Resilient Ambassadors of Change

Placebo Treatments Used More Often Than You Think

I read a disturbing article (http://www.comcast.net/articles/news-health/20081026/MED.Placebo.Ethics/) stating that about half of American doctors regularly treat patients with placebos, and many of them aren’t doing so with informed consent of the patients.  In the article, it mentions that this treatment may be happening because a lot of doctors feel they should do “something” rather than “nothing.”  This ties into some reading I’ve been doing on cognitive medical errors.  Doctors feel pressure from their patients, patients’ families, and/or superiors to do something NOW as opposed to doing more intensive diagnosing, which can lead to medical errors.  We’ll be soliciting input from our advisory committee on Wednesday about their thoughts on cognitive errors, which I’m sure will stimulate me to post some ideas they chew on with us.

Mammographs Eyeballed by Computers

I read in the New England Journal of Medicine that in many European countries, it is standard for two people to read mammogram films as opposed to having just one person read them as it is practiced in the United States.  Having two people read the films obviously increases the chance that something that should be looked at will be caught. However, this can be a time and resource-consuming process.  In the New England Journal of Medicine, I saw an article from a group of scientists who wondered if there might be a way to use computers to read the films as a second set of “eyes” instead of another person. If so, can it be as accurate as two sets of human eyeballs?

This study found that the cancer-detection rate (people with definite cancer) was about the same with one person reading with computer aid and with two people reading the films.  However, the recall rate (people with suspicious masses that could be cancer) was significantly higher in the single person with computer aid group.  I see an up-side and a down-side to these findings.  The up-side:  Using one person as opposed to two frees up time and resources to read more mammogram films.  The down-side:  The recall rate is higher, meaning that many people who have benign tumors may be being called back for further testing.  This probably uses more time and resources than having two people initially read the scans. 

It’s very easy to connect this research with computer-assisted projects like our own item parsing pilot, Lucy, or with our interest in the field of computer simulations in general.  Even when results like these seem to break even, it’s important that people are doing this kind of research.  We’ll never figure out what technology works best without people experimenting in this field.

For those who are interested in the science-y numbers, check out the article in the New England Journal of Medicine 2008 Oct 16;359(16):1675-84. Epub 2008 Oct 1.

Finding Doctor Right

In a special section Decoding your health, the New York Times provides some solid information and advice to consumers in a variety of articles around topics like Googling your health, popular medical websites, FDA approval for medications, alternative medicine, and more. 

One of the articles, You can find Dr. Right, with some effort, gives consumers some direction for selecting a physician, using what little objective data is currenty available, as most consumers continue to rely largely on word-of-mouth referrals from family and friends.

The article suggests contacting the usual suspects like your State Medical Board for licensing information, your health plan (as some are beginning to provide some quality measures) and the American Board of Medical Specialties for specialty certification information, as well as some of the emerging services offering physician ratings.  Still, this is precious little information as the basis for a most intimate doctor/patient relationship--no quality measures of physician performance or even descriptive data about physicians' practices.

No surprises here, good objective data is hard to get, and volumes of subjective physician rating data will likely not provide the basis for good decision making.  The relevance and timliness of our discussions around physician matching, performance measures of physians in practice, physician practice profiles, and data compilation and report out continues to be supported by the increasing public demand for quality measures for physicians.

"...patients cannot get their hands on a wealth of information about physicians that is compiled by government agencies....  The Medicare program recently started a physician quality reporting iniative,...information is not yet public."

In an attempt to obtain data about procedures done by physicians (e.g., knee replacements, prostate surgery, etc.), last year the nonprofit group Consumers' Checkbook won a lawsuit granting access to Medicare's physician records.  The government is appealing the decision--there goes that big, publicly-available data set that we've been dreaming about.