Author Archives: Bob Finn

A Hidden Gem

Reporters at Elsevier Global Medical News cover a whole lot of medical meetings–in fact, we’ll cover about about 400 this year. We cover all the big ones–the ASCOs, the ADAs, the RSNAs–same as everyone else. But we also cover many small, unheralded meetings. In fact, I’m the only reporter at most of the meetings I attend. I’ve written about this before, here and here, even developing a list of Excellent but Little Known Medical Conferences.

Well, I’ve found a new gem of a medical meeting, and I’m there right now. It’s the WTSA Bannerannual meeting of the Western Thoracic Surgical Association, and once again I’m the only reporter in the room with a couple of hundred leading thoracic surgeons.

The content of this meeting is almost all meat, with very little fat. Virtually every talk reveals the results of a new study, most of which are both important and newsworthy. None of the talks are broad, such as “The History and Future of CABG.”  All of the talks target very specific topics. Here are two examples, which I’ll be writing about in coming days.

One study looked at how long patients survive after lung transplant and asked the question: Do the patients who receive lungs even though they have low “lung allocation scores” actually survive longer after receiving the transplant than if they had stayed on the waiting list? It turns out, counterintuitively, that on average they would have lived longer if they had not received the transplant, although possibly with a worse quality of life.

Another study examined an interesting dilemma. Thoracic surgeons have become so good at saving infants and young children with congenital heart disease, that more and more of them are living into adulthood. But when they need additional treatment as adults, it turns out that they tend to do worse when they’re operated on by thoracic surgeons with lots of experience with adult heart disease, and better when a specialist in surgery for pediatric congenital heart disease performs the operation.

Those are just two of the little golden nuggets I’ve found in this hidden gem of a meeting. Journalists tend to be pack animals, but I’m happy to work for an organization that doesn’t always travel with the pack.

—Bob Finn
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Filed under Cardiovascular Medicine, IMNG, Internal Medicine, Pediatrics, Pulmonary Diseases and Sleep Medicine, Surgery, Thoracic Surgery

Urology Goes to the Dogs

Here at Elsevier Global Medical News, we aim to report stories with direct clinical relevance. We rarely cover Phase I trials, and virtually never report on test-tube or animal studies. Here is an exception: This study is not so much about research on animals but on research by animals.

Here at the annual meeting of the American Urological Association, there are always many studies on detecting and treating prostate cancer. Existing screening methods leave a great deal to be desired. The popular PSA test, for example, is very non-specific—it flags many men who do not have prostate cancer.

Yet a group of French researchers have reported success at training a Belgian Shepherd (Malinois) owned by the French Army to detect prostate cancer by sniffing urine samples.

Here’s a video of the dog in action. The samples are in the drawers.

Presented with urine from 33 patients with confirmed prostate cancer and 33 with elevated PSA levels but without prostate cancer, the dog correctly identified every cancer patient and correctly excluded all but three of the non-cancer patients. Thus the sniff test had a sensitivity of 100%  and a specificity of 92%, a truly remarkable result.

Now you’re not going to see lab-coated pooches in your local doctor’s office any time soon. For one thing, an attempt to train a second dog was unsuccessful. The French investigators hope to figure out which volatile organic compound the dog is detecting, and develop an “electronic nose” to do this automatically.

One question remains: Will the electronic nose be cold and wet? Only time will tell.

—Bob Finn
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Filed under IMNG, Oncology, Urology

A Giant of Medicine

At a meeting on cardiovascular disease epidemiology and nutrition, I was fortunate to hear a lecture by Dr.  Jeremiah Stamler, a pioneer in research connecting diet with cardiovascular disease.

Dr. Jeremiah Stamler

Photo credit: JAMA/Jim Ziv

Dr. Stamler, now 90 years old, is a diminutive man who became a giant in medicine. He was among the first to research and champion the idea that the societial impact of cardiovascular disease can be halted by preventive medicine, a field that he essentially invented.

He gave a fascinating talk on the Mediterranean eating style, a diet that appears to be effective in preventing heart disease. Sadly, in the 30 years since the association was noticed, Italians and Greeks appear to be learning some bad habits from Americans.

