Thursday, December 31, 2015

Quantification of Medical Treatments: TREATMENT SCORES

The bar for understanding medical treatments is very low. A recent study of 531 physicians showed that the majority of physicians (over 80% in some cases) don’t understand treatment effects.[1] What this means is that nearly all patients don’t understand treatments. We have the blind leading the blind.

Why so much confusion? Because the math is hard.

When you are given a list of treatments for your disease you need to see the Treatment Score for each treatment. But you never do. Why not? Because Treatment Scores represent the “net absolute treatment benefit” in the literature, and the mathematics of determining the “net absolute treatment benefit” from medical studies is very difficult. Therefore, very little useful quantification of treatments is done today.

What is the quantification today? Today, the evidence behind treatments is sometimes quantified into three categories:
  1. Likely beneficial
  2. Likely harmful
  3. We can’t tell

We must do better than this because people’s lives are literally at stake. People’s lives, your health, permanent side effects, and resulting disabilities all come into play. In fairness, some systems try to be a little bit more helpful by sticking in extra categories that can be paraphrased as “really likely to be beneficial,” “really unlikely to be beneficial,” and “sometimes beneficial and sometimes harmful,” which gives people six vague categories instead of three vague categories.

We need to know if statistics suggest the “net absolute treatment benefit” is 1% or 99%, or somewhere in between. We need Treatment Scores.

With the tools at TreatmentScores.com, we are quantifying the science of medicine behind treatments from 0 to 100. We are also separating treatments into grades A, B, C, D, and E (using a 20-point range for each). Grade F is reserved for things that appear harmful.

If you undergo a cancer treatment, is it a grade A treatment score? If you take statins for high cholesterol is that a grade A treatment score or a grade E treatment score? What about the 130 treatments for insomnia? What about the 57 treatments for acute migraine headache?

We are parsing our words. We are looking at what the evidence behind a treatment is; we are not recommending or rating the treatments themselves. That is up to your experienced medical professional. We are producing the starting point for shared-decision making using the evidence in the medical literature. See our disclaimers at the bottom.

We think it is time to go from vague “treatment quantification” to more helpful Treatment Scores and Treatment Grades.

Follow Treatment Scores:
Twitter:
https://Twitter.com/TreatmentScores
AngelList:
https://angel.co/treatment-scores
Facebook:
https://Facebook.com/TreatmentScores
Website:
http://TreatmentScores.com
Blog:
http://TreatmentScoresBlog.com

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 educational 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 © 2015 Treatment Scores, Inc.

Sources
[1] "Do clinicians understand the size of treatment effects? A randomized survey across 8 countries." Bradley C. Johnston, Pablo Alonso-Coello, et al. CMAJ October 26, 2015.
http://www.cmaj.ca/content/early/2015/10/26/cmaj.150430


Sunday, December 27, 2015

Cold Remedies - What's the evidence?

As we navigate through cold and flu season this year I began thinking about the different remedies we have to try to prevent or alleviate the signs and symptoms of the cold or flu. The most common remedies I found were ginger, green tea, honey, garlic, nasal rinses, or steam.

Treatment Scores is a great platform to assess the evidence behind each of these remedies and provide a quick, understandable comparison of the evidence.  We can use the score to help educate ourselves on the evidence of each remedy, but we must use caution that the interpretation, diagnosis, and treatments should be done in consultation with your licensed physician within the patient-physician relationship. (See disclaimers below.)

The first step in my assessment was to complete a quick search of the literature for each of these.  While some of these had no evidence immediately available, there were several that came up with an assortment of different levels of evidence.  Hopefully we can use Treatment Scores to combine these different levels and quality of evidence to create a simple, easily understandable, comparable score for each treatment.

While Treatment Scores cannot recommend a specific treatment the next time you catch a cold, it can allow you to have a clearer understanding of the science behind each treatment.

Over the next few weeks I'll be taking a look at each of these treatments in the Treatment Scores Calculator.  By the end of our series we will have a score for each of the treatments, providing us a simple comparison of the evidence behind each treatment. (See the disclaimers below.)

Please use the comments section below for any additional remedies you would like to see evaluated.

Follow Treatment Scores:
Twitter:
https://Twitter.com/TreatmentScores
Facebook:
https://Facebook.com/TreatmentScores
Blog:
http://TreatmentScoresBlog.com
Website:
http://TreatmentScores.com

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 SOM® Treatment Scores. Treatment Scores are for educational 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 in the past they do not predict the future.

Copyright
Copyright © 2015 Treatment Scores, Inc.

Thursday, December 24, 2015

Help a Billion People with TREATMENT SCORES

“The best way to become a billionaire is to help a billion people.” - Peter Diamandis. Peter Diamandis is the founder of the XPrize and a serial entrepreneur.[1] Now we have a way to help a billion people. We have Treatment Scores.

Here’s why you need them:

1. Almost no one understands the net absolute treatment benefit (studies prove this)
2. Treatment Scores save time
3. Treatment Scores will save money (tens of billions of dollars globally)
4. They solve the “unsolvable treatment transparency” problem
5. They solve the “unsolvable quality assurance” problem
6. They are disruptive from the bottom up
7. They are scalable
8. They are deliverable to smart phones
9. They will help 7.3 billion people

What TreatmentScores.com does, and what we blog about at TreatmentScoresBlog.com, is help people review the medical literature and quantify the net absolute treatment benefit for the patient, which we call the “Treatment Score” for simplicity.

How many people will Treatment Scores help? Approximately all 7.3 billion people on the planet, not to mention all healthcare professionals, educational institutions, health related non-profits, health related businesses, and all governments around the world involved with healthcare.

