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  A report by the British Medical Journal found that when outcome data were re-analyzed to include the unpublished data for 42 previously FDA-approved drugs, a whopping 93% of the outcomes changed.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.

Take one of our health surveys:

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?

 

Pay it Forward

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An old idea to be sure, but certainly one that merits consideration as we begin the New Year. Perhaps as much now as during any other time in history, the world is at odds with itself. Political, economic and civil strife are more common than not. Polarizing ideals are becoming more and more entrenched with an inversion of priorities so execrable that truth and morality have become equivocal and subject to whims of corporate or political marketing. Worse yet, those who should be leading have ensconced themselves with a false allegiance to some bastardized theory of capitalism and patriotism, leaving the rest of us to fend for ourselves. And fend we must.

At the risk of being overly melodramatic and cliche ridden, (and yes, I admit that I am drawn to such flourishes), it is time stop all this nonsense and look beyond our own individual success. It’s time to create the world we want our children and grandchildren to live in- to pay it forward.

Over the last year, I have had the opportunity to see how little instances of paying it forward can build a community from scratch and excite an entire town. Sure we’re not nearly as impressive as the OWS movement, but in our way, what is happening in Las Vegas is a microcosm of what is possible.

For those of you not familiar with Las Vegas, we’ve had a bit of an economic downturn. Sure the casinos are doing fine, but just about everything else tanked. Las Vegas boldly competes for highest unemployment and foreclosure rates in the nation and the lowest scores in education, education funding, healthcare, family services, research grant funding, VC funding and just about every indices that sane, educated, people look at when determining where to live and where to do business. To add insult to injury our libertarian roots, rather than guide us toward to the possible, have forced the political leadership into policy contortions so pretzelled the circus would be impressed.

This all changed about eight months ago when the rest of us began fending for ourselves, realigning priorities and paying it forward. The benefits of a crashed economy, if there can be any, are that only up is possible. Vegas was given the opportunity to re-build, re-define, re-align. Although the bastions of economic development have yet to realize this opportunity, our little movement towards economic re-birth is growing, one little startup company at a time.

In the spirit of the New Year, I’d like to recognize all those who are re-building the Las Vegas economy. Those individuals, who in addition to building their own businesses are helping to build their neighbor’s business and the community as a whole. And of course, we’d like to thank those who have helped Lucine grow over the last year. Here’s my list of Southern Nevadans paying it forward within the business community. Feel free to add to it.

In no particular order:

Cybertek Networks, James Lauf and Ellen Saravis, for supporting and helping build Southern Nevada Biotechnology Entrepreneurs  and Henderson’s (suburb of Las Vegas) nascent Parallel Innovations Labs ( biotech incubator facility).

Rick Duggan, Zappos, for growing and organizing the Thursday night Jelly from a lonely few developers to a vibrant community of over 150. Kudos.

David and Jennifer Gosse, founders of Tracky, founders of MOMOLasVegas, supporters of Vegas Tech, StartupWeekend, Ignite Las Vegas, LaunchUp Las Vegas, driving all sorts of community building efforts.

Tony Hsieh, Zappos, for putting his money where his mouth is and investing in Downtown and the new tech economy.

Kate Marshall, Steve George, Mark Mathers, for SB75 and NCIC small but important steps for the new Nevada economy.

Switch– for things to come.

Arnold Gold – for being a great Lucine mentor and advisor.

Shavonnah Tiera– for bringing StartupWeekend to Las Vegas and being an ardent supporter of startups.

VCubate – for giving Lucine and other companies a place to work.

Bob Cooper and Jeff Leake – City of Henderson Office of Economic Development- for being the most progressive, supportive development office in the Nevada.

John Lynn, EMR, EHR and HIPAA,  for growing Las Vegas Startup, mentoring young companies and helping to rebuild our site after the hack.

Dillon MartinGreen Valley Med and an ardent supporter of health and wellness dillonmartin. net  for being a founding and active member of SNBE, building the SNBE website and supporting Lucine.

Quertle.com -Jeff Saffer and Vicki Burnett, for co-founding SNBE with me, for work on Parallel Innovations Labs and for raising the bar for technology companies in Las Vegas by winning the National Library of Medicine Technology Award.

Ayloo.net for driving the conversation on community building.

The Beat Coffee House, we couldn’t ask for a better place to meet and co-work.

Usr/lib – take a look.

The guys at LaunchUP Las Vegas—for bringing the concept of barn-raising to the startup community.

John Hawkins of 9Seeds for building the VegasTech site, help with our site, hosting the WordPress camps and for things to come.

And the incredible Lucine team, for doing whatever it takes.

What can you do to pay it forward?