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Kent Bottles MD is one of the best healthcare thinkers I’ve met. Yesterday he completed a two-part tour de force on The Health Care blog titled “The Difficult Science.” Here are part 1 and part 2.

This is about “how do we know what we think we know – and what the heck can we do with this uncertainty??” It starts with a real-world conundrum:

On the same day in November, headlines from the Wall Street Journal and the New York Times reported on the same story.

“Triple That Vitamin D Intake, Panel Prescribes” [said] the WSJ story; “Extra Vitamin D and Calcium Aren’t Necessary, Report Says” stated the New York Times. (Discussion on Freakonomics)

How should you decide what advice to follow about the relationship between your diet, lifestyle, medications, health, and wellness?

Is this just another example of how the media does a terrible job? … It turns out that it is really complicated to figure out what the “truth” is about diet, exercise, medicines, and your individual well being. Everybody (journalists, government panel members, scientists, patients, physicians, and nurse practitioners) needs to change.

He goes on to detail, thoughtfully, his recommendations for each of those fields. It’s a long read, because the truth here isn’t simple. Well worth it.

Related material –

Kent’s posts here include Why I Joined the Society for Participatory Medicine and The Ideal Doctor-Patient Relationship. The latter asks, “Can Doctors Ever Know What Will Benefit the Patient?” This is a core question in the field of SDM (shared decision making), because patients often ask doctors “What would you do, if you were me?”

Take a fresh look, too, at this short Susannah Fox post from 12/1/09:

Inviting Controversy: David Eddy at ICSI

David Eddy did nothing to reassure Kent Bottles about evidence-based guidelines in his recent keynote, saying essentially: “The problem is that we don’t know what we are doing” (!!)

That second link is a Bloomberg Business post from May 2006(!) with a reportedly mind-blowing ten minute presentation at Kaiser showing that the conventional treatments for diabetes do not work at preventing complications, and simpler things do.

Sure wish I could see that presentation – blowing minds and changing an org the size of Kaiser is a neat trick in ten minutes!


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