Think the Answer’s Clear? Look Again

DEBUNKER Dr. Donald A. Redelmeier is an internist-researcher in Toronto.

Presidential elections can be fatal.

Win an Academy Award and you’re likely to live longer than had you been a runner-up.

Interview for medical school on a rainy day, and your chances of being selected could fall.

Such are some of the surprising findings of Dr. Donald A. Redelmeier, a physician-researcher and perhaps the leading debunker of preconceived notions in the medical world.

In his 20 years as a researcher, first at Stanford University, now at the University of Toronto, Dr. Redelmeier, 50, has applied scientific rigor to topics that in lesser hands might have been dismissed as quirky and iconoclastic. In doing so, his work has shattered myths and revealed some deep truths about the predictors of longevity, the organization of health care and the workings of the medical mind.

“He’ll go totally against intuition, and come up with a beautiful finding,” said Eldar Shafir, a professor of psychology and public affairs at Princeton University who has worked with Dr. Redelmeier on research into medical decision-making.

Dr. Redelmeier was the first to study cellphones and automobile crashes. A paper he published in The New England Journal of Medicine in 1997 concluded that talking on a cellphone while driving was as dangerous as driving while intoxicated. His collaborator, Robert Tibshirani, a statistician at Stanford University, said the paper “is likely to dwarf all of my other work in statistics, in terms of its direct impact on public health.”

As an internist who works at Sunnybrook Hospital in Toronto, Canada’s largest trauma center, Dr. Redelmeier sees a large number of patients in the aftermath of crashes. As a result, one of his abiding professional preoccupations is with vehicle crashes. He found that about 25 more people die in crashes on presidential Election Days in the United States than the norm, which he attributes to increased traffic, rushed drivers and unfamiliar routes.

He also discovered a 41 percent relative increase in fatalities on Super Bowl Sunday, which he attributed to a combination of fatigue, distraction and alcohol. After publication of the findings on the Super Bowl, the National Highway Traffic Safety Administration embarked on a campaign with the slogan “Fans don’t let fans drink and drive.”

In preparation for a recent interview in his modest office in the sprawling hospital complex, Dr. Redelmeier had written on an index card some of his homespun philosophies.

“Life is a marathon, not a sprint,” he read, adding, “A great deal of mischief occurs when people are in a rush.”

To that end, he studied the psychology around changing lanes in traffic. In an article published in Nature in 1999, Dr. Redelmeier and Professor Tibshirani found that while cars in the other lane sometimes appear to be moving faster, they are not.

“Every driver on average thinks he’s in the wrong lane,” Dr. Redelmeier said. “You think more cars are passing you when you’re actually passing them just as quickly. Still, you make a lane change where the benefits are illusory and not real.” Meanwhile, changing lanes increases the chances of collision about threefold.

Often he works from a hunch. In the Canadian Medical Association Journal in December, Dr. Redelmeier examined University of Toronto medical school admission interview reports from 2004 to 2009. After correlating the interview scores with weather archives, he determined that candidates who interviewed on foul-weather days received ratings lower than candidates who visited on sunny days. In many cases, the difference was significant enough to influence acceptance.

Dr. Redelmeier’s work on longevity began 10 years ago, when he was watching the Academy Awards and noticed that the celebrities on stage “don’t look anything like the patients I see in clinic,” he said. “It’s not just the makeup and the plastic surgery and wardrobe. It’s the way they move, it’s their gestures. They seem so much more vivacious. It seemed so much more than skin deep and might go all the way to longevity.”

His findings: Academy Award winners live an average of three years longer than the runners-up. A potential explanation could be an added measure of scrutiny, a public expectation of healthier living.

Dr. Redelmeier did not set out to be a researcher. “For years, I thought I’d be a straight clinician,” he said. But during his years at Stanford in the 1980s and early 1990s, first as a medical resident, then as a fellow, he met Amos Tversky, the cognitive psychologist who helped inspire the field of behavioral economics, which examines the cognitive, social and emotional aspects of people’s financial decisions.

Professor Tversky, who was Dr. Redelmeier’s fellowship supervisor, changed Dr. Redelmeier’s thinking entirely.

In 1990, he and Professor Tversky published a paper in The New England Journal of Medicine showing that when physicians make a medical decision for a single hypothetical patient, they favor more expensive treatments than when making a decision for a group of hypothetical patients with similar symptoms. And in 1996 the two scientists found that increased arthritis pain had nothing to do with the weather. They attributed the misperception to the human tendency to look for patterns even where none may exist.

