Tag Archive for: Quoc-Dien Trinh

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Why I care about social media – and why you should too

I was born in the ‘Eighties’. I was a teenager when the Internet first became accessible to the general public and a medical student when Facebook was launched in 2004. It seems improbable and surreal that my time spent ‘liking’ and ‘poking’ Facebook posts from college acquaintances would someday be of any use to my career and research. Indeed, ‘I was there’ at the very beginnings of social media, but I had little idea of what it would become.

The social media revolution started in the early millennium, with the emergence of blogs: microsites consisting of topical entries usually displayed in reverse chronological order. Blogs, such as Deadspin or Gizmodo, became pillars of the new era, breaking news at an unprecedented pace and gaining millions of page views by the second. Meanwhile, the print media were slow to adopt a digital strategy, often branding the aforementioned websites as ‘hacks’ or ‘teenagers with a lack of journalistic integrity’. Almost simultaneously, a website called Wikipedia was launched on 15 January 2001 by Jimmy Wales and Larry Sanger, a ‘social’ alternative to bulky reference books, such as the Encyclopaedia Britannica. Fleetingly, Wikipedia rose to fame and grew at an exponential rate, drawing along a significant chunk of web traffic. It caught idlers with such haste that some felt the need to ban the website from classrooms. Oh my, have things changed. In September 2010, Arthur Sulzberger Jr, Chairman and publisher of The New York Times, announced that the prestigious journal would cease to exist in print, sometime in the not-so-far future. In related news, the Chicago-based company behind the Britannica announced that it would stop printing the revered reference encyclopaedia after >200 years in press.

The adoption of new technology in any and every field follows a simple bell curve, as described in a sociological model by Joe Bohlen et al. at Iowa State University. The hypothesis indicates that the first group of individuals to use a new product is called ‘innovators’, followed by ‘early adopters’. The early and late majorities follow these, and the last group to ultimately adopt a product is called ‘laggards’. ‘Medicine’ as a collective crowd is usually the laggard. On one hand, it is reasonable and understandable that a field with such enormous responsibilities be as meticulous and practical in the process of adopting new drugs, technologies or paradigms. It is entirely within the realm of comprehension that a new drug must succeed at many stages of testing to show unequivocal safety and efficacy before being accepted into medical practice. Yet, on the other hand, most would safely agree that institution, tradition and dogma dominate the world of medicine, and most notoriously in surgical sub-specialties. Not unlike our most recent history in adopting robotic surgery, met initially with ferocious and apocalyptic discontent, many contemporary leaders in our field display excessive scepticism towards social media, even when its dissemination is widespread through all echelons of society. In an era where wars and revolutions are being fought over Twitter, and where the likelihood of experiencing an influenza pandemic can be accurately predicted based on relevant social media buzz, I am not sure what doctors are waiting for to accept social media for what it is – an inevitable revolution in how we communicate.

As many of you ponder whether or not to embrace social media, there is good evidence that medicine has finally absorbed the latest innovation. I could cite many factual titbits to demonstrate that this is in fact true. I could provide propensity-matched-instrumental-variable-adjusted analyses to show its benefits. Yet, wise men once said that stories, not statistics, drive change: here are some stories of how social media has already transformed our field.

The ‘uro-twitterverse’ is now a rich and engaging planet of its own. Since November 2012, >100, I am not making the numbers up, users engage in a monthly Urology journal club on Twitter, enhanced by the presence of the lead investigator of the study open for discussion. Even the most prestigious of first-tier Ivy League institutions would not be able to attract lead authors to attend every single journal club, even less to convince a pool of key opinion leaders from around the world to comment and critique these studies.

Every day, I know that I can turn to my fellow ‘Twitterati’ to ask a hard clinical question. Should I perform a lymph node dissection in this patient with prostate cancer? What is the value of positron-emission tomography-CT to assess recurrence in a patient with bladder cancer? What is the recommended evaluation for a patient with suspected interstitial cystitis? Across 24 standard time zones, I know that an answer is a couple of seconds away. Somewhere in the world, a knowledgeable authority is answering my tweet, either while reading the morning news at breakfast, between two major cases in the operating theatre, or checking the Internet right before going to sleep. Having Twitter on my smartphone is a click away from being at a grand rounds talk, with everyone – from Benjamin Davies to Stacy Loeb – in attendance.

Every year, physicians travel thousands of miles to attend medical conferences. Many academics converge at these meetings with the hope of building relationships with potential collaborators. Twitter has brought the academic world under a single digital roof. Most of my research collaborators are on Twitter. I exchange direct messages with them every day to discuss research, grant and collaborative opportunities. I met several of my peers and collaborators on Twitter before actually gathering in person. In fact, many have questioned the need for so-called ‘formal’ medical conferences in the new digital era. While I am not ready to cancel my annual trip to the AUA and the European Association of Urology meetings – especially when they are being held at exotic destinations, such as San Diego and Milan, these social phenomena suggest that change is inevitable.