Although somewhat frail and walking with a cane (the consequence of joint damage from running track during his younger years, according to former employee Laura Newman), Dr. Stamler is still sharp as a tack. He’s the recent recipient of a brand new R01 research grant from the National Institutes of Health, and he’s just applied for another. He opened his talk by observing, “When Mozart was my age, he’d been dead for 50 years.”

The next day Dr. Stamler presided over a session including talks by five young investigators presenting their research and competing for the Jeremiah and Rose Stamler Research Awards for New Investigators. I found it inspirational to watch him listen to those talks, taking copious notes, and asking insightful questions of each speaker.

Dr, Stamler is clearly not just an advocate for preventive medicine. He’s a living advertisement for its efficacy.

I think I’ll have pasta e fagioli and one glass of red wine for dinner.

—Bob Finn (on Twitter @bobfinn)
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Filed under Cardiovascular Medicine, IMNG

Are virtual medical meetings the wave of the future?

It’s now possible to go to a medical meeting without actually going to the meeting.CROI Webcasts

I was assigned to cover the annual Conference on Retroviruses and Opportunistic Infections (CROI), one of the year’s most important HIV/AIDS meetings, currently underway in San Francisco. But through a series of snafus too boring to mention I was not able to register for the conference.

No problem, said the organizers, more than 90% of the conference will be webcast.

I’ve heard this song before, and usually it means that at some distant future date some low-quality audio may be available for purchase at the rate of $40/session or thereabouts.

But I was pleasantly surprised to learn that CROI is offering much, much more. The webcasts are free, they include high quality audio, video, and PowerPoint slides, and the day’s sessions are all available the same evening. Oh, and the audio files, with slides, are also available for download in mp3 and iTunes format. For free.

Virtual attendance via webcast has both advantages and disadvantages compared to physical attendance in “meatspace.”

Advantages

  • No need to pay for travel, hotel, or even meeting registration.
  • Smaller environmental impact.
  • Can attend all sessions, even ones occurring simultaneously.
  • Can clearly hear and see the speaker, the slides, and participants in the Q&A session.
  • Can pause and rewind audio, study PowerPoint slides closely, and actually read those slides that speakers introduce by saying, “Now this slide is a little busy, but . . .”
  • Can attend in pajamas.

Disadvantages

  • No schmoozing, no networking, no catching up with old friends and colleagues.
  • Requires a fairly fast Internet connection for non-jerky video. Even with a fast connection (in CROI’s implementation, at least) streaming tended to stop halfway through a 2-hour session, and the only way to resume was to exit and reload.
  • Not possible to get a sense of how interested–or uninterested–the audience was in a particular talk.
  • I’m a big fan of poster sessions, but the CROI did not make the posters available on its webcast.
  • No way to earn CME credit for watching the webcasts, in this implementation at least.
  • No opportunity to spend time in San Francisco, one of the most exciting and beautiful cities on Earth.

I’m interested in hearing from physicians who have attended a conference via webcast. What did you think about the experience? I’d also like to hear from physicians who think this is the worst idea since bloodletting went out of fashion. Please vote in the poll and leave comments!

— Bob Finn (on Twitter @bobfinn)

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Filed under IMNG, Infectious Diseases, Polls, Practice Trends

Placebos vs. Antidepressants: Not Quite a Draw

There’s a fascinating study in today’s Journal of the American Medical Association. It’s a

sugar pills

Photo by flicker member DISCARDEDteenz used under Creative Commons license

meta-analysis of randomized controlled trials comparing antidepressants vs. placebo. And it showed that the placebo effect is so strong in depression that placebos work as well as paroxetine (Paxil) and imipramine (Tofranil) for all patients except those with major depressive disorder that’s classified as “very severe.” Placebo tied active medication for “mild,” “moderate,” and even “severe” depression.

Here’s a link to an abstract of the JAMA article, and here’s a link to my article about the study.

Why didn’t we know this before? The study’s authors explained that there are two reasons. One is that the vast majority of the thousands of clinical trials on depression enroll only patients with very severe depression, even though the vast majority of people taking antidepressants have less severe forms of the disorder.

The second reason is that many studies include what’s called a “placebo washout” period, in which all patients being considered for the trial are given a placebo for a few days up to a week. Those who show more than 20% improvement in their depression are dropped. But removing placebo responders clearly biases the study in favor of finding significant medication effects.

