It’s not all about chance

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 and now at the University of Toronto,
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.

Redelmeier was the
first to study cell phones and automobile crashes. He also found that about 25
more people die in crashes on U.S. presidential Election Days than the norm,
which he attributes to increased traffic, rushed drivers and unfamiliar routes.

He has discovered a
41 percent relative increase in fatalities on Super Bowl Sunday, which he attributes
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.”

Often he works from a
hunch. In the Canadian Medical Association Journal in December, 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.

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.

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.”

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.

Another Redelmeier
philosophical pearl is “Do not get trapped into prior thoughts. It’s perfectly
OK 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.

While 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,”’ Redelmeier said. “But I thought, ‘My
goodness, what a homogeneous population, akin to identical white mice, which
thereby controls for all sorts of differences.”

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