Sean Khozin, MD, MPH

The cover of the New Yorker’s anniversary issue this week,...

Wed, 08 Feb 2012 14:26:23 -0500

The cover of the New Yorker’s anniversary issue this week, called “Loading…,” acknowledges the fact that a growing number of their subscribers (like me) are reading the magazine on their iPads and have abandoned the print version. They almost tricked me into thinking that the cover was loading too slowly when I downloaded the issue on my iPad yesterday.

Yet another sign of our changing times.

Skewed logic.Via Journal of Clinical Oncology

Tue, 31 Jan 2012 17:11:11 -0500

Skewed logic.
Via Journal of Clinical Oncology

Eric Ficsher’s NYC Twitter map using geotags and frequency...

Tue, 24 Jan 2012 00:15:44 -0500

Eric Ficsher’s NYC Twitter map using geotags and frequency of tweets in 10000 points and 30000 vectors.

The conclusion? Broadway is “the spine” of the city.

Eye, Foetal Mouse (H&E stain) Via micro-scopic

Fri, 20 Jan 2012 22:27:42 -0500

Eye, Foetal Mouse (H&E stain)

Via micro-scopic

According to the Observer, scientists may have “a...

Tue, 10 Jan 2012 23:24:00 -0500

Adam Simpson, computational scientist

Scott Pitnick, evolutionary biologist

According to the Observer, scientists may have “a surprising and secret penchant for tattoos of a particularly cerebral nature”

"In every work of genius we recognize our own rejected thoughts: they come back to us with a certain..."

Thu, 05 Jan 2012 18:17:22 -0500

“In every work of genius we recognize our own rejected thoughts: they come back to us with a certain alienated majesty.”

- From Self-Reliance (1841) by Ralph Waldo Emerson

New Year’s resolutions as mobile phone backgrounds, part...

Thu, 05 Jan 2012 00:50:00 -0500

New Year’s resolutions as mobile phone backgrounds, part of Chris Streger’s Resolve Project.

"Tech bubbles happen, but we usually gain from the innovation left behind. [The current] one—driven..."

Mon, 02 Jan 2012 12:22:38 -0500

“Tech bubbles happen, but we usually gain from the innovation left behind. [The current] one—driven by social networking—could leave us empty-handed.”

- From “This Tech Bubble is Different” in Bloomberg Businessweek by Ashlee Vance. This is a statement that raises a lot of questions. With all eyes of the investment community on finding the next Twitter or Facebook, what will be the technology legacy of this era once the party is over?

Dr. Facebook?

Fri, 30 Dec 2011 13:49:38 -0500

A recent Danish study asked people to post symptoms of a medical problem on their Facebook page and ask their friends to come up with possible diagnoses. They found that the correct diagnosis was suggested in five out of the six presented cases after a median time of ten minutes. They described the responses from “relevant differential diagnoses to very silly diagnostic suggestions.”

I’m glad the researchers did not conclude that people can rely on their Facebook friends for making medical diagnoses. Instead, they suggested that people can use their Facebook friends to figure out if they should see a doctor for their symptoms. Although this is not a groundbreaking study, it points to the potential utility of crowdsourcing in medical research. The company Patients Like Me has been at this for some time, with about 125,000 patients detailing over 1000 conditions on their website.

Came across this sign near my clinic at NCI, in the belly of an...

Tue, 27 Dec 2011 18:15:37 -0500

Came across this sign near my clinic at NCI, in the belly of an aseptic corridor housing research specimens. Great to know I’m among people who think outside the box (or at least the limitations of classical mathematics)

Xray Christmas by Nick Veasey

Mon, 26 Dec 2011 14:27:20 -0500

Xray Christmas by Nick Veasey

curiositycounts: Skeleton Typogram by Aaron Kuehn

Sat, 17 Dec 2011 10:47:04 -0500

curiositycounts:

Skeleton Typogram by Aaron Kuehn

"Before I was diagnosed with esophageal cancer a year and a half ago, I rather jauntily told the..."

Sat, 17 Dec 2011 01:03:08 -0500

“Before I was diagnosed with esophageal cancer a year and a half ago, I rather jauntily told the readers of my memoirs that when faced with extinction I wanted to be fully conscious and awake, in order to “do” death in the active and not the passive sense. And I do, still, try to nurture that little flame of curiosity and defiance: willing to play out the string to the end and wishing to be spared nothing that properly belongs to a life span.”