If you are a student of macroeconomics, you know that quantification disrupts every industry it touches. Finally, medical treatments are going to be quantified!

Medicine and business can go together for the greater good. Few people know better than physicians the partial truth in the old saying, "If you have your health, you have everything." Physicians and nurses see more people deteriorate from old age and other medical problems until the life drains out of them than most people do.

Almost everyone knows the partial truth in the old saying, "Do what you love." In theory, if you do what you love everything else will fall into place.

Put these sayings together and you get Treatment Scores, Inc. Many people are passionate about helping other people, and also about doing evidence-based medicine. People love using science for good.

Why should this be a business? Why should TreatmentScoresBlog.com and TreatmentScores.com be businesses? Because Treatment Scores "cure severe pains" for consumers, educators, researchers, businesses, and governments.

Malay Gandhi, a venture capitalist at Rock Health says, “We are looking for ‘physician-first’ companies that build tools beloved by doctors. The sad fact is, doctors enjoy medicine less and less each day and dissatisfaction has never been higher. …..Enabling the provision of higher quality care is the number one driver of job satisfaction and your product must start there. Obvious bonus points here for enabling personalized health care at the point of care.”[2]

Why hasn’t this been done before?
The problem is that no one understands treatments. The Patient-Centered Outcomes Research Institute says, “Every day, patients and their caregivers are faced with crucial health care decisions while lacking key information that they need.” We need to translate “…existing scientific research into accessible and usable formats…”[3]

A recent study of 531 physicians found that over 80% of physicians could not correctly interpret two treatment effects from a medical study.[4] This means that 80% to 100% of patients probably can’t figure out treatments either.

Why is it so hard to figure out treatments? It’s because the math problem is ridiculously complex. You often need to organize over 10,000 pieces of information, and there is almost always missing data. Almost every statistic is a flawed statistic. Routinely, any two statistics on the exact same outcome can almost never be weighted equally. Conversion factors are missing. Essentially, every variable has another variable!

We have the Treatment Score Analyzer™, because the solution is figuring out the net absolute treatment benefit for the patients who have been studied already. That’s a mouthful, so we call it figuring out the “Treatment Scores.”

Dr. Richard Fogoros, a cardiologist, wrote: “This analysis shows what seems like a pretty good way to make some big bucks in healthcare while simultaneously saving lives: Figure out how to empower patients. Any enterprise that can supply patients with clear, correct, relevant, personal, and specific knowledge that enables them to protect themselves and their loved ones…will endear itself to…patients. Furthermore, anyone supplying such knowledge will be feeding a growing need for more. People's desire for the information to manage their own healthcare and the means to act on that information will become more than just a desire—it will become an expectation. A massive business opportunity awaits.”[5]

The problem for patients is that the medical literature is in a huge, dark, underground cavern containing over 22.5 million disorganized medical studies. It’s difficult to get into the cave, and after getting down there the medical vocabulary is incomprehensible and the statistics are next to impossible. Even the most highly skilled patient cannot overcome all these obstacles and the “avalanche of big data.” Every once in a while, a physician (or other expert - perhaps you) enters the cave, shines a flashlight into the darkness, and comes out to explain a few medical studies to a patient. Then, it all goes dark again. Our Treatment Score Analyzer™ goes into that huge dark cavern, wires it with electricity, and turns the lights on forever.

Migraine Headache
There are at least 57 treatments for an acute migraine headache. Wouldn’t it be nice to know what the medical literature says the treatment benefit is for all those treatments? Ask your healthcare provider: “What is the Treatment Score for Imitrex (sumatriptan) for an acute migraine headache?” They probably will have no idea. Ask them: “What is the Treatment Score for ginger powder for an acute migraine headache?” They will probably have no idea. (Sometimes alternative medicines have data and sometimes they don’t, but all we care about is the data.) What about the Treatment Scores for cancer treatments? We need to know!

Insomnia
You can find over 130 treatments for insomnia on the Internet. Ask your healthcare provider: “How many of those treatments are grade A?” Or ask them, “What are the Treatment Scores for all those treatments?” The problem is that there is no useful quantification of the “net absolute treatment benefit” for the patients studied in the past. With Treatment Scores we can fix this.

Quantification, once achieved, will change the world for the better. It will be disruptive for medical education, for all 7.3 billion potential consumers of healthcare, for all healthcare related nonprofits, for all healthcare related businesses, and for all governments around the world that participate in healthcare. Many medical disasters have happened because of the lack of quantification: frontal lobotomies, the epidemic of unnecessary hysterectomies, knee surgeries that did not work, and medications for heart arrhythmias that turned out to be killing people.

Medical Reviews
Physicians, and all other medical professionals, generally love to help people, and they love to review the medical literature, because it is fascinating, because they love science, and because reviewing what happened to patients in the past is how we learn. Medical reviews are the starting point for evidence-based medicine and shared decision-making. “Quantified medical reviews” with Treatment Scores, will be the next step in the evolution of big data and statistics.

“Quantified medical reviews” of treatments can be combined with clinical experience moving forward.

Why will Treatment Scores help so many people? A “better system” can help more people than any one person can ever help in their lifetime working alone. Physicians already do Journal Clubs, Grand Rounds, Morbidity & Mortality Conferences, and Continuing Medical Education. They are lifelong learners. But what if learning could be taken to the next level with quantification of treatments? That would be a game changer.

Bill Gurley, a Venture Capitalist at Benchmark, has tweeted that for healthcare he wants disruptive technology without onerous regulatory hurdles.[6] It is important to start the revolution like Treatment Scores is doing, without needing a 100 million dollars for step by step clinical trials.

