Thursday, September 7, 2017

Should You Take a Statin? Treatment Score = 0.055%, Number Needed to Treat = 1,818

Should you take a statin to prevent your death? Let’s assume you are a 66-year-old person with a normal cholesterol level (of about 186 mg/dl) and you want to know if you will live longer if you take a statin.

Let’s add the condition that you have an elevated high-sensitivity C-reactive protein level (of about 4.2 mg/liter). C-reactive protein is a measure of inflammation in the human body. High-sensitivity C-reactive protein (hsCRP) might be more highly associated with causing disease than regular C-reactive protein (CRP).

Under these conditions, if you take rosuvastatin (Crestor) 20 milligrams for 2 years, will you live longer? Will side effects bother you? Will you have a net positive benefit?


The Treatment Score = the net treatment benefit for the patient as summarized from the existing medical literature. Treatment Scores incorporate the ideals of treatment transparency, evidence-based medicine, shared-decision making, patient engagement, patient safety, personalized medicine, and patient empowerment. It’s especially important to personalize the Treatment Score to your preferences.

In order to solve the health illiteracy problem, we all need to start explaining treatments in three ways:

  1. The Treatment Score
  2. The proportion
  3. The Number Needed to Treat based on the Treatment Score

One way of looking at taking rosuvastatin (Crestor) 20 mg is this:

  1. The Treatment Score is less than 1%. In fact, the Treatment Score is less than 0.01%.
  2. Less than 1 person like me out of a 100 will benefit. In fact, only about 1 person out of 2,000 will benefit.
  3. The Number Needed to Treat for the net benefit is 1,818, which means you need to treat 1,818 patients to get 1 patient to benefit.

THE TREATMENT SCORE
I started with a gross overall survival treatment benefit of 0.55% from the Jupiter Trial. Then, after subtracting the negative side effects I arrived at a Treatment Score of 0.055% for someone with my preferences.


Note that I weighted the 8 negative side effects heavily before subtracting them, because of my personal experiences. Another person would weight them differently. That math is not being show here for simplicity’s sake, but personalized medicine is an important part of Treatment Scores.


THE NUMBER NEEDED TO TREAT
The Number Needed to Treat (NNT) was invented back in the 1980’s. However, it has always been a seriously flawed statistic because it is not what the patient needs to know. The Number Needed to Treat based on the Treatment Score is much more meaningful to the patient.


CANS OF FOOD
Medical treatments are like cans of food without labels. With Treatment Scores, we are putting labels on these blank cans so they can be better assessed. With Treatment Scores, we can organize lists of treatments with Treatment Scores, so that all the treatments are evaluated with the same outcome measure, over similar time periods, and with similar patient populations.

EXPERTS 
Other physicians have found concerns after reviewing the medical literature on statins. I want to recognize Malcolm Kendrick, M.D. for his blog post, “How much longer will you live if you take a statin?” In his blog, he writes:

“Results: 6 studies for primary prevention and 5 for secondary prevention with a follow-up between 2.0 and 6.1 years were identified. Death was postponed between −5 and 19 days in primary prevention trials and between −10 and 27 days in secondary prevention trials. The median postponement of death for primary and secondary prevention trials were 3.2 and 4.1 days, respectively.”

Basically, when you look at statins from the patients’ point of view, which is the important point of view, statins do not necessary do well in terms of their “net treatment benefit.”

You might want to read this by Charles Bankhead. “Should Healthy People Take Statins? New Studies Say No.”
https://www.medpagetoday.com/cardiology/prevention/20948

Michel de Lorgeril, MD and others wrote: “Clearly, the time has come for a critical reappraisal of cholesterol-lowering and statin treatments….”
http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/416101

Also read: Ben Spencer, "Now MORE experts claim statins are a waste of time: They say studies show cutting bad cholesterol fails to slash heart risk. Millions being misled about the controversial drugs says group of doctors," The Daily Mail. 24 November, 2016.
http://www.dailymail.co.uk/health/article-3969692/Now-experts-claim-statins-waste-time-say-studies-cutting-bad-cholesterol-fails-slash-heart-risk.html#ixzz4rzpGMB58

From another article: "Students and pharmacists investing a small amount of time in 'studying a study' and applying the principles of interpreting clinical research could come up with markedly different views of the therapeutic value of a drug than that reported in the general media." [Typo fixed]
"Analysis of the Rosuvastatin (Crestor) Jupiter Trial."  April 6, 2009.
https://lecom.edu/analysis-of-the-rosuvastatin-crestor-jupiter-trial/

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Follow this blog by submitting your email address into the box near the top right.

DISCLAIMERS
You must always see a licensed physician for diagnosis and treatment. You cannot use Treatment Scores to diagnose or treat yourself. Treatment Scores are only an informational exercise. Death or permanent disability can result if you don't see your own medical physician. Death or permanent disability can result if you don’t call an ambulance or go to the emergency department immediately for emergency or urgent medical issues. We claim no accuracy for Treatment Scores, because the underlying medical studies can be wrong or the methods can be wrong. You must always see your own physician. We make no promises, claims, or warranties whatsoever.

