Evidence-Based Medicine for Insomnia using Treatment Scores: Figuring out the Diagnosis

Evidence-based medicine is not easy. Let's review the medical literature (using TreatmentScores.com) for treatments for insomnia. Our first obstacle is organization. We are going to have to look at insomnia six different ways.

There are at least five different symptom scales for insomnia. They are the Insomnia Questionnaire Score, the Insomnia Severity Index, the Leeds Sleep Evaluation Questionnaire, the Pittsburgh Insomnia Rating Scale, and the Visual Analog Scale.

We will have to look at insomnia with each of these symptom scales as the main outcome measure, and we will also look at insomnia trying to combine all the outcome measures. This project has already turned into an organizational nightmare, but TreatmentScores.com makes it more doable than ever before.

In fact, let's look at just one potential treatment to get started. Someone who suffers from insomnia asked me about cherry juice for insomnia. They had read about treating insomnia with cherry juice in a magazine.

One of the great things about TreatmentScores.com is that it doesn't matter whether it's Eastern medicine, Western medicine, herbal medicine, or any other type of alternative medicine. What matters is if a study (or studies) and statistics exist.

However, I have run into my second big obstacle. I have to find the statistics. Statistics that should be available to me in seconds are not available to me. They will be available to me in seconds in the future when TreatmentScores.com goes from an alpha website to a beta website, which will take some time. For now, I have to download and read some studies. Meanwhile, stay tuned for part 2 on insomnia.

Follow Treatment Scores:
Twitter:
https://Twitter.com/TreatmentScores
Facebook:
https://Facebook.com/TreatmentScores
Blog:
http://TreatmentScoresBlog.com
Website:
http://TreatmentScores.com

DISCLAIMERS:
You must consult your own licensed physician, or other licensed medical professional, for diagnosis, treatment, and for the interpretation of all medical statistics including SOM® Treatment Scores. Treatment Scores are for educational purposes only. Treatment Scores may be incomplete, inaccurate, harmful, or even cause death if used for treatment instead of consulting a licensed medical professional. No medical advice is being given. We DO NOT CLAIM to cure, treat, or prevent any illness or condition. Nor do our services provide medical advice or constitute a physician patient relationship. Contact a physician or other medical professional if you suspect that you are ill. Call emergency services (call 911 if available) or go to the nearest emergency room if an emergency is suspected. We are not responsible for any delays in care from using our website, our services, or for any other reason. We are not responsible for any consequential damages of any nature whatsoever. We make no warranties of any kind in connection with our writings or the use of TreatmentScoresBlog.com or TreatmentScores.com. Treatment Scores are about what happened in the past they do not predict the future.

Copyright
Copyright © 2015 Treatment Scores, Inc.

Putting a Graphical User Interface on Evidence-Based Medicine

Have you been watching the diet wars? People have strong opinions about low-fat, high-fat, carbohydrates, sugar, protein, gluten, genetic influence, and every diet out there.

I want to see the numbers. I want to see exactly what people are thinking when they make a claim. However, typically when I read an article there are very few numbers, but lots of opinion. How can we reverse that? How does one figure out who is using the best statistics and the best evidence-based medicine? (There are some great evidence-based medicine experts who are writing excellent articles.)

What we need to do is put a graphical user interface (GUI) on the evidence-based medicine process. That's what we are doing at TreatmentScores.com, and that's what we are writing about here at TreatmentScoresBlog.com.

Remember the early days of the computer when only those who could do machine programming could use a computer? Then, Apple and Windows (or maybe someone else) put on a graphical user interface and suddenly everyone could use a computer?

At TreatmentScores.com we are putting a graphical User Interface (GUI) over the evidence-based medicine process, and are going to make it so simple and convenient that doctors, nurses, and all patients around the world can do it as an educational experience. We already have a minimum viable product - in the form of an alpha website.

Our Treatment Score Analyzer™ will eventually allow shared decision-making and evidence-based medicine to be combined.

The Treatment Score Analyzer™ has four parts:

1. Diagnosis Tool™
2. Treatment Organizer™
3. Treatment Score Calculator™
4. STAR™ Blocks

Stay tuned by subscribing to this blog with your email address in the box at the top right, or bookmark this URL so you can come back often.

