Stiff was a pretty popular book back in its day (2003 or so) so I’m not going to dwell long on its excellence, which you can read about at length on the back cover. However, I will say that it was quite an enjoyable read, and very touching in a strange way. The cadavers Roach describes move, sag, limp and fester in ways that are unexpectedly poignant. They are infused with new life, though Roach is very explicit about separating the medical cadaver and its scientific importance from the human it once was, or, as she likes to call them, the previous owner.

The uses for cadavers are astounding, and go well beyond the gross anatomy lab of first year medical students. Forensic research, organ transplants and car safety are some of the projects that Roach explains throughout. She highlights some fascinating historical medicinal and scientific uses as well. Lots of it is gross, too, of course, but if you’re reading this, I have a pretty good idea that you can take it.

I was just reading about how some medical students are meeting live patients on their first day of school, instead of the cadavers that med schools typically introduce their first-years to. This is no doubt a good thing. But after reading Stiff, I think it sure would be a shame to see the cadavers of the anatomy lab, and the learning and empathy they can promote, not still have their moment in the sun.

Most of the book seems to be available online through Google, so check out the first chapter and see what you think (if you haven’t already).

I thought this was pretty neat.

Last week someone asked on MEDLIB listserv if it was possible to search within that little list of “Related Citations” that pops up when you are viewing an article abstract in PubMed. When you’re in the article view, you only see the first five, but generally there are many more underneath that you can see and browse through by selecting “See all…”

Using the list of Related Citations is not an exact science, of course, and I myself am unsure what algorithm exactly generates that list of Related Citations. But when you are starting searches on a new treatment or condition, scoping a research topic, or trying to generate search vocabulary, this list can be very useful as a launching point into the literature (provided you have found a good starting article).

In my example, I already have a good starting article. Let’s say, because I live in Vancouver, I’m interested needlestick injuries, asked around, and found out about a seminal study in the journal Pediatrics. Now, because I don’t know where to go next, the Related Citations may be particularly useful. As I mentioned briefly, to see the whole list of PubMed’s Related Citations, you click that little “See All…”

Notice that now instead of only 5 Related Citations, I have 636! But, here’s a problem. Many needlestick injuries occur on the job, to medical professionals. This is documented and reported on, and thus not what I want to research. I want to find information on needlesticks acquired on the street, in the community, to non-health workers. So, to the heart of the matter: from my 636, I can search within this list by clicking to “Advanced Search.”

That makes my Related Citations into a set. If you rarely do any advanced searching in PubMed, don’t fear the new screen. Simply take note of the number that your new set has been given (in my case, oddly, #4). To pare down your list, add search terms and include “AND #4″ to ensure that your new results are all plucked from that set.

Having completed this search, it does expose some holes in the Related Citations algorithm, because I noticed, right next to each other, good articles on what I want, and unrelated articles on other “community-acquired” problems, such as Staph and pneumonia.

As I said before, it’s not an exact science, but for just starting out, this is a handy trick to have up your sleeve.

There is a rather alarmist meme going about with the launch of Facebook Places, a Foursquare (and Gowalla and Brightkite) knock-off that looks to log your social activities by “checking-in” to the places you visit. This technology is not new, but people are up in arms. What gives? The difference between Places and Foursquare is two-fold.

1. Places is an opt-out application. If you’re on Facebook, you’re automatically part of Places. This differs from Foursquare significantly in that you have to choose to download Foursquare, and you start with no connections. You build your location-based network the old-fashioned way: approving friend requests. With Places, you’re dropped in with your existing Facebook contacts and have to choose to say “No, thanks” instead of “OK, I’ll try.”
2. Places lets other people check you in. If you’re with your pals at the bar and one of them makes a check-in on Foursquare, there’s no indication that you’re there as well, and Foursquare doesn’t ask if you see anyone else you know there . Places, on the other hand, allows folks checking-in to “tag” other people as also there, without their permission or notifying them. Later, you have to go in and remove those tags if you’d rather not have your high-school buddies knowing you ditched them to hang out with your work buddies.