REFERENCES & SOURCES:
Malcolm Kendrick, M.D. for his blog post, “How much longer will you live if you take a statin?”
https://drmalcolmkendrick.org/2015/10/27/how-much-longer-will-you-live-if-you-take-a-statin/

Charles Bankhead. “Should Healthy People Take Statins? New Studies Say No,”
MedPage Today, June 28, 2010.
https://www.medpagetoday.com/cardiology/prevention/20948

Michel de Lorgeril, MD; Patricia Salen, BSc; John Abramson, MD; et al Sylvie Dodin, MD; Tomohito Hamazaki, PhD; Willy Kostucki, MD; Harumi Okuyama, PhD; Bruno Pavy, MD; Mikael Rabaeus, MD. "Cholesterol Lowering, Cardiovascular Diseases, and the Rosuvastatin-JUPITER Controversy: A Critical Reappraisal." Arch Intern Med. 2010;170(12):1032-1036. doi:10.1001/archinternmed.2010.184.
http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/416101

Ben Spencer. "Now MORE experts claim statins are a waste of time: They say studies show cutting bad cholesterol fails to slash heart risk. Millions being misled about the controversial drugs says group of doctors" The Daily Mail. 24 November, 2016.
http://www.dailymail.co.uk/health/article-3969692/Now-experts-claim-statins-waste-time-say-studies-cutting-bad-cholesterol-fails-slash-heart-risk.html#ixzz4rzpGMB58

Paul M Ridker, M.D., Eleanor Danielson, M.I.A., Francisco A.H. Fonseca, M.D., Jacques Genest, M.D., Antonio M. Gotto, Jr., M.D., John J.P. Kastelein, M.D., Wolfgang Koenig, M.D., Peter Libby, M.D., Alberto J. Lorenzatti, M.D., Jean G. MacFadyen, B.A., Børge G. Nordestgaard, M.D., James Shepherd, M.D., James T. Willerson, M.D., and Robert J. Glynn, Sc.D., for the JUPITER Study Group.
"Rosuvastatin to Prevent Vascular Events in Men and Women with Elevated C-Reactive Protein." N Engl J Med 2008; 359:2195-2207November 20, 2008DOI: 10.1056/NEJMoa0807646
http://www.nejm.org/doi/full/10.1056/NEJMoa0807646

"Analysis of the Rosuvastatin (Crestor) Jupiter Trial."  April 6, 2009.
https://lecom.edu/analysis-of-the-rosuvastatin-crestor-jupiter-trial/

FDA.gov Drug Data
https://www.accessdata.fda.gov/drugsatfda_docs/label/2010/021366s016lbl.pdf

Thursday, August 24, 2017

Are Prescribed Statins a Good Idea for Patients with Normal Cholesterol? by Stephen Fitzmeyer, M.D.

This is the first of a series of blog posts that will use the TreatmentScores.com application to verify or debunk treatment claims, studies, and gossip.

This week's topic received a Treatment Score of -0.1.

Half of all heart attacks and strokes happen in apparently healthy people with LDL cholesterol levels below the current recommended level. So, we asked: "If your cholesterol is normal, can taking statins reduce your risk of death from heart disease or stroke?"

Cardiologist Dr. Paul Ridker, a professor of medicine at Harvard Medical School, the lead scientist on the landmark JUPITER trial, showed that statins, specifically rosuvastatin, might offer a substantial benefit to people with normal or even low levels of cholesterol.

In the JUPITER trial they "randomly assigned 17,802 apparently healthy men and women with low-density lipoprotein (LDL) cholesterol levels of less than 130 mg per deciliter (3.4 mmol per liter) and high-sensitivity C-reactive protein levels of 2.0 mg per liter or higher to rosuvastatin, 20 mg daily, or placebo and followed them for the occurrence of the combined primary end point of myocardial infarction, stroke, arterial revascularization, hospitalization for unstable angina, or death from cardiovascular causes." We focused on Overall Survival to calculate the Treatment Score, because it is the hardest, most objective endpoint.

We plugged several studies' statistical results into the Treatment Score Calculator(TM), added negative side effects, and came up with a not-so-great Treatment Score of -0.1.

Our original gross Treatment Score for Overall Survival was 0.55, as in an increase in overall survival of 0.55% at 2 years, which equates to a grade of 'E'. However, the risk of complications from negative side effects lowered that score to -0.1.

Of greatest concern was the increased risk of developing diabetes or rhabdomyolysis, which suggests that preventative rosuvastatin is not worth the trade-off.

Negative side-effects we scored: constipation, diabetes, headache, myalgia, myopathy, nausea, rhabdomyolysis, tendinopathy, and weakness.

In the next article I will look into studies that claim lowering homocysteine levels in the blood can prevent heart disease.

Stephen Fitzmeyer, MD
Dr. Fitzmeyer is a Physician Informaticist with advanced post-doc training in medical informatics from Boston University/Boston Medical Center and the Boston VA Healthcare System.

SOURCES:
N Engl J Med. 2008 Nov 20;359(21):2195-207. doi: 10.1056/NEJMoa0807646. Epub 2008 Nov 9.
Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein.
Ridker PM, Danielson E, Fonseca FA, Genest J, Gotto AM Jr, Kastelein JJ, Koenig W, Libby P, Lorenzatti AJ, MacFadyen JG, Nordestgaard BG, Shepherd J, Willerson JT, Glynn RJ; JUPITER Study Group.

Link to abstract: https://www.ncbi.nlm.nih.gov/pubmed/18997196

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DISCLAIMER
You must always see a licensed physician for diagnosis and treatment. You cannot use Treatment Scores to diagnose or treat yourself. Treatment Scores are only an educational exercise. Death or permanent disability can result if you don't see your own medical physician. Death or permanent disability can result if you don’t call an ambulance or go to the emergency department immediately for emergency or urgent medical issues. We claim no accuracy for Treatment Scores, because the underlying medical studies can be wrong or the methods can be wrong. You must always see your own physician. We make no promises, claims, or warranties whatsoever.

