Monday, February 22, 2016

Patient Power: Problems That Treatment Scores Solve

Patients and doctors don’t understand treatments. There are 130 treatments for insomnia. There are 18,147 papers on insomnia indexed on Medline. How many physicians carry all that medical information in their head? How many people know how effective each treatment is on a one-hundred-point scale? The Patient-Centered Outcomes Research (PCORI) team says, “Every day, patients and their caregivers are faced with crucial health care decisions while lacking key information that they need.”

The problem is that doctors don’t understand treatments and therefore patients don’t understand treatments. A study called, “Do clinicians understand the size of treatment effects? A randomized survey across 8 countries” proves that physicians do not understand treatments. In that study of 531 physicians at teaching institutions, 60 - 80% could not correctly identify treatment effects. In other words, the majority of physicians do not understand treatments. Why would they? Useless and complex statistics are often reported in studies. The statistic most important to the patient is almost never put in a medical paper.

Sadly, when physicians don’t understand treatments, patients don’t understand treatments. It basically becomes the blind leading the blind. However, it is not the physicians’ fault. The problem is that the medical industry has always been using the wrong statistic. That’s why we have invented the Treatment Score. The Treatment Score equals the “net treatment benefit for the patient.”

There is precedent for an entire industry using the wrong statistic. Baseball was using the wrong statistic until Sabermetrics were invented. Treatment Scores are “Sabermetrics for medicine.”

We have created the Treatment Score Calculator, which allows the physician and patient to see the main statistic and the secondary statistics. This enables the patient and physician to discuss the treatment along with the side effects so that they can, together, do true shared decision-making. It is vitally important that the patient understands the potential benefit of a treatment, and it’s also vitally important that the patient can have input regarding the side effects of a treatment.

For example, I have seen urinary incontinence happen after surgery for BPH in men. One man I saw apparently went insane after becoming incontinent and went from being a working man with a family to being homeless and dripping urine as he walked down the hospital hallway for his clinic visit. I have seen patients with half-paralyzed faces after neurosurgery. Patients need to be able to “weigh” the importance of these side effects to them, as opposed to having the “importance” be determined by some anonymous third party. The patient has to live with the side effect forever, the 3rd party only has to write their opinion about the side effect. Those are two different worlds. The days of the patient being clueless are supposed to be over. When I went to medical school that was called “paternalistic medicine.” It was supposed to be replaced by “informed consent” and evidence-based medicine.

Treatment Scores solve many of the biggest problems in healthcare. Let’s make a list of the things that Treatment Scores can do for us and discuss them.

Problems Solved:

  1. Treatment Scores save money 
  2. Treatment Scores save time 
  3. Patient empowerment/patient engagement
  4. The previously unsolvable treatment transparency problem
  5. Personalized medicine
  6. Patient safety
  7. The previously unsolvable quality assurance problem
  8. Continuing medical education
  9. Solves medical discovery to medical adoption taking 17 years 
  10. Physicians not doing evidence-based medicine

Treatment Scores save money

A lot of money is spent on treatments that don’t work, or are no better than a placebo. Why? Because patients are not given enough information about treatments. Treatment Scores fix this problem. Imagine being offered a car, but never being told if it’s a Roll Royce, Chevrolet, or Edsel. That is basically what happens with treatments today. For example, Cochrane Systematic Reviews, frequently used by physicians, basically only tell us that the treatment probably works, probably doesn’t work, or says we don’t have enough information to tell. We must do better than three measly classifications. We need all the specifications!

When the Ebola outbreak occurred in Africa a treatment was promoted by a physician that had zero clinical evidence behind it, but many Africans did not understand that, because there were no Treatment Scores. Simply knowing what the evidence-based medicine behind treatments is as Treatment Scores will make more people select more scientifically proven treatments. We will suddenly save the entire system money by reducing fraud, waste, and abuse from poor quality treatments, hype, and unjustified marketing, and will increase the use of high quality treatments. Saving 1% in the 7 trillion-dollar healthcare industry will save 70 billion dollars. The bottom line is that Treatment Scores will help distribute more healthcare to more people at lower cost.

And we can do much more to lower costs with Treatment Scores as you will see later.

