Solving Worldwide Health Illiteracy with the Science of Medicine, SOM®

The first step in solving Worldwide Health illiteracy is learning the Science of Medicine, SOM®.  What is the Science of Medicine? The Science of Medicine is the most objective part of the existing medical knowledge; the part most free of human bias and conflicts of interest.

The Science of Medicine SOM® is derived from statistics within the medical literature. For example, how much does a particular chemotherapy increase your 5-year overall survival according to the best study done so far?

Evidence-Based Medicine has three steps:

1. The Science of Medicine SOM®
2. The knowledge of the physician
3. The values and preferences of the patient

What patients, doctors, nurses, and others need is an online database of the Science of Medicine, SOM®. It's very difficult to review and summarize the over 29 million medical articles on Medline. We should have an online, and offline, database that does it for us.

We need a list of treatments with Treatment Scores for everything. We need an online database of what we actually know and don't know, and it needs to be quantified. We need a database about the medical literature, about the gross and net treatment benefit of medical treatments, and also about hypotheses regarding medical treatments.

I saw a commercial on TV for a drug called Harvoni. It is used to treat hepatitis C. Interestingly, by narrowing down the diagnosis to a more specific diagnosis, and by only reviewing randomized controlled trials, I found the gross treatment benefit for Harvoni to be 95%, as in a 95% cure rate at three months. This is impressive as the old interferon-based treatment for hepatitis C only had a Treatment Score of about 40, or 40%. Harvoni appears to be at least twice as good as the old treatment.

Healthcare should be this simple. You get a diagnosis. Then, you get a list of treatments with Treatment Scores for that diagnosis.

DISCLAIMERS: I have nothing to do with Harvoni and don't get paid by Harvoni. Always see your own physician for diagnosis and treatment. We do not give medical advice and we do not form patient-doctor relationships.

Bradley Hennenfent, M.D.
@BradMD on Twitter

Copyright (C) 2019. Treatment Scores, LLC







EBM® Easy Basic Math is Needed in Healthcare

EBM® Easy Basic Math is Needed in Healthcare
by BradMD
(Brad Hennenfent, MD)



There is an 88% health illiteracy rate according to Health.gov. How can patients understand healthcare better? I believe much of the health illiteracy problem is connected to the math illiteracy problem.  


A 2008 medical article defines evidence-based medicine as:

"Evidence based medicine (EBM) is the conscientious, explicit, judicious and reasonable use of modern, best evidence in making decisions about the care of individual patients. EBM integrates clinical experience and patient values with the best available research information."SOURCE: Izet Masic, Milan Miokovic, and Belma Muhamedagic. Evidence Based Medicine – New Approaches and Challenges. Acta Inform Med. 2008; 16(4): 219–225. Accessed 11-28-2018. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3789163/


This means we need to combine the mathematics of three things for patients:

1. Statistics from the medical literature
2. Adjustments to those statistics based on the values and preferences of the physician
2. Further adjustments to those statistics based upon the values and preferences of the patient.

Copyright (c) 2018. All rights reserved.

The Science of Medicine - SOM®

The Science of Medicine - SOM®
by BradMD
(Brad Hennenfent, MD)

What is the science of medicine?

The science of medicine is the first step of evidence-based medicine. So, What is evidence-based medicine?

Evidence-based medicine consists of three things.

1. What the science says
2. What the physician knows
3. What the patient wants

I have summarized my simple definition of evidence-based medicine partly from a complicated 2008 medical article, which defines evidence-based medicine as:

"Evidence based medicine (EBM) is the conscientious, explicit, judicious and reasonable use of modern, best evidence in making decisions about the care of individual patients. EBM integrates clinical experience and patient values with the best available research information."
SOURCE: Izet Masic, Milan Miokovic, and Belma Muhamedagic. Evidence Based Medicine – New Approaches and Challenges. Acta Inform Med. 2008; 16(4): 219–225. Accessed 11-28-2018. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3789163/

You can see that this "Masic, Miokovic, and Muhamedagic" definition combines three things:

1. best evidence
2. clinical experience
3. patient values and preferences

What makes it confusing is that there are three terms:

1. Science-based medicine
2. Evidence-based medicine
3. Evidence-based practice

These terms are defined differently in different places and during different times in medical history. Most people would probably be surprised at the range of definitions and controversies surrounding evidence-based medicine.

Gordan Guyatt, MD, from McMaster University is credited with inventing the term "evidence-based medicine" and publishing it in 1991.
SOURCE: Guyatt GH. Evidence-Based Medicine [editorial]. ACP Journal Club 1991:A-16. (Annals of Internal Medicine; vol. 114, suppl. 2).

