N of 1

What really works for people with cancer who cannot use Western medicine for whatever reasons?  And how can we know?

The Gold Standard for medical research, and the basis of what we hear from doctors, comes from controlled clinical trials with hundreds of patients, randomly sorted into groups, using placebos or other controls, to see whether there is a statistically significant aggregate answer about a proposed treatment.  It’s about averages. It serves the scientists, who are mostly funded by large pharmaceutical companies.   But averages don’t tell us what will happen to an individual, the 1 in a N of 1.  The data given to me, for example, is just that: an average result, and it is not really about me, and it’s not the final word.  In some cases, it’s not only not about me, it might be harmful.  Chemo, for example, would kill me.

One way to deal with this is to use a N of 1 trial, where the number of participants in the trial is one.  You, for example, or me.  By controlled clinical trials, it has been shown that N of 1 is a patient-specified, individual answer which leads to improved patient outcomes.  In other words, me and my doctor try various treatments, and see what works.  When patients and doctors do this, they get better results than if they refer only to the averaged data.  This type of research serves patients needs directly.

This can be costly, bureaucrats don’t like it, and people don’t always understand it.  Doctors often don’t have the time or support staff to make this really work.  But guess what?  It’s gaining traction because it works.  Better than the other way.  The catch is that we need to start by documenting a baseline, and track symptoms before we try a new treatment, and then track afterwards, and test treatments separately.  That last part lets me out, I think.

This process leads to experiments that can answer questions and change treatment plans for the better.  Doctors can tailor care, and its cheaper to do, instead of relying on expensive tests and such.  It’s lower tech, and achieves personalized medicine.  It’s about improving patient care.  Instead of trying to wrangle the patient (you or me) into a averaged body of statistical data, it personalizing the treatment and the outcome as well.

You can read a professional journal for this new movement, The Patient: Patient Centered Outcomes Research.   In 2010, the Affordable Care Act established the Patient Centered Outcomes Research Institute.  I read about this in the November 2014 Discover magazine, starting on page 28.

My thoughts are as usual a little off the wall, but my guess is that people are moving away from Western medicine, which is expensive, impersonal, kind of like a machine conveyor belt, towards Alternative Medicine such as naturopathic care or Chinese medicine or Tibetan medicine, because it is personal, cheaper, and in many cases, more effective for chronic issues.

When Western medicine does apply for cancer treatment, by all means, go for it.  Sometimes it doesn’t, and so this provides an alternative way to proceed.

If Western docs have learned anything from Integrative Medicine, it’s that people are not averages, they are a N of 1.  And if they are to compete, they need to deal with this.

In my case, I get my next scan towards the end of this month.  If the tumors are receding, I won’t know if it’s the turmeric, Eric’s food as medicine, medical marijuana, Tibetan herbs, my own internal meditation and visualizations, or what else in my two page treatment plan.  I’m okay with this, because I have a hunch that what I am doing is a whole plan, and it’s probably better not to try to pull it apart into separate strands.

Time will tell.  Meanwhile, I am encouraged to hear about N of 1 moving into mainstream medicine.  Yippee!

 

 

 

 

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