Saturday, January 30, 2016

The Treatment Score for Ginger in the Common Cold

In our last column we began structuring the Treatment Scores algorithm to assess the evidence of ginger in the common cold.  After this structure is in place, we are able to search the literature.  A search of PubMed for ginger and ginger root revealed many articles, including 29 reported clinical trials.  These trials ranged from ginger for colonic cancer, hyperemesis gravidarum, motion sickness, vertigo, and asthma, among others.  Unfortunately there were no trials in the common cold.  A search of clinicaltrials.gov again revealed many trials of ginger in other indications, but none in the common cold.  Since no trials were found, we then assessed PubMed for case reports or series.  Again, we were unable to find any published literature to support ginger for the common cold.

You'll see in the Treatment Score Calculator above that we were unable to score ginger for the common cold due to a lack of scientific evidence behind the treatment.  This does not mean the treatment is not effective, it only means that we were unable to locate significant clinical evidence to support it's use.  These trials may have not been done for a myriad of reasons beyond efficacy, such as funding or sponsor interest.

An interesting observation made during our research is that there actually are several controlled trials of ginger for anti-emetic use.  While this is too far astray from the common cold to be included in our current analysis, it opens the question to what the Treatment Score for ginger in nausea or vomiting would be.  Maybe we will assess this in a future analysis.

This blog post does not intend to give medical advice or opinion, it is purely an educational exercise utilizing the literature and all patients should consult their physician (please see disclaimer 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 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 © 2016 Treatment Scores, Inc.


Stem Cells and Osteoarthritis

Stem cell therapies have been a controversial over the past decade.  Over the past decade, however, despite the controversy behind them, more and more research is being done to support their use, and more and more people are being treated with stem cell therapies.  There are many medical specialties that are already using stem cells as a means of treatment.  

Stem cells are not only derived from embryos.  In fact, the majority of stem cells used in medicine today are derived from adult stem cells.  A stem cell is a cell that has the potential to renew itself, to differentiate into a variety of tissue types, and to repair damaged tissue.  Based on these three characteristics, one can see how stem cells could be used to heal existing injuries.

Orthopedics is one area of medicine that is using adult stem cells.  These stem cells are either derived from fat tissue, or from bone marrow.  Once the tissue is extracted, the stem cells are typically injected into damaged areas (arthritis areas) to help decrease pain and increase cartilage repair in those areas.  

The most recent study being evaluated compares adipose (fat) derived stem cells in combination with mircofracture, with microfracture treatment alone, to help heal knee arthritis (femoral condyle chondral defect).  




In the above study, it turns out that the group of people who had stem cells in combination with the microfracture procedure had improved cartilage repair on MRI and decreased pain as compared to the group that did not have the stem cells.  At the 2 year follow up, both groups of patients, however, reported similar improvements in quality of life and activities in daily living.  Despite visibly seeing improvements in cartilage regrowth on MRI, and having less pain, patient reports of overall outcomes remained the same.  Using the Treament Score CalculatorTM, we are able to quantify and compare the many upcoming studies that are being done on the usefulness and effectiveness of stem cell treatments down the line.  




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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.

Wednesday, January 13, 2016

What's the evidence for ginger for the common cold?

Following our last post on the use of Treatment Scores to assess the evidence of several treatments of the common cold, I'd like to start by looking at the evidence to support ginger in the common cold.  A simple Google search of ginger and common cold reveals many websites purporting ginger as a symptomatic treatment of the cold.  I want to see the scientific evidence behind this.

The first step in my process was to define the diagnoses in the Diagnosis Tool.  I picked several different medical conditions that typically are lumped together as the common cold.  I included upper respiratory infection, nasopharyngitis, and rhinopharyngitis.  These are not inclusive, but representative of what I think most people consider as the common cold.  Figure 1 shows the diagnoses entered into the Diagnoses Tool.

