My goal in Tech Medicine will be to explore the intersection of medicine, new technologies, and the Internet. This is a purposefully broad topic. Several times weekly I will post focused reviews of issues interesting to health professionals and nonprofessionals alike. Posts may include examinations of medical devices, pharmaceuticals, scientific advances, internet services, and other technologies involving health care and the practice of medicine. Mirroring as it does the nature of the Internet and the sometimes surprising nature of new technologies, the content may also include topics that are wonderful, unusual, hilarious, or strange.
I'm trained as a nephrologist (a kidney and blood pressure specialist). For the last two years I've written Kidney Notes, a blog designed to filter and process medical news. Most recently, Kidney Notes has become a collection of links, commentary, and scraps of information -- a reference database of interesting things with the help of a popular social bookmarking service called del.icio.us. While I will continue posting to Kidney Notes, several friends have asked me to write longer posts of original content -- and this is what I will be writing on Tech Medicine. (Recently, I have also written a blog on personal productivity called The Efficient MD.)
There are many topics I plan to cover, but I'm also open to suggestions and tips. Please email them to techmedicine@gmail.com.
Slate is one of the few online magazines I read regularly. Their "Human Nature" column is particularly good. A sample:
Several U.S. military widows have produced children using their dead husbands' sperm. These are not pregnancies that were underway when the husband died; they're pregnancies that didn't exist. A leading sperm bank has offered discounts to servicemen going to Iraq; many have banked sperm in case they're exposed to chemicals that damage their fertility. Arguments for using the sperm: 1) It's part of the life my husband and I could have had. 2) "When he died, I was 40 and it's not like I had time to look for another person." 3) The sperm bank offered servicemen the discount explicitly "to help ensure the future of their families." 4) The child can be "something good that came out of the war." Objections: 1) Maybe "the guy hadn't planned to die, so he didn't say you could use his sperm." 2) Even if he did, the widow might regret bearing his child when she later "meets someone else." Related: 1) The first court-approved production of a baby between a corpse and a stranger. 2) Human Nature's take on making and selling embryos from stranger/s.
Medgadget discusses scientists altering the sexual orientation of worms, which the mainstream media has also found particularly interesting.
Sermo's CEO, Dr. Daniel Palestrant, invited users in New York City out to dinner near Times Square last week. (Sermo is the largest online community for physicians, allowing doctors to ask each other questions, vote on answers, and post comments. Some questions are also asked by clients, primarily Wall Street firms, which pay physicians for their answers through Sermo.)
Palestrant, the CEO and founder of one of the most successful and interesting "Health 2.0" companies, is not what you'd expect. Tieless, youthful, open, engaged, informed, and passionate, he spent four hours nonstop in conversation. If I wasn't already a fan of the community and a believer in Sermo's mission, I was when I stepped out the door at midnight.
The following are brief notes from the dinner.
* The name "Sermo" ("conversation" in Latin) originated when Palestrant was being treated with prednisone for a herniated disk -- "in a steroid psychosis," he joked.
* Sermo had three phases. "Kvetch club," commentary on Paris Hilton, and (now) "useful clinical tool."
* The responses that physicians provide are anonymized. No one -- including Pfizer or other clients of Sermo -- can tell who has voted in a particular way. He was very clear on this. (Comments on posts are a different story. These can be traced back to individuals and their self-provided profiles.)
* Palestrant apologized and took full responsibility for the previously circulated screenshots which appeared to show that clients could view the results of individual physicians. That was apparently a mistake, as the information was actually anonymized. "We were a rookie company," he said.
* We talked about how physicians have lost their market power and have been unwilling, unable, or unaccustomed to sharing information.
* "The United States health care system is larger than the economy of China and it's a cottage industry."
* As has been reported everywhere, Pfizer is now partnering with Sermo, which some users have found controversial. Palestrant explained the move by saying that both physicians and companies like Pfizer have been looking for new (and less expensive) alternatives to drug reps visiting physicians in their offices. And since Pfizer and other companies already employ doctors who visit Sermo, this would at least allow industry doctors to be clearly labeled.
* Pfizer and other companies would also be at risk of having their products criticized by the Sermo community. These criticisms could not be removed by the companies.
* I sensed that, partially in response to concerns over its arrangement with Pfizer, Sermo is about to become even more radically transparent. Palestrant said that they plan to divide the message boards into two groups: one with posts by physicians only, the other with posts by clients.
* Sponsored posts make up only 2% of Sermo.
* Sermo posts will soon be linked to clinical guidelines (through "hotspots"), which users can then comment and vote on.
* Palestrant provided a few examples of problems that were noticed by the Sermo community before the mainstream media -- problems with certain models of pacemakers, for example, and generic Wellbutrin.
* 50% of physicians on Sermo are over 45. This is stunning, considering the demographic of the typical web user.
