Following the Blogging Trail

The trail started with a Google Alert: The Antidote to Simplistic Health Journalism, an interview by Nicholas Genes, second-year resident in emergency medicine, at Mount Sinai Hospital in NYC, with Emily De Voto an epidemiologist who blogs on The Antidote. DeVoto's goal is to promote evidence based health journalism--and health care. A huge undertaking.

One of DeVoto's blogging trails leads to the debate over obesity and its relationship to morbidity and mortality. DeVoto links us to the blog, Junkfood Science in which Sandy Szwarc reviews the campaign by the CDC to link obesite to mortality in the US and thus frame obesity as a public health problem. A study by Katherine Flegal published in JAMA challenges that construction (see Junkfood Science for important excerpts). As Szwarc concludes:

The whole “obesity” thing has been an easy sell because our culture has come to believe so strongly that thin is better and fat is bad, and so loves to hate fat people, that the idea of questioning it is inconceivable.

It is well worth browsing through The Antidote. Note especially, DeVoto's Grand Rounds. In December Grand Rounds included 37 links to other health bloggers in arenas ranging from Mental Health to Research to Policy, Public Health, and Insurance, and leading off with "In The Trenches," which loosely means bloggs by clinicians "in the front lines of practice" (although there are certainly other trenches in health care, including the trenches of health system change which more clearly resemble WWI death traps for advocates and politians alike).

Finding DeVoto's blog struck a responsive cord this week when I have particularly sensitive to issues of evidence-based practice and the lack thereof. We are engaged in a family "discussion" over the risks and benefits of Procrit for an elderly family member. (Procrit is epoetin alfa used to treat anemia, usually in people with serious kidney disease or as a result of chemotherapy for cancer, medications for HIV, or to prevent or treat blood loss before or after surgery.) Without belaboring the debate, it really revolves around the off label use of Procrit recommended by the cardiologists involved. Some of us are uncomfortable proceeding with Procrit for off label use without the evidence of treatment risks and benefits to guide us; others in the family feel that if a physician makes a recommendation, s/he can and should be trusted to know what is best. Anecdote vs. data again. Or, as DeVoto notes in her profile: "The plural of anecdote is not data." As advocates so many of us in the Health Advocacy Program face at home exactly the advocacy issues we research, discuss and act upon with school and work. Contextualizing these issues within a family dynamic, within the cultures of belief, within the clinician-patient or clinician-family relationships creates layers of meaning and nuances of communication that humble each of us. Would that prospective advocates and clinicians alike could have required experience as cared for and care giver.