Winning the Hardware Software Game Winning the Hardware-Software Game - 2nd Edition

Using Game Theory to Optimize the Pace of New Technology Adoption
  • How do you encourage speedier adoption of your product or service?
  • How do you increase the value your product or service creates for your customers?
  • How do you extract more of the value created by your product or service for yourself?

Read more...

Latest Comments

  • Anonymous said More
    Well written. Well constructed. 1 week ago.
  • Ron Giuntini said More
    As always a good read.
    I have always... Thursday, 25 January 2018

In 2005, a physician-scientist research pioneer, John Ioannides, published what has come to be a widely circulated paper, “Why Most Published Research Findings Are False.” The replication crisis we’re having in science embodies the concern voiced by Mr. Ioannides. Yet, despite much evidence that so many studies are not valid, scientific professionals continue to rely almost exclusively on study results when deciding on best practices.

So many studies are flawed. As a simple example, please take my survey by answering the following question:

Over the past 12 months, how many times have you visited a doctor?

Take as much time as you need to answer the question…

Got your answer?

Okay, now let me ask you a few questions about the number of visits you just “reported” for my study.

First, to answer my question, did you just think back in your mind, or did you actually check your records? Most people will probably come up with a “good estimate” based on what they can quickly recall. Relatively few people will make the effort to reference records to help them come up with a more accurate estimate.

As for what we remember, researchers continue to discover new ways in which our memories paint an inaccurate portrait of “the truth” (to the extent the truth exists). For example, the telescoping effect is a common cognitive bias affecting our memory, where we tend “to displace recent events backward in time and remote events forward in time, so that recent events appear more remote, and remote events, more recent.” The telescoping effect is just one of many different cognitive biases – Wikipedia lists 42 different cognitive biases that affect our memories – any one of which may cause your reported number of visits to the doctor over the past 12 months to be more or less than the “true” number.

Second, what types of providers did you include in your estimate? Did you include any visits to a dentist, nurse practitioner, therapist, optician, optometrist, pharmacist, herbalist, or other allopathic provider? Different people will have different interpretations of what’s included in the category “doctor.”

Third, if you visited the same “doctor” (however you define it) more than once (perhaps for a follow-up), did you count that as one visit or two? Some people will count multiple visits to the same doctor as a single visit – that is, what they consider “a visit” is more figurative – whereas others will interpret that phrase more literally.

So then what’s the “actual” number of visits to the doctor I’m looking for? How do I define “doctor”? How do I define a “visit”? It depends: what am I trying to measure?

Now that I’ve posed some of the problems with the information I would have collected, how much faith would you put in any findings I would have reported based on analyses of such data? Probably not much, and rightfully so.

Perhaps, that’s a little simplistic. Clinical studies are generally more precise than my little survey study, aren’t they? Perhaps, but not necessarily. Many clinical trials study patient-reported outcomes, such as depression, anxiety, or fatigue. These types of reported outcomes are subjective. Clinical studies are also subject to bias from many different possible sources, most notably selection bias.

Well, then, that’s why we use randomized control trials (RCTs). RCTs are studies that are considered to be the gold standard for establishing “evidence-based” healthcare practices. RCTs control for all the problems potentially associated with other clinical trials, don’t they? Not necessarily. While randomizing a sample and providing a control group eliminate some potential forms of bias, other errors and forms of bias may still be present. In other words, even RCTs may not generate “the truth.”

Take, for example, the case of medical cannabis. The effects of a dose of cannabis on a particular individual will vary, depending on

  • Characteristics of the individual, such as genetics, metabolism, and age
  • Characteristics of the individual’s history with cannabis, such as history of use and tolerance
  • Characteristics of the particular sample of cannabis consumed, including
    • Origin of sample: whole plant extract, isolate, synthesized compound, etc.
    • Form of use: flower, tincture, edible, etc.
    • Profile of contents in sample: profile of cannabinoids, ratio of cannabinoids, profile of terpenes, etc.
    • Size of dose: 5 mg, 25 mg, etc.
  • Setting in which the cannabis was consumed: isolated in a sterile lab room, relaxing with others in a comfortable room, etc.

