Category Archives: research methodology

His Brother’s Keeper – The PatientsLikeMe story

Heyworth is the founder and former CEO of the ALS Therapy Development Institute (ALS TDI), a non-profit biotechnology organization driven to developing treatments for amyotrophic lateral sclerosis (ALS). The first half of Heyworth’s talk focused on his emotional motivation for ALS TDI, which began when his younger brother Stephen was diagnosed with ALS. Heyworth’s investigation into the options available for managing his brother’s disease revealed a disturbing fact: as much as 80% of ALS research outcomes could not be replicated, making much of the support for ALS clinical trials statistically unsubstantiated.

Heyworth raised the question of how we can move forward when there are faults in the data at the heart of our assumptions. The fact that ALS, considered one of the best-researched medical conditions, might have no real supportable data drove Heyworth to establish ALS TDI in 1999 with the aim to champion a new model of disease research based outside of academia and for-profit organizations. Heyworth’s story was captured by author Jonathan Weiner in His Brother’s Keeper and by the PBS documentary So Much So Fast.  Heywood’s discussion also touched on his work as co-founder of PatientsLikeMe, an online resource for disease-specific medical information. The tool allows patients to track their diseases and share this information with others dealing with the same conditions. PatientsLikeMe disrupts the current system of clinical trials with patient-driven databases that provide insight into the efficacy of specific treatments.

Taken from: http://www.medgadget.com/2013/11/futuremed-day-4-the-end-of-the-beginning.html

The behaviour change arms race…

Behavior change is difficult, but to date it has dominated by industries, such as the processed food industry, who have mastered the art of mass market behaviour change through a withering combination of product research, development and engineering, marketing, advertising and promotion, all founded on an unstoppable and lucrative business model. At this moment in history, industry is the unopposed, global behaviour change super power. Serious capital investment with serious returns but with the unfortunate side-effect of producing a global epidemic of non-communicable disease.

The institutions charged with protecting the public’s health have been caught flat footed. Rather than trying to neutralise industry’s behaviour change efforts, medically-dominated health systems have instead chosen to layer their own lucrative pharmaceutical and surgical business model on top.

Doctors quite legitimately pay lip service to the “diet and exercise” mantra because they know it doesn’t work. And why doesn’t it work? Because anyone can say eat healthier food and exercise, thus making it difficult to justify their years of training and high fees. It’s much better for doctors to note “diet and exercise”, but then pump the drug and surgery options.

So what needs to happen?

A countervailing super power must be established. Not one founded around a powerful business model, but rather a movement of interested citizens, concerned by the grotesque monentization of the population’s health. In effect, a competing super power in the behaviour change arms race.

Key characteristics:

  • protect the children
  • use evidence, but don’t wait for conclusive results
  • empower with data
  • apply political dark arts

Funding sources:

  • social impact bonds
  • crowd sourcing
  • private health insurers
  • government (not a good time for this)

Inspirations

  • Purpose.com
  • GetUp.org.au

 

Cth Fund on health management apps

  • 40,000 to 60,000 health and wellness apps
  • health app market estimated to be work $700M in 2012, doubling by end of 2013
  • 52% of smartphone owners have used their device to gather health information
  • 19% have at least one health app on their phone
  • safety-net populations have better-than-expected access to mobile devices and are more likely to use their phones to access health information
  • chronic disease (diabetes and asthma) management apps are often extensions of proven interventions that yield clinical benefits and/or financial savings
  • User’s (particularly older users) most popular features: diagnoses, monitoring BP, BSLs
  • User’s least popular features: medication and exercise reminders
  • Providing feedback on progress supports sustained use
  • 30 – 60% of melanomas screened via a teledermatology app were diagnosed as benign!!!!
  • Asthmapolis is an asthma app that is fully integrated with the rescue inhaler to indicate where and when the inhaler is used, correlate that with weather etc.
  • FDA differentiates between lifestyle apps and apps which send data to clinicians – the latter are considered medical devices and will be regulated.

 

PDF: 1713_SilowCarroll_clinical_mgmt_apps_ib

Source: http://www.commonwealthfund.org/Publications/Issue-Briefs/2013/Nov/Clinical-Management-Apps.aspx?omnicid=20

Institute for Health Metrics and Evaluation

 

This extraordinary resource by the Institute for Health Metrics and Evaluation was handsomely funded by the Gates Foundation and features interactive data visualisations across a range of country-based and global data sets. The data has been carefully curated and is very handy for looking at risk factors and causes.

IHME

http://www.healthmetricsandevaluation.org/gbd/visualizations/gbd-arrow-diagram

Lehrer on shaky science… HAH! :: The Decline Effect

Who would have thought that the most esteemed form of scientific research methodology could be so boldly dubious. This is a classic Lehrer New Yorker article, prior to his spectacular fall from grace… such a pity!

Source: http://www.newyorker.com/reporting/2010/12/13/101213fa_fact_lehrer (Local PDF)

Source: http://www.newyorker.com/online/blogs/newsdesk/2011/01/jonah-lehrer-more-thoughts-on-the-decline-effect.html (Local PDF)

The Economist on science

The Economist goes in hard on science, with plenty of compelling insights:

  • VC’s believe half of published scientific research cannot be replicated, though the figures cited from Amgen and Bayer are even more dismal
  • between 2000 and 2010, 80,000 patients took part in clinical trials based on research later retracted
  • 1 in 3 researchers know of a colleague who has fudged results
  • Negative results now account for 14% of papers, down from 30% in 1990

The false trails laid down by shoddy research are an unforgivable barrier to understanding.

Source: http://www.economist.com/news/leaders/21588069-scientific-research-has-changed-world-now-it-needs-change-itself-how-science-goes-wrong

PDF: Problems with scientific research