the empowered patient -- question everything

by Dr. Donna Douglas

As a scientist I have been trained to accept nothing at face value, to question the status quo and find compelling evidence to the contrary. However, as a patient and caregiver I have sometimes found myself to be a little too complacent and acquiescent about medical choices.

Though we live in one of the most technologically advanced societies, our medical system is fallible. On one hand, we are inclined to believe that big pharma’s sole desire is to assuage suffering. This is antithetical to the charter of a corporation. (This is not to say that the pharmaceutical industry has not provided benefit to consumers. Therapies such as insulin save the lives of millions each year.) On the other, it seems near impossible to find sources of information about treatment options that are independent and balanced.

What about our treatment options? In order to receive medical treatment we must give informed consent. According to the AMA, "Informed consent can be effectively exercised only if the patient possesses enough information to enable an intelligent choice (AMA, 1999)." Are we really informed of all our options? With the direct-to-consumer media assault, statistical misinterpretation, drug utilization based remuneration and snake oil purveying, how do we sift through the mess and find enough truth to chart a treatment path?

Ask a lot of questions. Ask questions until you understand your treatment and its side effects, treatment duration and alternatives. Get a second opinion, and a third, until you are satisfied with the answers you receive. So here’s my short list of questions for evaluating any treatment option.

For Pharmaceuticals/Technology:

Why is this type of treatment being recommended as opposed to other options?
What are the reported side effects? How common was this event?
Do the benefits outweigh the risks?
How effective is this treatment? What is the likelihood of success?
More importantly, how is success defined and measured?
Does success translate into improvement in my quality of life?
How large was the study (the more people, the better)?
Was it a controlled study? How do we know that the effect did not happen by chance?
Who conducted the research and what are their qualifications?
Was this treatment tested on people of similar age, women, race?
How will we know if the treatment is working?

For Botanicals:

Where and how has this treatment been traditionally used? Is this the way in which it will be administered?
Are there published studies on this botanical? Do we know how it works?
Are there side effects associated with its use?
Is it known to enhance the effects of pharmaceuticals? If so, how should dosing be handled?
Which part of the plant is used in therapy? How is potency and consistency assured?
Is this product produced by a manufacturing facility with GMP certification?
Is the administrator skilled in its traditional use? Did they attend an accredited Naturopathic Medical College or Traditional Medical School?
What is the treatment duration?
How will we know if the treatment is working?

Frank Herbert once said, “The people I distrust most are those who want to improve our lives but have only one course of action.” There are always options, and options are only as good as the information we have about them. I question the idea, along with Frank Herbert, that there is essentially only one way to treat cancer. I question the idea that only synthetic compounds with their inherent safety concerns can correct health problems. I question why we don’t exploit the body’s innate capacity to heal itself. I question the belief that medical integration will ruin the economy. I question why we don’t ask more questions.

So ask away my friend, ask away. For it is only when we ask the right questions that we find the right answers.

Posted June 2007