Saturday, December 5, 2009

Consensus Methods - Who To Believe? And Why?

While studying various consensus methods as part of our curriculum, a classmate departed from main stream discourses looking at the recently controversial news about breast cancer screening. In my opinion, her analysis merits a post on this blog.

While the full version of the US Preventive Services Task Force is quite comprehensive, it gives no indication as to the type of deliberation and consensus method used. The contents of the article I am referring to can be found here: "Screening for Breast Cancer: U.S. Preventive Services Task Force Recommendation Statement. "

As a scientist, I think of myself as one of them too *smile*, I find that tit-bit somewhat disturbing. Why? Because while there is no way for all to know everything about every thing, there are definitely many reasons to validate or, invalidate such reports. Should we trust such a panel of experts? My personal verdict is still out.

Interestingly, I found out about the "Screening Policies won’t change - US Officials say" article shortly after the initial debate on this question. When I saw the title of the article, my mind put a "case closed" stamp on this rather quickly but, it probably shouldn’t be so in hind sight.

Whether the data is scientifically valid or not, a physician worth his/her salt will find time to review such reports to make informed decisions about recommending what and, to whom. So many factors will influence a decision for or, against mammograms in this case. It heavily depends on the patient. As an example, the DELPHI method, modified or not, will likely never bring any one group to consensus on this item, not yet anyway. This is in fact, one of the biggest challenges that face the migration to EMR - Electronic Medical Records. You can read more about those problems here: "Implementing Electronic Medical Records ". I have first hand testimony on this effort. I attempted to help an Internal medicine friend with her small-practice EMR project. It was already a disaster by the time I was asked to contribute. Reading the article above from my hard copy, I ripped it out and gave it to her. I recommended she held off for a bit longer. The frustrations she experiences just aren’t worth the trouble at this time.

There is great merit to moving to such a platform nationwide, even world wide! It could become a very meaningful source of data, like in the case of the breast cancer debate. There would be some source of data to analyze. However, there are also significant draw backs.

It’s evident that the importance of breast cancer screening remains high since it is the number TWO leading cause of CANCER deaths among women. I read that lung cancer is the number one but, I'm told ovarian has the highest mortality rate. This is because its discovery is nearly always in stage three, the point of no return, usually. Ovarian gets no press because it affects a very small community of women in spite of its close-to-no-mercy status. Another fact to remember is that there are also instances of cancer in patients whose family history shows no trace of cancer at all. I know this first hand as well, unfortunately. Would there not have been reason to find this out sooner? Maybe some day, enough well-analyzed data will lead to such conclusions. For now, those relatively few cases will remain victims of unknown circumstances.

To me, this is a case scenario where a process like
"Christakis's SDP" could truly make a difference. It would remove emotions and, hopefully politics, allowing for factual contributions from various sources of experts, and non-experts alike, to prevail.

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