TwitJC Transcript 12-6-11

8/6/2019 TwitJC Transcript 12-6-11

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Transcript: Twitter Journal Club Second Meeting

8pm, Sunday 12th June 2011

Geoffrey Rose (1981) Strategy of prevention: lessons from cardiovasculardisease, BMJ - Available at http://t.co/Grhzf6d

Hosted by Fi Douglas and Natalie Silvey

twitjournalclubRight, tweeps, welcome to the second Twitter Journal Club, which this week will bediscussing Geoffrey Rose's Prevention Paradox. #TwitJC -8:00 PM

behrouzn RT @twitjournalclub: Right, tweeps, welcome to the second Twitter Journal Club, whichthis week will be discussing Geoffrey Rose's Prevention Paradox. #TwitJC -8:01 PM

twitjournalclubPlease have a look at our blog if you want to familiarise yourself with the paper:http://twitjc.wordpress.com #TwitJC -8:02 PM

davecurtis314 First point seems to have four questions? #twitjc -8:03 PM

davecurtis314 Sorry, five. #twitjc -8:03 PM

petermbenglish Interesting choice for a journal club paper. Usually I've done studies. This paper ismore of an editorial, floating an idea #TwitJC -8:04 PM

doctorblogs now: @twitjournalclub Week2: points http://wp.me/p1BLwH-1j PDFhttp://1.usa.gov/iM7Ybh Prevention Paradox BMJ;1981 #twitjc -8:04 PM

frolickingfood Joining in by iPhone this evening so bear with me! Dave #TwitJC -8:04 PM

petermbenglish This means that the usual criteria for critiquing a [study] paper are not applicable#TwitJC -8:05 PM

twitjournalclub If we can start with introductions... Fi will be presenting this paper, tweeting from@fidouglas. #TwitJC -8:05 PM

dtwatkin Sorry I'm late. #twitjc -8:05 PM

northern_doctor @petermbenglish Agreed - more of a general debate, but some interesting stuffthere! #twitjc -8:06 PM

amitns GP registrar #twitjc -8:06 PM

fidouglasHi, I'm Fi, medical student at Cambridge going into my 3rd year in October. Currentlybased in a developmental biology lab. #TwitJC -8:06 PM

themattmak #TwitJC agree with @petermbenglish - will be interesting to 'critique' as not a study assuch -8:06 PM

silv24 Hi, Natalie, F1 in gastroenterology at the moment #twitjc -8:06 PM

anaestheticdoc Hia consultant anaesthetist. #twitjc -8:07 PM

northern_doctor I'm Mark, ST3 in Geris & stroke, currently working as TRF #twitjc -8:07 PM

carlylou I'm Carly I'm a nurse & student health visitor, so v interested in public health & prevention#twitjc -8:07 PM

fidouglas See http://t.co/xr8CYfG for why I think this is an important paper to discuss. #TwitJC -8:07 PM


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dtwatkin David, paediatrics specialty trainee. #twitjc -8:07 PM

medicscott Scott, medical student, just finished 1st Year at Warwick. #TwitJC -8:07 PM

themattmak #TwitJC hi all, I'm Matt, a medical SHO based in London, will probably spend theevening lurking and learning from much cleverer people! -8:08 PM

DrDLittleOops my wife was logged in. First iPhone fail of the evening. I'm Dave, soon to be radiology

trainee #TwitJC -8:08 PM

aj0610 Sorry slightly late! AJ, 4th year medic in Aberdeen #twitjc -8:08 PM

davecurtis314 Consultant psychiatrist. Do statistical and psychiatric genetics. #twitjc -8:08 PM

NHS_GP Hi Twoctors, I hadn't read this paper before. Really good, and as a GP very applicable. Reall statins we are meant to prescribe #TwitJC -8:08 PM

Hamstav Denis, pharmacist in Montral #TwitJC -8:08 PM

amitns Agree this is an interesting and important paper to discuss, thoug unconventional #twitjc -8:08 PM

davecurtis314 Hardest part so far is spelling #twitjc -8:08 PM

DrDLittle@amitns one of the great points of #TwitJC -8:09 PM

fidouglas Please remember this paper was chosen back when we thought 5 people were going toshow up for #TwitJC, hence it being a bit unconventional! -8:09 PM

drpaulmorganHi, ICU consultant. May not interact much as dinner nearly ready! #twitjc -8:09 PM

amitns RT @DrDLittle: @amitns one of the great points of #TwitJC Couldn't agree more -8:10 PM

davecurtis314 Um, so, first point seems to ask five questions? #twitjc -8:10 PM

northern_doctorRT @fidouglas: See http://t.co/xr8CYfG for why I think this is an importantpaper to discuss.


