PBFluids has been quiet. Took awhile to just clear the cobwebs to get this post up.
One of the things that has kept me busy has been a project with a company called MedMastery. Franz Wiesbauer was a fan of my fluids book and reached out to me. We worked together to create a curriculum covering body water, diuretics, IV Fluids, sodium and potassium. The full course is about 1,000 slides. But the genius of MedMastery is how they edit and craft the course so it is broken up into an odd fifty 6-minute morsels. It is medical school for Generation Keurig.
MedMastery has opened up a few of the K-cups for promotion.
Art Levinson is the current Chairman of Apple. He was brought on to the board in 2000 during Job’s second act and was present for the introduction of the iPod, iTunes and iPhone.
Art Levinson is always introduced as the former CEO of Genentech but I didn’t know his story until I read the Herceptin story in Emperor of All Maladies. Turns out Levinson was trained by Nobel Michael Bishop of oncogene fame. In the late 80’s Levinson was leading a group pursuing treatment for breast cancer by doggedly tracking a gene called HER-2. Genentech’s executives turned away from cancer research after some high profile failures in the 80’s. This should have been the end of genentech’s role in HER-2 except for the leadership of Levinson. He dodged the bureaucracy, pursued resources and lead a small team to continue work on HER-2. The group produced Herceptin, one of the most important breakthroughs in chemotherapy in the molecular era in, a jaw-dropping, 3 years. Laureate
Reading that story I can see why Jobs would want him on the Apple board.
As we were gearing up for NephMadness Mealnie Hoenig mentioned that she loved working with the Nephmadness crew because they were “her people.” This resonated with me and has become my latest way of looking at the word. This particularly resonated with me when my college roommate introduced me to Public Broadcast Service.
Gene Kranz
There best song is “Go” which samples Gene Kranz dialog with his flight controllers during the Apollo 11 lunar lander landing. I love this because though I have heard the story of the Apollo mission a 100 times I had never thought of it from the perspective of the flight controllers.
This struck me as a great example of my people. While I never could imagine myself as Neil Armstrong, I could imagine me, and my ilk, being a flight controller in Houston. Which one would I be? flight SURGEON, of course.
Summary of the different flight controllers can be found here.
Transcript from the song:
Narrator (NASA Spokesman?) This is Apollo Control 102 hours into the flight of Apollo 11. It has grown quite quiet here at Mission Control A few moments ago Flight Director Gene Krantz requested that everyone sitdown and get prepared for the events that were coming and he closed with the remark “Good luck to all of you.” [Ed. not quite One small step for man; one giant leap for Mankind] 12 minutes now until ignition for powered descent. Everything still looking very good at this point Gene Krantz Okay all flight controllers, “Go” “No go” for powered descent.
CAPCOM we are go for powered descent [CAPCOM, capsule communicator, was an astronaut in Houston responsible for communicating with the mission astronauts. At the time of the landing it was Charlie Duke] We are off to a good start. Play it cool. Okay all flight controllers, I’m going around the horn RETRO? Go! FIDO? Go! GUIDANCE? Go! CONTROL? Go! Deltcom? Go! GNC? Go! EECOM? Go! SURGEON? Go!
Armstrong: Houston…ah…Tranquility base here. The Eagle has Landed.
Kranz: Okay keep the chatter down in this room. [The greatest moment in the history NASA and Kranz is focused on keeping his team on task]
CAPCOM: T1 standby for T1
Kranz: Stay or no Stay all flight controllers [Apparently it was possible to land on the moon but have something go wrong requiring an immediate return to orbit, so this was a check to see if they could proceed to the lunar surface mission]
no need to determine stone composition prior to treating stones
no need to analyze blood chemistry before treating stones
no need to do 24-hour (or 48-hour) urine collections before treating stones
What makes those positions so absurd is that if increased fluid intake did not reduce stones the authors suggested a trial of allopurinol, thiazide diuretics or citrate (without guidance on how to dose, follow or how to choose among those therapies). These recommendations are based on research done on patients where the type of stone had been determined. Not following those enrollment criteria makes the conclusions irrelevant.
It is as if the ACP said not to measure blood pressure because there has never been a randomized controlled trial of patients where blood pressure was measured versus patients who do not measure blood pressure.
