Your Medical Mind_ How to Decide What Is Right for You - Jerome Groopman [104]
62 Rodney Hayward’s important article is in Kerianne H. Quanstrum, Rodney A. Hayward, “Lessons from the mammography wars,” NEJM 363 (2010), pp. 1076–1079. Also see Finlay A. McAlister, “Applying evidence to patient care: From black and white to shades of grey,” Ann Intern Med 138 (2003), pp. 938–939; Carla C. Keirns, Susan Dorr Goold, “Patient-centered care and preference-sensitive decision making,” JAMA 302 (2009), pp. 1085–1086.
63 In addition, “arbitrary” cutoffs for treatment of atrial fibrillation are discussed in Liana Fraenkel, Terri R. Fried, “Individualized medical decision making,” Archives of Internal Medicine 170 (2010), pp. 566–569.
63 For a discussion of guidelines and their limitations, see Allan D. Sniderman, Curt D. Furberg, “Why guideline-making requires reform,” JAMA 301 (2009), pp. 429–431; John P. A. Ioannidis, “Contradicted and initially stronger effects in highly cited clinical research,” JAMA 294 (2005), pp. 218–228; Mary E. Tinetti, “Potential pitfalls of disease-specific guidelines for patients with multiple conditions,” NEJM 351 (2004), pp. 2870–2874; Patrick J. O’Connor, “Adding value to evidence-based clinical guidelines,” JAMA 294 (2005), pp. 741–743; Finlay A. McAlister et al., “Users’ guides to the medical literature. Integrating research evidence with the care of the individual patient,” JAMA 283 (2000), pp. 2829–2836; Patrick Conway, Carolyn Clancy, “Comparative-effectiveness research: Implications of the federal coordinating council’s report,” NEJM 361 (2009), pp. 328–330; Jerome Groopman, How Doctors Think (New York: Houghton Mifflin, 2007); Pamela Hartzband, Jerome Groopman, “Keeping the patient in the equation: Humanism and health care reform,” NEJM 361 (2009), pp. 554–555; Jerome Groopman, “Health care: Who knows ‘best’?” New York Review of Books 57 (2010), pp. 12–15; Editorial, “Guiding the guidelines,” Lancet 377 (2011), p. 1125. Because of the many limitations of guidelines, some researchers propose “individualized” guidelines. These are centered on outcome and cost but do not include detailed utility assessment: David M. Eddy et al., “Individualized guidelines: The potential for increasing quality and reducing costs,” Ann Intern Med 154 (2011), pp. 627–634.
64 There are differing expert recommendations about how to treat elevated cholesterol levels in adults, including “Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III),” Circulation 106 (2002), pp. 3143–3421; Uli C. Broedl, Hans-Christian Geiss, Klaus G. Parhofer, “Comparison of current guidelines for primary prevention of coronary heart disease,” JGIM 18 (2003), pp. 190–195. This study done in Germany of one hundred consecutive people seen in a clinic for elevated cholesterol analyzed whether each patient would be treated with a statin drug according to one set of guidelines in the United States versus a set of guidelines shared among European countries and a third set developed in the United Kingdom. Twice as many Americans would have a statin drug recommended to treat their elevated cholesterol compared with Europeans and more than twice as many compared with people in England, Scotland, and Wales. This is not because American physicians who formulate these recommendations are smarter or more ignorant than their counterparts or that one expert group is working from a different database compared with another group. All three of the expert committees were analyzing the information primarily from large multiyear clinical studies. Rather, differences in recommendations reflect differences in weighing the value of the treatment in preventing certain cardiovascular problems versus the risks of the medications and, to be sure, their costs.
64 Potential conflicts