participating in clinical research

An article in the ACRP Wire caught my attention today. Many Americans recognize the value of medical research but many don't participate because they don't have time. But now more patient self-report studies are being conducted online, giving participants a convenient way to contribute to medical knowledge.

It is exciting to see any industry grow and adapt to new technologies. And the Internet holds much promise in gathering self-reported health information from people all over the world.

You can find the ACRP article here: http://newsmanager.commpartners.com/acrpwire/issues/2008-07-31/2.html

children and the media and sugary breakfast cereal

Nothing stirs passions among communication scholars quite as much as a conversation on children and the media. The influence of media on children has gotten the attention of public health officials, whose attention has turned to the makers of sugary cereals, greasy fast food and fizzy soda. The Federal Trade Commission released a report this week about the pervasiveness of such advertisements and a coalition of food companies released their own report on the progress made on self-regulation of advertising and increasing the nutritional value of foods marketed to children.

Whether the answer is government regulation or self-monitoring, the attention paid to this issue demonstrates the power of mass communication as an influence on children's health.

You can read more in the New York Times article here: http://www.nytimes.com/2008/07/30/business/media/30adco.html?ex=1375156800&en=18798a00c135aaf6&ei=5124&partner=permalink&exprod=permalink.

a rocky relationship

Well this is not news to anyone who works in health care or studies health care, but The New York Times published an article and accompanying blog today about the rocky, and in some cases deteriorating, relationship between physicians and patients.

There are many causes to blame for the deteriorating relationship and everything from the proliferation of health information on the Internet to declining reimbursements to short visit times get blamed.

I believe an effective physician-patient relationship is ultimately founded on effective communication based on mutual trust and respect. This requires open and honest communication in an environment where both parties feel safe. Of course, this is easier said than done in the current health care environment in this country. But it begins with taking a deep breath and trying not to enter the interaction with hostility, no matter how short the time you get with the doctor.

You can find the article here: http://www.nytimes.com/2008/07/29/health/29well.html?ex=1375070400&en=49ba4622b20ecda8&ei=5124&partner=permalink&exprod=permalink and the blog and discussion here: http://well.blogs.nytimes.com/2008/07/28/doctors-and-patients-a-rocky-relationship/.

cosmetic and medical procedures

The New York Times published a revealing article about a trend in dermatology practices across the country. Some dermatologists are devoting more of their clinic time, space and effort to cosmetic patients to the detriment of those seeking dermatology medical problems. And because the cosmetic patients pay top dollar out-of-pocket, these clinics are catering to them with nicer waiting rooms, immediate access to appointments, and longer visit times that those who are paying for medical procedures through insurance.

The article generated some interesting and heated discussion about the responsibilities of physicians, capitalism in medicine, and a two-class medical system in this country.

You can find the article here: http://www.nytimes.com/2008/07/28/us/28beauty.html?ex=1374984000&en=a17cc8b23e040a96&ei=5124&partner=permalink&exprod=permalink

The last lecture

Randy Pausch, the Carnegie Mellon Professor whose Last Lecture became a popular Internet video and later a best-selling book, died today. His lecture didn't focus on dying, but focused instead on living life and working to achieve your childhood dreams and helping others achieve their own dreams. You can now find the lecture at: http://www.thelastlecture.com.

The Wall Street Journal obituary is here: http://online.wsj.com/article/SB121699381188384657.html?mod=hpp_us_whats_news

Slowing down and respecting the moment.

Dr. Jennifer Israel wrote a moving article in the Cases section of the New York Times Health section yesterday about the need, as a doctor, to slow down. Physicians are busy and because they are so busy, they sometimes risk becoming desensitized to the beauty and pain of life and death. So they must make an effort to slow down and take in and respect the moments that make up their professional lives.

You can find the article here: http://www.nytimes.com/2008/07/22/health/views/22case.html?ex=1374465600&en=558e88206d6b356e&ei=5124&partner=permalink&exprod=permalink.

This article also reinforces my belief that it is useful to teach medical students the art of reflection, through study of the arts and humanities. Being able to write and reflect on the experiences of dealing with life and death gives physicians a coping mechanism for facing the particular stresses of their job. But ultimately, it is a lesson we can all learn: to slow down when life seems rushed and take in the moment.

altruism and research participation

A story on last night's NBC Nightly News touched on what of the motivators for participants in medical research that is sometimes not evident: altruism.

The story is about genetic research in Iceland, where most of the nation's population descended from Vikings and many have extensive knowledge of their family ancestry. This means that the people of Iceland offer a potential gold mine of genetic knowledge. Th research is voluntary and many are proud to volunteer for such as effort.

