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NOT QUITE THE MORNING LINE
Mary G. Barry, MD
Louisville Medicine Editor
editor@glms.org
W
ith a new Triple Crown winner (at last! - my heart, with
millions of others, leapt high
with happiness when American Pharoah
charged through that stretch), my thoughts
lately have more than once touched on odds.
Doctors calculate risks all day, all the
time. If the patient needs the test, will it hurt
him more than help his care? If the patient
needs the treatment, will it help enough to
outweigh the cost and side effects? If the patient needs the best judgment, whom should
I consult? If the patient needs a procedure,
who is the right doctor for the case? And
on and on, endlessly in clinical practice,
doctors make risk/benefit decisions in concert with (and in emergencies, on behalf
of) their patients, sometimes needing only
seconds, and sometimes requiring days of
researching the question, first.
These risks are derived from trial and
error: formal trials, that inform medical
decisions with what we hope are facts transferable to our patients, and informal trials
based on our sum-total experience with a
certain test or treatment, learned (sometimes the hard way) with these patients.
We broaden that experience by consulting
peers, specialists, and the internet (faster
than books, but I still keep classic texts in my
office, to remind and teach me how patients
presented and were diagnosed before the
age of genes and CT scanning).
We also consult the patient. People perceive risk very differently (God forbid I
should take care of an actuary). As we get
older, perceptions change. Intimations of
mortality start later than ever this century, if
we are lucky enough to have avoided flood,
fire, famine and fever, poverty, ignorance
and motor sports. People begin to ask, how
long do I have?
Several years ago “death calculator” indices became popular, and we have a new one
now, called the Ubble quiz, just reported
from The Lancet (Ingelsson and Ganna,
June 2015). “Ubble” stands for the United Kingdom Biobank Longevity Explorer.
The UK Biobank is a long-running study of
500,000 citizens of the UK who were aged
between 40 and 69 when recruited during
2006-2010. The participants were evaluated for socio-demographic information,
past medical history, physical measurements, blood chemistry and other labs, and
healthy/unhealthy behaviors. They agreed to
long-term follow-up. In the past 18 months,
over 1,800 scientists have used the data for
all kinds of studies.
The Ubble quiz was developed by two
Swedish professors, Drs. Andrea Ganna
and Erik Ingelsson. They looked at over
a thousand variables in many categories
and ended up identifying 12 questions that
predict, without laboratory or clinical examination, one’s five year overall mortality.
The questions can be answered online (from
your couch-potato perch, for instance, or
while striding your treadmill-desk). Men
and women share the bulk of questions,
but only men are asked about heart disease,
stroke, hypertension and diabetes, and only
men are asked about earnings and living situation. Only women are asked about anxiety