26 of 29 people found the following review helpful
on February 16, 2010
As a physician with a public health background, I have a healthy amount of scepticism when 'the next great book' comes along and claims to change the way we live. However, while reading Goetz' book, it didn't take long for me to realize I was in for a wonderful surprise. Perhaps it is his background as an editor at Wired magazine that makes his writing so engaging. Combine that with a solid grounding in the public health arena and the result is impressive. Although written with the patient in mind, this book will serve as an invalubale tool for clinical practitioners and epidemiologists alike. It opens a window into the field of medicine that I found fascinating and highly educational. More importantly, it gives us a glimpse at the way the doctor-patient relationship will look in the future. And, whether we like it or not, as Goetz eloquently reminds us, we would be wise to take notice now.
29 of 36 people found the following review helpful
When it comes to assessing the problems with our health care system and identifying ways to make it better, this book by Thomas Goetz is among the best I've ever read. Hopefully, it will be highly influential, especially considering that we live in an age when most of the "easy" medical problems have been solved and the hard ones remain (eg, cancer and many chronic conditions). Goetz proves to be an incisive analyst, a creative thinker, a balanced pragmatist, and a lucid writer.
The main idea presented in this book is that decision tools need to be developed which enable all available information to be rationally, systematically, and efficiently assembled and weighed in order to cost-effectively maximize individual and collective health outcomes. In other words, health care needs an engineering approach. This is really just common sense, yet our health care system unfortunately falls far short of this ideal, so we need books like this to help open people's eyes.
Here are some further key points from the book:
* Patients need to play an active role in their health care decisions, using physicians and other health care professionals largely as consultants, and collaborating with other patients in sharing information.
* Health care information (medical records, drug labels, etc.) needs to be presented in a sensible standardized format and made easily accessible online on a real-time basis.
* To account for biological heterogeneity among people, preventive measures and treatments need to be tailored to each individual. Thus, the information used to make decisions must include both statistical information drawn from populations as well as specific information particular to each individual (both phenotypic and genetic).
* Costs need to be controlled by emphasizing prevention of disease, lowering the cost for FDA drug approval, avoiding replacement of older/cheap drugs with newer/expensive drugs which aren't significantly better, avoiding use of expensive drugs which don't significantly improve outcomes (eg, many cancer drugs), using/avoiding screening based on relationship to outcomes, avoiding overuse of expensive medical technology, and linking physician payments at least partly to outcomes rather than extent of services.
The above ideas overlap considerably with ideas I arrived at myself after years of intense involvement with health care issues (especially related to cancer research and treatment). For example, see my detailed review of The War on Cancer: An anatomy of failure, A blueprint for the future by Guy Faguet.
This is a brilliant and important book, and I can't recommend it strongly enough.
5 of 5 people found the following review helpful
The prose is in this book is engaging and often anecdotal, which is good, because the subject matter is so dry and dense that I really wanted to give up a few times. I'm very glad that I stuck with it, because the book does describe a very useful method for gaining and using medical knowledge about oneself. At its most basic, a "decision tree" is a flow chart comprised of a logical series of questions and answers that starts with the information one has, and progresses through "if A is true, what do I do next?" hypothoses, potential diagnoses, treatments, etc. until one has developed a plan of action. Or inaction. Sometimes, the decision tree leads the patient to leave things be.
But the book jumps from premise to anecdote to new premise, almost as if the author's brain is working too fast for his word processor.
And it's a bit rambly. It took somewhere between 50 and 60 pages to even point out that regular people can order their own DNA analyses, which is really what they need to do before they can design an effective decision tree (based on the concept that our health is the combined result of genetics and environmental factors. Once we know our genetic risks, we can make informed choices to avoid or ameliorate many, if not most, environmental triggers.)
Although the book addresses the fear surrounding the giving and the getting of this knowledge - the idea that patients will collapse, quit their jobs, become erratic in general if the news is bad - it neglects the financial incentive, in today's insurance climate, to avoid genetic testing if one wants to remain insurable.
In addition to arguing for genetic testing, Goetz argues against excessive use of other forms of screening, which can lead to wrong diagnoses and unnecessary (and dangerous, in some cases) treatment. He also details examples of decision trees that start with symptoms, or with decisions (like "quit smoking"), which maes the book a useful reference regardless of whether the reader wants to take Goetz' advice to get some genetic testing.
I would recommend this book to anyone who has recently received troubling news about his or her health or who is questioning whether to ask a doctor to run tests or who has a nagging feeling about some strange symptoms.
I took the book's advice and ordered genetic testing from Pathway Genomics (the least expensive alternative I could find). I have an autoimmune disorder (SLE), and when you have one of those, doctors tend to dump every little symptom you get into the autoimmune bucket, unless they find something else within the first or second try. It's frustrating for them, and for the patient as well, because autoimmune disorders mimic so many other diseases and conditions. They also complicate other diseases and conditions. So, when my heart rate spiked last year and stayed there, my doctors did some tests, decided the increase was due to damage to my nervous system (which is probably true), and said that it was benign absent any other cardiovascular risk factors, which, as far as they can tell, I don't have. My cholesterol and blood pressure are awesome. And because I'm sick and don't have a choice, I take extra care about diet and exercise.
