Heroes Not Zombies

Thomas Goetz’ new book, “The Decision Tree” looks interesting. His theory, based on research evidence, is that two behaviours significantly improve health outcomes – being personally involved in taking the decisions about your own health care, and sharing with others.

A decision tree, essentially, is a flow chart – it’s a kind of algorithm, a way to factor in various strands of information and probabilities to move towards an optimal outcome. So it’s a way of thinking about our healthcare as a series of deliberate choices, where we are the primary decision-makers. When we take on that role, we tend to have better health.

I like what he says about DNA – that it’s an indicator, not an inevitability. However, I wonder how people will cope with the knowledge of their DNA disease markers? Will they feel like they’ve got some ticking time bombs on board? And, he’s very balanced about screening programs, recognising that they are problematic, not least because of the false positives they throw up.

He points out that giving people personal feedback on their behaviour changes and involving them in communities are two tried and tested techniques which can be delivered much more easily now with smartphones and online communities.

In an interview with him on the freakonomics site, he says this –

One of the amazing things I learned in writing the book is that many popular drugs don’t really work all that well. Anti-depressants work at best around half the time; chemotherapies for cancer work at best 20% of the time. This is the hit and miss of modern pharmacology – there are no sure things.

It’s amazing how that well-established fact is still ignored. As he’s an editor of Wired magazine, it’s no surprise that his hope lies in pharmacogenomics coming up with the ways to produce more targeted drugs.

I’m pretty excited about the Health 2.0 ideas. Social networks and wikis are two potentially useful tools for patients, and I think Goetz’ book adds others – the decision tree itself and the emphasis on personalised feedback.

Potentially, this is all about a shift in power, away from doctors and towards patients. In my opinion that’s a trend to be encouraged.