The lack of a feedback loop from the practice of medical care to the science of medical care is shocking. I'd been thinking about how little learning occurs, how little data is gathered, from the actual outcomes of people based on what doctors do to them, prescribe for them, or tell them to do— but at the highest levels, in a high-profile case, the seven patients who died within a year or three of a new type of surgery are reported as not known if the procedure led to death - http://www.bbc.com/news/magazine-37311038 - that indicates a complete lack of even the most rudimentary system of tracking patient outcomes and trying to learn from them. I don't think our medical care should be informed solely by randomized scientific trials (or on utter malarkey, whatever makes up the balance)— we can and must have methods of learning from the outcomes of medical care as practiced. An opportunity for a #PlatformCooperative own-your-data kind of business, as tracking and making use of this highly sensitive data should be under control of those with the greatest stake in outcomes— people who receive medical care, not insurance companies nor medical or pharmaceutical corporations nor even nurse or doctor associations. More data could also enable us to learn more from epidemiological studies, such as the presence of environmental toxins— those that aren't everywhere already, at least. All this is a matter of life and death, and we can do better.