The Science of Medicine - SOM®
by BradMD
(Brad Hennenfent, MD)
What is the science of medicine?
The science of medicine is the first step of evidence-based medicine. So, What is evidence-based medicine?
Evidence-based medicine consists of three things.
1. What the science says
2. What the physician knows
3. What the patient wants
I have summarized my simple definition of evidence-based medicine partly from a complicated 2008 medical article, which defines evidence-based medicine as:
"Evidence based medicine (EBM) is the conscientious, explicit, judicious and reasonable use of modern, best evidence in making decisions about the care of individual patients. EBM integrates clinical experience and patient values with the best available research information."
SOURCE: Izet Masic, Milan Miokovic, and Belma Muhamedagic. Evidence Based Medicine – New Approaches and Challenges. Acta Inform Med. 2008; 16(4): 219–225. Accessed 11-28-2018. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3789163/
You can see that this "Masic, Miokovic, and Muhamedagic" definition combines three things:
1. best evidence
2. clinical experience
3. patient values and preferences
What makes it confusing is that there are three terms:
1. Science-based medicine
2. Evidence-based medicine
3. Evidence-based practice
These terms are defined differently in different places and during different times in medical history. Most people would probably be surprised at the range of definitions and controversies surrounding evidence-based medicine.
Gordan Guyatt, MD, from McMaster University is credited with inventing the term "evidence-based medicine" and publishing it in 1991.
SOURCE: Guyatt GH. Evidence-Based Medicine [editorial]. ACP Journal Club 1991:A-16. (Annals of Internal Medicine; vol. 114, suppl. 2).
One website says: "Dr. Gordon Guyatt from McMaster University, who coined the term 'evidence-based medicine'...."
SOURCE: UpToDate. Accessed 11-28-2018. https://www.uptodate.com/home/editorial
The McMaster University website, in an article written by Gordon Guyatt, MD, says:
"What are the defining principles of EBM?
"EBM describes a set of practices to help solve clinical problems
"Essentially, EBM encourages physicians to use the best available evidence to inform clinical decisions
"Evidence takes the form of published literature, or unpublished personal observations"
SOURCE: Gordon Guyatt. Evidence-based Medicine. McMaster University Website. Accessed 11-28-2018.
https://www.mcmaster.ca/cfh/ktebm.html
Note, that in the original Gordon Guyatt - McMaster University definition of evidence-based medicine, the patient was left out of the decision-making process. Gordon Guyatt, and McMaster University defined evidence-based medicine as only two things:
1. Best available evidence
2. Unpublished personal overservations
The patient was left out of EBM in the beginning, and medicine remained paternalistic. The doctor told you what was best, based on what the doctor thought was the best evidence and based upon the doctor's unpublished personal observations.
Today, because of the transparency of information brought about by the Internet, many patients, patient groups, doctors, and nurses are trying to end paternalistic medicine and move medicine, the science of medicine, evidence-based medicine, or evidence-based practice, into a process of shared decision-making so that the patient is never left behind. In medical ethics, this is part of the principle of "patient autonomy."
Problems - Medical Treatments - Treatment Scores
This short video describes how patients and physicians should be doing evidence-based medicine and shared decision-making together, calculating the Net Treatment Benefit for the patient. The direct URL is: https://youtu.be/ymJVwiFDxD0
When you get sick with any illness you need a list of treatments with Treatment Scores. The Treatment Score = the net treatment benefit for the patient.
The Treatment Score is calculated using EBM guidelines and shared decision-making. Treatment Scores solve health illiteracy while taking into account the values and preferences of individual patients.
Together you use the:
- Outcome measure important to the patient
- Time scale important to the patient, and
- Absolute outcome measures not relative outcome measures
Treatment Scores Solve Problems
Dr. Kit Byatt and Sarah Chapman recently published an article titled, "Being patient with EBM. 'Just because we can, doesn’t mean we should' – supporting informed decision-making."
It's an excellent article about what patients, doctors, and healthcare journalists need, so let's offer a solution.
The authors want certain things when it comes to medical information. They see problems. To quote from them:
"This information should be in a form that:
Treatment Scores solve the problems listed in this article. The Treatment Score = the net treatment benefit for the patient.
Furthermore, the Treatment Score = the net treatment benefit for the patient using evidence-based medicine guidelines and shared decision-making. In other words, Treatment Scores make the medical literature simple and understandable for patients, doctors, and healthcare reporters using absolute outcome measures. Treatment Scores also allow for the values and preferences of patients to be taken into account.
What patients need, and what physicians and healthcare journalists need to report is a list of treatments with Treatment Scores for every disease. Treatment Scores would be the starting point for shared decision-making because of the chain of visual aids behind them that make them clear, understandable, and adaptable to patient input.
REFERENCE:
Kit Byatt and Sarah Chapman. "Being patient with EBM. 'Just because we can, doesn’t mean we should' – supporting informed decision-making." Evidently Cochrane. April 26, 2018.
http://www.evidentlycochrane.net/being-patient-with-ebm-supporting-informed-decision-making/
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 Treatment Scores. Treatment Scores are for informational 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 to patients studied in the past; they do not predict the future.
COPYRIGHT:
Copyright © 2018 Treatment Scores, Inc. All Rights Reserved.
It's an excellent article about what patients, doctors, and healthcare journalists need, so let's offer a solution.
The authors want certain things when it comes to medical information. They see problems. To quote from them:
- "Offer people information about their absolute risk of...absolute benefits and harms of an intervention...."
"This information should be in a form that:
- "presents individualised risk and benefit scenarios and
- "presents the absolute risk of events numerically and
- "uses appropriate diagrams and text."
Treatment Scores solve the problems listed in this article. The Treatment Score = the net treatment benefit for the patient.
