Consumer Reports Health is a good place to start learning about your options. We think of a treatment decision as a three-legged stool, with each leg equally necessary. The first leg is the clinical evidence, the second is the doctor's expertise, and third is the patient's values and preferences. The Treatment Ratings, Condition Reports, and other information on the Consumer Reports Health are designed to help you take a more active role in that decision-making process by informing you about the evidence for different treatment options and specific ways to partner with your doctor to figure out what's right for you.

Yes. Our treatment ratings and recommendations are based on the best available research evidence--the first leg of the stool. This is essential, because in many cases research has overturned longstanding practices that were just assumed to be helpful. For example:

• Tonsillectomies: For years it was believed that kids should have their tonsils removed in order to prevent recurrent sore throats. I had my tonsils out; my brother had his tonsils out; my mother had her tonsils out. But when this was properly studied, it turned out that removing the tonsils hurt more than it helped.
• Bed rest: When I was a resident, patients who'd had a heart attack were put on bed rest for 14 days. We now know that the last thing you want to do with a heart-attack patient is have him or her in bed, not moving for two weeks.
• Estrogen therapy: In theory, it made good sense to put women on hormone replacement therapy after menopause. But when the issue was thoroughly studied, it turned out that it may domore harm than good.

Evidence-based medicine means looking at the totality of the available evidence, not just cherry-picking the articles that you like or that support your conclusion. For the section on osteoarthritis, for example, our medical experts examined 43 individual studies and 21 systematic reviews--summaries of the research that often include large numbers of studies. In other words, we look at every piece of published clinical research. Once the analysis is done, our writers "translate" the information into plain, consumer-friendly language and add additional information specific to patients. The sections called "What Will Happen" and "Questions to Ask" are especially tailored to help consumers understand their options and ask the right questions.

Evidence-based medicine just means we use the best available evidence. On any given day, the published evidence is going to answer less than half of the clinical questions a doctor is faced with. If there are no large clinical studies, we move down the hierarchy of evidence to what we have. Perhaps there are a few small research trials. Or perhaps we can only rely on the consensus of physicians in the field.

The second leg of the stool is the doctor's clinical expertise and his or her years of experience in treating patients in general and you in particular. But while practicing evidence-based medicine doesn't mean relying solely on the scientific literature in making treatment recommendations, it always takes it into account. Your doctor should be receptive to questions about what the research shows and be able to provide reasonable answers. I would be wary about answers that begin only with, "In my experience…" But at the same time, doctors need to also integrate their experience treating patients like you, and what they believe is right based on that experience.

The third leg of the stool is the values and preferences of the patient. Patient values could include religious beliefs, ethics, thoughts about living wills and advance directives, and so on. For example, Jehovah's Witnesses may refuse a blood transfusion, and some women will risk their health rather than have an abortion. Preferences involve individual sensitivities. Some people are keen to avoid drug therapy, while others find it very difficult to make lifestyle changes. Some prefer not to undergo surgery because of the potential risks or diminishment of quality of life during the recovery. Financial considerations may also play a role.


A good example is prostate cancer, where the evidence provides no clear-cut idea of what intervention is best. Doing nothing ("watchful waiting"), radiation, or surgery are all reasonable choices. One man might say that he can't stand the thought of cancer in his body, and for him surgery might be best. Another might say that he would never risk the possibility of impotence or incontinence by having surgery and would prefer watchful waiting since there are no potential complications of nontreatment. Another man might choose radiation because it's doing something but has fewer potential serious complications than surgery.

Women with breast cancer have similar decisions to make around mastectomy vs. lumpectomy and in some cases whether to have additional radiation therapy or chemotherapy.

Along with telling you the evidence behind various treatments, the Consumer Reports Health describes each one in detail so you gain a sense of the pros and cons of each option. Knowing more about what each treatment entails and how it will affect your life can help you make the decision that's best for you. What's right for a friend or relative might not be the best choice for you. So the key is to read up on all of the options, ask lots of questions, and then consult your gut feelings to see what feels right.