Friday, June 23, 2017

Help Patients!

You can help patients by writing and speaking about the need for better treatment transparency. Patients, and patient advocates, want these four deadly problems solved:
  1. There is an 88% health illiteracy rate among patients (Health.gov)
  2. 60 to 80% of physicians don't understand treatment effects (CMAJ)
  3. 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.”
  4. PCORI also says that we need to translate “…existing scientific research into accessible and usable formats…”
We have created the solution for all four problems; we produce Treatment Scores. The Treatment Score = the net treatment benefit for the patient. Treatment Scores put patients first by summarizing medical studies from the patient's point of view.

How to explain Treatment Scores? We figure out our “gross income” and “net income” when we do our income taxes. Why can't we figure out the “gross treatment benefit” and the “net treatment benefit” for patients from the medical literature? It is simple with Treatment Scores technology.

Did you see the movie “Moneyball” about Sabermetrics starring Brad Pitt? Treatment Scores are “Sabermetrics for medicine.” Sabermetrics have revolutionized sports. Treatment Scores will revolutionize healthcare for the same reason, because like Sabermetrics, Treatment Scores reduce disorganized data down to one number.

Patients are suffering from health illiteracy, under-treatment, over-treatment, and even mistreatment, because they cannot understand complex medical studies. Patients need understandable treatment transparency. If you are interested in helping patients, and you read medical studies, please contact me at
Dr.Hennenfent@gmail.com
My colleagues and I would like to speak with you, but first read on for more information.

Treatment Scores put a graphical user interface (GUI) over evidence-based medicine (EBM). In the early days of the computer, you had to know how to use machine language to use a computer. Once Windows and Apple put a GUI over machine language everyone could use a computer. Similarly, with Treatment Scores, everyone can do evidence-based medicine.

Every step within Treatment Scores can be validated and verified. Treatment Scores are the opposite of cookbook medicine. Patients get what they want: understandable information. Physicians get what they want: evidence-based medicine in a format that saves time. Bloggers and writers can bring treatment transparency out of the dark ages.

REVELATIONS
When you do Treatment Scores you can make some astonishing discoveries.

The Ebola epidemic in Africa was not optimally treated. Hundreds of patients probably died unnecessarily. With Treatment Scores, you can see who was more logical, Doctors without Borders, or one physician at the World Health Organization who saw in the data what we saw with Treatment Scores.

Harvoni (ledipasvir/sofosbuvir) is a major advance in treating a subset of hepatitis C, having a Treatment Score of 95% (as in 95% cure rate) for some patients, compared to the old interferon based protocol that has a Treatment Score of 40%.

Steve Jobs (of Apple) allegedly had pancreatic cancer (stage 1, neuroendocrine type) found by accident. No doubt, such a smart, wealthy CEO would immediately undergo the "most scientific treatment" for this most curable form of all pancreatic cancers, right? No! Remember, there is an 88% health illiteracy rate among patients (Health.gov). Even “the genius” Steve Jobs wasted precious time, apparently 6 months or more, doing treatments that were not backed by clinical evidence. How many times did his cancer double in size over the 180-day delay? Doubling time can be as low as 62 days (Pancreas, 2001). Would Steve Jobs still be alive today if he had simply had immediate access to a list of all possible treatments with Treatment Scores? His cancer reportedly spread beyond his pancreas (became metastatic) and he passed away.

A COMPLETE LIST OF TREATMENTS
Patients need a complete list of treatments. Recently, a man told me about being diagnosed with hives (urticaria of unknown etiology). He went from doctor to doctor without ever finding a cure. He was working from a list of treatments that included antihistamines and steroids, and all the sub-classes of those medications orally and topically. He was also taking four showers per day for itching. The treatment that finally cured him wasn’t even on any of the typical lists of treatments. I have heard this same story many times about many different diseases. Did you know there are 130 treatments for insomnia? Did you know there are 57 treatments for an acute migraine headache? Why can’t we give patients a complete list of every treatment in the literature for every disease, and a Treatment Score for every one of those treatments? Not to say what patients must do, but to say here is what you can do, and here is how the Treatment Score changes depending on your personal preferences.

Patients want to know the science behind treatments whether they are Western medicine, Eastern medicine, herbal medicine, naturopathic medicine, Ayurveda, or any other type of alternative medicine. Patients spend $34 billion dollars per year on alternative medicine. You can give patients what they want with treatment lists and positive Treatment Scores, because sometimes excellent clinical studies do exist. Or, you can tell them when the Treatment Score = 0, because studies do not exist or the treatments effects are zero. You can even tell patients when the Treatment Score is negative (harmful).

LOOKING
We are looking for a person (or a group of people) who want to help patients with treatment transparency using Treatment Scores. This is a great educational opportunity (over the Internet), and there are many uses for Treatment Scores in healthcare and business.

AUDIENCE
If you volunteer with us, the essays you blog or write with Treatment Scores will be seen by a wide audience. We have over 150,000 followers on Facebook, over 9,750 followers on Twitter. As I write this, we hold all top 10 positions on Google search, and we are growing by over 1,500 followers per day on all our social media accounts combined. Patients clearly want better treatment transparency.

You could write for your hometown newspaper or for major publishers. Everyone needs Treatment Scores. You could become a spokesperson for patients, for treatment transparency, evidence-based medicine, shared-decision making, patient engagement, patient safety, and patient empowerment.

LEARNING
You will receive an extraordinary education in evidence-based medicine. You will discover amazing revelations hidden in the medical literature. You will find scoop after scoop that can “go viral” as there is so little treatment transparency right now.