As much as we like the world we are accustomed to living in, there is little doubt that scientific journals, professional societies, and medical institutions need to adapt to this growing revolution. And, as regrettably experienced by traditional portals, e.g. the print media, those who do not will struggle to remain relevant. Of course, there are caveats to social media. How do we set boundaries between patient care and personal endeavours? Regardless of these issues, society has dreamt forever of the open and free opportunities provided by social media. The world cannot wait.

At BJUI, we are using social media, especially Twitter and Facebook, to highlight the most important international studies published in the journal, e.g. July’s ‘Article of the Month’ from Taiwan comparing tract creation using plasma vaporization with balloon dilatation in percutaneous nephrolithotomy.

Quoc-Dien Trinh
BJUI Associate Editor Health Services Research,
Department of Surgery and Center for Surgery and Public Health, Brigham and Women’s Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.

 

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Ten stories of 2012, part II

Thanks for all the helpful input regarding my first blog post. Constructive criticism is always helpful, especially if I am to get better at this.

If you haven’t read it, part 1 is here.

So, in no particular order, part 2 of 2:

+ Metastatic prostate cancer – it’s getting complicated…

2012 was a year of hope for metastatic prostate cancer patients.  First, Enzalutamide (also known as MDV3100), in the context of a phase III RCT, was shown to prolong the survival of men with metastatic prostate cancer after chemo. And just when we thought the year was over, Abiraterone, which was previously shown to improve survival in patients with metastatic prostate cancer after chemotherapy, was found to be beneficial even in chemo-naive patients. All this translates into more complicated algorithms for castrate-resistant prostate cancer.  That said, my question is the following: what happens if these drugs are effective at treating localized prostate cancer? It seems that some medical oncologists are trying to figure that out. Prostatectomists, murky waters lie ahead! Oh wait, I’m part of that group.

+ The changing landscape of surgical education

Times They Are a-Changin’. Residents are working less but don’t sleep more. 16-hour work day restrictions. More women are admitted into surgical fields. Protected nap (sleep) time during calls. Residents not covering floor consults during the day (those are actually the rules where I work). Most trainees now value quality of life above anything else, possibly even the quality of their training (do read this beautiful piece by a Urologist in JAMA: Considering Life Before Lifestyle. Yet, the amount of knowledge a resident needs to consolidate during residency is at least 10-fold greater than what the old geezers had to learn back in the days (the current Campbell-Walsh is 134 chapters, 4320 pages). Whether or not you agree with any of the above (which is irrelevant anyways, because it’s happening whether you like it or not), attending surgeons and urologists are finding it hard to adapt or understand. “Honey, things were much harder back when I was a resident…” How do we evolve as a sub-specialty without compromising surgical education (or lengthening residency)? Status quo is not an option.

+ Radiotherapy for prostate cancer – what’s up with that?

A nice observational study from Sheets et al in the JAMA thematic issue on Comparative Effectiveness Research showed that “use of IMRT compared with conformal radiation therapy was associated with less gastrointestinal morbidity and fewer hip fractures but more erectile dysfunction“. Yet, Jacobs et al, using the same dataset and almost the same study years, showed that the risks of salvage therapy and complications are comparable between the two modalities, for most patients. And let’s not get started about proton-beam therapy. Whilst this costly approach is gaining precedence in the treatment of localized prostate cancer, severe doubts exist regarding its efficacy. The bombshell: another observational study from Yale, based on Medicare data: “Although proton radiotherapy is substantially more costly than IMRT, there was no difference in toxicity in a comprehensive cohort of Medicare beneficiaries with prostate cancer at 12 months post-treatment“. Ouch.  To be perfectly honest (sometimes I’m told I should shut up), it would be hypocrisy for robotic surgery fanboys to condemn proton beam therapy right now. As we all know, it took years before convincing observational data showed that robotic radical prostatectomy is better than open, at some levels. Maybe someone responsible will actually perform a prospective comparative effectiveness assessment between these modalities. As an avid blogger suggests, maybe the proton beams and the robots should fight for world domination.

+ Urology at the forefront of the social media revolution

As a group, we should be proud of how we embraced social media in 2012. In the field of medicine, where anything novel is usually met with smirk and mockery (see: surgery, robot-assisted), social media has been surprisingly well received, thanks to a tight-knit community of twitter champions (if you’re new to twitter, you should definitely follow urologymatch.com’s list of key opinion leaders (KOLs) in Urology. Moreover, the first International Urology Journal Club was held in November 2012 and has been a global success ever since. I’m sure that 2012 was only the start. It will be exciting to see the role of social media in upcoming international meetings such as the EAU, AUA and BAUS. Virtual high-five everyone!

