Still Nothing

Trying to pass a Bill through a legislature demands a hardy disposition. I have been involved in three attempts on different issues—one bill passed, one is still in limbo, and a third, the most salient for me, failed. In the latter case, I was the sole proposer of the Bill. My idea captured the imagination of a state representative who said she would sponsor it, but, first, she wanted to get some other views. Eleven lobbyist conversations later, my Bill was dead. Something about the legislator being worried that my Bill would be taking on the First Amendment, which allows…
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Future of Health CareMedical Decision-MakingResearch
May 16, 2018

“Just the Facts, Ma’am”

Communication, according to Webster’s: “exchange of information” You and I talk all the time. We are constantly “communicating.” Communication is a huge idea that encompasses and displays our views of the world. But communication is more than just the sum of the words used to communicate; the words are contextual. Raymond Carver wrote with simple, universally understood words, but I could not communicate like him even if I used the same words and labored intensively. Communication, in a sense, is a five-syllable word that is nearly elevated to a sixth sense, like taste, sight, touch, smell and sound. But here’s the rub. I don’t…
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Consumers & PatientsMedical Decision-MakingResearch
May 2, 2018

Patients Deserve Truth-based Medicine—But Most Aren’t Getting It

“I have breast cancer; I read that I should not drink wine because it may cause my cancer to return. I always wanted to be a sommelier, but that dream is dashed!” People, sensibly, read about their medical conditions, searching for things that might help or hurt them. However, patients are vulnerable. Their vulnerability may cause them to overestimate concerns, or, alternatively, hopes after learning of a medical advance. Physicians and medical reporters have a daunting, yet crucial obligation to give people information that is credible; strategically, we also need to thwart information that is useless. Giving poor, non-science information…
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Medical Decision-MakingPatient EmpowermentResearch
December 6, 2017

For Tough Medical Decisions, Hard Choices Require Hard Facts—Not Conventional “Wisdom”

What matters in medical decisions is what we know, not what we think. In the late 1980’s I cared for a pregnant woman with breast cancer. Breast cancer is the most common form of cancer in pregnancy, but uncommon in frequency, occurring in about 1 in 3,000 pregnant women. Providing and receiving treatment is certainly a complex emotional experience; at that time, uncertainty about how to treat was the norm. The woman had a mastectomy but did not take chemotherapy based on concern for her baby. Three months after her delivery, now receiving chemotherapy for her aggressive breast cancer, the…
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Future of Health CareMedical Decision-MakingPatient Empowerment
October 25, 2017

Medical Treatment Should Be Based on More Than Just “Doing Something”

Memory is malleable. This was made quite clear to me at my recent 50th high school reunion. Despite my fallacious recollections, I could not dispute the data of my forgotten activities, awards and foibles captured in pictures and written comments in my high school yearbook. Then there were the comments about my behaviors “back then,” interpreted or misinterpreted by my former high school comrades. These conversations reinforced for me how difficult it is to correctly intuit the motives and thoughts of others, when my own are occasionally tarnished or refurbished. None of us can truly read another’s mind. Even if…
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