Unlike choosing between Asperine or Tylenol when you have a headache, decisions regarding cancer treatment and knee surgery have longer term consequences, and understanding the distribution of those consequences takes time and a lot of examples. People don’t much like being test subjects, but to some degree we all are when it comes to conventional wisdom and treatment choices. What is unfortunate, is that it is difficult to look back over time, and across a large population of patients to see if stuff works. The answer is there, but invisible because the data is not acquired and usable.
This is where Comparative Effectiveness (CE) and healthcare information systems come together. CE has lots of promise in improving the utility of some of the treatment decissions we make. I recall a time early in my RN career, that it was thought to be good for stomach ulcers to drink Half&Half, and indeed many physicians ordered that along with antacids for the treatment of peptic ulcer disease. Now, just 25 years later we look back on that with astonishment as to how medicine could have gotten it so wrong.
Remaining is the issue of human nature and how we are going about to capture the necessary information from which we hope to gain so much valuable insight. This, as the cartoon on the right illustrates, is step 2.
Tom
