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FM","link":"/"}},"stateofhealth_182584":{"type":"posts","id":"stateofhealth_182584","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"182584","score":null,"sort":[1462832157000]},"guestAuthors":[],"slug":"john-oliver-takes-on-sloppy-state-of-science-coverage","title":"John Oliver Takes on Sloppy State of Science Coverage","publishDate":1462832157,"format":"video","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>\"A new study shows that drinking a glass of red wine is just as good as spending an hour at the gym.\"\u003c/p>\n\u003cp>If you're thinking, \"HUH?\" then you'll want to watch the latest from \u003ca href=\"https://www.youtube.com/watch?v=0Rnq1NpHdmw\" target=\"_blank\">Last Week Tonight \u003c/a>host John Oliver. His show Sunday night was devoted to science -- and how scientific studies are poorly reported by the mainstream press.\u003c/p>\n\u003cp>You'll recognize plenty of the headlines he cites. Does coffee cure everything or kill you? Numerous studies have either trumpeted its benefits or gravely warns of its risks.\u003c/p>\n\u003cp>\"Coffee today is like God in the Old Testament,\" Oliver says. \"It will either save you or kill you depending in how much you believe in its magical powers.\"\u003c/p>\n\u003cp>Oliver expounds on the dual problems of scientists under pressure to publish something new (\"There is no reward for being the second person to discover something; no Nobel Prize for fact checking\") and news programs/websites' desire to feed the public shareable headlines.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Remember this one: \"Scientists say smelling farts might prevent cancer\"?\u003c/p>\n\u003cp>It was based on a group of papers, \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/24755204\" target=\"_blank\">one of which was titled this way\u003c/a>:\u003c/p>\n\u003cblockquote>\u003cp>AP39, a novel mitochondria-targeted hydrogen sulfide donor, stimulates cellular bioenergetics, exerts cytoprotective effects and protects against the loss of mitochondrial DNA integrity in oxidatively stressed endothelial cells in vitro.\u003c/p>\u003c/blockquote>\n\u003cp>Hmmmm, that's not so eye-catching any more.\u003c/p>\n\u003cp>Gary Schwitzer publishes the nonprofit \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/24755204\" target=\"_blank\">HealthNewsReview,\u003c/a> which is exactly what it sounds like -- a site where knowledgeable people analyze claims both about health care interventions and the accuracy and completeness of health news stories. (Like many of my health/science reporter colleagues, I worry about stories I write showing up on the site.)\u003c/p>\n\u003cp>The massive attention these \"smelling farts\" studies received appear to have been sparked by a university press release, Schwitzer says, \"which used the word flatulence (five) words in.\"\u003c/p>\n\u003cp>Not so surprisingly, the word \"flatulence\" caught reporters' eyes. The day after the study was published, Schwitzer did a Google search and got 330,000 returns. That's a lot of coverage.\u003c/p>\n\u003cp>The press release ultimately \"increased click rates,\" Schwitzer said, \"and that's the coin of the realm.\"\u003c/p>\n\u003cp>It's worth noting that the scientists have added a disclaimer at the end of the \"flatulence\" \u003ca href=\"http://www.exeter.ac.uk/news/research/title_393168_en.html\" target=\"_blank\">press release\u003c/a> saying that the studies do not \"make any reference at all to cancer or to any health benefits from inhaling (sniffing) hydrogen sulfide.\" It was simply an early stage drug development project, they said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Oliver clearly explains that science is \"hugely important,\" but needs to be accurately reported, not \"twisted out of proportion and turned into morning show gossip.\"\u003c/p>\n\n","blocks":[],"excerpt":"Only John Oliver could compare the scientific studies around coffee to God in the Old Testament.","status":"publish","parent":0,"modified":1462832189,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":17,"wordCount":440},"headData":{"title":"John Oliver Takes on Sloppy State of Science Coverage | KQED","description":"Only John Oliver could compare the scientific studies around coffee to God in the Old Testament.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"182584 http://ww2.kqed.org/stateofhealth/?p=182584","disqusUrl":"https://ww2.kqed.org/stateofhealth/2016/05/09/john-oliver-takes-on-sloppy-state-of-science-coverage/","disqusTitle":"John Oliver Takes on Sloppy State of Science Coverage","videoEmbed":"https://www.youtube.com/watch?v=0Rnq1NpHdmw","path":"/stateofhealth/182584/john-oliver-takes-on-sloppy-state-of-science-coverage","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>\"A new study shows that drinking a glass of red wine is just as good as spending an hour at the gym.\"\u003c/p>\n\u003cp>If you're thinking, \"HUH?\" then you'll want to watch the latest from \u003ca href=\"https://www.youtube.com/watch?v=0Rnq1NpHdmw\" target=\"_blank\">Last Week Tonight \u003c/a>host John Oliver. His show Sunday night was devoted to science -- and how scientific studies are poorly reported by the mainstream press.\u003c/p>\n\u003cp>You'll recognize plenty of the headlines he cites. Does coffee cure everything or kill you? Numerous studies have either trumpeted its benefits or gravely warns of its risks.\u003c/p>\n\u003cp>\"Coffee today is like God in the Old Testament,\" Oliver says. \"It will either save you or kill you depending in how much you believe in its magical powers.\"\u003c/p>\n\u003cp>Oliver expounds on the dual problems of scientists under pressure to publish something new (\"There is no reward for being the second person to discover something; no Nobel Prize for fact checking\") and news programs/websites' desire to feed the public shareable headlines.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Remember this one: \"Scientists say smelling farts might prevent cancer\"?\u003c/p>\n\u003cp>It was based on a group of papers, \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/24755204\" target=\"_blank\">one of which was titled this way\u003c/a>:\u003c/p>\n\u003cblockquote>\u003cp>AP39, a novel mitochondria-targeted hydrogen sulfide donor, stimulates cellular bioenergetics, exerts cytoprotective effects and protects against the loss of mitochondrial DNA integrity in oxidatively stressed endothelial cells in vitro.\u003c/p>\u003c/blockquote>\n\u003cp>Hmmmm, that's not so eye-catching any more.\u003c/p>\n\u003cp>Gary Schwitzer publishes the nonprofit \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/24755204\" target=\"_blank\">HealthNewsReview,\u003c/a> which is exactly what it sounds like -- a site where knowledgeable people analyze claims both about health care interventions and the accuracy and completeness of health news stories. (Like many of my health/science reporter colleagues, I worry about stories I write showing up on the site.)\u003c/p>\n\u003cp>The massive attention these \"smelling farts\" studies received appear to have been sparked by a university press release, Schwitzer says, \"which used the word flatulence (five) words in.\"\u003c/p>\n\u003cp>Not so surprisingly, the word \"flatulence\" caught reporters' eyes. The day after the study was published, Schwitzer did a Google search and got 330,000 returns. That's a lot of coverage.\u003c/p>\n\u003cp>The press release ultimately \"increased click rates,\" Schwitzer said, \"and that's the coin of the realm.\"\u003c/p>\n\u003cp>It's worth noting that the scientists have added a disclaimer at the end of the \"flatulence\" \u003ca href=\"http://www.exeter.ac.uk/news/research/title_393168_en.html\" target=\"_blank\">press release\u003c/a> saying that the studies do not \"make any reference at all to cancer or to any health benefits from inhaling (sniffing) hydrogen sulfide.\" It was simply an early stage drug development project, they said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Oliver clearly explains that science is \"hugely important,\" but needs to be accurately reported, not \"twisted out of proportion and turned into morning show gossip.\"\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/182584/john-oliver-takes-on-sloppy-state-of-science-coverage","authors":["240"],"categories":["stateofhealth_2407","stateofhealth_13"],"tags":["stateofhealth_344"],"featImg":"stateofhealth_182585","label":"stateofhealth"},"stateofhealth_28382":{"type":"posts","id":"stateofhealth_28382","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"28382","score":null,"sort":[1432067442000]},"guestAuthors":[],"slug":"suffering-from-sciatica-common-treatment-may-be-little-help","title":"Suffering From Sciatica? Common Treatment May Be Little Help","publishDate":1432067442,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>If you’ve ever felt a sharp, debilitating pain shoot from your lower back and down your legs along the sciatic nerve, you might have been prescribed steroids. And it might have seemed the steroids stopped the pain. But they probably didn’t.\u003c/p>\n\u003cp>One in ten people will experience this radiating pain, called radiculopathy or sciatica , at some point in their lives, but oral steroids, one of the most commonly prescribed treatments for this pain, apparently are not as effective as previously thought, \u003ca href=\"http://jama.jamanetwork.com/article.aspx?articleid=2293294\" target=\"_blank\">new research suggests\u003c/a>. In fact, they are no better than a placebo, found the first randomized trial to test oral steroids to treat for sciatica caused by a herniated disk.\u003c/p>\n\u003cp>The findings offer another example of a standard treatment lacking solid evidence, said the study’s lead author, Dr. Harley Goldberg, director of the Spine Care Program at Kaiser Permanente San Jose Medical Center.\u003c/p>\n\u003cp>“It is certainly well known that the practice of medicine doesn’t always, or even often, follow the evidence,” Goldberg said. “At the same time, many, many things don’t have evidence, and this is one of those examples. People have been using steroids for well reasoned physiologic belief, and we did the study because of the impression clinically that patients get so much better.”