Long before we had decent independent bookstores in our neighborhood, there was a Barnes & Noble. I remember the days when I went to a bookstore and all hardcovers were a percentage discount--staff favorites, bestsellers and then all of a sudden there weren't. Now discounts were only reflected on New York Times bestsellers (homogenized thought) but I think in some respects, they are coming full circle. Although, a long-time bookseller lamented recently, "I didn't sign on to work in a toy store." Looking around the store I see what he means. Adjusting to declining sales in brick and mortar book-selling chains and increased digital competition--the new mantra seems to be "see what sticks" or as my old boss used to say "Put it up the flag pole and see if anyone salutes". Puzzles, stuffed toys, games, and even aisles of preschool toys are among the published relics that once dominated the square footage.
I feel the same away about writing. I didn't become a medical writer to help commercialize drugs, devices, or industry. The good news is that I own the skills. Decision modeling, health economics, biostatistics, clinical medical knowledge, analytics--I now primarily use the skills outside of industry. Imagine if patient populations and healthcare providers were emboldened with the marketing prowess and economic modeling that prevails in medical affairs departments? Yes pharmacodynamic and pharmacokinetic principles are vital to understand how drugs work in our biologic systems but we often confuse pharmacology as health inducing. What we need to understand is the data. What do we really know based on research findings--not misleading headlines.
I will be writing about the 2015 National Conference on Health Statistics in future posts. There is an abundance of relevant information about the health status of the US population, impact of major policy initiatives (ACA), disparities in healthcare, trends in health indicators, as well as recommendations about EHR, quality measures, and population health data. To facilitate the national exchange of health statistics we need to join the dialogue. A surprising absence of representative healthcare stakeholders was evident. I reviewed several peer-reviewed articles that confused the terms below. Why is that important? As you can see here, there are different assumptions that impact data reporting, relevance, and urgency.
A surrogate endpoint is an endpoint observed earlier than the true endpoint (a health outcome) that is used to draw conclusions about the effect of treatment on the unobserved true endpoint. A prognostic marker is a marker for predicting the risk of an event given a control treatment; it informs treatment decisions when there is information on anticipated benefits and harms of a new treatment applied to persons at high risk. A predictive marker is a marker for predicting the effect of treatment on outcome in a subgroup of patients or study participants; it provides more rigorous information for treatment selection than a prognostic marker when it is based on estimated treatment effects in a randomized trial.--Evaluating surrogate endpoints, prognostic markers, and predictive markers: Some simple themes
When we write about healthcare, medicine, economics, and the impact of policies on the healthcare status of our communties, do we understand the data? Or are we just nailing jello to the wall?
I am a captain for Right Care Action and even if you don't get involved, perhaps a few of the ideas in the forum can be integrated into your practice environment or educational programs. Join Right Care Action week here.
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In a world of "evidence-based" medicine I am a bigger fan of practice-based evidence.
Remember the quote by Upton Sinclair...
“It is difficult to get a man to understand something, when his salary depends upon his not understanding it!”