In any RCT, the form, profile, and dose of cannabis is generally standardized across patients. It follows from the bullet points above that the effects of that standardized dose will vary widely across different users. So then it’s quite possible that the standardized dosing will not correspond to the dosing specifications that would be effective for different patient populations. As such, RCTs could easily suggest that cannabis was effective, if the form, dose, and setting matched those appropriate for the group of patients studied. On the other hand, the very same RCT could easily suggest just the opposite. The study could very well determine that cannabis is not helpful for the patients studied, if the form, dose, or setting used were not appropriate for the particular group of patients examined.

One can probably find flaws in just about any study. Of course, having a flaw doesn’t necessarily invalidate a study. However, we must take study findings in their proper perspective. We cannot simply accept the findings of any RCT because it’s the gold standard or reject the findings of another study for not being an RCT. Medicine is not about “hard science.” It’s about people. People are complex. They don’t fit nicely into well-defined boxes.

Yes, studies can provide us with information. However, we shouldn’t depend solely on studies to find “the truth,” that is, what’s best in a particular situation or for a particular patient. Rather, we should depend on experts – such as doctors – to do what they have been trained to do: rely on knowledge, skills, and experience to deliver personalized medicine, to help patients find the best treatments that meet their particular needs.

More Blogs

Best Practices in Medicine Should Rely on Providers' Knowledge, Skills and Exper…

13-08-2019 - Hits:46 - Ruth Fisher - avatar Ruth Fisher

In 2005, a physician-scientist research pioneer, John Ioannides, published what has come to be a widely circulated paper, “Why Most Published Research Findings Are False.” The replication crisis we’re having in science embodies the concern voiced by Mr. Ioannides. Yet, despite much evidence that so many studies are not valid...

Read more

Actions without Consequences Are Causing Our Healthcare Crisis

02-07-2019 - Hits:347 - Ruth Fisher - avatar Ruth Fisher

Actions Have Consequences I often turned to my father for advice. I would ask him, “What’s the right decision to make?” And he would invariably reply, “There’s no right or wrong. There are only consequences.” By taking the morality out of the equation, my father forced me to focus not on the...

Read more

Cash-Based Models for Healthcare

16-06-2019 - Hits:473 - Ruth Fisher - avatar Ruth Fisher

The configuration of our current healthcare system is a product of its history: It has evolved into its current form as a consequence of two primary sets of factors. First, the healthcare system has evolved into its current form due to historical laws and regulations that have generally catered to...

Read more

The US Healthcare System Is Massively Complex and Massively Interconnected 

31-10-2018 - Hits:2485 - Ruth Fisher - avatar Ruth Fisher

Consider how the different groups of players in the healthcare system are connected to one another: Healthcare Industry Trends Trends in society and in the healthcare industry over time have led to  Increases in medical information  Increases in numbers and specialties of service providers Increases in numbers of available medical devices and pharmaceuticals Increases in malpractice...

Read more

Playing the Marijuana Market Transition Game

26-09-2018 - Hits:2555 - Ruth Fisher - avatar Ruth Fisher

Download PDF Timeline of US Marijuana Laws California Is Different from Other Legalized States Description and Implications of CA Legislation Marijuana Supply Chain Regulations and Realities Players of the CA Market Transition Game CA Market Evolution to Date Future Market Evolution   California is currently transitioning from illegal and semi-legal markets for marijuana to legal markets. The black and...

Read more

Playing the Virtual Reality Game

29-08-2018 - Hits:2438 - Ruth Fisher - avatar Ruth Fisher

Key Concepts Before we can understand the issues related to 360°, 3D, AR and VR technologies, we have to understand some key concepts. Immersion and Presence The goal of 360°, 3D, AR and VR technologies is to immerse users in an environment, so that they feel they have been “teleported” to this new...

Read more

Is Our Economy Playing the Demand Side or Supply Side Game?

10-08-2018 - Hits:936 - Ruth Fisher - avatar Ruth Fisher

Which actions should government take to spur economic activity during economic recessions? Liberals tend to believe in Demand Side Economics, that is, demand drives the economy. So during recessions, government should stimulate demand through spending. Conservatives, on the other hand, tend to believe in Supply Side Economics, that is, supply drives...

Read more

Why Don’t Projects Go As Planned?

26-06-2018 - Hits:1034 - Ruth Fisher - avatar Ruth Fisher

Business projects, government programs, and social activities. We make plans and projections for the activities we are going to undertake. Yet, when we actually implement the programs, all too often, the results don’t turn out as well as we had planned. Why not? I had a client, for example, that employed...

Read more