But does this really warrant all the worried-parent sounding headlines? Hell, even the Electronic Frontier Foundation weighed in: “How to Protect Your Privacy on Facebook Places“. But over the past year, Facebook has done so much privacy demolishing, has anyone who is truly concerned about being spotted and tagged at a bar not already taken action to limit their privacy settings? My sense is that if you’ve still got your profile open to that nasty and misleading “Everyone” then you’ve got bigger problems than the possibility of getting dumped for skipping your girlfriend’s art opening.

Yes, it is annoying to opt-out of a Facebook initiative again. No, I did not expect anything different.

At the end of the day, we have the alarming headlines to thank for alerting us. Lord knows Facebook isn’t going to try too hard to keep you private. But remember to keep things in perspective: (most of) your Facebook friends are still your friends. And if they’re not, then it’s time to rethink your Facebook usage in general.

Again, this issue in my mind is more principle than practical. I’m not so sure it’s the end of the world if I woke up to find that my pal “tagged” me at the Cactus Club. I’d still be more concerned if the photos of the evening showed up, but that’s not a new issue and it’s one that isn’t made particularly worse even if the exact venue is known.

A fellow student of mine at SLAIS, Sue Bradley, recently won a prize and publication for a directed research project, entitled “Examination of the Clinical Queries and Systematic Review ‘hedges’ in EMBASE and MEDLINE.” The paper compares the translations of various search filters and “hedges” (some PubMed examples) used to narrow results in biomedical searches, and found some striking differences in the results across the different interfaces (OvidSP, EBSCO and PubMed).

The NLM Systematic Reviews subject subset hedge searches for high quality EBM material such as systematic reviews, clinical practice guidelines, and consensus development conferences. Although it has not undergone testing to determine sensitivity, specificity, precision, and accuracy, translations of it are available in OvidSP and EBSCO MEDLINE. A major problem was found with the OvidSP MEDLINE version of this, as well as with two other subject subset filters. Ovid was notified, and the problem was resolved in late June 2009. Thereafter, similar search results were found using the “equivalent” hedges in the three MEDLINE interfaces examined. The fact that Ovid MEDLINE subject subset filter search strings contain proprietary information that is not publicly available is alarming. Health science librarians need to be able to evaluate hedges to determine whether or not to use them. Without being able to examine the search string, it is difficult to evaluate the possible utility or limitations of a filter.

There has been a long thread recently–and long before, and surely to come again–on the MEDLIB listserv about various advantages and disadvantages (::cough::$$$::cough::) of OvidSP’s MEDLINE over the free PubMed interface, but a discussion of actual search results and filtering hasn’t seemed to surface in the discussion. Because narrowing the “clinically irrelevant” results out of the set is particularly important for health library reference, the topic of this paper is especially relevant.

1. Bradley S. Examination of the Clinical Queries and Systematic Review “hedges” in EMBASE and MEDLINE. J Can Health Libr Assoc. 2010 Aug;31(2):27-37.

I’ve been pondering Apple’s new patent to identify (and subsequently humiliate) so-called “unauthorized” users of their mobile devices like iPhones and iPads. Essentially, Apple is seeking to patent technology that will detect an “unauthorized” user and use that as an OK to wipe data off of the device, activate the camera to expose and publish incriminating information to prevent them from using the device for evil. Ars Technica reports:

If the various analyses detect someone who is not authorized to use the device, it could set off a number of automated features designed to protect the device’s data, suss out the offending party, and alert the device owner. Sensitive data could be backed up to a remote server and the device could be wiped. The device could automatically snap pictures of the unauthorized user and record the GPS coordinates of the device, as well as log keystrokes, phone calls, or other activity. That information could be sent along with an alert to any useful service, such as e-mail, voicemail, Twitter, Facebook, or a “cloud service” like MobileMe.