Think how Uber has changed the world. I read an article where someone said Uber did not build new taxis, Uber did not build new infrastructure, Uber simply reorganized what already existed. That’s what we’re doing with Treatment Scores.

I have read many articles about Airbnb. Airbnb did not build new hotels. They reorganized what already existed so that everyone could participate. That’s what we’re doing with Treatment Scores. We are bringing evidence-based medicine to the masses.

Uber may be worth 50 billion dollars. Airbnb may be worth 25 billion dollars. Companies can change the world by reorganizing it with software. Marc Andreessen, a venture capitalist, famously wrote: "In short, software is eating the world."[7]

Treatment Scores are designed to help people. They will mean better transparency in healthcare. They will help the people that need help the most: the sick, the dying, and the disabled.

Physicians have set up Treatment Scores, Inc. as a vehicle to attract other physicians, and other evidence-based medicine “connoisseurs” such as health writers and bloggers. We want to create international interest in quantifying the science of medicine behind medical treatments. We want people who are seeking a higher purpose.

There are many important buzzwords and phrases being floated around about how to improve medicine. Things like: evidence-based medicine, shared decision-making, treatment transparency, personalized medicine, patient mentoring, patient engagement, participatory medicine, patient-centered care, and patient-generated research. Treatment Scores can make all these things actually happen instead of just being theoretical.

I love the E-patient movement and the “Spoonie” chronic pain patient movement. Treatment Scores can give these movements the tools they need to make a huge difference in people's lives.

Contact:
I’m not motivated by a billion dollars, but I do have an obsession, an all-consuming desire to figure out the net benefit of treatments. Please email me at: Dr.Hennenfent ((at)) Gmail.com if you want to help with Treatment Scores. (See the disclaimers below.)

Follow Treatment Scores:
AngelList:
https://angel.co/treatment-scores
Twitter:
https://Twitter.com/TreatmentScores
Facebook:
https://Facebook.com/TreatmentScores
Blog:
http://TreatmentScoresBlog.com
Website:
http://TreatmentScores.com

Links to Previous Blog Articles:
"Mobile Health Desperately Needs Treatment Scores: Health Information Technology"
http://www.treatmentscoresblog.com/2015/12/mobile-health-desperately-needs.html

"Is Bromelain from Pineapples a Miracle Cure for Cancer? Treatment Scores.”
http://www.treatmentscoresblog.com/2015/12/is-bromelain-from-pineapples-miracle.html

"Lunesta for Insomnia in Patients with Rheumatoid Arthritis: Treatment Scores"
http://www.treatmentscoresblog.com/2015/12/lunesta-for-insomnia-in-patients-with.html

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 educational 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 © 2015 Treatment Scores, Inc.

References:
[1]Peter Diamondis was quoted by INC. December 2014/January 2015. P. 40.

[2]“Ideas We’d Like to Fund.” November 10, 2014. https://rockhealth.com/ideas-wed-like-fund-2/

[3]“Patient-Centered Outcomes Research Institute Funding Announcement: Communication and Dissemination.” PCORI. Published May 22, 2012, Revised September 17, 2012, P. 7. Accessed December 1, 2012,  http://www.pcori.org/assets/FINAL-PFA-Communication-and-Dissemination-v3.pdf

[4]“Do clinicians understand the size of treatment effects? A randomized survey across eight countries.” By Bradley C. Johnston, PhD, et al.
http://www.cmaj.ca/content/early/2015/10/26/cmaj.150430

[5] Richard M. Fogoros, M.D., Fixing American Healthcare, 2007, Publish Or Perish DBS, Pittsburg, page 31.

[6] Bill Gurley on Twitter. https://twitter.com/bgurley/

[7] Why Software Is Eating The World, by Marc Andreessen. Wall Street Journal. August 20, 2011. Accessed December 23, 2015.
http://www.wsj.com/articles/SB10001424053111903480904576512250915629460

Saturday, December 19, 2015

Pulling it all together - SLT for Glaucoma

In the past few posts we have gone through the steps to set up the diagnosis using the Diagnoses Tool™, defined the treatment in the Treatment Organizer™, and entered the data into the STAR™ Blocks. The last step is to use the Treatment Calculator™ to come up with a simple, understandable score of SLT laser for glaucoma.

Once we finish our STAR™ Blocks and return to the Treatment Score Calculator™, we will be given the Treatment Score™ based on our main statistic.  In the figure below, you'll see the Treatment Calculator™ for the evidence behind SLT for glaucoma.  Our prior posts outlined the selection of patients requiring additional therapy as the main statistic and entering the data from several studies into our STAR™ Blocks.


The left column gives us the diagnoses we entered into the Diagnoses Tool™, the main statistic, and the patient parameters. The third column analyzes our secondary statistics.  In our example here I included pain because some of the studies included this as a side effect and although it is temporary, it is something for us to consider.  This was created from a separate STAR™ Block I entered to address the statistic.  Finally, the center column delivers our Treatment Score™ and an explanation of the score. In this case, the evidence behind SLT laser entered into our Star Blocks gives us a Treatment Score™ of 70, which is assigned a grade of B. This is based on several randomized controlled trials which showed that SLT patients did not require additional therapy in the first year after laser in approximately 75% of cases and our assessment of pain as a secondary statistic.  The Treatment Calculator™ compiled and summarized these studies for us and gave us what appears to be an appropriate Treatment Score™.

