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      The Missing Reality of Real Life in Real‐World Evidence

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      1 ,
      Clinical Pharmacology and Therapeutics
      John Wiley and Sons Inc.

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          Abstract

          Reality is defined as a real event, a real thing, or state of affairs. Reality exists in the places where we live our daily lives, in the relationships we have with others, and in our experiences, circumstances, and situations that occur across the lifespan. As the everydayness of our lives becomes increasingly digitized, data generated from the reality that exists outside of our healthcare encounters holds much promise to fill recognized gaps in real‐world evidence (RWE). In the past decade, many factors have converged to uniquely position person‐generated data for use in health care delivery, payment reform, product development, and regulatory decision making. Yet, real‐world data will fall short of its promise to fill gaps in RWE if what we learn does not reflect the real lives of real people from across the spectrum of social, economic, and cultural experiences.

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          Most cited references16

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          Good intentions are not enough: how informatics interventions can worsen inequality

          Health informatics interventions are designed to help people avoid, recover from, or cope with disease and disability, or to improve the quality and safety of healthcare. Unfortunately, they pose a risk of producing intervention-generated inequalities (IGI) by disproportionately benefiting more advantaged people. In this perspective paper, we discuss characteristics of health-related interventions known to produce IGI, explain why health informatics interventions are particularly vulnerable to this phenomenon, and describe safeguards that can be implemented to improve health equity. We provide examples in which health informatics interventions produced inequality because they were more accessible to, heavily used by, adhered to, or effective for those from socioeconomically advantaged groups. We provide a brief outline of precautions that intervention developers and implementers can take to guard against creating or worsening inequality through health informatics. We conclude by discussing evaluation approaches that will ensure that IGIs are recognized and studied.
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            What Is Real-World Data? A Review of Definitions Based on Literature and Stakeholder Interviews.

            Despite increasing recognition of the value of real-world data (RWD), consensus on the definition of RWD is lacking.
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              Accelerated clinical discovery using self-reported patient data collected online and a patient-matching algorithm.

              Patients with serious diseases may experiment with drugs that have not received regulatory approval. Online patient communities structured around quantitative outcome data have the potential to provide an observational environment to monitor such drug usage and its consequences. Here we describe an analysis of data reported on the website PatientsLikeMe by patients with amyotrophic lateral sclerosis (ALS) who experimented with lithium carbonate treatment. To reduce potential bias owing to lack of randomization, we developed an algorithm to match 149 treated patients to multiple controls (447 total) based on the progression of their disease course. At 12 months after treatment, we found no effect of lithium on disease progression. Although observational studies using unblinded data are not a substitute for double-blind randomized control trials, this study reached the same conclusion as subsequent randomized trials, suggesting that data reported by patients over the internet may be useful for accelerating clinical discovery and evaluating the effectiveness of drugs already in use.
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                Author and article information

                Contributors
                sokun@patientslikeme.com
                Journal
                Clin Pharmacol Ther
                Clin. Pharmacol. Ther
                10.1002/(ISSN)1532-6535
                CPT
                Clinical Pharmacology and Therapeutics
                John Wiley and Sons Inc. (Hoboken )
                0009-9236
                1532-6535
                21 May 2019
                July 2019
                21 May 2019
                : 106
                : 1 , Real‐World Data: Real‐World Evidence ( doiID: 10.1002/cpt.2019.106.issue-1 )
                : 136-138
                Affiliations
                [ 1 ] PatientsLikeMe Cambridge Massachusetts USA
                Author notes
                [*] [* ]Correspondence: Sally Okun ( sokun@ 123456patientslikeme.com )
                Author information
                https://orcid.org/0000-0002-4789-5599
                Article
                CPT1465
                10.1002/cpt.1465
                6617711
                31002396
                b54727a0-0109-4295-8fb6-d11a651acbe9
                © 2019 The Author Clinical Pharmacology & Therapeutics published by Wiley Periodicals, Inc. on behalf of American Society for Clinical Pharmacology and Therapeutics

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

                History
                : 08 January 2019
                : 08 April 2019
                Page count
                Figures: 0, Tables: 0, Pages: 3, Words: 2700
                Categories
                Review
                Reviews
                Reviews
                Custom metadata
                2.0
                cpt1465
                July 2019
                Converter:WILEY_ML3GV2_TO_NLMPMC version:5.6.5 mode:remove_FC converted:10.07.2019

                Pharmacology & Pharmaceutical medicine
                Pharmacology & Pharmaceutical medicine

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