At first, this sounds pretty good, especially if you get your iPhone swiped by a bicycle thief. The problem, though, is the shady definition of “unauthorized”: are we talking about a physical thief, a hacker who has taken control of your device remotely, or maybe just a regular user who has jailbroken their device (which is legal now by the way)?

Based on Apple’s public stance on jailbreaking, I am tempted to think that the latter will be deemed unauthorized. Coupled with Apple’s bizarre and inconsistent application approval process, in my opinion, iOS is becoming an increasingly uncomfortable platform to use.

mHealth applications designed to run on smartphones are already in a tenuous position because they have to balance the competing demands of cellular carriers, data security and platform divergence (eg iPhone vs Android vs Blackberry). But because the iPhone has been popular among physicians (and everyone else) for some time, the critical mass of users and developers has arrived. For now, the users are happy and there has been an explosion of helpful, informative and intuitive apps for the iOS platform. This is good.

Indeed, it is even argueable that the Apple’s ability to remotely seize a device is an useful security measure, especially for those devices that may have access to sensitive patient or hospital data. However, there are a number of flaws in that argument including:

1. Redundancy: Patient data is stored on an external server, not on the mobile device itself. Rare would be the case that an unauthorized user, unless also armed with several username/password combinations, would have access to sensitive data in the first place (especially on an iPhone, which has very little capability for local file storage beyond what is available in iTunes).
2. The Wrong Enforcers: If anyone should have the capability to seize and disarm your device it should be your employer or the institution being hacked, not the cell carrier of the device and least of all the manufacturer of the device. Imagine if all the corporate laptops in the world could be shut down by Dell or Lenovo at a moment’s notice.
3. Big Brother: This sort of infringement on basic tenets of ownership is more akin to a piece of rented equipment than something you’ve actually purchased. This is partly caused by carrier agreements,but even if you purchase an iPhone outright (for $599!) you gain no extra control. Apple seems to be giving you the $199 plus $70+ privilege to rent out an iPhone for specific, pre-approved tasks. And if you fall outside of them, they have the means to shut you down. Let me put it this way: Will it be the case in the future that I can’t install Linux on my MacBook if I am so inclined? Will they seize my laptop remotely, too, and install a fresh copy of OS X (while taking my picture with the webcam and emailing it to the Better Business Bureau)?

mHealth and its potential for groundbreaking technological applications has enough to worry about with assuaging the privacy concerns of governments and care providers, not to mention patients themselves. Adding the Machiavellian policies of iOS development and, with this patent, “unauthorized” iPhone usage is an unneeded stumbling block. (Speaking pragmatically, if you don’t want to jailbreak your device, then who cares? But open software philosophy is about more than just getting the job done.)

Of course, control and “security” as offered by Apple’s patent may be just what mHealth needs, especially to convince worried stakeholders. But as other competitors become stronger in the space (eg, the Cisco Cius tablet which has some pre-release corporate promise) and Apple’s stranglehold on mobile app development gets weakened by Android, we may be seeing more diversity in the medical smartphone development space soon. However, until med schools stop giving out iPads, and until it stops being more fun and useful than troublesome to use them, it’s going to be an interesting ride.

As services that rely on GPS-tracking and location-based data — Foursquare and Gowalla come to mind — become more popular, and services like Google Latitude and the upcoming Facebook Places start vying for a piece of the traffic, will mobile health providers be able to get in on the action? ReadWriteWeb seems to think so:

From emergency to non-emergency to everyday preventative health care, location tracking technologies could make a big impact on our health and well-being in the future. While two million consumers use Foursquare today to find the best nearby coffee shops and bars, what if in the future they used it to locate the best pediatricians, emergency clinics, or even restaurants that catered to their unique health needs? Some intersection between location and health care has already begun, but what we’ve seen so far is likely only the beginning.