But the genetic testing revealed that I have a higher than normal risk of cardiovascular disease. It also showed that I have a genetic sensitivity to methotrexate (a chemo drug used to treat autoimmune disorders). So, when it came time to put me on that drug, my doctor knew to give me another prescription to make sure the methotrexate doesn't make me sicker. Cool huh?
10 of 13 people found the following review helpful
on February 16, 2010
Thomas Goetz catalogs the recent advances (and setbacks) in medicine & personal health, but also maps out the possibilities for how things could get better. He does this so convincingly that you can't believe it's not already taking root: clear labeling on drugs & food, passive tracking of our exercise routines, open access to our health data.
There are enough lessons for self-improvement in the book that I found myself comparing it to What to Expect When You're Expecting, but since Goetz focuses on the big picture (prevention, diagnosis, disease management) it is more like What to Expect When You're Expecting a Long Life.
Unlike the pregnancy bible I read 10 years ago (and more than once threw across the room), Goetz doesn't preach from a lofty whole-grain pulpit. He doesn't think we should ask people to do more, nor should we scold people for every mistake they have made, but rather we should give them tools to make better health choices.
You know how MDs are always asked for cocktail-party diagnoses? This book is for all the MPHs who stood nearby wishing that someone would ask them for on-the-spot health advice.
1 of 1 people found the following review helpful
I found this book interesting. The first couple of chapters were a bit slow for me because for the few new things I learned, they were repeated several times. As a matter of fact, the author repeats the theme of taking control of your health early throughout the book. I did learn some interesting things, like why so many pharmaceutical companies abandon research that might seem promising - they simply don't stand to make enough money. The author says they want to make at least 1 billion dollars per cure, so they abandon the ideas that might only generate a few hundred million. The book has a lot of interesting ideas like that in it, but ultimately it doesn't come to a prescriptive method for taking control of your health. While it is called the Decision Tree and there are several examples of Decision Trees in the book, it doesn't ultimately result in "the" decision tree. However, it does mention several potentially useful websites throughout, such as 23andme, patientslikeme, curetogether, and several others. I only investigated 23andme and the price for genetic sequencing looks to have gone down to $299. Anyways, this is an interesting book and once I got through the first couple of chapters I read through it rather quickly. The author clearly did his research and the effort shows. However, you will not find any magic fomula for managing your health in this book. Instead, you will find lots of suggestions, examples about people who already have issues and their decision trees, and some complaints (I think very legitimate ones) about the way health care is administered today.
3 of 4 people found the following review helpful
We've reached the point of critical mass when it comes to our collective health in the United States and that's why it is so important for people to stop trusting the conventional medicine of our day and take back control of their own health. While most doctors unfortunately pass out prescription medications as the ONLY option for treating chronic disease, the reality is there are natural dietary options for people wanting to get healthy that are rarely talked about outside of alternative medicine circles. That's what Thomas Goetz attempts to share in THE DECISION TREE--although there are a few flaws in his thinking about this, too. While railing against the current system of treating patients with drugs, part of his "decision tree" plan for patients is to look to pharmaceutical options. HUH?! What we know about most chronic illnesses is that simple changes in nutrition and lifestyle can go a long way in improving virtually any of these issues. That's the real decision that needs to be made...but it's not promoted as a primary method in this book. I love the idea of personalized medicine, but the drug promotion needs to go if we're ever gonna truly heal the health of Americans.
5 of 7 people found the following review helpful
on March 2, 2010
I found "The Decision Tree" to be an entertaining read, similar to what I expect to see in Wired magazine. However, what I was hoping for was a more cohesive argument for taking control of your own health using all avenues available to a patient today. I found that the author would tend to link various thoughts together by saying how important it is to use a Decision Tree instead of linking the thoughts via a solid argument or relevant research data. To me this was just showing that the book wasn't really complete, it reads like a collection of essays that you would expect to see in a blog. There certainly are the beginnings of a good argument far taking control of your own health, but "The Decision Tree" could have been so much better if the author had really polished the arguments he presents.
9 of 13 people found the following review helpful
With a topic as dense as public health, THE DECISION TREE would have benefited from more rigorous editing and streamlining. It's just long and goes from anecdote to fact to observation to study to blah. I want to take control of my health but I felt like I needed a primer in public health before started this book. It was over my head. My other frustration with this book is that in some cases the expert advice or treatment that you need may be unknown or unavailable to you. Taking charge of your health implies that healthcare is something you direct, which implies a certain level of security and education.
on April 19, 2015
In The Decision Tree, author Thomas Goetz offers a clear, balanced perspective of the personalized medicine and patient empowerment movements sweeping America.
The book is divided into 3 parts:
1. Prediction and Prevention
2. Detection and Diagnosis
3. Treatment and Care
The following is a sampling of the main ideas presented throughout the book, and an evaluation of them from the perspective of a former patient with experiences in the American healthcare system.
