Do Doctors Play a Medical Guessing Game?

Physician's Money Digest, January 2007, Volume 14, Issue 1

Since the time of Hippocrates, medicine has been a mysterious endeavor contained by guidelines and shaped by opinions. Although technology has advanced medicine far beyond the practices of ancient Greece, physicians must still rely on their opinions to develop a course of treatment. And because results can vary so much from case to case, some patients are starting to wonder if the treatments they receive are actually doing any good, or if they're just the best guess for a course of action by the medical community, derived from rules and traditions.

According to a recent article in BusinessWeek, this speculation has gained steam over the past few years, marshalled by David Eddy, MD, PhD, a former heart surgeon turned mathematician and health care economist. Dr. Eddy strongly believes that practicing medicine is more guesswork than actual science, and little is known about which common treatments actually work. Although this stance may rightfully offend many doctors, Dr. Eddy stresses that the physicians themselves are not to be blamed, but the haze of evidence surrounding the practice of medicine today.

Treatment Legitimacy

Dr. Eddy first became concerned with the state of medicine when he started his career as a cardiac surgeon in the 1970s. He started to question the validity of evidence available that supported the medical procedures being performed. He found that doctors were simply relying on their best judgment when treating patients, based on the traditions of the physicians who had come before them instead of hard scientific proof. Dr. Eddy began to see the light in the form of mathematics, and felt that it could help find answers to longstanding medical conundrums. While earning a PhD in mathematics at Stanford University, his thesis revealed that annual chest x-rays and pap smears for women who were at low risk for cervical cancers were a terrible misuse of resources. As a result, the American Cancer Society revised its guidelines. Soon after, Dr. Eddy debunked the treatment of high pressure on the eyeball by proving pressure-lowering medications were dangerous. He later testified in several court cases on behalf of Blue Cross against coverage of bone marrow transplants for women with breast cancer, stating there was no evidence that the costly procedure saved lives. Clinical trials produced shortly thereafter confirmed that the treatment didn’t work.

Although great strides have been made in medical knowledge over the past few decades, finding effective treatment for several ailments is still a guessing game, particularly in illnesses such as cancer and diabetes. An ensuing problem is that going to different doctors usually results in different treatments. For example, a surgeon would recommend surgery for a cancer patient, but a radiologist would recommend radiation treatment. As BusinessWeek points out, many doctors today agree that the traditional remedies for serious ailments are usually not the best course of action, but when multiple treatment options are presented to a patient, they misguidedly believe that the most aggressive choice is the best. This leads to a demand for the development of cutting-edge medical technology, and the medical center with the latest and greatest machine often gets referred to more, leading to overuse. Despite the massive amount of spending on technology, middle-aged Americans are still in worse shape health-wise than those in Britain, who spend half as much.

Archimedes Resurrected

In his attempt to apply mathematics in finding medical advances, Dr. Eddy developed a computer simulation called Archimedes, in which virtual doctors conduct trials on virtual patients to determine what treatments are successful against specific illnesses. Archimedes was tested by comparing it to a 41/2-year clinical trial on the effectiveness of cholesterol-lowering statins, and the computer simulation came to the same conclusion as the extensive, expensive clinical trial. On behalf of Kaiser Permanente, Dr. Eddy’s team then took on the bigger task of discovering an effective treatment for patients with diabetes who also have further ailments, in an effort to reduce heart disease. They performed a simulation through Archimedes that involved thousands of virtual patients taking a trio of medicines. The simulation took 30 minutes and reached the same results as a 30-year clinical trial would have—enormous cost- and life-saving advantage. As a result, the physicians at Kaiser Permanente changed their standard care for diabetes by incorporating the drugs from the simulation.

The effect of Archimedes on a family practice is twofold, as Dr. Eddy tells Physician’s Money Digest, "First, we are developing calculators that can be used by individual patients and their physicians to help estimate risks and management options relating to coronary artery disease, diabetes, and the metabolic syndrome. These are being developed jointly with the American Diabetes Association." Physicians can take a look at the first generation of these calculators, Diabetes PHD, by visiting the American Diabetes Association’s Web site at www.diabetes.org/phd.

The second way the Archimedes model can aid family practitioners is through their work with organizations such as the American Diabetes Association, American Heart Association, American Cancer Society, and the Centers for Disease Control and Prevention. "We have several projects with these organizations to analyze a variety of guidelines relating to the prevention of cardiovascular disease and diabetes and its complications," Dr. Eddy says. "As these studies and the resulting guidelines are published they should provide family practitioners with useful information about the prevention of these conditions."

Although it will take some time for Archimedes to be widely accepted by the medical industry, it's a positive step in shedding light on several treatments that have long been beset by conjecture. The time-saving aspect alone should be attractive to many, alleviating the need for costly clinical trials. Dr. Eddy hopes one day that all important medical inquiries will be run through Archimedes, so, perhaps, doctors won't have to guess anymore.

More Information on Diabetes PHD

Powered by the health modeling computer program Archimedes, Diabetes Personal Health Decisions (PHD) is designed to be a powerful health risk assessment tool. Many physician investors are already familiar with mortgage calculator programs that can deduce your monthly payment based on down payment, the cost of a property, interest rate, etc. When you increase your down payment, the monthly payments become lower; other adjustments can have the same affect. Diabetes PHD works in a similar way, except instead of payments, users have the opportunity to view and adjust their potential health outcome. Patients develop a very detailed health profile including stats, current activities, and health state (eg, height, smoking, being overweight, etc), which is then compiled to estimate their risk of diabetes, kidney failure, stroke, etc. Patients can then view how changing their current choices could affect their future health. For example, if they quit smoking and lose 10 pounds, their risk of stroke is reduced. Although a computer program will never take the place of a physician’s care, it may help to make a doctor’s case when urging a patient to improve their compliance.