I’ve long been skeptical of the usefulness of location-based services like Foursquare. For a while there, it was really just a game. A way for smartphone toters to annoy their friends, or shame them, on Twitter and Facebook by showing them what restaurant they visited for lunch. (Not making it any easier on those of us trying to convince colleagues of the professional usefulness of social media.) Now, however, companies like Starbucks are launching coupons, and a new company called GroupTabs is linking the popular Groupon service with location-based apps to give deals to users who can “prove” by means of a check-in, that they’re enjoying the establishment’s wares.

Moving into the health sphere, location-based stuff seems like it may translate well and, in fact, the seeds of location-based health have been around for quite a while. For those in the US who need to find a cheap doctor in-network (bless their souls) or someone in Vancouver trying to find a family doctor accepting new patients (good luck), these location-based media may find a niche. For pragmatic travellers, the application pictured above uses augmented reality to plot the location of the nearest public AED.

But there are problems to the mobile health side of things as well:

“Ultimately, I think we’re going to need to be platform independent, even device independent,” Ahier argues. “We’re going to need to be able to use an Ubuntu netbook, an iPad, etc. Our EHR (electronic health records) are going to have to run on all those.”

Compounding the compatibility problems is the fact that most health information is regulated by some form of government oversight (HIPAA, PIPEDA, you name it). So not only do mobile health developers have to join the platform wars between Apple and Android, Flash and HTML5, native and web apps (not to mention cloud computing), but they will also have to ensure that privacy and confidentiality are taken more seriously than heavy hitters and potential future partners, Google and Facebook, have previously been known for.

I don’t relish the long road ahead, but I very much look forward to seeing the innovations on the other side.

Lots of news this weekend on practicing medicine online, everywhere from the LA Times to the Mayo Clinic.

One doctor leverages social media for the good of her practice, and her patients:

In October 2009, she started a texting program and asked three 17-year-old high school seniors and their parents to get involved. They agreed.

Since then, Dyer has texted each teen every Thursday at 5 p.m. She begins with this introduction, “Hi, this is Dr. Dyer.” After they respond, she’ll ask them a personal question—such as, “How was lacrosse practice?” or “How were finals?”Once getting a response back, she asks: “How are you doing with your boluses? How are your blood sugars? Are they high or low?”

After three months, she says, the results have been successful. Before, the teens would usually miss taking about half of their boluses each week. Now, she says, teens miss only about three boluses each week.

Another doctor questions how much work he’s doing for free, after hours, and at what cost:

But medical care based on electronic communications is commandeering doctors’ personal lives. Our instantaneous availability is breathlessly touted by health care systems eager to serve their patient customers… To preserve their personal life and get home at a reasonable hour each day, test reviews and patient communications are increasingly performed from home – all for free. Worse, our similarly web-enabled patient population has learned that many of their health care issues can now be addressed online free of charge – just send a two-page e-mail – who needs an office visit?

One doctor doesn’t use email:

Until this happens – until we are somehow paid for giving care outside of the office – this useful technology will remain unused.  Is it greedy to not want to give things away for free?  Is it greedy for me to not want to spend less time with my family, make less money, or spend less time with patients?  Is it greedy to think I am worth $20?

While still others share their notes online with their patients:

I’d reported a crusty lesion on my forehead at the hairline. I’d had the same kind of lesion last year, and the dermatologist had frozen it off. (I have a history of skin cancer.) This time, the need to handle it had slipped my (ever slippery) mind.

Several weeks had already gone by so I emailed Dr. Sands (in the PatientSite secure portal) asking if I should insist on a fast appointment. He said no.

Notice that all this happened without any phone calls, because I could do it online. And that means it all happened sooner (act in the moment, no phone tag). And it captured the action in the moment when I thought of it.

