Clinical Gray Zones

When a patient is deteriorating by the minute, how does a doctor grapple with clinical gray zones? It’s not uncommon in medicine: long-held practices, or even new therapies, that make sense but lack strong data to back them up. Recently, I wrote a feature on the use of Impella in cardiogenic shock. Quite honestly it was one of the hardest stories I’ve ever written, in large part because though I went into it expecting a clear solution, I came out humbled by the difficulty of conducting rigorous studies in chaotic real-world emergencies. Would love to hear your feedback.

To RCT or Not to RCT? Impella Debate Pivots on How Best to Study Patients on the Brink of Death



We made a newspaper! The CRF editorial team descended on Washington, DC, last month to create the ‘paper of record’ for our organization’s annual meeting, the Transcatheter Cardiovascular Therapeutics symposium (aka TCT). This happens every year, but this is the first time that I’ve sat at the big editing table. It was crazy and exhausting and worth it. The Monday issue is my favorite.

Where Industry and Practice Intersect (or Don’t)

A very interesting post on the blog Pharmalot today describes the efforts of one practice to curb industry ties. What’s stands out most to me is the avoidance of a ‘cold turkey’ approach. Instead of taking away every small gift and free lunch, the practice began slowly by educating its staff and physicians about the need for peer-reviewed literature, a brand-free environment, etc.

This article also reminds me, yet again, that many community practices do not have free access to academic journals and unbiased information. And that medical journalism has an important role in disseminating news to improve patient care.

Cervical Cancer Trials in India

I just came across a story from The Arizona Republic (care of USA Today) that, in some ways, updates an article I wrote for the Indian environmental magazine Down to Earth several years ago.

My 2007 story examined the ethical ramifications of introducing the then-new cervical cancer vaccine Gardasil on a wide scale in India. When a vaccine is taken out of the context of screening and regular medical care, does it carry the same benefit? Or could it actually do more harm than good?

Bob Ortega’s article delves into 2 US-funded research studies of cervical cancer in India. Together, the studies may have prevented up to 100,000 women from being screened and, if necessary, treated. The women instead received health care visits and counseling, and they were monitored to see how many cancers developed.

All this raises many questions, from what is required for informed consent to what constitutes ‘standard of care’ in an evolving health care system. Thoughts?

In the Long Run

Although Wikipedia will do in a pinch, in the long run you really do have to dig deeper.

So where do you start, if a sentence reads like a web of jargon? Don’t panic. Remind yourself that somewhere in there are subjects, verbs, and objects. Google unfamiliar words. Then try to summarize that whopper out loud. Make a list of acronyms and what they mean. And move on to the next one.

Think about how the terms can be categorized. For example, there is a spectrum of symptomatic heart disease. On the low end, you have stable angina (chest pain that predictably appears during strain or exercise). Next comes unstable angina (chest pain that pops up out of nowhere), followed by what is commonly called a ‘heart attack.’ Myocardial infarction (MI) itself can be divided according to its severity based on ECG results: non-ST-segment elevation MI and ST-segment elevation MI (aka NSTEMI and STEMI). Everything worse than unstable angina can be grouped as acute coronary syndromes (ACS).

I could probably recite this in my sleep by now, but at one point it had me in knots. And reading the paragraph I just wrote, I understand why. Whew.

A Different Take on Interviewing Sources

Early in my training as a journalist, I got the idea that I should approach interviews as openly as possible. Especially those on topics that confused or intimidated me. (A recent post on The Last Word on Nothing captures this Science Writing 101 quite well) Only when I could explain the ideas backwards and forwards did I begin writing. I felt like my job was to translate concepts so thoroughly that someone new to them could still follow.

I realized during my very first interview for TCTMD that writing for physicians is an entirely different beast.

My interviewee was an extremely nice doctor not much older than me, chosen no doubt because he is such a nice guy. Without any hesitation, I began by mentioning, “Now I’m new to this, so…” And he stopped right there, laughing, “Never show fear. Seriously.”

He was right. Number one, the leading cardiologists are pretty confident people and don’t want to feel like they’re wasting their time on someone who isn’t equipped to listen. Number two, the only way to get them to answer at a level that would interest their colleagues is to pretend to be at that level.

So how did I pretend? In the short run, Wikipedia. More on the long run later.