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Better Doctors, Better Patients, Better Decisions

Envisioning Health Care 2020

edited by Gerd Gigerenzer and J.A. Muir Gray

Publication Year: 2011

How eliminating “risk illiteracy” among doctors and patients will lead to better health care decision making.

Published by: The MIT Press

Series: Strüngmann Forum Reports

Cover, Title Page, Copyright

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pp. 1-5


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pp. v-vi

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The Ernst Strüngmann Forum

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pp. vii-viii

Founded on the tenets of scientifi c independence and the inquisitive nature of the human mind, the Ernst Strüngmann Forum is dedicated to the continual expansion of knowledge. Through its innovative communication process, the Ernst Strüngmann Forum provides a creative environment within which experts scrutinize high-priority...

List of Contributors

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pp. ix-xi

Health Literacy: Is the Patient the Problem?

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pp. 1-58

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1. Launching the Century of the Patient

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pp. 3-28

Patients appear to be the problem in modern high-tech health care: they are uninformed, anxious, noncompliant folk with unhealthy lifestyles. They demand drugs advertised by celebrities on television, insist on unnecessary but expensive computer tomography (CT) and magnetic resonance imaging (MRI) scans, and may eventually turn...

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2. When Misinformed Patients Try to Make Informed Health Decisions

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pp. 29-43

A recent press release advertised the results of an international randomized controlled trial on the benefits of using PSA tests for prostate cancer screening. It stated that PSA screening would reduce the risk of dying from prostate cancer by 20% (Wilde 2009). But what does that really mean? Just how big is 20%, and how many people does it equate...

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3. Reducing Unwarranted Variation in Clinical Practice by Supporting Clinicians and Patients in Decision Making

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pp. 45-52

In 1938, J. Allison Glover reported on the incidence of tonsillectomy among school children in England and Wales (Glover 1938). He meticulously documented peculiar increases and decreases in rates over the preceding 15 years as well as unexplained differences by age, gender, and social status. Most striking was a tenfold variation in tonsillectomy...

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4. Do Patients Want Shared Decision Making and How Is This Measured?

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pp. 53-58

Shared decision making has been advocated as an appropriate approach to involve patients in decision making. Since the late 1990s, when several publications on conceptual definitions of shared decision making emerged (Charles et al. 1997; Coulter 1997; Towle 1997), interest in this approach has steadily grown, especially for diseases for which more than...

Health Illiteracy: Roots in Research

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pp. 59-134

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5. Health Research Agendas and Funding

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pp. 61-81

There is increasing concern that the results from health research do not lend themselves to information that is practical and understandable by patients and other members of the public, clinicians, policy makers, and journalists. In other words, there is a gap between what health researchers study and communicate among themselves, and what lay audiences and clinicians want and need...

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6. Reporting of Research: Are We in for Better Health Care by 2020?

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pp. 83-101

Clinical research, like any research, is driven by highly trained people who are motivated, for the most part, by intellectual curiosity and academic advancement. Research is also driven by financial gains and the aspiration for power. The currency of research for academic promotion and advancement as well as profit and power is publicizing research...

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7. Medical Journals Can Be Less Biased

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pp. 103-116

Over the last ten years, a revolution has occurred in how medical literature is perceived. Instrumental to this change, the Cochrane Collaboration has shifted the emphasis on quality, not just quantity, of medical literature. In the initial stages of the Cochrane Collaboration, people began to learn that when considering evidence about the effects of an intervention, the randomized controlled trial was...

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8. What Is Needed for Better Health Care: Better Systems, Better Patients or Both?

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pp. 117-134

Research has shown that the communication of scientific evidence is often incomplete and/or nontransparent, thus reducing its usability (Gigerenzer et al. 2007). This compromises health literacy (i.e., the ability to understand and use the current evidence base) of clinicians (Wegwarth and Gigerenzer, this volume), policy makers, as well as the general...

Health Illiteracy: Spread to the Public

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pp. 135-212

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9. Statistical Illiteracy in Doctors

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pp. 137-151

In 1996, results of four randomized trials on mammography screening, which included approximately 280,000 women (Nyström et al. 1996), showed that out of every 1,000 women who participated in screening over ten years, 3 women died of breast cancer; for every 1,000 women who did not participate in screening over a 10-year period, 4 women died of breast cancer. Further analysis showed similar...

