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A “Decision Tree” For Personalized Medicine

ImagesWhat’s amazing is that despite the vocal movement to empower patients, no one has put together a well-referenced, readable book to help patients understand how they should use personalized medicine to influence their health — until now.

Enter The Decision Tree: Taking Control of Your Health in the New Era of Personalized Medicine (Rodale 2010), something of a blueprint of patient liberation written by Thomas Goetz, executive editor of Wired magazine. It offers constructive narrative not only about the importance of the decisions we make but how to apply the concept of an old-fashioned decision tree in making those decisions.

“We are constantly making a series of decisions, some unconsciously, some with great intent, that combine to create our health.” It’s these decisions, argues Goetz, that define our medical destiny. These health decisions are centered around three fundamental principles that include early decisions, utilization of data and open collaboration. How we might make health decisions in the context of current social and medical technology comprises The Decision Tree’s 250 pages.

It’s an excellent read, but I do have a couple of thoughts that I think are worth mentioning:

Personal genomics push

The Decision Tree does its part to encourage the use of personal genomics to steer individual health decisions. 

It’s an incontrovertible fact that decisions influenced by the understanding of our individual DNA will drive health decisions in the 21st century. And I believe that the practical application of this technology isn’t far away. But I’m not ready to believe that the benefit of personal genomic screening outweighs the confusion and misunderstanding that it often creates.

And I would have preferred that The Decision Tree draw more serious attention to the concerns and criticisms of those experts who have spent the better part of a generation identifying the genes and technology that serve as the foundation of the personal genomics movement.

Some of the genomics discussion falls victim to the health infosphere’s greatest fallacy: information = power. But information without understanding is useless. Genetic information delivered out of context is alphabet soup –- fun to look at but largely nonsensical.  

But a naysayer I’m not. I embrace a future as predicted by Mr. Goetz. The most exciting generation of medicine is before us as we progressively and methodically link our understanding of the genome with the practical care of patients.

Silly old doctors

Perhaps I’m sensitive, but I found that The Decision Tree at times portrayed physicians as benevolent old naysayers, dated in our thinking, and bypassed by advances in areas such as genetics. This is an unfortunate generalization. And the book repeatedly cites AMA statistics as representative of physician thinking but conveniently waits until the final pages of the book to disclose that the AMA actually doesn’t represent the beliefs of most doctors.

But who’s gonna trust a patient empowerment book that empowers doctors?  I get this — empowerment is about breaking the ties with those who might control access to the information about our health. 

So let’s get untied.

There’s muted mention of partnering with professional providers to help sort out these complicated issues. I think some discussion of how to identify and access new generation professionals would have strengthened the book.

Read it

In the final analysis, The Decision Tree is an approachable, well-referenced wireframe for a generation working to take health matters into its own hands. Goetz does a remarkable job of capturing this early stage of the patient movement. And more than a personal roadmap to health The Decision Tree perhaps plays a stronger role in offering a cultural roadmap to the changes underway in healthcare. 

More important than the loosely branded concept of a Decision Tree (all caps) is the overriding principle that we are now responsible for ourselves. We are, as Goetz points out, stewards of our own health.

The Decision Tree has landed a comfortable place in the early discussion of personalized medicine and for that it will enjoy long backlist success.

Check out the following reviews:

Susannah Fox’s review:  The Decision Tree:  What to Expect When You’re Expecting a Long Life

Brian Ahier’s review:  Data Not Drugs 

Kent Bottle’s review:  Check Lists & Decision Trees v. Spontaneity & Imagination

*This blog post was originally published at 33 Charts*

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