Follow Treatment Scores:

Twitter:

https://Twitter.com/TreatmentScores

Facebook:

https://Facebook.com/TreatmentScores

Blog:

http://TreatmentScoresBlog.com

Website:

http://TreatmentScores.com

DISCLAIMERS:

You must consult your own licensed physician, or other licensed medical professional, for diagnosis, treatment, and for the interpretation of all medical statistics including SOM® Treatment Scores. Treatment Scores are for educational purposes only. Treatment Scores may be incomplete, inaccurate, harmful, or even cause death if used for treatment instead of consulting a licensed medical professional. No medical advice is being given. We DO NOT CLAIM to cure, treat, or prevent any illness or condition. Nor do our services provide medical advice or constitute a physician patient relationship. Contact a physician or other medical professional if you suspect that you are ill. Call emergency services (call 911 if available) or go to the nearest emergency room if an emergency is suspected. We are not responsible for any delays in care from using our website, our services, or for any other reason. We are not responsible for any consequential damages of any nature whatsoever. We make no warranties of any kind in connection with our writings or the use of TreatmentScoresBlog.com or TreatmentScores.com. Treatment Scores are about what happened in the past they do not predict the future.

Copyright

Finding the Evidence Behind Treatments

SOM® Treatment Scores

Every day I find myself wondering about the details of our treatment options for patients. Most conditions have an array of options for patients. These are in addition to the home remedies and Eastern medicine alternatives which patients are inquiring about and are beginning to be trialed in the literature. One of the toughest decisions we make with the patient and their family is: Which treatment has the best evidence behind it for a particular disease?

Our medical literature gives us guidance on this question. We have randomized controlled trials to compare treatments, and we have systematic reviews, Cochrane reviews, and meta-analyses where there is significant controversy. These studies and reviews build a strong foundation for our individualized conversations with patients. Increasingly the doctor-patient relationship is becoming more of a partnership with the physician giving advice and recommendations, but also giving patients the options and a thorough discussion about which option may or may not be appropriate for each individual patient. I find this leads to situations and attempted comparisons made from extrapolation of the literature.

Here’s an example. Take the case of a simple traumatic iritis. No other ophthalmic problems, just a simple mild iritis from blunt trauma without other traumatic sequelae. The treatment options in this scenario typically include: observation, topical steroids, or topical steroids plus pharmacological dilation. Seems relatively straight forward – until you consider the individualization of treatment for each patient. Let’s say the patient is a pilot and will not be able to function if you pharmacologically dilate her eye. What’s the literature or support for cycloplegia (giving medication to dilate the eye) in simple traumatic iritis?

What has happened to patients who have been studied in the past regarding true risks and benefits both with or without treatment? We end up extrapolating from broader literature and attempting to score each treatment for the patient’s situation. In this case the pilot and her physician may elect not to receive pharmacological dilation, or may choose a short treatment period. Now imagine the patient was known to develop high intraocular pressure with steroids, or that the patient is a child? We quickly begin to find that our literature can be somewhat difficult to apply to each and every individual situation and may require some extrapolation. Hence the Art of Medicine.

Similar scenarios play out in many disease processes in all specialties every day. Over the next few weeks I am going to take you step-by-step through a new tool, the Treatment Score Analyzer™, we now have to give a simple, inclusive, and comprehensive comparison of the literature supporting each treatment. The evidence-based scoring of treatment options will hopefully empower us to make better decisions both for and with our patients every day. See the disclaimers below.

Follow Treatment Scores!

Twitter:

https://Twitter.com/TreatmentScores

Facebook:

https://Facebook.com/TreatmentScores

Blog:

http://www.treatmentscoresblog.com/

Website:

http://TreatmentScores.com

Disclaimers:

Evidence-Based Medicine, Treatment Scores, and the Hepatitis C Commercial on TV

Have you seen the commercial on TV for Harvoni? It's one of the seemingly hundreds of TV commercials about medicines frequently seen on TV. When I saw the Harvoni commercial I was skeptical. Was it all hype or was it for real? Hepatitis C is a bad disease and if you Google it, many celebrities have allegedly suffered from it such as: Stephen Tyler, Evel Knievel, David Crosby, and Pamela Anderson.

So, how does one do an evidence-based medicine review of the literature? First, I established the diagnosis that I wanted to review. After doing some searching on Medline I came up with: hepatitis C, chronic, genotype 1 infection.

Then, I decided on the outcome measure. The outcome measure most important to the patient, in my opinion, is a cure of hepatitis C. The medical literature uses the phrase: "sustained virologic response," which means that no virus can be detected in your body. It's more cautious than using the word cure. After all, what if the disease relapses years later?

At this point, to define things further I was willing to look at "adult patients" and "any time period" of follow-up. Although, after I while I realized that many studies used 12 weeks as their follow-up time period.

So, I collected some studies into STAR™ Blocks. STAR™ stands for a "Statistic and a Reference."

I was able to find some great randomized controlled studies. The main outcome measure was above 90% for sustained virologic response in three such studies. I finally settled on 95% as the number I would use as a weighted average of the statistics from the three studies.