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10. Statistical Illiteracy in Journalism: Are Its Days Numbered?

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pp. 153-167

Journalists have been thrust into an uncertain world over the past decade. Like antelope crossing a dry stretch of savanna, herds of news gatherers nervously crane their necks and sniff the wind, checking to see who succumbs next to the pitiless lions of the Computer Age. Newspaper reporters, magazine writers, television news producers, and a gaggle...

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11. Improving Health Care Journalism

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pp. 169-190

Medical and health care issues rank consistently at the top of all scientifi c topics covered by the international mass media. In an analysis of three leading German newspapers, research at my institute found that from 2003–2004 medical issues comprised 27.7% of all scientific articles reported; in 2006– 2007, this figure rose to...

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12. Barriers to Health Information and Building Solutions

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pp. 191-212

Health literacy is a broad, social concept. The Institute of Medicine (IOM 2004) defines it as “the degree to which individuals can obtain, process, and understand basic health information and services they need to make appropriate health decisions.” Statistical literacy can be interpreted as the ability to grasp the meaning of numbers, proportions...

Health Care 2020

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pp. 213-227

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13. How Can Better Evidence Be Delivered?

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pp. 215-232

In evidence-based medicine, the term “bias” is usually used to refer to a systematic error in the design, conduct, or the analysis of a study. We will use the term in a broader sense to include manipulation of information, intentional or not. Bias can result during the production and dissemination of information as well as when...

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14. The Drug Facts Box: Making Informed Decisions about Prescription Drugs Possible

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pp. 233-242

Direct-to-consumer prescription drug advertising exists only in the United States and New Zealand. In the United States, the first direct-to-consumer advertisement (an ad for the pneumonia vaccine) appeared in Reader’s Digest in 1981. Today it is hard to find any American magazine or television show without finding...

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15. Reengineering Medical Education

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pp. 243-263

Long before calls in the United States were made for health care reform, it was clear that a reengineering of health care and subsequent training of health professionals to match such was urgent. Among many reports that articulated the need for change in health care systems, the U.S. Institute of Medicine (IOM) identified the need to reengineer...

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16. The Chasm between Evidence and Practice: Extent, Causes, and Remedies

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pp. 265-280

We have huge amounts of evidence that many patients do not receive optimal care and that many people do not receive preventive interventions that could benefit them (IOM 2001). This has been the case for a very long time, and it is not clear whether this situation is better now than it was 25 years ago. We also have...

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17. The Future of Diagnostics: From Optimizing to Satisficing

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pp. 281-293

In the United Kingdom, 81% of costs in patient services result from hospital expenditure (Dept. of Health 2005). One way to reduce these costs is to improve health care management of people at high risk of hospital admission. Among older people, certain subgroups are at a particularly high risk. If these high-risk individuals can be identified...

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18. Direct-to-Consumer Advertising: Status Quo and Suggestions to Enhance the Delivery of Independent Medication Information

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pp. 295-316

Pharmaceutical companies and providers of medical devices use DTCA to promote medications and medical devices to the public through many media forms—newspapers, magazines, billboards, television, radio, and the Internet (Wilkes et al. 2000). Additional forms (e.g., patient brochures and videos) are...

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19. How Will Health Care Professionals and Patients Work Together in 2020? A Manifesto for Change

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pp. 317-337

Immediately after the election of Barack Obama and in the midst of the worst economic recession since the Great Depression, the President Elect’s newly designated chief of staff, Rahm Emanuel, pronounced what has since become known as the Emanuel Principle: “Rule one: Never allow a crisis to go to waste. They are opportunities...


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pp. 339-341


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pp. 343-345


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pp. 347-385

Subject Index

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pp. 387-391

E-ISBN-13: 9780262298957
E-ISBN-10: 0262298953
Print-ISBN-13: 9780262016032
Print-ISBN-10: 0262016036

Page Count: 416
Publication Year: 2011

Series Title: Strüngmann Forum Reports