Entering the Fray

The vast majority of biomedical research conducted in the United States is funded by taxpayers through grants distributed by the National Institutes of Health.  This includes investigator-initiated laboratory research (the work we do in our labs) as well as clinical trials, both large and small (NIH is a large supporter, for example, of the Children's Oncology Group).  In the not-too-distant past, the results of all of this research were published in scientific journals which were available to anyone who could gain entrance to a medical library.  With the rise of the internet, journals began publishing online, and charging a fee for viewing these articles on their websites.  Those of us who work at academic centers generally have free access to most (but not all) of these websites because our universities buy institutional subscriptions.  Others, including people who work at smaller centers and the general public, have less (or no) access to this work.

All of this changed in 2008, when the NIH instituted a Public Access Policy that stated, in brief, that results of research funded by the NIH had to be made freely available to the general public.  Along with NIH's Public Access Policy came the advent of the Public Library of Science, a non-profit organization co-founded by Michael Eisen, a professor at UC Berkley (and blogger), dedicated to open access to scientific research.  I have published in one of their journals, PLoS ONE.  I am a strong supporter of open access to the results of research, mine and everyone else's.

This concept of free access to taxpayer-funded research is under attack by a bill introduced into the House of Representatives last month, the Research Works Act.  In essence, this bill would forbid the NIH to require that its grantees provide copies of their papers to the National Library of Medicine for online, open access.  There are innumerable reasons to oppose this bill, and Dr. Eisen discussed them far more eloquently than I ever could in an Op-Ed piece published in the New York Times. 

If you agree that the results of research paid for by your tax dollars should be freely available, please contact your congressperson and express your opposition to the Research Works Act.  As the PLoS journals have demonstrated, high quality research can be published online and made freely available to all, and the research enterprise will flourish because of this, not suffer. 

It's Been A While

It's been a while since I've been able to post. There are numerous reasons, too many to list here. Life is like that sometimes. Grant deadlines come and go, manuscripts need to be written, patients need to be cared for, and of course my family needs me as well.

Sometimes, I think, people need to be reminded why we do what we do. Please watch this video. This is why I do what I do.



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The Orwellian Language of Pediatric Oncology

George Orwell is most famous for his novel, 1984, which described a future world run by Big Brother, who controls all aspects of society. One of Big Brother’s methods of control is the manipulation of language, referred to by Orwell as Newspeak – the use of words to mean essentially their opposite.

I was struck this past weekend by how we doctors use words in ways not originally intended. An oncologist might say the following about her patient, “Frank failed cisplatin/doxorubicin, so we are going to use ifosfamide and etoposide.” What the doctor meant was that Frank was treated with cisplatin and doxorubicin, but these drugs did not control his disease. The drugs failed Frank, even though the doctor said that Frank failed the drugs.

In my most recent blog post, I discussed how it can be good to be wrong. But is that what I really meant? Of course not. It’s never good for me to be wrong. What is good is that I told the family there were two possible explanations for their child’s CT scan results, one more likely and one unlikely – and the unlikely (but better for the patient) result turned out to be correct.

On Sunday, the mother of my patient updated her CarePage. Her son, she said, is “getting bored with cancer.” Reading this reminded me of something I often tell patients when they are in the hospital and not much appears to be going on: “It’s better to be bored. Bored is good.” That sounds like something from 1984. Or from the Oliver Stone movie Wall Street (“Greed is good.”). But in this case, it’s true. Being bored with your cancer can only be a good thing. It means things are going well, there are no acute crises, and (to quote my patient’s parent’s blog again) “adrenaline [isn’t] flowing like a volcano.”

Sometimes Newspeak DOES reflect the truth.

Another Milestone

Our society puts a great deal of weight on anniversaries and especially on multiples of 10, and so it is in that spirit that I note that this is the 100th entry in my blog. Moments like this are supposed to prompt us to reflect on where we’ve been and where we are going to.

Where have I been? When I first started this blog, I had no idea what I was doing, no idea what to write, and no plan. I just started writing, and figured I’d follow whatever path presented itself. I’ve been pleasantly surprised at how things have turned out. I’ve enjoyed writing this blog – thank you all for reading and for your comments.

Where am I going? I’m going to keep following the same path. Writing about my patients, about new science, and about the health care system. It’s been a great ride, and I can’t wait to see where it goes from here!