This gave me a Treatment Score Calculator™ that looks like this:

I now have the main statistic on the left and the secondary statistics on the right. I still need to go through and come up with event rates for all the secondary statistics. But for right now, I think they are worth getting "cured" of chronic hepatitis C. Since they are relatively minor side effects I am only reducing the main statistic down one point to get a Treatment Score of 94 for Harvoni. This may change later with more study.

In other words, the medical literature seems to say, as I now understand it, that there is a 94% net treatment benefit when you treat Chronic hepatitis C of this type with Harvoni. That's much better than the old "gold standard" treatment with interferon.

The bottom line is that with a new statistic, the SOM® Treatment Score, we can begin to quantify the science of medicine behind treatments as part of the educational process. And we can make the entire process transparent to the patient from the diagnosis, to a list of treatments, to the Treatment Score Calculator™, and finally to the STAR™ Blocks. This system will eventually allow for shared decision-making and evidence-based medicine to be combined.

Follow Treatment Scores:

Twitter:
https://Twitter.com/TreatmentScores

Facebook:
https://Facebook.com/TreatmentScores

Blog:
http://TreatmentScoresBlog.com

Website:
http://TreatmentScores.com

DISCLAIMERS: You must consult your own licensed physician, or other licensed medical professional, for diagnosis, treatment, and for the interpretation of all medical statistics including SOM® Treatment Scores. Treatment Scores are for educational purposes only. Treatment Scores may be incomplete, inaccurate, harmful, or even cause death if used for treatment instead of consulting a licensed medical professional. No medical advice is being given. We DO NOT CLAIM to cure, treat, or prevent any illness or condition. Nor do our services provide medical advice or constitute a physician patient relationship. Contact a physician or other medical professional if you suspect that you are ill. Call emergency services (call 911 if available) or go to the nearest emergency room if an emergency is suspected. We are not responsible for any delays in care from using our website, our services, or for any other reason. We are not responsible for any consequential damages of any nature whatsoever. We make no warranties of any kind in connection with our writings or the use of TreatmentScoresBlog.com or TreatmentScores.com. Treatment Scores are about what happened in the past they do not predict the future.

Copyright
Copyright © 2015 Treatment Scores, Inc.

Why No One Understands Treatments: Lack of Easy Basic Math (EBM™) and Net Treatment Benefit (NTB™)

A well done study in the CMAJ shows that 60 to 80% of physicians don't understand the treatment effects from studies. If highly trained, highly intelligent physicians don't know what's going on, what chance do patients have without any training at all? We need to do things differently. We need simpler statistics for the Science of Medicine (SOM®) behind treatments and we need to explain everything in Easy Basic Math (EBM™).

Why is this important to patients? Because patients need the net treatment benefit (NTB™). However, the statistics that studies actually give doctors and patients are things like the relative risk ratio, the hazard ratio, the odds ratio, the number needed to treat, disease specific survival, surrogate outcome measures, risk difference, relative risk, ratio of means, standardized mean difference, and so on and so forth.

In other words medical studies produce "gibberish" that few people understand. This is why, the Patient-Centered Outcomes Research (PCORI) team says, “Every day, patients and their caregivers are faced with crucial health care decisions while lacking key information that they need.”

PCORI also says that we need to translate “…existing scientific research into accessible and usable formats…”

Shockingly, Dr. John P.A. Ioannidis, MD, DSc, wrote "Why Most Published Research Findings Are False" in 2005. It struck a chord as Ioannidis has been cited 3,130 times according to Google Scholar.

In other words, understanding treatments is a mess for many different reasons!

We are attempting to fix the "treatment transparency" problem at Treatment Scores, Inc. You should follow this blog or follow us on Twitter, Facebook, or at our early Alpha website as below:

https://twitter.com/TreatmentScores

https://www.facebook.com/TreatmentScores

http://TreatmentScores.com/

Let's fix this mess.

References:

"Do clinicians understand the size of treatment effects? A randomized survey across 8 countries." by Bradley C. Johnston, Pablo Alonso-Coello, Jan O. Friedrich, et al. October 26, 2015.

http://www.cmaj.ca/content/early/2015/10/26/cmaj.150430

PCORI Funding Announcement: Communication and Dissemination Published May 22, 2012. Revised September 17, 2012.
http://www.pcori.org/assets/FINAL-PFA-Communication-and-Dissemination-v3.pdf

"Why Most Published Research Findings Are False." by John P. A. Ioannidis, M.D., Dsc. PLOS Medicine. August 30, 2005. http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.0020124

Treatment Scores Blog

Terms of Use

Follow on Twitter