1. Support for genetic testing as a foundation for disease prevention.
Patients should get genetic testing (23andme.com) to better tailor treatments to them as individuals, instead of relying on statistical estimations from broad population studies.
Agreed. However, I was left wondering why we can't just have everyone, genetic risks or not, implement positive behavior changes geared to prevent chronic disease. However, since Goetz is focusing on the big picture, he is right to assume most of the population will not become active participants in their health until faced with a health risk or problem as a result of a test, so I can understand the argument made for genetic testing for consumers.
- Against paternalism in the medical profession.
Patients should get access to their genetic test results, and be told if they have risks for life threatening conditions (e.g. cancer), because they will not only not face adverse emotional effects from the news about their disease risks, but will also see improvements in outcomes over time due to increased proactivity.
"For every 1 percent higher risk a person had of developing Alzheimer's, he or she was 5 percent more likely to make certain positive behavior changes."
"Traditional science is the laggard here, because it takes years for researchers to examine these technologies and and assess their effectiveness. By using the very principles of that health behavior research has established--personalized information is more effective than generalized information, as is setting goals and incremental goals within them--Nike+ and its ilk are far ahead of anything the medical community has come up with."
- Behavior change is important for preventing disease, sometimes more than conventional medicine.
Having seen the dramatic effect a few lifestyle changes have been for the curing of a "chronic" condition, I was grateful that behavior change was emphasized as a key factor for preventing the onset of illness.
On the other hand, I was disappointed that behavior change was not mentioned at all in the part about Treatment and Care, nor in most of the Decision Tree examples...as if the only effective treatments are pharmaceuticals and surgical procedures!
Au contraire. The experiences of my fellow patients in the growing Quantified Self and citizen scientist communities in San Francisco will serve to disprove the notion that pharmaceuticals are the most effective interventions. Rather, they indicate that behavior change in the relatively unsexy lifestyle factors (diet, exercise, sleep) are often underrated in efficacy for treatment of common chronic conditions (e.g. diabetes, metabolic syndrome).
- Personalized medicine is a better approach than generalized information from population studies.
Agreed with the conclusion, but not with the argument that brings us to the final verdict. In an argument about the importance of personalized medicine, there is a story about HRT (hormone replacement therapy), in which the author throws out the baby with the bathwater. This is a finer point that few people unaffected by hormone deficiencies will appreciate, but one that shows a degree of lack of care in research. The side effects reported in the cited study on estrogen-progestin studies are for synthetic hormones, which is dramatically different from the outcomes in studies on bio-identical hormones (identical to the ones produced endogenously in our bodies). Synthetic hormone treatments were created by pharmaceutical companies in order to hold a patent and sell the drug. So if synthetic hormones were the only treatment available to patients, then we should by all means use a personalized medicine perspective to ensure the drug is effective for them, but it is not exactly the case. There's nothing wrong with personalized medicine, but the premise of the argument is based on flawed assumptions.
- Support for decentralization of medical information, and release to patients.
Online patient-to-patient platforms serve a social networks for patients to gain insights that often elude even doctors about their conditions. These platforms include patientslikeme.com and curetogether.com.
Agreed. These platforms made a significant positive impact on my ability to treat my condition in under 3 years, when about a dozen doctors couldn't figure out to fix the problem. The wisdom of patients who have been through the gauntlet and figured things out for themselves is gold.
Despite certain flaws in argument, the execution of the writing is entertaining for the lay reader, as Goetz doesn't get bogged down with too much technical details over the course of presenting the ideas. This book serves as a greatly illuminating read for the lay reader who wants to gain a familiarity with the topics of healthcare, chronic disease treatment, and behavior change for health and wellness.
This book, written by Thomas Goetz, the executive editor of Wired magazine is packed with information about how to take part in making your own health decisions. At a time when there is a shortage of primary care physicians in almost all parts of the country and this is our first line of defense, we're sometimes looking at very little time spent per patient to diagnose our medical problems. There has never been more of a need to be proactive with our own health care.
When I selected this book, I thought from the description that it was going to be mostly about DNA testing and how to go from a DNA test to managing your own health. Actually the book was a whole lot more. Goetz discusses some very high tech ways of managing health care like different types of scans and screening tools, some computer and iPhone applications to track not only health conditions but exercise and food choices. He also discusses some low tech, but very useful things like a drug facts box that is now being reviewed by the FDA that would tell us in simple terms what is prescription drug is for, how it works, symptoms and life threatening side effects and how long it has been in use. It would be very similar to the nutrition labeling required on most of our packaged foods. He even discusses solutions like Weight Watchers and why that type of an approach can work.
Some parts of the book are exciting, discussing new technologies and some are just plain depressing like how our drugs come to market and which ones are at the top of the list because they'll make billions of dollars because of the demand and which ones are left "sitting on the shelf" because they're too expensive to develop and test because a smaller amount of people will need them. The discussion of costs for many of the tests and scans and which ones get priority and why is pretty eye opening as well.
All in all a very fascinating book, jam packed with information and ideas. Goetz doesn't have an answer or a solution for all the questions that he asks, but he'll have you Googling on a lot of different health care subjects by the time you finish this book.