Dr. Redelmeier credits Professor Tversky, who died in 1996, with shaping his own approach to research in the medical realm. “He provided me with a language and a logic for tackling issues that seemed to be around me all the time, but weren’t so apparent to other people,” he said.

Dr. Redelmeier isn’t one to forget about his past research. With the Academy Award study, for instance, he regularly updates the database.

“It’s important for him to know this wasn’t some statistical blip we happened to stumble across,” said Dr. Sheldon Singh, a cardiologist at Sunnybrook Hospital and assistant professor of medicine at the University of Toronto who co-wrote the Academy Awards paper. And in a paper coming out in the September issue of Chance, a statistics journal, Dr. Redelmeier and Professor Tibshirani show that on Election Day 2008, more fatalities occurred than on two control days, the Tuesdays before and after the election. This paper is a follow-up to an earlier one published in The Journal of the American Medical Association.

“Part of the satisfaction for Don is knowing the results stand the test of time,” Dr. Singh said.

Dr. Redelmeier’s unusual approach goes hand in hand with some pronounced personality quirks. His e-mails, which are legendary among their recipients, are written as lists, with a number assigned to each thought. Dr. Redelmeier does this, he said, in order to focus on the content of a message rather than get distracted by grammar, punctuation and syntax.

“I remember the first time I got one, I was a little offended,” Dr. Singh said. “I’d never gotten an e-mail not written in a paragraphed format. Yet he addressed everything I needed to know.”

Dr. Redelmeier takes the results of his research seriously. He rides his bike to work, and when he does drive, he resists “small temptations to change lanes.”

Dr. Redelmeier said he was currently looking at attention deficit disorder among teenage drivers, and whether, like epilepsy, the disorder should be considered a medically reportable condition.

Not everyone has unconditional admiration for Dr. Redelmeier’s work. Professor Tibshirani, for instance, has reservations about some of Dr. Redelmeier’s choices, and declined to collaborate on the Academy Awards study.

“I honestly thought it was frivolous, and we’ve argued about it,” Professor Tibshirani said. He also questioned the Election Day research. “Of course there’s more traffic, so it seemed self-evident,“ he said.

That perspective amuses rather than offends Dr. Redelmeier. When asked about it via e-mail, he responded within one of his numbered missives:

15) I sometimes tell a joke to tackle the issue

16) that is, about people’s ability to judge “frivolity”

17) namely, imagine Charles Darwin 150 years ago

18) at the time he disappointed his father by neglecting medical training

19) and asked, instead, to go on a two-year vacation in the tropics

20) with an emphasis on bird watching (finches)

21) the father was not impressed and thought the son was wasting his time

Another Redelmeier philosophical pearl is “Do not get trapped into prior thoughts. It’s perfectly O.K. to change your mind as you learn more.”

In patient care, he said, he frequently does just that. “I think I know the diagnosis and start the treatment, then follow up and realize I was wrong,” he said. “I intercept a lot of my own errors at a relatively early stage.”

This, not surprisingly, became the basis of some classic Redelmeier research around raising physicians’ awareness of their own thinking — cognitive shortcuts that might lead to a diagnostic error.

Professor Tibshirani said he once accompanied Dr. Redelmeier on rounds at the hospital. “I watched him talk to patients, and they love him,” he recounted.

While Dr. Redelmeier enjoys his patient interactions, he appears incapable of resisting the lure of a good research topic. Several years ago he compared medical school class presidents to a control group of others in the class and found that the presidents died an average 2.5 years earlier than those in the control group. The type who would run for class president, he concluded in the resulting paper, “may also be the type who fails to look after their health or is otherwise prone to early mortality.”

The idea came to him one day in a hallway at the University of Toronto’s Faculty of Medicine, where he had stopped to admire a century’s worth of class photos showing mostly white men.

“Some people might say, ‘What an old boys’ network,’ ” Dr. Redelmeier said. “But I thought, ‘My goodness, what a homogeneous population, akin to identical white mice, which thereby controls for all sorts of differences.’ ” Thus was born another Redelmeier classic.

Katie Hafner, New York Times

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Full article and photo: http://www.nytimes.com/2010/08/31/science/31profile.html