Figure 1 showing the Diagnosis Tool.
Once we have entered the diagnoses we need to define our main statistic.  To complete this I went to the medical literature and browsed around clinical trials in the common cold.  I was able to find a validated symptom questionnaire called the Wisconsin Upper Respiratory Symptom Score which appeared to be appropriate for our question.  I also set the follow up as 3 weeks, as this should allow sufficient time for the natural course of the disease.  Figure 2 shows the entry into the Diagnosis Tool of the main statistic.

Figure 2 showing the Main statistic
Once these are completed we are ready to go to the Treatment Organizer.  Figure 3 shows the view of the Treatment Organizer.  In our next post we will go through the Treatment Organizer and start entering the evidence to find a Treatment Score for ginger in the common cold. (Please see disclaimers below, these are simply for educational purposes and we do not pretend to diagnose or treat medical conditions. Please see your physician for any medical problems.)
Figure 3 showing the Treatment Organizer

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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.

Tuesday, January 12, 2016

Doctors, Ask Yourself These Questions about Treatment Scores

A 50-year-old man is just diagnosed with type II diabetes. He wants to discuss the following 5 treatments with you.

1. Metformin
2. Glucotrol (glipizide)
3. Cinnamon capsules
4. Diet and exercise
5. Farxiga (dapagliflozin)

You immediately give your patient the Treatment Scores which represent the “net treatment benefit” according to the medical literature. Wait? You don’t do that. Why don’t you do that? Because the most important thing the patient needs to know, the “net treatment benefit,” doesn’t exist. How have you practiced your entire medical career without knowing the net treatment benefit for the patient?

This gaping hole has never been filled because the mathematics is difficult and the organization of the data is extremely complex.

Ask yourself to at least grade the above treatments. Are those treatments grade A? Grade B? Grade C? Grade D? Grade E? Are you unable to quantify 5 of the most common treatments in the world for one of the most common diagnoses in the world?

My cantankerous great aunt Nellie was right. All doctors are quacks. (Smile.)

It’s dark. Why hasn’t anyone invented the light bulb yet?

It’s not the doctors’ fault that patients never have any idea what the net treatment benefit for them might be. Doctors have never had the tools that they need.

Here at TreatmentScoresBlog.com we are writing essays and demonstrating the tools that we have invented to derive the net treatment benefit.

Treatment Scores fix the problem. We give physicians the 4 tools they need. 

Together, let’s figure out what the existing 27 million medical studies actually say about treatments. (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 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.

Monday, January 4, 2016

TV Show about Treatment Scores

People don’t believe statistics; they believe people who can explain statistics. That’s a truism that I’ve seen over and over in my lifetime. People trust experts not numbers.

There have been some great science communicators. Carl Sagan taught the world about cosmology. Isaac Asimov taught the world about chemistry, physics, and put the science back in science fiction.

I predict that there will be a TV show about Treatment Scores; therefore,
Treatment Scores needs a spokesperson.

Going Deep with David Rees
David Rees can make watching the grass grow interesting. He did a show on making ice cubes and it was fascinating. He did a show on making toast! It was engrossing. Going Deep with David Rees on the National Geographic Channel, makes ordinary things spectacular. Rees uses a lot of guest experts. Treatment Scores TV needs a host like David Rees.

Adam Ruins Everything
Adam Conover is a comedian. Adam Ruins Everything started on YouTube and became an “educational sketch comedy” on truTV. Adam Conover is great because of the way they “fast cut” the show and flash the references onto the screen. The references enhance his credibility. Treatment Scores can do this because we have invented simple, great new visuals for data. Adam Conover’s “super annoying” personality is part of Adam Ruins Everything. Treatment Scores TV needs a host like Adam Conover, but maybe more Macus Welby, M.D., than annoying.

Diagnose Me
Diagnose Me on the Discovery Life Channel is a great show about medicine. It’s a medical detective show. Diseases are puzzles that must be figured out. The show uses many different patients, doctors, and nurses. It’s riveting what people must go through before they can get diagnosed. Maybe the Treatment Scores TV show should be called “Treat Me!”

