Ghost Writers and Wyeth Pharmaceuticals

In the not so distant past, we told you about Merck paying Elsevier to publish phony journals. Well, now, there is a new reason to be a little more skeptical about what you read in medical journals.  Apparently, Wyeth pharmaceuticals paid ghost writers to write 26 articles (mostly review) which were published in 18 different journals  supporting the use of their homorne replacement therapies from 1998 through 2005.  Sales for these pharmaceuticals soared as many women were placed on these drugs due to downplayed side effects and exagerrated benefits.

 In 2002, a large federal study was cancelled when it became apparent that these same hormone treatments were correlated to increased breast cancer, heart disease and stroke. A later study even showed that the treatments were also linked to increased dementia in elderly patients.

 Unfortunately, it appears that Wyeth is not the only pharmaceutical company to use ghost writers to draft up articles supporting their treatments or to get physicians to sign their names to articles they may not have written completely (or even partially) themselves. 

 If you are interested in finding out more about this scandal, you can check out The New York Times or Stephen Colbert (for a funnier, if not less accurate depiction).  He doesn’t actually start talking about hormones until around 4:50, but it’s interesting to see how this phenomena has infiltrated the popular media.

Research First Aid – Welcome Back and Library Liaisons

 In this episode, Mark and Amy welcome everyone to a new semester and talk about the liaison programs at Laupus and Joyner Libraries. 

APA style updates and you

Are you all as interested in style manuals as we librarians are? Probably not, but that’s why we’re librarians, right? Regardless of your level of excitedness, if you are a researcher, student, or instructor, it’s worth noting that there is a new edition of the Publication Manual of the American Psychological Association, which we most commonly refer to as the APA style guide. The manual is now in its 6th edition and includes some noteworthy revisions and updates. So, before you go writing your first paper of the semester or begin grading your students’ reference pages, take note of some of the changes:

• Check out section 6.31 Electronic Sources and Locator Information. This section explains changes in publishing models since the 5th edition was published and mentions the DOI system. To prevent this post from running on too long, just know that DOI stands for Digital Object Identifier. It’s a number used to identify items like electronic journal articles in a standardized and systematic way. For examples of citing items with a DOI, refer to section 7.01 in the new manual.
• E-books are also mentioned in the reference example section, 7.02. You’ll see ways to cite the e-version of a print book, an electronic-only book, and the e-version of a republished book.
• Into social media or web-based resources? The 6th edition also mentions how to cite blogs, message boards, listservs, and other online communities. These examples include using a screen name as author, the proper format for YouTube videos, and how to cite comments to discussion groups. These examples are given in section 7.11.

For other revisions on writing an effective paper, working with publishers, and reference formats, please consult the new edition which is available for use at Laupus Library. You can also visit the APA Style site online at www.apastyle.org. Looking for information on other styles? Laupus has a style guide page as well.

Update on Medical Applications for the iPhone/iPod Touch

Back in February, I wrote a piece called Medical Applications for iPhones and iPod Touches. Five months later, I thought it would be fun to take a look at the developments these applications have made as well as look for what’s new.

 I was inspired to revisit this topic because I found this great website called Timeline: The iPhone as Medical Tool. Apparently, it wasn’t until November of 2008 that Apple created a section for medical apps. By April of 2009, medical applications were the third fastest growing applications out of the 20 categories of Apple’s iTunes store.

Let’s start by just taking a look at the apps available for PubMed, one of the most well known interfaces to the Medline database.  Since I’ve already talked about some of them before, this entry will only focus on newly released apps.

 SemanticWeb–0.99–This tool is part of SemanticWeb, a project that claims to use artificial intelligence to search for life sciences information. The article tab on this app links to PubMed citations.

Papers–9.99–This application is one I have not tried out, but it is more a way to store articles and papers than a search engine. It does provide access for searching PubMed, Google Scholar, JStor and other databases. There have been mixed reviews as to it’s functionality.

PubMed on Tap Lite–Free–When I last talked about iPhone/iPod touch applications, this app was only available in a 2.99 version called PubMed on Tap. Now, they have a lite version which claims to have all the features of the original, but only returns 5 results per search. I’m not sure how they pick only 5 (date, relevancy, etc.), but it is a nice little app.  A search on Mirena pulled up 5 articles all from 2009 with 2 appearing to be on topic. They were not the same top 5 results as when I did the same search in PubMed.  I like that this app allows you to add the proxy URL for your institution so that you can access full text articles from journals your library subscribes to. I did have to talk with my IT person to tweak the proxy URL to get it to work, so you may want to ask your librarian for this information.