\u003c/p>\n\u003cp>Clinicians have suspected inflammation was a primary cause of sciatic pain, making anti-inflammatories a reasonable treatment choice – and one that appeared to work in practice. This study now calls that idea into question.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>In the trial, 269 adults, all suffering from sciatica for less than three months, received either a placebo or a course of prednisone, an oral steroid, for two weeks. Then researchers assessed the study participants’ function and pain at three weeks and one year later.\u003c/p>\n\u003cp>All participants showed improvement, but those in the prednisone group experienced slightly better function. Both groups had the same level of pain relief. The study, funded by the National Institutes of Health, was published Tuesday in the journal JAMA.\u003c/p>\n\u003cp>“Sometimes treating a condition with medication actually leads to improvements in pain and function,” Goldberg said. “Other times, however, simply letting time pass leads to improvement on its own.”\u003c/p>\n\u003cp>Letting that time pass without prednisone may mean eventually feeling better without suffering the side effects of oral steroids.\u003c/p>\n\u003cp>Most side effects from steroids are mild, short-term and well-tolerated, Goldberg said, but they can include agitation, insomnia, tremors, gastritis, headaches and, for diabetics, increased blood sugar. Other treatment options include non-steroidal anti-inflammatories or other medications, epidural steroids, surgery or even no treatment at all.\u003c/p>\n\u003cp>“Now we have good evidence, and now we can have a better discussion about what’s appropriate for a particular patient and weigh whether a little bit of improvement in function is worth the risk of a steroid,” Goldberg said.\u003c/p>\n\u003cp>The findings echo what has been found with other interventions for sciatica. Clinicians previously believed the direct compression on the nerve root by a herniated disk caused the pain, so surgery was a common treatment option, Goldberg said.\u003c/p>\n\u003cp>While studies have shown that surgery for a herniated disk does lead to immediate short-term relief, patients’ pain is no different a year later than that of patients who didn’t receive surgery.\u003c/p>\n\u003cp>The results also explain the push in recent years to test more and more treatments previously regarded as standard practice.\u003c/p>\n\u003cp>“Many interventions we use in clinical medicine today are there primarily because of traditional and long-term use, not because they have a solid evidence base to justify their use in the clinical setting,” said the study’s senior author, Dr. Andrew L. Avins, a research scientist at the Kaiser Permanente Northern California Division of Research.\u003c/p>\n\u003cp>So there's been increasing interest in testing such beliefs with randomized-controlled trial, the gold standard of medical study. “We do find that many therapies in which we’ve placed great trust over the years actually have very little benefit for patients, compared to a placebo,” Avins said.\u003c/p>\n\u003cp>What these findings mean for individual patients, however, will depend on the patients themselves and their doctors.\u003c/p>\n\u003cp>“This result, most practitioners will probably tell you, is surprising,” said Dr. Gowriharan Thaiyananthan, a neurosurgeon and founder of the Brain and Spine Institute of California in Newport Beach. “Often evidence-based medicine is not practiced because the evidence has not been established yet. The hope is that physicians will be cognizant and dynamic enough to incorporate new evidence into changing their practice habits appropriately.”\u003c/p>\n\u003cp>But these findings don’t necessarily take oral steroids off the table as a treatment option. It just means the risk-benefit calculation changes as patients weigh their options, Thaiyananthan said. “Modest improvements in patients with no contraindications for steroid use may suffice to treat these patients with steroids,” he said, or clinicians may discuss other treatments options with patients.\u003c/p>\n\u003cp>\u003cspan style=\"line-height: 1.5\">Meanwhile, this research adds to the trend of finding out whether what was thought to be true about a particular treatment or condition, actually is true.\u003c/span>\u003c/p>\n\u003cp>“This is a great example of the dangers of practicing 'anecdotal medicine.' For years, we’ve been giving oral steroids because we see many of our patients get so much better so quickly when we do it, and we pat ourselves on the back for being such great clinicians offering great therapies, and patients believe in what we do,” Avins said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“Now what we’ve discovered is that mostly what we’re watching is the natural course of the condition, maybe with some element of placebo effect as well,” he continued. “And the great benefit of this kind of study is to finally give patients and their providers some hard evidence with which they can now have an informed decision about whether it makes sense to try oral steroids as an option.”\u003c/p>\n\n","blocks":[],"excerpt":"First randomized study of steroids to treat sciatica shows they are no better in controlling pain than placebo.","status":"publish","parent":0,"modified":1432141418,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":24,"wordCount":1010},"headData":{"title":"Suffering From Sciatica? Common Treatment May Be Little Help | KQED","description":"First randomized study of steroids to treat sciatica shows they are no better in controlling pain than placebo.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"28382 http://ww2.kqed.org/stateofhealth/?p=28382","disqusUrl":"https://ww2.kqed.org/stateofhealth/2015/05/19/suffering-from-sciatica-common-treatment-may-be-little-help/","disqusTitle":"Suffering From Sciatica? Common Treatment May Be Little Help","nprByline":"Tara Haelle","path":"/stateofhealth/28382/suffering-from-sciatica-common-treatment-may-be-little-help","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>If you’ve ever felt a sharp, debilitating pain shoot from your lower back and down your legs along the sciatic nerve, you might have been prescribed steroids. And it might have seemed the steroids stopped the pain. But they probably didn’t.\u003c/p>\n\u003cp>One in ten people will experience this radiating pain, called radiculopathy or sciatica , at some point in their lives, but oral steroids, one of the most commonly prescribed treatments for this pain, apparently are not as effective as previously thought, \u003ca href=\"http://jama.jamanetwork.com/article.aspx?articleid=2293294\" target=\"_blank\">new research suggests\u003c/a>. In fact, they are no better than a placebo, found the first randomized trial to test oral steroids to treat for sciatica caused by a herniated disk.\u003c/p>\n\u003cp>The findings offer another example of a standard treatment lacking solid evidence, said the study’s lead author, Dr. Harley Goldberg, director of the Spine Care Program at Kaiser Permanente San Jose Medical Center.\u003c/p>\n\u003cp>“It is certainly well known that the practice of medicine doesn’t always, or even often, follow the evidence,” Goldberg said. “At the same time, many, many things don’t have evidence, and this is one of those examples. People have been using steroids for well reasoned physiologic belief, and we did the study because of the impression clinically that patients get so much better.”\u003c/p>\n\u003cp>Clinicians have suspected inflammation was a primary cause of sciatic pain, making anti-inflammatories a reasonable treatment choice – and one that appeared to work in practice. This study now calls that idea into question.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>In the trial, 269 adults, all suffering from sciatica for less than three months, received either a placebo or a course of prednisone, an oral steroid, for two weeks. Then researchers assessed the study participants’ function and pain at three weeks and one year later.\u003c/p>\n\u003cp>All participants showed improvement, but those in the prednisone group experienced slightly better function. Both groups had the same level of pain relief. The study, funded by the National Institutes of Health, was published Tuesday in the journal JAMA.\u003c/p>\n\u003cp>“Sometimes treating a condition with medication actually leads to improvements in pain and function,” Goldberg said. “Other times, however, simply letting time pass leads to improvement on its own.”\u003c/p>\n\u003cp>Letting that time pass without prednisone may mean eventually feeling better without suffering the side effects of oral steroids.\u003c/p>\n\u003cp>Most side effects from steroids are mild, short-term and well-tolerated, Goldberg said, but they can include agitation, insomnia, tremors, gastritis, headaches and, for diabetics, increased blood sugar. Other treatment options include non-steroidal anti-inflammatories or other medications, epidural steroids, surgery or even no treatment at all.\u003c/p>\n\u003cp>“Now we have good evidence, and now we can have a better discussion about what’s appropriate for a particular patient and weigh whether a little bit of improvement in function is worth the risk of a steroid,” Goldberg said.\u003c/p>\n\u003cp>The findings echo what has been found with other interventions for sciatica. Clinicians previously believed the direct compression on the nerve root by a herniated disk caused the pain, so surgery was a common treatment option, Goldberg said.\u003c/p>\n\u003cp>While studies have shown that surgery for a herniated disk does lead to immediate short-term relief, patients’ pain is no different a year later than that of patients who didn’t receive surgery.\u003c/p>\n\u003cp>The results also explain the push in recent years to test more and more treatments previously regarded as standard practice.\u003c/p>\n\u003cp>“Many interventions we use in clinical medicine today are there primarily because of traditional and long-term use, not because they have a solid evidence base to justify their use in the clinical setting,” said the study’s senior author, Dr. Andrew L. Avins, a research scientist at the Kaiser Permanente Northern California Division of Research.\u003c/p>\n\u003cp>So there's been increasing interest in testing such beliefs with randomized-controlled trial, the gold standard of medical study. “We do find that many therapies in which we’ve placed great trust over the years actually have very little benefit for patients, compared to a placebo,” Avins said.