Many hospitals wrestle with Facebook:

In the incident at St. Mary Medical Center, nurses and staff posted a photograph of Wells on their public Facebook accounts for about two days before fellow staffers reported them to hospital officials, according to an employee who saw the photo and Facebook posts. Hospital staffers also circulated the photo in text messages, said the employee, who asked not to be identified for fear of being fired…

News of the Facebook posting at St. Mary coincided with the hospital’s launch of a massive online marketing campaign last month that will include a new Facebook page, Twitter account and appearances by doctors on YouTube.

While one hospital starts a social media education and training center:

“We see immense opportunities to use internal social networking tools for collaboration among our employees to improve patient care, education, research and administration,” Aase explains. “As we find new applications, we plan to conduct research into their effects so we can measure any cost savings, efficiency gains and improved effectiveness. And when we do, we’ll be sharing those findings externally to help the whole health system improve.”

Librarians are involved, too, and struggle to coordinate their work with research teams:

I was impressed by the level of involvement of the clinical librarians and the time they put not only in searching, but also in presenting the data, in ranking the references according to study design, publication type, and date and in annotating the references. I hope they prune the results as well, because applying this procedure to 1000 or more references is no kidding. And, although it may be ideal for the library users, not all librarians work like this. I know of no Dutch librarian who does. Because of the workload such a ready made wiki may not be feasible for many librarians.

Lots of problems that have yet to be resolved. It’s a learning process and setting boundaries is going to be an increasingly important priority in this space in years to come. The convenience of social media can obviously lead to overwork and a shift in work-life balance. I would love to be a librarian available 24 hours a day via email, Twitter and Facebook, and in many respects, I am willing to try. But I still need to make dinner, read books, and take time for myself. Where do we draw the line?

UPDATE: “Blocking Facebook won’t stop stupidity.” Great responses to the LA Times by two other venerable blogging doctors.

Two days ago we learned that Google is stopping development on Wave, its once-anticipated, soon-found-out-to-be-confusing tool for real-time collaboration.

To understand these parallel events, let’s think about Google’s trajectory into the web application sphere so far.

Things Google does well:

• Maps. Everyone knows “Google Maps is the best.” (Bonus link for Canadians who can’t see Hulu videos: Did Lazy Sunday pave the way for YouTube’s sale?)
• Reader. Bringing RSS to the rest since 2005.
• Gmail. Web-based email addresses you don’t have to be ashamed of.
• Docs (/Apps). My amateur hypothesis is that Google Docs works so well that Wave simply wasn’t necessary.

Things Google doesn’t do so well:

• Buzz. OK, Google Buzz might have some platform advantages over Twitter, but what it doesn’t have is coolness, easiness or a user base.
• Social Networking. Orkut totally rocks if you live in Brazil. If you don’t, well, you’re on Facebook.
• Profiles. Google has profiles? Yes. That is all.
• Things that aren’t utilities (except YouTube, which you can all argue is the grand exception. But remember, the YouTube offices are off-campus, likely for good reason)

The last is more general, but basically, Google hasn’t fared too well in the spaces that rely on factors other than the usefulness of a tool or programming interface. Google Maps “is the best” because not only is it easy to use, but the APIs allow manipulation and exploitation of their data for free. That is the advantage of being an advertising-driven business: driving traffic through tools, not locking content behind paywalls, is the way they make money.

But it is not, so to speak, the wave of the Internet Future. Everyone is talking about how social media is where it’s at, and will be going for a while. So Google needs a way to enter that space and make sure they don’t have a) another PR disaster that sank Buzz before it could really get going or b) an esoteric solution to a problem that no one had. OK, so Wave was trying to be “social” but it was like the difference between a cocktail party and dinner with the in-laws. Sure, you might get a job from your father-in-law if you play your cards right, but wouldn’t you rather be living it up across town with your friends?

Now we know that there is something called Google “Me” in the works that is supposed to buoy Google’s presence in social spaces. I suppose this is where the expertise and enthusiasm of the team behind SuperPoke! comes in. Like the folks at Zynga, Slide’s team is good at making cute stuff that can grab your attention and hook you in before you realize how much time you just spent clicking on sheep. (Of course, even the sheep have their critics.)