While the score does reflect an objective measurement of the studies entered, we should be careful to understand that there are subjective inputs such as study selection, quality and relevance of the studies, and identification of the main and secondary statistics.  One of the beautiful things about Treatment Scores™ is that you can access this assessment and add studies, tweak subjective ratings, and assess different statistics to analyze the effects on the score.  This also underlies the reason that Treatment Scores™ must only be used as part of your assessment of the overall literature, and not to affect the diagnosis or treatment of any individual patient, whom all have specific, individual considerations that require a formal consultation with a physician.  This is the art of medicine which physicians are keenly astute to and Treatment Scores™ should not and does not influence. (See the disclaimers below.)

Follow Treatment Scores:
Twitter:
https://Twitter.com/TreatmentScores
Facebook:
https://Facebook.com/TreatmentScores
Blog:
http://TreatmentScoresBlog.com
Website:
http://TreatmentScores.com

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 SOM® Treatment Scores. Treatment Scores are for educational 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 in the past they do not predict the future.

Copyright
Copyright © 2015 Treatment Scores, Inc.

Friday, December 18, 2015

Is Bromelain from Pineapples a Miracle Cure for Cancer? Treatment Scores.

An acquaintance sent me an article about how a natural substance, bromelain, which comes from pineapples, is better than a "medical drug," better than a chemotherapy, for cancer. He got the article from one of "those emails" people get. I wanted to understand the science. Sometimes alternative medicines work and have medical studies to support them, and sometimes they don't. So I decided to search for the "amazing truth" mentioned in the article.

The article had a headline like this: "Pineapple Enzyme Kills Cancer Without Killing You." It seemed to imply that the pineapple enzyme bromelain can cure you of cancer. So using the tools at TreatmentScores.com I created a diagnosis for cancer.


I decided to look at the main statistic = main outcome measure of "overall survival" for any available follow-up time period for adult patients.


I searched PubMed many different ways using the terms "cancer" and "bromelain." My most effective search technique came up with 111 total studies, 65 of which were human studies, and 3 of those were clinical studies. As I searched all these studies for "overall survival" statistics for the use of bromelain, I kept coming up with "no statistic."


Normally, I would be putting a statistic in the this box instead of "no statistic," because the way you do evidence-based medicine is you organize all the important statistics.

In this situation, a review of the medical literature, shows that bromelain has a treatment score of "0" or no data when it comes to increasing overall survival for cancer, according to the existing medical literature that I found.


All is not lost for bromelain however. There are laboratory studies and animal studies that suggest bromelain has mechanisms of action against various types of cancers. More studies need to be done, more laboratory studies, and more animal studies. And, finally clinical studies in human beings need to be done. In addition, if we looked at bromelain for another outcome measure, such as improving dry mouth and joint pain in breast cancer patients, it might well have a positive Treatment Score.

TreatmentScores.com can become a source for patient-generated research. If we quantify the net treatment benefit behind treatments, we can all see when research needs to be done, and patients, physicians, nurses, and all health professionals can come together to get the needed studies done.

Imagine a world where you could review the literature for all 57 treatments for an acute migraine headache, or you could review the literature for all 130 treatments for insomnia. And, you could actually learn more than you know now about the "net absolute treatment benefit" according to the medical literature. Imagine a world where transparency, evidence-based medicine, and shared decision-making could really happen. We are headed in that direction. (See the disclaimers at the end.)

Follow Treatment Scores:
Twitter:
https://Twitter.com/TreatmentScores
Facebook:
https://Facebook.com/TreatmentScores
Blog:
http://TreatmentScoresBlog.com
Website:
http://TreatmentScores.com
AngelList:
https://angel.co/treatment-scores

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 educational 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 © 2015 Treatment Scores, Inc.

Lunesta for Insomnia in Patients with Rheumatoid Arthritis: Treatment Scores

Evidence-based medicine is difficult. Mathematically it is nearly impossible. You may need to organize and process 10,000+ pieces of information to come up with a list of treatments for a disease and review the science behind those treatments. In medicine, each statistic has variables, and each variable has more variables, so the complexity quickly escalates out of control.

Complex problems can be solved by breaking them down into steps. Let's review treating insomnia in patients with rheumatoid arthritis. I am doing personalized medicine, by creating a very specific diagnosis:


I am looking at patients suffering from insomnia, who have rheumatoid arthritis, who do not have fibromyalgia, do not have juvenile rheumatoid arthritis, do not have sleep apnea, and do not have untreated restless leg syndrome.


I will look at Lunesta (eszopicline) as a 3 mg dose for treating insomnia in this situation. As can be seen below, I put the main statistic, the improvement in the Insomnia Severity Index compared to placebo, on the left. It is 16. I put the secondary statistics on the right. Sometimes they are positive and we put them in the green zone. Sometimes they are negative side effects and we put them in the red zone.



The Treatment Score begins at 16 per the Treatment Score Calculator™ above. However, we need to make adjustments for the secondary statistics on the right. We need to try to figure out what the medical literature says the "net treatment benefit" was for the patients who were studied to create the Treatment Score.

Currently, digesting these numbers is the "art of medicine." This is because there is almost always missing data. For example, one side effect of Lunesta (eszopicline) is an unpleasant taste. It occurred in 27% of the patients taking Lunesta (eszopicline), but in none of the patients taking placebo. Where is the mathematical formula for converting the side effect of unpleasant taste into units on the Insomnia Severity Index? Such a formula does not seem to exist. However, in the future we need to collect such data. We need to survey the patients for starters.

Some side effects already have conversion formulas. For example, the Global Burden of Disease project has converted many side effects into "disability adjusted life years" or "quality adjusted life years." Getting all the side effects converted to values that can be mathematically subtracted from the main statistic (or main outcome measure) will be an important part of the future of medicine.

