Life & Times Transcript

 

Val>> Suppose you've been diagnosed with a serious illness.
Now you have to make decisions about which would be best
possible treatment. Your doctor can make some recommendations,
but there are hundreds of studies out there that your doctor may
not be familiar with. That's where "Doctor Evidence" comes in.
It's a private company that offers clients individual medical
research customized to their particular situation. Dr. Todd
Feinman is one of its founders. I met him at his home in
Venice
where he showed me how it works.

Dr.
Todd Feinman>> Well, the traditional way of getting a
diagnosis or treatment now is to go to your doctor, tell him
your symptoms, get a physical exam, sit in a chair and then he
will make recommendations about tests and treatments. You may
or may not get the right diagnosis or you may or may not get the
right treatment. The antidote to that problem is to go get
evidence, also known as outcome data, that identifies the most
accurate tests and the most effective treatments and the safest
treatments.

Val>> To get your own evidence that pertains to your particular
case?

Dr.
Todd Feinman>> Exactly.

Val>> Now a lot of people would say, well, yeah, you can just
go on the web and do that. There is all sorts of information
these days, medical information, on the web.

Dr.
Todd Feinman>> The typical website or the typical result
from surfing the internet is you're going to get review
information, general review information, as opposed to actual
outcome data, but it won't identify a surgeon in your area that
has the best outcomes. It won't identify a diagnostic center
that's famous for diagnosing correctly most of the time.

Val>> Okay, so give us an example of a client who came to you
with a particular question. This case is a diagnostic question.
He wasn't sure whether his problem was being diagnosed
correctly.

Dr.
Todd Feinman>> Okay. This client is a gentleman who was
diagnosed with lung cancer a year ago, had curative surgery and
the lung cancer came back. He has been told -- he had a PET
scan that told him that the cancer has come back and it's
positive and he wants to know if the PET scan is truly positive.
What is the accuracy of a PET scan?

Val>> So he wants to know whether that PET scan is accurate,
whether he can trust it or not, right?

Dr.
Todd Feinman>> That's right.

Val>> So you've designed a very specific technical question.

Dr.
Todd Feinman>> And the question is, what is the accuracy of
a PET scan to confirm that a solitary lung mass is truly cancer
and if the cancer is metastatic, also known as spreading, in a
patient who has a history of resected non-small cell squamos
lung cancer?

Val>> All right, so then, in response to that question, you
have --

Dr.
Todd Feinman>> -- so a question is framed. It's given to
our librarian who has a Masters in Library Science and they are
given that and they look up every clinical study all over the
world that answers that question. A hundred abstracts will come
back or a hundred clinical trials and we cherry-pick and pick
the ones that are most relevant and most valid and we load them
in. We found twenty articles, twenty abstracts, twenty clinical
trials that answered that question.

Val>> Clients then look over all the abstracts and, if there's
a term they don't understand, all they have to do is click on
it. The program is linked to a medical dictionary that will
explain what the terms mean. The clients then choose which
abstracts are most interesting or relevant and, if they want,
they can view the entire text. And not only can they see it,
but their doctor can get into their portal and they can discuss
it together, right?

Dr.
Todd Feinman>> Exactly.

Val>> That's really a good thing.

Dr.
Todd Feinman>> We provide access for our client to the
portal and we provide access for their doctor so they can review
the evidence with them and help them evaluate it and use the
evidence to get the right tests and treatments. For this
particular client, what he did was read the full-text articles.
We had three clients using this information.

One client used this information to confirm to get a PET scan
done. He had never had a PET scan done. He got a PET scan done
at a center that had a high accuracy rate and the spot in his
lung was determined to be truly cancer and he ended up having
curative surgery.

Another client who reads this information who'd never had a PET
scan before had the PET scan done and it truly showed that it
wasn't cancer and he did not need surgery and he's now being
followed every six months by his doctors.

Another client had the PET scan done and it was positive, but it
wasn't done initially at a center that had a high accuracy rate,
so he's getting the PET scan redone at another center that has a
better outcome rate, a better accuracy rate.

Val>> So basically this is private medical -- customized, I
should say -- this is customized medical research that pertains
to your individual situation, something that you will not get
from your doctors because they just don't have the time.

Dr.
Todd Feinman>> And most doctors all over the country use
our service when they want it to find evidence for themselves.
When a doctor gets sick, he loves this service because he needs
evidence. He knows how to read it and he's going to get it.
Other doctors will use our service to get evidence for their
patients. The reason they do that is because, one, very few
doctors have time to look it up and, two, most doctors don't
have the resources or the skills to actually go through all the
medical search engines, find relevant abstracts and full-text
articles and then store it. You have to have the technology to
store it, so we make it simple for them. We get it, store it
and give it to them.

Val>> "Doctor Evidence" charges clients by the question, $250
per question, then an additional charge of about twenty or
thirty dollars for each full-text article retrieved. The whole
process can take anywhere from a day to a week or so. How else
can you use this information gathered from "Doctor Evidence"?

Dr.
Todd Feinman>> Once you frame a question, find the
evidence, evaluate it and you've made an informed decision with
your doctors about what tests and treatments you want, you have
to get your insurance plan to pay for it and prove it. An
insurance plan cannot deny you access to a diagnostic test that
has proven to be highly accurate or a treatment that has been
proven to be highly effective.

Val>> So if you've been denied treatment by an HMO, you could
come here, get the evidence that shows that this will give me a
positive outcome and turn it in to them and they have to pay
attention to that?

Dr.
Todd Feinman>> Exactly. The medical director or the case
manager for that insurance plan cannot deny you that treatment
or that test if you have evidence proving it's very effective.
That's part of our insurance advocacy program. We have clients
who use evidence to overturn denials or use evidence to get
approval for a test or a treatment that's effective.

Val>> That's really important. And then the other thing you're
interested in doing is --

Dr.
Todd Feinman>> -- besides finding evidence and storing
evidence and getting evidence to the people, we also want to
create better evidence. One of the ways we do that is to do
programs and initiatives that create databases of outcomes. For
example, we're gearing up to do a huge initiative with a large
pharmacy outlet, one of the largest pharmacy outlets in the
country, to create a database of patients on hundreds of
different medications and seeing what their outcomes are. For
example, if a patient is on a cholesterol drug, did the
cholesterol drug work? Were there any side effects? We're
going to enroll millions of patients into that database and
measure the outcomes and get the outcomes to the people and to
the drug companies.

Val>> These are people who voluntarily take part in this?

Dr.
Todd Feinman>> Exactly. There will be programs that
incentivize them to do it and most patients want to be in a
program like that to find out if the drugs really work and if
they're safe.

Val>> So the idea is to avoid another Vioxx fiasco?

Dr.
Todd Feinman>> Exactly. This program will prevent future
Vioxx.

Val>> Dr. Feinman, thank you very much for giving us a survey
of "Doctor Evidence".

Dr.
Todd Feinman>> Okay. It's been great.