{"id":8126,"date":"2010-12-29T09:34:16","date_gmt":"2010-12-29T13:34:16","guid":{"rendered":"http:\/\/pmedicine.org\/epatients\/?p=8126"},"modified":"2011-01-03T12:52:43","modified_gmt":"2011-01-03T16:52:43","slug":"the-difficult-science-series-by-kent-bottles-md","status":"publish","type":"post","link":"https:\/\/participatorymedicine.org\/epatients\/2010\/12\/the-difficult-science-series-by-kent-bottles-md.html","title":{"rendered":"&#8220;The Difficult Science&#8221;: series by Kent Bottles"},"content":{"rendered":"<p>Kent Bottles MD is one of the best healthcare thinkers I&#8217;ve met. Yesterday he completed a two-part <em>tour de force<\/em> on The Health Care blog titled &#8220;The Difficult Science.&#8221; Here are\u00a0<a href=\"http:\/\/www.thehealthcareblog.com\/the_health_care_blog\/2010\/12\/the-difficult-science.html\" target=\"_blank\">part 1<\/a> and <a href=\"http:\/\/www.thehealthcareblog.com\/the_health_care_blog\/2010\/12\/the-difficult-science-part-ii-.html\" target=\"_blank\">part 2<\/a>.<\/p>\n<p>This is about &#8220;how do we know what we think we know &#8211; and what the heck can we do with this uncertainty??&#8221; It starts with a real-world conundrum:<\/p>\n<blockquote><p>On the same day in November, headlines from the Wall Street Journal and the New York Times reported on the same story.<\/p>\n<p><strong>\u201cTriple That Vitamin D Intake, Panel Prescribes\u201d<\/strong> [said] the WSJ story;\u00a0<strong>\u201cExtra Vitamin D and Calcium Aren\u2019t Necessary, Report Says\u201d <\/strong>stated the New York Times. (Discussion on <a href=\"http:\/\/ow.ly\/3tJMe\" target=\"_blank\">Freakonomics<\/a>)<\/p>\n<p>How should you decide what advice to follow about the relationship between your diet, lifestyle, medications, health, and wellness?<\/p>\n<p>Is this just another example of how the media does a terrible job? &#8230; It turns out that it is really complicated to figure out what the \u201ctruth\u201d is about diet, exercise, medicines, and your individual well being. Everybody (journalists, government panel members, scientists, patients, physicians, and nurse practitioners) needs to change.<\/p><\/blockquote>\n<p>He goes on to detail, thoughtfully, his recommendations for each of those fields. It&#8217;s a long read, because the truth here isn&#8217;t simple. Well worth it.<br \/>\n<!--more-->____________<\/p>\n<p><em>Related material &#8211; <\/em><\/p>\n<p>Kent&#8217;s posts here include <a href=\"https:\/\/participatorymedicine.org\/epatients\/archives\/2010\/07\/why-kent-bottles-md-joined-the-society-for-participatory-medicine.html\">Why I Joined the Society for Participatory Medicine<\/a> and\u00a0<a href=\"https:\/\/participatorymedicine.org\/epatients\/archives\/2009\/07\/guest-post-on-the-ideal-doctorpatient-relationship-kent-bottles-md.html\">The Ideal Doctor-Patient Relationship<\/a>. The latter asks, &#8220;Can Doctors Ever Know What Will Benefit the Patient?&#8221; This is a core question in the field of SDM (shared decision making), because patients often ask doctors &#8220;What would you do, if you were me?&#8221;<\/p>\n<p>Take a fresh look, too, at this short Susannah Fox post from 12\/1\/09:<\/p>\n<blockquote><p><strong>Inviting Controversy: David Eddy at ICSI<br \/>\n<\/strong><br \/>\nDavid Eddy did nothing to reassure Kent Bottles about evidence-based guidelines in his\u00a0<a href=\"http:\/\/icsihealthcareblog.wordpress.com\/2009\/11\/30\/kent-bottles-david-eddy-delivers-controversial-reinertsen-lecture-about-future-of-evidence-based-medicine\/\" target=\"_blank\">recent keynote<\/a>, saying essentially: \u201cThe problem is that\u00a0<a href=\"http:\/\/www.businessweek.com\/magazine\/content\/06_22\/b3986001.htm\" target=\"_blank\">we don\u2019t know what we are doing<\/a>\u201d (!!)<\/p><\/blockquote>\n<p>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 <em>not <\/em>work at preventing complications, and simpler things do.<\/p>\n<p>Sure wish I could see that presentation &#8211; blowing minds and changing an org the size of Kaiser is a neat trick in ten minutes!<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Kent Bottles MD is one of the best healthcare thinkers I&#8217;ve met. 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