CONTACT
If you are interested in Treatment Scores, please email:
Dr.Hennenfent@gmail.com
Feel free to send your LinkedIn profile, CV, or any other information.

There is a 1-minute explainer video about Treatment Scores on YouTube:
https://youtu.be/GLIIB3oOVJA

There is an explanatory essay about Treatment Scores and Smart Phones here:
http://www.treatmentscoresblog.com/2017/03/patients-desperately-need-treatment.html

Bradley R. Hennenfent, MD
Physician & Economist (Retired)
United States
Dr.Hennenfent@gmail.com

ABOUT
Treatment Scores was started by an anesthesiologist, an emergency physician, a physician programmer, and Dr. Hennenfent. Brad Hennenfent graduated from Northwestern University with a degree in economics, graduated medical school from the University of Illinois, and did his Emergency Medicine residency at the UIC Affiliated Hospitals Emergency Medicine Residency Program. After two years as a practicing emergency physician, he became director of an inner-city emergency department in Chicago. Then, he went into business and became the director of over 10 emergency departments and urgent care centers. Dr. Hennenfent has had five uncles with prostate cancer. He became an advocate, and, while working with a medical non-profit, helped get over $20 million dollars of federal funding released for medical research to the National Institutes of Health. He also helped get over $100,000 worth of grants in kind or donations year after year. In his retirement in Florida, he has become very interested in medical statistics and treatment transparency for patients. He believes patients should be more informed and more powerful. Dr. Hennenfent likes to combine the mathematics of economics with the mathematics of medicine.

To support Treatment Scores and the treatment transparency movement:

FOLLOW FACEBOOK:
https://www.facebook.com/TreatmentScores

FOLLOW TWITTER:
https://twitter.com/TreatmentScores

FOLLOW THIS BLOG
Follow this blog by submitting your email address into the box near the top right.

DISCLAIMER
You must always see a licensed physician for diagnosis and treatment. Treatment Scores are only an educational exercise. Death or disability can result if you don't see your own medical physician, call an ambulance, or go to the emergency department immediately for your medical issues. We claim no accuracy for Treatment Scores because the underlying medical studies can be wrong, or the methods can be wrong. You must always see your own physician.

SOURCES
America's Health Literacy: Why We Need Accessible Health Information
https://health.gov/communication/literacy/issuebrief/

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

Patient-Centered Outcomes Research Institute
http://www.pcori.org/assets/FINAL-PFA-Communication-and-Dissemination-v3.pdf

COPYRIGHT
Copyright © 2017 Bradley R. Hennenfent, M.D. All rights reserved.




Monday, June 19, 2017

Help Patients: Blog and Write with Treatment Scores

Patients, and patient advocates, DESPERATELY need these five horrendous problems solved:

1. There is an 88% health illiteracy rate among patients (Health.gov)
2. 60 to 80% of physicians don't understand treatment effects (CMAJ)
3. 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.”
4. PCORI also says that we need to translate “…existing scientific research into accessible and usable formats…”
5. The majority of medical guidelines are written by authors with conflicts of interest (British Medical Journal).

We have created the solution for all five problems; we produce Treatment Scores. The Treatment Score = the net treatment benefit for the patient. It’s a way to summarize information to help patients understand medical treatments.


Patients are suffering from health illiteracy, medical scams, under-treatment, over-treatment, mistreatment, and being lied to with statistics. It’s horrible right now.

How to explain Treatment Scores? Well, every year we figure out our “gross income” and “net income” when we do our income taxes. So, we simply figure out the “gross treatment benefit” and the “net treatment benefit” for patients as digested from the medical literature. Did you see the movie "Moneyball" about Sabermetrics for baseball starring Brad Pitt? Treatment Scores are "Sabermetrics for medicine."



Treatment Scores put a graphical user interface (GUI) over evidence-based medicine (EBM). In the early days of the computer, you had to know how to use machine language to use a computer. Once Windows and Apple put a GUI over machine language everyone could use a computer. We have put a GUI over evidence-based medicine (EBM) so that everyone can do EBM.

Every step within Treatment Scores can be validated and verified. Treatment Scores are the opposite of cookbook medicine. Patients get what they want: understandable information. Physicians get what they want: Evidence-Based Medicine in a format that saves time. Bloggers and writers can stop lying with statistics.

REVELATIONS
When you do evidence-based medicine (EBM) with a graphical user interface (GUI), and you quantify the effects of medical treatments, you can make some astonishing discoveries.

A colleague looked at the trend not to give antibiotics to children under 2 years of age who present with ear aches (otitis media). He calculated a Treatment Score of 10% for symptom resolution for giving amoxicillin. He was surprised, because he thought the Treatment Score would be much higher. On the other hand, why withhold any treatment that has a “net treatment benefit” of 10% for resolving symptoms? It should be up to the patient. Patients want to know all the choices and all the information about each treatment; they want shared-decision making, because personal preferences can change the Treatment Score.

The Ebola epidemic in Africa was not optimally treated. Hundreds of patients probably died unnecessarily. With Treatment Scores, you can see who was more logical, Doctors without Borders, or one physician at the World Health Organization who saw in the data what we saw with Treatment Scores.

Harvoni (ledipasvir/sofosbuvir) is a major advance in treating a subset of hepatitis C, having a Treatment Score of 95% (as in 95% cure rate), compared to the old interferon based protocol that has a Treatment Score of 40%.

