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The Decision Tree: Taking Control of Your Health in the New Era of Personalized Medicine |  | Author: Thomas Goetz
Publisher: Rodale Books
Category: Book
List Price: $25.99
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as of 7/31/2010 15:34 MDT details
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Seller: btboxbty
Rating:  25 reviews
Sales Rank: 75515
Media: Hardcover
Edition: 1
Pages: 320
Number Of Items: 1
Shipping Weight (lbs): 1.3
Dimensions (in): 9 x 6.3 x 1.3
ISBN: 1605297291
Dewey Decimal Number: 613
EAN: 9781605297293
ASIN: 1605297291
Publication Date: February 16, 2010
Availability: Usually ships in 1-2 business days
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Product Description
In The Decision Tree, Thomas Goetz proposes a new strategy for thinking about health, one that applies cutting-edge technology and sound science to put us at the center of the equation. An individual’s Decision Tree begins with genomics, where $400 and a test tube of spit provides a peek at how your DNA influences your health. It taps self-monitoring and collaborative health tools, where iPhone applications and next-generation monitoring gadgets can help individuals successfully change their behavior, once and for all. And it turns to new screening techniques that detect diseases like cancer and diabetes far earlier and with far better prospects for our health. Full of thoughtful, groundbreaking reporting on the impact personalized medicine will have on the average patient, The Decision Tree will show you how to take advantage of this new frontier in health care.
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Showing reviews 1-5 of 25
 From a doctor's perspective.. February 16, 2010
Shigeki Minami
13 out of 15 found this review helpful
As a physician with a public health background, I have a healthy amount of scepticism when 'the next great book' comes along and claims to change the way we live. However, while reading Goetz' book, it didn't take long for me to realize I was in for a wonderful surprise. Perhaps it is his background as an editor at Wired magazine that makes his writing so engaging. Combine that with a solid grounding in the public health arena and the result is impressive. Although written with the patient in mind, this book will serve as an invalubale tool for clinical practitioners and epidemiologists alike. It opens a window into the field of medicine that I found fascinating and highly educational. More importantly, it gives us a glimpse at the way the doctor-patient relationship will look in the future. And, whether we like it or not, as Goetz eloquently reminds us, we would be wise to take notice now.
A brilliant and important book January 29, 2010
Irfan A. Alvi (Towson, MD USA)
18 out of 22 found this review helpful
When it comes to assessing the problems with our health care system and identifying ways to make it better, this book by Thomas Goetz is among the best I've ever read. Hopefully, it will be highly influential, especially considering that we live in an age when most of the "easy" medical problems have been solved and the hard ones remain (eg, cancer and many chronic conditions). Goetz proves to be an incisive analyst, a creative thinker, a balanced pragmatist, and a lucid writer.
The main idea presented in this book is that decision tools need to be developed which enable all available information to be rationally, systematically, and efficiently assembled and weighed in order to cost-effectively maximize individual and collective health outcomes. In other words, health care needs an engineering approach. This is really just common sense, yet our health care system unfortunately falls far short of this ideal, so we need books like this to help open people's eyes.
Here are some further key points from the book:
* Patients need to play an active role in their health care decisions, using physicians and other health care professionals largely as consultants, and collaborating with other patients in sharing information.
* Health care information (medical records, drug labels, etc.) needs to be presented in a sensible standardized format and made easily accessible online on a real-time basis.
* To account for biological heterogeneity among people, preventive measures and treatments need to be tailored to each individual. Thus, the information used to make decisions must include both statistical information drawn from populations as well as specific information particular to each individual (both phenotypic and genetic).
* Costs need to be controlled by emphasizing prevention of disease, lowering the cost for FDA drug approval, avoiding replacement of older/cheap drugs with newer/expensive drugs which aren't significantly better, avoiding use of expensive drugs which don't significantly improve outcomes (eg, many cancer drugs), using/avoiding screening based on relationship to outcomes, avoiding overuse of expensive medical technology, and linking physician payments at least partly to outcomes rather than extent of services.
The above ideas overlap considerably with ideas I arrived at myself after years of intense involvement with health care issues (especially related to cancer research and treatment). For example, see my detailed review of The War on Cancer: An anatomy of failure, A blueprint for the future by Guy Faguet.
This is a brilliant and important book, and I can't recommend it strongly enough.
What to Expect When You're Expecting a Long Life February 16, 2010
S. Fox (Washington, DC)
5 out of 6 found this review helpful
Thomas Goetz catalogs the recent advances (and setbacks) in medicine & personal health, but also maps out the possibilities for how things could get better. He does this so convincingly that you can't believe it's not already taking root: clear labeling on drugs & food, passive tracking of our exercise routines, open access to our health data.
There are enough lessons for self-improvement in the book that I found myself comparing it to What to Expect When You're Expecting, but since Goetz focuses on the big picture (prevention, diagnosis, disease management) it is more like What to Expect When You're Expecting a Long Life.
Unlike the pregnancy bible I read 10 years ago (and more than once threw across the room), Goetz doesn't preach from a lofty whole-grain pulpit. He doesn't think we should ask people to do more, nor should we scold people for every mistake they have made, but rather we should give them tools to make better health choices.