\u003c/p>\n\u003cp>What these findings mean for individual patients, however, will depend on the patients themselves and their doctors.\u003c/p>\n\u003cp>“This result, most practitioners will probably tell you, is surprising,” said Dr. Gowriharan Thaiyananthan, a neurosurgeon and founder of the Brain and Spine Institute of California in Newport Beach. “Often evidence-based medicine is not practiced because the evidence has not been established yet. The hope is that physicians will be cognizant and dynamic enough to incorporate new evidence into changing their practice habits appropriately.”\u003c/p>\n\u003cp>But these findings don’t necessarily take oral steroids off the table as a treatment option. It just means the risk-benefit calculation changes as patients weigh their options, Thaiyananthan said. “Modest improvements in patients with no contraindications for steroid use may suffice to treat these patients with steroids,” he said, or clinicians may discuss other treatments options with patients.\u003c/p>\n\u003cp>\u003cspan style=\"line-height: 1.5\">Meanwhile, this research adds to the trend of finding out whether what was thought to be true about a particular treatment or condition, actually is true.\u003c/span>\u003c/p>\n\u003cp>“This is a great example of the dangers of practicing 'anecdotal medicine.' For years, we’ve been giving oral steroids because we see many of our patients get so much better so quickly when we do it, and we pat ourselves on the back for being such great clinicians offering great therapies, and patients believe in what we do,” Avins said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“Now what we’ve discovered is that mostly what we’re watching is the natural course of the condition, maybe with some element of placebo effect as well,” he continued. “And the great benefit of this kind of study is to finally give patients and their providers some hard evidence with which they can now have an informed decision about whether it makes sense to try oral steroids as an option.”\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/28382/suffering-from-sciatica-common-treatment-may-be-little-help","authors":["byline_stateofhealth_28382"],"categories":["stateofhealth_13"],"tags":["stateofhealth_344"],"featImg":"stateofhealth_28408","label":"stateofhealth"},"stateofhealth_10585":{"type":"posts","id":"stateofhealth_10585","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"10585","score":null,"sort":[1360868727000]},"guestAuthors":[],"slug":"systems-can-work-rooting-out-variation-and-saving-millions-in-san-diego","title":"Systems Can Work: Rooting Out Variation and Saving Millions in San Diego ","publishDate":1360868727,"format":"aside","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>By Russ Mitchell, \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2013/February/14/chris-van-gorder-scripps-health-costs-solutions.aspx\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cfigure id=\"attachment_10588\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/02/14/systems-can-work-rooting-out-variation-and-saving-millions-in-san-diego/emergencyroomsign_anname-taber-andrew-bain/\" rel=\"attachment wp-att-10588\">\u003cimg class=\"size-medium wp-image-10588\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/02/EmergencyRoomSign_anName-Taber-Andrew-Bain--300x198.jpg\" alt=\"Among other changes, Scripps Health streamlined its ER admission process, slashing wait times and saving $29 million. (Taber Andrew Bain/Flickr)\" width=\"300\" height=\"198\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Among other changes, Scripps Health streamlined its ER admission process, slashing wait times and saving $29 million. (Taber Andrew Bain/Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>A hundred managers at Scripps Health jam shoulder-to-shoulder into a break room in San Diego. CEO Chris Van Gorder goes at them like a football coach down by 3 at halftime.\u003c/p>\n\u003cp>\"What are we trying to do in our health care system?\"\u003c/p>\n\u003cp>\"Reduce costs!\"\u003c/p>\n\u003cp>\"Why?\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"Health care is too expensive.\"\u003c/p>\n\u003cp>\"The solution is going to come from Washington D.C., right?\"\u003c/p>\n\u003caside class=\"pullquote alignright\">There was a cost difference of $6,000 between two Scripps hospitals performing the same cardiac procedures.\u003c/aside>\n\u003cp>\"Ha ha ha ha.\"\u003c/p>\n\u003cp>\"Sacramento then, right?\"\u003c/p>\n\u003cp>\"Ha.\"\u003c/p>\n\u003cp>\"The solution,\" says Van Gorder, pumping an index figure toward his team, \"is going to come from right here.\"\u003c/p>\n\u003cp>Van Gorder, an ex-cop turned hospital executive, rescued troubled Scripps from near insolvency a dozen years ago as its new CEO. Now, he's put Scripps in the middle of a cultural transformation aimed at saving hundreds of millions of dollars a year by -- get this -- coaxing physicians and managers at Scripps to work together, and standardizing care across every hospital in the system.\u003c/p>\n\u003cp>Just this week, we've seen how lack of standardization leads to a nearly-inexplicable price range of \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/02/11/how-much-for-a-hip-replacement-good-luck-trying-to-find-out/\" target=\"_blank\">$11,000 to $125,000 for a standard hip replacement\u003c/a> across the country.\u003c!--more-->\u003c/p>\n\u003cp>Price variation among hospitals within the same system is even harder to explain. At Scripps, there was a cost difference of $6,000 between two Scripps hospitals performing the same cardiac procedures, using the same protocol, even with the same surgeon.\u003c/p>\n\u003cp>And that's standard: Most health care systems still manage each hospital or clinic as its own silo -- each with different management, operations and clinical procedures.\u003c/p>\n\u003cp>Van Gorder, 60, tells his staff that major change is inevitable. Political leaders, employers and patients themselves are fed up with health care costs. Given federal budget deficits and the calls for entitlement reform, Medicare margins will continue to be under pressure. Politicians fearing a backlash from cutting benefits to consumers will take aim at hospitals and other providers. The Advisory Board Company predicts the typical hospital will see its margins collapse by as much as 20 percent over the next 10 years as reimbursements drop.\u003c/p>\n\u003cp>\"Hospitals that can't find a way to deliver their product less expensively and with better quality are going to go out of business,\" Van Gorder says. \"It's as simple as that.\"\u003c/p>\n\u003cp>\u003cstrong>The $6,000 Cost Difference\u003c/strong>\u003c/p>\n\u003cp>Consider the $6,000 cost difference for the cardiac valve and coronary artery bypass graft procedures. No one paid attention to it, because there was no incentive to do so. When a cross-system team dissected hospital-to-hospital variations in 2010, they found that the Scripps Memorial Hospital in La Jolla required that nitric oxide be administered to the patient, ostensibly to boost oxygen intake in the blood.\u003c/p>\n\u003cp>Fourteen miles away, at Mercy Hospital in downtown San Diego, such patients received no nitric oxide. A look at the data showed the outcomes were the same. Today, a doctor at any hospital in the Scripps system can still order up nitric oxide, but it’s no longer required. Savings: $400,000 per year.\u003c/p>\n\u003cp>Some of the other savings that netted $150 million in the first year:\u003c/p>\n\u003cul>\n\u003cli>The ER: Once, the wait could be as long as eight hours. Now, it averages 30 minutes. Scripps requires doctors and nurses to see patients at the same time, early in the process, instead of forcing them through a gauntlet of information-takers, where they’d repeat the same complaints over and over. Fewer handoffs mean better communications, fewer errors and more patients seen for a $29 million revenue boost.\u003c/li>\n\u003cli>Radiology: For imaging tests, each hospital stocked its radiologist's own favorite contrast agents -- the iodine, barium, gadolinium and other chemicals used to highlight structures and fluids in a patient's body. After doctors agreed to use a few brands, volume discounts saved $1.5 million a year.\u003c/li>\n\u003cli>Surgery: OneScripps focused on three cardiac surgeons at one hospital and studied their work habits for needless variation. Voluntary best-practice protocols were established which have decreased length of hospital stay by almost a day and saved the system $3.6 million a year.\u003c/li>\n\u003c/ul>\n\u003cp>\u003cstrong>A Story With Twists And Turns\u003c/strong>\u003c/p>\n\u003cp>Van Gorder's campaign has not been without challenges. Historically, doctors have felt threatened by changes imposed from outside the profession, which they fear will undermine their autonomy and income. \"You can’t force feed doctors,\" says Brent Eastman, recently retired chief of medicine at Scripps, now president-elect of the American College of Surgeons.\u003c/p>\n\u003cp>Sensitive to this culture, Van Gorder created what he called a Physician Leadership Cabinet \"to share the responsibility of running this company together.\" The board includes the medical staff and physician members elected by their peers because \"We don't want 'yes people' sitting on the group.\" The key to cooperation, says Van Gorder, is transparency -- sharing all information.\u003c/p>\n\u003cp>Early on he was tested. The doctors demanded $4 million to pay for on-call doctors for the emergency rooms. Van Gorder said he couldn’t afford it, and laid out the numbers. The doctors cut the demand in half.\u003c/p>\n\u003cp>Van Gorder trusts that sharing financial information, especially on costs, along with data on treatment and outcomes, will usually lead doctors to the best-outcome-at-lowest-cost decisions.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>So far, that strategy has inspired buy-in. \"Probably only once every hundred years will there be a generation that can truly change the way health care is delivered,\" says Eastman, the physician. \"We are that generation.