The Xiao procedure for incontinence in children with spina bifida has been reported as being 80% successful in some studies. When evidence-based medicine is applied and biased are removed the Treatment Score = 0% (or even turns negative because of harm from the surgery).

Steve Jobs (of Apple) allegedly had stage 1, neuroendocrine, pancreatic cancer found by accident. No doubt, such a smart, wealthy CEO would immediately undergo the "best treatment" for this most curable form of all pancreatic cancers, right? No! Remember, there is an 88% health illiteracy rate among patients (Health.gov). Even “the genius” Steve Jobs wasted precious time, apparently 6 months or more, doing treatments that were not backed by clinical evidence. How many times did the tumor double in size over the 180-day delay? Doubling time can be as low as 62 days (Pancreas, 2001). Would Steve Jobs still be alive today if he had simply had immediate access to a list of all possible treatments with Treatment Scores? His disease reportedly became metastatic and he passed away.

A COMPLETE LIST OF TREATMENTS
Patients want a complete list of treatments. Recently, a man told me about being diagnosed with hives (urticaria of unknown etiology). He went from doctor to doctor without ever finding a cure. He was working from a list of treatments that included antihistamines and steroids, and all the sub-classes of those medications orally and topically. He was also taking four showers per day for itching. The treatment that finally cured him wasn’t even on any of the typical lists of treatments. I have heard this same story many times about many different diseases. Did you know there are 130 treatments for insomnia? Did you know there are 57 treatments for an acute migraine headache? Why can’t we give patients a complete list of every treatment in the literature for every disease, and a Treatment Score for every one of those treatments? Not to say what patients must do, but to say here is what you can do, and here are how the Treatment Scores change depending on your personal preferences.

Patients want to know about all treatments whether they are Western medicine, Eastern medicine, herbal medicine, naturopathic medicine, Ayurveda, or any other type of alternative medicine. Patients spend $34 billion dollars per year on alternative medicine. You can give patients what they want with treatment lists and positive Treatment Scores, because sometimes excellent clinical studies do exist. Or, you can tell them when the Treatment Score = 0, because studies do not exist or the treatments don’t work. You can even tell patients when the Treatment Score is negative (harmful).

LOOKING
We are looking for a person (or a group of people) who can help lead the movement for treatment transparency using Treatment Scores. We are looking for people passionate about patient education, shared decision-making, patient engagement, patient empowerment, and personalized medicine. This will be a great educational opportunity (over the Internet).

AUDIENCE
The essays you write with Treatment Scores will be seen by a wide audience. We have over 100,000 followers on Facebook, over 9,000 followers on Twitter, and we hold all top 10 positions on Google search. As I write this, we are growing by over 1,000 followers per day on all our social media accounts. Patients clearly want better treatment transparency. You can also write for your hometown newspaper and prove to your local community that, with technology, you are the smartest patient advocate in town. Major publishers also need Treatment Scores.

LEARNING
What will Treatment Scores give you besides worldwide and local publicity? You will receive an extraordinary education in evidence-based medicine. You will discover amazing revelations currently hidden in the medical literature. You will find “scoops” and information that needs to “go viral.”

If you want to help patients, you should be interested in social media: Facebook, Twitter, YouTube, and blogging. You should not be afraid of appearing on TV, and you should be good with a smart phone.

IMAGINE A FUTURE
Imagine a future where patients actually understand evidence-based medicine and where treatment transparency disrupts the entire medical industry.

CONTACT
If you are interested in Treatment Scores, please email:
Dr.Hennenfent@gmail.com
Feel free to send your LinkedIn profile, CV, or any other information.

There is a 1 minute explainer video about Treatment Scores on YouTube:
https://youtu.be/GLIIB3oOVJA

There is an explanatory essay about Treatment Scores and Smart Phones here:
http://www.treatmentscoresblog.com/2017/03/patients-desperately-need-treatment.html

Bradley R. Hennenfent, MD
Physician & Economist (Retired)
Florida, USA
Dr.Hennenfent@gmail.com

ABOUT
Treatment Scores was started by an anesthesiologist, an emergency physician, a physician programmer, and Dr. Hennenfent. Brad Hennenfent graduated from Northwestern University with a degree in economics, graduated medical school from the University of Illinois, and did his Emergency Medicine residency at the UIC Affiliated Hospitals Emergency Medicine Residency Program. After two years as a practicing emergency physician, he became director of an inner-city emergency department in Chicago. Then, he went into business and became the director of over 10 emergency departments and urgent care centers. Dr. Hennenfent has had five uncles with prostate cancer. He became an advocate, and, while working with a medical non-profit, helped get over $20 million dollars of federal funding released for medical research to the National Institutes of Health. He also helped get over $100,000 worth of grants in kind or donations year after year. In his retirement in Florida, he has become very interested in medical statistics and treatment transparency for patients. He believes patients should be more informed and more powerful. Dr. Hennenfent likes to combine the mathematics of economics with the mathematics of medicine.

To support Treatment Scores and the treatment transparency movement:

FOLLOW FACEBOOK:
https://www.facebook.com/TreatmentScores

FOLLOW TWITTER:
https://twitter.com/TreatmentScores

FOLLOW THIS BLOG
Follow this blog by submitting your email address into the box near the top right.

DISCLAIMER
You must always see a licensed physician for diagnosis and treatment. Treatment Scores are only an educational exercise. Death or disability can result if you don't see your own medical physician, call an ambulance, or go to the emergency department immediately for your medical issues.

Copyright © 2017 Bradley R. Hennenfent, M.D. All rights reserved.

Monday, June 12, 2017

Teach the World Evidence-Based Medicine (Help Patients!)