The Right Move

Several times in the past I have blogged about newpaper articles featuring my patients. Now I’m going to blog about a newspaper article/blog post written by one of my patient’s parents. So often, our focus is on the children who are being treated, and that is only appropriate. But childhood cancer affects the entire family, even when the “child” is 20 and a college student.

I have a patient who was referred to me by one of my colleagues who used to be one of my trainees. His mother writes for a local newspaper. Her farewell column deals, in part, with what it’s like to be the parent of a kid with cancer. I loved what she had to say. Please go take a look!

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Happy Anniversary (Well, Blogiversary)

Today is the 1 year anniversary of Doctor David’s Blog. I want to thank everyone who has ever read my blog, whether you just stopped by once or twice, or you are a subscriber. A blog is nothing without readers.

Honestly, I’m amazed at what has happened over the past year. I’m not sure I knew what would happen that day I sat down to make my first post. Certainly, I had no idea that I would have made 79 posts the first year and would have almost 100 people subscribing to my RSS feed! Even more exciting, though, are the connections I’ve made as a result of this blog. Some connections have been short-lived – a patient or parent calling or emailing and asking for advice. But some have developed into real friendships or have strengthened bonds with patients and their families (and I think you know who you are). I wouldn’t have predicted any of this, but I’m so glad it’s happened.

Anniversaries are traditionally times to reflect on the previous year, and I’ve been thinking back on some of my more popular posts. I wasn’t surprised to learn that my introductory post was one of my most popular, but it was neat to see that my post on a new sarcoma drug, trabectedin (Medicine from the Sea) was also among the most popular. Other highlights from this year included my first ever giveaway (and are those the coolest socks ever, or what?) and the (occasionally controversial) series on viruses and cancer. It has been great to hear from medical students who have responded positively to the posts about what it is like to be a pediatric oncologist.

But above all, my favorite posts to write are the patient stories. Some are heartwarming stories of triumph, while others don’t end as well. But all relate stories of patients and their families facing tremendous odds and triumphing, even in the face of death. I’d like to take a moment to update some of these stories:

K, who was the subject of my first patient story post, has graduated from college and is moving to California to take over the internet (I hope he remembers me fondly when he rules the world!).

M, who I have mentioned recently, passed away after participating in the Phase I study. His family sent me a lovely thank you note, however, and they truly were at peace with how his struggle ended.

Natalie continues to do very well.

Ben not only beat his tumor, but has become involved with Stomp Out Cancer, a group of indie musicians who create and sell CDs to raise money for Ewing’s sarcoma research. Rock on, Ben!

This has been a remarkable blog year for me. I can’t wait to see what Year 2 has in store.

Hear Me on the Doctor Anonymous Show!

This Thursday, June 19th, at 9PM EST, I will be a guest on Doctor Anonymous' popular Blog Talk Radio Show.
You can listen in by clicking the icon.



For thorough instructions on listening in, click here.

I'd love to hear from you, so please call in ((646) 716-9514) with your questions or comments.

My Famous Blog Friend

This morning, I opened up my local newspaper, the Baltimore Sun, and guess who I saw? Fellow medical blogger, Dr. Val! This is a great piece about Revolution Health, online support groups, and how accessible medical information has become online, so check it out here.

Mark Your Calendars - Doctor Anonymous Show

On June 19th, at 9PM EST, yours truly will be on Doctor Anonymous' infamous blog talk radio show. Since that is over a month from now, check out some of his upcoming shows with other medical bloggers, and don't hesitate to call in ((646) 716-9514) with your questions or comments:

5/22: Amy Tenderich
5/29: Bruce Campbell
6/5: Gwenn O'Keeffe
6/12: DoctorsChannel

What an Image!

One of the highlights of every weekend is being able to read the new secrets on PostSecret. If you haven’t seen this site, I highly recommend it. People send in anonymous postcards, often hand-made or otherwise personalized, containing a secret about themselves. They are sometimes funny, sometimes, sad, often incredibly powerful. This past Sunday, someone sent in this one:

Photo Credit

I love it because it completely captures the spirit of NOT allowing a serious illness, like cancer, to control the patient’s life. I hope it helps us all to remember that people with an illness are just that – PEOPLE. We are not defined by our illness. We are defined by who we are.