Let's do an adjustment and come up with a working Treatment Score. The positive side benefits on the right of the Treatment Score Calculator™ are mostly built in to the Insomnia Severity Index. So I am not going to raise the Treatment Score. Since I don't have all the mathematical "conversion rates" I need for the side effects, we have to make some estimations based on what we think we know. For example, 1 patient (1.3%) dropped out of the study because of the unpleasant taste. The other side effects may be temporary and may not be highly significant compared to the benefits. And, there are some other benefits (that I did not list in this example), because patients reported mixed improvements in their rheumatoid arthritis pain and other arthritis symptoms because of getting better sleep. In the end I have decided on a Treatment Score of 15. (In the future this decision will hopefully be done all by math.)


Where do we get the hard numbers? They come from the medical literature. For example the number 16 comes from the following medical study.


We call this a STAR™ Block of information. STAR™ means Statistic and a Reference.

Treatment Scores is an early prototype system. You can see that in the future everything can be improved. More and more automation can be done. Statistical methodology can be improved and validated. Quantification of treatments will change everything: education, research, reimbursement, and distribution.

The main point is that we can begin to quantify treatments better than we do now. Currently, the medical world essentially quantifies what the medical literature says about treatments into 1) It probably works 2) It probably doesn't work, or 3) We can't tell. In the future we need to do better. What if you have cancer? Don't you want to know if the patients treated in the past got a 1% net treatment benefit from chemotherapy or a 90% net treatment benefit from chemotherapy? (See the disclaimers below.)

Follow Treatment Scores:
Twitter:
https://Twitter.com/TreatmentScores
Facebook:
https://Facebook.com/TreatmentScores
Blog:
http://TreatmentScoresBlog.com
Website:
http://TreatmentScores.com

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 educational 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 © 2015 Treatment Scores, Inc.

Friday, December 11, 2015

Mobile Health Desperately Needs Treatment Scores: Health Information Technology

People have chosen their computer of choice; it's the smart phone.* Smart phones are ubiquitous around the world. This means that we need to be able to get medical information on smart phones in a way that it can be easily understood. We need Treatment Scores, which represent the net treatment benefit for the patients studied in the past.


Imagine being a physician, nurse, or allied health care provider and having Treatment Scores figured out for every treatment that is important to your medical practice. Such Treatment Scores, created using the tools at TreatmentScores.com, might be based on guidelines already on the web site, or using evidence-based medicine guidelines as determined by you, your journal club, or other experts.

Having Treatment Scores would save time. If the Treatment Scores were transparent, it would be a huge step forward in teaching the entire world how evidence-based medicine works. Such a system would finally make shared decision-making possible.

Let's say a physician is with a patient and he or she pulls up their "homework," which is their own review of the medical literature for 130 different treatments for insomnia on their cell phone. The physician may show some of the treatments to the patient, because the patient wants to learn about them.

Perhaps your Treatment Score results are typical of a recent "systematic review" of the medical literature that seems to say cognitive behavioral therapy was an effective treatment for the patients studied. You may bring up this list: cognitive behavioral therapy, Ambien (zolpidem), indiplon (off the market), and tart cherry juice (which reportedly raises melatonin levels). Your Treatment Scores are 40, 32, 9, and 8.


Personalized Medicine. Now you decide to do personalized medicine and shared-decision making with the patient. You show them the next screen behind the Treatment Score for "cognitive behavioral therapy," which is the Treatment Score Calculator™. Now, you can both see the problem.


On the right it says "not scored." The problem is that no "weight" has been given for the "side effect" on the right of having to go to group therapy for 90 minutes per day, six days per week for six weeks! (Which is one of the schedules for cognitive behavioral therapy in a study supporting it as a treatment for insomnia.) The patient appears horrified. You ask for their input. They say, "That reduces the Treatment Score to nearly zero for me. I don't have 90 minutes per day for six weeks to go to group therapy! I have a job, kids, family...." You say, "Okay let's reduce the Treatment Score for cognitive behavioral therapy down to almost zero based upon your input."


You reduce it to 1. So, the Treatment Score for cognitive behavioral therapy drops to 1 based on the patient's input. Suddenly, Ambien (zolpidem) rises to the top of the current list based on the patient's preferences. [I have no association with companies that make Ambien (zolpidem).]

A different patient may be exactly the opposite. They may love the idea of going to cognitive behavioral therapy for 90 minutes a day. They may have the time and the inclination, and may not want to take any medications if they can avoid them. This is why patient input as part of shared decision-making is so important. But for now, let's look at this patients preferences incorporated into the decision-making process. We are looking at the remaining three treatments to discuss with the patient.



The patient and physician can discuss the pros and cons of these three treatments and can look at the Treatment Score Calculator™ behind each one. Or, you can pull up other treatments from your list of 130 treatments for insomnia.

This is why we need a system that allows patient input. In this example the patient had some input into the review of the treatments. The patient was able to let the doctor know that the time that would be needed for therapy sessions was a huge negative for them.

What if the side effect in question was something more serious? Like the side effect of facial nerve paralysis that can happen with brain surgery? Or the side effect of incontinence that can happen during pelvic surgery? Or the side effect of permanent neuropathy than can happen with chemotherapy? Shouldn't we have a system like this where patients can have some input? Shouldn't we be able to combine evidence-based medicine and shared decision-making? Shouldn't we help educate patients about these things before they are treated, not after they've already been treated and have suffered the consequences? Doesn't informed consent require sharing the numbers? Doesn't continuing medical education require this new and improved system?