\"\u003c/p>\n\n","blocks":[],"excerpt":"Van Gorder, an ex-cop turned hospital executive, rescued troubled Scripps from near insolvency a dozen years ago as its new CEO. Now, he's put Scripps in the middle of a cultural transformation aimed at saving hundreds of millions of dollars a year by -- get this -- coaxing physicians and managers at Scripps to work together, and standardizing care across every hospital in the system.\r\n\r\nJust this week, we've seen how lack of standardization leads to a nearly-inexplicable price range of $11,000 to $125,000 for a standard hip replacement across the country.","status":"publish","parent":0,"modified":1360868731,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":29,"wordCount":959},"headData":{"title":"Systems Can Work: Rooting Out Variation and Saving Millions in San Diego | KQED","description":"Van Gorder, an ex-cop turned hospital executive, rescued troubled Scripps from near insolvency a dozen years ago as its new CEO. Now, he's put Scripps in the middle of a cultural transformation aimed at saving hundreds of millions of dollars a year by -- get this -- coaxing physicians and managers at Scripps to work together, and standardizing care across every hospital in the system.\r\n\r\nJust this week, we've seen how lack of standardization leads to a nearly-inexplicable price range of $11,000 to $125,000 for a standard hip replacement across the country.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"10585 http://blogs.kqed.org/stateofhealth/?p=10585","disqusUrl":"https://ww2.kqed.org/stateofhealth/2013/02/14/systems-can-work-rooting-out-variation-and-saving-millions-in-san-diego/","disqusTitle":"Systems Can Work: Rooting Out Variation and Saving Millions in San Diego ","path":"/stateofhealth/10585/systems-can-work-rooting-out-variation-and-saving-millions-in-san-diego","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>By Russ Mitchell, \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2013/February/14/chris-van-gorder-scripps-health-costs-solutions.aspx\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cfigure id=\"attachment_10588\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/02/14/systems-can-work-rooting-out-variation-and-saving-millions-in-san-diego/emergencyroomsign_anname-taber-andrew-bain/\" rel=\"attachment wp-att-10588\">\u003cimg class=\"size-medium wp-image-10588\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/02/EmergencyRoomSign_anName-Taber-Andrew-Bain--300x198.jpg\" alt=\"Among other changes, Scripps Health streamlined its ER admission process, slashing wait times and saving $29 million. (Taber Andrew Bain/Flickr)\" width=\"300\" height=\"198\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Among other changes, Scripps Health streamlined its ER admission process, slashing wait times and saving $29 million. (Taber Andrew Bain/Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>A hundred managers at Scripps Health jam shoulder-to-shoulder into a break room in San Diego. CEO Chris Van Gorder goes at them like a football coach down by 3 at halftime.\u003c/p>\n\u003cp>\"What are we trying to do in our health care system?\"\u003c/p>\n\u003cp>\"Reduce costs!\"\u003c/p>\n\u003cp>\"Why?\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"Health care is too expensive.\"\u003c/p>\n\u003cp>\"The solution is going to come from Washington D.C., right?\"\u003c/p>\n\u003caside class=\"pullquote alignright\">There was a cost difference of $6,000 between two Scripps hospitals performing the same cardiac procedures.\u003c/aside>\n\u003cp>\"Ha ha ha ha.\"\u003c/p>\n\u003cp>\"Sacramento then, right?\"\u003c/p>\n\u003cp>\"Ha.\"\u003c/p>\n\u003cp>\"The solution,\" says Van Gorder, pumping an index figure toward his team, \"is going to come from right here.\"\u003c/p>\n\u003cp>Van Gorder, an ex-cop turned hospital executive, rescued troubled Scripps from near insolvency a dozen years ago as its new CEO. Now, he's put Scripps in the middle of a cultural transformation aimed at saving hundreds of millions of dollars a year by -- get this -- coaxing physicians and managers at Scripps to work together, and standardizing care across every hospital in the system.\u003c/p>\n\u003cp>Just this week, we've seen how lack of standardization leads to a nearly-inexplicable price range of \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/02/11/how-much-for-a-hip-replacement-good-luck-trying-to-find-out/\" target=\"_blank\">$11,000 to $125,000 for a standard hip replacement\u003c/a> across the country.\u003c!--more-->\u003c/p>\n\u003cp>Price variation among hospitals within the same system is even harder to explain. At Scripps, there was a cost difference of $6,000 between two Scripps hospitals performing the same cardiac procedures, using the same protocol, even with the same surgeon.\u003c/p>\n\u003cp>And that's standard: Most health care systems still manage each hospital or clinic as its own silo -- each with different management, operations and clinical procedures.\u003c/p>\n\u003cp>Van Gorder, 60, tells his staff that major change is inevitable. Political leaders, employers and patients themselves are fed up with health care costs. Given federal budget deficits and the calls for entitlement reform, Medicare margins will continue to be under pressure. Politicians fearing a backlash from cutting benefits to consumers will take aim at hospitals and other providers. The Advisory Board Company predicts the typical hospital will see its margins collapse by as much as 20 percent over the next 10 years as reimbursements drop.\u003c/p>\n\u003cp>\"Hospitals that can't find a way to deliver their product less expensively and with better quality are going to go out of business,\" Van Gorder says. \"It's as simple as that.\"\u003c/p>\n\u003cp>\u003cstrong>The $6,000 Cost Difference\u003c/strong>\u003c/p>\n\u003cp>Consider the $6,000 cost difference for the cardiac valve and coronary artery bypass graft procedures. No one paid attention to it, because there was no incentive to do so. When a cross-system team dissected hospital-to-hospital variations in 2010, they found that the Scripps Memorial Hospital in La Jolla required that nitric oxide be administered to the patient, ostensibly to boost oxygen intake in the blood.\u003c/p>\n\u003cp>Fourteen miles away, at Mercy Hospital in downtown San Diego, such patients received no nitric oxide. A look at the data showed the outcomes were the same. Today, a doctor at any hospital in the Scripps system can still order up nitric oxide, but it’s no longer required. Savings: $400,000 per year.\u003c/p>\n\u003cp>Some of the other savings that netted $150 million in the first year:\u003c/p>\n\u003cul>\n\u003cli>The ER: Once, the wait could be as long as eight hours. Now, it averages 30 minutes. Scripps requires doctors and nurses to see patients at the same time, early in the process, instead of forcing them through a gauntlet of information-takers, where they’d repeat the same complaints over and over. Fewer handoffs mean better communications, fewer errors and more patients seen for a $29 million revenue boost.\u003c/li>\n\u003cli>Radiology: For imaging tests, each hospital stocked its radiologist's own favorite contrast agents -- the iodine, barium, gadolinium and other chemicals used to highlight structures and fluids in a patient's body. After doctors agreed to use a few brands, volume discounts saved $1.5 million a year.\u003c/li>\n\u003cli>Surgery: OneScripps focused on three cardiac surgeons at one hospital and studied their work habits for needless variation. Voluntary best-practice protocols were established which have decreased length of hospital stay by almost a day and saved the system $3.6 million a year.\u003c/li>\n\u003c/ul>\n\u003cp>\u003cstrong>A Story With Twists And Turns\u003c/strong>\u003c/p>\n\u003cp>Van Gorder's campaign has not been without challenges. Historically, doctors have felt threatened by changes imposed from outside the profession, which they fear will undermine their autonomy and income. \"You can’t force feed doctors,\" says Brent Eastman, recently retired chief of medicine at Scripps, now president-elect of the American College of Surgeons.\u003c/p>\n\u003cp>Sensitive to this culture, Van Gorder created what he called a Physician Leadership Cabinet \"to share the responsibility of running this company together.\" The board includes the medical staff and physician members elected by their peers because \"We don't want 'yes people' sitting on the group.\" The key to cooperation, says Van Gorder, is transparency -- sharing all information.\u003c/p>\n\u003cp>Early on he was tested. The doctors demanded $4 million to pay for on-call doctors for the emergency rooms. Van Gorder said he couldn’t afford it, and laid out the numbers. The doctors cut the demand in half.\u003c/p>\n\u003cp>Van Gorder trusts that sharing financial information, especially on costs, along with data on treatment and outcomes, will usually lead doctors to the best-outcome-at-lowest-cost decisions.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>So far, that strategy has inspired buy-in. \"Probably only once every hundred years will there be a generation that can truly change the way health care is delivered,\" says Eastman, the physician. \"We are that generation.\"\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/10585/systems-can-work-rooting-out-variation-and-saving-millions-in-san-diego","authors":["240"],"categories":["stateofhealth_15","stateofhealth_13"],"tags":["stateofhealth_344"],"featImg":"stateofhealth_10588","label":"stateofhealth"},"stateofhealth_10305":{"type":"posts","id":"stateofhealth_10305","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"10305","score":null,"sort":[1359594102000]},"guestAuthors":[],"slug":"5-myths-busted-about-obesity","title":"Sex Doesn't Burn Weight and 4 More Popular Myths About Dieting Debunked","publishDate":1359594102,"format":"aside","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cfigure id=\"attachment_546\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2011/11/21/bay-area-kids-get-a-little-fatter-except-in-san-mateo-county/scalegeneric081211/\" rel=\"attachment wp-att-546\">\u003cimg class=\"size-medium wp-image-546\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2011/11/ScaleGeneric081211-300x200.jpg\" alt=\"Woman's feet on scale.