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 CarePatient EmpowermentResearch
August 9, 2017

How to Recognize “Fake” Medical News — And Why It Matters

Is coffee good for you? A recent headline suggested that people who drink coffee live longer. Sounds great to me. I drink a lot of coffee, so maybe I will be immortal. But, wait, another report links coffee to cancer. Dang. Estrogens were once touted as a life saving elixir for women of elegant ages, until these hormone supplements were linked to increased cancer risk. Wine will either add to your life expectancy or increase chances of breast cancer. But if you are married and have cancer, your outcome is better; you live longer (and can drink more wine?). Eggs…
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Future of Health CareMedical Decision-MakingPatient EmpowermentResearch
June 7, 2017

Physician Comparisons Based on Performance Don’t Tell the Right Story

Medical decision-making requires a comparison. There is, most often, more than a single option for your care. New tests and treatments are constantly being added to the medical portfolio by scientific inquiry. The only way to advance care, in fact, is by comparing options. Comparing incites a difficult task, however: the compared option that is best for your disease-related outcome may be worse for your test- or treatment-related outcomes. For example, for men with early stage prostate cancer, surgery may reduce the chance of dying of prostate cancer from 8 to 6 percent over 10 years, but surgery increases, simultaneously,…
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Future of Health CareMedical Decision-MakingPatient EmpowermentResearch
February 21, 2017

For Patients, “Trust Me” Is No Longer Good Enough for Medical Decision-Making

It’s time to rethink ideologies of medical care that no longer make sense. The following may sound revolutionary, but are nonetheless true: Patients are the future leaders in medical care. Patients must and can make their own medical decisions after being informed. Patients can and must learn to discern useless from useful information. Science must improve to match the increasing abilities of patients. At present, none of these concepts are fully embraced by the business of medicine and, in fact, may be a 180-degree reversal from the way things work now. So, why are these statements important? Because getting the…
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Future of Health CarePatient EmpowermentResearch
December 6, 2016

A Populist’s Wish List for Patient Empowerment

Health care turmoil of the last 10 years was wild enough, but the ride ahead promises to be even wilder. News and social media are swirling with proposals to “reset” health care. Among the dizzying array of possible scenarios, one idea is gaining traction: patient “empowerment.” It will, without doubt, be a prominent call-to-arms in the months ahead. But, what exactly is patient empowerment? The newly branded concepts presented in health care proposals are murky and incorporate everything from patient responsibility for lifestyle changes and following treatment plans (patient “compliance”) to greater financial responsibility for health care (shared premiums). Patient…
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Registry ScienceResearch
November 15, 2016

Bedside Viewpoint: Why Watson Will Never Know Enough to Replace Your Physician

Every conversation with a patient is an exercise in big data analysis. Your patient’s appearance, changes in mood and expression, and eye contact are data points. The illness narrative is rich in semiotics: pacing, timing, nuances of speech and dialect are influenced by context, background and insight, which, in turn, reflect religion, education, literacy, numeracy, life experiences and peer input. To all this, add personality traits such as recalcitrance, acceptance and personal philosophies. Taking a history generates a wealth of data. Mix in physical findings of variable reliability, laboratory markers of variable specificity, imaging bits and bytes, and you have…
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