Thursday, August 19, 2010

Weighing the Costs and Benefits Part I -- What Counts?

Manifesto

If I am a lab rat, I will be a free-range lab rat.

There.  I feel better already.

To recap from last week:

You Have to Weigh The Costs and Benefits

That is what the doctor says.

Last week I promised I would develop a way to do that.  So this week we play math games.  For the next few weeks, actually.

Now, don't freak out.  I am not going to ask you to do math.  I am going to make up some rules.  You are along for the ride.  Though do feel free to suggest better rules.  Plus, I promise lots of pictures.  And a musical interlude.

I am a rat.  I live in a laboratory, where I participate in the Chemistry Experiment.  Along with other scientists, I am trying to find the chemicals that will make a dent in my mood disorder.  Not theirs.  Mine.  Which is how I got the rat end of this job.  But because I am a free-range rat, I get to decide which experiments I am willing to try.

I now insist that I contribute more to this enterprise than my body.

I have decided my contribution will be to develop the missing algorithm that lab rats of the species homo sapiens need to weigh our costs and benefits.  Something more scientific than our gut and desperation.

I call it an algorithm because that is what we scientists call it.

Algorithm:  A logical set of rules for solving a specific problem, which assumes that all of the data is objective, that there are a finite number of solutions to the problem, and that there are logical steps that must be performed to arrive at each of these solutions.

Remember the goal: logical rules applied to objective data to solve a problem.

The problem we want to solve is this:

Do I Want To Put These Chemicals Inside My Body?

Figuring out the rules is turning out to be quite a job, which might explain why nobody has done it so far, not even the FDA, who is supposed to decide whether a drug works well enough to warrant putting people through the consequences of taking it.  They don't have a formula.  They seem to decide on the basis of their own gut, just like us lab rats, plus lots of advice from the companies that want to sell the drugs, just like our doctors.  As it turns out, the FDA's standards are lower for meds used to treat mental illness than for meds used to treat other conditions.

But never mind.

I begin by defining the terms, the factors that I will use in my algorithm.  Factors is the scientific word for things you have to take into account, usually numbers.  There are a lot of factors.  The doctor will tell you, if you ask, 40% efficacy rate, 15% risk of insomnia, 15% mortality rate unless you take the meds for the rest of your life.

Now weigh your costs and benefits.

But there are lots and lots of these costs and benefits to weigh.  The numbers you get in your fifteen minute med check are abbreviated and oversimplified to the point of useless.  That is why this series will run over several weeks, so that I can weigh the costs and benefits that your fifteen minute med check skipped.

But remember, there will be a musical interlude.  Maybe two.

I have started several posts this week, and keep discovering I need to back up, start at an earlier point.  But for you, dear readers, I press on.  And for me.  And for science!  Not that I am expecting a Nobel Prize or anything.  I am not manic, after all.  Just excited.

Okay, so the best I can do this week is to list the factors.  Before you decide this is a measly week's work, wait until you read my list of factors.  40% efficacy, 15% insomnia, 15% mortality rate?  HAH!

Below are lists of the benefits, costs and considerations that will influence the odds.  Remember, it's all about the odds.  When you buy a Powerball ticket, the cost is $1.  The benefit is $97,000,000.  Now, weigh your costs and benefits.  It's a no-brainer.  Until you look at the odds.

A consideration in the case of Powerball might be whether you have enough money in your pocket for both the ticket and the milk.  Another consideration might be who is waiting at home for the milk.

BENEFITS OF THE CHEMICALS IN QUESTION:

Efficacy
   (LOTS of considerations to be factored here)
Shorter time to recovery or remission
   (I will explain the difference later)
Longer time to relapse
   (one number for recovery, another for remission)
Long term brain health
   (this may be indicated by time to relapse)
Lower mortality risk
   (needs to be weighted by other factors)

COSTS OF THE CHEMICALS IN QUESTION:

Side effects
   (tolerability is a consideration)
Down stream side effects
    (e.g., heart disease, liver disease, gum disease)
$$$$, both for medication and for med management
Risk of wrong diagnosis and inappropriate medication
   (may accelerate the course of real condition)

CONSIDERATIONS THAT INFLUENCE THE COSTS AND BENEFITS AND HENCE, YOUR DECISION

Severity of present condition
Number of previous trials
Spontaneous remission rate
Family health history
Factors specific to your own mortality risk
Family/job issues
What is your time frame?

See why this is going to take a while?  Are there other benefits, costs and considerations I have missed?  Ones that could be quantified, that is.  Not your favorite rant.  How about you put your favorite rant into you own blog and then link to mine?

Wish me luck.

All these images are Facebook Flair

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