Medical Education Shows
There are many other medical education shows like The Doctors on CBS hosted by Travis Stork M.D., an emergency medicine physician. There is also The Dr. Oz Show from NBC (now ABC) hosted by Mehmet Oz, M.D. Remember, Dr. Oz was discovered by Oprah Winfrey and soon after had his own TV show. Treatment Scores could create its own celebrities. There is nothing more dramatic than educating people about life-and-death problems, and, everyone also is interested in everyday health issues.

There are medical reality shows like Save My Life: Boston Trauma on ABC, Trauma: Life in the ER on The Learning Channel, and Untold stories of the ER on the Learning Channel and Discovery.

There are also crossover medical shows with fiction and reality combined: Chicago Med, Code Black, and Grey's Anatomy. Who could ever forget the cantankerous but brilliant Dr. Gregory House, of House, M.D., who was exactly like one of my dramatic attending physicians during my medical school training.

Science Shows
Think of all the great science shows: MythBusters, 3 Scientists Walk into a Bar, Mysteries at the Museum, Bill Nye the Science Guy, Things We Don't Know (a Web based TV show), and astrophysicist Neil deGrasse Tyson has been on many different TV shows. Sadly, it is Mythbusters' last season. They have rabid fans that suggest myths they should bust. Treatment Scores TV also expects to have rabid, “desperate,” fans from around the world seeking better medical information in the form of Treatment Scores.

The Movie: Moneyball
Let’s not forget movies! The movie, Moneyball, starring Brad Pitt as Billy Beane is a great movie! I had no idea about Sabermetrics when I started Treatment Scores. However, when I learned about it by watching Moneyball on Cable TV, I read the book, Moneyball: The Art of Winning an Unfair Game by Michael Lewis, and discovered the parallels. Bill James, the inventor of Sabermetrics, realized that the entire sport of baseball had always been using the wrong statistic so he invented a new one. Medicine has always been using the wrong statistic for patients so we invented a new one, the Treatment Score. Now we are quantifying something life and death important: the science of medicine behind medical treatments using evidence-based medicine guidelines. Treatment Scores are Sabermetrics for medicine.

There are many, many excellent movies with medical themes. What will the Treatment Score movie be like? I can’t wait for it to happen. It would be an underdog story about how a small group of doctors invented health information technology and turned it into a greater discovery than the invention of penicillin for mankind. Treatment Scores will help billions around the world forever into the future, while the main benefits of penicillin have come and gone.

Treatment Scores TV needs a much better spokesperson the guy in the following 1 minute video. Treatment Scores needs somebody with outstanding charisma and an incredible voice; someone who can make evidence-based medicine as mesmerizing as it actually is. The drama surrounding medical treatments is high. It’s life and death. Your health is forever at stake. (See the disclaimers below.)


Contact
If Treatment Scores are your passion, contact Bradley Hennenfent, M.D., at: Dr.Hennenfent ((at)) Gmail.com.

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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.

Saturday, January 2, 2016

Compassionate End of Life Care and Evidence-Based Medicine: Treatment Scores

My father-in-law was 87-years-old when we got the call. It was a Saturday night. He’d set off the alarm in his house and his alarm company was calling us since he was not answering his cell phone.

He lived about 10 miles away so my wife jumped in the car and arrived at his house to find him febrile, confused, and complaining of some vague abdominal pain.  After the ambulance arrived, the driver insisted on taking him to the closest hospital which was about 2 miles closer to his house than the hospital where I worked.

After the CAT scan and lab tests, it became apparent that he had a stone obstructing his common bile duct. The next day was Sunday and after being NPO and getting some fluids, his symptoms were much better and he was beginning to look like his old self.

Monday came next. Since my father-in-law had a Bilroth II procedure in the 1960’s, the usual treatment for a bile duct stone, which is an ERCP (endoscopic retrograde cholangiopancreatography), became problematic due to the changed anatomy. That morning the internal medicine doctor told my wife that since an ERCP was not an option, he needed a percutaneous bile duct stent, and the radiologist would be able to do it in the afternoon. The gastroenterologist came by in the late morning and said he would need surgery, but we might consider sending him home in a day or two in order for things cool down. He mentioned some drugs and said they should do an intraoperative cholangiogram when they took out his gallbladder. About an hour later, the surgeon called and said he was on the schedule for a laparoscopic cholecystectomy in the morning and we needed to cancel the bile duct stent.

