33 Charts

Wakefield's Last Stand

In an attempt to save what remains of his ramshackle reputation, Andrew Wakefield took to the airwaves tonight in Dateline’s A Dose of Controversy to pitch his long-disproven theory linking autism to the MMR vaccine.

For the unaware, Wakefield’s crafted study published in Lancet in the late 1990’s sparked a worldwide panic over the MMR and its relation to autism.  The paper was ultimately retracted by Lancet when numerous irregularities were revealed.  And since that time several independent studies involving thousands of children have failed to show any connection between vaccines and autism as suggested by Wakefield.  But the world has been unable to let go of Andrew Wakefield and his concocted ideas.

Tonight NBC’s Dateline told the story.

With Matt Lauer on the record declaring the issue as a ‘controversy,’ the deck was stacked against Dr. Paul Offit and the rest of the thinking world who have witnessed the ever-growing mountain of evidence against the autism-vaccine link.  Offit, a Professor of Pediatrics at UPenn/Children’s Hospital of Philadelphia, has been a vocal champion of vaccination and archenemy of those looking to link immunizations with aberrant neurodevelopment. 

Despite predictions that the piece would create more questions and in turn embolden the vocal antivax minority, Lauer orchestrated an evenhanded story.  And when truth is on your side, evenhanded is good.

As far as the key players were concerned, Offit was disciplined and on cue refuting the claims of autism’s false prophets.  Wakefield was … well, he was Wakefield: sanctimonious and self-obsessed.  Brian Deer, the reporter who blew the whistle on Wakefield, represented the evening's most compelling character.

I believe this revealing story represents Wakefield’s last stand.  Based on his deteriorating base of supporters and his pending General Medical Council investigation for professional misconduct, I would be surprised if he ever sees the light of prime time again. The world is finally moving on.

Congratulations Mr. Lauer and NBC for responsibly presenting the facts in a way that lets the world see Andrew Wakefield for what he is:  A charlatan who’s greed and reckless actions have undermined the work of a generation of pediatricians.

Self-Surfing Patients

When I finish a history and exam I always ask parents what they understand about their child’s problem.  It’s a critical question.  It helps me understand how they see their child.

When answering the question, parents often introduce their comments with, "I know I shouldn’t be on the Internet but…"

Translation:  “I know as my doctor you’ve always been my sole source of information but I really want to look around and, quite honestly, I feel awkward admitting it to you.”

It’s an interesting way to open a discussion and it says a lot about where we’re at with patients and where patients are headed (or have already gone).  Most importantly it says parents feel embarrassed admitting that they’re working to learn about their child’s problem.

That’s unfortunate.

The medical profession has a long way to go as far as surrendering its stranglehold on information.  It has a longer way to go in helping patients achieve online health literacy.  And while much of what’s available to patients may not represent anything worth seeing, our recognition of their drive to participate is the first step in accepting them as thinking partners in a healing relationship.

Is There a Doctor on the Plane?

There was obvious commotion in the galley.  Something was up.  I initially turned a deaf ear to the overhead call for a doctor but my laptop’s Powerpoint images were a dead giveaway.

Flight service attendant:  Are you a doctor? (you’re not dressed nearly well enough but we thought we’d ask)

DrV: Yes (but trust me, not the kind you need)

Flight service attendant:  We have a sick passenger and we were wondering if you might help us out (beyond the chiropractor in first class who’s desperately trying to sell himself as a doctor, you’re all we’ve got)

DrV:  I’d like to help you but I’m not sure I can.  I’m a kid’s tummy doctor, you see and….

Flight service attendant:  ….come right this way, doctor.  We need you out back.

Moments later in the galley I find an obese, 55-year-old woman sporting an oxygen facemask and looking at me like I’m her last great hope.  Little does she know.  After some awkward pleasantries surrounding my introduction as baby doctor and my referral to her as a ‘big baby’, I chuckle nervously and we get started.

DrV:  Maam’, what seems to be bothering you?

Patient:  Well doc, I was just sittin’ there and suddenly I became dizzy and sweaty (kinda like you)

DrV:  Are you having any other symptoms?

Patient:  No.

DrV:  Do you have any medical problems? (Oh, sweet Jesus, please say no)

Patient:  High blood pressure.

DrV:  What medicines do you take? (as if I’ll recognize them)

Patient:  2 antihypertensives (didn’t recognize ‘em … but very catchy names)

DrV:  (scratching chin, one eyebrow dramatically higher than the other) Hmm, okay then, let’s get some vitals.

At this point three flight service attendants look at me impressed with my apparent command of this dizzy, perspiring woman on medications I’ve never heard of.

Flight service attendant:  Just for your information, doctor, we have a functioning AED on board.

DrV:  Perfect (what the blazes is an AED?). 

