Florence Nightingale, passionate statistician
A tip of the twitter-hat to @TimOReilly for this, from Science News:
When Florence Nightingale arrived at a British hospital in Turkey during the Crimean War, she found a nightmare of misery and chaos. Men lay crowded next to each other in endless corridors. The air reeked from the cesspool that lay just beneath the hospital floor. There was little food and fewer basic supplies…
“I can buy a damn good amputation…”
Paul Grundy MD, of IBM, chair of PCPCC, is interviewed in the current Crain’s Benefits Outlook, a business publication about employee benefit programs. This quote alone is worth the price of admission:
I can buy a damn good amputation for my diabetic, but what I can’t get is a good system in place to prevent my diabetic from needing the amputation. We don’t reward a system in which comprehensive coordinated care and robust prevention is valued.
Amen. What are we thinking, insurers, when we fund treatments instead of preventing them??
“The Evidence Gap”: Pharma impedes patient access to better treatment
A lot of effort and study is going into improving healthcare and untangling its cost structure. So methinks it’s nearly criminal when someone blocks adoption of a treatment that’s better, especially when it’s also less expensive.
Case in point, from yesterday’s NY Times: The Evidence Gap: The Minimal Impact of a Big Hypertension Study
The surprising news made headlines in December 2002. Generic pills for high blood pressure, which had been in use since the 1950s and cost only pennies a day, worked better than newer drugs that were up to 20 times as expensive.
The findings, from one of the biggest clinical trials ever organized by the federal government, promised to save the nation billions of dollars in treating the tens of millions of Americans with hypertension.
Six years later, though, the use of [diuretics] is far smaller than some of the trial’s organizers had hoped.
What?? I use diuretics, prescribed by my e-patient doc, Danny Sands. Doesn’t every BP patient? They reduce water content in the body, lowering blood pressure. Why isn’t every BP patient doing this?
Engage With Grace
The following post was written by Alexandra Drane and the Engage With Grace Team. Here’s an image of the slide, and below is the post that many are sharing today. (The original PowerPoint slide is linked within the post.) Please see comments at end.
Reducing Disparities, Spreading Improvement
Josh Seidman asks a very good question that goes toward our discussion of spreading improvement and the digital divide, “If [targeted] interventions… have been shown to have an enormous impact on the health of these populations, maybe Ix and related initiatives can be applied to a wide variety of challenges that underserved populations face — to help with education, employment, and ultimately, poverty itself… Where are the opportunities to extend the principles, research and insights we have gained from years of Ix advancement to improve society more broadly?”
Illness in the Age of ‘e’: A case study in participatory medicine
Last month, the Connected Health Symposium at Harvard Medical School saw a first: a full-length case study in participatory medicine, described concurrently by both the patient and his physician. The physician was our own Danny Sands MD, and the patient was our e-Patient Dave. It was “a remarkable story,” as Matthew Holt said on The Health Care Blog:
… a great session in which e-Patient Dave (Dave deBronkart) and his physician, Danny Sands described his use of listservs, the Internet, email and BIMDC’s PatientSite and other tools in his (successful!) battle with renal cancer—after being told median survival was 24 weeks. I won’t tell the whole story as they’re trying to get it published in an authoritative journal—so that physicians will pay attention and promote this use of technology by patients.
The presentation was videotaped, and we present it here.
Read more
No *other* conflict of interest, huh?
What’s wrong with this picture?
While continuing to search for information regarding the collective statistical illiteracy issue covered a couple of days ago, I found a brand new article in the New England Journal of Medicine.
As an exercise I decided to reorganize some of the paragraphs of the article, bringing to the top a couple of paragraphs that are located at the bottom of the original. FYI, the conclusion of the article is simple: “In this trial of apparently healthy persons without hyperlipidemia but with elevated high-sensitivity C-reactive protein levels, rosuvastatin (Note by G.F: Crestor, manufactured by AstraZeneca) significantly reduced the incidence of major cardiovascular events. ” Surprise, surprise! Crestor is good for you, even if you don’t have high cholesterol levels. Read the rest, it may explain:
Lies, Damn Lies And Statistics: Collective Statistical Illiteracy
Everyone knows the supposed origin of the phrase. But as you can see here it goes back to Medicine:
“Look at the dozens of operations by me this year without a death,” says the operator. His less enthusiastic neighbor thinks of the proverbial kinds of falsehoods, “lies, damned lies and statistics” and replies “reports of large number of cases subjected to operations seldom fail to beget a suspicion of unjustifiable risk”.
In “Some Surgical Sins”, John B. Robert A.M, M.D., Chairman’s Address on Surgery and Anatomy, 45th Meeting of the AMA, June 1894.
It looks like no much has changed since then.
Making sense of health statistics
Cross-posted from my own blog, with a late p.s. from this morning’s paper
When John Grohol read my post the other day about evidence-based medicine, he steered me to a paper worth reading: Helping Doctors and Patients Make Sense of Health Statistics.
This is relevant to the e-patient movement because as you and I become more responsible for our own healthcare, we need to be clearer about what we’re reading. Plus, it appears we could be more vigilant about what our own professional policymakers – and even our MDs – are thinking.
The paper is 44 pages, but even the first few will open your eyes to how statistically illiterate most of us (and them) are. Consider this question, which was given to 160 gynecologists:
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Your Health Information at Your Fingertips
Nancy B. Finn is a journalist with an expertise in the implementation of digital communications in health care and shared this story about personal health records:
I was recently hospitalized. Fortunately I did not have to go through the emergency department but was admitted directly to a room. When I arrived, the nurse assigned to my case sat down with me to go over my medical history and medications. Much to her surprise I provided her with my personal health record (PHR) that I had created several months earlier on the iHealth Record web site www.ihealthrecord.org. My PHR included information on the illnesses I had contracted; my family medical history, medical proxy, and most important my medications and allergies to medications and food. With this information, the nurse was able to complete our interview quickly and efficiently, confident that the information was accurate and up to date. She let me know that she had not run into a patient with a PHR before and that she was clearly impressed.
white paper
e-Patients:
How They Can Help Us Heal Healthcare
