WARNING: After this entry was originally posted, it came to my attention that I had not received all of the early entries for this round of the Carnival. The following post was edited to reflect these updates.
In the context of the looming deadline for comments on the FDA’s development of social media guidelines, the Medlib’s Blog Carnival theme this month was on free speech in health information. Briefly, the FDA has a long history of managing and establishing guidelines to prevent unethical publication of inaccurate or misleading health information from persons or corporate entities promoting the use or sales of drugs or medical devices. The flip side of this is to encourage informed decisionmaking based on high quality unbiased health information. There were few submissions this month, but those received were sound contributions looking at various aspects of this complicated issue.
Laika provided not one, but TWO excellent posts. The first one, “NOT ONE RCT on Swine Flu or H1N1?! – Outrageous!,” discusses the issue of popular news and hype as opinion influencers in comparison with actual research. Taking H1N1 as an example, she begins with a Twitter post and popular press, then discusses when it is appropriate to expect what kind of evidence in support of a question, simple tips for finding better quality evidence, as well as specific scientific and clinical contextual issues that beautifully illustrate not just issues of scientific research and methodology, access to information and information quality assessment, but also quite a bit of useful information about H1N1 itself! Laika provides a strong voice for clear reason and balanced information, but at the same time respects the importance of scientific dialog and communication in shaping the evolution of what we know about any given topic.
Laika’s MedLibLog: NOT ONE RCT on Swine Flu or H1N1?! – Outrageous!. http://laikaspoetnik.wordpress.com/2009/12/16/not-one-rct-on-swine-flu-or-h1n1-outrageous/
In her second post for this Carnival, Laika again zeroes in on the issue of dialog in science, and the broader issue of respect. This is true not just for dialog between scientists, as in the example she discusses, but even more so among the public and news media. The life lessons learned by Laika in her tale of disrespect and influence among scientists are ones we should all keep in mind when observing disagreements about science. I wanted to cheer when I read her excellent, methodical review of the limits of evidence-based medicine, and when one should or should not apply its finding to a given situation. While EBM is a very useful tool, I also have encountered worrisome instances in which a useful, low-risk, low-cost intervention is not used because there are not yet sufficient RCTs or because it is being researched for XYZ use but hasn’t yet been approved for it by the FDA. When EBM becomes a barrier to good clinical care, we have a different problem. I particularly liked the example she gave of a systematic review finding insufficient evidence to support the use of parachutes when jumping from a plane, and the selection of quotations from comments. My favorite, succinct and clear, was this line from a clinician at my institution, “RCTs aren’t holy writ, they’re simply a tool for filtering out our natural human biases in judgment and causal attribution. Whether it’s necessary to use that tool depends upon the likelihood of such bias occurring.” Read, read, and read this post again.
Laika’s MedLibLog: #NotSoFunny – Ridiculing RCTs and EBM. http://laikaspoetnik.wordpress.com/2010/02/01/notsofunny-ridiculing-rcts-and-ebm/
Dr. Shock’s post about BioMedSearch focused on “free” as in free access to quality healthcare information. A related concept in his post were the barriers traditional search methods provide to discovery of quality health information, and if it is time for a change. While you are visiting his blog, you might want to take a look at another recent post on “The Hidden and Informal Curriculum During Medical Education,” which talks about overt and covert concepts and communications in medical education. While the specific example was about narratives in a secured online space, the concepts are perhaps even more important when thinking about healthcare communications in unsecured social media spaces.
Dr. Shock, A Neurostimulating Blog: BioMedical Search on BioMedSearch: http://www.shockmd.com/2009/11/28/biomedical-search-on-biomedsearch/
In an oblique connection, Novoseek, the innovative biomedical web search engine covering Medline, grants and online publications, offered a post on their new feature, allowing searchers to limit by publication type. While this doesn’t directly connect to free speech (rather the reverse) it does directly connect to quality of health information and control through peer review, both of which are implied contextual issues. Being able to use a health specific search tool automatically focuses results on a narrower and higher quality subset of the information available on the web. Being able to limit by publication type enables the searcher to slice the search even more finely, focusing on just the highest quality health information available.
Novoseek: Tip #1 to improve searches in novoseek – Filter results by publication type. http://blog.novoseek.com/index.php/resources/tip-1-to-improve-searches-in-novoseek-filter-results-by-publication-type.html/
PS. While you are taking a look at that blogpost, you might want to also take a look at an earlier post from Novoseek called The importance of context in text disambiguation. It is a kind of geeky, technical post, but the fundamental concept is central to how humans (as well as computers) identity quality when they see it.