Saturday, November 28, 2015

The Frustration of Evidence-Based Medicine

I have been reading a medical paper about a treatment for insomnia for several days. Why is it taking so long? For one thing, I have to steal five minutes of time here and there to read the paper.

The most frustrating thing of all is that I want to figure out the net treatment benefit of this particular treatment for the patients studied. You would think this would be the easiest statistic to find. However, it's like medical papers always "bury the lead." The treatment statistic I need for the gross treatment benefit was on page 8 out of 10, buried near the end of this very dense, highly technical, medical article, which was full of other statistics that are less important to the patient.

Evidence-based medicine, in my opinion, should be mostly about figuring out the net treatment benefit for the patients studied. However, medical studies are often mostly about other statistics and surrogate outcome measures instead of the absolute value statistics that are really needed.

We need to have the statistics organized so that it is easy to find these things:
  1. gross treatment benefit
  2. side effects
  3. side benefits
Only by doing the equation:
Gross treatment benefit - side effects + side benefits can we understand the net treatment benefit for the patients studied in a medical paper.

We hope to change all the confusion at TreatmentScores.com. We hope to bring clarity to evidence-based medicine by better organizing medical statistics. We hope to help everyone figure out the net treatment benefit much more easily. We call this statistic the Treatment Score. Every diagnosis should have a list of treatments arranged by their treatment scores.



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.

SOM®, EBM™, NB™, NTB™

SOM®

EBM™
EBM Scores™
EBM Treatment Scores™

NB™
NB Scores™
NB Treatment Scores™

NTB™
NTB Scores™
NTB Treatment Scores™

Friday, November 27, 2015

EBM™ Treatment Scores

EBM™ Treatment Scores
EBM Treatment Scores™

Easy Basic Math

Glaucoma Part II - Structuring the problem

Last week we set up the Diagnosis Tool for glaucoma.  This week I want to answer a specific question: Does the medical literature say selective laser trabeculoplasty (SLT) is effective in reducing intraocular pressure?  SLT is a relatively new in office treatment for glaucoma patients and many ophthalmologists are using it as a first line therapy to reduce the necessity of eye drops. While there is a lot of literature amassing regarding the topic, I'm interested in the evidence behind SLT.

To get started we clicked through to the Treatment Organizer and added SLT in the new treatment block.  This added the treatment to the organizer (figure 1) and now we are ready to click through to the Treatment Calculator.  

Figure 1. Treatment Organizer

Once we click through to the calculator we see the diagnosis to quantify on the left, the treatment score in the center, and the secondary positive or negative endpoints on the right (figure 2).  
Figure 2. Treatment Calculator
This is going to be the graphical representation of our final quantification of the problem, but first we must input the data into the Star Block format.  

So far we have identified the problem and entered it into the Treatment Scores system.  Our third blog post will go through the Star Block creation process and the magic that begins to answer our question.

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.

Sunday, November 22, 2015

Why Everyone Needs Treatment Scores

People in general, including physicians, nurses, and other medical professionals do not understand medical treatments. The medical literature is too complex, too disorganized, and too hard to interpret.

Researchers studied 531 physicians and 60 - 80% of the physicians could not correctly identify the magnitude of treatment effects.
(Source: "Do clinicians understand the size of treatment effects? A randomized survey across 8 Countries." Bradley C. Johnston, Pablo Alonso-Coello, et al. October, 2015. http://www.cmaj.ca/content/early/2015/10/26/cmaj.150430)

This confusion filters down through the entire medical industry. When the majority of physicians can't understand treatments, this probably means that nearly 100% of patients don't understand treatment effects.

Here is a list of "gobbledygook." It is a list of treatment effect statistics used in medical studies:
  • Risk Difference
  • Relative Risk
  • Relative Risk Ratio
  • Ratio of Means
  • Standardized Mean Difference
  • Experimental Event Rate 
  • Control Event Rate  
  • Relative Benefit Increase  
  • Number Needed to Treat
  • Absolute Benefit Increase
The study of 531 physicians, mentioned above, actually says this: "Presenting results as a standardized mean difference, the longest standing and most widely used approach, was poorly understood and perceived as least useful."

