Wednesday, 28 November 2018

Technological disruption in health

Salvador Casado

We all talk about the technological revolution being witness about how it is transforming our environment. First there were the travel agencies, then the taxis, later the tourist apartments rental, o online shopping, online education...

However, one question remains to be answered: how will health disruption affect health systems and their professionals and users?

From my point of view we can know something: the change will be progressive and will come from the successive implementation of technologies that provide advances in different aspects of clinical practice, management and organization of resources. We also know that health systems are huge organisations with high inertia and that health professionals tend to have a conservative profile when it comes to incorporating new technologies. Before we adopt them we need to have scientific evidence that is both useful and beneficial to the patient and society. The problem is that scientific evidence is costly and very slow. The average time for a new molecule to become an accepted drug is about ten years, which is unreasonable for products and services in the digital sphere.

Monday, 26 November 2018

Incentives to change unhealthy habits: Do they work? Are they ethical?

Pedro Rey

In a previous post I talked about the use of economic incentives to improve the quality of the prescription that physicians make. Today I want to focus on the other side of the problem, that of patients who try to self-stimulate or receive external incentives, to change their life habits towards healthier behaviour. There are two questions of interest for me: 1. Do incentives work? 2. Is it "ethical" to use "economic" incentives to induce changes towards healthier behaviours?

Monday, 19 November 2018

Precision medicine cannot turn its back on emotions

Gustavo Tolchinsky

Two weeks ago in his post, Jordi Varela brought us a critical vision of precision medicine, which shows us a somewhat less triumphalist scenario than expected. Precision medicine was born with the intention to give better answers to spaces of uncertainty regarding clinical problems from different areas of medicine such as genomics or big data. Linking with this theme, we shouldn’t forget that even being more effective than what has been proven at the moment, we still depend on the human factor to reach the best possible result. When it comes to decision making, multiple factors are involved. There is a rational part, which we believe we control, but above all there is an emotional part that ends up directing us towards that scenario in which we believe we are going to be more comfortable in.

Montori points out that the tools he uses in decision-making only serve as a support, aware that the emotional factor needs to be guided with the least abstract information possible. In addition to that, our verbal communication carries more than one message: the explicit and the symbolic. The explicit derives from the literal meaning, what we call Verbatim, very limited and of an exact, unequivocal definition, and doesn’t give rise to mistakes of understanding by itself. The symbolic is that which derives from the context, the interpretation and the value of those who understand it in their own way, what we call it Gist.

Monday, 12 November 2018

Should we statinize society?

A 2011 Cochrane review concluded that there was not enough evidence to prescribe statins for people with a cardiovascular risk of less than 20% in 10 years, a claim that was consistent with the British NICE guideline (2006-2008) and with the American Heart Association (2011). The surprise came when, unexpectedly, the 2013 Cochrane review changed its mind and lowered the statin threshold to the 10% risk at 10 years, a recommendation that was quickly adopted by the NICE guidelines.

Strongly opposed to this change of approach, John Abramson (Harvard Medical School), and collaborators, in "Should people at low risk of cardiovascular disease take a statin?" ensure that with the criteria of 2011, in the population over 60 years, it would have been necessary to statin 16% of women and 48% of men, but with the recommendations of 2013 the market was extended to practically all the population of older people, given that age is the most influential cardiovascular risk variable in risk calculators. The authors have reviewed the meta-analysis that led to the change of criteria ("The effects of lowering LDL cholesterol with statin therapy in people at low risk of vascular disease: meta-analysis of individual data from 27 randomized trials") and have reached conclusions that contradict the Cochrane recommendations of 2013:

Monday, 5 November 2018

Reflections on precision medicine

Precision medicine, or personalized medicine, is an initiative of the US government that aims to adjust, according to individual characteristics, the prevention and treatment of diseases with genetic, phenotypic, clinical, environmental and lifestyle data. For this reason, the federal government, through the National Institutes of Health (NIH), is financing projects to sequence more genomes, create large bio-banks and generate big data studies from electronic medical records and all types of electronic devices of diagnosis and monitoring (for more information we advise you to visit the post of Cristina Roure on the subject).