Real time searching

Google now includes real time searching and I recently came across a Phil Bradley presentation that include this as well. Could this be useful for health information? I find Twitter search useful to keep up to date in my field and as I’m working for an organisation who are affected by political fluctuations then Tweetminster may be useful too.  Searchengineland looked at where the results are coming from and there is ambiguity as to whether there are fees involved in appearing in a search but this is in fact aggregated search and not real time search and Google has developed  social search for Twitter Google Experimental Labs  whereby when you search for things you can see who in your social circle has written about it, sort of like a search within your followers or facebook friends. I can definitely see real time search being useful when tracking drugs in development or seeing what patients think of a treatment. It’s just the next stage of the semantic web…

Making sense of the literature

Biomed Central’s blog highlights the problem of defining what original research is. This is the problem of the same trial being reported in different papers so that when you get to compiling a meta-analysis you may be double counting or and overestimating the effectiveness of an intervention. This 1997 BMJ study by Tramer et al found that 17% of the published literature and 28% of patient data is duplicated, either overtly (after a bit of comparison) or covertly where different authors are used and so it is more difficult to tell if the papers are related. It would of course help if there was some compulsion to use the trial registry number or similar reference but as far as I know posting your trial plans with a registry is optional (and I wonder whether people do this retrospectively and only if they are happy with the results).

If it’s difficult for researchers and practitioners to make sense of the literature (and duplication is only one possible source of confusion) then how about the general public who find that everything causes cancer according to whichever newspaper they care to read? This study in Plos One looked at worldwide reporting of medical research and promisingly found that “Only 57% of front-page stories reporting on medical research are based on mature research, which tends to have a higher evidence level than research with preliminary findings”. I actually thought 57% was pretty good. I know Lord Drayson certainly argued at an RI debate earlier this year that science (and therefore health) reporting wasn’t that bad and he is making positive noises about evidence based policy so perhaps he’s right.

EBM: it’s about evidence, not physicians or patients…

There’s some chatter on the evidence-based healthcare message board about the definition of “evidence based medicine” and I have to say I get a bit fed up sometimes as people always talk of the “holy trinity” of EBM, that of: use of evidence + physicians’ experience + patient choice.

But I mean to say, it’s not really, is it? The practice of medicine is a combination of these things, sure, but evidence-based medicine is all about evidence, not experience and not patient choice. It’s not patient-centric medicine, or experience-based medicine, or authority-based medicine. In fact, it’s explicitly NOT about those things. Physicians have had plenty of authority during the long and slow development of medicine, and stil have much weight to throw about; they still harm patients too (they cure people and alleviate a lot of suffering too – I’m not anti physician – far from it, I think they’re great, particularly when I’m ill – just making the point that they’re not omnipotent). As for patient-centric medicine that is indeed important and, like any business, the client is key; the needs of patients do have to play a role in medicine. But that’s not what evidence-based medicine is about. It’s about evidence, evidence and evidence, it’s about the application of the scientific method to healthcare, and to say otherwise is just to try and sweeten the bitter pill that EBM might be to certain healthcare stakeholder groups.

Long live EBM. Long live science…

It’s apparently Global Handwashing Day …

It’s apparently Global Handwashing Day today and I can’t resist mentioning the British study (mentioned in the Guardian) that exposed men and women to signs cajoling them to wash their hands (“soap it off or eat it later”) in motorway service station toilets. Without the signs, 2/3 of men did not use soap (!!) and 1/3 of women couldn’t be bothered either. With the pro-handwashing signs, the researchers found that 12% more men, and 11% more women, used soap.

Author mapper

Just got an email about the inclusion of Biomed Central articles on Author Mapper. This tool maps, quite literally, where authors are located and also has nifty information like synonyms, a count of author frequency and common journals featuring your search term. For example a search for Barrett’s. It does only map Springer (the host publisher) and Biomed Central articles but surely this is a mash up someone else has thought of…would be great in a catalogue context as well.