From the limited reading I have done so far, I do not see any common treatment that has a Treatment Score higher than Ambien (zolpidem) on the Insomnia Severity Index, which is the main outcome measure I have been using. Most people don't realize that many treatments, perhaps even most treatments, in medicine are grade C, D, or E. (Each grade is a range of 20 points on our 100 point scale.)



It becomes extremely vital to know the Treatment Grades when the outcome measure is something like overall survival. People with cancer often have no idea if the treatments being offered to them are grade A (the highest), or grade C (average), or grade E (the lowest of the positive grades for treatments) using this system.

This is why we need to be able to organize the data more in line with what the patient needs regarding the diagnosis important to them. For insomnia, is the diagnosis predominately difficulty falling asleep, staying asleep, quality of sleep, or all of those? And when we give the net treatment benefit for patients from past medical studies, we need to show the statistics and get the patient's preferences for how the side effects may be weighted.

Can it be done? Yes. Sabermetrics are used to reduce what is important in baseball down to one number. Treatment Scores can be used to reduce what is important in medicine down to one number. We call it the net treatment benefit, or the net absolute treatment benefit (for the patients studied in the medical literature in the past).

Steve Jobs Quote
"You‘ve got to start with the customer experience and work back toward the technology - not the other way around." - Steve Jobs. What this means is that the front end of Treatment Scores needs to be very simple, fast, and understandable. The back end can be full of statistics (ranges, confidence intervals, standard deviations, statistical power, p values, number needed to treat, ratio of means, relative risk, and so on). The front end can also be customized for the casual user versus the advanced user.

Do We understand Treatments Now?
No. In a study of 531 physicians, "Do clinicians understand the size of treatment effects? A randomized survey across eight countries," by Bradley C. Johnston, PhD, et al. They found that over 80% of physicians could not correctly figure out the treatment effects that were reported as "mean difference in natural units" or as "standardized mean difference." This is just one example of all the confusion! I think one can reasonably assume that if physicians don't understand treatments, then patients don't understand treatments. See the disclaimers below.

Note:
*Someone made a similar statement before me about cell phones being so dominant, but using Google I was unable to find the original source.

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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 educational 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.

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Copyright © 2015 Treatment Scores, Inc.

Thursday, December 10, 2015

Gathering the evidence - STAR™ Block formation for Glaucoma Lasers

Our third post in the assessment of the evidence behind SLT for glaucoma we will enter the data into the STAR™ Block, allowing us to create the Treatment Score.  STAR™ stands for Statistic and a Reference.  At the top of the screen you'll see the Diagnosis Levels, Treatment, Statistic We Want, Follow up, and Patients (figure 1) carried over from our entry into the Diagnosis Tool™ from our earlier post.


After searching PubMed and identifying the highest quality research, we need to create a STAR™ Block for each.  Below the Diagnosis Level you'll find that Treatment Scores™ allows you to either create an empty STAR™ Block or enter a PubMed ID.  Figure 2 shows the view after a PubMed ID is entered to create a new Star Block™.  Treatment Scores™ pulls in the abstract and auto-populates the first few columns of the Star Block™.  The rest of the columns we enter.  Of particular importance is the Statistic We Have, which is the main outcome statistic at the heart of the study.


For our analysis, I chose to use the percentage of patients who did not require additional therapy during the study.  This statistic was available in all the studies I included and represents clinical success of the treatment.  The next important blocks to fill are the Quality and Relevance of the study.  These are somewhat subjective analyses, using evidence-based medicine guidelines, and I gave relatively high quality and relevance scores because the studies included were randomized controlled trials with similar design and endpoints. These numbers would be lower should I include case series or non-controlled trials.  Figure 3 shows the completed STAR™ Blocks.


Once the relevant STAR™ Blocks are completed we can chose whether or not to include the STAR™ Blocks in our analysis on the right.  The last thing to do on the STAR™ Block entry is to set the description of the statistic we have and the ceiling number.  Once these are entered we are ready to go back to the Treatment Calculator™ and finish our analysis.  We'll pick up there in our next post. See the disclaimers below.

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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 SOM® Treatment Scores. Treatment Scores are for educational 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 in the past they do not predict the future.

Copyright
Copyright © 2015 Treatment Scores, Inc.

Tuesday, December 8, 2015

Navigating the Complicated Web of Medicine

Knowledge.  It's everywhere.  In this day and age, a person can leave their doctor's office with a new diagnosis and a prescription, and not fully grasp the magnitude of the diagnosis, or the side effects of the prescribed medication. Often, these diagnoses and medications come with a myriad of questions. Questions that were not thought of and not answered while at the doctor's office. What does a person do?  They go home and do an Internet search of their new found diagnosis, in order to better understand what their specific disease entails, and perhaps even search for the "alleged" best treatment for the disease.

What does a person find?  The person finds innumerable web pages dedicated to medical reviews, other people's opinions, and any other number of answers, both from reputable sources and otherwise.  It is extremely difficult as a patient to navigate through the mass amounts of information on the internet.  How does a person know which websites have good medical knowledge?  Which opinions can be trusted or not?  How do physicians navigate through the immense amounts of research there is on the internet and otherwise, and come up with a well educated treatment plan?

TreatmentScores.com can help!

Treatment Scores is a new, innovative website that strives to assemble the mass amounts of information from the web and from medical articles.  It is meant to give you the tools to organize medical statistics and make sense of what they say. One can actually conglomerate hundreds of evidence-based medicine articles and websites.

Treatmentscores.com is for patients and physicians alike, to make transparent what the science of medicine (SOM) shows.  It can be used to better understand a diagnosis, or better understand what treatment options are available.  It is not a replacement for an actual physician, but the educational tools can be used for a discussion between a patient and their own physician.

