When a patient is deteriorating by the minute, how does a doctor grapple with clinical gray zones? It’s not uncommon in medicine: long-held practices, or even new therapies, that make sense but lack strong data to back them up. Recently, I wrote a feature on the use of Impella in cardiogenic shock. Quite honestly it was one of the hardest stories I’ve ever written, in large part because though I went into it expecting a clear solution, I came out humbled by the difficulty of conducting rigorous studies in chaotic real-world emergencies. Would love to hear your feedback.

To RCT or Not to RCT? Impella Debate Pivots on How Best to Study Patients on the Brink of Death

Oh, hey! Our website has relaunched. Check out the new look, easier navigation, and all that at TCTMD.com. Fresh content every day.

We made a newspaper! The CRF editorial team descended on Washington, DC, last month to create the ‘paper of record’ for our organization’s annual meeting, the Transcatheter Cardiovascular Therapeutics symposium (aka TCT). This happens every year, but this is the first time that I’ve sat at the big editing table. It was crazy and exhausting and worth it. The Monday issue is my favorite.

A very interesting post on the blog Pharmalot today describes the efforts of one practice to curb industry ties. What’s stands out most to me is the avoidance of a ‘cold turkey’ approach. Instead of taking away every small gift and free lunch, the practice began slowly by educating its staff and physicians about the need for peer-reviewed literature, a brand-free environment, etc.

This article also reminds me, yet again, that many community practices do not have free access to academic journals and unbiased information. And that medical journalism has an important role in disseminating news to improve patient care.

I just came across a story from The Arizona Republic (care of USA Today) that, in some ways, updates an article I wrote for the Indian environmental magazine Down to Earth several years ago.

My 2007 story examined the ethical ramifications of introducing the then-new cervical cancer vaccine Gardasil on a wide scale in India. When a vaccine is taken out of the context of screening and regular medical care, does it carry the same benefit? Or could it actually do more harm than good?

Bob Ortega’s article delves into 2 US-funded research studies of cervical cancer in India. Together, the studies may have prevented up to 100,000 women from being screened and, if necessary, treated. The women instead received health care visits and counseling, and they were monitored to see how many cancers developed.

All this raises many questions, from what is required for informed consent to what constitutes ‘standard of care’ in an evolving health care system. Thoughts?

Although Wikipedia will do in a pinch, in the long run you really do have to dig deeper.

So where do you start, if a sentence reads like a web of jargon? Don’t panic. Remind yourself that somewhere in there are subjects, verbs, and objects. Google unfamiliar words. Then try to summarize that whopper out loud. Make a list of acronyms and what they mean. And move on to the next one.

Think about how the terms can be categorized. For example, there is a spectrum of symptomatic heart disease. On the low end, you have stable angina (chest pain that predictably appears during strain or exercise). Next comes unstable angina (chest pain that pops up out of nowhere), followed by what is commonly called a ‘heart attack.’ Myocardial infarction (MI) itself can be divided according to its severity based on ECG results: non-ST-segment elevation MI and ST-segment elevation MI (aka NSTEMI and STEMI). Everything worse than unstable angina can be grouped as acute coronary syndromes (ACS).

I could probably recite this in my sleep by now, but at one point it had me in knots. And reading the paragraph I just wrote, I understand why. Whew.

Early in my training as a journalist, I got the idea that I should approach interviews as openly as possible. Especially those on topics that confused or intimidated me. (A recent post on The Last Word on Nothing captures this Science Writing 101 quite well) Only when I could explain the ideas backwards and forwards did I begin writing. I felt like my job was to translate concepts so thoroughly that someone new to them could still follow.

I realized during my very first interview for TCTMD that writing for physicians is an entirely different beast.

My interviewee was an extremely nice doctor not much older than me, chosen no doubt because he is such a nice guy. Without any hesitation, I began by mentioning, “Now I’m new to this, so…” And he stopped right there, laughing, “Never show fear. Seriously.”

He was right. Number one, the leading cardiologists are pretty confident people and don’t want to feel like they’re wasting their time on someone who isn’t equipped to listen. Number two, the only way to get them to answer at a level that would interest their colleagues is to pretend to be at that level.

So how did I pretend? In the short run, Wikipedia. More on the long run later.

This blog has been dormant for over 5 years, and it’s time to get reacquainted.

Last you heard from me, I was wrapping up 14 months in India, where I worked as a freelance journalist specializing in science and medicine. I have since returned to New York and, starting almost as soon as my plane hit the ground, been writing and editing for the cardiology news website TCTMD. For obvious reasons, I can’t write directly about the people and research I deal with at work every day. But I look forward to using this space in other ways, namely to think about what it means to be a journalist who speaks to a specialized, well-informed audience.

What, as a medical journalist, do I have to offer physicians with mountains of expertise? And what choices do I make when writing within very tight word counts and daily deadlines?

When I opened up the India International Centre’s event calendar the other day, I hardly expected to see such a familiar name: Dr. Marion Nestle, professor of nutrition, food studies, and public health and professor of sociology at New York University. I became aware of Nestle during my days working at a Tufts nutrition lab, an environment that made her 2002 book Food Politics seem particularly timely to me.

But based on her continued status as expert on all things related to food politics, industry, research, and marketing, I doubt I was the only one struck by the thoroughness of her writing. And later, when I was attending NYU’s science journalism program, she was kind enough to send a personal rejection to my emailed request for her to be my mentor. With her schedule, I don’t blame her!