Goldfarb’s letter added some other incredible details to the story I was unaware of including:
None of the authors of the paper have a single other co-authorship in PubMed relevant to kidney stones, other than the AHRQ review. I believe that none of the authors are nephrologists or urologists, none have a kidney stone clinic, none appear at, or present research at, kidney stone meetings, none have any experience regarding management of kidney stones
And this doozy, in response to a comment of the paper from the lead author:
As we point out in the guideline, we are aware that many physicians do select medications based on stone type, for example, allopurinol for uric acid stones, and we do not discourage that practice.
Physicians who regularly treat stones or who played NephMadness (2014 edition) know that allopurinol is used to prevent calcium stones not uric acid stones which are best treated with alkalinization.
Swapnil and I are delighted with the success of the endeavor which launched with humble beginnings on Medium aweek before the first chat with this manifesto:
Coincidental to the calendar turning over, NephJC is being recognized in two articles in the medical literature. The first is the first systematic review of microblogging journal clubs. It is an interesting and thought provoking article. NephJC takes a victory lap in Table 2:
NephJC is third in participants and total number of tweets and first in tweets and impressions per month. I found this paragraph particularly insightful:
I can’t recommend the video enough. In this age where everything is sanitized and abstracted as much as possible this video is just authentic. It’s as real as it gets. To me it brings to life all of the little things we ask dialysis patients to do, from waking up early, to restricting fluids, to spending 12 hours a week in a recliner hooked up to a machine with only one hand free.
I was invited to speak at the Canadian Society of Nephrology last fall. Swapnil set up a talk on social media. My first international speaking gig. Very cool.
We have two associates out on Maternity leave and another key partner retired a couple of months ago, so practice is tight. No way I could take half a week like I do for Kidney Week. I left for my 1:30 talk at 8:30 that morning. Direct flight from the D to Montreal. As I’m walking through the airport I’m looking for nephrologist ads. During Kidney Week there will always be a big a pharma company advertising in the airport. I love seeing those ads and trying to imagine wha percentage of the general population have any idea what Samsca™ or Aranesp™ are. Montreal had none of these advertisements. I took a taxi to the Hotel Bonaventure.
Found my way to the conference center and registered for the conference. The conference had about 450 people in total, about one 30th the size of Kidney Week. It is like Kidney Week Mini Me. Same clothes, same attitude but smaller. In this case a lot more than just one eighth the size.
Kidney Week is a major international conferences. I heard more foreign languages in Philadelphia last Novemebr than I heard at CSN which was being held in Montreal. We often associate size with quality but thie would be totally unfair to CSN. The lectures were amazing. They absolutly stand toe to toe with the quality you get at Kidney Week. Of course, there are some Canadian specific lectures that didn’t interest me, but the general nephrology content was excellent. Five lectures in particular were amazing:
1. Patient oriented symptoms of ESRD
emolients weak data but little down side. Baby oil, primrose oil. #csn15 — Joel Topf (@kidney_boy) April 25, 2015
Uremic Pruritus: other possible txs SSRI, Ondansetron, granisetron, thalidomide, activated charcoal 6g daily. (Never duplicated) #csn15 — Joel Topf (@kidney_boy) April 25, 2015
2. Conservative care With Dr. Fliss Murtagh
Murtagh is quite prolific. Is planning an RCT to look at onservative care vs dialysis in edge cases. http://t.co/IlP4czPkKq#csn15 — Joel Topf (@kidney_boy) April 25, 2015
If your dialysis pt is/has: age >80, CHF, CAD, CVD, PVD, or BMI<19 they get all the risk of the screening and none of the benefit. #csn15 — Joel Topf (@kidney_boy) April 24, 2015
#CSN15: @NavTangri referring to a sub-group analysis on a surrogate outcome in ACCORD. Quinn looking more confident…. — Scott Brimble (@S_brimble) April 25, 2015
Con: Quinn: MDRD study primary and secondary outcomes were actually all negative. So was AASK. (proteinuria was only +ve outcome) #csn15 — Swapnil Hiremath, MD (@hswapnil) April 25, 2015
Con: Quinn demolishing AASK: if U ACHIEVE a low BP (regardless of Rx) less progression. But if U TARGET lower BP, there is no diff. #csn15 — Swapnil Hiremath, MD (@hswapnil) April 25, 2015
The plan was a one-two punch, where Sawpnil presented why you should engage with social medi,a and I followed with a “how to” engage in social media. It went well. I had some trouble using Keynote on the iPhone app to advance the slides. I used Keynote on the iPhone to control Keynote on my computer. It worked perfectly during my (admittedly abbreviated) practice sessions and for about half my presentation before it crapped out. I need a more reliable solution, please tweet recommendations. The AV-guy was pretty good at picking up my signals to advance the slides but it wasn’t natural and threw my rhythm off. I’m Sorry Canada, I could’ve done better. That was another difference from ASN. At CSN they had no trouble wiring in my MacBook Air to their AV set-up. Much slicker than the MUST USE POWERPOINT party line from ASN.
