Henrik Vogt - Academia.edu (original) (raw)

Papers by Henrik Vogt

Tidsskrift for Den norske legeforening, 2017

Systemmedisin, en spydspiss i den nye presisjonsmedisinen, lover både helhetstenkning og en revol... more Systemmedisin, en spydspiss i den nye presisjonsmedisinen, lover både helhetstenkning og en revolusjon i forebyggende medisin. Men løftet er ikke troverdig. Foto: Nicolai Bauer Allmennlegen møter hele mennesker over tid. Derfor behøver de en form for helhetstenkning eller holisme som teoretisk forankring. I dag selges en teknologisk transformasjon av helsevesenet inn som en løsning på helsevesenets problemer. Grunnideen er å fortolke store mengder «big data» (stordata) fra ulike kilder. Dette skal gi oss en ny persontilpasset, prediktiv og preventiv medisin som lover å revolusjonere medisinens nytteverdi (såkalt P4-medisin).

Journal of Evaluation in Clinical Practice

Scandinavian Journal of Primary Health Care

Can precision medicine be personal; Can personalized medicine be precise?

Precision medicine—or personalized medicine—promises greater precision and certainty in medicine.... more Precision medicine—or personalized medicine—promises greater precision and certainty in medicine. This paper highlights a ‘precision paradox’: that it may, in important ways, also create more uncertainty and imprecision. First, the aim of precision medicine is to tailor treatment to the individual. However, when the number of individuals that are seen to have a specific health problem moves towards one (n = 1), it becomes hard to employ randomized control trials or other statistically based methods. This creates uncertainty about what kind of rationality and evidence will be seen as validating what works in medicine. Just as biomedicine aims to turn personalization into science, the art of medicine resurfaces. Second, one strategy in precision medicine is to make models more complex in order to make them more accurate and thus certain. However, there is a fundamental tension between complexity and precision. Beyond a certain threshold, as more variables are included, models paradoxi...

Humana.Mente, 2016

Proponents of the emerging field of P4 medicine (defined as personalized, predictive, preventive ... more Proponents of the emerging field of P4 medicine (defined as personalized, predictive, preventive and participatory) argue that computational integration and analysis of patient-specific “big data” will revolutionize our health care systems, in particular primary care-based disease prevention. While many ambitions remain visionary, steps to personalize medicine are already taken via personalized genomics, mobile health technologies and pilot projects. An important aim of P4 medicine is to enable disease prevention among healthy persons through detection of risk factors. In this paper, we examine the current status of P4 medicine in light of historical and current challenges to predictive and preventive medicine, including overdiagnosis and overtreatment. Moreover, we ask whether it is likely that in silico integration of patient-specific data will be able to better deal such challenges and to turn risk predictions into disease-preventive actions in a wider social context. Given the l...

Rationale and aims: Precision medicine (PM) raises a key question: How can we know what works whe... more Rationale and aims: Precision medicine (PM) raises a key question: How can we know what works when the number of people with a health problem becomes small or one (n=1)? We here present a formative case from Norway. The Norwegian Board of Health Supervision was faced with a cancer patient, who had improved after treatment with a drug in the private health sector but was refused continued treatment in the public health service due to lack of clinical trial evidence. The Board overturned this decision, arguing that the drug had been unambiguously documented to work in the individual case. We aim to provide an in-depth analysis of this case and The Board´s decision and thereby to illustrate and elucidate key epistemological and ethical issues and developments in PM. Method: We provide our analysis and discussion using tools of critical thinking and concepts from philosophy of science and medicine such as uncertainty, evidence, forms of inference and causation. We also examine the case ...

Tidsskrift for Den norske legeforening, 2018

Oral presentations, 2018

This presentation highlights recent publications showing that the evidence for the efficacy of ph... more This presentation highlights recent publications showing that the evidence for the efficacy of pharmaceutical treatment in children with ADHD diagnosis is weak, especially over the long term and that it comes with previously unrecognized risks of side-effects.Despite widespread pharmacological treatment of ADHD, the first comprehensive systematic review on the use of methylphenidate in children and adolescents was not published until 2016. A Cochrane group examined 185 randomised controlled trials with more than 12 000 children and adolescents and concluded that existing studies were of such low quality due- to high risk of bias – that it was not possible to say for certain whether methylphenidate is beneficial for children and adolecents with an ADHD diagnosis. An additional review from Cochrane concludes that the evidencebase for the use of amphetamines in ADHD is similarily weak. Spring 2017, the latest results form the Multimodal Treatment Study of Children with ADHD (MTA) concluded, 16 years after the start of the study, tht longterm use of stimulants is associated with suppression of adult height, but no reduction in symptoms. A new Cochrane review (in print 2018) included 260 relevant non-randomized studies with 2,283,509 participants worldwide. The occurrence of serious adverse events in the comparative cohort and patient-controlled studies was 1.36 times more frequent in participants that used methylphenidate when compared to controls. The proportion of withdrawals from methylphenidate due to serious adverse events in cohort studies without a control group was 1.50%, and the proportion of withdrawals due to adverse events of unknown severity was 7.30%. In addition, the proportion of withdrawals due to non-serious adverse events was 6.2%, and 16.2% for unknown reasons. These findings are discussed in light of overdiagnosis. Children with ADHD have genuine and serious problems. However, we cannot ignore the fact that several recent studies have yielded only weak evidence to support the extensive use of medication that occurs today. This state of affairs should trigger renewed public and expert discussion on the pharmacological treatment of ADHD in children and adolecents. Objectives A presentation of recent reviews on the pharmacological treatment of ADHD in children and adolecents in light of overdiagnosis. Method Discussant review. Results Recent studies have yielded only weak evidence to support todays extensive use of ADHD-medication to childen and adolecents. Conclusions The state of affairs should trigger renewed public and expert discussion.