We need to end this confusion by using Treatment Scores.


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.




Treatment Scores on Social Media

Treatment Scores, Inc. has a simple idea. Let's make evidence-based medicine understandable for everyone. Let's put the main outcome measure that's important to the patient on the left side of our Treatment Score Calculator™ and let's put the side benefits and negative side effects on the right side of our Treatment Score Calculator™. So in the end, it looks something like this:

Main Statistic (Outcome) - Side Benefits
                                          - Side Effects

By using the tools at TreatmentScores.com, people can finally organize statistics from the medical literature, and can finally start to understand treatment effects by quantifying everything on the same scale. Treatment Scores are a way to simplify evidence-based medicine. At least one study shows that the majority of physicians do not understand the magnitude of treatment effects, which probably means that nearly 100% of patients do not understand treatment effects.
Source: http://www.cmaj.ca/content/early/2015/10/26/cmaj.150430

So how are Treatment Scores doing on social media?

Twitter:
https://Twitter.com/TreatmentScores
3,092 Followers

Facebook:
https://Facebook.com/TreatmentScores
1,724 Likes

Blog:
http://TreatmentScoresBlog.com
10,312 visitors. You should follow this blog by signing up with your email address in the upper right.

Website:
http://TreatmentScores.com
77 registered users




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.


Saturday, November 21, 2015

Treatment Scores: We Write Review Articles in a New Way - with Quantification and Graphics

At TreatmentScores.com we write medical review articles just like you would do for any popular website for the lay public. What we do differently is we focus on evidence-based medicine, treatment effects, and quantification. And, for the time being we publish our reviews here at the TreatmentScoresBlog.com with graphics that are generated using our tools.

You begin by doing "journal club." You figure out a diagnosis. You search for the best statistics from the best medical articles and you create STAR™ Blocks. STAR™ stands for a statistic and a reference. You put all the statistics in a Treatment Score Calculator™ and you put the net treatment benefit on a 100 point scale to make it easy to understand. We are not doing anything different than in regular medical review article, we are just organizing it better, especially when it comes to reporting the treatment effects.

When you actually do the evidence-based medicine process you find out that there are usually only a small number of high quality studies with the treatment effect statistics that you need. Often there are no high quality studies.

We establish one outcome measure, and we use that main outcome measure, as the starting point for quantifying all the different treatments on the same treatment effect scale. We try to use the main outcome measure that is most important to the patient. We report the data as the SOM® Treatment Score.

We want to show the world how to do evidence-based medicine, and we want to demonstrate to the world the potential we have for doing medical review articles in a new and better way.

We need people to see why we need to go from an Alpha website to a Beta website. Better technology will help us to come up with revelations more quickly. By using the universal SOM® Treatment Scores we make treatment effects that are impossible to understand now, almost instantly understandable.

What's the absolute easiest way to explain this? Right now so many different outcome measures and treatment effects are reported in the medical literature that everyone is confused. One study found that 60 to 80% of physicians could not correctly figure out the treatment effects in a study about chronic pain.
(http://www.cmaj.ca/content/early/2015/10/26/cmaj.150430)

If the majority of physicians are confused, it's probably fair to say that almost all patients are confused. Patients are inadequately informed and inadequately educated about their treatments.

You also have a highly reputable evidence-based medicine physician who has published a famous essay: "Why Most Published Research Findings Are False."
http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.0020124

We also have this well-written articlee: "The unreliability of systematic reviews."
http://rapid-reviews.info/2015/11/15/the-unreliability-of-systematic-reviews-2/

The bottom line is that evidence-based medicine is in a state of confusion due to lack of organization and a lack of understandable quantification.

