The wisdom of patients (and dogma of Wikipedia)

A couple of health 2.0 stories. Wikipedia is getting criticised by e-patients.net because according to Wikipedia’s ‘guidelines’ (read ‘rules’) you’re not allowed to refer to patient groups, or any information from their websites etc, when editing Wikipedia articles. This seems a tad ironic, in that patient support groups are an example of wisdom of the crowds, for what such wisdom is worth, and so is Wikipedia. It seems a bit rich for the latter to ban the former…

“If you or a loved one suffer from a rare condition you should not consider any wikipedia article to be an inclusive source of information regarding that condition. Due to the strict editing guidelines of wikipedia, some of the most useful sources of hard to find information regarding your condition, including all patient communities, cannot be mentioned in any article. In conclusion, wikipedia articles should be neither the first nor the principal source of information to give to a newly diagnosed patient, since wikipedia doesn’t accept, in principle, mention of any patient-generated information because that information is not considered ‘authoritative’”

And if you are into the “wisdom of the patients” a report on the topic has just been published.

“The report details how innovative collaborations online are changing the way patients, providers, and researchers learn about therapeutic regimens and disease management. It examines the benefits and concerns regarding Health 2.0 and it also includes an extensive listing of health media resources.”

The full text is available here [PDF].

Pharma accused over ghostwriters

An article today reveals (or perhaps “accuses”) just how much pharma companies use ghostwriters to influence the interpretation and publication of medical research. Merck & Co (poor old Merck & Co, why do they always get it in the neck? Well, OK, maybe Vioxx has something to do with it…) have been accused of frequently using paid academics to take the credit for, and authorship of, research articles that have been written by the pharma company’s medical writers

Dr. Catherine DeAngelis, JAMA’s editor-in-chief, said “The manipulation is disgusting. I just didn’t realize the extent”. She admitted that doctors, medical researchers and journal editors bear some responsibility for those harms and that “…we’re the ones who have allowed this to happen. Now we’ve got to make it stop.”

Google Docs: cloudless skys ahead?

Google and their Google Docs, which are worrying Microsoft, have taken another step towards world domination by making Google Docs available offline. It’s all to do with cloud computing, wherein rather than using local software, one uses remotely hosted software (a little like me writing this blog using the remotely hosted WordPress authoring software). This offers the advantage of firms not having to pay huge piles of cash for lots of local software, disk space, not to mention IT departments etc. However, if you’re away from the internet or wherever the hosted service may be, i.e. the cloud, you no longer have access to the software or the documents you’re working on. But…

“… with Google Docs offline, I can take my little piece of the cloud with me wherever I go.”

Apparently Adobe are developing something cloudy too, Adobe AIR.

Variations in healthcare remain

One would’ve thought by now, what with all these guidelines and systematic reviews and RCTs available, and evidence-based medicine being the buzzword heard everywhere (sometimes ad nauseum) that the variation in healthcare from region to region, hospital to hospital, would slowly become less and less. But, it ain’t so. The Dartmouth Atlas of Health Care has been tracking variation in health care in the US for over 20 years, and if anything the amount of variation is going up. Why? I have some of ideas, though I’m sure you have too. If you want a snappy, journalistic review of the latest report, take a look at the Boston Globe. Snippet below:

“It’s a really disappointing commentary on us all that these guys have been publishing this stuff forever, and it hasn’t had anywhere near the kind of impact you hope it would on what we do,” said Charles Baker, president of Harvard Pilgrim Health Care…

Sell Sativex; buy cannabis

An interesting story from yesterday’s FT showing how RCTs can impact on the marketplace and share prices. GW are hurting because an RCT didn’t quite come out as they hoped. Their new (cannabis-based) drug, Sativex, worked! It reduced neuropathic pain. The trouble is, so did placebo…

“GW Pharmaceuticals became the latest casualty in the embattled biotechnology sector on Tuesday, after the pioneer of cannabis-based medicine saw its shares fall by more than a quarter after the failure of a critical clinical trial. The company said a final stage trial for Sativex, its lead drug hope, to treat neuropathic pain in multiple sclerosis patients had shown a high response rate but narrowly failed to show significant benefits because of an unexpectedly large placebo response…”

“The shares fell 19½p to 52p…”

Clinical librarians – evidence of efficacy?

A case control study at Louisiana State University Health Sciences Centre suggests that patients treated by doctors supported by clinical librarians spend less time in hospital and have lower hospital charges than those treated by doctors without librarian support (Librarian-assisted group: Median length of stay = 3 days, Median hospital charge = $7,045; Control group: 5 days and $10,663, respectively).

OK, so it’s a bit more complicated than that, but go have a quick look at a nice summary at the Minervation blog or go to the full text [PDF]. If you are a clinical librarian it might just made your day!

The James Lind Library; a history of EBM

When you have a moment, take a look at the James Lind Library. To illustrate the evolution of testing in medicine (from 2000 BCE onwards!) the library takes passages from old manuscripts, books and journal, translates them where necessary, and for many of them gives a commentary, biography and other relevant detail. You can also access a free book, made available under Creative Commens, called ‘Testing Treatments’, which was originally published by the British Library in 2006.

An example piece of text from the library reads (emphasis added):

al-Razi (10th century AD). Kitab al-Hawi fi al-tibb [The comprehensive book of medicine].

‘When the dullness (thiqal) and the pain in the head and neck continue for three and four and five days or more, and the vision shuns light, and watering of the eyes is abundant, yawning and stretching are great, insomnia is severe, and extreme exhaustion occurs, then the patient after that will progress to meningitis (sirsâm) … If the dullness in the head is greater than the pain, and there is no insomnia, but rather sleep, then the fever will abate, but the throbbing will be immense but not frequent and he will progress into a stupor (lîthûrghas). So when you see these symptoms, then proceed with bloodletting. For I once saved one group [of patients] by it, while I intentionally neglected [to bleed] another group. By doing that, I wished to reach a conclusion (ra’y). And so all of these [latter] contracted meningitis.’

The harsh world of 10th Century EBM!