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Give or take a few years (Feb-05)

A longer life may result from the amount of social support present in your life, but is the longevity due to giving or receiving that support?

Imagine that in your busy schedule each week, you typically at least have Wednesday and Saturday nights free as time to spend however you want. Recently, however, one of your close friends had her car break down and now she is wondering whether you would be willing to drive her to and from a yoga class on Wednesday nights for the next three weeks while the car is in the shop. She told you that the class is only about a 15 minute drive each way. She said that you shouldn't feel pressured, and she just thought she'd ask if you had the time to help her out.

Would you be willing to drive your friend to and from her yoga class for the next three weeks?
  • Yes, I'd take the time to help her out.
  • No, I'd keep my Wednesday nights free.
Do you think that helping out others could at all affect your health?
  • Yes
  • No

Giving vs. receiving: effects on mortality

A research team of investigators at the U of M Institute for Social Research teamed up with CBDSM investigator, Dylan Smith, to conduct a study investigating whether giving or receiving help affects longevity. The researchers noted that receiving social support is likely to be correlated with other aspects of close relationships, including the extent to which individuals give to one another. Based on this, they hypothesized that some of the benefits of social contact, sometimes attributed to receiving support from others, may instead be due to the act of giving support to others.

Using a sample of 423 married couples from the Detroit area, the investigators conducted face-to-face interviews over an 11-month period. The interviews assessed the amount of instrumental support respondents had given to and received from neighbors, friends, and relatives, as well as the amount of emotional support they had given to and received from their spouse. Instrumental support included things like helping with transportation, errands, and child care, whereas emotional support involved having open discussions with a spouse and feeling emotionally supported. Mortality was monitored over a 5-year period by checking daily obituaries and monthly death record tapes provided by the State of Michigan. To control for the possibility that any beneficial effects of giving support are due to a type of mental or physical robustness that underlies both giving and mortality risk, the investigators also measured a variety of demographic, health, and individual difference variables, including social contact and dependence on the spouse.

The investigators found that those who reported giving support to others had a reduced risk of mortality. This was true for both instrumental supoprt given to neighbors, friends, and relatives, and for emotional support given to a spouse. They also found that the relationship between receiving social support and mortality depended on other factors. Specifically, receiving emotional support appeared to reduce the risk of mortality when dependence on spouse, but not giving emotional support, was controlled. Receiving instrumental support from others actually increased the risk of mortality when giving support, but not dependence on spouse, was controlled.

What can we make of these findings?

It appears from these results that the benefits of social contact are mostly associated with giving rather than receiving. Measures that assess receiving alone may be imprecise, producing different results as a function of dependence and giving support.

Given the correlational nature of this study, it is not possible to determine conclusively that giving support accounts for the social benefit traditionally associated with receiving support. Nevertheless, the results of the present study should be considered a strong argument for the inclusion of measures of giving support in future studies of social support, and perhaps more importantly, researchers should be cautious of assuming that the benefits of social contact reside in receiving support.

It's true that when helping others out, you might have to give up some of your own time, but based on the above findings, it looks like in the long run you may end up ultimately gaining more time.

Read the article:

Providing social support may be more beneficial than receiving it: results from a prospective study of mortality.
Brown S, Nesse RM, Vinokur AD, Smith DM. Psychological Science 2003;14:320-327.

It's your call: your intuition against the experts' advice (Jan-05)

A respected national organization has released new guidelines. As a physician, would you change your patient's treatment based on these recommendations? Imagine you are a primary care physician taking care of a male patient, Sam, with mildly elevated cholesterol. He doesn't like taking pills and, fortunately, his cholesterol has been good enough that he doesn't need any pills. But now, a respected National Organization has just revised its recommendations, and are urging doctors to treat cholesterol more aggressively, even in people like this patient, who has no history of heart disease or diabetes.

What role should these new guidelines play in your decision?

The guidelines should not be a strong consideration 1       2       3       4        5  The guidelines should be a strong consideration
What would you recommend to your patient, Sam?
I would... 
  • ask him to take a pill.
  • urge him to take a pill.
  • give him information about cholesterol and let him decide.
  • urge him not to take a pill.
  • ask him not to take a pill.

How do your answers compare?

What were some of the things you were weighing when you made your decision? Perhaps you were wondering why the National Organization would recommend taking a pill even when a patient's cholesterol is good enough that they wouldn't necessarily need the more aggressive treatment. You might have found yourself wondering whose interests were reflected in these guidelines. Did the National Organization have some kind of investment in the pill or the pharmaceutical company that produces it? You might have had some doubts about just how much you could trust the guidelines.

Resistance to practicing "cost-effective" medicine

In the past, physicians did what was best for each individual patient in their care, without having to consider cost or having to figure out whether an HMO or accreditation board was looking over their shoulders. But now physicians are put in the awkward position of having to judge whether a particular patient will benefit enough from a specific therapy for that therapy to be cost-effective. It is not surprising that physicians disparage cost-effectiveness in health care, given that traditional medical education teaches that they should not consider the cost of medical interventions when treating individual patients.