UCentral–Free with institutional subscription–UCentral contains Medline Journals which should allow you to create searches and recieve alerts for them. You will need to log into your UCentral account and then click on Medline Journals. From this point you can select the journals that you want to look at from their list and add them to “My Medline Journals.” The next time you open the app on your iPhone or iPod Touch, you will need to update it before the journals will show up. I believe this is more of a table of contents service that will only show the most recent issues of these journals.  It’s still a nice way to access latest articles. 

These aren’t apps, but they are my new favorite tools for accessing PubMed from my iPhone. I’d love it if you would share your favorite ways to access PubMed from your iPhone or other mobile device in our comments section.

This is a search page for Pubmed that’s optimized to mobile devices.

http://pubmedhh.nlm.nih.gov/nlmd/pubmed/index.html

This is a special PICO form optimized for searching Pubmed with a mobile device

http://pubmedhh.nlm.nih.gov/nlmd/pico/piconew.html

And this is the homepage for both.

http://pubmedhh.nlm.nih.gov/nlmd/index.html 

Another app worth mentioning is…

Pocket First Aid and CPR–3.99–This first aid application has come out from the American Heart Association and was recently reviewed by the Washington Post. One of the features that I found interesting is that this app works a bit like a personal health record since it can store information about a person on it. The other feature I appreciated was that the information is stored on the phone, so a signal is not required to access information. 

On The Horizon

There has been a lot of talk online about how Apple is working to create more apps that can turn the iPhone into a monitoring device. You can see some talk of this in the following article Qualcomm SSLS: Wireless + Medicine and how the iPhone ties them together. 

There has also been some research on using Smart Phones as clinical tools in areas that are lacking quality medical centers, but do have access to cell phones.  Perhaps the iPhone and other similar products will help bring better care to underserved areas. Mobile Phone Based Clinical Microscopy for Global Health Applications.

Health News Review

Have you ever wondered about the accuracy of health stories that appear on the news?

Healthnewsreview.org evaluates current news items for accuracy and comprehensiveness.   Stories concerning treatments, procedures, and diagnostic tests are rated by a panel of medical professionals.  Coverage of the reports are given zero to five stars on the ability of the journalist to provide thorough information on the particular topic.   Ten specific areas of criteria are measured including the use of additional independent sources, the discussion of advantages and disadvantages for the treatment, and the ability to assess the quality of evidence.   The aim of the website is to appraise the news story itself, not the actual treatment or procedure. 

The website examines the nation’s top 50 newspapers, network newscasts, and weekly news magazines.  Transcripts and links to the original article are provided for users.  Individuals can search for reviews by date of publication, news organization, number of stars, and keyword.  Consumers can view a general critique of the article as well as detailed information on the ability of the news story to address the ten areas of assessment criteria.

For instance, a recent story from the Wall Street Journal, “Bone Proteins Costly in Surgery, Study Says” received two out of five stars for its inability to address the  cost, benefits, problems of the procedure,  in addition to the failure of the news story to include limitations of the study.

Health News Review is an excellent website that you can use to get a second opinion on the latest medical news story.   

Acetaminophen in the News

You may be hearing a lot about acetaminophen in the news right now.  An advisory committee for the FDA is recommending that the dosage instructions be changed to lower amounts to prevent possible liver damage.  According to Medscape, the FDA is not required to follow the advisory committee’s advice, but usually does.  It will be months before a decision is made and publicized. 

 Acetaminophen is a drug found in many over the counter medications such as Tylenol and Excedrin.  It is also found in prescription drugs like Percocet and Vicodin. This is part of the concern. A lot of people are unaware that prescription drugs contain acetaminophen, so they are more likely to exceed the recommended dosage amount. 

 For more information, see the following articles:

 FDA News Release

Introduction. Prescriber’s Letter: July 2009; Vol: 16, No. 7

Kindle in health education and clinical practice

Many of you may be aware of Amazon’s Kindle e-book reader, a product which has received a lot of attention lately. If not, here’s the lowdown: its a sleek, lightweight device which uses a paper-like display for reading electronic versions of books. You can download thousands of books from Amazon’s ever-expanding Kindle bookstore directly from the device and start reading within about 60 seconds. And, though the device is billed as an e-book reader, you are also able to download newspapers, some websites, and blogs as well.

So, what kinds of applications does the Kindle have for our healthcare community? There hasn’t been a lot of research done in this area yet, but there are some interesting commentaries and opinions online. If you’re interested, you might consider checking out the following:

• Life as a Healthcare CIO – CIO and Dean for Technology at Harvard Medical School John Halamka’s blog has multiple informative posts on the device, including one on implementing Kindle support for all educational resources at the school
• Thoughts on reading the New England Journal of Medicine and reference texts from PatrickMD.net
• The Dental Technology Blog from the editor of Dental Products Report magazine has a number of posts about the Kindle

If you’ve used the Kindle for health education or in clinical practice, we’d like to hear about your experiences.  You are welcome to share your own thoughts in the comments section below.