The lecture took place on October 2nd, which is Gandhi’s birthday and thus a national holiday in India. It was the 8th annual Albert Howard Memorial Lecture set up by Navdanya, a group that works on preserving the diversity of local food culture. Albert Howard appears to be the grandfather of organic farming in India; he was sent in by the British in the early 20th century to modernize Indian agriculture but instead found he had a lot to learn from Indian farmers about non-chemical pest control and fertilizers.

I was eager to see whether Nestle would be able to connect her interpretation of food, which focuses largely on the American context, with India’s food universe. She did remarkably well. And having lived in Delhi for over a year now, when she described the awe-inspiring supermarket aisles in the US, the scene’s instant familiarity practically gave me the chills.

The lecture, as well as the opening and closing remarks of Navdanya’s Dr. Vandana Shiva, covered a lot of ground. Here are the highlights:

• Dr. Shiva began by summarizing India’s multidimensional food crisis. She highlighted sugarcane farmers from western Uttar Pradesh, who still haven’t received payment from the sugar mills for last year’s crop. She reminded the audience to think about this injustice every time they put sugar in a cup of coffee or tea. Given that processed sugar is marketed here as pure and “untouched by hands,” this example draws an important connection between urban consumerism and rural agriculture.

• She also said that India’s food crisis consists of two main elements: food sovereignty (being able to provide all of its people with adequate quantities of nutritious food) and food safety (free of agricultural chemicals, unadulterated, fresh, not genetically modified). She pointed out that the latter point is particularly relevant because India is currently considering how to label, test, and ensure the safety of genetically modified foods.
• Dr. Nestle first examined how corporations are changing India’s food supply. She was surprised, as I no longer am after a year here, to find Frito Lay chips being sold at a roadside stand on the way to Jaipur. Frito Lay is owned by Pepsico, and in India the chips cost about 50 cents for a three ounce bag, around the same price as a simple meal of rice, daal (lentil soup), and subzi (vegetable).
• WalMart’s impending entry into the Indian marketplace was, naturally, a big topic. Dr. Nestle reported that, according to the Wall Street Journal, India has a $335 billion retail economy that the superstore is eager to tap into. She didn’t say anything I hadn’t heard before in the Indian press, but she did firmly state to the audience that small retailers would, as they did in the US, be overcome by WalMart. Some politicians and business people here are arguing otherwise, that small general stores and local grocers will continue to fill a niche with their personalized service and accessible locations. I tend to fall on the side of Dr. Nestle, though the idea of large chain stores in India does baffle me. For them to be successful at keeping their products at bare-minimum prices, they will need to transform transportation and supply networks throughout the country.
• Dr. Nestle then shifted gears a bit, adapting her analysis of the American food industry to fit the interests of her Indian audience. She explained how the glut of certain agricultural products in the US (namely corn) has lowered prices so much that the food industry must struggle to make a profit. This economic concern has translated into a variety of practices that contribute towards obesity: people being encouraged to eat outside the home, companies selling large volumes of food at cheaper prices than smaller portions, and heavy marketing to promote processed foods, especially to children who will be life-long consumers.
• As I mentioned above, my favorite part of the evening was when she diagrammed the typical American supermarket. She explained how the layout influenced shopping choices: dairy items placed at the back so that people must walk through many aisles to reach them, fruits and vegetables up front to create the mood of a farmers’ market, expensive processed items at eye level and in great quantities that encourage stocking up. By comparison, the Delhi supermarkets I’ve visited (and shopped at) are hardly larger than a gas station convenience store and are very status-oriented (stocking American Skippy peanut butter rather than Indian Prutina, which is perfectly good stuff and a third of the price).
• Her message was that this is the future India has to look forward to: low prices at impersonal corporate stores, the transformation of agriculture, and a slew of overeating-related health problems. All the while, India will still have to address its millions of undernourished citizens. Outright famine is rare here, but stunted growth and chronic diseases caused by malnutrition are common. The sad thing is that India actually has enough food: 2,500 calories available for each person (as compared to 3,900 in the US). The problem is that, due to corruption and poor storage techniques, the food isn’t distributed to everyone who needs it.
• Dr. Shiva concluded with a reminder that India’s food crisis is acute: by the end of the year, she estimates that 200,000 farmers will have committed suicide over their financial desperation.
• On a positive note, the elite, well-connected audience at the lecture seemed very passionate about these issues. Considering how much of this country’s decisions seem to be made through personal connections and networking, maybe this group will be able to use its power to influence how the food business takes shape over the coming years. India in no way has to follow the American example. And Dr. Nestle, for her part, ended her talk with the many grassroots efforts Americans are making to take control over their food supply.

These photos of Naypyidaw, Burma’s two-year-old capital city, are breathtaking. I can’t help but think of the many abandoned cities and forts that I’ve visited in India. I imagine they were equally absurd displays of government resources in their day, and now they’re in ruins.

You can learn a lot about people’s aspirations in these scenes: the yawning concrete plazas in front of tidy malls, brightly lit and symmetrical towers, uniformly painted homes…I can process these images and recognize their themes from growing up in the United States. I would love to know what the equivalents were in prior city building. In the 14th century, when Sultan Muhammed bin Tughluk moved the entire, half-million population of Delhi to his new capital Daulatabad, did the elite inhabit something like today’s “model home”?