Scholar Medical Publication DIY by Harvard Medical Students

If, as F. Scott Fitzgerald is reported to have said, action is character, then the current crop of Harvard medical students are impressive characters. Amid all the din about who controls publication, open access and shortening the loop between academia  and public dissemination, a small group of determined individuals have just come out with their premiere issue of Harvard Medical Student Review. Considerable forethought, extensive deliberations with HMS leadership and creative talent have produced what is likely to become an authoritative voice for medical students and those interested in medical education and science.  In the words of the student publishers themselves:

Today we are introducing the Harvard Medical Student Review, an online journal that will serve as a forum for students to participate in the conversations on healthcare and medicine. Our classmates here and around the world come from innumerable backgrounds, rich in thought-provoking experiences; we have much to share. Topics may range from research to reflections on training and experiences with patients. We hope that through writing and reflection, we can spark productive debate, generate innovation, and learn from one another at the beginning of our professional education and careers.

As members of the medical community, we have a duty to review the facts and communicate the truth with clarity, precision, and humanity. In his address at the 2012 Harvard Medical School commencement ceremony, Dr. Don Berwick called upon new physicians to wield their voices proudly in carrying out this duty, as each voice “can be loud, and forceful, and confident, and will be trusted.” [2] The Harvard Medical Student Review is a space for students, trainees, and professionals to answer that call.

We hope you will join us.

Do you get to read your own genetic data?

My distinguished colleague Patrick Taylor and genetics/bioethics researchers Wylie Burke and Laura Beskow engaged in an interesting debate that can be listened to at TheScientist.

What the Tell-Tale Heart Tells Us About Healthcare

At the end of his short story, Edgar Allen Poe's haunted murderous protagonist lets loose in front of the unsuspecting police officers:

"Villains!" I shrieked, "dissemble no more! I admit the deed! -- tear up the planks! -- here, here! -- it is the beating of his hideous heart!"

It is this story that inspired the title of a paper we published a few years ago on how we could detect the increase (and subsequent decrease) of myocardial infarctions coincident with the rise and fall of the use of Vioxx. This investigation relied solely on the informational byproducts of healthcare delivery. This weekend a Senate report on the risk of Avandia and what was known by GSK came to light. This resonated because we had recently published an article in Diabetes Care about the rapid identification of an increased risk of myocardial infarction with Avandia in patients with diabetes mellitus as compared to other drugs, even drugs in the same class, such as Pioglitazone. Whereas the current headlines are about what the pharmaceutical company knew or dissimulated, there is a broader question that needs addressing: Should every healthcare system not be instrumented so that the clinical leaders of these systems should know whether there are unexpected changes in the risks and health status of their patient populations?

Often, the state of clinical practice is compared unfavorably to the practice of commercial air travel, but what remains underemphasized is that as a system, we are flying blind. There is no local, regional or national air-traffic-controller-equivalent for the healthcare system. Should not the local hospital, and Department of Public Health be the first to know if there is about to be a local health collision or crash? Should not such local surveillance systems run in parallel to regional and national systems? Do we not need multi-level redundancy and open communication to avoid tens of thousands of unnecessary deaths? Further, even as the federal government becomes more aware of the need of such instrumentation, we all expect that our local healthcare systems and health authorities should know of any untoward health trends. Perhaps healthcare systems will start to compete on being able to provide timely and localized health trend data to their customers. Unfortunately right now, the major investments in such health market intelligence is to the payors (i.e. the insurers) who quite reasonably want to know what are the local risks, performance and trends for each of their contracts. Will it take regulation or market competition to make such data extraction and return to patients a matter of course? Let's hope we do not have to wait for a post-mortem Poe'esque orgy of recrimination to find out.

You could be an information spigot

Even if you are not an information altruist, there are those who would like to just plug you in and take it from there.

Hat tip: Ken Mandl

What are medical libraries expected to do?

This is not an abstract question about the future of libraries, although that is also an interesting question. It is a question about what the medical school accrediting organizations have determined. "The Liaison Committee on Medical Education (LCME) is the nationally recognized accrediting authority for medical education programs leading to the M.D. degree in U.S. and Canadian medical schools. The LCME is sponsored by the Association of American Medical Colleges and the American Medical Association." and this is what they had to say (the bold face is mine for emphasis):

D. Information Resources and Library Services
ER-11 The medical school must have access to well-maintained library and information facilities,
sufficient in size, breadth of holdings, and information technology to support its education and
other missions.

There should be physical or electronic access to leading biomedical, clinical, and
other relevant periodicals, the current numbers of which should be readily
available. The library and other learning resource centers must be equipped to
allow students to access information electronically, as well as to use self-instructional
materials.

ER-12 The library and information services staff must be responsive to the needs of the faculty, residents
and students of the medical school.

A professional staff should supervise the library and information services, and
provide training in information management skills. The library and information
services staff should be familiar with current regional and national information
resources and data systems, and with contemporary information technology.
[Revised annotation approved by the LCME in October 2007 and effective immediately.]
Both school officials and library/information services staff should facilitate access
of faculty, residents, and medical students to information resources, addressing
their needs for information during extended hours and at dispersed sites.