The list of treatments for insomnia that I'm working on now is an excellent example. For one treatment, the authors report the Cohen's d statistic as a measure of the effect size. The Cohen's d statistic makes it sound like the treatment has a medium to large treatment effect. This actually seems misleading to me. By doing manual calculations I believe net treatment benefit is around 8%, maybe less. That's pretty low. Although the treatment has a positive net benefit according to the statistics, one must ask if it is a clinically significant benefit.

Why doesn't every review article in the medical literature simply list all the treatments and list all the treatment effects on one scale, i.e. the SOM® Treatment Score? When you have something like the diagnosis of acute migraine headache, which has 57 possible treatments or more in the medical literature, standardizing the reporting of the treatment effect would make everything much more simple.

We are trying to mentor and teach the whole world evidence-based medicine. Once we get enough bloggers, and enough examples, so that the entire world starts to understand that all treatment effects can be quantified in a standard way for the benefit of patients, doctors, nurses, health related businesses, and governments around the world, I think we can do something very important for mankind.

In the future we want SOM® Treatment Scores to become a really important part of your daily lexicon.

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.

Wednesday, November 18, 2015

Glaucoma - All the options - What's the data?

Primary open angle glaucoma (POAG) is a very common disease which affects millions worldwide.  This disease is chronic and requires life-long monitoring to hopefully prevent vision loss. There are three ways that POAG is traditionally approached; eye drops, laser surgery, or conventional surgery. These treatments are aimed at lowering intraocular pressure. You'll hear some people discuss more alternative treatments such as marijuana or physical exercise to regulate intraocular pressure. While there are intricacies to each patient's case which need to be evaluated and discussed with an individual's physician and we certainly do not want to suggest treatments for patients, I wonder what the data is behind each therapy. This is where SOM™ Treatment Scores come into play. The Treatment Scores system helps one to quantify the science of medicine behind potential treatments, but we must keep in mind that each patient is unique and treatments are tailored to individual patients and that treatment decisions must be made in concert with your ophthalmologist.  

In our effort to quantify the evidence behind treatments for POAG using the Treatment Scores Analyzer™, the first step is to set up the Diagnosis Tool™. Below is a screen shot of the Diagnosis Tool™ (figure 1).  

Figure 1. Diagnosis ToolTM showing the search diagnosis box and the add diagnosis tab.  On the left the Tx button will take you to the Treatment OrganizerTM

The first thing you will see is the search box. This box allows us to search for a diagnosis. Diagnoses already evaluated will show up and give you a starting point. If your diagnosis does not yet exist, you will need to use the Add Diagnosis tab. This tab will allow you to add up to 10 levels of your diagnosis (figure 2).  


Figure 2. Diagnosis Entry form showing my set up for primary open angle glaucoma.

You’ll see that I chose Glaucoma, Open angle, and Intraocular pressure greater than 22 as my diagnoses levels. Next is the Main Statistic. This requires a bit of searching through the literature to pick the main outcome measure you are interested in modelling. For this example I chose Reduction of IOP. The follow up is greater than 3 months and I am interested in studies of adult patients. Once you get the correct diagnosis entered into the Diganosis Tool™ you will be ready to hit the Tx button on the left and enter the Treatment Organizer™ and begin evaluating the treatment options for your diagnosis.  

To be continued...

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.


Insomnia Part II - Using Treatment Scores

It all started with a question from a friend: "Does drinking cherry juice work for insomnia?" I never recommend treatments (consult with your own physician for that), however, I do review the medical literature to see what the science of medicine says. I also have no prejudice against Eastern medical treatments, herbal treatments, natural treatments, or any other alternative medical treatment. I just want to see the studies and see the data.

At TreatmentScores.com we do medical review articles differently. Instead of leaving the treatment effect as a difficult statistic that few people understand, or leaving the treatment effect buried deep inside the article where it's difficult to find, we put the treatment effect front and center and describe it, or summarize it, in a new way as the treatment score.