Furthermore, the Treatment Score = the net treatment benefit for the patient using evidence-based medicine guidelines and shared decision-making. In other words, Treatment Scores make the medical literature simple and understandable for patients, doctors, and healthcare reporters using absolute outcome measures. Treatment Scores also allow for the values and preferences of patients to be taken into account.
What patients need, and what physicians and healthcare journalists need to report is a list of treatments with Treatment Scores for every disease. Treatment Scores would be the starting point for shared decision-making because of the chain of visual aids behind them that make them clear, understandable, and adaptable to patient input.
REFERENCE:
Kit Byatt and Sarah Chapman. "Being patient with EBM. 'Just because we can, doesn’t mean we should' – supporting informed decision-making." Evidently Cochrane. April 26, 2018.
http://www.evidentlycochrane.net/being-patient-with-ebm-supporting-informed-decision-making/
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 Treatment Scores. Treatment Scores are for informational 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 to patients studied in the past; they do not predict the future.
COPYRIGHT:
Copyright © 2018 Treatment Scores, Inc. All Rights Reserved.
What is the Treatment Score for that?
Whenever you are undergoing a medical treatment, you need to ask, "What is the Treatment Score for that?
The Treatment Score = the net treatment benefit for the patient. The higher the Treatment Score the better the treatment effect for patients as summarized from the medical literature.
Undertreatment and overtreatment occur because we don't know the Treatment Scores for anything. Runaway healthcare costs are happening because we don't know the Treatment Scores. If you undergo a treatment, does the medical literature suggest that patients will live only 2.6 weeks longer or 10 years longer? What is the cost/benefit for you? Knowledge is power.
Does a new treatment have a Treatment Score of 95% in terms of curing a disease, but you don't even know about it?
Importantly, the Treatment Score = the net treatment benefit for the patient (with the patients' values and preferences included). Treatment Scores allow for value-based healthcare to actually happen.
Got cancer? What is the Treatment Score for your suggested chemotherapy?
Got Alzheimer's disease? What are the Treatment Scores for Aricept, Namenda, Depakote, Zoloft, and Mobic? These are all medications that someone with Alzheimer's might be given.
Got insomnia? There are 130 treatments. What are the Treatment Scores for each and every one of those Treatments?
Have you ever wondered why you are not given this simple number, "the net treatment benefit," for any medical treatment (especially when it is life and death important)? Why is it that we can figure out "gross income" and "net income" every year, but we cannot figure out "gross treatment benefit" and "net treatment benefit" for patients? Answer: It's because the math is difficult.
Treatment Scores solve these problems:
DISCLAIMER: Always see your own licensed medical physician for diagnosis and treatment. Treatment Scores are for informational purposes only.
The Treatment Score = the net treatment benefit for the patient. The higher the Treatment Score the better the treatment effect for patients as summarized from the medical literature.
Undertreatment and overtreatment occur because we don't know the Treatment Scores for anything. Runaway healthcare costs are happening because we don't know the Treatment Scores. If you undergo a treatment, does the medical literature suggest that patients will live only 2.6 weeks longer or 10 years longer? What is the cost/benefit for you? Knowledge is power.
Does a new treatment have a Treatment Score of 95% in terms of curing a disease, but you don't even know about it?
Importantly, the Treatment Score = the net treatment benefit for the patient (with the patients' values and preferences included). Treatment Scores allow for value-based healthcare to actually happen.
Got cancer? What is the Treatment Score for your suggested chemotherapy?
Got Alzheimer's disease? What are the Treatment Scores for Aricept, Namenda, Depakote, Zoloft, and Mobic? These are all medications that someone with Alzheimer's might be given.
Got insomnia? There are 130 treatments. What are the Treatment Scores for each and every one of those Treatments?
Have you ever wondered why you are not given this simple number, "the net treatment benefit," for any medical treatment (especially when it is life and death important)? Why is it that we can figure out "gross income" and "net income" every year, but we cannot figure out "gross treatment benefit" and "net treatment benefit" for patients? Answer: It's because the math is difficult.
Treatment Scores solve these problems:
- Health illiteracy, because Treatment Scores are simple to understand.
- Runaway healthcare costs. We cut healthcare costs by creating treatment transparency for all medical treatments. Treatment Scores are the starting point for evidence-based medicine with shared decision-making.
- Lack of time. We save doctors, patients, nurses, insurers, and governments time because we digest the medical literature down to one number.
DISCLAIMER: Always see your own licensed medical physician for diagnosis and treatment. Treatment Scores are for informational purposes only.
Treatment Scores fix Problems
Treatment Scores are for the web, mobile web, and digital health. Treatment Scores solve three of healthcare's biggest problems: patient involvement, patient engagement, and shared decision-making. Treatment Scores save time, money, improve quality, and have the potential to solve health illiteracy. Treatment Scores make evidence-based medicine understandable.
Many of the buzzwords currently going around can only truly happen with Treatment Scores:
- personalized medicine
- treatment transparency
- patient empowerment
- patient engagement
- quality-based care
- value-based care
- precision medicine
- informed consent
Cost benefit analyses cannot be done without Treatment Scores.
Think of it in obvious terms. Every year you calculate your net income:
Net income = Gross Income - expenses.
Yet, in the whole history of medicine, we have never routinely calculated the "net treatment benefit for the patient," which we call the Treatment Score.
Treatment Score = gross treatment benefit + side benefits - side effects.
It's a lot of math; often 10,000 variables. Treatment Scores may be a technology a few minutes ahead of its time, because few people understand medical statistics. However, software is solving that problem, because it puts a graphical user interface over the math.
Treatment Scores are likely to help you personally someday. Treatment Sores have the potential to save lives and keep people healthy.
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