Teach the world evidence-based medicine, because patients and patient advocates, DESPERATELY want these five horrendous problems solved:

1. There is an 88% health illiteracy rate among patients (Health.gov)
2. 60 to 80% of physicians don't understand treatment effects (CMAJ)
3. 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.”
4. PCORI also says that we need to translate “…existing scientific research into accessible and usable formats…”
5. The majority of medical guidelines are written by authors with conflicts of interest (British Medical Journal).


We have created the solution for all five problems; we produce Treatment Scores. The Treatment Score = the net treatment benefit for the patient. It’s a way to summarize information to help patients (and everyone) understand medical treatments.

How to explain Treatment Scores? Well, every year we figure out our “gross income” and “net income” when we do our income taxes. So, for patients, we simply figure out the “gross treatment benefit” and the “net treatment benefit” for patients as digested from the medical literature. Did you see the movie "Moneyball" about Sabermetrics for baseball starring Brad Pitt? Treatment Scores are "Sabermetrics for medicine."


Treatment Scores put a graphical user interface (GUI) over evidence-based medicine (EBM) in order to help patients, doctors, nurses, journalists, writers, bloggers (and everyone else).

Back in the early days of the computer, you had to know how to use machine language to use a computer. Once a graphical user interface was put over machine language by Windows and Apple everyone could use a computer. With Treatment Scores, we have put a graphical user interface over evidence-based medicine (EBM) so that everyone can do EBM quickly and easily. Every step within Treatment Scores can be validated and verified. Treatment Scores are the opposite of cookbook medicine. Patients get what they want: understandable information. Physicians get what they want: Evidence-Based Medicine in a format that saves time. All other players in healthcare benefit as well.

AUDIENCE
The essays you write with Treatment Scores will be seen by a wide audience. We have over 100,000 followers on Facebook, over 9,000 followers on Twitter, and we hold all top 10 positions on Google search. As I write this, we are growing by over 1,000 followers per day on all our social media accounts. Patients clearly want better treatment transparency. You can also write for your hometown newspaper and prove to your local community that, with technology, you are the smartest patient advocate in town.

CONTACT
If you are interested in Treatment Scores, please email:
Dr.Hennenfent@gmail.com
Feel free to send your LinkedIn profile, CV, or any other information.

There is a 1 minute explainer video about Treatment Scores on YouTube:
https://youtu.be/GLIIB3oOVJA

There is an explanatory essay about Treatment Scores and Smart Phones here:
http://www.treatmentscoresblog.com/2017/03/patients-desperately-need-treatment.html

Bradley R. Hennenfent, MD
Physician & Economist (Retired)
Florida, USA
Dr.Hennenfent@gmail.com

ABOUT
Treatment Scores was started by an anesthesiologist, an emergency physician, a physician programmer, and Dr. Hennenfent. Brad Hennenfent graduated from Northwestern University with a degree in economics, graduated medical school from the University of Illinois, and did his Emergency Medicine residency at the UIC Affiliated Hospitals Emergency Medicine Residency Program. After two years as a practicing emergency physician, he became director of an inner-city emergency department in Chicago. Then, he went into business and became the director of over 10 emergency departments and urgent care centers. Dr. Hennenfent has had five uncles with prostate cancer. He became an advocate, and, while working with a medical non-profit, helped get over $20 million dollars of federal funding released for medical research to the National Institutes of Health. He also helped get over $100,000 worth of grants in kind or donations year after year. In his retirement in Florida, he has become very interested in medical statistics and treatment transparency for patients. He believes patients should be more informed and more powerful. Dr. Hennenfent likes to combine the mathematics of economics with the mathematics of medicine.

To support Treatment Scores and the treatment transparency movement:

FOLLOW FACEBOOK
https://www.facebook.com/TreatmentScores

FOLLOW TWITTER
https://twitter.com/TreatmentScores

FOLLOW THIS BLOG
Follow this blog by submitting your email address into the box near the top right. Then look for a confirmation email!

DISCLAIMER
You must always see a licensed physician for diagnosis and treatment. Treatment Scores are only an educational exercise. Death or disability can result if you don't see your own medical physician, call an ambulance, or go to the emergency department immediately for your medical issues.

Copyright © 2017 Bradley R. Hennenfent, M.D. All rights reserved.

Tuesday, May 30, 2017

Teach the World Evidence-Based Medicine

Teach the world evidence-based medicine, because patients and patient advocates, DESPERATELY want these five horrendous problems solved:
  1. There is an 88% health illiteracy rate among patients (Health.gov)
  2. 60 to 80% of physicians don't understand treatment effects (CMAJ)
  3. 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.”
  4. PCORI also says that we need to translate “…existing scientific research into accessible and usable formats…”
  5. The majority of medical guidelines are written by authors with conflicts of interest (British Medical Journal).
We have created the solution for all five problems; we produce Treatment Scores. The Treatment Score = the net treatment benefit for the patient. It’s a way to summarize information to save time for physicians and increase understanding for patients.


How to explain Treatment Scores? Well, every year we figure out our “gross income” and “net income” when we do our taxes. So, for patients, we simply figure out the “gross treatment benefit” and the “net treatment benefit” for patients as digested from the medical literature. Did you see the movie "Moneyball" about Sabermetrics for baseball starring Brad Pitt? Treatment Scores are "Sabermetrics for medicine."

Treatment Scores put a graphical user interface (GUI) over evidence-based medicine in order to help the practicing physician.

