Roji Intel Blog

Theresa Hush 0
10
Artificial IntelligenceFuture of Health CareResearch
February 12, 2020

Could AI Push Sales of Personal Health Data? How to Protect Consumers While Advancing Science

We are just beginning to see the power of Artificial Intelligence (AI) in medicine and management of conditions. AI is being used to enhance and speed diagnostic capabilities in conjunction with wearable devices as well as to identify health care cost issues and high risk patients. Companies, health care providers, and researchers hoping to move forward with better medical technology—and tools to make health care more affordable and accessible—are eager to use AI-powered data in applications. They are largely invested in the quest to use AI in health care for the good of consumers and their patients. But data is…
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Robert McNutt, M.D. 0
31
Future of Health CareMedical Decision-MakingResearch
September 11, 2019

Fixing Clinical Science Requires a Moonshot

“We chose to go to the moon” President John Kennedy’s statement instigated a monumental marshaling of resources to achieve a remarkable goal. Those famous words also established a powerful metaphor for aiming high. We need an equally monumental shift in purpose and commitment of resources for how we conduct clinical science. Nothing less than our nation’s health is at stake. In my view, there are only three possible ways research efforts might proceed: First, the conduct of research might not change, but continue to rely on observational studies and non-generalizable randomized trials (RTs). If so, populations of subjects included in…
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Robert McNutt, M.D. 0
1
Future of Health CareMedical Decision-MakingResearch
August 21, 2019

AI May Be the Future, But It’s Not (Yet) the Future of Clinical Research

Good medical practice depends on good clinical research. Without rigorous, replicable, reliable research findings, we cannot trust that our medical decisions are based on truth. To put it bluntly, flawed research leads to bad medicine. It’s essential that we get it right. In this series, I have argued for a more rigorous approach. The present model of clinical research is expensive, slow, studies insufficient populations of subjects—making generalizability difficult— and lacks power to examine important variations in clinical and personal characteristics of individuals. In my biased view, study design determines if research is being done. Without an appropriate design, we…
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Robert McNutt, M.D. 0
0
Future of Health CareResearch
July 17, 2019

How the Stock Market Models a Path to Better Research.

The better clinical research is, the better medical care will be. It is so crucial to the future of best medical care that I have highlighted deficiencies of the present conduct of randomized trials (RTs) in previous articles to suggest ways to improve. A system of better research must accommodate studies on any intervention aimed to improve care, including interventions such as a change in practice, any quality or safety plan, or an economic principle such as fee-for-service versus capitation—not just studies of new drugs. In my last article, I coined the term “Gallup Research Medicine” as a model to…
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Robert McNutt, M.D. 0
0
Future of Health CarePopulation HealthResearch
May 29, 2019

Here’s One Way to Do Better Science

Clinical research with randomized trials (RTs), as opposed to basic or bench research, is the science of comparison. RTs ask a fundamental question: Is “x” better than “y”? They do more than observe how treatments work; they also require methods that control the research environment. Finding an independent contribution of one action over another demands random, stratified populations in order to find truthful differences, as medical care advances on these differences. But the way that patients are typically recruited for RTs can undercut the validity of the study’s findings. I propose we take a different approach, one I call “Gallup…
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Robert McNutt, M.D. 0
3
Future of Health CareMedical Decision-MakingResearch
April 24, 2019

If Not Now, It’s Too Late: More Clinical Science Pitfalls and a Path to Improvement

Let’s review three major vulnerabilities with how randomized trials (RTs) are conducted, as discussed so far in this series. Critically appraising a research study involves determining the “internal and external” validity. Internal validity deals with the conduct of the study, per se. External validity deals with whether the study’s findings can be generalized to others in the population. Here’s what can go wrong: Populations being studied in RTs are too often convenience samples of patients/subjects rather than random or systematic samples of subjects. This diminishes our ability to externalize findings from the RT to the population at large. This is…
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Robert McNutt, M.D. 0
1
Future of Health CareMedical Decision-MakingResearch
April 3, 2019

If Not Now, It’s Too Late: Simple Randomization Can Lead to False Inferences 
About Treatment Decisions

Medical decisions are best made on the basis of clinical science. Accurate research, shared between physician and patient, enables the patient to make an informed choice about risks and outcomes of treatment options. That’s how it should work, in theory. But in practice, even with the best shared medical decision-making, far too much clinical research employs faulty methodologies that limit the relevance of findings. This must change. In a recent blog post, I suggested that clinical science can improve by choosing more representative groups of people for study. Many clinical studies use convenience samples of patients rather than samples chosen…
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Theresa Hush 0
1
Future of Health CareResearchWomen and Health Care
March 20, 2019

At the Heart of Gender Disparities in Health Care is Women’s Pain

Pain is a key symptom of injury or disease, and managing acute pain is usually one of the first services provided to patients. But if the patient in pain is a woman, the provider may require more convincing. Providers doubt that women’s pain is real and underestimate the level of pain for women. Substantial evidence shows that providers report higher levels of pain for men than for women. Gender stereotypes are so strong that in a recent pediatric study, participants evaluating a child’s pain reported higher levels when told that the child was a boy and lower if told it…
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Robert McNutt, M.D. 0
0
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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Robert McNutt, M.D. 0
0
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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