M*STAR, individuality and evidence based medicine

M*STAR is the Multiple Sclerosis Team Approach Rule.

While the concept is simple, straightforward and, you would think obvious, unfortunately in today's healthcare environment, the individual person (not patient) is marginalized, while doctors are forced to see more and more patient in less and less time.

[In a National Healthcare plan, this is going to get even worse -- we are going to set government standards on stripping each of us of our individuality, and instead we will all be numbers in the mega-healthcare risk pool -- remind anyone of the cogs in 1984 or a Brave New World?]

The recentering of the patient as the center of the health (not illness) team flies in the face of some of the recent trends in modern medicine. As we focus more and more of our energies on evidence-based medicine, we forget that clinical trials, analysis, post-hoc analysis and meta-analysis are all great tools, but they are only tools.

Patients are people and clinical trials are important, but they only hint at the potential effects of a given intervention (in neurology, that intervention is usually a medication). The results of these trials do not predict how an individual patient will respond to that medication. So, a positive trial (where the results are as we had hoped), does not necessarily mean that each individual will respond to the therapy -- it only gives a hint to the average response in the population in that specific trial. So too, a negative trial (where the results are disappointingly not what we had hoped), does not mean that no one will respond to the medication.

So, there may be great interventions for individuals, but unfortunately these individuals will be denied access to these medications because of the negative trials. This is a problem now, and it will become an even bigger problem as we enter the next phase of healthcare reform.


--
Dr. Daniel Kantor, MD BSE
Medical Director
Neurologique