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Grand Rounds

By signout on January 23, 2007.

At about this time last week, I asked for bloggers' thoughts on the interface of scientific evidence with health and health care. In an unscientific poll of the blogosphere, about 40% of you gave this theme the finger, while about 60% of you found it interesting to the point of arousal. To the first group, I say, I hope we can still be friends. Meanwhile, the second group should sit quietly and think about what it has done.

I sure have. There's great variety, great thought, and great effort evident (heh) among the entries in this week's collection. I hope you will find it as thought-provoking as I have.

At the risk of being cute, I've divided Grand Rounds 3.18 into the sections one would find in a scientific paper.

Enjoy!

ABSTRACT
Highlights and take-home messages

It wasn't easy choosing editor's picks from among the excellent posts submitted this week. Still, several standouts provided unique perspectives on the intersection of inquiry and patient care: In What's Inside, The Blog that Ate Manhattan wittily forecasts a future in which evidence is completely superfluous, as long as the marketing is good. In Trust, Wandering Visitor writes with great sensitivity of her reaction to the question, "Are you experimenting on me?" And Shinga at BreathSpa for Kids asks (and incisively answers) whether what we know about health changes our perception of health risks. Special thanks to these bloggers for bringing their insight and style to this week's collection.

BACKGROUND
The motivation for inquiry

Almost all questions in medical research are inspired by patients. This week, Keith from Digital Doorway writes poignantly of an HIV-positive couple struggling to renew their commitment to themselves even as their commitment to each other remains strong. Meanwhile, the community medicine doctor at Borneo Breezes writes of challenges faced in conducting clinical research in Pakistani refugee camps.

METHODS
Tools for asking questions

How research is conducted has great impact on the validity of its findings. Giving new meaning to "garbage in, garbage out," Dr. Wes explains why a retrospective investigation on carotid endarterectomy, coronary artery surgery, and stroke risk is misleading. Orac at Respectful Insolence explains in great depth why alternative medicine (an example is provided by way of ChronicBabe) should be subject to the same rigorous validation methods that allopathic medicine is. Pre-stem-cell bill-passing, Amy Tenderich of Diabetes Mine notes that, for better or worse (OK, for worse), politics play a role in determining whether certain research tools are legal.

RESULTS
Studies show...

When research findings roll in, the messages they send us aren't always ones we want to hear. For example, numbers made Kim of Emergiblog remove her fabulous acrylic nails for the safety of her patients. As Samuel Blackman of Blog, MD explains, two studies demonstrate that your television doesn't always reflect what real hospitals look like. (Literally.) And in a particularly distressing development implicating none other than you, a recent study reflects a new and growing addiction described at Anxiety, Addiction and Depression Treatments.

Sometimes, research findings are completely confused by their interpreters, resulting in messages that are less unpleasant than they are just plain wrong. Flea, MD explains how one critic of vaccination spins statistics in favor of her argument by leaving out an important number: relative risk. Sandy Szwarc of Junkfood Science shows how data on pediatric overweight were manipulated to create a message about obesity that she says was never really there.

DISCUSSION
How to use what we know

Using evidence to make decisions about patient care has proponents and detractors. Emily of The Antidote offers several perspectives explaining why we should bother using evidence at all. Meanwhile, James Baker at Mental Notes argues that evidence-based prescribing practice may exclude effective medicines made by smaller companies that can't afford research...sort of.

It often seems that the more we know, the less we know. At The Tangled Neuron, the daughter of a man with Alzheimer's Disease tries to make sense of conflicting opinions from patients and physicians. For Dr. Anonymous, uterus transplants provoke many questions, but few answers. The most evidence-based clinical algorithms can't replace clinical judgment, as illustrated by a seemingly straightforward case of Strep throat at Musings of a Dinosaur. The hopeful Type-B Premed worries that the superficial knowledge she gains as an emergency department scribe will make it more difficult to gain deeper knowledge later.

CONFLICTS OF INTEREST
When data clash with real life

Sometimes, patient care decisions are based on more than just evidence. David Williams of the Health Business Blog tells us why patients with Norovirus are sent to the emergency department when their doctors know they shouldn't be there--and why this is a bad thing. And Mother Jones at Nurse Ratched's Place explains why she neither passed go, nor collected $200, nor stopped to consider the evidence prior to providing care to a patient in crisis.

REFERENCES
Using the scientific literature

A careful literature search can provide the context an investigator needs to structure a research question. In this regard, the Internets really have changed everything: Steven F. Palter at Doc in the Machine sees many, many advantages to putting medical journals online.

FIGURES
Ilustrating findings

Images are often used to help clarify scientific information. In lieu of actual visuals, rich verbal "pictures" will do. At Protect the Airway, a series of vividly described scenes from an emergency room detail suffering in sharp relief. Similarly colorful images occur throughout Susan Palwick's series of sonnets at Rickety Contrivances of Doing Good, in which patients and one provider lyrically consider the afterlife.

ACKNOWLEDGMENTS
Giving thanks

Again, many thanks to all who submitted to Grand Rounds this week. As a first-time host, I used a combination of precedent and judgment in choosing entries to include. My apologies to those whose work was not included.

Extra thanks to Nick Genes, without whom Grand Rounds wouldn't exist--and even if it did, would almost certainly not be as easy to host.

Next week's Grand Rounds will be hosted at Envisioning 2.0.

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Very interesting presentation. A friend is lecturing to students in library science and informatics at present: a current hot topic is online access to journals (particularly science, medicine and education) and the growth of Science 2.0 to complement Web 2.0 as a tool for researchers. Blog MD offers an example of what Science 2.0 might look like in his field of paediatric oncology.

