Topol on Medscape Today and Can't-Miss Medical News

| Disclosures | September 04, 2013
 

Dear Medscape Members:

Before I get into some of the happenings in medicine over the past month, let me say how excited I am about the whole new look of Medscape. Since its inception, Medscape has gone out of its way to cater to each of the specialties in medicine, knowing that this is the way physicians and health professionals identify themselves and "flock together."

As a cardiologist, I often found myself having to hunt for new information in other specialty areas, such as oncology or rheumatology. With the new Medscape Today, all medical specialties are united for the first time. This coincides with a major shift in medicine today -- the convergence of diseases across disciplines, which has been taught to us through genomics.[1,2] For example, an altered biological pathway can just as easily induce inflammation, trigger tumor growth, or accelerate atherosclerosis. Beyond this, as physicians, the science of medicine was a strong allure for why so many of us pursued a medical career in the first place.

This change is intended to turn back the balkanization of medicine into its specialties, so to speak, reflecting Medscape's interest in and understanding of these changing times. Members now have the option of seeing the big picture while also staying up to date in their own specialty or branch of medicine. Surely, individualization and choice will be an ever-increasing part of how healthcare moves forward.

Now onto some interesting reports in recent weeks:

How Good Is Our Evidence From Randomized Controlled Trials (RCTs)?

A fascinating review of all the New England Journal of Medicine RCTs published over the past decade that purportedly should have changed medical practice showed that 46% were subsequently reversed.[3] An accompanying, highly provocative editorial stated, "After 65 years of randomized trials, ineffective, harmful, expensive medical practices are being introduced more frequently now than at any other time in the history of medicine."[4]

Gut Microbiome

Two articles in Nature highlighted that the more diversity (aka "microbial richness") of bacteria in the gut, the less likely is one to be obese.[5-7] Dietary intervention to enhance richness of the gut microbiome might even emerge someday as a new strategy to combat obesity.

Gene Therapy

While several years ago it was thought that gene therapy for treatment of diseases would be an abject failure, new evidence has just been published that strongly suggests otherwise. First, noted science journalist Carl Zimmer had an article in WIRED on the "fall and rise" of gene therapy.[8] Just a week later, 2 articles in Science showed evidence of benefit in 2 rare diseases -- one neurodegenerative, one immunodeficiency -- using a lentivirus vector, paving the potential for more broad application in the future.[9-11]

Digital Medicine

Some interesting new data showed that each day, 128 million Americans go on Facebook, and of those, 79% do so via a mobile device.[12] Are you reading this via the Medscape app on a mobile device? And while we are on social networks, a very interesting article at the Wall Street Journal showed how hospitals are getting patients and their families more engaged as e-advisors through Twitter and Facebook.[13]

As you know, I try to post all the interesting stuff in medicine on Twitter, and I invite you to follow me (@EricTopol) for more timely and complete updates.

Until next month...and check out Medscape Today if you haven't seen it yet!

Best regards,

Eric J. Topol, MD

Editor-in-Chief, Medscape

 
Latest in Family Medicine/Primary Care

References

  1. Parkes M, Cortes A, van Heel DA, Brown MA. Genetic insights into common pathways and complex relationships among immune-mediated diseases. Nat Rev Genet. 2013;14:661-673.

  2. Qi L, Qi Q, Prudente S, et al. Association between a genetic variant related to glutamic acid metabolism and coronary heart disease in individuals with type 2 diabetes. JAMA. 2013;310:821-828.

  3. Prasad V, Vandross A, Toomey C, et al. A decade of reversal: an analysis of 146 contradicted medical practices. Mayo Clin Proc. 2013;88:790-798.

  4. Ioannidis JP. How many contemporary medical practices are worse than doing nothing or doing less? Mayo Clin Proc. Mayo Clin Proc. 2013;88:779-781. http://download.journals.elsevierhealth.com/pdfs/journals/0025-6196/PIIS0025619613004035.pdf Accessed August 26, 2013.

  5. Buchon N, Broderick NA, Lemaitre B. Gut homeostasis in a microbial world: insights from Drosophila melanogaster. Nat Rev Microbiol. 2013;11:615-626.

  6. Hofer U. Viral evolution: variation in the gut virome. Nat Rev Microbiol. 2013;11:596-597.

  7. Zhao L. The gut microbiota and obesity: from correlation to causality. Nat Rev Microbiol. 2013;10:639-647.

  8. Zimmer C. The fall and rise of gene therapy. Wired. August 13, 2013. http://www.wired.com/wiredscience/2013/08/the-fall-and-rise-of-gene-therapy/all/ Accessed August 26, 2013.

  9. Aiuti A, Biasco L, Scaramuzza S, et al. Lentiviral hematopoietic stem cell gene therapy in patients with Wiskott-Aldrich syndrome. Science. 2013;341:1233151.

  10. Biffi A, Montini E, Lorioli L. Lentiviral hematopoietic stem cell gene therapy benefits metachromatic leukodystrophy. Science. 2013;341:1233158.

  11. Verma IM. Medicine. Gene therapy that works. Science. 2013;341:853-855.

  12. Our daily cup of Facebook. New York Times. http://bits.blogs.nytimes.com/2013/08/13/our-daily-cup-of-facebook/ Accessed August 23, 2013.

  13. Landro L. More hospitals use social media to gather feedback from patients' families. Wall Street Journal. August 19, 2013. http://online.wsj.com/article/SB10001424127887324108204579022843109511438.html Accessed August 26, 2013.

Authors and Disclosures

Author

Eric J. Topol, MD

Director, Scripps Translational Science Institute; Chief Academic Officer, Scripps Health; Professor of Genomics, The Scripps Research Institute, La Jolla, California; Editor-in-Chief, Medscape

Disclosure: Eric J. Topol, MD, has disclosed the following relevant financial relationships:
Serve(d) as a director, officer, partner, employee, advisor, consultant, or trustee for: AltheaDX; Biological Dynamics; Cypher Genomics (Co-founder); Dexcom; Genapsys; Gilead Sciences, Inc.; Portola Pharmaceuticals; Quest Diagnostics; Sotera Wireless; Volcano
Received research grant from: National Institutes of Health; Qualcomm Foundation

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