You can find the clip from last night's broadcast here:



The story continued this evening. You can find tonight's clip here:

Compassionate use

The New York Times published an article today that sheds insight into the complexities of medical research, desperate patients and investigational drugs. One mother fought hard to raise money and awareness for her son's disorder, thinking it would help get her son new treatments. But clinical research follows a set of strict protocols for who they enroll in trials with unproven medications. Those guidelines are both patient/research subject safety. But things get complicated when not everyone understands how and why medical research proceeds in certain ways.

It's compelling reading. You can find the article here: http://www.nytimes.com/2008/07/17/business/17dystrophy.html?ex=1373947200&en=9e58936b75dd9b17&ei=5124&partner=permalink&exprod=permalink.

Celebrity effect

Public figures who die from, or openly discuss their diagnosis of a particular illness, sometimes find themselves as the founder of an unintended effect. A celebrity face on an illness cloaked in shame or uncertainty can be the catalyst for the viewing public to get tested or at least raise public awareness. Perhaps the most well-known and studied celebrity effects are Betty Ford and breast cancer and Magic Johnson and HIV/AIDS. Now NBC Nightly News and other media outlets are reporting on the Tim Russert Effect, an increase in middle aged men seeking additional tests and more aggressive management of their heart health after the sudden death of NBC political analyst Tim Russert last month.

You can watch the video clip from Monday's newscast here:



Though the public does not know these public figures personally, many feel as though they can realte to these figures because they are so visible. When one of them gets sick, it may trigger some people who are watching to realize their own risk.

Your doctor and e-mail

Dr. Richard Friedman has an interesting article in the New York Times today about physicians, patients and e-mail. He offers a physician's perspective, from excitement about the time-saving possibilities of e-mail, to fear about possible harms when patients e-mail when they should be calling their doctor or 911. E-mail is great for rescheduling appointments or routine prescription refills. But it is problematic when a patient with suicidal thoughts e-mails his psychiatrist at 3 a.m. instead of calling or when a patient sees a delay in response as rejection.

He asks if e-mail should play a role in the therapeutic relationship?

And if e-mail can play a useful therapeutic role, what role, and how do you safeguard from potential abuse and harm?

You can find the article here: http://www.nytimes.com/2008/07/15/health/views/15mind.html?ex=1373774400&en=a13c40e0a6956439&ei=5124&partner=permalink&exprod=permalink.

Changing health by changing habits

The New York Times ran an interesting article about anthropologist Val Curtis, who wanted to find a way to encourage Africans to wash their hands with soap. When education campaigns failed, she turned to consumer market researchers. Market researchers study the psychology of habits, how habits are developed, and how habits can be manipulated to get consumers to exhibit a certain behavior. The method appears to be working for the hand-washing campaign. Reported hand-washing with soap is up dramatically.

Some people worry about the campaign's manipulative approach and would like to continue to focus on education effort. But where education efforts have failed, working to develop new habits is ultimately saving lives.

You can find the article here: http://www.nytimes.com/2008/07/13/business/13habit.html?ex=1373601600&en=e3072a7b2bc8ebf4&ei=5124&partner=permalink&exprod=permalink.

The power of the pen

No, I'm not speaking in a metaphorical sense. I'm speaking of free trinkets like coffee mugs, notepads, clipboards, and yes, pens, that pharmaceutical companies shower on physicians. The Pharmaceutical Research and Manufacturers of America, the trade association for pharmaceutical companies, has issued a new code of conduct for pharmaceutical companies discouraging companies from giving such trinkets to physicians and prescribers. The concern is that such gifts encourage over-prescribing or inappropriate prescribing of heavily advertised drugs, where older generics would suffice.

Some advocates are lauding this move, but others don't think it goes far enough. The guidelines say nothing about the large amount of money spent on consulting arrangements and speakers fees paid to physicians to advocate for a new drug. The guidelines take away the influences that patients see but do not address the pharmaceutical influences on physicians that patients do not see.

You can find a couple of articles here: http://www.nytimes.com/2008/07/10/business/10code.html?ex=1373428800&en=344e999790b6717d&ei=5124&partner=permalink&exprod=permalink and here: http://well.blogs.nytimes.com/2008/07/11/for-doctors-no-more-drug-company-trinkets/

The best prescription

Sometimes, the best prescription is simply to take a break.

So I'm going on vacation.

"A prescription for better communication" will be back online sometime after July 10.