My wife called me confused and overwhelmed and had no idea what to do. I am a physician and I felt exactly the same way. We decided that we needed to transfer him to the hospital where I worked where at least we knew the physicians and could sort things out.

Being a physician, I wanted to know, “What is the literature on the treatment of a common bile duct stone in a patient with a previous Bilroth II?”  It doesn’t seem like an extremely hard question. Let’s start with WebMD. There were a couple of things about ERCP’s and Gallbladder surgery in general neither of which was helpful in this case. So I went on to PubMed. Some case series studies came up about a double balloon enteroscopy for ERCP and there was a case series report on laparoscopic bile duct exploration. Okay; this is a start.

How about the Cochrane Reviews? There seemed to be one pertinent article, but it didn't specifically talk about patients who have had a Bilroth II. It seemed to be saying that open cholecystectomy and bile duct exploration may be just as good as endoscopic procedures. My father-in-law was 87. If you've ever seen an open cholecystectomy, this is not a procedure an 87-year-old would recover from easily. There was one study of laparoscopic bile duct exploration, but this was only done in specialized centers. After a couple of hours of frustrating searches, it was apparent there is no one place where the medical literature is organized so that a list of treatments and the studies behind them was available in the way I needed them.

This is where Treatment Scores comes to the rescue. Going to the website and the Treatment Organizer™ I put in a level 1 diagnosis of a common bile duct obstruction with a secondary diagnosis of history of Bilroth II. Our Main Statistic is the chance of reobstruction and we put a follow up of 1 year to start. Now I am able to list the treatments I've found so far in the Treatment Organizer™.  Moving into the STAR™ Blocks I am able to input the studies I've already looked at and eventually give my own Treatment Score using the Treatment Score Calculator™.  As shown in the Treatment Organizer™ below, most of the studies for these treatments are case series so none of them will have high Treatment Scores™ on a scale of 100, but at least now I know what the treatments are and what the evidence or in some cases lack of evidence is for each of them. Someday I will be able to build on the work of others. For now it’s just the studies I've entered, but at least they are organized in one place.





It was now 4 days since my father-in-law’s initial obstruction and his symptoms and lab tests had improved significantly. He had multiple stones in his gallbladder and it was clear it needed to come out. Here we go again. Is a robotic assisted laparoscopic cholecystectomy better than a laparoscopic cholecystectomy without the robot? What is the evidence behind each? Again after a significant amount of time searching the usual places, I listed the relevant studies in my STAR™ Blocks.  It’s apparent there are not many studies out there and none showing a significant difference as shown in the STAR™ Block below.



The laparoscopic cholecystectomy without the robot is a shorter procedure so it appeared to be the better option. When he had this done, there was clear evidence of metastatic cancer which was confirmed later by the peritoneal biopsy taken at the time of surgery. Once again, this led to many more hours of figuring out what were the treatments for his cancer, what were the benefits and what were the side effects? It consisted of going through multiple review articles, (most of which were not quite pertinent and presented with the biases of the writers), sorting through numerous articles on Medline to find the relevant ones and then figuring out which ones were well done and useful.

It was apparent that for his age and co-morbidities, the side effects and risks of chemotherapy were not worth any potential benefit. My father-in-law passed away a few months later with his family around him. He never had another bile duct obstruction. I’m confident we did everything right, but having Treatment Scores before all this started could have made things so much easier.

There is an old adage: “Know what you know and know what you don’t know.” In medicine today we haven’t yet got the “know what you know part.” Textbooks become outdated quickly. If you’re lucky there is a great review article, but it may not pertain to your situation and is written with the biases of the reviewers. We need access to the sources. Here is the literature and this is how good or bad it is. Treatment Scores answers this need.  It’s time to fill in the “know what you know part.”  It will be exciting to get Treatmentscores.com beyond the alpha web site it is today, so we can do just that with a future beta website. (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 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.