Wave is dead. Buzz is weak. Profiles are virtually unknown. But the pieces are in place. All Google needs now is a dose of aesthetics and personality before they launch another social project.

The Library of Congress just keeps on keeping on, don’t they? First they agree to archive Twitter. Then, they say it’s OK to jailbreak your iPhone and copy your DVDs for educational use. Now, they’ve released an iPhone app that will take you on a virtual tour of some of the beauty of the building and its collections. From the announcement:

The app includes highlights of exhibitions and architectural features, with photos, audio by curators and other experts, links to more detailed online exhibitions, and even a video about the history of Thomas Jefferson’s Library, which in 1815 reconstituted the Library of Congress after the British burned the Capitol in the War of 1812.  The architectural photos come courtesy of Carol M. Highsmith, who has been donating magnificent collections of images to the Library copyright-free, for the American people.

The app itself is easy and fun to use, each page of the exhibits includes a description, photographs and audio or video to accompany if available. Some screenshots are below.

Most of this content is already on the myloc.gov website; the virtual tours there take advantage of Silverlight and are quite something that you just can’t replicate on a 5-inch screen. However, that doesn’t stop this app from providing a great tour experience, one that would be a fantastic companion, especially in the halls of the library itself.

From the most recent statement of the Librarian of Congress of the United States:

Today I have designated six classes of works. Persons who circumvent access controls in order to engage in noninfringing uses of works in these six classes will not be subject to the statutory prohibition against circumvention…

The six classes of works [include]…

Computer programs that enable wireless telephone handsets to execute software applications, where circumvention is accomplished for the sole purpose of enabling interoperability of such applications, when they have been lawfully obtained, with computer programs on the telephone handset…

In English, please?

In essence, this legalizes the practice of “jailbreaking” your iPhone. Jailbreaking, for the uninitiated, is the process of unlocking your mobile device (your iPhone, specifically, though the process is now also being done on Android devices) with the intention of getting better applications and user experience that can’t be done with limited system permissions.

The history of jailbreaking is a long and fun one, filled with the drama of the first hack achieved followed by the cat and mouse game played ever since with Apple, as they update their firmware and are inevitably thwarted again, usually by a group of programmers known as the iPhone Dev Team. It also used to be a very real possibility that you would end up with a dead, or “bricked,” phone in the process. As the development community has become more familiar with the iPhone platform that possibility is diminished, but has not completely disappeared.

The folks at the Dev Team have released a browser-based jailbreak tool called jailbreakme.com. This is a large step forward for jailbreaking because it opens up the idea of jailbreaking to a much wider audience. Instead of downloading a program and following a series of steps, you simply navigate to a web page, swipe, and you’re done. Combined with the now much-reduced possibility of ruining your device, jailbreaking has become a much more tempting possibility.

What is not so clear is the benefit of jailbreaking your device. I am not overly excited about applications developed outside of the App Store; none seem to bring major value beyond the mostly excellent iPhone experience. Perhaps this list will convince you. In my opinion, the trade-offs of security and the hassle of re-jailbreaking with each iOS update make this issue a battle of principle and a questioning of basic rights of device ownership.

Apple, for their part, discourages users from jailbreaking their devices because it destabilizes them and makes them more vulnerable to attack. For this reason, you void your warranty if you jailbreak an Apple device. But for the free-software advocates and the folks working hard to start a conversation about copyright law in the electronic age, this is a big step forward, and I look forward to continuing to follow along.

PS: Feeling technical? Curious how this all works? Try this on for size! It’s really quite frightening. Essentially a PDF file is downloaded to your phone that has an “image” embedded in it. But thanks to a bug, the “image” is actually allowed to execute a program that jailbreaks the phone. Go figure.