Tidsskrift for Den norske legeforening, 2018

Tidsskrift for Den norske legeforening, 2018

Tidsskrift for Den norske legeforening, 2018

Nature biotechnology, Jan 6, 2018

Nature biotechnology, Jan 11, 2018

Tidsskrift for Den norske legeforening, 2017

Clinical chemistry, Jan 21, 2017

Theoretical Medicine and Bioethics, 2016

Proceedings of the National Academy of Sciences of the United States of America, Sep 29, 2016

More than 2 million people in the United States have myalgic encephalomyelitis/chronic fatigue sy... more More than 2 million people in the United States have myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). We performed targeted, broad-spectrum metabolomics to gain insights into the biology of CFS. We studied a total of 84 subjects using these methods. Forty-five subjects (n = 22 men and 23 women) met diagnostic criteria for ME/CFS by Institute of Medicine, Canadian, and Fukuda criteria. Thirty-nine subjects (n = 18 men and 21 women) were age- and sex-matched normal controls. Males with CFS were 53 (±2.8) y old (mean ± SEM; range, 21-67 y). Females were 52 (±2.5) y old (range, 20-67 y). The Karnofsky performance scores were 62 (±3.2) for males and 54 (±3.3) for females. We targeted 612 metabolites in plasma from 63 biochemical pathways by hydrophilic interaction liquid chromatography, electrospray ionization, and tandem mass spectrometry in a single-injection method. Patients with CFS showed abnormalities in 20 metabolic pathways. Eighty percent of the diagnostic metabolite...

Tidsskrift for Den norske legeforening, 2017

Systemmedisin, en spydspiss i den nye presisjonsmedisinen, lover både helhetstenkning og en revol... more Systemmedisin, en spydspiss i den nye presisjonsmedisinen, lover både helhetstenkning og en revolusjon i forebyggende medisin. Men løftet er ikke troverdig. Foto: Nicolai Bauer Allmennlegen møter hele mennesker over tid. Derfor behøver de en form for helhetstenkning eller holisme som teoretisk forankring. I dag selges en teknologisk transformasjon av helsevesenet inn som en løsning på helsevesenets problemer. Grunnideen er å fortolke store mengder «big data» (stordata) fra ulike kilder. Dette skal gi oss en ny persontilpasset, prediktiv og preventiv medisin som lover å revolusjonere medisinens nytteverdi (såkalt P4-medisin).

Journal of Evaluation in Clinical Practice

Scandinavian Journal of Primary Health Care

Can precision medicine be personal; Can personalized medicine be precise?

Precision medicine—or personalized medicine—promises greater precision and certainty in medicine.... more Precision medicine—or personalized medicine—promises greater precision and certainty in medicine. This paper highlights a ‘precision paradox’: that it may, in important ways, also create more uncertainty and imprecision. First, the aim of precision medicine is to tailor treatment to the individual. However, when the number of individuals that are seen to have a specific health problem moves towards one (n = 1), it becomes hard to employ randomized control trials or other statistically based methods. This creates uncertainty about what kind of rationality and evidence will be seen as validating what works in medicine. Just as biomedicine aims to turn personalization into science, the art of medicine resurfaces. Second, one strategy in precision medicine is to make models more complex in order to make them more accurate and thus certain. However, there is a fundamental tension between complexity and precision. Beyond a certain threshold, as more variables are included, models paradoxi...

Humana.Mente, 2016

Proponents of the emerging field of P4 medicine (defined as personalized, predictive, preventive ... more Proponents of the emerging field of P4 medicine (defined as personalized, predictive, preventive and participatory) argue that computational integration and analysis of patient-specific “big data” will revolutionize our health care systems, in particular primary care-based disease prevention. While many ambitions remain visionary, steps to personalize medicine are already taken via personalized genomics, mobile health technologies and pilot projects. An important aim of P4 medicine is to enable disease prevention among healthy persons through detection of risk factors. In this paper, we examine the current status of P4 medicine in light of historical and current challenges to predictive and preventive medicine, including overdiagnosis and overtreatment. Moreover, we ask whether it is likely that in silico integration of patient-specific data will be able to better deal such challenges and to turn risk predictions into disease-preventive actions in a wider social context. Given the l...