\" width=\"300\" height=\"200\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Justin Sullivan/Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>I don't cover a lot of dieting stories here on State of Health. I figure you get enough of that elsewhere. For example, here are\u003ca href=\"http://www.google.com/webhp?hl=en&tab=ww#hl=en&tbo=d&sclient=psy-ab&q=how+can+I+lose+10+pounds%3F&oq=how+can+I+lose+10+pounds%3F&gs_l=hp.3..0l4.4205.7940.0.8163.25.25.0.0.0.0.160.2521.11j14.25.0.les%3Bcqn%2Ccconf%3D1-2%2Cmin_length%3D2%2Crate_low%3D0-035%2Crate_high%3D0-035%2Csecond_pass%3Dfalse%2Cnum_suggestions%3D2%2Cignore_bad_origquery%3Dtrue%2Conetoken%3Dfalse..0.0...1c.1.JokXr73weUw&pbx=1&bav=on.2,or.r_gc.r_pw.r_qf.&bvm=bv.41642243,d.cGE&fp=a9017c0373b80654&biw=1554&bih=842\" target=\"_blank\"> 88 million places\u003c/a> I found by Googling \"How can I lose 10 pounds?\"\u003c/p>\n\u003cp>But I love evidence-based medicine. So when a group of respected researchers shatter widely-held beliefs about weight loss, I'm there. In Thursday's\u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJMsa1208051#t=articleTop\" target=\"_blank\"> New England Journal of Medicine\u003c/a>, a group of researchers does just that.\u003c/p>\n\u003cp>In the review, the researchers categorized as myths those \"beliefs held to be true despite substantial refuting evidence.\" In other words, people have been repeating these ideas for so long, everyone thinks they're true. But they're not.\u003c/p>\n\u003cp>So, here we go:\u003c/p>\n\u003cp>\u003cstrong>Myth #1: Small changes -- eating less or exercising more -- done over time will yield large weight loss. \u003c/strong>This myth comes from the idea that a pound is equal to 3,500 calories. But the short-term studies that looked at burning 3,500 calories to lose one pound were done 50 years ago. More recent research shows that individuals will burn calories differently as they lose weight. So the 100 calories you're burning in exercise today will affect your body differently than the 100 calories you burned, say 18 months ago, when you started these small changes. Note that it's not to say that exercising more -- or eating less -- is pointless (you will see why later in this post).\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cstrong>Myth #2: If you lose a lot of weight really fast, you'll just gain it back really fast; you'll have better long-term results if you lose weight slowly. \u003c/strong>When researchers actually looked at the studies, they found \"no significant difference\" between the two approaches in relation to long-term weight loss.\u003c!--more-->\u003c/p>\n\u003cp>\u003cstrong>Myth #3: Physical-education classes, in their current form, play an important role in reducing or preventing childhood obesity. \u003c/strong>As a parent, I found this to be somewhat depressing, although the writers did include a caveat: \"There is almost certainly a level of physical activity ... that would be effective in reducing or preventing obesity. Whether that level is plausibly achievable in conventional school settings is unknown, although the dose-response relationship between physical activity and weight warrants investigation in clinical trials.\"\u003c/p>\n\u003cp>\u003cstrong>Myth #4: Breast-feeding protects against obesity. \u003c/strong>Say it ain't so! No less than the esteemed World Health Organization reported that breast-feeding is protective against obesity. But our myth busters found evidence of \"publication bias\" in the WHO research. Furthermore, the myth busters report a study of 13,000 children that found \"no compelling evidence of an effect of breast-feeding on obesity.\" They do stress that breast-feeding has other benefits for both infant and mother \"and should therefore be encouraged.\"\u003c/p>\n\u003cp>\u003cstrong>Myth #5: You burn 100 to 300 calories by having sex.\u003c/strong> The myth busters start with a premise that some people may find troubling: \"Given that the average bout of sexual activity lasts about six minutes,\" the myth busters say, \"a man in his early-to-mid-30s might expend approximately 21 (calories) during sexual intercourse.\" But it gets even better: \"Of course, he would have spent roughly one third that amount of energy just watching television.\"\u003c/p>\n\u003cp>The myth busters also highlight presumptions, \"widely accepted beliefs that have neither been proved nor disproved.\" They call for gathering solid evidence so these presumptions can be proved or disproved.\u003c/p>\n\u003cp>At present, there is no evidence to support these ideas:\u003c/p>\n\u003cul>\n\u003cli>Regularly eating breakfast is protective against obesity.\u003c/li>\n\u003cli>Eating more fruits and vegetables will result in weight loss or less weight gain, regardless of whether any other changes to one's behavior or environment are made.\u003c/li>\n\u003cli>Weight-cycling is associated with increased mortality. It's likely that any observations that lead to this conclusion are confounded by a person's health status.\u003c/li>\n\u003cli>Snacking adds to weight gain and obesity. Studies have not consistently found an association.\u003c/li>\n\u003c/ul>\n\u003cp>\u003c/p>\n\u003cp>The myth busters insist they are not nihilistic, and their report includes these facts:\u003c/p>\n\u003cul>\n\u003cli>Exercise, exercise, exercise. \"Regardless of body weight or weight loss, an increased level of exercise increases health,\" the researchers write.\u003c/li>\n\u003cli>Exercise \"in a sufficient dose\" helps with long-term weight maintenance.\u003c/li>\n\u003cli>For overweight children, \"parents and the home setting\" should be included in any weight loss plan to improve success.\u003c/li>\n\u003c/ul>\n\n","blocks":[],"excerpt":"I don't cover a lot of dieting stories here on State of Health. I figure you get enough of that elsewhere. For example, here are 88 million places I found by googling \"How can I lose 10 pounds?\"\r\n\r\nBut I love evidence-based medicine. So when a group of researchers shatter widely-held beliefs about weight loss, I'm fascinated. And before you think this can just be 88 million and 1 articles about weight loss, this review was published in the New England Journal of Medicine, which tends to have a pretty high bar for publication.","status":"publish","parent":0,"modified":1359674202,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":14,"wordCount":727},"headData":{"title":"Sex Doesn't Burn Weight and 4 More Popular Myths About Dieting Debunked | KQED","description":"I don't cover a lot of dieting stories here on State of Health. I figure you get enough of that elsewhere. For example, here are 88 million places I found by googling "How can I lose 10 pounds?"\r\n\r\nBut I love evidence-based medicine. So when a group of researchers shatter widely-held beliefs about weight loss, I'm fascinated. And before you think this can just be 88 million and 1 articles about weight loss, this review was published in the New England Journal of Medicine, which tends to have a pretty high bar for publication.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"10305 http://blogs.kqed.org/stateofhealth/?p=10305","disqusUrl":"https://ww2.kqed.org/stateofhealth/2013/01/30/5-myths-busted-about-obesity/","disqusTitle":"Sex Doesn't Burn Weight and 4 More Popular Myths About Dieting Debunked","path":"/stateofhealth/10305/5-myths-busted-about-obesity","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_546\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2011/11/21/bay-area-kids-get-a-little-fatter-except-in-san-mateo-county/scalegeneric081211/\" rel=\"attachment wp-att-546\">\u003cimg class=\"size-medium wp-image-546\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2011/11/ScaleGeneric081211-300x200.jpg\" alt=\"Woman's feet on scale.\" width=\"300\" height=\"200\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Justin Sullivan/Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>I don't cover a lot of dieting stories here on State of Health. I figure you get enough of that elsewhere. For example, here are\u003ca href=\"http://www.google.com/webhp?hl=en&tab=ww#hl=en&tbo=d&sclient=psy-ab&q=how+can+I+lose+10+pounds%3F&oq=how+can+I+lose+10+pounds%3F&gs_l=hp.3..0l4.4205.7940.0.8163.25.25.0.0.0.0.160.2521.11j14.25.0.les%3Bcqn%2Ccconf%3D1-2%2Cmin_length%3D2%2Crate_low%3D0-035%2Crate_high%3D0-035%2Csecond_pass%3Dfalse%2Cnum_suggestions%3D2%2Cignore_bad_origquery%3Dtrue%2Conetoken%3Dfalse..0.0...1c.1.JokXr73weUw&pbx=1&bav=on.2,or.r_gc.r_pw.r_qf.&bvm=bv.41642243,d.cGE&fp=a9017c0373b80654&biw=1554&bih=842\" target=\"_blank\"> 88 million places\u003c/a> I found by Googling \"How can I lose 10 pounds?\"\u003c/p>\n\u003cp>But I love evidence-based medicine. So when a group of respected researchers shatter widely-held beliefs about weight loss, I'm there. In Thursday's\u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJMsa1208051#t=articleTop\" target=\"_blank\"> New England Journal of Medicine\u003c/a>, a group of researchers does just that.\u003c/p>\n\u003cp>In the review, the researchers categorized as myths those \"beliefs held to be true despite substantial refuting evidence.\" In other words, people have been repeating these ideas for so long, everyone thinks they're true. But they're not.\u003c/p>\n\u003cp>So, here we go:\u003c/p>\n\u003cp>\u003cstrong>Myth #1: Small changes -- eating less or exercising more -- done over time will yield large weight loss. \u003c/strong>This myth comes from the idea that a pound is equal to 3,500 calories. But the short-term studies that looked at burning 3,500 calories to lose one pound were done 50 years ago. More recent research shows that individuals will burn calories differently as they lose weight. So the 100 calories you're burning in exercise today will affect your body differently than the 100 calories you burned, say 18 months ago, when you started these small changes. Note that it's not to say that exercising more -- or eating less -- is pointless (you will see why later in this post).\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>Myth #2: If you lose a lot of weight really fast, you'll just gain it back really fast; you'll have better long-term results if you lose weight slowly. \u003c/strong>When researchers actually looked at the studies, they found \"no significant difference\" between the two approaches in relation to long-term weight loss.\u003c!