One website says: "Dr. Gordon Guyatt from McMaster University, who coined the term 'evidence-based medicine'...."
SOURCE: UpToDate. Accessed 11-28-2018. https://www.uptodate.com/home/editorial

The McMaster University website, in an article written by Gordon Guyatt, MD, says:

"What are the defining principles of EBM?
"EBM describes a set of practices to help solve clinical problems
"Essentially, EBM encourages physicians to use the best available evidence to inform clinical decisions
"Evidence takes the form of published literature, or unpublished personal observations"

SOURCE: Gordon Guyatt. Evidence-based Medicine. McMaster University Website. Accessed 11-28-2018.
https://www.mcmaster.ca/cfh/ktebm.html

Note, that in the original Gordon Guyatt - McMaster University definition of evidence-based medicine, the patient was left out of the decision-making process. Gordon Guyatt, and McMaster University defined evidence-based medicine as only two things:

1. Best available evidence
2. Unpublished personal overservations

The patient was left out of EBM in the beginning, and medicine remained paternalistic. The doctor told you what was best, based on what the doctor thought was the best evidence and based upon the doctor's unpublished personal observations.

Today, because of the transparency of information brought about by the Internet, many patients, patient groups, doctors, and nurses are trying to end paternalistic medicine and move medicine, the science of medicine, evidence-based medicine, or evidence-based practice, into a process of shared decision-making so that the patient is never left behind. In medical ethics, this is part of the principle of "patient autonomy."

Problems - Medical Treatments - Treatment Scores



This short video describes how patients and physicians should be doing evidence-based medicine and shared decision-making together, calculating the Net Treatment Benefit for the patient. The direct URL is: https://youtu.be/ymJVwiFDxD0

When you get sick with any illness you need a list of treatments with Treatment Scores. The Treatment Score = the net treatment benefit for the patient.

The Treatment Score is calculated using EBM guidelines and shared decision-making. Treatment Scores solve health illiteracy while taking into account the values and preferences of individual patients.

Together you use the:
  1. Outcome measure important to the patient
  2. Time scale important to the patient, and
  3. Absolute outcome measures not relative outcome measures
DISCLAIMER: Always see your own licensed medical physician for diagnosis and treatment. Treatment Scores are an organizational tool only.

Treatment Scores Solve Problems

Dr. Kit Byatt and Sarah Chapman recently published an article titled, "Being patient with EBM. 'Just because we can, doesn’t mean we should' – supporting informed decision-making." 

It's an excellent article about what patients, doctors, and healthcare journalists need, so let's offer a solution.


The authors want certain things when it comes to medical information. They see problems. To quote from them:

  • "Offer people information about their absolute risk of...absolute benefits and harms of an intervention...."

"This information should be in a form that:

  • "presents individualised risk and benefit scenarios and
  • "presents the absolute risk of events numerically and
  • "uses appropriate diagrams and text."

Treatment Scores solve the problems listed in this article. The Treatment Score = the net treatment benefit for the patient. 

Furthermore, the Treatment Score = the net treatment benefit for the patient using evidence-based medicine guidelines and shared decision-making. In other words, Treatment Scores make the medical literature simple and understandable for patients, doctors, and healthcare reporters using absolute outcome measures. Treatment Scores also allow for the values and preferences of patients to be taken into account.

What patients need, and what physicians and healthcare journalists need to report is a list of treatments with Treatment Scores for every disease. Treatment Scores would be the starting point for shared decision-making because of the chain of visual aids behind them that make them clear, understandable, and adaptable to patient input.

REFERENCE:
Kit Byatt and Sarah Chapman. "Being patient with EBM. 'Just because we can, doesn’t mean we should' – supporting informed decision-making." Evidently Cochrane. April 26, 2018.
http://www.evidentlycochrane.net/being-patient-with-ebm-supporting-informed-decision-making/

DISCLAIMERS:
You must consult your own licensed physician, or other licensed medical professional, for diagnosis, treatment, and for the interpretation of all medical statistics including Treatment Scores. Treatment Scores are for informational purposes only. Treatment Scores may be incomplete, inaccurate, harmful, or even cause death if used for treatment instead of consulting a licensed medical professional. No medical advice is being given. We DO NOT CLAIM to cure, treat, or prevent any illness or condition. Nor do our services provide medical advice or constitute a physician patient relationship. Contact a physician or other medical professional if you suspect that you are ill. Call emergency services (call 911 if available) or go to the nearest emergency room if an emergency is suspected. We are not responsible for any delays in care from using our website, our services, or for any other reason. We are not responsible for any consequential damages of any nature whatsoever. We make no warranties of any kind in connection with our writings or the use of TreatmentScoresBlog.com or TreatmentScores.com. Treatment Scores are about what happened to patients studied in the past; they do not predict the future.

COPYRIGHT:
Copyright © 2018 Treatment Scores, Inc. All Rights Reserved.