Science & Research

Studies in uncertainty and risk

Dr. Michelle Driedger is conducting a number of studies into communication, uncertainty and knowledge translation in the health-care system. Many examine highly controversial issues. "Some of my work, for example, looks at how we make those decisions when we have limited budgets, and how do we make effective and equitable decisions that might fund one drug at the expense of funding another," she says. Her work has been funded by the Canadian Institutes of Health Research, the Canadian Cancer Society Research Institute, the Multiple Sclerosis Society of Canada and the Manitoba Health Research Council. Here are a few examples of the projects now underway:

Mammography screening

Several different studies have looked at the effectiveness of this screening test for breast cancer, often with differing results. Driedger says the dilemma for policy-makers is deciding, based on the sometimes conflicting evidence, at what age to make screening mandatory. "Recommendation is age 50 nationally and in Manitoba, but there are some provinces, like B.C., that start at age 40," she says. "You might also have individual clinicians in Manitoba, for example, who might send a woman in her 40s to get screened because the clinician believes that should be done." Her work doesn't look at whether one recommendation is better than the other so much as it focuses on how the reasons for that decision are communicated to clinicians and women.

HPV vaccination

Human papillomavirus is a common sexually transmitted disease that infects millions. While it's generally considered a relatively harmless virus in the short-term, it is linked to cervical and other cancers over the long-term. Public health officials in many regions have recommended vaccination programs for girls to prevent infection as a form of cancer prevention, but the vaccine is controversial. Some people are concerned about the risks of vaccination in general. Others worry the vaccination sends the wrong message to adolescent girls because the vaccine protects against a sexually transmitted disease. The study is especially timely, given that new research suggests the HPV vaccine may be just as effective at two doses as it is with three, which is practice in Manitoba's vaccination program. Dropping one dose could save a significant amount of money. In addition, Prince Edwad Island now vaccinates Grade 6 boys, and Alberta recently confirmed that it was looking at the possibility of vaccinating boys, a decision that, should it come to pass, will again spark debate about the issue.

Multiple sclerosis liberation therapy

This controversial form of treatment for MS sufferers is among the most contentious areas of research for Driedger. "In the case of liberation therapy, we've got politics meeting science," she says. "A lot of patient advocates were pushing to have this therapy approved and available in Canada so that people with MS could avail themselves of the treatment." So far, the province has provided $5 million in funding to participate in a pan-Canadian trial to test the effectiveness of liberation therapy, essentially angioplasty to open narrowed, malformed major veins leading from the brain. Its lead proponent, Italian researcher Dr. Paolo Zamboni, says the therapy reduces MS patients' symptoms. Both specialists in vascular cardiology and neurology in Canada may have differing views on its efficacy, but they do agree more clinical trials are needed to prove whether it works and if it's worth the potential risks. Although initial studies and anecdotal reports have shown it may work for some patients, results from other studies indicate liberation therapy only lessens the symptoms for a period of time before they return. Furthermore, it's not without its risks. "People have died from the procedure, and early evidence from the 30-patient clinical trial going on through the University of Buffalo has shown that some patients have developed more disease progression following the procedure. From the neurologist's perspective, they don't know what it's doing for someone with MS," she says. Driedger's role, as in her other work, isn't to find out if liberation therapy works. She wants to understand how public pressure and scientific evidence intersect to influence policy-makers so they can make better decisions that are not just fair, but understood as fair by all stakeholders - even if it may not be the decision they want to hear.

Wave: May / June 2013

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Wave is published six times a year by the Winnipeg Health Region in cooperation with the Winnipeg Free Press. It is available at newsstands, hospitals and clinics throughout Winnipeg, as well as McNally Robinson Books.

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