Don’t just swallow, check the evidence first - it applies to diet, medications, and more

The wrong approach

According to the food conglomerate Danon: “Evidence is increasing that even mild dehydration plays a role in the development of various diseases.” It’s a campaign, sponsored by the producers of Volvic, Evian, and Badoit bottled waters, to get us all to drink more water.

But what and where is this evidence? A doctor replies: “This is not only nonsense, but is thoroughly debunked nonsense.”

The right approach

Worried by the fact that European guidelines classified almost all older people as being at high risk of cardiovascular disease, Norway has developed its own guidelines that use differential risk thresholds according to age.

Compared with the European guidelines, the total sum of life gained is about the same, but the number of patients treated is considerably lower.

How does clinical evidence work?



Ben Goldacre's Moment of Genius on BBC4 radio:

"Clinical trials in medicine are designed to be free from bias. They test, as objectively as possible, the effectiveness of a particular intervention.

When you bring the results of all these individual trials together, however, how do you weigh up what evidence is relevant and what is not? In 1993, a method of "systematic review" was introduced that enables us to get the clearest possible view of the evidence."

References:

Don’t just swallow, check the evidence first. Godlee 343. BMJ, 2011.

Image source: Plastic bottles before processing. Wikipedia, dierk schaefer, Creative Commons Attribution 2.0 License.

A doctor admits: "I love to blog but I still don’t really know why"

From Mike Cadogan, the founder of one the most popular medical blogs Life in The Fast Lane, based in Australia:

I blog to vent, to educate, to converse, to cogitate, to archive thoughts and to stimulate discussion.

I love the concept of a launching a thought, an image, a moment… into the inferno of the blogosphere, and observing the response.

With the average blog-reader attention span being around 90 seconds, I find that most of my ‘good’ posts – thoroughly researched, with well constructed arguments and propositions… are lost on this ‘average‘ reader… Yet, strangely I feel better having taken the time to arrange my thoughts, review the evidence and archive the information.

The advent of Facebook and Twitter has changed the way readers comment and share, and in many cases the promoted discussion continues out-with the confines of the original medium…

I love to blog but I still don’t really know why…

My reply is here:

You blog because you have to, Mike. And we are lucky to have you as a writer.

I have more prosaic and simple reasons to keep several blogs focused on different aspects of clinical practice: internal medicine, allergy and immunology, pediatrics, and IT.

I simply blog as a way to keep track of the new developments in medicine that are relevant to my practice and patients. The blog is a digital notebook and an archive accessible from any place and device with an internet connection.

A lot of people find it useful and that's great but this is an added bonus. If I don't find a blog post interesting and useful, I don't hit the "publish" button. A custom-made Google search engine makes it all searchable in 0.2 seconds. It just works.

Quotes from an interview with Seth Godin and Tom Peters:

"Blogging is free. It doesn’t matter if anyone reads it. What matters is the humility that comes from writing it. What matters is the metacognition of thinking about what you’re going to say.

No single thing in the last 15 years professionally has been more important to my life than blogging. It has changed my life, it has changed my perspective, it has changed my intellectual outlook, it’s changed my emotional outlook.

And it’s free."



Comments from Google Plus:

Neil Mehta - Loved your poetic post. I attempted to reflect on this earlier this year and came up with some reasons http://blogedutech.blogspot.com/2011/05/reflections-on-why-do-i-blog.html but find that it does not come close to your beautiful prose. Thanks for sharing.

References:

Why I Blog?
Why I Blog: Andrew Sullivan from The Atlantic Shares His Thoughts on Blogging
Why Do I Blog?
Why blog? Notes from Dr. RW. A perfectly reasonable list. All doctors should consider blogging. It's do-it-yourself CME.
"One of the best decisions I’ve made in my career was to start a blog and a wiki, leaving a paper trail of ideas" http://bit.ly/GX7Z6C

Mick Jagger (68) on staying fit: "Don’t look at the clouds of tomorrow through the sunshine of today"

Prticipation in sport is associated with a with a 20—40% reduction in all-cause mortality compared with non-participation. Exercise might also be considered as a fifth vital sign, according to the Lancet: http://goo.gl/gyxYf

Mick Jagger on staying fit: "You watch what you eat, you exercise, you have a bit of fun. You keep on going forward. Don’t stop. Do what makes you happy. Don’t look at the clouds of tomorrow through the sunshine of today. That’s it."

