DB'S MEDICAL RANTS

Internal medicine, American health care, and especially medical education

Search

Listening to Patients: The Key to Better Medical Outcomes

Not news, but important

We all now understand the cardiac dangers of hormone replacement therapy. Here is another article on that subject – First Year of Hormone Treatment Is Found to Raise Risk of Heart Attack

The researchers found that a woman’s risk of a heart attack rises by 81 percent in the first year of hormone therapy. It levels off, so that after 5.6 years – the length of the study – the increased risk is 24 percent.

Still, Dr. Manson and other physicians not connected to the study noted that the increase in risk may be worth taking for many women whose baseline risk of heart disease is low and who suffer severe hot flashes or night sweats during menopause.

So my position remains – hormone replacement only for those women whose quality of life has deteriorated secondary to menopausal symptoms. And I would even argue against that use in a woman a moderate or higher risk of coronary artery disease.

A good idea

Keeping up with the medical literature takes time … and money. Medical journals are very expensive. As an author of many publications, I can assure you that authors receive no money for their articles. In fact, you are encouraged to spend money on reprints.

I do favor capitalism, however, I wish that the medical literature was more accessible. So does the Dr. Harold Varmus. Open Access to Scientific Research

A number of influential scientists have begun to argue that the cost of research publications has grown so large that it impedes the distribution of knowledge. Some subscriptions cost thousands of dollars per year, and those journals are usually available online only to subscribers. This looks less like dissemination than restriction, especially if it is measured against the potential access offered by the Internet. That is why a coalition led by Dr. Harold Varmus, the former director of the National Institutes of Health, is creating a new model, called the Public Library of Science.

Several years ago Dr. Varmus’s group issued an open letter, signed by some 30,000 colleagues, calling on the publishers of scientific journals to make their archived research articles freely available online. Most journals declined, so they would not undercut the profitable business of selling expensive subscriptions to libraries. But there is a basic inequity when much of the research has been financed by public money.

The Public Library of Science plans to confront that inequity by establishing a new series of peer-reviewed journals that will be freely available on the Internet. The first ones, published this October, will be PLoS Biology and PLoS Medicine. The aim is to create a freer flow of data about research and results. The journals will pay for themselves by charging a small fee to the organizations and institutions that support the research.

Most of us, admittedly, will not have much use for free access to new discoveries in, say, particle physics. But it is a different matter when it comes to medical research. Popular nostrums abound on the Web, but it can be very hard, if not impossible, to find the results of properly vetted, taxpayer-financed science ? and in some cases it can be hard for your doctor to find them, too. The Public Library of Science could help change all that, creating open access to research. The publishers of scientific journals are naturally skeptical, but the real test will come in the marketplace of ideas. What will matter this fall, when the new journals make their debut, is how many scientists choose to publish in them rather than in the journals traditionally deemed the most prestigious in their disciplines.

Categories
Meta
Blogroll
Newer Blogs