Can Knowledge About Heterogeneity in Treatment Effects Help Us Choose Wisely?
Authors: Frank Davidoff
Journal: Annals of Internal Medicine (2016)

Ideas and Opinions17 January 2017Can Knowledge About Heterogeneity in Treatment Effects Help Us Choose Wisely?Frank Davidoff, MDFrank Davidoff, MDFrom Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M16-1721 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail In daily clinical practice, the pressure to treat can be intense and unrelenting. Many patients view the provision of treatment (see Glossary for definition of terms as used in this article) as a sign that providers truly care about them and are therefore disappointed if clinicians do not recommend treatment. Clinicians often feel more comfortable taking tangible steps than simply watching and waiting, especially under conditions of uncertainty. It takes considerable time to justify to patients the decision not to pursue treatment. Professional and financial incentives not to treat are scarce. Further, a centuries-old "therapeutic illusion" reinforces the pressure (1).... References1. Casarett D. The science of choosing wisely—overcoming the therapeutic illusion. N Engl J Med. 2016;374:1203-5. [PMID: 27028909] doi:10.1056/NEJMp1516803 CrossrefMedlineGoogle Scholar2. Bothwell LE, Greene JA, Podolsky SH, Jones DS. Assessing the gold standard—lessons from the history of RCTs. N Engl J Med. 2016;374:2175-81. [PMID: 27248626] doi:10.1056/NEJMms1604593 CrossrefMedlineGoogle Scholar3. Dahabreh IJ, Hayward RA, Kent DM. Using group data to treat individuals: understanding heterogeneous treatment effects in the age of precision medicine and patient-centered evidence. Int J Epidemiol. 2016: [Forthcoming]. CrossrefGoogle Scholar4. Kent DM, Nelson J, Dahabreh IJ, Rothwell PM, Altman DG, Hayward RA. Risk and treatment effect heterogeneity: re-analysis of individual participant data from 32 large clinical trials. 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[PMID: 24239923] doi:10.1016/j.jacc.2013.11.002 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire.Acknowledgment: The author thanks David Kent for his assistance in the preparation of this article.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M16-1721.Corresponding Author: 1010 Waltham Street, Apartment 311, Lexington, MA 02421; e-mail, [email protected]com.Author Contributions: Conception and design: F. Davidoff.Analysis and interpretation of the data: F. Davidoff.Drafting of the article: F. Davidoff.Critical revision of the article for important intellectual content: F. Davidoff.Final approval of the article: F. Davidoff.Collection and assembly of data: F. Davidoff.This article was published at www.annals.org on 8 November 2016. 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Matthews, MA(Oxon) 17 January 2017Volume 166, Issue 2Page: 141-142KeywordsDisclosurePatientsPhase 2 trialsPopulation statisticsPrecision medicineResearch designStatistical dataSystematic reviewsTreatment guidelines ePublished: 8 November 2016 Issue Published: 17 January 2017 Copyright & PermissionsCopyright © 2016 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...