{"id":6116,"date":"2010-06-11T07:07:59","date_gmt":"2010-06-11T12:07:59","guid":{"rendered":"http:\/\/pmedicine.org\/epatients\/?p=6116"},"modified":"2010-06-15T06:18:41","modified_gmt":"2010-06-15T11:18:41","slug":"e-patients-and-doctors-both-wise-up-if-you-havent-already","status":"publish","type":"post","link":"https:\/\/participatorymedicine.org\/epatients\/2010\/06\/e-patients-and-doctors-both-wise-up-if-you-havent-already.html","title":{"rendered":"e-Patients and doctors both, wise up. If you haven&#8217;t already."},"content":{"rendered":"<p>I&#8217;ve only been studying healthcare for two years &#8211; far less than most people on this blog &#8211; and I hesitate to be overly assertive. But I have, finally, reached the point where I feel confident in citing cases where people are simply being unscientific: ignoring evidence. That&#8217;s always hazardous, and it becomes insidious when it&#8217;s caused by a blind, unquestioning belief in our institutions.<\/p>\n<p>Case in point:<\/p>\n<p>Julie Thoren is an active practitioner of Participatory Medicine who&#8217;s seen first-hand the tremendous value informed e-patients share with each other. This morning she wrote to me about a post, <a href=\"http:\/\/www.kevinmd.com\/blog\/2010\/06\/online-patient-communities-money-patient-data.html\" target=\"new\">How online patient communities make money from  patient data,<\/a> on the blog of KevinMD, a neighbor of mine in Nashua NH.<\/p>\n<p>Kevin pointed out, correctly, that patients need to have their eyes open about what might be done with their data, etc. Commenter &#8220;Doc D&#8221; cited the chestnut &#8220;The plural of anecdote is not data,&#8221; and Julie responded about Participatory Medicine and the value she&#8217;s found in online communities.<\/p>\n<p><a href=\"https:\/\/participatorymedicine.org\/epatients\/wp-content\/uploads\/sites\/3\/2010\/06\/jopm-logo-trimmed.gif\" data-rel=\"lightbox-image-0\" data-rl_title=\"\" data-rl_caption=\"\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft size-medium  wp-image-6124\" title=\"\" src=\"https:\/\/participatorymedicine.org\/epatients\/wp-content\/uploads\/sites\/3\/2010\/06\/jopm-logo-trimmed-300x94.gif\" alt=\"\" width=\"221\" height=\"79\" \/><\/a>Here&#8217;s my comment (with a few edits), reflecting on the realities I&#8217;ve personally seen and what others have written in JoPM (the <a href=\"http:\/\/jopm.org\" target=\"_blank\">Journal of Participatory Medicine<\/a>):<!--more--><\/p>\n<p>_________________________<\/p>\n<p>This is a complex and multidimensional subject. I couldn\u2019t agree more  with Kevin\u2019s basic assertion that patients need to be on guard.<\/p>\n<p>On the other hand, I know first-hand (and second-hand many times  over) that Julie\u2019s got her facts straight that many many many patients  have suffered at length because they presumed the right\/smart thing to  do was whatever their physician told them, and who only learned of other  options \u2013 sometimes life-altering \u2013 from an online patient community.<\/p>\n<p>Patients and caregivers (and, I\u2019d assert, physicians and insurers and  policy people) simply need to wise up about the difficulty and skills  and knowledge and risks that health and healthcare involve. In my view,  only when someone realizes all of that, can they make truly informed  decisions without blinders on or their head in the sand. JoPM editorial board member Trisha Torrey has  written a <a href=\"http:\/\/trishatorrey.com\/you-bet-your-life\/\" target=\"_blank\">well documented book<\/a> about this: <em>You Bet Your Life: Ten  Mistakes Every Patient Makes \/ How to fix them to get the health care  you deserve.<\/em> Those are not imaginary stories \u2013 including her own, where the physicians, in whom she of course had faith, told her she had six months to live due to inoperable  cancer, when in fact she didn\u2019t have cancer at all, and she only found it  out through her own research.