You know how MDs are always asked for cocktail-party diagnoses? This book is for all the MPHs who stood nearby wishing that someone would ask them for on-the-spot health advice.
A guide to taking charge of your own health January 20, 2010
PT Cruiser (CA USA)
5 out of 7 found this review helpful
This book, written by Thomas Goetz, the executive editor of Wired magazine is packed with information about how to take part in making your own health decisions. At a time when there is a shortage of primary care physicians in almost all parts of the country and this is our first line of defense, we're sometimes looking at very little time spent per patient to diagnose our medical problems. There has never been more of a need to be proactive with our own health care.
When I selected this book, I thought from the description that it was going to be mostly about DNA testing and how to go from a DNA test to managing your own health. Actually the book was a whole lot more. Goetz discusses some very high tech ways of managing health care like different types of scans and screening tools, some computer and iPhone applications to track not only health conditions but exercise and food choices. He also discusses some low tech, but very useful things like a drug facts box that is now being reviewed by the FDA that would tell us in simple terms what is prescription drug is for, how it works, symptoms and life threatening side effects and how long it has been in use. It would be very similar to the nutrition labeling required on most of our packaged foods. He even discusses solutions like Weight Watchers and why that type of an approach can work.
Some parts of the book are exciting, discussing new technologies and some are just plain depressing like how our drugs come to market and which ones are at the top of the list because they'll make billions of dollars because of the demand and which ones are left "sitting on the shelf" because they're too expensive to develop and test because of a smaller amount of people who will need them. The discussion of costs for many of the tests and scans and which ones get priority and why is pretty eye opening as well.
All in all a very fascinating book, jam packed with information and ideas. Goetz doesn't have an answer or a solution for all the questions that he asks, but he'll have you Googling on a lot of different health care subjects by the time you finish this book.
Update: I followed the advice in the book and may have gotten info that could save my life January 11, 2010
L. Gildart (Somerville, MA USA)
4 out of 6 found this review helpful
Please see the update at the end of this review. I followed the book's suggestion re: genetic testing and learned some surprising and helpful things about myself.
Reading this book was a little like sitting in the classes of some of my favorite professors. The prose is engaging and often anecdotal, which is good, because the subject matter is so dry and dense that I really wanted to give up on this book a few times. I'm very glad that I stuck with it, because the book does describe a very useful method for gaining and using medical knowledge about oneself. At its most basic, a "decision tree" is a flow chart comprised of a logical series of questions and answers that starts with the information one has, and progresses through "if A is true, what do I do next?" hypothoses, potential diagnoses, treatments, etc. until one has developed a plan of action. Or inaction. Sometimes, the decision tree leads the patient to leave things be.
But the book, like my favorite professors, jumps from premise to anecdote to new premise, almost as if the author's brain is working too fast for his word processor.
And it's a bit rambly. It took somewhere between 50 and 60 pages to even point out that regular people can order their own DNA analyses (before I wrote this review today I checked online and found out it costs about $500, which is a lot, but which is also less than the price of a decent television), which is really what they need to do before they can design an effective decision tree (based on the concept that our health is the combined result of genetics and environmental factors. Once we know our genetic risks, we can make informed choices to avoid or ameliorate many, if not most, environmental triggers.)
Although the book addresses the fear surrounding the giving and the getting of this knowledge - the idea that patients will collapse, quit their jobs, become erratic in general if the news is bad - it neglects the financial incentive, in today's insurance climate, to avoid genetic testing if one wants to remain insurable.
In addition to arguing for genetic testing, Goetz argues against excessive use of other forms of screening, which can lead to wrong diagnoses and unnecessary (and dangerous, in some cases) treatment. He also details examples of decision trees that start with symptoms, or with decisions (like "quit smoking"), which maes the book a useful reference regardless of whether the reader wants to take Goetz' advice to get some genetic testing.
I would recommend this book to anyone who has recently received troubling news about his or her health or who is questioning whether to ask a doctor to run tests or who has a nagging feeling about some strange symptoms.
UPDATE:
I took the book's advice (and my own from the end of this review) and ordered genetic testing from Pathway Genomics (the least expensive alternative I could find). I have an autoimmune disorder (SLE), and when you have one of those, doctors tend to dump every little symptom you get into the autoimmune bucket, unless they find something else within the first or second try. It's frustrating for them, and for the patient as well, because autoimmune disorders mimic so many other diseases and conditions. They also complicate other diseases and conditions. So, when my heart rate spiked last year and stayed there, my doctors did some tests, decided the increase was due to damage to my nervous system (which is probably true), and said that it was benign absent any other cardiovascular risk factors, which, as far as they can tell, I don't have. My cholesterol and blood pressure are awesome. And because I'm sick and don't have a choice, I take extra care about diet and exercise.
I have a strapless heart rate monitor that I got right here on Amazon, and I watch it in case there's any further increase, because that would be really bad, but my doctors told me not to worry. Except, I couldn't really shake the feeling that maybe I was missing something. I had an incomplete family history, because my father's mother and uncle had both died suddenly and pretty young and nobody really followed up on it at the time. So, I took the test, waited six weeks, and learned that I'm at a significantly higher than average risk for myocardial infarction. Now, I know.
And I feel better, not worse. I feel sort of empowered.
Showing reviews 1-5 of 25
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