Forge Friday Roundup - October 11, 2019

October 11, 2019

In today’s Roundup: pet the dog, but beware of confounders; update on peer review for code; falling short on prenatal immunization; still no substitute for randomized clinical trials; inside an “n-of-1” trial; Singapore cracks down on soda; navigating the complexities of value-based care; second act for rofecoxib?; much more:

AI, Statistics & Data Science
  • In a research article by Fang and colleagues published in the Journal of the American Medical Informatics Association, a study that used a pool of “virtual patients,” a machine learning approach was not able to sufficiently cope with bias in selecting individualized therapeutic regimens.
  • A study by Bartlett and colleagues published in JAMA Network Open suggests that most randomized clinical trials cannot be fully replaced by observational studies that rely on claims or EHR data. The team of Yale researchers found that out of the 220 RCTs published in high-impact journals in 2017, only 15% could be feasibly replicated using currently existing real-world data sources. 
  • In a post for Nature’s Of Schemes and Memes blog, Elizabeth Hawkins shares an update from a pilot study that the journal conducted to assess the feasibility of applying peer review to computational code accompanying research papers. Findings to date suggest that reviewing code with a suitable platform not only streamlines the review process but also improves the code’s reproducibility.  
  • “To claim that these devices are the result of some kind of ever-improving natural process not only misunderstands how evolution works, but it also suggests that everything from biological weapons to fraudulent startups like Theranos are necessary and natural.” Vox’s Rose Eveleth challenges tech industry’s assertion that it is driven by natural evolution and consumers desires, and the idea that they “have our best interests in mind.”
  • Medical Xpress reports on a new Georgetown cancer study published in the Journal of the American Medical Informatics Association in which a team of researchers and scientists has reduced the assessment time for tumors in cancer patients and their suitability for inclusion in a clinical trial from 14 days to just 4 using virtual computing techniques (H/T @eperakslis).

Basic Science, Clinical Research & Public Health
Pregnant woman protectively cradling her midsection.
Image credit: Heather Mount via Unsplash
  • “Getting these vaccines protects pregnant women. But the antibodies that are passed to the developing fetus protect their babies after birth as well, when they are too young to be vaccinated. Babies get their first shot of pertussis-containing vaccine at 2 months and can’t be vaccinated against flu until they are 6 months old.” STAT News’ Helen Branswell reports on new data from the US Centers for Disease Control and Prevention (CDC) showing that a considerable number of pregnant women in the U.S. are not receiving a pair of crucially important vaccines (Tdap and flu shots) despite a persistent push from the CDC for prenatal immunizations (H/T @ArthurCaplan).
  • “While the Vioxx brand might be tarnished in the popular consciousness, the drug has a much different reputation in the hemophilia community.” STAT News’ Damian Garde reports on how Tremeau Pharmaceuticals, a private Massachusetts-based company, is “plotting to resurrect” the controversial anti-inflammatory drug Vioxx, withdrawn from the market in the early 2000s due to concerns about elevated levels of cardiovascular risk, for the treatment of severe joint pain in people with hemophilia.
  • In a move to curtail some of the highest diabetes rates in the world, the ministry of health in Singapore is banning advertisements of a number of sugary fizzy drinks and juices and considering taxing sugar-sweetened beverage makers in order to halt the overconsumption of sugar in the country. Reuters’ John Geddie reports the story (H/T @CMichaelGibson).
  • The Economist reports on a new paper published in the Journal of Environmental Economics and Management by Burkhardt and colleagues that links exposure to air pollution with violent crime using crime and air-pollution data from the U.S. FBI and Environmental Protection Agency.
  • “Being a hospice nurse is a sacred calling. I’ve held many dying patients alone in a room at 2 AM in the morning. You have to care big to do that job. It's not glamorous, it's unseen. [But now] I have this condition, and I am requesting reasonable accommodation.” Medscape’s Nick Mulcahy shares the story of hospice nurse Chrissy Ballard from Nolensville, Tennessee who was fired by Caris Healthcare’s Nashville facility while undergoing chemotherapy for breast cancer.
  • “These results were a surprise...” said NIH Director Francis S. Collins, “We need to understand whether there is an intrinsic bias against such topics by reviewers, or whether the methodologies used in those fields of research need an upgrade.”  An NIH report found that research topics proposed by Black researchers are less likely to receive funding from the agency. The findings were published by NIH researchers in Science Advances.
  • STAT News’ Megan Thielking reports on new research published in Science Translational Medicine led by Warren Zapol, an anesthesiologist at Massachusetts General Hospital, aimed at improving therapeutic options for patients suffering from carbon monoxide poisoning. In a rat model study, Zapol and his team tested a device, designed to be used in conjunction with ECMO (extra-corporeal membrane oxygenation) to remove carbon monoxide from the bloodstream. The device shines high-intensity red light into the circulating blood, which helps break the tenacious bonds between the CO and the hemoglobin that would otherwise be transporting oxygen.
  •  “I made up my mind that if I lived through this experience, I would never jeopardize my life, my freedom, my family again. And I also made a vow to help anybody I can [avoid] making these same mistakes.” At Health Affairs, Rob Waters follows the story of community health worker Tommy Green and how the North Carolina-based Formerly Incarcerated Transition (FIT) rehabilitation program he works for is helping recently release inmates gain access to health and social services and get a new start after life in prison.
  • They’re all good dogs: a systematic meta-analysis by Kramer and colleagues published in Circulation: Cardiovascular Quality and Outcomes finds an association between having a dog and a reduced risk of death. Although dog owners are likely to hail these findings as self-evident, the researchers caution that their analysis did not adjust for cofounders.
  • Science News’ Tina Hesman Saey reports on new research by University of California researchers published in eLife that has found that a fluffy cloud-like protein protection keeps the DNA of the miniscule but nigh-indestructible animals known as tardigrades, or “water bears,” safe from damage, including that inflicted by ionizing radiation.