<\/p>\n<p>I couldn\u2019t agree more with Doc D that the plural of anecdote is not  data. Any patient community that doesn\u2019t understand this is being  unscientific. On the other hand, it\u2019s equally unscientific to think that  our established channels are reliable sources of information \u2013  especially to think they\u2019re the <em>only<\/em> reliable source. I won\u2019t  take time here to go into that in depth, but I\u2019ll quote <a rel=\"nofollow\" href=\"http:\/\/jopm.org\/index.php\/jpm\/article\/view\/12\/25\">this  from the Journal of Participatory Medicine<\/a>:<\/p>\n<blockquote><p>\u201c&#8230;evidence on the upside of peer review is sparse, while  evidence on the downside is abundant. We struggle to find convincing  evidence of its benefit, but we know that it is slow, expensive, largely  a lottery, poor at detecting error, ineffective at diagnosing fraud,  biased, and prone to abuse \u2026 most of what appears in peer-reviewed  journals is scientifically weak.\u201d<\/p><\/blockquote>\n<p>Was that said by an angry disillusioned patient, mad at publications  like the <em>British Medical Journal<\/em>? Why no, it was written by Richard  Smith, after 25 years as <em>editor<\/em> of the <em>British Medical Journal<\/em>.<\/p>\n<p>Then we have the <a href=\"https:\/\/participatorymedicine.org\/epatients\/archives\/2010\/05\/patients-like-me-beats-lancet-neurology-by-a-mile.html\">recent news<\/a> that the PatientsLikeMe community beat <em>Lancet<\/em> to the punch, by a long shot, regarding lithium, after a peer reviewed  journal had published a ludicrously inept paper (contradicted by both  PLM and Lancet).<\/p>\n<p>No smart patient will unthinkingly trust a patient community (nor a  physician), online or off. We all need to wise up and be smart  consumers. And based on Smith\u2019s writing, I assert that no smart  physician or consumer will unthinkingly trust evidence from medical  journals.<br \/>\n_______________<\/p>\n<p>Thanks to Julie for bringing this stimulating topic to my attention. Kevin, I suspect I don&#8217;t see entirely eye-to-eye with\u00a0 you on this, but as I said, I think we share a common sense that people need to wise up.<\/p>\n<p><em>(Another &#8220;wise up&#8221; tool, btw, is Gary Schwitzer&#8217;s <a href=\"http:\/\/healthnewsreview.org\/\" target=\"_blank\">Health News Review<\/a> site, supported by the <a href=\"http:\/\/informedmedicaldecisions.org\/\" target=\"_blank\">Foundation for Informed Medical Decision Making<\/a>.)<\/em><\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>I&#8217;ve only been studying healthcare for two years &#8211; far less than most people on this blog &#8211; and I hesitate to be overly assertive. But I have, finally, reached [&hellip;]<\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"give_campaign_id":0,"_et_pb_use_builder":"","_et_pb_old_content":"","_et_gb_content_width":"","_price":"","_stock":"","_tribe_ticket_header":"","_tribe_default_ticket_provider":"","_tribe_ticket_capacity":"0","_ticket_start_date":"","_ticket_end_date":"","_tribe_ticket_show_description":"","_tribe_ticket_show_not_going":false,"_tribe_ticket_use_global_stock":"","_tribe_ticket_global_stock_level":"","_global_stock_mode":"","_global_stock_cap":"","_tribe_rsvp_for_event":"","_tribe_ticket_going_count":"","_tribe_ticket_not_going_count":"","_tribe_tickets_list":"[]","_tribe_ticket_has_attendee_info_fields":false,"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":false,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2}},"categories":[114,5,3586,226,2304],"tags":[],"coauthors":[8260],"class_list":["post-6116","post","type-post","status-publish","format-standard","hentry","category-hcs-problem-list","category-ptdoc-co-care","category-research-issues","category-understanding-statistics","category-why-pm"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.3 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>e-Patients and doctors both, wise up. 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