book review: The Decision Tree: Taking Control of Your Health in the Era of Personalized Medicine

By Thomas Goetz

Boingboing.net featured this book the day it came out and it seemed so interesting that I went right out an ordered it. I know, the year of making do, what was I thinking?

Summary of the Book
The book looks at technology, and reasons that with doctors too busy to take care of you, you need to start taking control of your health. You have become the informed consumer. But what’s a girl to do? Go to medical school? The idea is to make medical decisions more systematic, make information more accessible and understandable, allow technology to help us rather than confuse us, and give people the tools to make changes to people’s lifestyles easier.

For example, if you wanted to quit smoking, then you would have two options, systematically speaking: cold turkey or nicotine replacement. If you chose cold turkey, then you would need to examine the effectiveness of this method. Once you learned that it is not effective then you might change your choice. Then you would need to choose the type of nicotine replacement therapy.

Mr. Goetz provides the reader an updated drug label which shows: who is to take the drug, why you are taking it, who should not take it, the type of testing needed by someone taking the drug, and other considerations. Below that he gives the patient the findings of the study that lead to the FDA approving the drug, and historical information about the drug. The label he has it clearly too big for a drug bottle, but is still a great idea.

A technological help he profiled was the Nike+. This little fob tracks your speed, in concert with our ipod, while you run. Then you synch it with your computer and it tells you how far you ran, and compares it to your other runs. Fun. I got one from Erica, but have had technical difficulties using it with my Vibram Fivefingers, and need to figure out what to do about that. Needless to say, seeing the data motivates me to run more.

One of the problems with reading the book is similar to the problem many medical students encounter: they start thinking that they have the diseases they are studying. I kept thinking my blood pressure was going up or that I was getting diabetes. Great motivator that book.

Finally, he explains genetic testing, why you might consider getting it, and how it works. I will not be doing any genetic testing in the near term.

Tidbits of Info from the Book
One super interesting point made in the book is that acetaminophen is the most common case of liver failure in the US. 50 percent of cases of liver failure are due to acetaminophen, which is also used in Vicoden and Percocet. The medical establishment now believes that this toxicity is not caused by taking too much of the drug but from a genetic problem which causes as many as 1/3 of all people taking acetaminophen to have raised blood levels of alanine transferease.

Criticisms of the Book
There are a few problems with his book, or rather with his examples. First, because he is using the examples to explain high-level ideas, he may not have done the research necessary to check out his high level understanding of the medical facts (a problem all of us face...). One example he uses is of the recent study that came out showing that Hormone Replacement Therapy (HRT) might be causing heart attacks in women. I have subsequently read that it might have been the type of HRT studied (the kind that uses horses urine to create the therapy) which caused the problems, not the therapy itself. A second example, is Weight Watchers. He holds it up as a successful example of a weight loss program. That it is not. Of all weight loss programs, it has the highest success rate, but most people who do Weight Watchers are going to remain heavy.

Finally, the book is really far ranging, from decision trees to Alzheimer’s to genetics. I suppose the point is we all need to know more about these conditions, but I will wait to learn more on a ‘need to know basis.’

And I remain a little annoyed that Mr. Goetz did not have a spare minute to respond to my email. If you want to read the book, I'll send it to you for free.