Sunday, February 14, 2016

Treatments to Prevent Death. Do You Want to Live Longer?

Bob wants to live longer! In fact, he never wants to die, especially if he can continue to be healthy. What are the treatments to prevent death? What can you do to increase your lifespan? Statistically speaking, what can you do to increase your overall survival?

Let me show you how personalized medicine, evidence-based medicine, and shared decision-making can actually work together. Let me show you the future of medicine: Treatment Scores.

Bob is a 62-year-old man. He is at the stage of life where he is reading the obituaries, because friends and acquaintances are dying every year. Bob has no diseases, but he has heard that lifestyle changes might make you live longer, and he has seen some of the headlines about “longevity pills.” He reads anti-aging magazines.

Like Bob, you may have seen this headline: “World’s first anti-ageing drug could see humans live to 120.” They were talking about metformin. Metformin is a medication usually used for type II diabetes patients. There is a study going on called: “Targeting Aging with Metformin (TAME).” The purpose of the study it is to see if healthy people without diabetes given metformin will live longer than a control group.

Why is there so much excitement about metformin (trade name Glucophage)? In one study, patients with type II diabetes on metformin actually had an increased overall survival rate compared to a matched control group. Some researchers also made the assumption that the diabetes type II group should have died off at a significantly higher rate than those without diabetes, because that is what usually happens according to some studies.

The problem is that there has never been a randomized controlled trial comparing people without type II diabetes who take metformin with those who don’t take metformin. The assumption that metformin may be a “fountain of youth” drug is based on making assumptions from less-than-perfect studies. Nevertheless, it’s a worthwhile hypothesis. It needs to be studied further. That’s why they are doing the “Targeting Aging with Metformin (TAME)” study.

Additional reasons to consider metformin as an antiaging drug are that metformin extended the life-span of worms and also extended the life-span of mice. However, animal studies often don’t translate when human studies are done. Sadly, there is a long history of drugs working in animals that end up not working in human beings. Yet, sometimes they do work.

Let’s look at three “treatments to prevent death” and see where they stand based on the studies that exist. When it comes to metformin we want to know what the actual human studies say. We want to know the human evidence, the clinical evidence, right now.

Our diagnosis is “death” and our treatments are “treatments to prevent death.”

I went to the medical literature and looked up studies on metformin. I found the studies that I thought were most important for figuring out the increase in overall survival for 62-year-old people without diabetes who take metformin. Then I created a Treatment Score using our Treatment Score Analyzer™ software to represent metformin as a treatment to extend life.

I came up with a Treatment Score of 0.1 for metformin. How did I come up with this number? What I’m about to show you next is the future of medicine. It is the Treatment Score Calculator™, which is the device that will allow for shared decision-making to happen between physicians and patients.

Below is our prototype Treatment Score Calculator™ of what the future will look like.

It’s simple. The main statistic is at the top left. The secondary statistics are on the right. When you "weight" and subtract the secondary statistics from the main statistic you come up with the Treatment Score in the bottom left. In this case, there were a lot of negative side effects, so the Treatment Score was reduced from 0.6 to 0.1.





Physicians will have to show you the numbers, and as a patient, you will have input on how to "weight" the numbers, especially the side effects and the side benefits on the right.

So metformin currently has a very low Treatment Score according to the data that I’ve seen. Let’s compare this to some other things. Let’s look at two lifestyle issues “never smoking” and “stopping smoking.”

What does this tell you? The Treatment Score for being a 62-year-old person and never smoking is 20, the Treatment Score for being a 62-year-old person and stopping smoking is 6.7, and the Treatment Score for metformin according to the studies we have right now is 0.1.

Bob needs to know that the medical literature suggests that he should never smoke, that he should stop smoking if he does smoke, and that metformin has a such a low Treatment Score (and it might be even lower because I didn’t score some of the side effects) that he should probably wait for the results of the metformin randomized controlled trial, in which I hope metformin turns out to be a significant life extender!

This is the future of medicine. Treatments will be presented to you in lists, and those treatments will have Treatment Scores which represent the evidence-based medicine that currently exists behind those treatments.

Treatment Scores will empower patients. They will greatly increase patient safety. They will combine personalized medicine, evidence-based medicine, quantification, and shared decision-making for the first time in medical history.

The genius, Albert Einstein, said this: "If you can't explain it simply, you don't understand it well enough."

I believe this suggests that if you can’t explain treatments simply with Treatment Scores, then you don’t understand treatments well enough. There is proof that this is a huge problem today. Here is a study that proves physicians do not understand treatments well enough: “Do clinicians understand the size of treatment effects? A randomized survey across 8 countries.” http://www.cmaj.ca/content/early/2015/10/26/cmaj.150430

It’s not the physicians’ fault by the way, it’s because they have never had the training or the tools they needed before. Once physicians understand treatments, they can explain them to patients much better, and there can be true shared decision-making.

Finally, if you understand economics, you should be able to predict that Treatment Scores will improve everything in medicine: education, informed consent, consumer engagement, treatment transparency, patient safety, patient choice, research, healthcare distribution, and reimbursement. (See the disclaimers below.)

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