Back in the early days of the computer, you had to know how to use machine language to use a computer. Once a graphical user interface was put over machine language by Windows and Apple everyone could use a computer. With Treatment Scores, we have put a graphical user interface over evidence-based medicine so that all physicians can do EBM quickly and easily. Every step within Treatment Scores can be validated and verified. Treatment Scores are the opposite of cookbook medicine. Patients get what they want: understandable information; and physicians get what they want: more knowledge, less wasted time, and more money.
  
REVELATIONS
When you do evidence-based medicine with a graphical user interface (GUI), and you quantify the effects of medical treatments, you can make some astonishing discoveries.

The Ebola epidemic in Africa was not optimally treated. Hundreds of patients probably died unnecessarily. With Treatment Scores, you can see who was more logical, Doctors without Borders, or one physician at the World Health Organization who saw in the data what we saw with Treatment Scores.

Harvoni (ledipasvir/sofosbuvir) is a major advance in treating a subset of hepatitis C, with a Treatment Score of 95 (as in 95% cure rate), compared to the old interferon based protocol that has a Treatment Score of 40.

A COMPLETE LIST OF TREATMENTS
Patients want a complete list of treatments. Recently, a man told me about being diagnosed with hives (urticaria of unknown etiology). He went from doctor to doctor without ever finding a cure. He was working from a list of treatments that included antihistamines and steroids, and all the subclasses of those medications orally and topically. He was also taking four showers per day for itching. The treatment that finally cured him wasn’t even on any of the typical lists of treatments. I have heard this same story many times about many different diseases. Did you know there are 130 treatments for insomnia? Did you know there are 57 treatments for an acute migraine headache? Why can’t we give patients a complete list of every treatment in the literature for every disease, and a Treatment Score for every one of those treatments? Not to say what patients must do, but to say here is what you can do, and here are how the Treatment Scores change depending on your personal preferences.

Patients want to know about all treatments whether they are Western medicine, Eastern medicine, herbal medicine, naturopathic medicine, Ayurveda, or any other type of alternative medicine. Patients spend $34 billion dollars per year on alternative medicine. You can give patients what they want with treatment lists and positive Treatment Scores, because sometimes excellent clinical studies do exist. Or, you can tell them when the Treatment Score = 0, because studies do not exist or the treatments don’t work. You can even tell patients when the Treatment Score is negative = harmful.

AUDIENCE
The essays you write with Treatment Scores will be seen by a wide audience. We have over 100,000 followers on Facebook, over 9,000 followers on Twitter, and we hold all top 10 positions on Google search. In combination, we are growing by over 1,000 followers per day on all our social media accounts. Patients clearly want better treatment transparency! You can write for your hometown newspaper and prove to your community that, with technology, you are the smartest doctor in town (if you want to build your practice).

CONTACT US
If you are a writer, blogger, reporter, or physician interested in Treatment Scores, please email:
Dr.Hennenfent@gmail.com
Feel free to send your LinkedIn profile, CV, or any other information.

There is a 1 minute explainer video about Treatment Scores on YouTube:
https://youtu.be/GLIIB3oOVJA

There is an explanatory essay about Treatment Scores and Smart Phones here:
http://www.treatmentscoresblog.com/2017/03/patients-desperately-need-treatment.html

Bradley R. Hennenfent, MD
Physician & Economist (Retired)
USA
Dr.Hennenfent@gmail.com

ABOUT
Treatment Scores was started by an anesthesiologist, an emergency physician, a physician programmer, and Dr. Hennenfent. Brad Hennenfent graduated from Northwestern University with a degree in economics, graduated medical school from the University of Illinois, and did his Emergency Medicine residency at the UIC Affiliated Hospitals Emergency Medicine Residency Program. After two years as a practicing emergency physician, he became director of an inner-city emergency department in Chicago. Then, he went into business and became the director of over 10 emergency departments and urgent care centers. Dr. Hennenfent has had five uncles with prostate cancer. He became an advocate, and, while working with a medical non-profit, helped get over $20 million dollars of federal funding released for medical research to the National Institutes of Health. He also helped get over $100,000 worth of grants in kind or donations year after year. In his retirement in Florida, he has become very interested in medical statistics and treatment transparency for patients. He believes patients should be more informed and more powerful. Dr. Hennenfent likes to combine the mathematics of economics with the mathematics of medicine.

FOLLOW
To support Treatment Scores and the treatment transparency movement:

Follow us on Facebook:
https://www.facebook.com/TreatmentScores

Follow us on Twitter:
https://twitter.com/TreatmentScores
And follow this blog by submitting your email address into the box near the top right.

DISCLAIMER
You must always see a licensed physician for diagnosis and treatment. Treatment Scores are only an educational tool. Death or disability can result if you don't see your own medical physician or go to the emergency department for your medical issues.

Copyright © 2017 Bradley R. Hennenfent, M.D. All rights reserved.

Saturday, March 11, 2017

Patients Desperately Need Treatment Scores

Treatment Scores

Patients, doctors, nurses, insurance companies, and governments desperately need Treatment Scores (they just don't know it yet). Treatment Scores are disruptive technology. This is an update of our most popular blog post.



People have chosen their computer of choice; it's the smart phone.* Smart phones are ubiquitous around the world. This means that we need to be able to get medical information on smart phones in a way that it can be easily understood. We need Treatment Scores, which represent the net treatment benefit for the patients studied in the past. Treatment Scores allow for shared decision-making and personalized medicine to actually happen, instead of just being ideas people talk about.