Resistance to practicing according to Clinical Practice Guidelines

Clinical practice guidelines, like the one you read about on the previous page, offer a potentially palatable way for physicians to consider the cost-effectiveness of medical interventions. High quality guidelines are based on thorough and systematic reviews of clinical and cost-effectiveness evidence. Still, physicians are often concerned that guidelines are tainted by financial conflicts of interest. The experts who are involved in writing the guidelines are often the same individuals who interact with the pharmaceutical industry.

Why cost-effectiveness and Clinical Practice Guidelines belong together

Investigator Ellen Hummel and CBDSM investigator Peter Ubel were asked by the editors of Virtual Mentor, the online ethics forum of the American Medical Association, to comment on whether clinical practice guidelines ought to incorporate cost-effectiveness information. These investigators begin by acknowledging the resistance to practicing cost-effective medicine. At the same time, however, they argue that including cost-effectiveness information in clinical practice guidelines is an essential way to address physicians' concerns about the kinds of conflicts of interest mentioned above. If cost-effectiveness evidence is presented up-front, physicians wouldn't have as many concerns that the guielines were intended to benefit the industry while sticking the patient with a higher cost. Imagine if on the previous page the guideline had presented evidence that the new, more aggressive cholesterol treatment was still well within accepted cost-effectiveness ratios despite potential conflicts of interest. You might have then better trusted the guideline's recommendation when assessing what to tell Sam.

Including cost-effectiveness information in clinical practice guidelines will enhance the credibility of their recommendations. At the same time, evidence-based guidelines help clinicians recognize the importance of practicing cost-effective medicine with their individual patients. With the help of high quality guidelines, physicians may be encouraged by groups of peers and respected authorities to restrain themselves from pursuing rare benefits for their patients, which is especially important in a time when our current health care system increasingly demands that we become involved with the costs of medical care.

Read the article:

Cost and clinical practice guidelines: Can two wrongs make it right?
Ubel PA, Hummel EK. Virtual Mentor 2004;6:np.

Darin Zahuranec’s survey study, “Variability in physician prognosis and recommendations after intracerebral hemorrhage” published in Neurology found that physicians vary substantially in ICH prognostic estimates and treatment recommendations. This study suggests that variability could have a profound effect on life and death decision-making and treatment for ICH.

Several CBSSM-affiliated faculty and alumni were co-authors: Angie Fagerlin, Meghan Roney, Andrea Fuhrel-Forbis, and Lewis Morgenstern.

Fri, February 28, 2014

Brian Zikmund-Fisher was quoted in a Scientific American article about risk communication of certain chemicals in the lives of expectant parents. He explains, “Look at your life and the choices you make, and do things that can make you safer easily, but don't overreact to anything ... There are very, very few things out there that have such huge effects on our lives or our baby's lives that one teeny bit of exposure is going to make a difference.”

Jacob Seagull, Ph.D., assistant professor of medical education, was part of a team recognized as winners of the sixth-annual Provost's Teaching Innovation Prize for their development of a training portal to help health care professionals better understand the needs of at-risk populations. is an online, modular curriculum that covers public healthcare systems and bio-psychosocial care for the underserved and is supplemented by a novel, game-based learning tool. Learn more...

Dr. Jason Karlawish, Professor of Medicine and Medical Ethics at the University of Pennsylvania, will discuss his forthcoming novel, "Open Wound: The Tragic Obsession of Dr. William Beaumont" on Thursday, October 20, 3-5 pm, at the Biomedical Research Science Building (BSRB), Room 1130.  "Open Wound" is a fictional account of true events along the early 19th century American frontier, tracing the relationship between Dr. William Beaumont and his illiterate French Canadian patient.  The young trapper sustains an injury that never heals, leaving a hole in his stomach that the curious doctor uses as a window both to understand the mysteries of digestion and to advance his career.  A reception will follow the talk, and books will be available for purchase on site from Nicola's Books.  The event is co-sponsored by the Center for Bioethics and Social Sciences in Medicine, the Center for the History of Medicine, and the University of Michigan Press.  Click here for more information about the book. 

Tue, September 20, 2011

The CBS News website recently featured 10 tips to make better decisions about cancer care from U-M’s Angela Fagerlin, Ph.D., associate professor of internal medicine. Below is an excerpt from the article:

Cancer is scary, and doctors sometimes sound as if they’re speaking a foreign language when talking about the disease and its treatment. But “people are making life and death decisions that may affect their survival and they need to know what they’re getting themselves into,” says Fagerlin “Cancer treatments and tests can be serious. Patients need to know what kind of side effects they might experience as a result of the treatment they undergo.”


Tue, January 10, 2017

Geoffrey Barnes was featured in a recent MHealth Lab article, "Medication Adherence a Problem in Atrial Fibrillation Patients." Dr. Barnes is the lead author of JAMA Cardiology article, which reports that while anticoagulant therapy is important for stroke prevention in people with atrial fibrillation, many people don’t stick with it for various reasons (side effects, physician advice, etc.).