--more-->\u003c/p>\n\u003cp>\u003cstrong>Myth #3: Physical-education classes, in their current form, play an important role in reducing or preventing childhood obesity. \u003c/strong>As a parent, I found this to be somewhat depressing, although the writers did include a caveat: \"There is almost certainly a level of physical activity ... that would be effective in reducing or preventing obesity. Whether that level is plausibly achievable in conventional school settings is unknown, although the dose-response relationship between physical activity and weight warrants investigation in clinical trials.\"\u003c/p>\n\u003cp>\u003cstrong>Myth #4: Breast-feeding protects against obesity. \u003c/strong>Say it ain't so! No less than the esteemed World Health Organization reported that breast-feeding is protective against obesity. But our myth busters found evidence of \"publication bias\" in the WHO research. Furthermore, the myth busters report a study of 13,000 children that found \"no compelling evidence of an effect of breast-feeding on obesity.\" They do stress that breast-feeding has other benefits for both infant and mother \"and should therefore be encouraged.\"\u003c/p>\n\u003cp>\u003cstrong>Myth #5: You burn 100 to 300 calories by having sex.\u003c/strong> The myth busters start with a premise that some people may find troubling: \"Given that the average bout of sexual activity lasts about six minutes,\" the myth busters say, \"a man in his early-to-mid-30s might expend approximately 21 (calories) during sexual intercourse.\" But it gets even better: \"Of course, he would have spent roughly one third that amount of energy just watching television.\"\u003c/p>\n\u003cp>The myth busters also highlight presumptions, \"widely accepted beliefs that have neither been proved nor disproved.\" They call for gathering solid evidence so these presumptions can be proved or disproved.\u003c/p>\n\u003cp>At present, there is no evidence to support these ideas:\u003c/p>\n\u003cul>\n\u003cli>Regularly eating breakfast is protective against obesity.\u003c/li>\n\u003cli>Eating more fruits and vegetables will result in weight loss or less weight gain, regardless of whether any other changes to one's behavior or environment are made.\u003c/li>\n\u003cli>Weight-cycling is associated with increased mortality. It's likely that any observations that lead to this conclusion are confounded by a person's health status.\u003c/li>\n\u003cli>Snacking adds to weight gain and obesity. Studies have not consistently found an association.\u003c/li>\n\u003c/ul>\n\u003cp>\u003c/p>\n\u003cp>The myth busters insist they are not nihilistic, and their report includes these facts:\u003c/p>\n\u003cul>\n\u003cli>Exercise, exercise, exercise. \"Regardless of body weight or weight loss, an increased level of exercise increases health,\" the researchers write.\u003c/li>\n\u003cli>Exercise \"in a sufficient dose\" helps with long-term weight maintenance.\u003c/li>\n\u003cli>For overweight children, \"parents and the home setting\" should be included in any weight loss plan to improve success.\u003c/li>\n\u003c/ul>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/10305/5-myths-busted-about-obesity","authors":["240"],"categories":["stateofhealth_12"],"tags":["stateofhealth_344","stateofhealth_117"],"featImg":"stateofhealth_546","label":"stateofhealth"},"stateofhealth_8671":{"type":"posts","id":"stateofhealth_8671","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"8671","score":null,"sort":[1351026632000]},"guestAuthors":[],"slug":"thats-right-there-is-no-silver-bullet","title":"Sorry, There Is No Silver Bullet","publishDate":1351026632,"format":"aside","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cfigure id=\"attachment_8677\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/10/Vial_bennylin0724_flickr.jpg\">\u003cimg class=\"size-medium wp-image-8677\" title=\"Drugs were a major component of interventions reviewed. (bennylin0724: Flickr)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/10/Vial_bennylin0724_flickr-300x289.jpg\" alt=\"Drugs were a major component of interventions reviewed. (bennylin0724: Flickr)\" width=\"300\" height=\"289\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Drugs were a major component of interventions reviewed. (bennylin0724: Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>If a medical study shows that a treatment has a big effect, how much should you trust it? According to a \u003ca title=\"http://jama.jamanetwork.com/article.aspx?articleid=1386610\" href=\"http://jama.jamanetwork.com/article.aspx?articleid=1386610\" target=\"_blank\">provocative report\u003c/a> published today, not very much.\u003c/p>\n\u003cp>A group of researchers from across the country -- including Stanford Medical Center -- and Brazil, looked at more than 85-thousand analyses. (In other words, they reviewed a LOT of research). They found that just under 10 percent of studies found a \"very large treatment effect,\" defined as a five-fold difference in people who received the intervention versus the control group.\u003c/p>\n\u003cp>But here the rub: more than 90 percent of the time, those \"very large effects\" don't hold up after further research.\u003c/p>\n\u003cp>Dr. John Ioannidis at Stanford led the study, which is published today in the Journal of the American Medical Association. In an interview he told me, \"Most of the time ... these very large effects largely evaporated, they became substantially smaller. It's not that they necessarily went away competely, but they were much, much smaller than the initial study.\"\u003c!--more-->\u003c/p>\n\u003cp>As the researchers say in the first line of their publication, \"Most effective interventions in health care confer modest, incremental benefits.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Of course, a modest benefit is not so bad, as Ioannidis quickly added. \"If you have several drugs or types of interventions and each of them could contribute some incremental benefit, that means we may have some room for ... progress in getting some better outcomes by using several of those interventions.\"\u003c/p>\n\u003cp>Still, when I pointed out that this news was likely to be a big bummer to lots of Americans used to the search for the silver bullet, he laughed softly and said, \"Yeah, too bad.\" He says that a belief in the silver bullet \"creates a vicious circle. It also creates an environment where claims for a silver bullet thrive against such overwhelming evidence.\"\u003c/p>\n\u003cp>There's room for more skepticism all around, Ioannidis asserts: from scientists, from patients, from the press and its readers, and from citizens. \"Whenever a very big discovery, or effect, or extraordinary finding is described,\" Ioannidis says, \"there should be some skepticism that it's not as huge, maybe it's not completely wrong, but it's not at that magnitude.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>There was only one single case where Ioannidis and his colleagues identified an intervention that dramatically reduced death risk (a treatment for newborns with respiratory failure). Ioannidis admitted that some interventions likely to have big effects are never tested in randomized trials -- for ethical reasons. For example, if someone is bleeding profusely, doctors will always try to stop the bleeding. Scientists cannot randomize two groups to test a hypothesis around stopping bleeding.\u003c/p>\n\n","blocks":[],"excerpt":"If a medical study shows that a treatment has a big effect, how much should you trust it? According to a provocative report published today, not very much.\r\n\r\nA group of researchers from across the country -- including Stanford Medical Center -- and Brazil, looked at more than 85-thousand analyses. (In other words, they reviewed a LOT of research). They found that just under 10 percent of studies found a \"very large treatment effect,\" defined as a five-fold difference in people who received the intervention versus the control group.","status":"publish","parent":0,"modified":1351184691,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":11,"wordCount":451},"headData":{"title":"Sorry, There Is No Silver Bullet | KQED","description":"If a medical study shows that a treatment has a big effect, how much should you trust it? According to a provocative report published today, not very much.\r\n\r\nA group of researchers from across the country -- including Stanford Medical Center -- and Brazil, looked at more than 85-thousand analyses. (In other words, they reviewed a LOT of research). They found that just under 10 percent of studies found a "very large treatment effect," defined as a five-fold difference in people who received the intervention versus the control group.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"8671 http://blogs.kqed.org/stateofhealth/?p=8671","disqusUrl":"https://ww2.kqed.org/stateofhealth/2012/10/23/thats-right-there-is-no-silver-bullet/","disqusTitle":"Sorry, There Is No Silver Bullet","path":"/stateofhealth/8671/thats-right-there-is-no-silver-bullet","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_8677\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/10/Vial_bennylin0724_flickr.jpg\">\u003cimg class=\"size-medium wp-image-8677\" title=\"Drugs were a major component of interventions reviewed. (bennylin0724: Flickr)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/10/Vial_bennylin0724_flickr-300x289.jpg\" alt=\"Drugs were a major component of interventions reviewed. (bennylin0724: Flickr)\" width=\"300\" height=\"289\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Drugs were a major component of interventions reviewed. (bennylin0724: Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>If a medical study shows that a treatment has a big effect, how much should you trust it? According to a \u003ca title=\"http://jama.jamanetwork.com/article.aspx?articleid=1386610\" href=\"http://jama.jamanetwork.com/article.aspx?articleid=1386610\" target=\"_blank\">provocative report\u003c/a> published today, not very much.\u003c/p>\n\u003cp>A group of researchers from across the country -- including Stanford Medical Center -- and Brazil, looked at more than 85-thousand analyses. (In other words, they reviewed a LOT of research). They found that just under 10 percent of studies found a \"very large treatment effect,\" defined as a five-fold difference in people who received the intervention versus the control group.\u003c/p>\n\u003cp>But here the rub: more than 90 percent of the time, those \"very large effects\" don't hold up after further research.