+ Be inspired.

OK, so this one has nothing to do with Urology, or Medicine for that matter. Here’s a toast to the events that shook 2012, and let’s hope that 2013 will be a great year!

 

 

Quoc-Dien Trinh
@qdtrinh

 

Quoc-Dien Trinh is a minimally-invasive urologist and co-director of the Cancer Prognostics and Health Outcomes Unit. His research focuses on patterns of care, costs and outcomes in prostate cancer treatment.

 

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Ten stories of 2012, part I

It is now my turn to welcome you to the BJUI blog. We [the editorial team] hope that you will be as excited as we are about the future. For my first blog posts, I decided to recap the year 2012 in ten stories. These are topics that caught my attention in 2012, and are certainly not representative of what others might think as ‘important’. Nonetheless, I hope that you will find this curated collection of some interest, and maybe stir a little controversy or two. Happy 2013!

In no particular order, part 1 of 2:

+ The re-election of Barack Obama

The bottom line is that the Patient Protection and Affordable Care Act, AKA Obamacare, will happen. What does this mean for American Urologists? Read the excellent review article by Kirk Keagan and Dave Penson on this sweeping piece of legislation aimed at addressing health care costs and disparities. From the paper: “Perhaps most germane to urologists, the ACA will restrain revenues generated from ancillary services, such as in-office imaging and via a bolstered Stark law that will prohibit physicians from referring Medicare patients to a hospital in which they have an investment or ownership interest.” Word on the street is that the AUA is not too happy. Is America ready for Cheesecake medicine?

+ Is robot-assisted radical prostatectomy really better?

Against a background of Jim Hu’s landmark JAMA paper, we learned new things with respect to the robot-assisted (RARP) vs. open RP (ORP) polemic. First, objective data shows that RARP has overtaken ORP as the main surgical approach for prostate cancer in the U.S (Link)(Link). Second, perioperative outcomes of RARP are better (Link)(Link)(Link). Third, RARP costs more. Fourth, nobody knows for functional outcomes (Link)(Link)(Link). Either way, some people really seem to hate robotic surgery, with a vengeance.

+ PSA screening – the controversy that refuses to die…

2012 will be forever (well, at least for nerdy urologists) remembered as the year the USPSTF downgraded PSA screening to a ‘D’ recommendation. In case you live in a cave, that means that “the science shows that more men will be harmed by PSA screening than will benefit. The expected harms are greater than the small potential benefit.” Nice rebuttal by Carlsson et al from MSKCC here. Nonetheless, primary care providers don’t seem to care, as up to 43.9% of men above the age of 74 were still getting screened in 2010. Conversely, in an article emphatically subtitled ‘Less is More’, the evidence shows that the incidence of prostate cancer is, for the first time in decades, decreasing. Prostatectomists, better find something else to do (just trolling, no hate mail please).

+ PSA screening – the Twitter Wars

2012 was a breakthrough year for social media in Urology. In the past year, Twitter has gained considerable traction in our field, thanks to the presence of Tweet (and real world) leaders such as Matt Cooperberg, Tony Finelli, Alex Kutikov, Mike Leveridge, Stacy Loeb, our own Declan Murphy, Dave Penson, Maxine Sun and the self-proclaimed King of Twitter himself, Ben Davies. That said, December hosted some lively exchanges on PSA screening. It started with a nicely-written-yet-a-little-oversimplistic blog post and accompanying tweet by @CBayneMD in favour of PSA screening, which led to some epic jostling between @cooperberg_ucsf (pro-screening) and @kennylinafp (against screening, wrote the evidence review for the USPSTF), amongst others. @daviesbj summary here. Oh yeah, be sure to follow me on Twitter as well as the BJUI itself.

+ The PIVOT trial

Timothy Wilt, of USPSTF fame, strikes again. Here’s one man who won’t be getting a Christmas card from an Urologist anytime soon. After representing the USPSTF at the 2012 AUA Town Hall  Meeting (brave), Wilt et al’s PIVOT trial demonstrated that “among men with localized prostate cancer detected during the early era of PSA testing, radical prostatectomy did not significantly reduce all-cause or prostate-cancer mortality, as compared with observation, through at least 12 years of follow-up.” Despite its many limitations and flaws (read Ian Thompson’s excellent accompanying editorial here), the lay press suggested in light of this trial that RP does not save lives.

Quoc-Dien Trinh
@qdtrinh

 

Quoc-Dien Trinh is a minimally-invasive urologist and co-director of the Cancer Prognostics and Health Outcomes Unit. His research focuses on patterns of care, costs and outcomes in prostate cancer treatment.

 

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