Treatment Scores save time

It can take an hour to read one systematic review of the medical literature, check the methods, and do your own math to be sure the authors are correct. Who has that kind of time? One study, “Evidence based medicine: a movement in crisis?” found that for one day’s worth of admissions from the Emergency Department the admitting physician might need to read 3,679 pages of national guidelines, which would take 122 hours. Why don’t we just look up the Treatment Scores? It would take about 30 seconds.

Patient empowerment/patient engagement

Patients want more power. There are patient empowerment movements. There are patient advocacy movements. There are patient mentoring movements. There are non-profit organizations all over the world trying to help patients. The patient should be the most powerful person in healthcare. It is the patient’s life that is at stake. It is the patient’s health that is on the line. I called a cancer non-profit for a friend and asked about the treatments for the cancer they were advocating for, and they had no clue. Treatment Scores will help nonprofits help their patients.

What makes patients more powerful? Information! The more information that the patients have the more powerful they become. When it comes to highly complex and highly technical medical information, the more understandable the information, the more powerful patients become.

The previously unsolvable “treatment transparency” problem

In economics, you are taught that you want “product transparency” to be an empowered consumer. Product transparency in economics translates to “treatment transparency” in healthcare.

We have already established that physicians do not understand treatments. We have also established that it is not the physicians’ fault. They have never had the tools they needed until we invented the Treatment Score Analyzer™.  The mathematical problem of understanding a treatment is astronomically difficult. One diagnosis may have 10 treatments. Each treatment may have 10 vital statistics. Each of those statistics may come from 10 different references. Each of those references may contain 10 different variables. That’s 10,000 pieces of information that must be organized and processed. And to be honest, there is much more to the mathematical problem.

The physician is the agent of informed consent in medicine. It’s their job to explain treatments to patients. However, when physicians don’t have the tools to understand treatments, patients don’t understand treatments either.

The genius Albert Einstein said this: "If you can't explain it simply, you don't understand it well enough." We would say if you can't give the Treatment Score for every treatment, you don't understand medical treatments well enough.

Former Apple CEO Steve Jobs said this: "You've got to start with the customer experience and work back toward the technology - not the other way around." That’s why the front end of the Treatment Score system is so simple. You figure out a treatment and its Treatment Score. The Treatment Scores can be more generally classified into grades A, B, C, D, and E. Each grade stands for 20 points on a hundred-point scale. Grade F is for anything negative or harmful.

Evidence-based medicine right now is like the early days of the computer. In the early days of the computer, you had to understand machine language programming to use a computer. Then Xerox, Apple, and Windows came along and put a graphical user interface over machine language, and suddenly, everyone could use a computer. What we have done with our Treatment Score Analyzer™, is put a graphical user interface over the evidence-based medicine process. Soon, everyone will be able to do evidence-based medicine.

Right now, evidence-based medicine is over 26 million medical studies stored inside a deep, dark underground cave. It’s difficult to get down into the cave. Once inside the cave, it’s hard to find anything. Once you find something you need a light. Once you look at a study it’s written in difficult technical language using incomprehensible statistics.

Every once in a while, perhaps someone like you, goes down into the cave and shines a flashlight around. You read a few important studies, and you come out and explain the evidence-based medicine to a patient. Then the cave goes completely dark again.

What we do with our Treatment Score Analyzer™, is go down into the deep dark cave, wire the entire cave with electricity, and turn the lights on forever.

Still not convinced that there is a treatment transparency problem? Take a look at this article, “The Use of Superlatives in Cancer Research” that explains how treatments are so misreported.
http://oncology.jamanetwork.com/article.aspx?articleid=2464965

Recently, when I was talking to a physician colleague, she brought up the fact that often her rehabilitation patients didn’t know whether the chemotherapy they were on was curative or palliative. The patients didn’t know whether their treating physician was trying to cure them or simply trying to reduce their symptoms while they die. That’s a huge misunderstanding. Every cancer patient should know if their chemotherapy has a 0% chance of curing them, a 1% chance of curing them, or a 90% chance. Too often, no one has any idea of the Treatment Score, or the time period.

