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Tag: Translational medicine

What’s So Wrong With Randomized Trials?

Screen Shot 2014-09-24 at 7.32.39 PMOften, at scientific conferences, the most important learning happens in the question and answer period.

I spoke at the American Diabetes Association conference earlier this year, presenting results of an observational study we did on medication adherence and diabetes.

We found that if people starting using the online patient portal (sometimes called the personal health record), to order their medication refills, they were more likely to take their medication regularly. Dr. Katherine Newton of Group Health Research Institute spoke before me, describing a randomized study showing that a clinical pharmacist-led blood pressure management program did not lower blood pressure any more than usual care by an outpatient provider.

The first audience comment came from a program officer from the National Heart, Lung, Blood Institute, part of the National Institutes of Health. Program officers are incredibly important because they help set the research priorities for the major funding mechanism for medical research. I will never forget her comment, because it was so strongly worded.

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The Mentalists

Obama’s most significant healthcare-related accomplishment this year may well have been his campaign’s demonstration of the effective use of analytics and behavioral insight – strategies that also offer exceptional promise for the delivery of care and the maintenance of health.

For starters, of course, there’s the widely-reported “big data” success of the Obama campaign.  In unprecedented fashioned, they collected, mined, analyzed, and actioned information, microtargeting voters in a remarkably individualized fashion.

Imagine if healthcare interventions could be personalized as effectively (or pursued as passionately).

Another example:  according to the NYT, the Obama campaign hired a “dream team” of behavioral psychologists to burnish their message and bring out the vote, using a range of techniques the field has developed over the years.

According to the article, the behavioral experts “said they knew of no such informal advisory committee on the Republican side.”

This idea of focusing intensively on behavior change is without question an idea whose time has come.

Earlier this year, for instance, a colleague (with similar training in medicine, molecular biology, and business) and I were surveying the biopharma landscape, and were struck by the extent to which classic biology hasn’t (yet) delivered the cures for which we had hoped; physiology turns out to be extremely complicated, and people, and communities, even more so.

We were also struck by the remarkably low adherence rates for many drugs, abysmal whether you look at this from the perspective of clinical care or commercial opportunity (imagine if Toyota lost half their cars on the way to the dealership).
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