How I Evaluate New Therapies

In appointments and in everyday life, people frequently ask about a therapy they heard about on a podcast or morning show. In this post, I want to share how I evaluate new therapies so that you too can systematically evaluate therapies.  

As an economics major and prior analyst, I consider the risk to benefit ratio for all therapies that I implement for patients, whether I am assessing risk versus benefit of a surgery or a supplement. I find this analysis particularly helpful when we think about lifestyle and integrative therapies. A simple risk to benefit analysis is very straightforward, but we should not dismiss its power because it seems too simple. I want to walk you through my thought process when I am looking at a new therapy using a recent example I have been considering for a few of my patients.

I was recently at an event and met the guy heading up the Virtual Medicine Department at Cedars-Sinai. At Cedars, they are getting great results using virtual reality (VR) in the area of pain management and IBS among other things. I had not spent much time thinking about VR and potential clinical applications, but I was thoroughly intrigued. The idea of using a therapy that is easily accessible to those people who are overbooked and can’t take several hours out of a day to see a doctor or therapist or for those in remote locations this seemed like a great idea. In evaluating this therapy, I wanted to look at a specific indication as there could be many. I thought I would walk the reader through my consideration of VR in the treatment of pain. Let’s first consider the risks (as we must first do no harm).

There would be virtually no risk of physical harm in a VR based program, however there is the risk of missing out on alternative therapies, especially if it were to be used exclusively instead of adjunctively. (Alternative therapies for chronic pain include opioids, NSAIDs, Tylenol, supplements, acupuncture, physical therapy and massage among others.) The largest risk in a VR therapy appears to be the cost associated with this novel approach. I then looked at the study data to see if there were any studies on VR and if so if any adverse outcomes were reported. In the studies I evaluated, I did not see any. However, I suppose we could imagine a bad therapy session in VR, like a bad therapist, could leave one feeling worse. 

When considering the benefits, I also looked to study data to try to understand if there was a significant benefit.  In the case of pain management and VR, given the novelty of VR in treatment, the studies are sparse. I found a study looking at acute pain performed at Cedars. In that study, their primary endpoint demonstrated a benefit as reported by pain scores, but not in opioid use. Another study demonstrated reduction in chronic back pain with the use of VR. There is a company called AppliedVR that is FDA authorized and is NIH funded for ongoing studies in pain, which is a promising sign to me.

In this scenario, given the minimal risks and potential upside as recognized by many leading institutions, if a patient was struggling with pain that was interfering with their quality of life, I would likely recommend they take a look at this therapy. In this scenario, there is very little risk associated with the proposed intervention, so I am less concerned with the paucity of data, given the largest risk is the cost. Certainly this equation changes for an intervention such as surgery. A surgery has much larger potential risk and therefore must show greater upside. 

I hope this helps you the next time you are considering a new therapy.

All the best,

Amy