The Decision Tree: Taking Control of Your Health in the New Era of Personalized Medicine [Rilegato]

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.

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.

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.