Rationale and aims: Precision medicine (PM) raises a key question: How can we know what works whe... more Rationale and aims: Precision medicine (PM) raises a key question: How can we know what works when the number of people with a health problem becomes small or one (n=1)? We here present a formative case from Norway. The Norwegian Board of Health Supervision was faced with a cancer patient, who had improved after treatment with a drug in the private health sector but was refused continued treatment in the public health service due to lack of clinical trial evidence. The Board overturned this decision, arguing that the drug had been unambiguously documented to work in the individual case. We aim to provide an in-depth analysis of this case and The Board´s decision and thereby to illustrate and elucidate key epistemological and ethical issues and developments in PM. Method: We provide our analysis and discussion using tools of critical thinking and concepts from philosophy of science and medicine such as uncertainty, evidence, forms of inference and causation. We also examine the case ...

Tidsskrift for Den norske legeforening, 2018

Oral presentations, 2018

This presentation highlights recent publications showing that the evidence for the efficacy of ph... more This presentation highlights recent publications showing that the evidence for the efficacy of pharmaceutical treatment in children with ADHD diagnosis is weak, especially over the long term and that it comes with previously unrecognized risks of side-effects.Despite widespread pharmacological treatment of ADHD, the first comprehensive systematic review on the use of methylphenidate in children and adolescents was not published until 2016. A Cochrane group examined 185 randomised controlled trials with more than 12 000 children and adolescents and concluded that existing studies were of such low quality due- to high risk of bias – that it was not possible to say for certain whether methylphenidate is beneficial for children and adolecents with an ADHD diagnosis. An additional review from Cochrane concludes that the evidencebase for the use of amphetamines in ADHD is similarily weak. Spring 2017, the latest results form the Multimodal Treatment Study of Children with ADHD (MTA) concluded, 16 years after the start of the study, tht longterm use of stimulants is associated with suppression of adult height, but no reduction in symptoms. A new Cochrane review (in print 2018) included 260 relevant non-randomized studies with 2,283,509 participants worldwide. The occurrence of serious adverse events in the comparative cohort and patient-controlled studies was 1.36 times more frequent in participants that used methylphenidate when compared to controls. The proportion of withdrawals from methylphenidate due to serious adverse events in cohort studies without a control group was 1.50%, and the proportion of withdrawals due to adverse events of unknown severity was 7.30%. In addition, the proportion of withdrawals due to non-serious adverse events was 6.2%, and 16.2% for unknown reasons. These findings are discussed in light of overdiagnosis. Children with ADHD have genuine and serious problems. However, we cannot ignore the fact that several recent studies have yielded only weak evidence to support the extensive use of medication that occurs today. This state of affairs should trigger renewed public and expert discussion on the pharmacological treatment of ADHD in children and adolecents. Objectives A presentation of recent reviews on the pharmacological treatment of ADHD in children and adolecents in light of overdiagnosis. Method Discussant review. Results Recent studies have yielded only weak evidence to support todays extensive use of ADHD-medication to childen and adolecents. Conclusions The state of affairs should trigger renewed public and expert discussion.

Tidsskrift for Den norske legeforening, 2018

Tidsskrift for Den norske legeforening, 2018

Tidsskrift for Den norske legeforening, 2018

Nature biotechnology, Jan 6, 2018

Nature biotechnology, Jan 11, 2018

Tidsskrift for Den norske legeforening, 2017

Clinical chemistry, Jan 21, 2017

Theoretical Medicine and Bioethics, 2016

Proceedings of the National Academy of Sciences of the United States of America, Sep 29, 2016

More than 2 million people in the United States have myalgic encephalomyelitis/chronic fatigue sy... more More than 2 million people in the United States have myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). We performed targeted, broad-spectrum metabolomics to gain insights into the biology of CFS. We studied a total of 84 subjects using these methods. Forty-five subjects (n = 22 men and 23 women) met diagnostic criteria for ME/CFS by Institute of Medicine, Canadian, and Fukuda criteria. Thirty-nine subjects (n = 18 men and 21 women) were age- and sex-matched normal controls. Males with CFS were 53 (±2.8) y old (mean ± SEM; range, 21-67 y). Females were 52 (±2.5) y old (range, 20-67 y). The Karnofsky performance scores were 62 (±3.2) for males and 54 (±3.3) for females. We targeted 612 metabolites in plasma from 63 biochemical pathways by hydrophilic interaction liquid chromatography, electrospray ionization, and tandem mass spectrometry in a single-injection method. Patients with CFS showed abnormalities in 20 metabolic pathways. Eighty percent of the diagnostic metabolite...