Tired Resident
As I recall, I was on Service 2 as a third- or fourth-year resident. I was extremely tired. I was presenting a patient to my attending, who was extremely well-published. He knew the literature incredibly well. (He’s one of these men who can quote an article he read five years ago and tell you what journal it was in and who wrote the article.) After my presentation, he asked me what I wanted to do with the patient. I gave him an answer and then he looked at me and asked what was the data to support my answer. I had no clue. I just knew this is what we had done before. It seemed to work. Here is when he began to lecture on data versus anecdote. He stressed how important it was to know the difference. I think he really needs to lecture to the whole United States. We don’t know the difference between data and anecdote.
Say we take 300 children that all have “colds” and we give half of the children a cough suppressant and the other half a placebo. Our results, if correctly tabulated, would be data. If I told you that I personally have had lots of colds over my life and I use Robitussin because it works better and I get well quicker, this is an anecdote. Anecdotes are nice. They can help make a point. Anecdotes should never carry the same weight as data.
This brings me to an opinion piece in the Wall Street Journal. This is written by a 67-year-old woman who is a breast cancer survivor. She’s had two recurrences. She’s had several rounds of chemotherapy using multiple drugs. At her last recurrence she was found to have several tumors in the liver. She writes:
Thankfully, a clinical trial had recently started and I was selected for a combination of Xeloda and Avastin. Xeloda is a chemotherapy pill that kills cancerous cells. Avastin cuts off blood-flow to tumors. Almost immediately two of my tumors disappeared. The duel-pronged approach appeared to be working.
Nearly three-and-a-half years have passed. Today, I’m not just living life; I’m enjoying it. While I get tired more easily than I used to, I can take part in just about all normal activities. I can go out to dinner with my husband. I can visit with friends.
The Wall Street Journal tells us nothing about this lady. She seems to be a nice lady who can write fairly well. She has metastatic breast cancer which is incurable. The Wall Street Journal decided to print her anecdote but they didn’t print any data to give the reader some perspective. Why? If the Wall Street Journal told you that the drug Avastin was shown in a wonderfully designed trial with over 700 patients with metastatic breast cancer to have no significant effect on overall breast cancer survival, would we read this lady’s anecdote a little bit differently? Of course we would. Had the Wall Street Journal told you that treatment with this drug can cost 50,000-$100,000 a year would that have changed your mind about the anecdote?
Terri Schiavo
This brave woman who is fighting breast cancer is arguing to save the drug Avastin (several trials showing no benefit in breast cancer) which is going on the chopping block in front of the FDA. She is arguing that this drug has saved or prolonged her life. We don’t know this. All we know is that she had a remarkable response to double drug therapy. This is really all we know. It is critical that we make decisions, especially in healthcare, based on data. Remember when we, as a country, went completely crazy over Terri Schiavo? She was one patient with a severe brain injury. There are over 100,000 patients are hospitalized every year with brain injuries. I don’t know the percentage of these patients who are in a persistent vegetative state like Terri Schiavo. The number is clearly in the thousands. Yet, we had a special law drafted and passed in Florida based on her experience and not the collective experience of thousands. Congress was then moved to act based on her experience and not on the overall data. We have to do better.
I’m not saying that we shouldn’t be moved by individual stories. I like hearing the stories. But it is important for us to know the data before we start drafting legislation.
Interesting that you relate an anecdote to tell us not to rely on anecdotes.
I think we need to remember that 'data' is often just a compilation of anecdotes.
The breast cancer survivor did survive.
Can we simply discount her testimony because she is only one instance of the successful combination of these drugs that is known?
No.
We need to dig further into her story and find WHY it worked for her, when it may not have worked for many others. Perhaps there was a third factor at work that augmented the first two. Maybe not.
But we can't simply blow it off with , ah well that's anecdotal, unless we have a better explanation for why she is alive.
I'm not surprised to see you trying to trash the efforts to save Terri Schiavo's life, though I am disappointed.
My mother in law is in the hospital presently and the family has endured numerous instances of medical personnel pressuring them to 'make a decision' because 'she cant stay on a ventilator forever you know'. Their (not so subtle) push for killing her is disgusting and thank God we have a surgeon in charge who is level headed and engaged in the process.
FYI Data: factual information (as measurements or statistics) used as a basis for reasoning, discussion, or calculation (Merriam Webster dictionary). Date is never a compilation of anecdotes. Scientific methods do not involve anecdotes.
I'm sorry about your mother in law's and your family's suffering. I truly hope you all have a good outcome.
thanks Allison, I appreciate it.
You aren't supposed to like your mother-in-law, but I like mine. A lot.
She is currently recovering from a procedure on Wed to reposition and reattach a feeding tube to the stomach which had come loose after only 2 days in place.
yes. We can discount her story because we don't have the technology nor the resources to do what you suggest. We have the study that I quoted in the post in which you have the survival rates for each drug therapy. You can look at the number of patients that survived each year of the study. There are 14 patients in the combination drug group who survived 4 years. What did they have in common? Was it something in their genes which made them better at surviving than those in the single drug group? I'm positive that researchers have already asked this question.
I did more than simply use her anecdote. I quoted and linked to data so that you can read it for yourself.
I'm sorry you're disappointed about Terri Schiavo. I thought it was extremely appropriate to bring her up. she's an excellent example that there was no objective evidence which suggested that she interacted with her environment. She had clearly stated her wishes and no matter what the motive of her husband, her wishes should have been honored. Everybody has a right to self-determination.
finally, I'm not going to comment on your situation with your mother-in-law. All I can tell you is that 99% of the nurses and doctors that I work with try to do what's “best” for the patient. This means, patients who want “everything done” we try to do everything. This also means, that we try to inform the family about what's ahead. Nobody likes to lose a patient. At the same time, nobody wants to see a patient suffer. So we have to balance these competing interests.
May God bless you and your mother-in-law in these very difficult times and may HIS will be done.
Dr Thompson wrote:
” We can discount her story because we don't have the technology nor the resources to do what you suggest. ”
What nonsense.
Dr Thompson wrote:
“there was no objective evidence which suggested that she interacted with her environment.”
Only people like her philandering husband, who didn't care if she lived or died, are objective, I suppose.
Dr Thompson wrote:
“99% of the nurses and doctors that I work with try to do what's “best” for the patient.”
I'm glad to hear it. We've had some doozies.
One nurse. after the mother had been sedated and on ventilator for a little over a week as she battled a massive lung infection following lung cancer surgery, asked the daughter “Do you think your dad would be willing to make a decision to withdraw life support?”
A nurse told the son in law “Well he (the husand) needs to 'make a decision' because she cant stay on a ventilator more than a couple of weeks”
After almost 2 weeks, she began to be responsive and the infection was eliminated, and as the husband was gently explaining to his wife about the upcoming tracheotomy (ordered by the surgeon) the next day, a nurse came into the room and confrontationally stated “I don't think that is a good idea. You shouldn't let them do that”
thank goodness it appears she will should be out of that place soon and in a rehab hospital to complete her recovery.