recurrence Archives - Where Is The Outrage?

Data versus anecdotes

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.

By ecthompsonmd|2010-09-17T06:59:45-04:00September 17th, 2010|Congress, Healthcare|Comments Off

Serious Healthcare Reform – Part Two (Goals)

So, what are the goals of health care reform? Some believe that the goals are just to rearrange the deck chairs. In my mind, we’re sailing on the Titanic; therefore, rearranging the deck chairs is not going to fix the problem. Instead, I think we need to take this opportunity to perform a comprehensive overhaul of our health care system. We must remember that our system developed over the last 100 years. It has developed mostly as a hodgepodge. There hasn’t been one person or one group of people who sat down and thought about how health care will be delivered.

Let’s guarantee health care for all. In my mind, universal coverage is the only way to get this done. This does not mean that everybody deserves or should be covered for everything. Instead, I do believe that office visits and hospitalizations need to be covered. Preventive medicine needs to be covered along with mental health care. Physical therapy and occupational therapy, prescriptions and dental care all need to be covered.

There has to be some mechanism to control costs. We’ve seen over the years that without cost controls medical costs skyrocket. Does every hospital need the latest CT scanner ?

Americans should be able to choose their own physician and their own hospital. Also, Americans need better data on what they are choosing. How good is that hospital, really? That data should be readily available. If you’re going to a surgeon for a hernia repair, what is his/her rate of recurrence?

We need to fix the problem concerning access to health care. Many patients complain about being unable to see a physician. When most doctors offices are open from nine in the morning until four in the afternoon and most people work from 8:30 in the morning until 5:30 in the afternoon, no wonder there’s an access problem. We need clinics to be open earlier and stay open later. We need clinics open on the weekends.

Health care reform must include high-quality, coordinated health care. We have to have a mechanism to control medical errors. How do we decrease or eliminate hospital-acquired infections? How do we guarantee that we are not paying for procedures that have not been proven to be of benefit? These things need to be worked out in order to control costs. A patient who is in a car crash in northern Pennsylvania is currently without his medical records. His physicians are flying blind, as it were. We should be able to put a system in place where his physicians have timely access to his records even if he’s from southern Florida.

We have to do something about malpractice. There’s not a day that goes by that physicians don’t worry about malpractice. Many physicians practice defensive medicine, driving costs up and doesn’t necessarily add to the quality of medicine that they are delivering. We need to develop a malpractice system were patient grievances are compensated adequately and quickly. On the other hand, frivolous lawsuits also need to be handled with minimal costs to physicians, hospitals and insurance companies.

Finally, we have to fund the system in such a way that is fair to all Americans. Everyone should have to pay their fair share.

I believe that these are the correct goals for reforming our health care system. What are your thoughts?

By ecthompsonmd|2009-03-25T20:20:25-04:00March 25th, 2009|Economy, Healthcare|Comments Off

Access to McCain's Medical Records a Joke

A hand-selected group of reporters (only 20 people) were allowed to access 1,173 pages of Senator John McCain’s medical records for three hours. No one was allowed to photocopy or photograph the records, but a reporter could take notes. Oh, also there were no cellphones allowed.

So, what do we know? Not much. The types of tests done to look for cancer recurrence were not revealed in the AP article I reviewed. We do know that the cancer removed from his jaw was of an intermediate depth. We also know that his lymph nodes were negative. This is about all the reporters could find out in the limited time allowed. If they read 1,173 pages in three hours, they would have to read a page every six minutes. You can’t get any detail from that. I’m not sure that we know more now than we did before the records were flashed in front of our eyes.

To be honest, this was a great political maneuver by the McCain camp: Release the information on a Friday before a holiday weekend, a slow news day, when nobody is paying any attention and then control what is said. The McCain camp got the exact headlines that they wanted. Reuters stated: “McCain deemed in good health by doctors.” The McCain camp couldn’t have written it any better.

Update: The McCain campaign has released a short summary of the Senator’s medical records. I guess they did this to quiet critics like me. There is still no thoughtful summary of the follow-up tests that have been done or their results. It is clear that some tests would have been done to look for spread of his cancer. . To me, the only nugget of new information was that John McCain had another melanoma on his nose that I didn’t know about. That makes the fourth site that I know of.

By ecthompsonmd|2008-05-25T22:37:02-04:00May 25th, 2008|Election 2008, Senate|Comments Off