I’ve just come across a study that shou …

I’ve just come across a study that should be on the NCBI ROFL website. Research that is perhaps interesting in theory but of dubious (or debatable, if you’d like to give me your thoughts) value. Impact of nurses clothing on anxiety in hospitalised children by Roohafza et al. Roohafza’s team found that, apparently, white clothing was more anxiety-provoking in paediatric patients than coloured clothing. I don’t question the ideals here-it is just the thought of the clownish bright colours being made standard kit instead of the clean, professional whites, that makes me smile. I was about to bemoan the quality of nursing research also, but all but one of the authors of this study is an MD.

Why we must ration health care

Peter Singer, the controversial ethicist based at Princeton University, writing in the New York Times argues for a rational debate about rationing in the face of decisions such as those around cancer drugs such as sutent:

You have advanced kidney cancer. It will kill you, probably in the next year or two. A drug called Sutent slows the spread of the cancer and may give you an extra six months, but at a cost of $54,000. Is a few more months worth that much?

 
If you can afford it, you probably would pay that much, or more, to live longer, even if your quality of life wasn’t going to be good. But suppose it’s not you with the cancer but a stranger covered by your health-insurance fund. If the insurer provides this man — and everyone else like him — with Sutent, your premiums will increase. Do you still think the drug is a good value? Suppose the treatment cost a million dollars. Would it be worth it then? Ten million? Is there any limit to how much you would want your insurer to pay for a drug that adds six months to someone’s life? If there is any point at which you say, “No, an extra six months isn’t worth that much,” then you think that health care should be rationed.

This debate will run and run…

Green Dam, Youth Escort

A presentation at ISKO UK 2009 by Zhang Yunliang and an article this weekend in the FT have highlighted some worrying trends in internet filtering and politics. A filtering software called Green Dam/ Youth Escort (which ironically, in my opinion, smacks of salacious content hidden behind a login) will become obligatory and will be installed on all computers sold in China, as of 1st July 2009.  It has already been installed on school computers. While its stated purpose is to protect the innocent people of China from porn and other nasties, experts fear it will used as a method of restricting what they can find on the internet. Read the article. It does an elegant job of summarising tactics by other governments (Burma, Moldova, Uzbekistan and Iran) to censor the internet.

Freeing information and healthcare

Wolfram Alpha is heading up the Twitter trending charts (yes I’m hooked now too) but I wish we had a UK version as I searched for the number of dietiticians (a query on LIS-MEDICAL) and found US figures. The interesting thing about it is that it is not a search engine but a computational knowledge engine, using a private database of public facts, very intriguing.

The Atlantic has an interesting article railing against comparative effectiveness studies in Obama’s much anticipated healthcare reforms. I agree that IT doesn’t always free up time and public health measures may not free up money but are these the purposes for which they were set up? Perhaps the aims and objectives of such measures just need to be redefined as more realistic outcome measures might bring about more manageable projects.

Peter Murray Rust is becoming one of my favourite bloggers if only because I wish I had done a chemistry degree. Here he talks about why we don’t buy journals nationally and the evils of copyright in the hands of publishers thus destroying the income and then existence of learned societies.

Swine flu – hug a mexican today

Joe Collier on BMJ blogs recommends some manoeuvres he’s been following for avoiding Mexican flu, including not travelling east on the Picadilly line. While the Picadilly line advice might seem rather left-field (I believe it’s a baseball analogy) to some, the advice is on the whole pretty common sense stuff. An interesting angle however is presented by one of the comments on the post that suggests that this might be a good time to get said flu, while it’s not particularly virulent (remember that the 1918 flu [which, and I don't want to worry you, apparently killed around 2.5% of the world's population!] started off mild then returned the following winter with a vengeance). Perhaps we should follow our parents and grand-parents examples of “measles parties” wherein they took their poor little kiddies along to an infected friend’s house so that they too would get infected and so get over it sooner rather than later. So find someone coughing and looking rough, and give them a nice big hug…

If you’re feeling a little down about the flu, then perhaps a game will cheer you up. Sneeze is an online game wherein you’re a vindictive person with a virus and you have to try and get your virus spread by choosing when and where to sneeze. It’s great fun, particularly when you’re infecting the your fellow commuters at the railway station… I’ll have to try it for real tomorrow morning.