More Can Also Be Less: We Need A More Complete Public Discussion About Comparative Effectiveness Research
When the public turns its attention to medical effectiveness research, a discussion often follows about how this research might restrict access to new medical innovations. But this focus obscures the vital role that effectiveness research will play in evaluating current medical and surgical care.
I am now slogging through chemotherapy for stomach cancer, probably the result of high doses of radiation for Hodgkin lymphoma in the early 1970s, which was the standard treatment until long-term side effects (heart problems, additional cancers) emerged in the late 80s. So I am especially attuned to the need for research that tracks the short and long-term effectiveness — and dangers — of treatments.
Choosing a surgeon this September to remove my tumor shone a bright light for me on the need for research that evaluates current practices. Two of the three surgeons I consulted wanted to follow “standard treatment procedures” and leave a six-centimeter, cancer-free margin around my tumor. This would mean taking my whole stomach out, because of its anatomy and arterial supply.
The third surgeon began our consultation by stating that her aim would be to preserve as much of my stomach as possible because of the difference in quality of life between having even part of one’s stomach versus none. If at all possible, she wanted to spare me life without a stomach.
But what about the six-centimeter margin? “There isn’t really much evidence to support that standard,” she said. “This issue came up and was discussed at a national guidelines meeting earlier in the week. No one seemed to know where it came from. We have a gastric cancer registry at this hospital going back to the mid 1990s and we haven’t seen support for it there, either. A smaller margin is not associated with an increased risk of recurrence.” Read more »
My colleagues at Harvard Health Publications and I have a mission: To provide accurate, reliable information that will help readers live healthier lives. We work hard to fulfill that mission, and the feedback we get from folks who read our newsletters, Special Health Reports, books, and online health information indicates we are on the right track. Every so often we hear something from a reader that makes me especially proud of the work we do.
One of your mailings undoubtedly saved me a lot of grief. (My kids, anyway.) I was aware of a woman’s heart attack symptoms being different from a man’s, and your brochure contained a paragraph confirming that. Early in June I was packing for a trip to celebrate my brother’s 90th birthday, at the same time a ditching project was being done in my back lot. Trying to deal with several matters at the same time is a talent I’ve outgrown, at 88, so didn’t think too much of the sudden fatigue and vague aches I felt in jaw & arms. I crashed for a nap in my recliner, felt OK afterwards, and figured it was just stress. The next day I was ready to leave, but got to thinking of those symptoms, and the fact the brochure had arrived at just that time, and wondered if it was more than coincidence and maybe I should pay attention? Didn’t much like the idea of something happening out in the middle of nowhere, so took myself to the fire hall where an EMT was on duty. He ushered me into the ambulance, did an EKG, and soon I was being helicoptered on doctor’s orders to St. Joseph’s Hospital. There I had 3 stents installed, and they apparently are doing their job. Thank you!Read more »
If you don’t truly understand how draining it can be to live with chronic illness, including chronic pain, go read The Spoon Theory right now. In five minutes it forever changed my own awareness of my wife’s arthritis and bone pain.
On Twitter I saw “spoonies” raving about this months ago, but I finally took time to read it: 2,100 words and worth every second. Also, on Twitter follow @bydls – “But you don’t look sick!” – and explore their smart website, where they’re wisely selling posters of the story for doctors’ waiting rooms, and everything else imaginable in modern outreach through social media.
These are smart people, and this is a powerful piece of writing.
*This blog post was originally published at e-Patients.net*
By 2020, an estimated 15 percent of adults will have diabetes and 37 percent will have prediabetes, a total of 39 million people, compared with rates of 12 percent and 28 percent today, respectively.
Today, more than 90 percent of people with prediabetes, and about a quarter of people with diabetes, are unaware of it, according to a report from UnitedHealth Group, the provider of insurance and other health care services.
The health savings alone of preventing diabetes would bend the cost curve of health care spending in the country. Health spending associated with diabetes and prediabetes is about $194 billion this year, or 7 percent of U.S. health spending, the report said. That cost is projected to rise to $500 billion by 2020, or a total of almost $3.4 trillion on diabetes-related care.
Engaging the at-risk population could save up to $250 billion, or 7.5 percent of estimated spending on diabetes and prediabetes, in the next decade. Of that money, $144 billion, or about 58 percent, would come from savings in Medicare, Medicaid and health care exchange subsidies. Read more »
*This blog post was originally published at ACP Internist*
A gripping piece by the Transport Accident Commission (TAC) in Victoria about drinking and driving and the use of illicit drugs. Words cannot depict this powerful and graphic piece. Take a look:
“On December 10, 1989 the first TAC commercial went to air. That year the road toll was 776. Twenty years on it has fallen to 303. There is still a long way to go.”
We would love to hear from you. Did this video move you in any way? Did it increase your awareness? We would love for you to share your insightful thoughts. As always, thank you for your time.
*This blog post was originally published at Health in 30*
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