Tuesday, September 1, 2009

NIH Draft Consensus Statement on Family History

The NIH conference on Family History came and went.

What were we left with?

A Consensus Statement.

What is the crux of it?

"The panel recognized that family history has an important role in the practice of medicine and may motivate positive lifestyle changes, enhance individual empowerment, and influence clinical interventions. The panel found that it is unclear how this information can be effectively gathered and used in the primary care setting for common diseases."

Well ladies and gentlemen. I can give you all sorts of anecdotal evidence. That being said, we are evidence driven creatures, so I suggest you give me a call and we set up studies in Primary Care practices with different family history tools.

Things such as the "SCREEN" screen versus a detailed 3 generation pedigree versus 1st generation.

It is pretty easy and inexpensive to set these studies up if you use current technologies.

What else did the panel say?

"For a systematically collected family history for common diseases to become an evidence-based tool in primary care clinical settings, substantial additional research will be needed."

I agree, it is time we develop these tools as multifactorial shotguns which hit lots of targets. This IS what DTC is arguing that there puny little scans do. Without evidence Family History champions like myself run the risk of sounding like the marketing hacks out in Silicon Valley and PR firms like NYC.

That being said there are some evidence tools where Family History helps clinical classification. I think specifically of the
Reynolds Risk and how it beat the Framingham

We should attack this one precisely the same way. Start by each individual risk calculator ADD family history and see what it does.

Then do a cohort study of practices which routinely perform 3 generation pedigrees and see how the incidence of diseases like diabetes, HTN and MI shake out.

That could be done over 5-10 years. Not a long wait to get some great evidence, if you ask me.

The Sherpa Says: The evidence may be weak for Family History as a Poly-Tool. But as a clinical marker in certain diseases it is ESSENTIAL.


Molecular Creativity said...

Missed opportunity? Family histories were emphasized when I taught medical genetics as one of easiest and most educational aspects of medical genetics but is not paid for and is problematic due to lack of payment. This meeting was an opportunity to educate the nonspecialist doctor who rarely develop a long term relationship with the patient/client (people move) to know about his/her family history. Dr. Welby does not exist and most doctors are meeting patients for the first time and not getting to know the individual. Medicine is taught to treat the general population and not the individual. Did this meeting fail?

Molecular Creativity said...

I forgot some quotes that should be included in the first day of medical school, I think?
"Treasure your exceptions" William Bateson

"The Doctor does not treat 'man' except accidentally; He treats Calius or Socrates or someone else...So if someone .... knows the universal without knowing the individuals contained in it, he will often fail in his treatment; for it is the individual that has to be treated."

"Chemical individuality-genetically determined biochemical characteristics and capabilities which confer our predisposition to and immunities from the various mishaps which are spoken of as disease." Archibald Garrod

Steve Murphy MD said...

Tough to say failure. This was a State of the Science conference. The science is not as solid as ALLHAT....but that is no surprise. Who is funding Family History research. My take, the science is good for some risk predictive models, but not as a poly-tool.

Doesn't mean we shouldn't be doing it. Even CPT coding requires we do it, so we must be missing something. Like education.

But this conference was not for that. Mike Murray's up in Boston is. We need more conferences like that......