January 28, 2013

We Need Not Accept Cheesecake Factory Medicine

Last Friday, I reported on the second of Dr. David Shaywich's three health-care tensions for 2013: the one that exists between the relentless standardization of medical treatment and the need for more individualized care.

Shaywich compared visiting a doctor's office today with going to lunch at the Cheesecake Factory, where everybody ends up getting pretty much the same thing. I've talked about this issue often. Shaywich calls it "Cheesecake Factory" medicine; I call it "one-size-fits-all" medicine. Same complaint.

Bell Curve and Cheesecake Factory Meals & Medicine
It helps me to envision the standard bell curve (above). The Cheesecake Factory offers a menu that (let's say) 2.15 percent of the populace (the yellow segment on the left) thinks is the best ever... 68.2 percent (the blue segments in the middle) considers good but not great... and another 2.15 percent on the right (including me) are happy to avoid altogether.

When it comes to medical treatment, even the best doctors prescribe medications and treatments that provide nearly miraculous results to the 2.1 percent on the left. Those therapies may work reasonably well (and with few side effects) for the 50 percent on the left of the midpoint. But they yield declining benefits (and increasing side effects) for those to the right. When you reach the 2.1 percent on the far right, treatments aren't helping at all, and patients are dealing with serious adverse effects from drugs or therapies.

Here's the problem: too many medical providers think that the experience of the 50 percent on the left side is the full story, leading to the Cheesecake Factory's "one-size-fits-all" overly standardized medical treatment.

How the Quacks Distort the Bell Curve
The bell curve also is worth envisioning as a model for another medical care problem I've described: the hype for coconut oil as a treatment for Alzheimer's. The primary hucksters for this unsubstantiated claim are Dr. Mary Newport and Pat Robertson. Dr. Newport has reported that her Alzheimer's-afflicted husband experienced an almost miraculous reversal in his symptoms after she began giving him increasing amounts of coconut oil. Pat Robertson produced a video of Dr. Newport and her husband for his Christian Broadcast Network.

As a result, he got 5 million viewers, making this topic his most popular program last year. Dr. Newport has written and promoted a book, Alzheimer's Disease: What If There Were a Cure? Since they are both making money from this claim, they continue the hype, as I recently reported.

Dr. Newport says she's received several hundred positive reports from Alzheimer's caregivers about  coconut oil. With any disease, but especially Alzheimer's, the patient and the caregiver are so desperate for a remedy -- and the manifestations of the disease are so idiosyncratic -- that hype sometimes turns hope into belief. I've written often about this "placebo effect."

Assuming positive results have been achieved for Dr. Newport's husband and others (and I hope that's the case), it's clear -- in light of the millions who certainly must have tried this highly touted miracle cure -- that the real successes are few... on that narrow 2.1 percent far left of the bell curve.

I emphasize this issue because the coconut oil hype is just one example of what Oprah, Dr. Oz, Dr. Mercola and others have been doing for years: taking anecdotal reports from a few individuals and touting them as new miracle cures.

The internet and late-night TV infomercials have made it easy for patients to find quacks, and for quacks to find willing patients with credit cards. Sufferers order bogus supplements, lotions, books, CDs, and other products, eager for relief. Sadly, desperate patients are easily fooled. They take the bogus panacea and may get sicker or even die sooner. Or maybe -- like that lucky 2.1 percent on the bell curve's left extreme -- they find a miraculous solution.

But Let's End on a Positive Note
Maybe more than Dr. Shaywich, I see great promise for a dramatic move away from our "one-size-fits-all" trajectory. The information gathered and tested from the Human Genome Project over the last decade has the potential to forever transform medicine.

Thanks to this project (one of those government-sponsored research projects that today's budget cutters wouldn't fund), more is known about human genetics, disease and wellness than ever before. DNA-based medicine, frequently called "personalized medicine," may well be the future of healthcare.

Sunday's Washington Post had news of a promising development here. It  reported on the $350 million donation that Michael Bloomberg has just announced he's making to his alma mater Johns Hopkins. Among the things he specified it be used for is studying "individualized health-care delivery."
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Until DNA healthcare truly arrives, WE can personalize our medical treatment now by taking an active role in monitoring our health and finding what works best for us.

My urologist says he sees me as one of the outliers on the positive side of the  Bell Curve for  Parkinson's, mainly because I'm so engaged in managing my disease. I saw him for a regular checkup last week and he gave me a higher (i.e. better) score on the UPDRS (Unified Parkinson's Disease Rating Scale) than I'd had at my prior visit

While coconut oil and other miracle cures promoted by the hucksters may actually work for 1%  of us, taking charge of our own medical care has the potential to benefit most of us, particularly if we focus on the Big Three -- exercise, diet and meditation or other stress reducers.  

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