It’s a demonstration that the “gold standard” of medical research–the randomized, double-blind, placebo-controlled trial–can be misleading, especially when we bow to the temptation to generalize results from a highly selected group of test subjects to the wider population.

–Bob Finn
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Barriers to Accurate Reporting

From the annual meeting of the American Academy of Child and Adolescent Psychiatry, Honolulu

“Speakers and Attendees: Please check with the Press Office in Sea Pearl 4 before accepting a media interview.”

This message appeared prominently on page 11 of the program for the AACAP meeting, which I just finished covering.

My next hint that reporters at the meeting were in for a difficult time was a warning that was read by session moderators and also appeared in a black-box on page 7 of the program:

“This presentation and the accompanying materials are protected by copyright and may not be reproduced or summarized, in whole or in part, for any commercial purpose without prior written authorization from the copyright holders.”

Now I’m no lawyer, but I do know that no one can copyright an idea, only a particular expression of an idea. Any summary that a reporter writes in his or her own words cannot on its face constitute a copyright violation. In addition, the Fair Use provisions of copyright law permit anyone to quote brief word-for-word excerpts.

So what gives?

I spoke with Rob Grant, AACAP’s new communications manager, to register my objections to this policy. He said these standards were established about 2 years ago after members of an anti-psychiatry organization gained entry to the meeting by posing as reporters. Rob wouldn’t discuss details, and said the AACAP did not intend to prevent attendees from talking to legitimate members of the press. He gave me his mobile phone number and said to please phone him directly or give the number to any attendees who balked at talking to me.

Fortunately, none of the speakers and attendees who I interviewed insisted on talking first to Rob or being lugged up to the Press Office for preapproval.

Yet another proviso, a ban on taking pictures, and the unavailability of PowerPoint slides for the press, certainly got in the way of confirming that the numbers and other details in my articles are accurate.

As an alternative to setting up roadblocks, perhaps the American Academy of Child and Adolescent Psychiatry could adopt procedures for credentialling reporters. The American Society of Clinical Oncology, for example, requires online registration for reporters and asks them to submit recent examples of their reporting, preferably about cancer topics.

It’s not a foolproof solution, but it would seem preferable to threats and limitations.

—Bob Finn (@bobfinn on Twitter)
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Toxin Language at the FDA

In the infinite wisdom of the FDA, the agency has decided that the 3 forms of botulinum toxin need new generic names.

Photo by Flickr member EverJean. Used under Creative Commons license

Photo by Flickr member EverJean. Used under Creative Commons license

Botulinum toxin type A, trade name Botox, will henceforth be known as onabotulinumtoxinA.

Botulinum toxin type A, trade name Dysport, will henceforth be known as abobotulinumtoxinA.

Botulinum toxin type B, trade name Myoblock, will henceforth be known as rimabotulinumtoxinB.

The FDA’s announcement says the reason for this change is “to reinforce individual potencies and prevent medication errors.  The potency units are specific to each botulinum toxin product, and the doses or units of biological activity cannot be compared or converted from one product to any other botulinum toxin product.  The new established names reinforce these differences and the lack of interchangeability among products.”

I think the FDA should have consulted a linguist, or an editor, or for that matter any random person off the street, before making these changes. Do they really think that using 9-syllable, 18- or 19-letter, compound words will actually prevent medication errors? I think they’re going to cause errors!

—Bob Finn

posted 11:50am PDT Aug 4, 2009

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Filed under Dermatology, Internal Medicine, Plastic Surgery

Anti-Vaccine Crowd Gearing Up for Flu Season

With a vaccine for the novel H1N1 flu (also called swine flu) expected to be available in October, it comes as no surprise that the anti-vaccine forces are gearing up.

Photo by Flickr user djuggler used under Creative Commons license

Photo by Flickr user djuggler used under Creative Commons license

A friend and neighbor of mine called my attention to this article on Mercola.com, a popular alternative medicine site. Here’s what my friend wrote:

” I am not anti-vax, but I came across this article about squalene in the new swine flu virus potentially being the cause of Gulf War Syndrome…. pretty disturbing.”