iPhone use in Hospitals

Physicians at Doylestown Hospital in Pennsylvania needed something that is a beeper, cell phone, and tool for getting information about patients in real time. According to a recent article from Apple,  the “iPhone became an instant favorite among Doylestown physicians, in part due to its ease of use.” The physicians rely on iPhone features like push email, calendar, and contacts from Microsoft Exchange ActiveSync. One of the greatest uses has been the ability to give doctors secure mobile access to the hospital’s electronic medical records system, MEDITECH Client/Server 6.0. “Literally anywhere a physician is in the world, as long as that doctor has secure access to the Safari browser on iPhone, they can access patient information.” The iPhone has helped the Doylestown medical team work more efficiently, improving communications not only between doctors, but throughout the local healthcare community.

The key to using smart phones in hospitals is secure access, which is one reason some people are concerned about people using the iPhone.  The Krafty Librarian points out that at a majority of hospitals “Blackberry’s are the only mobile phones that are able to access email from off campus.  Many hospitals were very reluctant to allow iPhone users the same type of email access because of security concerns.“ iPhones simply were not created with the business user in mind. However, an exciting new app may change all of that. Citrix Receiver is a free app that enables iPhone and iPod touch users to run any Windows application as a service on their device. Connecting to a Citrix XenApp environment, iPhone fans can securely work with apps from Oracle, SAP, McKesson, Cerner, and other vendors. The only information sent over the wireless connection consists of screen taps, gestures, keyboard input, and screen updates so it is simple to keep data secure. In enterprises, such as hospitals that depend heavily on Citrix already, we should see more hospitals allowing the same types of access to iPhone users that we already see with Blackberry users.

What is Wolfram|Alpha?

 Wolfram|Alpha considers itself to be a “computational knowledge engine”, which in laymen’s terms consists of a site where you can search for factual information.  The website handles quantitative knowledge and directly answers questions as opposed to supplying the user with links to locate the information themselves. 

Launched May 18, many people thought Wolfram|Alpha would be a new search engine that would compete with Google, but that isn’t the case.  The website is in no way similar to Google.  For instance, it will not provide you with driving directions or information about local events.  However, it will provide information on medical computations, hospital information, mortality data, and human growth charts. 

The site is updated frequently and claims to obtain most of its data from systematic sources.  For example the weather and financial inquiries are continually streaming.  In addition, references can be located at the end of each results page.

One of the major drawbacks with using this search engine is that it is not exactly user friendly.  Unfortunately, you have to utilize very specific syntax or search within the examples provided.  Also the majority of information contained on the site seems to involve scientific information; as such your results can be nowhere near what you expect.   Results that concern questions on science and math have the best answers, this is due to the fact that Wolfram|Alpha stemmed from the developers of Mathamatica software.  If you are a first time user, it is suggested you start with examples.   Similar to a “gigantic brain, it doesn’t know everything, but it knows a ton — and discovering what it knows is half the fun of using it (Conlon, 2009)”.  There are still kinks in the site, but Wolfram|Alpha possesses great potential that has yet to be seen.

 For additional information:

The Grouse Weighs in on Wolfram by Tom Conlon  

Wolfram Alpha Searching for its Niche by Tom Krazit

Wolfram Alpha Show Data in a Way that Google Can’t by Stephen Shankland and Rafe Needleman

Wolfram Alpha the New Greek Almanac by David Coursey      

Medical Journals and Facebook

Apparently, medical journals are starting to find their way onto the social networking site, Facebook. According to the The Wired Campus, a blog put out by the Chronicle of Higher Education, the The New England Journal of Medicine has decided to create a facebook page as a new way to get closer to their users. What other journals can you find in Facebook? Well, Wired says JAMA has created a facebook page as well as Science.

 After reading the article in Wired, I decided to see for myself what sort of pages the journals were creating. I looked at pages for JAMA, AAS, and, of course, the New England Journal of Medicine. After looking at the JAMA Facebook page (look them up as “Journal of the American Medical Association”), I did not see a lot of value in the site. If you are on Facebook, you can become a fan, and maybe read about the journal, but that is all they have posted to date. Perhaps there is more to come later. As for Science magazine, all I could find for my searching efforts was a page for the company that produces the magazine, AAAS. The page did have a lot of interesting content, though.  The New England Journal of Medicine site is pretty sparse and comprable to JAMA’s page. Under info, you can find a link to the journal’s website and wikipedia, but not much else.

 I personally have not become a fan of any medical journals in Facebook.  I was a little disappointed by the lack of content on their sites, but I will keep an eye on them to see if additional content turns up later. It would be nice to friend a journal if you would get a feed of new articles that were being published or if they would send out notices of some of the new cool things they are doing on the web (like NEJM: Videos in Clinical Medicine).  When that happens, I’ll think more about becoming a fan or friending a journal.