Is Crowdsourcing the New Face of Evidence-Based Medicine?

September, 2017

In the 1990s, Ofer Ben-Shachar suffered a leg injury. Doctors recommended he get surgery, estimating they would have him back running marathons within weeks. Before going under the knife, Ben-Shachar wanted to find data on this surgical option to see how effective it really was. However, the little research he could dig up was confusing and inconclusive. Frustrated, he succumbed to the assurances of his confident surgeon. What happened instead was so debilitating, it took him five years before he was able to drive a car again (you can read more about this story here). He vowed that one day he would create a website to help people get the kind of information he wished he had had at the outset.

After selling a successful startup, Ben-Shachar was able to follow through on his promise and funded a venture that he has named HealthOutcome.


Health Outcome homepage showing the highest and lowest rated solutions for Lower Back Pain

The website reads, “To [Ofer’s] surprise, no one from the medical community (his doctor, the hospital, or his insurance company) contacted him to learn about the result of his surgery.” Ben-Shachar goes on to say, “There is no meaningful data on medical treatments or surgery outcomes available to patients or physicians." Despite over 51 million surgeries (750,000 of them back surgeries) performed annually in the US, there was little to no patient-reported outcome data available to patients. "We are actively addressing this void of outcome data with a platform built to capture the voice of the patient.”


Data on medical outcomes has been limited and is not always trustworthy

In response to this lack of information, HealthOutcome has democratized treatment outcome data by collecting crowdsourced ratings and reviews. People need to hear from each other, not just in anecdotes, but in numbers. Ben-Shachar explains, “after 80 reviews are submitted for an intervention, we see the rating stabilize, which is in itself a sign of validity. The scale of the studies we are doing here is beyond anything happening in clinical trials. At 1/10,000th the cost per patient, we pool unbiased results from the public and are reflecting important truths about what works and what doesn’t.” There is truth in numbers, and the website has gotten the attention of a group of Stanford researchers who have recently published an article about the site "Is Crowdsourcing Patient-Reported Outcomes the Future of Evidence-Based Medicine? A Case Study of Back Pain", showing it to be a valid tool for measuring medical outcomes.


In the Evidence-Based Medicine triad, ‘relevant scientific evidence’ can now be bolstered by crowdsourced outcome data

Researchers note that the findings on HealthOutcome are consistent with the findings from randomized controlled trials, while the numbers are vastly greater than can be achieved from a randomized controlled trial (RTC). Furthermore, HealthOutcome allows for people to rate treatment success many months or years later, giving a better picture of the longevity of an outcome. For most surgeries, doctors perform little or no follow-up, and controlled trials are limited in that they cannot check back in on the trial patients one, two, three years later to see how their condition has progressed.

The Gokhale Method Institute recognizes the need for research on our program, but has had to face the reality of how difficult it is for a small organization to gather ‘pure’ data, in the form of an RTC. These trials are expensive and take specialized knowledge and a specialized cast of characters to design, implement, analyze, and publish.


This figure shows the change of mean values of the number of check-marked pain-related questions from the Roland Morris Pain Questionnaire due to Gokhale Method Foundations course.

In our journey for scientifically sound data, various studies have been conducted on the Gokhale Method. A San Jose State University study showed increased vitality and increased hamstring flexibility from taking the Foundations Course. An ongoing in-house study has shown remarkable changes in the frequency of back pain that students experience before the course, at completion of the course, and four weeks after completion. These studies, though highly encouraging, fall short of the RTC standard.


Enter HealthOutcome with reliable and valuable data!

HealthOutcome, with its overwhelming validation of the Gokhale Method and Postural Modification, was therefore a very welcome recent discovery. Lower back pain is one of the conditions the site has highlighted and...drumroll…Postural Modifications wins by a landslide margin! While most treatment options on the site differ by only 0.1 or 0.2 points (on a 0–5 rating scale) from the next best treatment option, Posture Modification stands head and shoulders above the next best treatment: compare a rating of 3.7 for Posture Modification with 2.9 for Yoga, with over a thousand reviews between them.

The Gokhale Method had been added to the list of interventions on the site, and we’re very proud to have a 4.6 out of 5 rating. With less than 500 reviews, our treatment doesn’t yet make it ‘above the fold.’ However, this excellent rating is a huge deal for the Gokhale Method, for back pain research, and for the public.


The Gokhale Method needs more reviews, but it is quickly becoming the top-rated solution on the Health Outcome website

This site is a tremendous service to us all, and I hope it flourishes and expands to cover an increasing number of conditions. There has long been a need for an efficient, trustworthy way to collect reviews of available treatment options, both to help patients gather the information they need to make informed medical decisions, and to help inform medical professionals (who have little time to research new treatments for every condition and to compile detailed treatment reviews) of the variety and efficacy of the options available for their patients. There is also a great need for a platform that non-clinical treatment options, such as posture modification and exercise regimens, can use to efficiently gather data, learn how effective their programs are, and share this news. The Gokhale Method is very excited to be able to see quantifiable validation of what we hear from our students every day, and to share our success with a larger audience.

I hope as readers of this article, you will share your experience after taking the Gokhale Method Foundations course on HealthOutcome if you were suffering from either lower back pain or neck pain.

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Comments

The Gokhale Method has made all the difference for me and so I have added my data to HealthOutcome.org and I recommend that all of us who have been healed by Gokhale add our voices to the site so that others can be helped.

     Tony

Thank you for taking the time and trouble to add your voice, and encouraging others to do the same! We're seeing several additional reviews for lower back pain and neck pain on healthoutcome.org - this is very gratifying. Thanks to everyone who is participating!

Oh my gosh, this is so exciting and so needed!  I too will add my voice to the project!  I can testify to the Gokhale Method being absolutely remarkable but on another issue all the pointless heart surgeries need to come under more scrutiny.  My husband's open heart surgery was a shameful travesty.  So many surgeries of all kinds are done simply to support a system (clinic and hospital costs) rather than for the true benefit of an individual.  

Thank you for this information.

Tara

This data, and Randomized Controlled Trials, do indeed show that we overuse surgery in our culture. And sorry to hear that your husband had great problems.  But I believe it's important to keep in mind how great surgery is when you really need it. It takes an enormous amount of time, training, and dedication to do right by our bodies when surgery is necessary - my daughter is a medical resident and I now have an insider's view of what's invovled in medical training - oy! Every industry has its problems and abuses, but I feel enormously grateful to the people and complex systems that support us when simple measures are not enough.