Keep posted to find out how acetyl L carnitine affects depression!






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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 SOM® Treatment Scores. Treatment Scores are for educational 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 in the past they do not predict the future.

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Copyright © 2015 Treatment Scores, Inc.

Researching Evidence Based Medicine

As a practicing physician, I like to keep current on my medical knowledge, not only for my specialty, but for diseases and conditions that relate to my specialty. In order to do this, I keep current on journal articles that are mailed to me through my association.  I also try to do some research on my own, especially when an interesting patient comes through my doors.

Researching on the internet is extremely difficult and cumbersome to sift through the endless amounts of information.  How does one determine which websites are accurate and which patient reports are real or worthy of looking in to?  Even in reading current journal articles, it is difficult to determine how good or bad the treatment being discussed is.

Treatmentscores.com is a new website designed to organize the net treatment benefit of a variety of diseases and their different treatments.  It aims to quantify the evidence based medicine that already exists and to compare the multitude of studies which are available, and give each treatment a letter score (A-F).  This will provide both physicians and patients, alike, a means of understanding the mass amounts of information that has already been studied.

Below is an example of how some of this information is quantified:


The above diagram represents only one study on depression and minimal hepatic encephalopathy.  Once that entire study has been entered into treatment scores, it will be rated.  As more and more studies are entered with different treatments for depression, with or without hepatic encephalopathy, we will be able to compare the net benefit effects of a variety of treatments for depression. You would then be able to discuss these options with your physician. See the disclaimers below. We are providing education about what happened in the past, not making any recommendations for future patients.





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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 educational 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.

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Copyright © 2015 Treatment Scores, Inc.

Friday, December 4, 2015

Insomnia Demonstrates the Future of Evidence-Based Medicine: Treatment Scores

The most important thing a medical review article should do is figure out the benefit for the patients studied. Yet, medical review articles often don't even try to do this. Why not? Because it is tremendously difficult. It has been said to be impossible!

Take insomnia for example. You would think it would be easy to figure out the evidence-based medicine for insomnia. It's an extremely common medical problem. Using the Treatment Score Analyzer™ software at TreatmentScores.com I created a diagnosis for insomnia.


The problems begin immediately. How do you define insomnia? It's not nearly as straightforward as you think it would be. Are we talking about primary insomnia? Or secondary insomnia caused by some other medical issue such as chronic pain? What time scale are we looking at? 2 weeks? 3 months? The reality is that you have to combine studies over different time periods when you review the literature.

What patients are we looking at? Kids? Teens, Adults? I am focusing on adults only, but with all the inclusion criteria and exclusion criteria, or lack thereof, describing the patient population can be much more complicated.

Insomnia can mean several things. Insomnia can mean difficulty falling asleep, difficulty staying asleep, or waking up too early. Insomnia can mean poor quality sleep, so that you wake up feeling like you haven't slept well.

For this review, I decided to quantify treatments that were studied with the Insomnia Severity Index as the outcome measure, because it is a questionnaire that tries to take many of the components of insomnia into account. After a ridiculous amount of work, because the tools we need for evidence-based medicine are still in their infancy, I came up with a treatment list and Treatment Scores for three treatments. This is the output that all patients need for every diagnosis: Treatment Scores. 

Treatment Scores represent the net treatment benefit for the patients studied in the medical literature (on a 100 point scale).


Why this list of treatments? I chose Ambien (zolpidem) because it is one of the most common prescription medications for insomnia. I actually wanted to review 5 mg, not 10 mg, but I could not find enough appropriate studies.

I chose to review "indiplon" as a treatment because I was able to find a high-quality randomized controlled trial that used the Insomnia Severity Index as an outcome measure. Indiplon is interesting, because if you read Wikipedia (https://en.wikipedia.org/wiki/Indiplon) it sounds like the company obtained FDA approval, but the FDA apparently asked for more studies, and the drug company, Neurocrine, may have simply given up at that point. It's not entirely clear, but that would be another interesting essay for another day. Why did they give up?

I chose to study "tart cherry juice," because a friend asked me a question something like this: "I read about tart cherry juice for insomnia in a magazine, what do you think?" When I looked up tart cherry juice in the medical literature it turns out that there is biochemistry supporting it. It apparently increases melatonin levels and may also have anti-inflammatory properties, both of which might be mechanisms to help people sleep better. At TreatmentScores.com we don't care if a treatment is Western medical, Eastern medical, natural, herbal, or any other type of alternative medicine, we only care about the data.

Wouldn't it be nice if you could look up a diagnosis, get a list of all the possible treatments for that diagnosis, and see what the Treatment Scores are? That's what we are working towards with the tools at TreatmentScores.com and are blogging about here at TreatmentScoresBlog.com.

In fact, what we want to get to is Treatment Scores and Treatment Grades. We want to figure out if a treatment is a "grade A treatment" according to the medical literature, which is the highest grade, or a grade C treatment, which is average, or a grade E treatment, which is the lowest positive grade. In other words we are using grades A, B, C, D, E for positive net benefits found in the medical literature. For treatments that are harmful according to the medical literature, we give them a grade F. See the disclaimers at the end of this document. We have Treatment Scores and Treatment Grades in our graphic below:


Ambien (zolpidem) is interesting, because unlike some of the previous prescription medications for insomnia that were in the benzodiazepine (Valium) class of drugs, Ambien (zolpidem) allegedly does not produce tolerance, sedative effects, or signs of withdrawal when the drug is stopped (at least according to some sources). Ambien (zolpidem) is in a completely different chemical class, the "imidazopyridine family."