(This is taken from:
http://www.lcme.org/functions2008jun.pdf found at:http://www.lcme.org/standard.htm
Hat tip David Osterbur.)

These are important recommendations and ones which foreshadow trends from the very near future. We have embraced this educational mission from access of electronic resources to teaching biomedical researchers how to perform bioinformatics-enabled research (see the bioinformatics nanocourses offered to all by Reddy Galli— details here ). The central question is whether librarian training will embrace the information technology that will be required to keep libraries current and relevant to their patrons. The answer to that question will determine where the future librarians are trained and that will in turn determine how central libraries remain to the academic mission.

The alien within and other tales of curatorial genetic mishap

As reported by the New Scientist.

Another quality improvement challenge for the genomically-knowledgeable librarian.

Search + Internet = Better Public Health?

Our very own John Brownstein, has just published an article in the Canadian Medical Association Journal which demonstrates the consequences of removing information bottlenecks between the public and population-level analytics. Some have expressed skepticism regarding the value of mining web-activity for "objective" reporting but, in this instance at least, it seems that a distributed network of non-experts can be effective in detecting outbreaks earlier than through standard surveillance methods.

Your face or your health?

The recent brouhaha regarding the Facebook change of terms or service illustrates just how much many care about their personally placed public information. Do we, as patients, care any less about who gets to have our personal data in perpetuity? Should we advocate for tighter personal control of our health information?

How long do you have to wait in the Emergency Room?

If you ever have had a visit to the emergency room that was not a life-threatening emergency you might have made an unfavorable comparison of queue management there to that in a supermarket. It is therefore all the more stark how innovative this site from Australia is in this regard. What will it take to make this functionality available routinely? It certainly would allow consumers to effectively spread the load across the local emergency rooms.

Hat tip to HISTalk via Dan Nigrin.

The Empire Strikes Back?

House Judiciary Committee Chairman John Conyers has introduced legislation to overturn the legislatively mandated open access publication of National Institutes of Health-supported biomedical research (i.e. taxpayer supported research).

The text of the introduced legislation currently states: "No Federal agency may, in connection with a funding agreement-- (A) impose or cause the imposition of any term or condition that--`(i) requires the transfer or license to or for a Federal agency of- `(I) any right provided under paragraph (3), (4) or (5) of section 106 in an extrinsic work; or..."

Peter Suber provides a sober analysis of this effort and makes the point very clearly that the current mandate does not in anyway violate publisher's copyright. This is certainly an interesting time, made all the more vivid by the extent of the economic stakes.

When publication is too slow?

This story at cnn.com is of the kind that usually makes me cringe because it clearly provides advertising for a new healthcare technology that has not been widely tested and uses a truly dire personal circumstance to illustrate that the new technology can almost magically save the day. This is a technique that has been repeatedly used to hype several drugs or devices or alternative medicines that ultimately have not proven to be helpful (or worse). Yet in this instance, it seems that it is the real deal, a brain tumor that was effectively inoperable and there was a newly available technology that could do the job. And it was applied in the nick of time. Let's assume that this case in fact represents the appropriate application of technology. It might be interesting to view it as an opportunity to ask some questions of the current peer review and publication process in order to meet the following goal: timely communication of the best globally acquired knowledge for state-of-the-art treatment.

• Where can we find an authoritative system for timely reviews of new healthcare treatments on which patients with experience or physicians (in this instance, parents of children with an intracranial teratoma and neurosurgeons).



• How do we minimize the "gaming" of such an authoritative system?



• Is there a mechanism in the current academic publication pipeline that would support such a system or should we look to electronic social networks, mass media and word-of-mouth to provide the solution?



• Can we represent the degree of certainty we have about efficacy of a new treatment in a way that is both intuitive (i.e. actionable by the lay public) and that has solid statistical or evidentiary support?



• If we do not support timely dissemination of potentially useful technologies, is our ethical position suboptimal? Alternatively, does any premature knowledge dissemination fly in the face of the time-tested admonition to first do no harm.



• Can the federal government provide a transparent and timely vehicle of expert opinion in this regard?

In a crowd, but anonymous no longer

In the words of my colleague, Ben Reis "The days of being anonymous in public are officially over."

Go to the following crowd shot and realize that you can zoom in all the way. You can see the faces of thousands of people in detail.

Ben continues "In a real-life version of where's waldo, see if you can find Yo-Yo ma using his iPhone to take a picture."

iFail

Even in the rarefied reaches of the ivory tower, you will find various previously productive scientists with their hands under the table banging on their personal communication devices. In that context, this report on the failure rate of these devices may be of interest. Nonetheless, there does appear to be real functionality that is well suited for scholarly communication and education.

Out of date but not dated?

This is a great example of how the instant-at-hand-reflexive-cut-and-paste nature of electronic information can bridge the virtual to inflict real harm. Contemplate how clinical out-of-date information can be similarly used to boost the medical malpractice of the incidentalome. Will medical libraries step up to the challenge of keeping the medical profession up to date?

[Thanks to Ben Reis for the pointer]