First published 5/17/11 on Health Populi
Randomized controlled trials (RCTs) have been the rational cornerstone of medical decision making for decades. RCTs demonstrate a drug or therapeutic course’s efficacy – that is, the extent to which a specific intervention, procedure, or regimen produces a beneficial result under ideal conditions.
Of course, how a particular therapy works in an individual is highly personalized based not only on a body’s biochemistry, but personal preferences, perceptions, and personality. That’s why Dr. Andrew Weil and his colleagues, Dr. Scott Shannon and Dr. Bonnie Kaplan, say that medical decision making should take into account the patient perspective.
In Medical Decision Making in Integrative Medicine, published in Alternative and Complementary Therapies in April 2011, the research trio writes, “There are reasonable alternatives to the overdependence on the RCT as the measure of the potential impact of a treatment.” In particular, looking at risk and patient factors would enhance medical decision making, the team asserts.
The essay explains the importance of “an ecological model of evaluation.” This focuses on the broader framework of patient factors that influence health in total: environmental, physical, emotional, mental, social and spiritual aspects of each person.
In conclusion, Weil et al say that, “Three elements for the irreducible basis for appropriate medical decision making: safety, efficacy and patient factors.”
Health Populi’s Hot Points: A growing movement of participatory medicine and health recognizes that the patient is the most underutilized stakeholder in health care. Shannon, Weil and Kaplan call this out in their approach to more holistic medical decision making.
This approach challenges the time-honored research-based modus operandi of Big Pharma and Big Research. Yet increasingly, patients are playing a role in peer-to-peer health and health care, sharing perspectives and hard clinical data with each other and, in some cases, with scientists themselves. This is the start of a new kind of medical research that incorporates the patient perspective. Expect tremors underneath the science and investment communities to begin rocking and rolling. The wheels are already in motion among the patient-crowd. PatientsLikeMe, CureTogether, and 23andMe are just the beginning…
Jane Sarasohn-Kahn is a health economist writing at Health Populi.