I take her blood pressure, respiratory rate and pulse.  Slightly hypertensive and tachycardic.  Not tachypneic.  (Differential? Good gosh, what makes an adult lightheaded?  Okay, think now, she’s an adult…. diverticulitis, pheochromocytoma?  No … focus, focus, you fool.  Okay, airway/breathing/circulation.  No, no…that’s for a code).

At that very moment, vindication.   From the main cabin appears an internist sportin’ a Tommy Bahama shirt, a tan and sparkling porcelain veneers.  Like an angel on my shoulder he followed up on my basic history with a little more detail.  And nearly as quickly as help appeared, the woman removed her oxygen mask and reported that she felt 100% better.  She reclaimed her seat in the main cabin where comfortably spent the remainder of the flight.

In the minutes to follow I hung out in the galley and learned, among other things, how they cook those savory microwave hamburgers.  The attendants regaled me with their experiences ministering to the sick and indisposed at 30,000 feet.  And at that point I realized how much my presence was appreciated.  When you’re a flight service attendant alone in a plane, even a kid’s tummy doctor is a whole lot better than nothing.  And having an internist in your back pocket never hurts.

I took my seat and collected a complimentary beverage. 

Two weeks later I received a warm letter from a senior executive and 1,250 frequent flier miles. 

Take a Peek to the Beach

I’ve never done this before.  The folks over at Typepad asked if I’d like to monkey around with a Peek device.  I said yes.  They mailed me one.  No money ever changed hands.  I took it on vacation and here  we are. 

I will remind you, however, that I’m no Walt Mossberg.

For the uninformed, the Peek is a bare bones email/text only device working to position itself among a growing population of smart devices.  The Peek Pronto allows up to 5 email accounts, unlimited email/text, ability to view PDFs and images as well as exchange support.

I activated my Peek with before heading out for a week at Hilton Head, SC.  Despite the fact that I rigged up my Peek cross-eyed at 11:30 pm after packing, total time to setup was a flat 2-3 minutes.  And after an overnight charge we were good to go.  I did leave the manual at home which as it turns out wasn’t an issue.  As my IT guy might say, ‘this thing’s so easy even a doctor can figure it out.’

The Peek Pronto served as my wife’s sole access to email during our week away.  She uses a standard flip phone so the novelty of portable email was something to see.  Otherwise, it performed really well and was easy for us to understand and put to immediate use.  Battery time was outstanding despite a bright, crisp screen.  And interestingly the email reception on the Peek Pronto far exceeded what I was able to achieve with my iPhone on Hilton Head (notoriously poor cell coverage).

With the recent shake up in the smart phone market the price of the Peek Pronto has dropped to a mind blowing $59.  This facile entry point with $20 a month buys you unlimited email and text.  Not a bad way to stay connected on the cheap.

The $59 question is this:  Are the desperate-to-be-connected going to quibble about 50 bucks and move to an iPhone or equivalent smart phone?  I don’t know.  I suspect that this device will find a home not with the desperate-to-be-connected but rather with the frugally minded and those who don’t need handheld web access. 

As the market never lies, only time will tell. 

For more insight, check out this Wall Street Journal piece, Peek Takes on Gadget Market

Is Social Media a Fad?

Think social media is a fad?  Check out this eye opening video which showcases the dramatic rise in online social networking.  Perfectly suitable for SM skeptics.

Via Ted Eytan

Dead by Mistake - Old News Retooled

Hearst Newspapers has finally discovered that doctors make mistakes.  Check out their latest collective project, Dead by Mistake, to witness journalism’s most recent boondoggle.  The project’s site profiles stories of medical error for public review.  From Mother bleeds to death after delivery to From a broken leg to a vegetative state, it's all there.  

Any patient who suffers the complications of a medical intervention is a tragedy.  But how Dead by Mistake is newsworthy isn’t clear.  This sensational repository of error serves to create fear, apprehension and unnecessary suspicion in the public eye.  Perhaps it’s the charge of kicking an already battered group of professionals.  Maybe it’s schadenfreude for a generation that feels disenfranchised by the medical profession.

But Hearst is late to the party.  I might suggest that the gaggle of journalists roped into this project grab a copy of Atul Gawande’s Complications.  The physician as less-than-perfect is old news.  And e-patients knew long ago what the old media is just figuring out:  To err is human and you’ve gotta do your homework.

iChat Adopted at Packard Children's Hospital ER

While the world laments the absence of communication between doctor and patient, look no further than Stanford’s Packard Children’s Hospital for innovation.  They’ve installed eight iMacs in their ER that, among other things, allow parents to chat with the ward clerk.  It’s like an emasculated HelloHealth but only for your kid's ER visit.

And if you’ve got some time check out the Packard Children's Hospital YouTube channel.  This represents a nice example of how a children’s hospital can use SM to advance parental education, children’s health and their brand.

via Gregg Masters @2healthguru