How bizarre...

Dr Amal Mattu goes through some BIZARRE ECG cases and debunks an age old myth as well.



For more of his videos, go to his UMEM website.

Webucation 17/2/14

This round of web publications comes from wonderful websites talking about paediatrics, radiology, neurosurgery and even some pharma thrown in. Be sure to visit the content creators.

  • Another radio myth? - Can we finally let go of this myth? 
  • Difficult though it may be to admit that we have been misled all this time. Could it be that we finally need a cross specialty study to finally end this conjecture -  for future generations sake...

    Refresher course in Novara, Italy

    If you're an Emergency trainee and looking for a conference in May, here's one for you.




    Critical thinking and the art of Mindfulness

    You're at a meeting. The discussion gets heated. Comments are thrown around. Tempers fray. Do people really know what they're saying? Do people actually listen and think before they speak?
    This can be a problem. And it's not confined to meetings, but to everyday situations. And I believe this is quite apparent even in the clinical work space. How does it affect our work as doctors and clinicians during patient encounters? How does it affect our communication with our peers or superiors? How does it impact our decision making in emergency medicine?
    What we need is a heap of 'mindfulness'. We're already bad at recognising our own biases in our thought processes. And we immediately form biases upon hearing any information or fact, unconsciously or not. Are we even able to think critically and mindfully about anything?
    Mindfulness, in contrast, involves observing without questioning. If the takeaway from research on cognitive biases is not simply that thinking errors exist but the belief that we are immune from them, then the virtue of mindfulness is pausing to observe this convoluted process in a non-evaluative way. We spend a lot of energy protecting our egos instead of considering our faults. Mindfulness may help reverse this.
    So, to help open our minds, confront our innate biases, and think about our own thinking, take a listen to the following: David Foster Wallace's commencement address to the 2005 graduating class of Kenyon college

    Is EBM broken?

    Published in this month’s BMJ, by a general practitioner, on the ills of evidence based medicine as it is practiced today. Well worth reading and food for thought. (BMJ 2014;348:g22)

    Evidence based medicine (EBM) wrong footed the drug industry for a while in the 1990s. We could fend off the army of pharmaceutical representatives because often their promotional material was devoid of evidence. But the drug industry came to realise that EBM was an opportunity rather than a threat. Research, especially when published in a prestigious journal, was worth more than thousands of sales representatives. Today EBM is a loaded gun at clinicians’ heads. “You better do as the evidence says,” it hisses, leaving no room for discretion or judgment. EBM is now the problem, fueling overdiagnosis and overtreatment.1 
    You see, without so called “evidence” there is no seat at the guideline table. This is the fundamental “commissioning bias,” the elephant in the room, because the drug industry controls and funds most research. So the drug industry and EBM have set about legitimising illegitimate diagnoses and then widening drug indications, and now doctors can prescribe a pill for every ill. The billion prescriptions a year in England in 2012, up 66% in one decade,2 do not reflect a true increased burden of illness nor an ageing population,3 just polypharmacy supposedly based on evidence. The drug industry’s corporate mission is to make us all sick however well we feel.4 As for EBM screening programmes, these are the combine harvester of wellbeing, producing bails of overdiagnosis and misery.
    Corruption in clinical research is sponsored by billion dollar marketing razzmatazz and promotion passed off as postgraduate education. By contrast, the disorganised protesters have but placards and a couple of felt tip pens to promote their message, and no one wants to listen to tiresome naysayers anyway.
    How many people care that the research pond is polluted,5 with fraud, sham diagnosis, short term data, poor regulation, surrogate ends, questionnaires that can’t be validated, and statistically significant but clinically irrelevant outcomes? Medical experts who should be providing oversight are on the take. Even the National Institute for Health and Care Excellence and the Cochrane Collaboration do not exclude authors with conflicts of interest, who therefore have predetermined agendas.6 7 The current incarnation of EBM is corrupted, let down by academics and regulators alike.8
    What do we do? We must first recognise that we have a problem. Research should focus on what we don’t know. We should study the natural history of disease, research non-drug based interventions, question diagnostic criteria, tighten the definition of competing interests, and research the actual long term benefits of drugs while promoting intellectual scepticism. If we don’t tackle the flaws of EBM there will be a disaster, but I fear it will take a disaster before anyone will listen.

    References

    1. Moynihan R. Preventing overdiagnosis: how to stop harming the healthy. BMJ2012;344:e3502.
    2. Health and Social Care Information Centre. Prescription cost analysis England 2012. April 2013. https://catalogue.ic.nhs.uk/publications/prescribing/primary/pres-cost-anal-eng-2012/pres-cost-anal-eng-2012a-rep.pdf.
    3. Spijker J. Population ageing: the timebomb that isn’t?BMJ2013;347:f6598.
    4. Centers for Disease Control and Prevention. Mental health basics. 2011. www.cdc.gov/mentalhealth/basics.htm.
    5. Cohen D. FDA official: “clinical trial system is broken”. BMJ2013;347:f6980.
    6. The Cochrane Collaboration. Conflicts of interest and Cochrane Reviews. August 2013. www.cochrane.org/editorial-and-publishing-policy-resource/conflicts-interest-and-cochrane-reviews.
    7. National Institute for Health and Clinical Excellence. Advisory body recruitment pack. September 2007. www.nice.org.uk/media/134/39/CodePractice2AdvisoryBodyQuickGuide.pdf.
    8. Light DW. Risky drugs: why the FDA cannot be trusted. Harvard University Edmond J. Safra Center for Ethics. www.ethics.harvard.edu/lab/blog/312-risky-drugs.