The NYTimes had a recent article on real world testing of drugs. This raises questions, such as how are consumers to be informed today?
There are limited head to head
trials, and almost all of the data comes from highly selected groups of
individuals under conditions that are nearly impossible to replicate in
the real world. Ivory tower medicine indeed, giving us the best case
scenarios only…but far from the outcome impact for all the spend and
utilization occurring in very different ways out in the real world.
It’s an interesting question as to which should be the better gold standard in addressing the patient before a physician: randomized clinical trials with non-matching study populations or outcome databases with real world utilization of patients matching her symptoms?
This used to be a hypothetical question and rationale for the quest
for the holy EMR (the one to unite them all). However, recent advances
in social networking using pools of individual experiences in places
like Patients Like Me and Sermo bring tantalizing “wisdom of the crowds” potential in evaluating the effectiveness of various treatments.
As medical tools increasingly help us to personalize and segment
populations, it forces a pause in how the delivery of the appropriate
data and heuristics will occur. In a world where we ask individuals to
make choices, is our ivory tower approach to group statistics relevant
to individuals who want the best for them?
Vijay Goel is a doctor and former McKinsey & Co. consultant based in Los Angeles. He blogs regularly at Consumer-focused Healthcare.