\u003c/p>\n\u003cp>Dr. John Ioannidis at Stanford led the study, which is published today in the Journal of the American Medical Association. In an interview he told me, \"Most of the time ... these very large effects largely evaporated, they became substantially smaller. It's not that they necessarily went away competely, but they were much, much smaller than the initial study.\"\u003c!--more-->\u003c/p>\n\u003cp>As the researchers say in the first line of their publication, \"Most effective interventions in health care confer modest, incremental benefits.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Of course, a modest benefit is not so bad, as Ioannidis quickly added. \"If you have several drugs or types of interventions and each of them could contribute some incremental benefit, that means we may have some room for ... progress in getting some better outcomes by using several of those interventions.\"\u003c/p>\n\u003cp>Still, when I pointed out that this news was likely to be a big bummer to lots of Americans used to the search for the silver bullet, he laughed softly and said, \"Yeah, too bad.\" He says that a belief in the silver bullet \"creates a vicious circle. It also creates an environment where claims for a silver bullet thrive against such overwhelming evidence.\"\u003c/p>\n\u003cp>There's room for more skepticism all around, Ioannidis asserts: from scientists, from patients, from the press and its readers, and from citizens. \"Whenever a very big discovery, or effect, or extraordinary finding is described,\" Ioannidis says, \"there should be some skepticism that it's not as huge, maybe it's not completely wrong, but it's not at that magnitude.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>There was only one single case where Ioannidis and his colleagues identified an intervention that dramatically reduced death risk (a treatment for newborns with respiratory failure). Ioannidis admitted that some interventions likely to have big effects are never tested in randomized trials -- for ethical reasons. For example, if someone is bleeding profusely, doctors will always try to stop the bleeding. Scientists cannot randomize two groups to test a hypothesis around stopping bleeding.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/8671/thats-right-there-is-no-silver-bullet","authors":["240"],"categories":["stateofhealth_14"],"tags":["stateofhealth_344"],"featImg":"stateofhealth_8677","label":"stateofhealth"},"stateofhealth_8077":{"type":"posts","id":"stateofhealth_8077","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"8077","score":null,"sort":[1345141408000]},"guestAuthors":[],"slug":"in-medicine-dont-believe-everything-you-know","title":"In Medicine, Don't Believe Everything You Know","publishDate":1345141408,"format":"aside","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cfigure id=\"attachment_8104\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/08/MedicalTextbooks_Pmccormi_Flickr.jpg\">\u003cimg class=\"size-medium wp-image-8104\" title=\"(Pmccormi: Flickr)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/08/MedicalTextbooks_Pmccormi_Flickr-300x225.jpg\" alt=\"(Pmccormi: Flickr)\" width=\"300\" height=\"225\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Pmccormi: Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Eve Harris\u003c/strong>\u003c/p>\n\u003cp>How do you know your doctor is right? Ideally you and your doctor have a relationship based on trust. That is, you believe she knows the best options to recommend to you. \u003cem>You\u003c/em> may think your doctor is right, but -- how does \u003cem>your doctor \u003c/em>know she's right? We'd like to think physicians are relying on the latest evidence of medical practice. But not all physicians do that.\u003c/p>\n\u003cp>I recently joined in a robust, four-day discussion designed to address this issue at the \u003ca title=\"http://www.cochrane.org/news/tags/authors/14th-rocky-mountain-workshop-how-practice-evidence-based-health-care-steamboat-spr\" href=\"http://www.cochrane.org/news/tags/authors/14th-rocky-mountain-workshop-how-practice-evidence-based-health-care-steamboat-spr\" target=\"_blank\">14th Rocky Mountain Workshop on How to Practice Evidence-Based Health Care\u003c/a>. Doctors, policy makers and yes, journalists gathered to explore what many patients might have thought they were already getting: evidence-based health care, also called evidence based medicine.\u003c/p>\n\u003cp>In evidence based medicine, a hierarchy of evidence\u003cem> \u003c/em>guides decisions about patient care. But at the same time, evidence based medicine recognizes that \u003cem>evidence alone is not sufficient\u003c/em>. That's because treatment options come with risks, and different patients will react differently to different risks. It's not a simple matter of \"Drug X\" or \"Treatment Y\" has a five percent higher likelihood of success. If \"Treatment Y\" involves a risk or side effect a patient finds unacceptable, then this patient's preference is part of the decision process.\u003c/p>\n\u003cp>Decision makers \u003ca title=\"http://www.ncbi.nlm.nih.gov/pubmed/8963526\" href=\"http://www.ncbi.nlm.nih.gov/pubmed/8963526\" target=\"_blank\">must always acknowledge these trade offs\u003c/a>.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003c!--more-->\u003c/p>\n\u003cp>The emphasis on patients’ considerations makes evidence based medicine a patient-centered practice, ideal for the coming age of healthcare reform. It’s imperative that both providers and patients learn to properly evaluate their sources of medical information. Even tougher -- old habits die hard, as we all know. Earlier this year in the \u003ca title=\"http://jama.jamanetwork.com/article.aspx?articleid=1104821\" href=\"http://jama.jamanetwork.com/article.aspx?articleid=1104821\" target=\"_blank\">Journal of the American Medical Association\u003c/a>, Stanford professor \u003ca href=\"http://med.stanford.edu/profiles/John_Ioannidis/\">John Ioannidis\u003c/a> (and others) wrote of just how hard it is to reverse established medical practice:\u003c/p>\n\u003cblockquote>\u003cp>\u003cem>\u003c/em>Ideally, good medical practices are replaced by better ones, based on robust comparative trials in which new interventions outperform older ones and establish new standards of care. Often, however … what was thought to be beneficial was not. In these cases, it becomes apparent that clinicians, encouraged by professional societies and guidelines, have been using medications, procedures, or preventive measures in vain.\u003c/p>\u003c/blockquote>\n\u003cp>Factors beyond science -- including bias -- can alter the outcome of a study. They can even affect what research is conducted and published. Ioannidis is well known for exposing ways this happens and why it is harmful to patients and physicians.\u003c/p>\n\u003cp>One take-away from the workshop I particularly endorse came from the U.S. Preventive Services Task Force chair \u003ca href=\"http://www.uspreventiveservicestaskforce.org/tflongbios.htm\">Virginia Moyer\u003c/a>: researchers should stop designing research around outcomes that don't matter to patients! One example we discussed was bone density. What patients care about is preventing fractures. But studies looked at bone density, believing bone density was linked to fractures. Turns out it's not. In this case, studies that look at fractures are what's needed.\u003c/p>\n\u003cp>But overall it appears that patient perspectives and values are increasingly part of research design. The Patient Centered Outcomes Research Institute (PCORI) is funding innovative new studies. In a recent article, PCORI explains \"\u003ca href=\"http://www.pcori.org/blog/why-methods-matter/\" target=\"_blank\">Why Methods Matter\u003c/a>.\" Today, patients have more treatment options than ever, and changes in the way we receive our healthcare today – shorter hospital stays, for example -- may affect outcomes. So although difficult, it’s crucial for patients and providers to understand and use the most relevant information when making decisions.\u003c/p>\n\u003cp>Doctors and patients are making progress in defining and trying out new ways of communicating about treatment decisions. Achieving the best outcomes via this newer, more participatory practice of medicine requires attention not only to the evidence provided by high quality studies but also clinical judgment and the bottom line: patient values.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Eve Harris is a Bay Area writer. Check out her health blog, \u003ca href=\"http://eve-harris.blogspot.com/\">A Healthy Piece of My Mind\u003c/a>.\u003c/em>\u003c/p>\n\n","blocks":[],"excerpt":"How do you know your doctor is right? Ideally you and your doctor have a relationship based on trust. That is, you believe she knows the best options to recommend to you. You may think your doctor is right, but -- how does your doctor know she's right? We'd like to think physicians are relying on the latest evidence of medical practice. But not all physicians do that.\r\n\r\nI recently joined in a robust, four-day discussion designed to address this issue at the 14th Rocky Mountain Workshop on How to Practice Evidence-Based Health Care. Doctors, policy makers and yes, journalists gathered to explore what many patients might have thought they were already getting: evidence-based health care, or evidence based medicine.","status":"publish","parent":0,"modified":1345229814,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":15,"wordCount":650},"headData":{"title":"In Medicine, Don't Believe Everything You Know | KQED","description":"How do you know your doctor is right? Ideally you and your doctor have a relationship based on trust. That is, you believe she knows the best options to recommend to you. You may think your doctor is right, but -- how does your doctor know she's right? We'd like to think physicians are relying on the latest evidence of medical practice. But not all physicians do that.\r\n\r\nI recently joined in a robust, four-day discussion designed to address this issue at the 14th Rocky Mountain Workshop on How to Practice Evidence-Based Health Care. Doctors, policy makers and yes, journalists gathered to explore what many patients might have thought they were already getting: evidence-based health care, or evidence based medicine.