Thanks for all the work that went into managing and compiling this.

Regards - Shinga

Nice job, Signout. I really enjoyed the format, and your selections. Thanks for including my entry, and again, congratulations on the move to ScienceBlogs!

Nicely done! Easy to follow, links easy to find! And interesting to boot! : )

Thanks for including Emergiblog and thanks for hosting!

Nice job! The format is great - easy to read, flows well, good writing. (as usual)

Thanks for hosting. I'll put up a link over at my place.

Thanks to all for the kind words, and for reading.

Shinga, I'll put in a second plug for the post you've linked to. It probably belongs in GR itself in the sense that it highlights the limitations of data gathering and analysis as we know it and makes some not-unreasonable speculation about the direction of clinical trials from here on out.

I admit, I didn't think my post would fit your theme. You're very clever. Thanks for including my ramblings and kudos on a job well done!

Take care.

Thanks for including my post on electronic medical publishing. I really enjoyed how you organized this week and love that you bent the theme rules a bit (I hate hard and fast inclusion themes)

I had wanted to submit on the topic of EBM, but didn't get around to it--what a surprise to find my little piece included anyway! (Even if right next to a daunting slice of criticism).
Well done, and thanks for contributing to a vital dialogue.

Nice job, Signout. I really enjoyed the format, and your selections. Thanks for including my entry, and again, congratulations on the move to ScienceBlogs!

Thanks for including my post on electronic medical publishing. I really enjoyed how you organized this week and love that you bent the theme rules a bit (I hate hard and fast inclusion themes) teÅekkürler..

I admit, I didn't think my post would fit your theme. You're very clever. Thanks for including my ramblings and kudos on a job well done!

Take care.

Thanks to all for the kind words, and for reading.

Shinga, I'll put in a second plug for the post you've linked to. It probably belongs in GR itself in the sense that it highlights the limitations of data gathering and analysis as we know it and makes some not-unreasonable speculation about the direction of clinical trials from here on out.

I admit, I didn't think my post would fit your theme. You're very clever. Thanks for including my ramblings and kudos on a job well done!

Take care.

Who are these people making these comments here, and why isn't NSF calling them up for advice? Both comments are right on the money and are helping relieve my anxiety today.

Dodos had such a clear warning about the communications savvy of the anti-evolutionists. And for a year or so I was feeling like I might have gotten it wrong as the Discovery Institute seemed to fumble with such amateurish things as the Hoax of Dodos website they built to attack my movie. But I had heard over a year ago about Ben Stein getting involved in an anti-evolution movie, and I tried to start warning people what was coming thank you

Dodos had such a clear warning about the communications savvy of the anti-evolutionists. And for a year or so I was feeling like I might have gotten it wrong as the Discovery Institute seemed to fumble with such amateurish things as the Hoax of Dodos website they built to attack my movie. But I had heard over a year ago about Ben Stein getting involved in an anti-evolution movie, and I tried to start warning people what was coming thank you

Thank You. Shinga, I'll put in a second plug for the post you've linked to. It probably belongs in GR itself in the sense that it highlights the limitations of data gathering and analysis as we know it and makes some not-unreasonable speculation about the direction of clinical trials from here on out.

Thank you very much. Dodos had such a clear warning about the communications savvy of the anti-evolutionists. And for a year or so I was feeling like I might have gotten it wrong as the Discovery Institute seemed to fumble with such amateurish things as the Hoax of Dodos website they built to attack my movie.

Cennetevi. Actually, the only person in danger of being silenced was you, yourself, for making a dumb threat on the internet. You told me personally several times to "shut up and listen," but like I said, I don't take orders from random anonymous people on the internet.

I admit, I didn't think my post would fit your theme. You're very clever. Thanks for including my ramblings and kudos on a job well done!

Thanks..

I admit, I didn't think my post would fit your theme. You're very clever. Thanks for including my ramblings and kudos on a job well done!

Take care.

It probably belongs in GR itself in the sense that it highlights the limitations of data gathering and analysis as we know it and makes some not-unreasonable speculation about the direction of clinical

If the tortoises from all of the islands are inter-fertile I would suggest seeding Pinta Island with a tortoise or two from each island (including Lonesome George). That way that 'neo-pintan' tortoises will be descended from as wide a genetic diversity as possible. (If the Pintan ecology is very well-restored it would be possible to harvest an occasional tortoise.) And free Lonesome George! Who knows, maybe if George was free to roam as king of Pinta Island, and had a harem of female tortoises, he would come out of his shell (!) and start mating again

Nice job, Signout. I really enjoyed the format, and your selections. Thanks for including my entry, and again, congratulations on the move to ScienceBlogs!

probably cut and paste that into all of the unrelated stories on the website so that everyone is forced to skim past your drivel.

If the tortoises from all of the islands are inter-fertile I would suggest seeding Pinta Island with a tortoise or two from each island (including Lonesome George). That way that 'neo-pintan' tortoises will be descended from as wide a genetic diversity as possible. (If the Pintan ecology is very well-restored it would be possible to harvest an occasional tortoise.) And free Lonesome George! Who knows, maybe if George was free to roam as king of Pinta Island, and had a harem of female tortoises, he

Emre, you won't catch me saying that there aren't still plenty of underfunded DB pension plans, but the Pension Protection Act (2006?) has made it more difficult to quietly engage in significant underfunding. The "quietly" part has some impact, as that sort of thing signals economic weakness to investors. That means it hits stock prices, which tend to flow through to executive compensation.