American Statistical Association
New York City
Metropolitan Area Chapter

New York State Psychiatric Institute
at Columbia University Medical Center
Biostatistics Seminar



N-OF-1 TRIALS: WHAT, WHY, AND WHITHER?

by

Richard L. Kravitz, M.D., M.S.P.H.
Division of General Internal Medicine
University of California, Davis


Abstract

N-of-1 trails are single patient trials of treatment effectiveness and safety. When feasible, they are uniquely capable of establishing the best treatment in an individual patient. Yet after a flurry of interest in the early 1990ís, n-of-1 trials largely faded from view. This seminar is presented in 3 parts. Part 1 is a brief history of n-of-1 trials. Part 2 summarizes qualitative research with doctors and patients and examines potential barriers to wider n-of-1 trial uptake. Part 3 questions whether randomization, blinding, and reliable measurement (the 3 defining characteristics of n-of-1 trials) are truly indispensable going forward and asks whether increased therapeutic precision might be achieved in other ways. In particular, I argue that major gains in therapeutic precision could potentially be achieved by focusing on measurement alone. Technological advances such as Smartphones may facilitate needed change.

Biographical Note

Richard L. Kravitz M.D., M.S.P.H., is Professor and Co-vice Chair for Research, Department of Internal Medicine, University of California, Davis and Co-Editor in Chief, Journal of General Internal Medicine. Primary research interests focus on the theme of patients as agents for quality and physician behavior. Over 20 years ago, he and his Medical Outcome Study co-authors reported on the relationship between patient mix, utilization of health care services, physician specialty and system of care. He has since examined the impact of the malpractice system on defensive medical practices, patients' expectations for care, how physicians respond to patients' requests for services, and how direct-to-consumer advertising of prescription drugs influences physician decision making. He is currently PI of an NIMH sponsored project to develop and test targeted and tailored message delivery systems to enhance care of primary care patients with depression. Recent work has also focused on tailoring evidence for care of individual patients. A Fellow of the American College of Physicians and Academy Health, Dr. Kravitz is a graduate of Stanford University and UC San Francisco School of Medicine. He completed additional clinical and research training at UCLA, where he served on faculty until his 1993 arrival at UC Davis.


Date: Tuesday, October 19, 2010
Time: 3:00 - 4:00 P.M.
Location: New York State Psychiatric Institute
1051 Riverside Drive
6th Floor Multipurpose Room (6602)
New York, New York
(Directions)

RESERVATIONS ARE NOT REQUIRED

Coffee: 2:45 to 3:00 P.M.
Reception: 4:00 to 4:30 P.M.


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