Personalized medicine

We need personalized medicine. You need to know the Treatment Score for chemotherapy for acute lymphocytic leukemia. You also need to know the personalized Treatment Score for a 52-year-old female with acute lymphocytic leukemia versus the Treatment Score for a 75-year-old male smoker with acute lymphocytic leukemia. The Treatment Score Analyzer™ allows for personalization of the diagnosis, and personalization of the treatment options.

Patient safety

First do no harm. Those are powerful words and they are a medical principle that is taught around the world. Patients often must take risks to try and get healthier. But they need to understand those risks. They need Treatment Scores and the Treatment Score Calculator. Many operations and medications are dangerous. Patients, for their own safety, must be better informed than they are today. We all know people who went for treatment and ended up worse off than before their treatment.

The previously unsolvable quality assurance problem

There is an interesting quality assurance problem that few people know about, but that we want to solve with Treatment Scores. When family medicine physicians, internal medicine physicians, and emergency physicians, have Journal club or grand Rounds they often invite in other medical specialists. When general practice physicians meet to discuss a neurosurgical case, they invite neurosurgeons to attend. When general practice physicians meet to discuss a gynecology case, they invite gynecologists to attend. So the general practice physicians have specialists looking over their shoulder. But who looks over the shoulder of the specialist? With Treatment Scores, every specialty of medicine will be able to look over the shoulder of every other specialty of medicine, see their thinking, and see if they are being logical, unbiased, and if they are truly doing evidence-based medicine. This improvement in quality assurance will prevent disasters from happening. Remember the frontal lobotomy? Remember the epidemic of unnecessary hysterectomies? Remember the epidemic of unnecessary knee surgeries? Remember, when doctors were giving patients antiarrhythmic medications and then found out they were killing patients instead of helping them? All of these things were preventable with better transparency such as Treatment Scores. Physicians want to do the best for their patients that is possible. But they have never had the proper collaboration tools before.

Continuing medical education that matters

The most important continuing medical education for physicians is figuring out which treatments have the best evidence-based medicine behind them. Currently, physicians rely mostly on “authority bias” to get their information, means that some physicians tell all the rest of the physicians what to do. The Treatment Score Analyzer™ allows physicians to go directly to the source of the data and to process the data themselves. Coming up with Treatment Scores is the continuing medical education that all physicians need to be doing on a near daily basis.

The Treatment Score Analyzer™ provides a virtual filing cabinet of clinical statistics for physicians. Physicians often read a paper, mark it up, and throw it in a filing cabinet. Then, five years later they can’t find those statistics. The Treatment Score Analyzer™ solves that problem.

Solves medical discovery to medical adoption taking 17 years

The time from invention of a new medical treatment to it being adopted throughout the medical system takes about 10 to 15 years. In fact, not so long ago, studies said that it took 17 years.

 “The translation of medical discovery to practice has thankfully improved substantially. But a 2003 report from the Institute of Medicine found that the lag between significant discovery and adoption into routine patient care still averages 17 years [3, 4].” – E-patient Dave
(http://www.epatientdave.com/2013/03/10/source-for-17-years-for-new-medical-practices-to-be-adopted/)

Treatment Scores, because of the simple front end design, will bring treatment transparency down to the smart phone, which is the computer that everyone in the world now uses.

Treatment Scores will disrupt healthcare just like Uber, Walmart and Amazon.com have disrupted their industries with organization and quantification.

If you love Journal club, love reading medical articles, and knowing important statistics, by all means get in touch with us and we will teach you how to use our tools.

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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.

Sources:

Bradley C. Johnston, et al. "Do clinicians understand the size of treatment effects? A randomized survey across 8 countries." CMAJ October 26, 2015 First published October 26, 2015, doi: 10.1503/cmaj.150430

[3] E. A. Balas, “Information Systems Can Prevent Errors and Improve Quality,” J. Am. Med. Inform. Assoc., vol. 8, no. 4, pp. 398-399, 2001, PMID: 11418547.

[4] A. C. Greiner and Elisa Knebel, Eds., Health Professions Education: A Bridge to Quality. Washington, D.C.: National Academies Press, 2003.

Trisha Greenhalgh, et al. Evidence based medicine: a movement in crisis?” BMJ 2014;348:g3725, June, 13, 2014.

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