How was the Treatment Score calculated for Ambiem (zolpidem)? I used the Treatment Score Calculator™. It looks like this:



The Treatment Score Calculator™ is a tool that allows you to put the main statistic, or main outcome measure on the left, and the positive side benefits and negative side effects on the right. The Treatment Score Calculator™ allows us to organize the statistics and then adjust the main statistic up or down to create the Treatment Score. Note that I don't have every single side benefit and side effect scored on the right side of the calculator. Eventually, I just ran out of time, and had to stop where I was (but will complete this for a future blog post). However, I have read that the side benefits of "quality of sleep," "time to fall asleep," and "total sleep time" are all positive. The negative side effects are relatively rare as can be seen by the low numbers. What are the mathematical formulas that need to be used to translate the things on the right into values that can be added or subtracted to the main outcome measure on the left? These are all things that we are working on.

Where do the numbers in the Treatment Score Calculator™ come from? They come from medical studies. We capture the statistics in what we call STAR™ Blocks. STAR™ stands for "statistic and a reference." Below is an example of a STAR™ Block. The statistic on the right in the "rose-colored" cell is what is most important, but also important are all the other reference information: the title, authors, journal name and so on. By doing evidence-based medicine this way, with 4 tools, the Diagnosis Tool™, Treatment Organizer™, Treatment Score Calculator™, and STAR™ Blocks, we make the entire process TRANSPARENT. We have made the process visual so that patients, doctors, nurses, and everyone can see what is being done.


This type of quantified evidence-based medicine is in its infancy. We are taking baby steps. There are many issues yet to be overcome, and I want to list some of my frustrations.

Frustration: There are over 130 treatments for insomnia! There is a list at Wikipedia here: (http://www.webmd.com/drugs/condition-3063-Insomnia.aspx?). Some of the treatments don't require a prescription; some of them do require a prescription. We need to know the Treatment Scores for all 130 treatments. But imagine the work? Just to do the three treatment scores above has taken me days of time and effort. Imagine having to do it for 130 treatments! However, we are getting there. With "big data," "natural search engine technology," and other tools that we are building out, we will make it doable. It has been difficult and time-consuming to come up with the Treatment Scores and Treatment Grades for these three treatments for insomnia. In fact, if I didn't have the tools at TreatmentScores.com, it would have been nearly impossible. A lot of time was spent searching the medical literature and a lot of time was spent reading the medical literature. We need to make this process of quantifying treatment effects faster and easier. The information is right there in the medical literature. Medical articles have the main treatment outcome. Medical articles usually have the frequency of the main side effects. However, all these statistics need to be combined to come up with the net treatment benefit for the patients studied. Doing this should be the focus of every single medical review article. All medical review articles should put what the patient needs to know front and center.

Frustration: More studies need to be done using the same outcome measures and the same dosages. Ambien (zolpidem) is often prescribed in lower doses than 10 mg. For the elderly and women, and even most men now, it may be only 5 mg. The dosage may be even lower for many people now. See your doctor, the full package insert, and FDA warnings. Figuring out Treatment Scores is a great example of why we need patient generated research. Why don't patients, doctors, nurses, and pharmacists get together and fill in the gaps?

Frustration: It's actually hard to come up with a diagnosis that is specific enough to find enough good data. What I finally did was use the outcome measure "Insomnia Severity Index," and a time frame of 2 weeks to 3 months, and adult patients. This is what doctors are doing in real life in their heads. They are combing all kinds of data from different time periods, and that are reported on different scales. No wonder few people really know what is going on, and no wonder there is so little transparency.


Frustration: There are so many possible side effects there is not room to list them all. Some are fairly trivial, some are rare but are life and death important. Ambien (zolpidem) has a rare side effect of "sleep driving." It has been reported that people actually do things under its influence and don't know they are doing them. I found that side effect next to impossible to quantify.

Here is a nice open source, full text review article you can read about Ambien (zolpidem): "Zolpidem Is an Effective Option with a Reduced Risk for Dependence in the Treatment of Insomnia," by Alam Shadab, MD, et al.
http://jddtonline.info/index.php/jddt/article/view/987 (I have nothing to do with the company or companies that make Ambien or generic zolpidem).

One more thing about Ambien (zolpidem). Before Ambien, many sleeping pills were in the benzodiazepine family. That family of medications, which includes Valium, causes a lot of side effects. Benzodiazepines cause sedation, impaired cognitive function, risk of abuse, addiction, withdrawal syndrome, and dependence on the medication. I'm not saying that Ambien does not cause some or all of the same things, but most of the medical literature I reviewed has concluded that the non-benzodiazepine sleeping pills we have today are superior to the benzodiazepine pills in terms of side effects.

Sleep Apnea: Getting the diagnosis figured out is critical, but can be extremely confusing. While reading the medical literature for this essay, it seemed like I was seeing a "sea change" in the diagnosis of insomnia over time. By using sleep laboratories using machinery, such as polysomnography, I realized that the literature seems to be saying that the underlying cause of insomnia for many people, or even most people, is actually sleep apnea. Therefore, when studying treatments in the future, we will need to study patients who do not have sleep apnea versus patients who do have sleep apnea.

I plan to return to review insomnia many times and in many different ways. I have seen a commercial on TV for Belsomra  (suvorexant). The US FDA approved Belsomra (suvorexant) on August 13th, 2014 for insomnia according to one of its press releases, and it needs to be studied in this same fashion, with quantification.

The future of quantifying medical treatments is bright! Quantification will save time, lower costs, and create transparency. Our system will become more and more automated; people will be able to share their work with each other, and each step will be able to be validated and verified.

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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 educational 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 © 2015 Treatment Scores, Inc.