Posts tagged The Decision Tree
Meet the Feedback Loop

About a year ago, right after The Decision Tree book came out, I realized that a concept I touched on in the book had far larger potential. The Feedback Loop, it struck me, had potential as a framework for improving human behavior throughout our lives. Indeed, feedback loops could be put into action beyond health, into areas such as productivity, energy consumption, and other categories where human behavior plays a pivotal role.

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A Prescription for Doctors

Enough about patients: What is a doctor to do? In the past few months, since The Decision Tree book came out, I've had the privilege to talk with many doctors about the opportunity and challenge of engaging patients in their own health. Some physicians, not surprisingly, have been suspicious, and even hostile to the idea that patients have a role to play. But thankfully, those have been rare exceptions. Most doctors I've spent time with have been eager to hear about new tools that might engage their patients, and they've been eager to share well-earned advice on where there's work to be done. It has been a delight and an education to talk about the potential of healthcare with these physicians who are, after all, doing the hard work of providing medical care every day.

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Why The Debate Over Personal Genomics Is a False One

I appeared on KQED's Forum show this morning to discuss this whole Walgreen's/Pathway Genomics fallout. Here's a link to the show: And here are some quick thoughts:

The controversy seems to have stirred the FDA to assert its authority - and that of physicians - over any and all medical metrics. As readers of The Decision Tree know, I have little patience for the argument that we need doctors as gatekeepers of our genetic information. This isn't a drug, and this isn't a device - it's information about ourselves, as ordinary as our hair color or our waist size or our blood pressure - all things that we can measure and consider without a doctor's permission.

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Screening HPV at Home

In Chapter 6 of The Decision Tree, "Screening for Everything", Thomas talks about the human papilloma virus (HPV), the virus that causes cervical cancer. Traditionally, doctors detected HPV by looking for irregular cells in the pap smear. But now, a cheap ($5) test can detect and analyze the DNA of the virus, determining if it is the high- or low-risk type, which can determine the likelihood of a patient developing cervical cancer. One problem remains: you still have to get women into the clinic to be tested. However, a new study in the British Medical Journal shows that home testing is not only a reality, but it may actually boost compliance rates. Roughly 28% of women using the home testing kit, which consisted of a simple cervicovaginal lavage, effectively screened themselves, while only about 17% of women required to go into the doctor's office for screening showed up.

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Can High Blood Glucose Levels Cause Cancer?

Diets high in simple sugars and refined carbs cause metabolic disorders and Type II diabetes in millions of Americans. But to make matters worse, new evidence suggests that high sugar diets may be even more dangerous than we initially thought. Having too much excess sugar in the bloodstream is never a good thing, and can lead to medical complications such as kidney failure, cardiovascular disease, and eye problems. But could high blood sugar also cause cancer? A Swedish research team addressed this question by tracking over 500,000 patients for 10-25 yeas, and published their results in the December issue of PLoS Medicine.

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T-Minus 1 Day: A Progress Report

In these days before the book comes out - tomorrow! - there have been some wonderful write-ups about the book. Just thought I should note them here. Kent Bottles wrote a piece titled "Check Lists and Decision Trees" that mulled whether structures like a decision tree can help people negotiate the huge information dumps that come with data-driven medicine. Besides the flattering proximity to Atul Gawande's book, Bottles was generous in grasping the fact that I'm not claiming a decision-tree paradigm depends solely on rational decision making (which is inevitably unrealistic) but that I'm trying to find a way to bring our rational capacity together with our emotional needs - and therein lies better healthcare.

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The Quantified Pregnancy

An insightful post by Susannah Fox of the Pew Internet Project called "What's the Point of Health 2.0" was stuck in my mind all week.  For the people already living their lives as "e-patients", the concepts we talk about here at The Decision Tree simply make sense.  They'll say, "Of course I should track some aspect of my personal health".  Or, "Why wouldn't I engage with other people on the internet who have a similar medical condition as me?"  But what about the rest of the people out there?  How can I best convince them of the power of the Health 2.0 movement? In her post, Susannah said that Esther Dyson helps her understand that even though the Health 2.0 crowd is relatively small right now, these e-patients provide a glimpse of how powerful and interactive health care can become in the future.

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Why Calculators Are the Future of Medicine

Want to know the future of medicine and healthcare in one sentence?

For my money, it goes like this: The real opportunity in healthcare is to combine our personal data with the huge amount of general biomedical and public health research, in order to create customized information that's specific to our person and our circumstance. We need relevance, and the right information at the right time will help us make better choices for prevention, helping us stay healthier longer, it'll help us navigate diagnosis, letting us select screening tests that are useful and not unnecessarily fearful, and it'll let us make better decisions on care and treatment - when we're trying to choose among various treatments to find our way back to health.

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