* For a lot of physicians, especially for those not in academic communities, Sermo functions as a virtual doctor's lounge or grand rounds.
* They've timed it so physicians can post to Sermo in 50 seconds or less.
* We spoke about ways of visually presenting complicated threads of comments from users with different rankings. I mentioned Slashdot. He said that Paul Resnick, who has analyzed Slashdot, is analyzing Sermo.
* Sermo takes pains not to censor the posts of individual users. However, in certain cases, they've consulted with ethicists at the University of Pennsylvania.
* And lastly, Sermo is run entirely on Macs.
As someone who's been involved with online communities for over two decades, I appreciate the difficulty in creating one that works. (In a tangent, Palestrant and I spoke about Cory Doctorow's comparison of online communities to nuclear reactors that are always in danger of melting down.) Having spent time with Daniel Palestrant, I'm convinced he actually knows what he's talking about. And that's important, because the community is walking a fine line. On one side are physicians who are fiercely independent and suspicious of outside influence; on the other are pharmaceutical companies and investment firms which are essential to the business model.
Having met Palestrant, I think that if anyone can make this work, it's probably him. I admire his vision for the community, and I'm interested in where Sermo will go next.
To the amusement of a number of medical bloggers, the "examples of citations to blogs" includes many carefully constructed references to some prominent (and not so prominent) blogs. The list -- to the eye of someone who reads blogs -- was not created randomly, and several people have wondered whether it represents the reading list from someone at the National Library of Medicine.
In order of appearance, the following is a complete list of blogs that were cited. Some of these blogs I read regularly; some I haven't read in a long time; and some blogs I would have never discovered if not for this list.
How to Cite Blogs in Formal Academic Medical Papers
Sunday, October 14, 2007
Joshua Schwimmer, MD, FACP, FASN
Unexpectedly, the National Library of Medicine / National Institutes of Health, in the second edition of their Style Guide for Authors, Editors, and Publishers, included a section on citing blogs and other material on the internet. Also unexpectedly, as one of the examples, they included Kidney Notes, a personal blog which I've written for over 2 years.
KidneyNotes.com [blog on the Internet]. New York: KidneyNotes. c2006 - [cited 2007 May 16]. Available from: http://www.kidneynotes.com/.
Cory Doctorow posted a link to the style guide on BoingBoing, the most popular blog on the Internet, and it generated some interesting (and heated) discussion. I've also discussed issues related to citing blogs with some friends who are more scientific than I. Some of the arguments are summarized below:
Blogs (and wikis) are not credible sources of information and should not be cited in medical papers.
"Blog on the Internet" is a redundant phrase. Where else would a blog be?
There is useful information to be found in blogs, it should be cited and is going to be cited, and therefore there should be a style guide for citing it.
Citing blogs on your CV is just another way to pad it if you don't have more substantive publications.
The "permalink" should be cited, not the blog itself.
People have been citing "personal communication" for years. Why not blogs (or emails), which are forms of personal communication?
For more discussion on this topic, see these links:
Sermo was founded on the idea of information arbitrage, that there's valuable information locked in the heads of physicians, if you could only figure out a way to get to it.
The way Sermo works is this: physicians ask and answer anonymous questions, but some of the questions are also asked by firms. When physicians answer some of these questions, they get paid, but they don't know which questions will pay them. So the incentive is to answer as many questions as possible. Sermo is basically an experiment in classical conditioning, it mines physicians for information by turning them into compulsive gamblers and taking advantage of their desire to collaborate. And it works very well.
It's only about a year old but Sermo is the largest online network of physicians that's ever existed. Sermo is also partnering with the AMA and the FDA, who are interested in information from Sermo about the safety of medical products. Sermo may actually be a better way to encourage physicians to report problems with drugs and devices than the FDA's own website.
Naturally, prior to the conference, I was curious about the Sermo community's response to the question, "What do you consider to be the most disruptive change in healthcare?" (The full posting on Sermo, which you can access if you are a physician and have a free account, is here.)
Here are the top five responses:
The growing trend toward having non-MD's (i.e., insurance companies) making decisions about treatment options. (35%)
Too many to pick just one. (15%)
Quality improvement and quality measures driven by computers and administered by non-medical bureaucrats. (10%)
"Google Health" [The survey was administered before Adam Bosworth left Google]. (8%)
Widespread use of electronic medical records. (7%)
Proliferation of physician extenders, PA's NP's, etc (7%)
iGuard.org, a new website that recently launched, aims to help patients be better informed about their medications and about new safety alerts.
All medications have potential side effects, and it's sometimes difficult for patients to determine by looking at medication labels whether a given drug is truly "risky." iGuard seeks to simplify concerns about side effects by placing medications in one of five general risk categories: low risk, general risk, guarded, elevated risk, and high risk.
iGuard uses Risk Ratings to convert medical jargon into simple, actionable information. iGuard Risk Ratings form the basis of a new language that helps you understand more about the safety of your drugs - and respond more effectively as new information emerges.
