I was recently at a workshop for National Science Foundation Principal Investigators focused on how to communicate research to the public and the media. One of the suggestions was to develop a three-word summary of the principle message of your research work. This is hard.

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I’m writing from Philadelphia, at the annual meeting of the Society for Medical Decision Making. I’ve just had the pleasure of attending a great short course entitled “How to discuss evidence-based diagnosis with experienced clinicians (and avoid giving EBM at bad name)”, taught by Tom Newman and Mike Kohn from UCSF.

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The September 30, 2008 New York Times has a new feature section on “Decoding your Health”, which includes, among other articles, “Searching for Clarify: A Primer on Medical Studies” by Gina Kolata, an outstanding science writer. It also includes “You Can Find Dr. Right, With Some Effort” by Roni Caryn Rabin, which offers sound advice about how patients might go about selecting physicians.

The problem of choosing a physician is not a trivial one.

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Salon.com has recently reviewed a new book by pediatrician Dr. Paul Offit on the anti-MMR (and anti-thimerisol) vaccine movement. Back in February this year, a friend of mine wrote to me that she was “on the fence” about vaccinating her infant. As she put it, “Whom are we to believe?…I’d be interested in anything compelling on either side so I could just move on either way.  My confidence in institutions is at an all time low.”

My response to her (revised for this blog) reviewed some evidence, much of which also appears in the Salon article:

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A strange commentary in the Washington Times this week entitled “‘Evidence-based’ Rx miscues” makes claims about evidence-based medicine (EBM): both what the terms means and what it implies for health policy. The author suggests that EBM is equivalent to “one-size-fits-all” medicine that removes physician autonomy in pursuit of a “political imperative to cut costs – not the medical imperative to give patients the best care possible.”

Dr. Roy Poses, a well-respected physician who has done a lot of work studying physician probability judgment (one example of which is mentioned in Chapter 7 of Medical Decision Making) has posted a rebuttal on the Health Care Renewal blog. Dr. Poses demolishes the misrepresentation of EBM that appears in the original article (as well as asking some on-point questions about the author’s interests in the matter), and does it quite effectively, so I won’t repeat his criticism here. Instead, I’ll focus on some other misunderstandings in the original commentary: that cutting health care costs is at odds with the medical imperative to improve care, that patients are so biologically unique that studies of patient groups has little value, and that EBM reduces physician autonomy.

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“Buy on apples, sell on cheese” is an old proverb among wine merchants. Taking a bite of an apple before tasting wine makes it easier to detect flaws in the wine, and the buyer who does so will not as easily make the mistake of paying more than the wine is worth. Cheese, on the other hand, pairs well with wine and enhances its flavor, so a seller who offers cheese may command a higher price for the wine (and may even deserve it, if the wine is intended to be drunk with cheese).

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A bit of synchronicity strikes, as I come across two different pieces from quite different sources on the question of “even if we have a test that provides probabilities of future health states, do we really want to know?”

The first is journalistic. National Public Radio’s program Talk of the Nation did a segment on a new blood test that can diagnose early stages of Alzheimer’s diease.

The second is literary, as the science fiction podcast Escape Pod presented the story Results by Kristine Kathryn Rusch, originally written in 2000.

Very different formats, very similar ideas about patient-focused decision making. Each is well worth a listen.

The November 2007 issue of Consumer Reports features an article entitled “Treatment traps to avoid.” The article focuses on unnecessary and overused health care treatments (in the United States). One major emphasis of the report is the emphasis on the approval of new drugs and the marketing process for drugs in the U.S. in general, which includes both substantial direct-to-consumer marketing (illegal everywhere else in the world except for New Zealand), and extensive marketing to physicians — for both on-label and off-label uses — by means of gifts, samples, meals, and reprints of research sponsored by the manufacturers. Research frequently establishes a drug’s efficacy vs. placebo, but more rarely compares new drugs with the established standard of care and demonstrates incremental effectiveness, much less incremental cost-effectiveness.

As a result of a $430 million settlement between drug manufacturer Warner-Lambert and the U.S. government, several projects have been funded to study and address issues in the marketing of pharmaceuticals. One such project, Formulary Leveraged Improved Prescribing (FLIP) is centered across the street from my office, and is a joint effort between the University of Illinois at Chicago and the John H. Stroger, Jr., Hospital of Cook County.

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The 29th annual meeting of the Society for Medical Decision Making (SMDM) will be held in Pittsburgh, Pennsylvania, USA on October 24-27, 2007. All the relevant detail can be found at http://www.smdm.org.

This is the meeting to attend if you’re interested in medical decision science; presentations typically focus on clinical applications, methodological advances in decision and cost-effectiveness analysis, psychology of medical decision making, and other key topics in clinical and health policy decision science. There are also excellent short courses in the days before the meeting, providing education on MDM topics at a variety of levels (including a course on problem solving for medical educators by George, Frank Kee, and I).

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