We've all heard the mantra: keep LDL levels – the “bad” cholesterol – down, and the “good” HDL cholesterol up. But thanks in part to the ubiquity of statins, such as Lipitor, which allow us to simply pop a pill to limit LDL production in the body, we've recently adopted tunnel vision when thinking about managing cholesterol. LDL levels are all we seem to care about now, as we strive for lower and lower numbers at each visit to the doctor's office. However, I think we're missing the bigger picture by focusing solely on LDL. First, it's made us reliant on medication to solve a problem that can many times be addressed with changes in diet and exercise regimes. Once someone starts Lipitor treatment, they'll be taking it for life, and if LDL levels don't quite get as low as they should, it's all too easy to solve the problem by increasing the dose. When patients first begin Lipitor treatment, physicians typically prescribe the lowest possible amount, 10mg. However, dosing can go as high as 80mg, which begs the question: Do higher doses of the drug really improve outcomes?
Read MoreWhew, what a week. The Decision Tree debuted to some great acclaim and attention, and I think it's useful to update some of the highlights here
Read MoreDiets 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.
Read MoreThere are patients - and then there are active patients. And some of the people I talked to for my book I'd call veryactive patients. They have struck out on their own and made radical decisions about their healthcare. Teri Smieja is one of these heroes. When she learned that she had a genetic risk for breast and ovarian cancer, she embarked on a series of decisions - illustrated beautifully in this excerpt in Wired Magazine - that resulted in her getting two preemptive surgeries
Read MoreEvery day, we make dozens of decisions without thinking about them: what to feed the kids, how fast to drive to work, whether to hit the snooze bar. We make most of these decisions without a second thought. We go with our gut.
Read MoreIn 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.
Read MoreAn 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.
Read MoreAfter my recent post on the Healthcare Blog about calculators (aka nomograms) for risk assessment and treatment guidance, I got an email from James Michaelson at the Laboratory for Quantitative Medicine (what a name!) at Harvard Medical School. He pointed me to some calculators they've cooked up - and they are simply outstanding, pushing far beyond anything I've seen out there otherwise. The lab's philosophy is centered around something it calls "binary biology", and the mission statement is fascinating:
Read MoreWant 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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