We need to save time and money! Imagine being a physician, nurse, or allied health care provider and having Treatment Scores figured out for every treatment that is important to your medical practice. Such Treatment Scores, created using the software tools we have created, could be used for patient education, informed consent, shared decision-making, and personalized medicine. Treatment Scores should be done at every Journal Club at every medical school and residency program worldwide.

WE DARE TO ASK THE QUESTION: Why is that we can figure out our “gross income” and “net income” every year when doing our taxes, but physicians have never been able to tell patients the “gross treatment benefit” and the “net treatment benefit” of medical treatments? It's just mathematics. That's why we tell people Treatment Scores are "Sabermetrics for medicine." Did you see the movie "Moneyball" starring Brad Pitt, which was about Sabermetrics?

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

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

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


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


On the right it says "not scored." The problem is that no "weight" has been given for the "side effect" on the right of having to go to group therapy for 90 minutes per day, six days per week for six weeks! (Which is one of the schedules for cognitive behavioral therapy in a study supporting it as a treatment for insomnia.)

The patient appears horrified. You ask for their input. They say, "That reduces the Treatment Score to nearly zero for me. I don't have 90 minutes per day for six weeks to go to group therapy! I have a job, kids, family...." You say, "Okay let's reduce the Treatment Score for cognitive behavioral therapy down to almost zero based upon your input."


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

A different patient may be exactly the opposite. They may love the idea of going to cognitive behavioral therapy for 90 minutes a day. They may have the time and the inclination, and may not want to take any medications if they can avoid them. This is why patient input as part of shared decision-making is so important.

This is why we need a system that allows for patient input. In this example the patient had some input into the review of the treatments. The patient was able to let the doctor know that the time that would be needed for therapy sessions was a huge negative for them. We cannot know this without true shared decision-making between patients and physicians.

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

Steve Jobs Quote

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

Do We understand Medical Treatments Now?

No! In a study of 531 physicians: "Do clinicians understand the size of treatment effects? A randomized survey across eight countries" (Bradley C. Johnston, PhD, et al.) They found that over 80% of physicians could not correctly figure out the treatment effects that were reported as "mean difference in natural units" or as "standardized mean difference." This is just one example of all the confusion!

I think one can reasonably assume that if physicians don't understand medical treatments, then patients don't understand medical treatments. 

A wise physician once wrote: "Figure out how to empower patients. Any enterprise that can supply patients with clear, correct, relevant, personal, and specific knowledge that enables them to protect themselves and their loved ones...will endear itself to those patients. Furthermore, anyone supplying such knowledge will be feeding a growing need for more. People's desire for the information to manage their own healthcare and the means to act on that information will become more than just a desire - it will become an expectation. A massive business opportunity awaits." - R. Fogoros, MD

Interested in Treatment Scores? Contact me at:
Dr.Hennenfent@gmail.com

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

DISCLAIMERS: We claim zero accuracy with Treatment Scores. 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 © 2017 Treatment Scores, Inc.

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

Wednesday, February 22, 2017

Treatment Scores Explained in 1 Minute Video

There is a 1 minute explainer video on YouTube here:

https://youtu.be/GLIIB3oOVJA

The script of the animated video is below. (Embedding the video here did not work well, thus we have provided the link above only.)

Treatment Scores: Quantifying the science of medicine behind medical treatments. So how does it work? First, you receive a diagnosis from your physician. You want to know all your treatment options. One diagnosis can have upwards of 10, 50, or even 100 treatments. You also want to know which treatment is right for you. Treatment Scores gives you a personalized list of possible treatments. Each treatment on the list is given a Treatment Score. The Treatment Score is the number produced from a statistical analysis of the medical literature on that treatment. It summarizes the net treatment benefit for patients who have been treated in the past. You can share your Treatment Scores report with your doctor and discuss your options together. Take control of your healthcare. You need Treatment Scores. We all need Treatment Scores.

FOLLOW THIS BLOG:
Follow this blog by entering your email address in the box at the top right. You MUST CONFIRM your subscription VIA EMAIL. Then, you will automatically receive all new posts. If you have any problems, search for "feedburner" to make sure the confirmation email did not go into your spam folder.

Follow TREATMENT SCORES on Social Media:
Twitter:
https://Twitter.com/TreatmentScores
Facebook:
https://Facebook.com/TreatmentScores
AngelList:
https://angel.co/treatment-scores
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 © 2017 Treatment Scores, Inc. All Rights Reserved.

Sunday, January 15, 2017

You Get Diagnosed with a Disease: You Need Treatment Scores

video

Number 1. Unfortunately, you get diagnosed with a disease.
Number 2. You demand a long list of possible treatments for your disease instead of a short list.
Number 3. You are given a Treatment Score for each treatment, which summarizes the "net treatment benefit" for patients who have been treated in the past.
Number 4. With Treatment Scores you can understand your treatment options better than you did before. With Treatment Scores you can see the science behind the treatments. With Treatment Scores you can finally do personalized medicine and shared decision-making with your physician.

The YouTube link to this video is here:
https://youtu.be/v0Csjr9MzU8

FOLLOW THIS BLOG:
Follow this blog by entering your email address in the box at the top right. You MUST CONFIRM your subscription VIA EMAIL. Then, you will automatically receive all new posts. If you have any problems, search for "feedburner" to make sure the confirmation email did not go into your spam folder.

Follow TREATMENT SCORES on Social Media:
Twitter:
https://Twitter.com/TreatmentScores
Facebook:
https://Facebook.com/TreatmentScores
AngelList:
https://angel.co/treatment-scores
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 © 2017 Treatment Scores, Inc. All Rights Reserved.