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"8077 http://blogs.kqed.org/stateofhealth/?p=8077","disqusUrl":"https://ww2.kqed.org/stateofhealth/2012/08/16/in-medicine-dont-believe-everything-you-know/","disqusTitle":"In Medicine, Don't Believe Everything You Know","path":"/stateofhealth/8077/in-medicine-dont-believe-everything-you-know","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_8104\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/08/MedicalTextbooks_Pmccormi_Flickr.jpg\">\u003cimg class=\"size-medium wp-image-8104\" title=\"(Pmccormi: Flickr)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/08/MedicalTextbooks_Pmccormi_Flickr-300x225.jpg\" alt=\"(Pmccormi: Flickr)\" width=\"300\" height=\"225\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Pmccormi: Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Eve Harris\u003c/strong>\u003c/p>\n\u003cp>How do you know your doctor is right? Ideally you and your doctor have a relationship based on trust. That is, you believe she knows the best options to recommend to you. \u003cem>You\u003c/em> may think your doctor is right, but -- how does \u003cem>your doctor \u003c/em>know she's right? We'd like to think physicians are relying on the latest evidence of medical practice. But not all physicians do that.\u003c/p>\n\u003cp>I recently joined in a robust, four-day discussion designed to address this issue at the \u003ca title=\"http://www.cochrane.org/news/tags/authors/14th-rocky-mountain-workshop-how-practice-evidence-based-health-care-steamboat-spr\" href=\"http://www.cochrane.org/news/tags/authors/14th-rocky-mountain-workshop-how-practice-evidence-based-health-care-steamboat-spr\" target=\"_blank\">14th Rocky Mountain Workshop on How to Practice Evidence-Based Health Care\u003c/a>. Doctors, policy makers and yes, journalists gathered to explore what many patients might have thought they were already getting: evidence-based health care, also called evidence based medicine.\u003c/p>\n\u003cp>In evidence based medicine, a hierarchy of evidence\u003cem> \u003c/em>guides decisions about patient care. But at the same time, evidence based medicine recognizes that \u003cem>evidence alone is not sufficient\u003c/em>. That's because treatment options come with risks, and different patients will react differently to different risks. It's not a simple matter of \"Drug X\" or \"Treatment Y\" has a five percent higher likelihood of success. If \"Treatment Y\" involves a risk or side effect a patient finds unacceptable, then this patient's preference is part of the decision process.\u003c/p>\n\u003cp>Decision makers \u003ca title=\"http://www.ncbi.nlm.nih.gov/pubmed/8963526\" href=\"http://www.ncbi.nlm.nih.gov/pubmed/8963526\" target=\"_blank\">must always acknowledge these trade offs\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003c!--more-->\u003c/p>\n\u003cp>The emphasis on patients’ considerations makes evidence based medicine a patient-centered practice, ideal for the coming age of healthcare reform. It’s imperative that both providers and patients learn to properly evaluate their sources of medical information. Even tougher -- old habits die hard, as we all know. Earlier this year in the \u003ca title=\"http://jama.jamanetwork.com/article.aspx?articleid=1104821\" href=\"http://jama.jamanetwork.com/article.aspx?articleid=1104821\" target=\"_blank\">Journal of the American Medical Association\u003c/a>, Stanford professor \u003ca href=\"http://med.stanford.edu/profiles/John_Ioannidis/\">John Ioannidis\u003c/a> (and others) wrote of just how hard it is to reverse established medical practice:\u003c/p>\n\u003cblockquote>\u003cp>\u003cem>\u003c/em>Ideally, good medical practices are replaced by better ones, based on robust comparative trials in which new interventions outperform older ones and establish new standards of care. Often, however … what was thought to be beneficial was not. In these cases, it becomes apparent that clinicians, encouraged by professional societies and guidelines, have been using medications, procedures, or preventive measures in vain.\u003c/p>\u003c/blockquote>\n\u003cp>Factors beyond science -- including bias -- can alter the outcome of a study. They can even affect what research is conducted and published. Ioannidis is well known for exposing ways this happens and why it is harmful to patients and physicians.\u003c/p>\n\u003cp>One take-away from the workshop I particularly endorse came from the U.S. Preventive Services Task Force chair \u003ca href=\"http://www.uspreventiveservicestaskforce.org/tflongbios.htm\">Virginia Moyer\u003c/a>: researchers should stop designing research around outcomes that don't matter to patients! One example we discussed was bone density. What patients care about is preventing fractures. But studies looked at bone density, believing bone density was linked to fractures. Turns out it's not. In this case, studies that look at fractures are what's needed.\u003c/p>\n\u003cp>But overall it appears that patient perspectives and values are increasingly part of research design. The Patient Centered Outcomes Research Institute (PCORI) is funding innovative new studies. In a recent article, PCORI explains \"\u003ca href=\"http://www.pcori.org/blog/why-methods-matter/\" target=\"_blank\">Why Methods Matter\u003c/a>.\" Today, patients have more treatment options than ever, and changes in the way we receive our healthcare today – shorter hospital stays, for example -- may affect outcomes. So although difficult, it’s crucial for patients and providers to understand and use the most relevant information when making decisions.\u003c/p>\n\u003cp>Doctors and patients are making progress in defining and trying out new ways of communicating about treatment decisions. Achieving the best outcomes via this newer, more participatory practice of medicine requires attention not only to the evidence provided by high quality studies but also clinical judgment and the bottom line: patient values.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Eve Harris is a Bay Area writer. Check out her health blog, \u003ca href=\"http://eve-harris.blogspot.com/\">A Healthy Piece of My Mind\u003c/a>.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/8077/in-medicine-dont-believe-everything-you-know","authors":["8372"],"categories":["stateofhealth_12","stateofhealth_14"],"tags":["stateofhealth_344","stateofhealth_236"],"featImg":"stateofhealth_8104","label":"stateofhealth"}},"programsReducer":{"possible":{"id":"possible","title":"Possible","info":"Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. 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And you join us on the journey to find the answers.","imageSrc":"https://ww2.kqed.org/news/wp-content/uploads/sites/10/powerpress/1440_0017_BayCurious_iTunesTile_01.jpg","imageAlt":"\"KQED Bay Curious","officialWebsiteLink":"/news/series/baycurious","meta":{"site":"news","source":"kqed","order":"4"},"link":"/podcasts/baycurious","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/bay-curious/id1172473406","npr":"https://www.npr.org/podcasts/500557090/bay-curious","rss":"https://ww2.kqed.org/news/category/bay-curious-podcast/feed/podcast","google":"https://podcasts.google.com/feed/aHR0cHM6Ly93dzIua3FlZC5vcmcvbmV3cy9jYXRlZ29yeS9iYXktY3VyaW91cy1wb2RjYXN0L2ZlZWQvcG9kY2FzdA","stitcher":"https://www.stitcher.com/podcast/kqed/bay-curious","spotify":"https://open.spotify.com/show/6O76IdmhixfijmhTZLIJ8k"}},"bbc-world-service":{"id":"bbc-world-service","title":"BBC World Service","info":"The day's top stories from BBC News compiled twice daily in the week, once at weekends.","airtime":"MON-FRI 9pm-10pm, TUE-FRI 1am-2am","imageSrc":"https://ww2.kqed.org/app/uploads/2021/10/BBC_1400.jpg","officialWebsiteLink":"https://www.bbc.co.uk/sounds/play/live:bbc_world_service","meta":{"site":"news","source":"BBC World Service"},"link":"/radio/program/bbc-world-service","subscribe":{"apple":"https://itunes.apple.com/us/podcast/global-news-podcast/id135067274?mt=2","tuneIn":"https://tunein.com/radio/BBC-World-Service-p455581/","rss":"https://podcasts.files.bbci.co.uk/p02nq0gn.rss"}},"code-switch-life-kit":{"id":"code-switch-life-kit","title":"Code Switch / Life Kit","info":"\u003cem>Code Switch\u003c/em>, which listeners will hear in the first part of the hour, has fearless and much-needed conversations about race. Hosted by journalists of color, the show tackles the subject of race head-on, exploring how it impacts every part of society — from politics and pop culture to history, sports and more.\u003cbr />\u003cbr />\u003cem>Life Kit\u003c/em>, which will be in the second part of the hour, guides you through spaces and feelings no one prepares you for — from finances to mental health, from workplace microaggressions to imposter syndrome, from relationships to parenting. The show features experts with real world experience and shares their knowledge. Because everyone needs a little help being human.\u003cbr />\u003cbr />\u003ca href=\"https://www.npr.org/podcasts/510312/codeswitch\">\u003cem>Code Switch\u003c/em> offical site and podcast\u003c/a>\u003cbr />\u003ca href=\"https://www.npr.org/lifekit\">\u003cem>Life Kit\u003c/em> offical site and podcast\u003c/a>\u003cbr />","airtime":"SUN 9pm-10pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2021/12/CodeSwitchLifeKit_StationGraphics_300x300EmailGraphic.png","meta":{"site":"radio","source":"npr"},"link":"/radio/program/code-switch-life-kit","subscribe":{"apple":"https://podcasts.apple.com/podcast/1112190608?mt=2&at=11l79Y&ct=nprdirectory","google":"https://podcasts.google.com/feed/aHR0cHM6Ly93d3cubnByLm9yZy9yc3MvcG9kY2FzdC5waHA_aWQ9NTEwMzEy","spotify":"https://open.spotify.com/show/3bExJ9JQpkwNhoHvaIIuyV","rss":"https://feeds.npr.org/510312/podcast.xml"}},"commonwealth-club":{"id":"commonwealth-club","title":"Commonwealth Club of California Podcast","info":"The Commonwealth Club of California is the nation's oldest and largest public affairs forum. As a non-partisan forum, The Club brings to the public airwaves diverse viewpoints on important topics. The Club's weekly radio broadcast - the oldest in the U.S., dating back to 1924 - is carried across the nation on public radio stations and is now podcasting. Our website archive features audio of our recent programs, as well as selected speeches from our long and distinguished history. 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