In other news, you can do anything with a blog (full website and all) - the launch site of Mick Jagger's supergroup SuperHeavy is basically a blog: http://www.superheavy.com

Their new hit "Miracle Worker" plays with medical terminology:

"You have a medical condition.

In an emergency I'm very well prepared
My scalpel, mask and gloves; don't ever get too scared.

No need for anesthetics, I'll go check your charts

You're a Miracle Worker.
You're a surgeon of love."

-- Lyrics from SuperHeavy - Miracle Worker.



Mick Jagger is well-known as an exercise fanatic: "We were busy recording a song and Mick Jagger (68) was doing 120 situps and pushups and singing at the same time time", says Eurythmics founder Dave Stewart.

References:

Mick Jagger's new supergroup with Joss Stone and Dave Stewart. DailyMail.

Redefining age 65 - when your job description is "rockstar"

Cardiologist: Don't demonize saturated fat (CNN video)

The problem may be the dietary replacement of saturated fat with carbohydrates which may trigger metabolic syndrome.

Nurses seeking more health care authority, patients "don't see a big difference"

From USA Today:

Each year, Wendy Fletcher says, she and two partners see more than 5,000 patients at their practice in Morehead, Ky. They are not doctors, but rather registered nurse practitioners who say they are able to increase access to health care and make it more affordable.

"None of us are trying to play doctor," she said.

Nurse practitioners are "gaining traction because people are seeing how cost-effective they are," Patton said. "The primary care physician shortage is going to drive it."

Judi James, 56, who lives in Morehead, Ky., said she gets her basic medical care from a nurse practitioner and has no qualms about going to see a nurse rather than a doctor.

"I really just don't see a big difference," James said. "The nurses are the ones who take care of you anyway, not always the doctor. If I need a specialist, she'll send me there."

Is this the beginning of the end of the primary care doctors in the U.S.?

Comments from Google Buzz:

Vamsi Balakrishnan - Then...what's the difference of a nurse from a PA?

Aidan Finley - There's no real difference between a NP and a PCP for routine patient care.

From Twitter: @CarmenBPhillips: at ped's office, my kids most often seen by NP.

References:

Nursing covering more health care

Image source: OpenClipArt.org, public domain.

Taking charge of your toddler's vaccination record is the best way to ensure they don't miss any shots

From Reuters:

"In our country, we think the doctor should have all the medical records," said Dr. James McElligott, a pediatrician at the Medical University of South Carolina who worked on the study. "I like the idea of putting the ownership back in Mom's hands and empowering her a little bit."

When parents kept a so-called shot card, their child's odds of being up-to-date on vaccinations rose by more than half.

40 percent of the toddlers had a shot card, and 84 percent of these had up-to-date vaccinations. By contrast, only 79 percent of the children without a card had all their shots.

Use the card: it doesn't have a downside and it's cheap."

References:

Want kids' vaccinations up to date? Keep the record | Reuters, 2010.
http://www.reuters.com/article/idUSTRE61E37I20100215

The central part of medicine is patients - don't push them out of social media

Clinical medicine is disappearing fast as topic for blog posts

Something happened to medical blogs in the past 6-12 months. They now seem a lot less interesting, more industrialized and aggregated. They have also become "too safe", generic and detached for regular reading.

There seems to be a rise of group blogs, guest posts and semi-syndicated contents. Several "clinic-focused" health bloggers have retired due to a variety of professional and HIPAA-related concerns.

It looks like clinical medicine is disappearing fast as a topic for blog posts in the U.S., replaced by posts about social media itself. As a side note, "social media" is actually a plural noun (media vs. medium), but it seems to be used mostly in singular form nowadays.

The central part of medicine is patients - don't push them out of social media

The central part of medicine is patients. Yet, we tell doctors: "never, ever blog about patients". This somewhat misguided advice displaces the most important part of the equation - the patients themselves.

Some health bloggers claim that we have to "aim above HIPAA" to avoid privacy breaches and comply with the highest standard of professionalism required by our occupation as physicians. How high "above HIPAA" is good enough though? In most clinical scenarios, the compliance with omitting the 18 unique HIPAA identifiers strikes the right balance.

Physicians must maintain appropriate boundaries of the patient-physician relationship in accordance with professional ethical guidelines just, as they would in any other context. When physicians see content posted by colleagues that appears unprofessional they have a responsibility to bring that content first to the attention of the individual, so that he or she can remove it and/or take other appropriate actions. If the behavior significantly violates professional norms and the individual does not take appropriate action to resolve the situation, the physician should report the matter to appropriate authorities (Source: AMA Policy: Professionalism in the Use of Social Media, 2011; my edits are in bold in the text above).