After studying the medical literature for a while, I realized that the diagnosis I wanted to quantify was insomnia, elderly patients, with at least two weeks of follow-up. Trying to quantify the science of medicine behind medical treatments is actually an organizational nightmare. First you have to figure out the diagnosis. Then you have to figure out the outcome measure that is most important for the patient, and, just to complicate things, the best outcome measure may be different depending on the patient, so you may have to do several reviews using several different outcome measures. One patient may have trouble falling asleep at night. Another patient may have trouble staying asleep at night. Those are two significantly different outcome measures.

Many diseases have had symptom scores created for them to try to take into account many symptoms, and also so that there is standard that can be used to do studies. For insomnia there are at least five different symptom scores that need to be considered.
  1. Insomnia Severity Index (ISI) 
  2. Pittsburgh Insomnia Rating Scale (PIRS) 
  3. Visual Analogue Scale
  4. The Questionnaire Score
  5. Leeds sleep evaluation questionnaire
The development of symptom scores is an area in which patients should have a lot of influence, yet they sometimes have zero involvement. This is definitely an area for patient generated research in the future. These symptom scores can be biased, and can be designed to make certain treatments look better than other treatments. Do you know the people behind these symptom scores? Do you know their motivations? We can and should make all this transparent.

I decided to use the Insomnia Severity Index as my main outcome measure to see how many treatments I could quantify with it. Using the Treatment Scores Analyzer(TM) at TreatmentScores.com my diagnosis of insomnia now has the details listed below.


My treatment list will begin with one treatment, tart cherry juice, and I hope to expand it to more treatments over time. I have found clinical studies about a tart cherry juice in the medical literature. Tart cherry juice reportedly raises melatonin levels and is also an anti-inflammatory. One study used a tart cherry juice blend produced by CherryPharm, Inc. in Geneva, New York (I have nothing to do with the company). The fact that a company may be involved raises some issues, and they will be discussed later. For the moment my treatment list consists of only one treatment:


The best study I have found is this one: "Effects of a tart cherry juice beverage on the sleep of older adults with insomnia: a pilot study," which I have put inside a STAR™ Block (STAR™ = Statistic and a Reference). Note the treatment effect statistic of 8.09% on the right.



The Insomnia Severity Index
How was this statistic calculated? The Insomnia Severity Index goes from 0 to 28. According to the Insomnia Severity Index a score from 0 to 7 means no clinically significant insomnia.

This creates a bit of a problem for interpreting this study. If the score improves, what is the denominator? Is it going to be 28 or 21? Because of the way the Insomnia Severity Index is designed, I'm going to use 21 as the denominator, which may make the treatment effect seem better than it really is.

The 15 patients had a baseline Insomnia Severity Index of 15.5. In the placebo treated group the insomnia Severity Index Score dropped to 14.9. And doing the math, we get 15.5 - 14.9 = 0.6.

When the same patients were given the tart cherry juice their Insomnia Severity Index (ISI) dropped to 13.2. So the tart cherry juice reduced the ISI from 14.9 to 13.2, which is a difference of 1.7 compared to placebo.

Taking that difference of 1.7 and putting it over the denominator of 21 gives an improvement of 8.09% in the Insomnia Severity Index. The 8.09 goes into our Treatment Score Calculator™ as below.



Because of the potential side effect of night-time urination, or nocturia, I subtracted the 0.07, (which is a somewhat random estimation because there is no hard data), and gave tart cherry juice a SOM® Treatment Score of 8, which is a Treatment Grade of "E." As far as the nocturia goes, the study tried to mitigate that side effect by giving the tart cherry juice to patients twice a day, with the second dose being at least 2 hours prior to bedtime. So the treatment score and the corresponding treatment grade are:



Is this the statistically correct way to look at this situation? I think the Cohen's d statistic used in the study is misleading as it says the treatment effect is medium to high. For me, the "net treatment benefit to the patient" as the SOM® Treatment Score, is the more accurate, and understandable, way to report the treatment effect.

What I need to do next is review the treatment scores for Ambien, Restoril, melatonin, and other treatments for insomnia. What do the statistics say about the treatment effect of each?

Wouldn't it be nice if the net treatment benefit to the patient was always clearly spelled out for you as the SOM® Treatment Score?

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.

