The Conundrum of Choice

In case you haven’t heard, the FDA has found that TNF blockers are associated with an increased risk of lymphoma and other cancers when used in children and adolescents, so if you have a patient under the care of a specialist for RA, psoriasis, Crohn’s disease, or another immune disorder, they may want to seek additional information regarding TNF blocker therapy.

This brings me to a Wall Street Journal article that I ran across yesterday that, given the disconnect that can occur between research, doctors, and patients, I think discusses an important topic—decision aid programs. It’s a timely topic on a number of fronts, not the least of which is healthcare reform and the cost of treatment. But it also addresses (albeit, through the back door) the problem of health literacy to some degree and our rather insubstantial informed consent process.

All in all, I think the article does a decent job of presenting the issues from both the patient and the practitioner side of the treatment decision, giving air to the concern of physicians about the potential of adding another barrier between themselves and their patients. It also highlights the gap between patient and provider focus with respect to treatment decisions, as patients tended to put a very high premium on side effects when considering their options.

One can infer from reading about the two cases discussed (one with breast cancer, one with prostate cancer) that both patients were fairly well educated, and they were adults. How effective a decision aid program might be for pediatric patients or those with very a very low level of literacy is something that’s not addressed.

Also worth mentioning is a product I ran across on MedGadget this week: cranial remolding orthoses that can be used to treat deformational plagiocephaly. No, the product line isn’t new, but plagiocephaly is a rather common problem since the recommendation came out for infants to sleep on their backs. I interviewed a biomedical engineer a several years ago regarding plagiocephaly detection and correction, and there’s more available now than I imagined.