Anyone who has tried reading a drug label or a medical journal knows how difficult they are to understand. iGuard makes it simple for you to be aware of your risk of developing serious side effects, and to respond effectively to future drug safety information through our iGuard Risk Ratings.
In addition to proving risk ratings, which may highlight medications that have a higher potential for side effects, iGuard provides safety alerts. These alerts may come from the FDA, a drug manufacturer, or from new research studies. If patients register on iGuard, they can receive updated risk profiles and new safety alerts for each of their medications. Patients can have optionally also have these alerts sent to their physicians so they can be informed about what information iGuard is sending them.
Has the nightly news become your source for new drug safety information? Wouldn't you prefer your safety information be sent directly to you in a timely and personalized manner? Welcome to iGuard.
An iGuard Safety Alert is a short message sent to you the patient and your physician (subject to your consent). These alerts are sent as soon as something new is learned about a medicine you have reported taking in your iGuard Profile.
iGuard also encourages physicians to report new potential drug side effects through an interface that also reports to the FDA's MedWatch site. iGuard's business model seems to involve using information provided by patients on side effects to provide partners and clients with early, useful information:
To cover the cost of operating our efficiently structured communication network, iGuard will offer customized drug safety studies, risk management programs, and other research opportunities. We are confident that these market opportunities will cover the cost of our communication network and further our knowledge of drug safety.
PeerClip: Social Bookmarking for Healthcare Providers
Tuesday, October 02, 2007
Joshua Schwimmer, MD, FACP, FASN
PeerClip is a new social bookmarking service introduced at the Health 2.0 conference. The best example of a social bookmarking site on the web is del.icio.us, which I wrote about previously:
One of the most useful sites on the web is del.icio.us. (Yes, it's a pun; you type it in exactly like that.) In case you've not heard of it, del.icio.us is one of the best social bookmarking sites on the web. When you "bookmark" a web page in your browser, you're saving the link for future reference. Bookmarking a website on del.icio.us is similar, with a few major differences. First, other users can look at and subscribe to your bookmarks, and you can look at other users' bookmarks. You can also get a sense of the importance and popularity of a site by how many people have bookmarked it.
Second, you can apply "tags," which are labels, to each site. For example, you might bookmark the site healthline.com with the tags "health," "medicalinformation," "search," and "medicalblogs." You can then search or sort using tags. Bookmarks can be easily saved by using extensions for the firefox or internet explorer browsers.
Once you start using del.icio.us, it becomes your portable online filing system for the web. For health-related information in particular, del.icio.us can be used to tag and file away journal articles, health-related websites, news articles, and anything else you can think of that you might need for future reference.
Peerclip is similar to del.icio.us, but with important differences. First, it's open only to health care providers -- physicians, nurse practitioners, and physicians assistants. This ensure that all the sites bookmarked on Peerclip are related to medicine. Second, articles can be rated for quality. Third, you can form your own online networks of peers (in a specific specialty, for example).
This is a description from the PeerClip website:
Using PeerClip’s “research assistant” tool that integrates easily into any Web browser, physicians can “bookmark” any type content, including journal articles, blogs, podcasts and videos. Bookmarks are conveniently stored online for easy access in a central location, creating a personal homepage of relevant medical information. Physicians also can organize, keyword tag, rate and share bookmarks.
The PeerClip “research assistant” also provides physicians with at-a-glance information on articles that their peers have tagged and rated as useful. The combined ratings and tagging of all physicians helps the PeerClip member quickly find the information he or she is looking for. Additionally, the PeerClip “research assistant” also recommends other relevant information based on the member’s profile and interests. The simple act of member participation guides the recommendations as well as the member’s discovery while browsing.
Physicians also can invite peers to join the network as well as create personal online peer networks in order to track future bookmarks and comments by peers or Key Opinion Leaders across the PeerClip community.
It's a promising idea, but the problem with most social networking sites is that they require a certain critical mass of users in order to be useful. The reason del.icio.us has succeeded is that it has one million registered users -- most of whom, of course, are in technology-related fields and not in medicine. If PeerClip can achieve a critical mass of users in the medical professions, it would become a valuable service.
The Healthline Site, its content, such as text, graphics, images, search
results, HealthMaps, Trust Marks, and other material contained on the
Healthline Site ("Content"), its services, and any information or material
posted on the Healthline Site by third parties are provided for informational
purposes only. None of the foregoing is a substitute for professional medical
advice, examination, diagnosis, or treatment. Always seek the advice of a
physician or other qualified healthcare provider with any questions you may
have regarding a medical condition. Never disregard professional medical advice
or delay in seeking it because of something you have read on the Healthline
Site. If you think you may have a medical emergency, call your doctor or 911
immediately. Please read the Terms of Service for more information regarding
use of the Healthline Site.