I’ll post the slides when I get a chance, but first I need to add a slide crediting @Doctor_V and Howard Rheingold, who involuntarily donated ideas to my talk. And I want to pump up the Who to Follow section with a description of mining Symplur to find thought leaders. I also need a slide telling people about Twitter4Nephrons.
In the end, I had a great time at CSN and would definitely go again; maybe not next year in Halifax, but why don’t we meet the year after in British Columbia?
The ASN has long had a Twitter account but it was infamous among the nephrologists of Twitter as being a oneway mode of communication. A fact that was lampooned on the ASN Bingo board. Getting a reply from @ASNKidney was a badge of honor.
While complaining about how the leadership at the ASN just doesn’t get it was a great parlor game among the renal bloggers, things began to change. In the Fall of 2013, Sarah Faubel called me to ask if I thought we could do a social media symposium at Kidney Week 2014. This materialized as the Tweets, Likes, and Blogs: How to Use Social Media for Your Patients and Your Benefit session. See recaps here and here.
Even before the session other things were changing. In early November, the ASN sent out it’s first Work Force Task Force Report. In the e-mail that announced it, they asked people to discuss the report on Twitter with the hashtag #NephWorkForce.
It was the first time I had seen a hashtag come from ASN. The community was ready to talk and we had a great discussion about some of the issues, but strangely there was no participation by the ASN leadership. MGKatz said it best:
@kidney_boy@ASNKidney haha it’s like Coffee Talk With Linda Richman… Here’s a topic. Discuss amongst yourselves. — Michael Katz (@MGKatz036) November 6, 2014
But ASN was not foolish, just cautious. They were testing the waters. When the second Work Force Report was published they had Mark Parker available for a formal tweet chat and he was gracious enough to answer questions from me to knock together a table setting blog post. Again there was spirited discussion, and ASN was actively participating.
In mid February-Dr. Faubel drove one of the NephJC on NephroCheck. She suggested the article, wrote up the introduction and was one of the primary tweeters during the chat. Dr. Faubel is the chair of the ASN AKI Advisory Group. Jay Koyner, another member of that group also joined the chat.
This year’s WKD theme is of paramount importance given the stark disparities in CKD outcomes #WorldKidneyDay — Dr. Deidra Crews (@DrDeidraCrews) February 25, 2015
Hello all. Andy Narva, nephrologist & National Kidney Disease Education Program director. #WorldKidneyDay — Dr. Andrew Narva (@NarvaNKDEP) February 25, 2015
Deidra Crews here. Representing the ASN. I am a nephrologist at Johns Hopkins #WorldKidneyDay — Dr. Deidra Crews (@DrDeidraCrews) February 25, 2015
Tomorrow the ASN will continue this trend by hosting a chat about the upcoming ASN Hill Day, where ASN goes to the nation’s capitol to talk to our elected leaders about how the government can help kidney patients. The ASN is sending three representatives to chat about the event:
Crystal Gadegbeku@Crystal4Kidneys Section Chief, Temple Health Nephrology, kidney researcher, ASN public policy board member.
Michelle Josephson@Michelle53598125 Transplant Nephrologist and chair of the ASN Transplant Advisory Group
Richard Knight@knightra Transplant patient, vice president of the Association of American Kidney Patients
This should be an interesting chat about something that I have only thin knowledge. Please join the chat at 9PM EDT, hashtag #ACT4Kidneys
We have been calling for ASN to join the social media revolution, now that they’ve awoken we need to do our part to make this partnership meaningful and productive.
Feel free to join us for a Twitter chat to learn about this year’s Kidney Health Advocacy Day on 4/21 @ 9:00 pm EDT #Act4Kidneys — Am Soc Nephrology (@ASNKidney) April 20, 2015
One of the things that has kept me busy has been a project with a company called MedMastery. Franz Wiesbauer was a fan of my fluids book and reached out to me. We worked together to create a curriculum covering body water, diuretics, IV Fluids, sodium and potassium. The full course is about 1,000 slides. But the genius of MedMastery is how they edit and craft the course so it is broken up into an odd fifty 6-minute morsels. It is medical school for Generation Keurig.