Doctor David's Blog is Accredited!

The Health On the Net (HON) Foundation has accredited this blog with their HONcode.

The HONcode is 'the oldest and the most used ethical ... code for medical and health related information available on Internet'. It is displayed by many healthcare websites and medical bloggers who are compliant with HON's eight principles: authority, complementarity, confidentiality, attribution, justifiability, transparency, financial disclosure, advertising (as in, clearly distinguishing between advertising and editorial content).

If you are curious to learn more about what HON accreditation is, check this out.

My HONcode is on the lower right side of this blog, above the 'Ad-Free Blog' owl and can be verified here. I will be regularly evaluated for ethical compliance, and if I am ever non-compliant (like if I don't make my patient vignettes HIPAA-compliant) - my code will change.

The Latest Cancer Research Blog Carnival

Hear ye, hear ye! Cancer Research Blog Carnival #8 is up on The Skeptical Alchemist. Steppenwolf did a great job assembling these posts and dividing them into sections: News, Diagnosis, Therapy, and Quackery. As usual, there are some fascinating posts, and it is an honor to be included among them.

Go check it out. You'll be glad you did!

Top 100 Academic Medical Blogs

I just found out that this blog was named one of the top 100 Academic Medical Blogs. Thanks to the Online Nursing Degree Directory for the honor. There are a number of incredible blogs on their list, so take a look.

NPR takes on Medical Blogs

A week ago NPR did a story on the rise of medical blogs by health professionals. They mostly discuss the ethical questions that arise about Doctors/RNs blogging: are the bloggers maintaining their patient's privacy? are their entries HIPAA compliant?

I believe that all medical bloggers consider these questions each time they post. For most health professionals, we've been so rigorously trained to comply with HIPAA regulations in our work lives that we don't forget that training once we start blogging. Many medical blogs contain disclaimers or certifications that attest to our commitment to our patient's safety and privacy. I encourage you to take a look at my disclaimer in the lower right hand panel of this blog.

It is a valuable discussion if you enjoy reading, writing, or participating in medical blogs. Some popular medical blogs mentioned in the entry include Kevin, MD, Wachter's World, M. D. O. D., and White Coat Rants.

Cancer Research Blog Carnival #7

It's that time again! The seventh Cancer Research Blog Carnival has been posted on Highlight HEALTH. There are some wonderful articles this time around, including discussions of the ethics of science, cancer genetics, and things that increase your risk for developing cancer (obesity and working the night shift, for example). All in all, a great group of articles that I'm sure you'll enjoy.

Cancer Research Blog Carnival Number 6

The sixth edition of the Cancer Research Blog Carnival was posted yesterday. The folks at Bayblab do a wonderful job of hosting these events. It's a lot of effort, and it shows!

There are some great articles posted, including two written by cancer survivors and a fascinating look at the natural roots of a variety of current chemotherapy drugs. Go check it out, you won't be disappointed.

Nominated for the Medical Blog Awards - Thanks Everyone

DermDoc just let me know that I have made it to the finals of the Medical Blog Awards for Best New Medical Weblog. To whoever nominated me... thanks so much! I'm really honored. They have seven other categories that feature other excellent medical blogs, so please take a look.

To everyone who reads my blog... thank you!

You can click here to vote for Best New Medical Weblog.

Blog Carnival, Part Deux

Some months ago, I was invited to participate in the second Cancer Research Blog Carnival. I recall what an honor it was to be asked to participate, and how pleased I was to see the excellent entries that my colleagues had contributed. Well, I’m happy to say that there is another Cancer Research Blog Carnival. If you have a moment, please stop by and read some of the entries. They are all excellent… it is once again an honor to be in such company.

Cancer Research Blog Carnival and My Sister

A couple of weeks ago, I was invited to submit some of my blog entries for the second Cancer Research Blog Carnival, organized by The Bayblab, and hosted by the blog of a University of Chicago medical student who is simultaneously pursuing an MD and a PhD .

So… here is Cancer Research Blog Carnival #2. My colleagues have posted some amazing pieces and have some amazing blogs – so check it out, you’ll be happy you did.

While I’m announcing blogs – I recently found out that my baby sister, an elementary school teacher, has her own blog: Mrs. Holman’s Third Grade. Take a peek, and tell her I said “Hi”