- Christopher Hitchens

State of equipoise and uncertainty in clinical trials

Wed, 14 Dec 2011 17:35:36 -0500

Equi·poise, noun \ˈe-kwə-ˌpȯiz, ˈē-\

1: a state of equilibrium
2: counterbalance

Patients who enroll in clinical trials do so because they want to get experimental therapy. In a typical randomized trial with two arms, one arm of the study is either standard therapy and/or placebo and the other arm is experimental. I’m often asked by patients randomized to the standard therapy arm of a trial if they are missing out on potentially effective experimental therapy. The problem is that if we knew the answer to that question, we could not conduct the trial in the first place, given that all clinical studies exist in a state of equipoise.

For a clinical trial to continue, it must be in a state of equipoise. This means that none of the investigators, or the larger medical/scientific community, must be aware of any benefits of the experimental arm of a clinical trial over the standard/placebo arm. In other words, there must be genuine uncertainty about which therapy is better. The goal of clinical research is essentially progressive reduction of uncertainty about the effects of the experimental drug and/or increasing the level of confidence about the outcomes associated with it.

If there is a credible enough hint of benefit in the middle of a study, the trial stops and the superior therapy is offered to everyone.

Equipoise is crucial for gaining knowledge and learning new things from clinical trials. Without it, if a clear answer existed about the superiority of a particular therapy, asking patients to participate in a clinical trial that could exclude them from getting the superior therapy would not be acceptable.

And that’s how we conduct clinical research, learn new things, discover new drugs, and push the boundaries of knowledge in medicine. We live in a state of equipoise where uncertainty is a prerequisite.

the-rx: Time is of the essence The most precious commodity.

Mon, 05 Dec 2011 18:37:18 -0500

the-rx:

Time is of the essence

The most precious commodity.

"In surveys that seek to determine why patients volunteer as research subjects, responses such as “to..."

Wed, 16 Nov 2011 20:54:17 -0500

“In surveys that seek to determine why patients volunteer as research subjects, responses such as “to help develop new medicines,” “to help society,” and “to help the sick” are given more frequently than “to help my own health.””

- Michael A. Rogawski and Howard J. Federoff. Science Translational Medicine 3, no. 102 (2011): 102cm29.

Empty streets: the financial district before the...

Mon, 14 Nov 2011 00:54:34 -0500

Empty streets: the financial district before the “occupation.” It was always hard to spot anyone on the streets after 8pm from our rooftop.

Are we as doctors making too much of too little or are we achieving too little by giving too much?

Fri, 11 Nov 2011 18:17:52 -0500

This is the provocative title of a recent publication by a colleague and prominent cancer researcher at the National Cancer Institute (NCI). The main problem highlighted by this paper is whether the biologically targeted therapies that are supposed to “target” the broken cellular pathways that cause cancer worth the cost, effort, and toxicities considering the fact that many of these drugs are marginally beneficial in prolonging a cancer patient’s life.

This is not an easy question to answer because there are many factors involved in how a patient responds to treatment and we are beginning to uncover what some of these factor are. For example, the targeted cancer drug Erlotinib costs about $700,000 per QALY (quality-adjusted life years). This is a mathematical measure of the impact of a treatment. If a treatment gives a person an extra year of healthy life, that counts as one QALY.

If you give Erlotinib to patients with advanced lung cancer, about 10% will have their tumors shrink. But if you SELECT for patients whose tumors have specific mutations (called activating EGFR mutations), you can have more than 50% of patients who will have tumor shrinkage. This is the promise of “personalized medicine,” that is tailoring drug administration to fit the unique characteristics of each patient. We are now conducting a study at NCI where we first analyze the genetic profile of each patient’s lung cancer then give a drug that specifically targets that patient’s genetic abnormality.

The ultimate goal is to tailor each patient’s treatment in such a way that we can achieve a lot by giving little and avoid making too much of too little.

"The great thing in this world is not so much where we stand, as in what direction we’re going"

Wed, 09 Nov 2011 11:06:41 -0500

“The great thing in this world is not so much where we stand, as in what direction we’re going”

- Oliver Wendell Holmes, Sr.

A patient reflecting on his experience: Brain Hemorrhage

Sun, 06 Nov 2011 22:26:27 -0500

A patient reflecting on his experience: Brain Hemorrhage