Getting MAD about health at the Cochrane Colloquium

I'm in the Colorado Rockies this week with several hundred researchers and consumers trying to figure out how to better talk and write about science in health care. The aspen trees are golden now and that crisp smell of first snow is in the air. We are here for the Cochrane Colloquium—an annual get together of the Cochrane Collaboration.

The Cochrane Collaboration, established in 1993, is an independent and non-profit international network of people helping doctors, nurses, policy makers and patients/consumers make fully-informed medical and health care policy decisions. The Collaboration does that primarily by preparing and updating detailed assessments of the medical literature on hundreds of diseases and conditions and medical issues. There are now more than 4,000 "Cochrane Reviews," which are all published online in The Cochrane Library. The enterprise—it's essentially a virtual Web-only organization—is funded by government, universities, hospital trusts, charities, and personal donations. The funding is strictly no-strings-attached and contributors to the medical reviews must show they are not constrained by commercial and financial interests.

The conference's first day was devoted to consumer issues. Not surprisingly there was obvious concern about health in general and especially in the US. One of the more clever presentations urged we get "MAD" but in a different way than you might expect. Instead of getting angry we should "make a difference." The timing of this acronym seems propitious since nearly everyone present acknowledges that people (in the U.S. and other countries) appear to be very angry about health care. In the U.S., that's a byproduct of health reform, stressful economic times, an election cycle and a still struggling health care system.

It didn't take long to see that, regardless of our country of origin, we shared common concerns. Whether it was patient care or research there was a strong feeling that there should be "nothing about us without us," Consumers should of course be part of their individual care decision making—though there were many stories shared of patients ignored and even punished for speaking up. But if our involvement does not go beyond our own circumstances we lose an opportunity to prevent the same circumstance from happening to the next patient.

Consumers can make a difference by reaching beyond their own experiences. If we speak up in whatever way we feel comfortable, we can make a difference. We can insist, for example, when an error occurs that the reason for the error be identified and steps taken to prevent it from reoccuring in the future—that process is called root cause analysis. When we are unhappy with a physician or hospital's performance we can let them know and if not assured by their response seek care elsewhere. And if we have the time and energy we can reach out to consumer organizations that are seeking to make health care more consumer responsive. We need good doctors and good scientists…and they need us to do their best work.

I'll blog everyday from this conference. Next, I will share some examples from the Cochrane Colloquium about good science, good questions to ask, and more about consumers making a difference.

—John Santa MD Director, Consumer Reports Health Ratings Center