Category Archives: Metrics

Premature testification is not a laughing matter

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All opinions are my own and do not necessarily reflect those of Novo Nordisk.

“These studies, once validated, open an opportunity for creating tests that an expectant mother can take to see if she is producing these autoantibodies. ”

I wrote this statement back in July as part of a post describing the report that maternal autoantibodies to specific neural proteins correlated with the appearance of autism symptoms in the children of those mothers.  Little did I suspect that plans to create a test were already in the works.  Science recently reported (paywall) that researchers behind this study are teaming up with a testing company to develop and market a diagnostic test for maternal autoantibodies.

On the one hand I am much in favor of prognostic tests that will help us anticipate health problems.  I believe in many cases early knowledge and interventions can be helpful, even when there is no “cure.”  One of the hopes for the wave of genomic biomedical research going on now is that it will allow us to better estimate who will and will not come down with specific diseases based on clues in individuals’ DNA.  But on the other hand, it can be problematic when tests are created and released before the underlying biomedical hypothesis has been strongly vetted and supported. Continue reading →

Priming the pump: Biopharma contributions and prescribing patterns

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All opinions are my own and do not necessarily reflect those of Novo Nordisk.

How in control are we of the decisions we make every day?  How sure are we of our judgement, how we feel, what we believe?  I think many people would say they feel very in control and very certain.  I suspect many people are wrong.  Studies in behavioral psychology have begun identifying the effect of priming–how a subtle stimulus can affect how people, behave or think.  The field of priming is not without ongoing controversy, but at the same time the effect of priming has been seen in many studies (like this one) and appears to be a real phenomenon, albeit one that is still very challenging to clearly describe, test and validate.

Its in this context that a recent report describing physician prescribing patterns is particularly interesting.  And disturbing.  The study by Joseph Engelberg, Christopher Parsons and Nathan Tefft looked at the effect of Biopharma payments to what drugs doctors prescribe.  To quote from their introduction for some context:  “While such rent-seeking behavior [such as pushing more expensive merchandise by salespeople] might not surprise many people…that financial conflicts of interest could influence their doctor’s advice might be both less expected and more worrisome…intrinsic motivation is thought to be important in medicine, with the goal of optimizing patient health being a paramount objective.”  The null hypothesis would be that prescribing patterns would be related solely to health condition, general information about drug efficacy, and price to the patient.  That’s not what was found. Continue reading →

What would you want to do with genome sequence data?

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All opinions are my own and do not necessarily reflect those of Novo Nordisk

In the same issue of Nature that reported the HeLa sequence and the NIH agreement, Martin Bobrow of the University of Cambridge wrote a column discussing how we as a society choose to balance individual privacy and public good that arises from making data gathered from private samples public.

We are entering a strikingly different period of biological and biomedical research, as a number of different areas of research and technology are reaching a critical point of cross-fertilization.  Moore’s law has resulted in computers of amazing power that can analyze really stupendous amounts of data.  I was at the Seattle Museum of History and Industry recently, and in one of their displays they showed a 1980 IBM PC, and while showing it to my son, I pulled out my smartphone and told him that my phone today is just as powerful as that computer was.  Of course, I was wrong.  My phone is actually about 2.5 orders of magnitude more powerful than that PC. Continue reading →

Hanging with the herd, for the immunity of it all

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All opinions are my own and do not necessarily reflect those of Novo Nordisk.

When I hear about events such as the recent outbreak of measles among a small group in Texas, I am reminded of how complex, complicated and difficult public health efforts can be. In the US, for example, there are conflicting imperatives:  the rights of people to practice their beliefs versus the right of the community to be protected against preventable health threats.  This particular situation involved members of a church congregation, many of whom had not gotten vaccinated for measles due to worries about a link between autism and the Measles-Mumps-Rubella (MMR) vaccine.  While no scientific evidence has been found to support any such link, many had chosen not to be vaccinated “just in case.”

One day I hope to write about the link between the phenomenon of science denial and personal identity (one perspective can be seen here), but for now I just want to point out how this event and a recent publication by the Centers for Disease Control (CDC) on rotavirus vaccines demonstrate nicely the concept of herd immunity (article behind paywall, but writeup here).  There are different usage patterns for the term, so I’ll say up front I am using “herd immunity” to describe not just the proportion of individuals within a population who are immunized to a given pathogen but also the indirect effects for non-immunized individuals.  The term was first used in a publication in 1923, by Topley and Wilson, in the context of how to describe the host side of their studies in bacterial infection among mice.  The concept later gained mathematical underpinnings, including formulas describing how the different ratios of vaccinated to nonvaccinated individuals defines the degree of herd immunity depending upon how infectious a disease agent is. Continue reading →

The “good,” the “difficult” and the “reality”: patients in the digital age

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All opinions are my own and do not necessarily reflect those of Novo Nordisk.

With apologies to Sergio Leone.  And to you, for making you read that really bad pun.  Just move along.

In an engaging and thought-provoking perspective piece in the New England Journal of Medicine, Dr. Louise Aronson described her experience in getting treatment for her father, who was suffering from low blood pressure and other health issues.  Her father was admitted to the hospital and went through examinations and fluctuations in his health during his stay.  He seemed to stabilize but then his blood pressure dropped again and Dr. Aronson asked for someone to come and check on him.  The staff was polite but non-committal and she decided to perform an exam on him herself to check if he had internal bleeding.  He did, she obtained evidence, and her father received rapid care to prevent further blood loss. 

She relayed this story in the context of how health care providers often bin patients and their support networks into “good” and “difficult” categories, based on how much and how often those patients acquiesce rather than challenge or even seek information about ongoing treatments.  As she describes it, the staff “were polite, but their unspoken message was that they were working hard, my father wasn’t their only patient, and they had appropriately prioritized their tasks. ” Her message was that the medical profession needs a cultural shift,in which patients and their families whom are more actively engaged in their care are seen as an asset, not a detriment to medical practice.  She also suggested some practical elements that would help this, including tracking more clearly when patient engagement occurs and rewarding it through changes in billing codes and practices. Continue reading →