January 2012

Data Matter

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A dirty little secret in medical literature, systematic reviews are only as strong as the individual studies they examine. And when negative data are not published in the major medical or scientific journals, as is commonly the case, these reviews cannot help but be skewed.  A report by the British Medical Journal found that when outcome data were re-analyzed to include the unpublished data for 42 previously FDA-approved drugs, a whopping 93% of the outcomes changed.

All data matter, especially in medicine.  With systematic reviews and meta analyses, the gold standard in scientific publishing, researchers seek to make claims about a particular drug or health event based upon the totality of the published research. Physicians and other scientists use these systematic reviews to guide decision-making. Prescribing a drug based upon the positive findings of a systematic review gives one considerably more confidence than doing so based upon a few unrelated studies. When the systematic reviews are based upon insufficient reporting of negative or null results, the review is likely inaccurate.

Publication bias, as it is called in research circles, is a well known problem to many. By nature, scientific journals gravitate toward positive and novel results, in much the same way TV news reporting tends toward negative, salacious events. Both are clamoring for market share. Unlike in TV news, bias in the research industry can and does have serious consequences when medical-decision making rely on those results. Noted physician and medical blogger Harlan Krumholz, contends that medicine’s biggest threat is not some exotic virus, but missing data.

Case and point, when data about adverse events are withheld from publication, bad drugs, such as Vioxx are released into the market place and presumed safer than they actually are.  A similar scenario is emerging for Yaz/Yasmin. These birth control pills are currently facing a bevy of lawsuits  for some serious adverse events.

So what is one to do, who does one trust?  I don’t know the answer to that question, but I think that good first steps include transparency and open access to data and research. As a patient, this includes access to scientific and medical research as well as access to our own medical data. As we report in the stories below, access to research is at risk if the Research Works Act passes.

A next step is to demand all data be published in drug studies, the good, the bad and the ugly. The British Medical Journal reports, those data are available in many, but not all cases, through FDA and other repositories. However, culling and analyzing those data along side the published reports is no easy task.

Perhaps a third option, is post-market crowdsourcing. Granted, not the best option when dealing with potentially dangerous therapeutics, but in this new environment of empowered patients and big data, crowdsourced research is becoming more common. The organization adverseevents.com is aggregating patient-reported adverse reactions to medications. It’s freely available to patients and physicians globally. A myriad of other companies have come on the market in recent years to crowdsource the research for all sorts of medical conditions. These companies offer patients the opportunity to participate and learn directly from the research conducted. Unlike traditional clinical research, the data and results are not cloistered, but are open and readily accessible.

In the end it all comes down to data and how we use it to make decisions about our health.  I believe data matter. I believe data ought be open and accessible. What do you think?

Participate in Crowdsourced, Post-Market, Adverse Events Research

Take a few minutes to complete a survey about the medications and surgical procedures you have utilized. Take as many health surveys as are applicable and share the surveys with your friends. All surveys are anonymous and completely voluntary. We’re adding more surveys every month, so check back frequently or sign up for our weekly newsletter to keep abreast of the latest research news.

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Crowdfund Research on Medications that Matter to You

Lucine Health Sciences and Hormones Matter, are unfunded and run by Dr. Chandler Marrs along with a cadre of dedicated volunteers. We know the work we do is important and needed and so we’re doing it anyway, despite the lack of funding. We’re bootstrapped to the nth degree, but determined to fill the critical data void in healthcare, one study at a time.

We’ve set up an unsubscription model to fund our education and research programs. We call it an unsubscription because it is not really a subscription in the true sense. It’s just a mechanism to fund the work that maintains our commitment to open access health information on Hormones Matter.  By purchasing an unsubscription you are supporting our continued operations and research; research and health information we all need but can’t get anywhere else. To help fund additional research: Crowdfund Us.

 

Thoughts on How Physicians Die

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How one views death, says a lot about a person.  Should one avoid death at all cost, even when the end is near or should one accept it gracefully and live what life is remaining?  Or should one barrel through life without regard?

While death is highly personal, health and illness are social. Both affect those around us, sometimes perhaps more so than they affect us.  As a mom, I think about health, illness and death, probably more so than when I was young, single and childless; I am sure many of you do the same.  When I consider my own death, it is always with respect to how it would affect my children or my husband. That is why I was intrigued by an article published on Zocalo Public Square, entitled How Doctor’s Die.

The article, by Dr. Ken Murray, a Clinical Assistant Professor of Family Medicine at USC, details a vast disparity between how physicians and non-physicians or patients approach terminal illness and death.  Dr. Murray suggests that many physicians, having seen death, having seen terminal illness and having seen the pain and suffering associated with many end-of-life treatments frequently choose a quiet death, unaided by lifesaving heroics.  They choose to live, what life is remaining, with family and friends. In contrast, patients and their loved ones often grasp for every medical miracle, sometimes increasing pain and suffering for themselves and their family members along the way. Many patients, it seems, fight for the medicalization of death.

It may not be that simple. The comments posted following Dr. Murray’s blog suggest a myriad of responses, some none too polite. Research on the topic also suggests a bit more complexity than the doctor-patient dichotomy presented. In a recent study published by the Archives of Internal Medicine researchers found that when physicians were faced with a hypothetical terminal illness they were statistically more likely to take the riskier treatment themselves than recommend it to the patient. Indicating that physicians may fight more stridently for the latest, life-saving medical technologies.

Or it could be that when physicians face terminal illness, hypothetical situations aside, they are just as ‘irrational as the rest of us’ says former terminally ill patient and physician Eric Manheimer. While Dr. Manheimer wanted to cease treatment, his wife would have none of it and convinced him otherwise. He survived to tell about it. Maybe when it comes to illness and death, rationality has nothing to do with the decision-making process. Maybe it’s all about personal choice and personal choice is, more often than not, guided by a host of factors, including emotion.

I wonder if this holds true in life and health.  Do physicians take the medications they prescribe to their patients or do they seek alternative treatments? Or do they ignore their health altogether like so many of us do?  Do physicians approach surgical options in the same manner as patients? Does this unique and daily perspective of illness and death change one’s view of life or health? It must. How could it not? What do you think?