The article charges that squalene is likely to cause an autoimmune reaction. Now squalene is found naturally throughout the nervous system, and is also one of the beneficial antioxidants in olive oil. But the Mercola.com folks suggest that when injected, good squalene becomes bad squalene. The article repeats claims that squalene was added to the anthrax vaccine given to soldiers in the Gulf War, and that this vaccine component may be responsible for Gulf War syndrome.

The facts don’t support these charges. Take a look, for example at a lay-language FAQ by the World Health Organization. WHO points out, among other things, that 22 million doses of flu vaccine containing squalene have been administered since 1997 with no severe adverse effects. Clinical studies on squalene-containing vaccines have been done in infants without evidence of safety concerns. And it’s now known that squalene was not added to the vaccines administered to Gulf War troops.

Don’t you just hate it when pesky facts get in the way of beautiful theories?

—Bob Finn
posted 1:12 pm PDT 7/28/2008
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Filed under Allergy and Immunology, Family Medicine, Infectious Diseases, Internal Medicine, Pediatrics, Primary care

Transgender activists demonstrate at APA meeting

A small group of transgender activists and supporters demonstrated outside San Francisco’s Moscone Convention Center on Monday (May 19, 2009) as the American Psychiatric Association (APA) met inside.

The demonstrators’ concerns involved whether “gender identity disorder” or related diagnoses will be part of the new fifth edition of the Diagnostic and Statistical Manual of the Mental Disorders (DSM-V). DSM-V is  being drafted by more than 160 psychiatrists and other mental health professionals, with the final draft due in 2012.

Yesterday I conducted an extensive interview on DSM-V with Dr. Darrell Regier, the vice chair of the oversight committee. (I hope to be posting that interview as a podcast within a week or so.) Here’s what Dr. Regier had to say about the transgender controversy:

“We are certainly open to the concerns they have. We want to have a scientifically based set of diagnostic criteria to make a judgment on what is going to be the most scientifically credible and clinically useful assessment of gender identity disorder criteria. . . .

“We understand that there are some controversial issues, some strongly held positions in the community. There are individuals with gender identity disorder and transgender advocates who are very concerned that if it is not considered a mental disorder diagnosis they will not be eligible for treatment, whether they’re pharmacologic treatments or surgical treatments. And then there’s another group that feels this should be removed from the diagnostic criteria in the same way that homosexuality was removed as a diagnosis in 1973. So there’s a lot of disagreement within that community, and we’re hearing both sides.”

Here are some photos I took at the demonstration.

Transgender demonstration 1

Transgender demonstration 1

Transgender demonstration 2

Transgender demonstration 2

Transgender demonstration 3

Transgender demonstration 3

Transgender demonstration 4

Transgender demonstration 4

Transgender demonstration 5

Transgender demonstration 5

Transgender demonstration 6

Transgender demonstration 6

—Bob Finn
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Poster sessions done right

If you’re a reporter covering the American Psychiatric Assocation meeting here’s my advice: Ignore the plenary sessions. Ignore the symposia. Ignore the workshops. Ignore the medical courses. And spend most of your time and energy on the poster sessions.

Anyone who knows my approach to covering medical conferences knows that I love poster sessions. It’s possible to scan dozens of posters in the time it takes to listen to one oral presentation.

I’m covering the APA meeting in San Francisco right now, and the poster sessions at this meeting were exceptionally good. Here are some of the elements that make this meeting’s poster sessions so fine:

  • Virtually all posters presented original research studies.
  • There were a manageable number of posters in each session. There were three sessions today (9-10:30 am, 12:30-2 pm, and 3-5 pm). Each was limited to fewer than 150 posters.
  • Virtually all the presenters were standing right next to their posters for the entire poster session.
  • And last but not least, virtually all the presenters had a generous supply of  paper copies of their posters. As Denise Napoli wrote on this blog earlier this month: “Bring handouts of your poster. If Reporter A, also known as “I-have-twenty-stories-to-write-by-tomorrow” is walking past three equally interesting posters, also known as “seriously-intense-studies-of-gene-loci-using-statistical-methods-derived-from-string-theory,” and Poster 1 has a handout but the other two don’t, guess which one is more likely to be written up.” Today I didn’t have to make coverage decisions on the basis of handout vs. no handout. I had to make tougher decisions based solely on the quality and newsworthiness of the studies. I loved it.

—Bob Finn
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Filed under Psychiatry