Sunday, November 15, 2015

Evidence-Based Medicine for Insomnia using Treatment Scores: Figuring out the Diagnosis

Evidence-based medicine is not easy. Let's review the medical literature (using TreatmentScores.com) for treatments for insomnia. Our first obstacle is organization. We are going to have to look at insomnia six different ways.

There are at least five different symptom scales for insomnia. They are the Insomnia Questionnaire Score, the Insomnia Severity Index, the Leeds Sleep Evaluation Questionnaire, the Pittsburgh Insomnia Rating Scale, and the Visual Analog Scale.

We will have to look at insomnia with each of these symptom scales as the main outcome measure, and we will also look at insomnia trying to combine all the outcome measures. This project has already turned into an organizational nightmare, but TreatmentScores.com makes it more doable than ever before.


In fact, let's look at just one potential treatment to get started. Someone who suffers from insomnia asked me about cherry juice for insomnia. They had read about treating insomnia with cherry juice in a magazine.

One of the great things about TreatmentScores.com is that it doesn't matter whether it's Eastern medicine, Western medicine, herbal medicine, or any other type of alternative medicine. What matters is if a study (or studies) and statistics exist.

However, I have run into my second big obstacle. I have to find the statistics. Statistics that should be available to me in seconds are not available to me. They will be available to me in seconds in the future when TreatmentScores.com goes from an alpha website to a beta website, which will take some time. For now, I have to download and read some studies. Meanwhile, stay tuned for part 2 on insomnia.

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, November 13, 2015

Putting a Graphical User Interface on Evidence-Based Medicine

Have you been watching the diet wars? People have strong opinions about low-fat, high-fat, carbohydrates, sugar, protein, gluten, genetic influence, and every diet out there.

I want to see the numbers. I want to see exactly what people are thinking when they make a claim. However, typically when I read an article there are very few numbers, but lots of opinion. How can we reverse that? How does one figure out who is using the best statistics and the best evidence-based medicine? (There are some great evidence-based medicine experts who are writing excellent articles.)

What we need to do is put a graphical user interface (GUI) on the evidence-based medicine process. That's what we are doing at TreatmentScores.com, and that's what we are writing about here at TreatmentScoresBlog.com.


Remember the early days of the computer when only those who could do machine programming could use a computer? Then, Apple and Windows (or maybe someone else) put on a graphical user interface and suddenly everyone could use a computer?

At TreatmentScores.com we are putting a graphical User Interface (GUI) over the evidence-based medicine process, and are going to make it so simple and convenient that doctors, nurses, and all patients around the world can do it as an educational experience. We already have a minimum viable product - in the form of an alpha website.

Our Treatment Score Analyzer™ will eventually allow shared decision-making and evidence-based medicine to be combined.

The Treatment Score Analyzer™ has four parts:

1. Diagnosis Tool™
2. Treatment Organizer™
3. Treatment Score Calculator™
4. STAR™ Blocks

Stay tuned by subscribing to this blog with your email address in the box at the top right, or bookmark this URL so you can come back often.

Follow Treatment Scores:
Twitter:

Facebook:

Blog:

Website:

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, November 10, 2015

Finding the Evidence Behind Treatments

Finding the Evidence Behind Treatments

SOM® Treatment Scores

Every day I find myself wondering about the details of our treatment options for patients.  Most conditions have an array of options for patients.  These are in addition to the home remedies and Eastern medicine alternatives which patients are inquiring about and are beginning to be trialed in the literature.  One of the toughest decisions we make with the patient and their family is: Which treatment has the best evidence behind it for a particular disease? 

Our medical literature gives us guidance on this question.  We have randomized controlled trials to compare treatments, and we have systematic reviews, Cochrane reviews, and meta-analyses where there is significant controversy.  These studies and reviews build a strong foundation for our individualized conversations with patients.  Increasingly the doctor-patient relationship is becoming more of a partnership with the physician giving advice and recommendations, but also giving patients the options and a thorough discussion about which option may or may not be appropriate for each individual patient.  I find this leads to situations and attempted comparisons made from extrapolation of the literature. 

