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Friday, August 25, 2017

Physician in Residency? Evidence-Based Medicine with Treatment Scores

When I was Chief Resident In Emergency Medicine, at the end of Journal Club, I would ask the attending physicians, “What would you do?” They would often say, “Well the Jones study said that” but “the Smith study said that.” In other words, they would equivocate, because medical information is in a large disorganized cloud of over 25 million studies. There is little certainty.

Once, when I was at Morning Rounds in surgery. Two attending surgeons started screaming at each other other over how to treat a patient. Surgeon 1 screamed, “The Anderson study said X percent!” Surgeon 2 screamed, “The Williams study said Y percent!” I remember thinking if only we could only visualize their logic we would know which one was right.

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. Patients have always needed Treatment Scores.

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 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 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 168,000 followers on Facebook and over 9,900 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.

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DISCLAIMER
You must always see a licensed physician for diagnosis and treatment. Treatment Scores are only an informational 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.