Archive for the ‘Viewpoint’ Category

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Open source scientific data sharing

Sunday, September 28th, 2008

Let’s take this scenario:-

A prominent scientist X publishes a clinical trial that Drug A is effective in a particular disease.

Another scientist Y publishes another article reinforcing that Drug A is indeed an effective treatment.

Then several small studies are done which show that Drug A has harmful side effects. Some of these get accepted in prominent journals, while others are rejected. Five years later, FDA discovers to its surprise (!!!!) that Drug A is indeed associated with harmful side effects.

This has happened, is happening and will happen!!!

The big question is – Is there any way to prevent this?

Welcome to open source scientific data sharing.

Open source data sharing is similar to open source software, where not only the end result (i.e. software) but also the source code is given away for free. Open source data sharing therefore should aim to not only have all the scientific articles available for free but should also include the raw data that was generated during the course of the experiment or clinical trial.

There are thousands of scientists in the world who can benefit from this data and come up with amazing results. Probably, if the data for Vioxx and Vytorin studies was available online, their side effect profile would be exposed much earlier by “entrepreneur” scientists.

This talk given by Clay Shirky at TED in 2005 explains why we need to move from institutionalization towards open collaboration (which can only be enabled by data sharing).


Of course, there are certain differences between his and my proposal. He is giving public the authority to generate data. I am proposing that scientists generate data by careful experiments/clinical trials and publish their results but in addition make the data available for “entrepreneur” scientists to analyze. It is better to have many eyes looking at data rather than a few.

Besides searching for potential side effects in a mountain of data, open source data sharing has bigger benefits. Consider this:

Many NGO’s are currently funding scientific research in the hope of speeding up the process of scientific research to produce results quickly. Stand up to Cancer is bringing the best scientific minds across the world to develop new medications to fight cancer. This is excellent – but it goes back to Clay Shirky’s talk – Institutionalization vs open collaboration. The best brains can generate excellent data and also probably are the best people to analyze it. But, this data generated should be made available for all other scientists on this planet to analyze and build upon.

Historically most inventions happened by accident. Entrepreneur scientists can make these accidents happen more often - only if given access to scientific data.

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Gray’s Anatomy Vs Real doctors

Wednesday, September 17th, 2008

The television medical drama Grey’s Anatomy apparently has more to offer than Patrick Dempsey’s rakish smile and a good cry. A new survey reports watching the show also may increase a viewer’s health smarts.

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There is a lot of inaccurate information on television. According to this survey people remember health information imparted on TV, probably more so than given to them in their doctor’s office. Using the television media responsibly and effectively may increase public awareness of diseases and encourage healthy behavior.

The same goes for print media. Influential magazines should research medical articles before jumping to an opinion. The most recent example is an article in Time Magazine – Gastric bypass surgery less helpful for diabetics. A very catchy but misleading title. To the writer’s credit she did include this conversation with Dr. Hamdy:

I believe that the benefits of gastric bypass surgery outweigh any risk that a patient will have,” says Hamdy. “If you look at the mortality in relation to obesity itself, especially if it occurs with diabetics, that is much, much higher than the risk of mortality from the surgery.

… but it is included at the end of the article.

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In my opinion the title should have been more appropriately worded as it gives an impression that gastric bypass surgery may not help in diabetes.

A lot of furore is ongoing on controlling health blogs and their content. However, the print media has a greater reach and authority than most blogs in influencing health related decisions for patients. Therefore they should carry equal if not greater social responsibility than health blogs.

Reference: USA Today, Time, ACP Internist Blog

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Can children teach themselves?

Wednesday, September 3rd, 2008

This video demonstrates the tremendous capability of children to learn and adapt when provided with the right tools and environment.

Speaking at LIFT 2007, Sugata Mitra talks about his Hole in the Wall project. Young kids in this project figured out how to use a PC on their own — and then taught other kids. He asks, what else can children teach themselves?


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On “Content of weblogs written by health professionals”

Wednesday, July 23rd, 2008

My article Tolvaptan – New drug for low sodium in blood” has been recently quoted in an article titled “Content of weblogs written by health professionals” (pdf link) published in the Journal of General Internal Medicine by implying that the post is a product endorsement. The actual quote is:

“Up until now the treatment of this condition involved free water restriction and removal of inciting factors. Now a new drug – Tolvaptan promises to change it all.”

However, the article missed out the remaining post which in the end had my take on Tolvaptan -

“The main problem with the drug is that once approved, most clinicians will prescribe it for for a very long time especially in patients prone to developing and remaining hyponatremic. Since the study duration was only for 30 days, many new side effects may appear when the drug is finally marketed.”

Also my blog post was written in context of describing an article published in New England Journal of medicine and not for drug promotion which the article failed to mention. I should also add that I have no relationship with any pharmaceutical company as the article later implies (although not directly to this website) by writing:

“A recent survey reveals that 29% of blog authors have been approached by public relations professionals to endorse specific products, and 52% of them have written one post endorsing such products in their blog content. These endorsements are not advertisements that appear on the website; they are written into the blog narrative, often without any acknowledgement that they are paid promotions. Although we did find blogs that promoted health care products within their entries, we were unable to determine whether these were paid endorsements, because we found no disclosures indicating authors’ conflicts of interest.”

To all this I should also add that I pursue blogging because I have a passion for computers and technology and believe that we can help ourselves (physicians) as well as our patients by empowering them with the latest information in medicine that they can discuss with their physicians.

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Comfort measures for congestive heart failure

Sunday, July 6th, 2008

This case has been on my mind for some time and I thought that I would share it with the world and get some opinions.

A very elderly lady, Mrs. Y presented to the ER for worsening congestive heart failure (CHF). She was diagnosed with CHF about 2 years ago. She had decompensated in the past 4-5 months and had been in and out of the hospital and rehab facility for CHF exacerbations. In the ER, she said that she does not want any treatment and wants to die since she cannot live with her family and is tired of being sick. Therefore in consultation with the family (who were present in the ER) she was changed to comfort measures and admitted to the medical floor.

When I saw the patient, I thought she was depressed and most likely did not have the capacity to take her own decisions. The family supported the patients decision for comfort measures although they admitted that they would like the patient to be treated for CHF.

It was a difficult situation for me, as I clearly knew that the patient’s CHF was easily reversible and the patient was depressed and most likely unable to take decisions. Also I was unable to reverse the patients code status.

I decided to take the midline approach i.e. treat the patient for CHF with high dose diuretics and give her morphine for difficulty in breathing (which is also a treatment for pulmonary edema and CHF) along with an antidepressant. I hoped that if she responds to the diuretics (and morphine) her breathing would get better and by 2-4 weeks her depression would be under control by the anti-depressants. On the other hand if she does not improve or deteriorates, she would be on morphine which would keep her comfortable and thus honor her desire to be on comfort measures.

What would you do?

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