Here’s an example.  Take the case of a simple traumatic iritis.  No other ophthalmic problems, just a simple mild iritis from blunt trauma without other traumatic sequelae.  The treatment options in this scenario typically include: observation, topical steroids, or topical steroids plus pharmacological dilation.   Seems relatively straight forward – until you consider the individualization of treatment for each patient.  Let’s say the patient is a pilot and will not be able to function if you pharmacologically dilate her eye.  What’s the literature or support for cycloplegia (giving medication to dilate the eye) in simple traumatic iritis?

What has happened to patients who have been studied in the past regarding  true risks and benefits both with or without treatment?  We end up extrapolating from broader literature and attempting to score each treatment for the patient’s situation.  In this case the pilot and her physician may elect not to receive pharmacological dilation, or may choose a short treatment period.  Now imagine the patient was known to develop high intraocular pressure with steroids, or that the patient is a child?  We quickly begin to find that our literature can be somewhat difficult to apply to each and every individual situation and may require some extrapolation.  Hence the Art of Medicine. 

Similar scenarios play out in many disease processes in all specialties every day.  Over the next few weeks I am going to take you step-by-step through a new tool, the Treatment Score Analyzer™, we now have to give a simple, inclusive, and comprehensive comparison of the literature supporting each treatment.  The evidence-based scoring of treatment options will hopefully empower us to make better decisions both for and with our patients every day.  See the disclaimers below.

Follow Treatment Scores!


Twitter:

Facebook:

Blog:

Website:

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 © 2015 Treatment Scores, Inc.

Sunday, November 8, 2015

Evidence-Based Medicine, Treatment Scores, and the Hepatitis C Commercial on TV

Have you seen the commercial on TV for Harvoni? It's one of the seemingly hundreds of TV commercials about medicines frequently seen on TV. When I saw the Harvoni commercial I was skeptical. Was it all hype or was it for real? Hepatitis C is a bad disease and if you Google it, many celebrities have allegedly suffered from it such as: Stephen Tyler, Evel Knievel, David Crosby, and Pamela Anderson.

So, how does one do an evidence-based medicine review of the literature? First, I established the diagnosis that I wanted to review. After doing some searching on Medline I came up with: hepatitis C, chronic, genotype 1 infection.

Then, I decided on the outcome measure. The outcome measure most important to the patient, in my opinion, is a cure of hepatitis C. The medical literature uses the phrase: "sustained virologic response," which means that no virus can be detected in your body. It's more cautious than using the word cure. After all, what if the disease relapses years later?

At this point, to define things further I was willing to look at "adult patients" and "any time period" of follow-up. Although, after I while I realized that many studies used 12 weeks as their follow-up time period.

So, I collected some studies into STAR™ Blocks. STAR™ stands for a "Statistic and a Reference."


I was able to find some great randomized controlled studies. The main outcome measure was above 90% for sustained virologic response in three such studies. I finally settled on 95% as the number I would use as a weighted average of the statistics from the three studies.

This gave me a Treatment Score Calculator™ that looks like this:



I now have the main statistic on the left and the secondary statistics on the right. I still need to go through and come up with event rates for all the secondary statistics. But for right now, I think they are worth getting "cured" of chronic hepatitis C. Since they are relatively minor side effects I am only reducing the main statistic down one point to get a Treatment Score of 94 for Harvoni. This may change later with more study.

In other words, the medical literature seems to say, as I now understand it, that there is a 94% net treatment benefit when you treat Chronic hepatitis C of this type with Harvoni. That's much better than the old "gold standard" treatment with interferon.

The bottom line is that with a new statistic, the SOM® Treatment Score, we can begin to quantify the science of medicine behind treatments as part of the educational process. And we can make the entire process transparent to the patient from the diagnosis, to a list of treatments, to the Treatment Score Calculator™, and finally to the STAR™ Blocks. This system will eventually allow for shared decision-making and evidence-based medicine to be combined.

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.