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Interview with Dr. Michael E. Hochman, Author, 50 Studies Every Doctor Should Know

Created March 23, 2014 by Christy Crisologo
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Michael E. Hochman is a board certified general internist who attended Princeton University and Harvard Medical School. He completed his residency in internal medicine at the Cambridge Health Alliance in Cambridge, Massachusetts. He also completed a Robert Wood Johnson Foundation Clinical Scholars fellowship at the University of California, Los Angeles. Currently, Dr. Hochman is the Medical Director for Innovation at AltaMed Health Services in Los Angeles.

Dr. Hochman has an interest in communicating complex medical information in a digestible format. He has written numerous medically related articles for the Boston Globe and other lay media publications. In addition, Dr. Hochman enjoys teaching and has won several clinical teaching awards. Dr. Hochman has also published original research in top medical journals including the Journal of the American Medical Association.

When did you first decide to become a doctor? Why?
Quite simply, as an undergraduate I realized I enjoyed the sciences and wanted to use this knowledge to help people directly. I always enjoyed direct person-to-person interaction, and I felt medicine would be a good fit. I have certainly found this to be true. Medicine is an interesting profession (something new all the time) and provides lots of direct human interaction and the ability to help people in times of need.

How did you choose the medical school you attended?
I am originally from Massachusetts and when I got into a school near my family, I jumped at the opportunity. Medical school is a challenging time and it’s nice – if possible – to be near people who can support you.

What surprised you most about your studies in medical school?
I was surprised, and continue to be surprised, by the fact that although a tremendous amount is known about physiology and how the body works, appropriate clinical care is still mostly determined by trial and error. Treatments that should work in theory – for example albumin for patients with severe ascites – don’t, while some therapies that you wouldn’t expect to work do. I guess this shows there is still a lot we don’t understand.

What do you wish you had known when you started medical school?
As a student, I spent too much time worrying about the basic sciences and not enough about clinical research. When you are with a patient, what matters is what will work for the problems they are facing – not their underlying biochemistry. I wish I had focused more on how to find answers to clinical questions and identify evidence to guide patient management.

From your perspective, what is the biggest issue in healthcare today?
Certainly one of the biggest challenges is health care costs, which now consume more than 1/6th of GDP. We spend a lot of money on care that doesn’t provide much benefit, while not paying for basic services that do. For example, we spend a lot of money at the end of life for treatments that don’t even work and may even cause harm – feeding tubes in patients with advanced dementia, for example. At the same time, we don’t pay for basic services for many low-income patients who are uninsured or underinsured. I think if we shifted resources around in a more rational way, we could provide better care to more people while spending less. I’m optimistic that health care reform – with its emphasis on expanded coverage or incentives for high quality, cost effective care – is taking us in the right direction.

Please give us a brief overview of your book, 50 Studies Every Doctor Should Know.
My book summarizes 50 landmark clinical studies that changed the practice of medicine and continue to be relevant today. These studies address central clinical questions such as: Should patients with stable angina be managed initially with medical therapy vs. revascularization? Are medications or psychotherapy better for the initial treatment of depression? Is there a link between childhood vaccines and autism? For each study, I summarize the background, design, results, and conclusions, and try to put the findings in context.

While you may be familiar with some of the studies I picked, others are less widely known, but no less important. For example, one study summarized in my book clearly demonstrates that for patients with back pain, surgery has only very small benefits. Yet surgery for back pain is commonplace in the U.S.

Most of the studies in the book were published within the past two decades, and all continue to be clinically relevant today. I did not include studies only of historical importance, and I also tried to avoid preliminary studies that may be over-turned in the near future. In other words, I tried to pick the landmark trials that are clinically relevant and will likely continue to be clinically relevant at least for the next several years.

What led you to compile a book of studies?
As a medical student and resident, I always admired doctors who could cite key studies. They not only sounded smart, but more importantly were able to better guide their patients. I initially struggled to learn the key studies, but with the help of some important mentors I eventually did. I decided to write the book to share the knowledge I had accumulated with others.

How did you decide which studies to include? What makes these studies unique?
There is, of course, no perfect way to select studies for a book like this. I used several sources to guide the decisions, including advice from colleagues and the number of citations each study had. I also tried to focus on studies addressing important and common clinical decisions such as: which blood pressure medication is best? I avoided studies of topics only of relevance to specialists, such as which chemotherapy regimen is best.

Did you learn anything that surprised you while working on this book?
While writing the book, I discovered a few key studies I hadn’t been aware of, yet clearly should have been. For example, I knew that many children with ADHD are treated with medications, but discovered while doing research for this book that there is a pivotal study – the MTA trial – which compared medications vs. behavioral therapy for children with ADHD. When I read the details of the MTA trial, I discovered that the benefits of medications vs. behavioral therapy are much less clear than are frequently described. Specifically, it is not clear that medications have any lasting benefits on success in school for children with ADHD – rather the benefits of mostly just short-term behavioral improvements.

Why are these studies important for physicians to know?
As a doctor, you of course cannot know every study, and should not try. To make clinical decisions, you will frequently need to depend on guidelines and evidence summaries – as well as common sense. But by learning a few key studies on important topics, I believe physicians will be more confident in their decision-making.

How do you hope your book will impact the field of medicine?
I hope the book will show doctors that the medical literature isn’t really as overwhelming as it initially seems. Again, I believe that understanding a few key studies can go a long way.

I believe the book also highlights the importance of funding clinical research. There are many key questions that have yet to be answered.

Besides doctors, who else would benefit from reading your book?
I believe other medical professionals – including nurses, pharmacists, physician assistants, and health educators – could gain a lot from the book. I have attempted to write the book at a level that most licensed health care professionals – including the ones noted above – could understand.

But I also believe patients could benefit from knowing key medical studies, and I am in the process of developing a book like this targeted for a lay audience.

How have the studies in this book impacted your own career?
I think understanding these key studies has taught me that many clinical decisions are not clear cut and that patient preference is frequently important. For example, studies of screening mammography demonstrate that the benefits are actually quite small. I still encourage my female patients in the appropriate age category to receive mammograms, but if a woman does not want the test, I don’t push the issue. I know from the studies that the benefits of screening mammography are small, and if the patient does not want to undergo the test – which can lead to anxiety, false positive results, and the diagnosis of cancers that would never impact her life – I think that is a reasonable decision and I respect it. In fact, my mother recently decided to stop receiving mammograms, and I support her decision 100%.

How is current research shaping the future of medicine? What would make a study a “landmark” that would warrant inclusion in a future edition of your book?
I believe landmark studies define the approach for the management of common clinical situations. As I noted before, there are still many key clinical questions that require good answers. For example, for early stage prostate cancer is surgery, radiation therapy, or watchful waiting the best approach? Also, there are many important questions for health systems, for example do larger systems of care lead to better outcomes for patients compared to traditional small private practices? Studies that answer key questions like that would make it in future editions.

What advice do you have for student entering the field of medicine?
Now is a really exciting time for medicine. Many patients who previously did not have health insurance will for the first time have coverage. At the same time, we doctors need to find a way to care for our population in a high quality yet cost-efficient manner. My advice is to have fun with it – I think the years to come will be very interesting, regardless of what field you go into!

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