Communications & Digital Society
Full-page World War II-era cigarette advertisement, showing a domestic scene as a wife puts together a care package, including cigarettes, for her absent soldier husband.
Public domain image via Wikimedia Commons
  • “Tobacco killed an estimated 100 million people in the twentieth century. Without radical action, it is projected to kill around one billion in the twenty-first. This is happening even as the same old tropes return in debates over vaping, following deaths among people using e-cigarettes. Weeds, as Milov puts it, are hard to kill.” In a book review for Nature, Felicity Lawrence examines the recently published The Cigarette: A Political History by Sarah Milov, assistant professor of history at the University of Virginia who specializes in the history of tobacco and the tobacco industry.“Agents of disinformation have devised increasingly inventive methods for manipulating journalists, the social platforms and the subsequent media coverage. As a result, news organizations find themselves facing an array of new ethical challenges relating specifically to amplification.” First Draft has recently published an Essential Guide to Responsible Reporting in an Age of Information Disorder, first in a series of new guiding documents exploring the various challenges of online and digital journalism in the present times.
  • A new Lancet Digital Health study by Stanford professor Robert Harrington and colleagues share findings from their smartphone-based MyHeart Counts Cardiovascular Health Study  (a randomized, controlled, crossover trial) showing the positive outcomes of digital interventions through mobile apps in helping people adhere to short-term physical activity goals. (H/T @califf001).
  • The Verge’s Adi Robertson reports on the use of the popular live-streaming platform Twitch to broadcast a harrowing anti-Semitic hate crime that ended with multiple fatalities in the German town of Halle. Robertson explores how these live-streamed atrocities present unique challenges for social media as they work to quash such material before it spreads widely.
  • “Every doctor has his or her own personal origin myth, a story we tell about how and why we embarked on the profession. These myths are not unlike the many myths that human beings throughout history have crafted to explain natural phenomena and the very existence of the universe: stories that give meaning and structure to a process that can seem unsatisfyingly random.” In a perspective for The Lancet, Massachusetts General Hospital’s Suzanne Koven details a personal anecdote about her medical school admission application and why it was “not entirely honest.”
  • “Both of these companies, their bread and butter is negative takedown stuff—discrediting your opponent or competitor. But they can also promote companies, using the same networks of social media accounts.”Ars Technica’s Sean Gallagher reports on a recently released report by researchers from Recorded Future’s Insikt Group that created a mock company to engage and analyze the inner workings of “threat actors” (selling disinformation campaign capabilities similar to the ones used by Russian troll factories during the 2016 U.S. presidential campaign) and were able to launch two separate social media PR disinformation campaigns – one positive and one negative – about their mock company, within a month’s time and for only a few thousand dollars.
  • Wendy Rogers, a former primary care physician, is having a major impact after finding a second calling as a bioethicist, where her advocacy has led to more than 20 papers being retracted from the organ-transplantation literature due to profound ethical concerns about data derived from prisoners Medscape’s Diana Swift reports the story (H/T @RetractionWatch).

  • STAT News’ Meghana Keshavan shares the remarkable story of a young girl suffering from a rare and devastating genetic disorder called Batten disease, and how a team of determined parents and physicians devised an experimental tailor-made therapy exclusively for her condition, halting many of her disease’s symptoms “in their tracks,” leading the FDA to look further into the advancement of individualized or “N-of-1” treatments, as describe in a recent editorial in the New England Journal of Medicine by the FDA’s Janet Woodcock and Peter Marks.
  • “A look at an economic and political map of the United States, or that of almost any other industrial country, for that matter, points up the political stakes in deteriorating economic geography. The areas where distress is greatest and opportunity is least provide disproportionate support for candidates advocating populist nationalist policies that seek to close off the rest of the world, to demonize immigrants and to resist the inclusion of minority groups.” Washington Post’s Lawrence Summers urges policymakers and the federal government to recognize and take concrete steps towards eliminating economic, social and political disparities and imbalance within the United States. (H/T @AaronMcKethan)
  • “Transparency advocates say clinical study reports need to be made public in order to understand how regulators make decisions and to independently assess the safety and efficacy of a drug or device. They also say the reports provide medical societies with more thorough data to establish guidelines for a treatment’s use, and to determine whether articles about clinical trials published in medical journals — a key source of information for clinicians and medical societies — are accurate.”  Undark’s Barbara Mantel reports on Canada’s health department (Health Canada) making study data and results on newly approved or rejected medical therapies, drugs and devices available online for the public, with the goal of highlighting complete transparency in the regulator’s decision-making process. Now, transparency advocates in the United States are hoping the FDA can follow suit, but obstacles await (H/T @jross119).  
  •  “Giving addicts a place to shoot up without fear of arrest may seem peculiar to many Americans. But in Europe they are common. The first “drug-consumption room” was opened in Bern, the capital of Switzerland, in 1986 at the height of the AIDS epidemic. The aim was to contain open-air drug markets and combat diseases spread by dirty needles.” The Economist presents a map of safe injection sites in Europe while reporting on the latest developments toward the legalization of safe injection sites (where people can take drugs in a sterile environment under the supervision of medical professionals).
  • In a new research letter, JAMA Internal Medicine editor Rita Redberg and colleagues draw attention to deficiencies in the reporting of adverse events in premarketing clinical trials of medical devices to the FDA’s MAUDE adverse events database.
  • As recent study findings paint a somewhat ambiguous picture of the success to date of value-based care approaches, a JAMA viewpoint by Figueroa, Horneffer, and Jha highlights the need for more national efforts towards devising better policies and a more robust value-based agenda to improve quality of care for the Medicare population in the United States.