Doc Gurley Hosts Live Grand Rounds

Colin T. Son

Disclosures

March 10, 2009

It takes a critical eye to evaluate medical studies and their portrayal in the popular press. The proliferation of healthcare journals and other avenues for publishing research has only clouded the scene.

Dr. Jan Gurley, a board-certified internist, has dedicated herself to removing some of the mystery surrounding media coverage of controversial studies. At her blog, Doc Gurley, she covers a broad range of topics, such as diet fads, mental illness, and gender issues. She recently sat down and, with her typical wit, answered questions about her career as a physician-writer and her passion for handing out "BOGUS" Awards for medical research that is, well, bogus.

Colin Son: Your blog is lighthearted but deals with serious topics. Do you think that maintaining humor is important for healthcare professionals?

Dr. Gurley: In this profession we deal with so much tragedy and sorrow that we tend to damp down our responses -- I don't mean what we show the world, but what we allow ourselves to feel. The problem with that approach is that we can't selectively dampen a specific type of emotion, which means that we can lose our ability to feel joy as much as sorrow. Widespread, well-conducted research across all ages and subtypes of people has shown the benefits of optimism, altruism, and contentment in terms of health, quality of life, and even survival.

Although the study hasn't yet been done, I'm pretty sure that having a clinically depressed healthcare provider adversely affects a patient's survival. In healthcare these days, if you don't put some consistent effort into seeing the positive, it's way too easy to drown in the tidal wave of negative. So, for ourselves, our patients, and our families, keeping an eye out for our best, most realistically positive urges is as important as any other health-maintenance lifestyle effort.

Doc Gurley hosts Grand Rounds
March 10, 2009

Colin Son: Amazon says that your book, Dodging Death, is slated for a 2025 release. What?! Can you tell us a little bit about Dodging Death and what's going on with it?

Dr. Gurley: Amazon probably knows more than I do. (Sigh) Actually, 2025 is the date that Amazon assigns an industry book-in-process. As you may have heard in the news, the publishing industry is the equivalent of the ICU. In fact, the book might be paralyzed and intubated, which makes communication kind of hard. So far, there's no DNR order yet, for which I am grateful.

Colin Son: What exactly are the BOGUS Awards? What's your favorite recent BOGUS Award that you've handed out?

Dr. Gurley: BOGUS Awards are given out for "studies" that get widespread, uncritical (some might say gullible) mainstream media attention. The letters of the word BOGUS are an acronym for something ridiculous about the study (a generic example might be Bonehead Overblown Groundless Unverified Study).

My favorite recent one was widely covered in the media, including being featured on NPR [National Public Radio]. This "study" looked at the factors that determined baby gender and came to the conclusion that a mother's diet can influence a baby's gender. How? The authors did not understand basic genomics or statistics. The more factors you analyze, the more false positives you will get. This is a mathematical fact. Hence the need for something fancy called a "logistical regression model," which tries to decrease this effect, and the need for something simple, called basic biologic facts (or, as my grandmother would say, "horse sense").

Here's an example to explain the bogosity of this study. Say we take all US Senators and Representatives and we decide to analyze factors that might determine which seat they choose when Congress is in session. We make them keep food diaries and list all of the grooming products they use, their birth order, income, and number of stars in their daily horoscope. Our analysis shows that high-fiber cereal, Aqua Net hairspray, and a horoscope stating "You will meet the man of your dreams!" are all significant factors in where a Congressional butt lands. This is great stuff, isn't it?

So do we rush to publication, thereby boosting our chances of promotion, padding our resumes, and feeling -- as we give interviews to NPR -- like we're the Oprah of the pocket-protector set? Or instead do we pay attention to the person shouting, "You fool! Those seats are ASSIGNED."

The real kicker with that particular BOGUS Award, however, is that someone tried to get the media to understand the problem. A wonderful scientist requested the original dataset (which we can all do with published reports, and should do more often). He proved the glaring flaws in both study design and statistical methods. Unfortunately, Stanley Young was only quoted by NPR as a "skeptic," as opposed to being, say, "right."

Colin Son: What does the future hold for you in terms of your presence online and your career as an author?

Dr. Gurley: So far, I have found relative fame in quirky areas that are undervalued by others. For example, I "claimed" the stages of breast droopage (as in "The Gurley Stages of Breast Regression" published on Salon.com) and I published a paper in The New England Journal of Medicine about people who are "found down". I was, heartbreakingly, asked to be an expert witness for a person tragically found wedged between the wall and toilet -- my only offer to be an expert in anything, ever.

I tend to be a direct-to-consumer writer, with occasional forays into insider medical stories or pure opinion pieces. Given these harsh economic times, I've started a "Well Worth It" series on my blog. It covers proven, cheap, and effective interventions that don't get much media attention (usually because there's no profit-motivated public relations machine to promote them). I also have a running column titled "Five Things To Do For Your Health This Month." If you follow the series, at the end of the year you'll have had a reminder for health checks, easy ways to lower your personal adverse-events rate, and fun tips for hanging on to the joy in your life.

On March 9, 2009, Dr. Gurley holds a special "live" edition of Grand Rounds, the weekly collection of medical blog highlights. The archive of that event will be available on her site Tuesday, March 10, for everyone's viewing pleasure and will feature the author of this column as well as a "mystery guest."

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