Decisions, decisions, decisions
I don't know about you, but when I'm trying to make a decision, I often make lists. These lists might feature pros & cons or knowns & known unknowns. My lists typically consist of whatever seems most helpful to me as I sort through my thoughts and feelings on whatever topic it is that I'm tackling.
When it comes to making health-related decisions, I often find myself turning to comparative effectiveness research to help flesh out my lists and to help inform my decisions. You might not have heard of comparative effectiveness research before (or you could be very familiar with it), but I think it's super helpful when you're trying to make health-related decisions.
What is comparative effectiveness research?
Comparative effectiveness research, not surprising considering the name, involves comparing the effectiveness of different preventive measures, diagnosis methods, treatments, or methods of care delivery. This isn't an exhaustive list, but it gives you an idea of the breadth of the field and the potential of this research to help when making decisions about your health and health care.
If this all makes sense, then skip over this next section. If you're still wrapping your brain around the concept, then join me for a brief commercial break.
--- Commercial break ---
Do you remember watching a laundry detergent commercial (probably from the 90s when I actually had to watch commercials, ah modern advances!) where there's a stained shirt? And then one side of the shirt is washed with one detergent and the other side is washed with a different detergent? And, of course, the brand of detergent that's being promoted in the commercial does a better job of cleaning the shirt than the unnamed 'other' brand.
Well, comparative effectiveness research is a little bit like that, but without the bias and, of course, much more rigorously designed and thoughtfully conducted.
--- End commercial break ---
Are we all back together now?
Right then, let's get to the point of this whole shebang. Last Fall, two projects, funded by PCORI and conducted through PCORnet, published findings related to obesity. Let's take a look at what those studies found, and how you might use that information to make health-related decisions.
Comparing the benefits and harms of three types of weight loss surgery
Obesity is a complex disease that increases the risks for other health problems, including cancer, heart disease, and type 2 diabetes. Patients needing surgery to address their obesity are typically offered one of three different bariatric surgeries –
- Roux-en-Y bypass
- Sleeve gastrectomy
- Gastric banding
Deciding which surgery to pursue hasn't always been a straight-forward choice. As the PCORnet Bariatric Surgery study patient co-investigator, Neely Williams, MDiv, says in Partnering to Help People with Obesity Better Understand Their Surgical Options, "It was finally in 2011 that I underwent a Roux-en-Y bypass. The surgery has helped me, but I have also been impacted by many of the post-surgery conditions that I was not aware of until I began working on this study. The study's results would have been very helpful because I was not sure which procedure was best for me. The only guidance I received was from the surgeon. My pre-surgery screening did not offer details, and I didn't know what questions to ask."
Today if you're contemplating weight loss surgery, the results of this study, a head-to-head comparison of both the benefits and harms of the three most common bariatric surgeries, can help you decide between the surgical options. This information does not replace discussion with your physician or surgeon about your health care, but I hope that it empowers you to evaluate the research and ask questions of your health care team before deciding on the best option for YOU.
Basically, the researchers found that adults with severe obesity had greater weight loss with Roux-en-Y bypass surgery than with sleeve gastrectomy or gastric banding. They also found that while rates of complications occurring within a month of surgery were low for all three types of surgeries studied, the Roux-en-Y bypass had the highest rates of problems following surgery. Definitely not a straight forward answer of what's best, but really useful information to take on board when making decisions about bariatric surgery. Honestly, I've never had a surgery where there were options that I knew about as to the kind of surgery I could have. As much as I use comparative effectiveness research for non-surgical health decisions, I'm quite sure that having research to compare different surgery options would be incredibly useful!
But don't just take my word for it – get the scoop on this study from Neely Williams, MDiv, the study patient co-investigator, and David Arteburn, MD, MPH, the study principal investigator at this PCORI blog post - www.pcori.org/blog/partnering-help-people-obesity-better-understand-their-surgical-options.
Understanding how antibiotic use affects childhood obesity and growth
This one is a bit more abstract for me, as I'm well past making decisions about my daughter receiving antibiotics. Plus, to be honest here, I'm pretty sure that I wouldn't have based a decision about antibiotics use on the information currently available from this research. If the antibiotics are necessary and potentially life-saving, then I'm going to use them.
I think the area of most use for regular people (all of us non-researchers running about in the world) with regard to this study is in knowing that NECESSARY antibiotic use likely doesn't result in a big increase in weight in children. And that there's even more reason to avoid UNNECESSARY antibiotic use. But perhaps we're getting ahead of ourselves here.
The Obesity Observational Study looked at information from the medical records of more than 350,000 kids who were between the ages of four and five at the time of the study. Thirty-five PCORnet sites from across the country participated in this research. Some of the information that researchers examined included diagnosis of chronic conditions, number of antibiotics prescribed for the kids, and the specific types of antibiotics prescribed for them.
Researchers found that antibiotic use in young kids (under two years old) was associated with a slightly higher weight at age five. However, the difference amounted to less than a pound in weight for average height kids. And this difference was with kids who received four or more courses of antibiotics by age two, in comparison with kids who hadn't received any antibiotics at all by the age of two.
This study is ongoing through the end of this year. I'm sure that there will be additional information forthcoming from the study team regarding antibiotic use in children and childhood obesity. Stay tuned for more at the PCORI project site!
Comparative effectiveness research – is the generation and synthesis of evidence that compares the benefits and harms of alternative methods to prevent, diagnose, treat and monitor a clinical condition, or to improve the delivery of care. Evidence is generated through research that uses various study designs (e.g. observational, clinical trial) and synthesized through systematic reviews.
Effectiveness trials – intervention studies can be placed on a continuum, with a progression from efficacy trials to effectiveness trials. Efficacy can be defined as the performance of an intervention under ideal and controlled circumstances, whereas effectiveness refers to its performance under 'real-world' conditions.
PCORI – is an acronym that stands for Patient-Centered Outcomes Research Institute. PCORI was established to fund research that can help patients and those who care for them make better-informed decisions about the healthcare choices they face every day, guided by those who will use that information.
PCORnet – is the short name for The National Patient-Centered Clinical Research Network. PCORnet is a large, highly representative, national "network of networks" that collects data routinely gathered in a variety of healthcare settings, including hospitals, doctors' offices, and community clinics. By engaging a variety of stakeholders – patients, families, providers, and researchers – PCORnet empowers individuals and organizations to use this data to answer practical questions that help patients, clinicians, and other stakeholders make informed healthcare decisions.
Bariatric surgery – is an operation that helps you lose weight by making changes to your digestive system.
Antibiotics – are powerful medicines that fight bacterial infections. Antibiotics either kill bacteria or keep them from reproducing. Antibiotics do not fight infections caused by viruses, such as: colds; flu; most coughs and bronchitis; or sore throats unless caused by strep, a type of bacteria.
The PCORnet Bariatric Study – www.pcori.org/research-results/2015/comparing-benefits-and-harms-three-types-weight-loss-surgery-pcornet-bariatric – with links to all of the publications related to the study
Obesity Observational Study – www.pcori.org/research-results/2015/understanding-how-antibiotic-use-affects-childhood-obesity-and-growth – with links to all of the publications related to the study
PCORnet Study Results Show Small Link between Childhood Obesity and Antibiotics – archive.pcornet.org/2018/10/pcornet-study-results-show-small-link-between-childhood-obesity-and-antibiotics/