Different standards for individual doctors vs. health system conglomerates

There seems to be a discrepancy of the methods employed by doctors and institutions when using social media. We tell doctors: "never answer patient questions on Twitter". Yet, Cleveland Clinic runs regular Twitter chats soliciting patient questions which are then answered by doctors and healthcare personnel. Mayo Clinic and other institutions do the same.

A blog is your notebook for lifelong learning

Don't forget the most important thing: A blog is your notebook for lifelong learning. Doctors learn from their patients every day. Patients learn from their doctors every day too. Both groups must try their best to excel in the joint quest to achieve the best possible outcome.

Comments from Twitter

@scanman (Vijay): 3 doctors, @kmathan @razmohan & I, set up a twitter account @DrTamil to answer medical queries from Tamil tweeters.

@DrVes: You know the comment that you are going to get, right? "It will never happen here."

@DrVes: New trend: Hospitals tell doctors-in-training point-blank during orientation: "Don't blog. Don't tweet." Consequently, interns close blogs and Twitter accounts (confirmed via email from a trainee).

@macobgyn (MacArthur Obgyn) why do you think that is?

@SarahStewart (SarahStewart): I wonder if medical blogs are reacting to fear of litigation etc.

@DrVes: I'm sure they are. The community itself is not making things easier either.

@Skepticscalpel (Skeptical Scalpel): You're reading the wrong blogs. Try mine http://skepticalscalpel.blogspot.com

@CardioNP (Cardio NP): mirroring medicine in general? Agree w you re blogs; miss the early years ~2004-5. Agree skeptic that ur blog is a nice welcome addition

@marciovm (marcio von muhlen): will change as social media permeates society, informed consent will be feasible re: sharing medical info. Difficult to explain now.

@scanman (Vijay) This tweet - http://bit.ly/mpPL0P - by @DrVes, one of the most consistent medical bloggers, was meant for the Social Media Moral Police.

@vincristine (Vincristine): Who is 'we'? I imagine doctors will tweet what, where and how they choose to tweet, no matter what 'we' say

@laikas Laika (Jacqueline): A lot of interesting observations by @DrVes on the evolvement of medical blogs & social media use. I will take up my #FF habit #ff @DrVes

References

“The powers of medicines and the practice of healing - to exercise the quiet art” - Virgil, Aeneid http://goo.gl/5BUb3

The making of a modern physician - The Lancet http://goo.gl/SYfTu

Strictly speaking, “Doctor” is a word incorrectly applied to most medical practitioners http://goo.gl/wjA0S

Despite the dire warnings, use of social media among emergency physicians is unusually strong http://goo.gl/QlqnK

AMA Policy: Professionalism in the Use of Social Media, 2011.
Image source: Wikipedia, GNU Free Documentation License.

Related reading

Why I became an oncologist - by the president of the American Society of Clinical Oncologists - a patient defined his professional life. CNN, 2011.

Patients can teach us so much. We must pay attention. And yet some people want to silence their voice on blogs and Twitter.
Keeping all regulations in mind, a medical student soon finds there is nothing to blog about: http://goo.gl/541pj
HIPAA found in Hippocratic Oath: Keep the patients’ secrets a secret. Also: My colleagues will be my brothers and sisters http://bit.ly/pGObLI

Disclaimer

I am the Editor-in-Chief of several case-based curricula of medicine and related specialties. This is the information regarding patient data: There is no real life patient data on this website. Please note: we do not write or “blog” about patients. All case descriptions are fictional, similar to the descriptions you can find in a multiple choice questions textbook for board exam preparation. Case courses and descriptions do not follow real cases.

2 in 3 people with known risk factors for COPD don't know they have the disease

One in five heavy smokers over age 40 have findings of COPD, but only one-third have been previously diagnosed with the common lung disease.

10% of people worldwide over the age of 40 are affected by COPD.

Researchers screened 1,003 people aged 40 and over who were current or former heavy smokers. Heavy smoking was defined as a smoking history of 20 pack-years or more.

The results showed that 20.7% of the people screened met the criteria for a diagnosis of COPD but only 32.7% had previously been diagnosed with the disease or were aware of their COPD diagnosis.

References:
Many Unaware They Have COPD. WebMD.

Image source: Lungs, Wikipedia, public domain.