Affective Error

Last year, MedPage Today‘s John Gever wrote a piece for ABC News titled 25 Years in Arthritis: New Treatments, New Hope.  After glowing reports on the promise offered by multiple DMARDs and BRMs, how much better the prognosis is than it used to be, new treatments, new hope, ray of sunshine, rah-rah-rah, buried at the bottom of page three we find:

Life is still not a bowl of cherries for RA patients. Eventual disease progression remains the rule for patients, even though, compared with earlier generations, they will be much older when joint surgery becomes their best option.

WHAT!?  I was shocked when I read this.  Disease progression remains the rule?  But… but…

Aggressive management can improve function, stop damage to joints as monitored on X-rays, and prevent work disability. (MedicineNet)

Disease-modifying antirheumatic drugs…  can slow the progression of rheumatoid arthritis and save the joints and other tissues from permanent damage. (Mayo Clinic)

Strategies are all aimed at reducing pain and discomfort, preventing deformities and loss of joint function, and maintaining a productive and active life. (Johns Hopkins)

The goals of treatment with rheumatoid arthritis medications are to achieve remission and prevent further damage of the joints and loss of function, without causing permanent or unacceptable side effects. (UpToDate)

Early diagnosis and treatment of RA is critical if you want to continue living a productive lifestyle. Studies have shown that early aggressive treatment of RA can limit joint damage, which in turn limits loss of movement, decreased ability to work, higher medical costs and potential surgery. (Arthritis Foundation)

It’s so easy to hear the promise of how much better things are now than they used to be – to focus on the hope and promise of better treatments.  After reading that depressing little statement buried in the 25 Years article, I went back and re-read the RA articles previously referenced:

The optimal treatment of RA requires a comprehensive program that combines medical, social, and emotional support for the patient. It is essential that the patient and the patient’s family be educated about the nature and course of the disease.  Strategies are all aimed at reducing pain and discomfort…  (Johns Hopkins)

Medications can reduce inflammation in your joints in order to relieve pain and prevent or slow joint damage…   You may need stronger drugs or a combination of drugs as your disease progresses. (Mayo Clinic)

…the goal of treatment in rheumatoid arthritis is to reduce joint inflammation and pain, maximize joint function, and prevent joint destruction and deformity. Early medical intervention has been shown to be important in improving outcomes. Aggressive management can improve function… (MedicineNet)

I’ve been wondering how I could have so easily missed the warnings all these articles hold.  Last night, I might have found the answer.  I’ve been re-reading Dr. Jerome Groopman‘s How Doctors Think:

We all tend to prefer what we hope will  happen to the less appealing alternatives; this natural tendency is termed “affective error.”  We also lull ourselves into thinking that what we wish for will occur when we get the first inkling, however fragmentary, that our wish may come true.  In short, we value too highly information that fulfills our desires.

It reminds me of the discussion I had with my rheumatologist when she recommended adding a TNF-blocker.  I’d heard such wonderful things about biologics, but I questioned her, “So this will stop the joint swelling?  I’ll get my life back?”  Maybe.  That’s the goal.  No promises.

I highly recommend Dr. Groopman’s book, How Doctors Think
Another book, Anatomy of Hope (written with cancer patients in mind) is also pretty good