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silv24 Most interventions in preventative medicine still seem to conform to this paradox - statins area perfect example #twitjc -8:13 PM

GarethEnticott @fidouglas Rose was v influential for sociology of health and illness too. But alsoway ahead of Thaler and Sunstein "Nudge" theory #twitjc -8:13 PM

fidouglasHow do the points outline by Rose affect e.g. the threshold cholesterol concentrations atwhich doctors prescribe statins? #TwitJC -8:13 PM

petermbenglish @themattmak Can you explain what you mean about measles? #TwitJC -8:13 PM

davecurtis314 I agree still relevant. Many people still think best to focus on high risk patients.#twitjc -8:13 PM

northern_doctor@GabrielScally Great that we've got someone to give us a PH point of view forthis paper! #twitjc -8:14 PM

laikasHi, I'm Jacqueline , medical librararian (medical biologist by education) - the Netherlands#twitjc -8:14 PM

amcunningham@fidouglas ok- I'll join in. I@m Anne Marie- gp, masters in public health , andinterested in great doctors and improving health #twitjc -8:15 PM

davecurtis314 This is the argument for a polypill which everybody takes? #twitjc -8:15 PM

silv24 Why do you think people still focus so much on high risk patients @davecurtis314 #twitjc -8:15 PM

petermbenglish There seem to me to be (at least) two related points .What is the public healthbenefit; what is the benefit to the indiv #twitjc -8:15 PM

NHS_GP acceptability of drug harm in high risk/benefit pt cf med risks /benefit and the acceptabilityof harms not stressed enough I think #TwitJC -8:15 PM

petermbenglish And how do we pitch this to the low risk patient. #twitjc -8:16 PM

DrDLittle Problem with this whole idea is than human nature makes it difficult to comprehend long-term benefits when no tangible change #TwitJC -8:16 PM

Puffles2010 @silv24: Why do you think people still focus so much on high risk patients@davecurtis314 #twitjc *Puffles asks which people?* -8:16 PM

GabrielScallyMedical training based on treating the individual. #TwitJC -8:16 PM

thilb2 RT @northern_doctor: RT @fidouglas: See http://t.co/xr8CYfG for why I think this is an

important paper to discuss.


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GarethEnticott Rose's book http://t.co/0HcUzFF goes through ideas in more depth #twitjc -8:16PM

DrDLittle@silv24 @davecurtis314 because it is much more satisfying in the short term? #TwitJC -8:16 PM

davecurtis314 People focus on high risk patients because they don't understand Rose. But forindividual patient this is actually best. #twitjc -8:17 PM

adriamarilla #twitjc relevant paper show us the importance of an appropriate and preventivestrategy -8:17 PM

laikas I wonder... was involved in #meded. On basis of SR it was clear that tert/sec prevention withstatines worked, but NOT primary... #twitjc -8:17 PM

amcunningham@fidouglas and that reducing cholesterol level with statin- even at TC of 5 say, willalso reduce risk of CV event #twitjc -8:17 PM

petermbenglish I think the importance of the pyschology has become more obvious. Taking tabsturns you into a patient, for many people. #TwitJC -8:17 PM

carotomes #twitjc I'm a public health registrar, so i'm all about population health. Although theRose paper is dated it couldnt' be more relevant -8:17 PM

davecurtis314 High risk patients get more benefit. But population risk reduced by applyingintervention to all. #twitjc -8:18 PM

NHS_GP Big difference between vaccines where herd immunity vital and statins where individualunlikey to benefit and no protection society #TwitJC -8:18 PM

aj0610 @laikas NNT for 2ndry etc was about 20 whereas 1ry more like 200+ #twitjc -8:18 PM

MsPhelps Intro: I'm a medical information specialist (academic hospital), also from the Netherlands

(hi @laikas!) #twitjc -8:18 PM

northern_doctor@amcunningham Not necessarily - research suggests statins may have otherbenefits not directly related to total chol #twitjc -8:18 PM

silv24 Need to examine the risks as well as the benefits when giving preventative treatment, that hasto apply to every individual #twitjc -8:18 PM

kevfrost @silv24 #twitjc because with shared decision making, health professionals are looking atindividual risk benefits not population ones? -8:18 PM

Dr_Stuart Sorry I can't make it to @TwitJournalClub this week, feel free to listen to Radio 1 in the

background! ;-) #TwitJC -8:18 PM

The_Netherlands RT @MsPhelps: Intro: I'm a medical information specialist (academic hospital),also from the Netherlands (hi @laikas!) #twitjc -8:18 PM

aj0610 @NHS_GP Absolutely. Plus what is cost to society of SEs from statins? #twitjc -8:18 PM

davecurtis314 Often "risks"/"costs" understimated. #twitjc -8:19 PM

laikas@davecurtis314 that does depend on the intervention and the target disease doesn't it? #twitjc-8:19 PM

amcunningham@northern_doctor well, we are calculating risk reduction based on CV events...

#twitjc -8:19 PM

Trisha_the_doc @drpaulmorgan I'm cooking ours at the same time! Multitasking during #twitjc -8:19 PM


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anaestheticdoc Anyone mentioned cost. What the financial implications of treating everyone. Is itcost effective. #twitjc -8:19 PM

northern_doctor@amcunningham Yes, but we know that statins reduce cardiovascular events, sofocus should not solely be on chol #twitjc -8:19 PM

amitns @kevfrost @silv24 SDM is where I think many guidelines disappoint & confuse #twitjc -8:19PM

fidouglasHow can we go about deciding on where to draw the line between benefit to the individualvs benefit to the population as a whole? #twitjc -8:19 PM

davecurtis314 If RR constant high risk individuals get most benefit. #twitjc -8:20 PM

NHS_GP @silv24 Exactly. Do we yet know the risks of long term statin use in women? Who areunlikely to benefit individually. #TwitJC -8:20 PM

alijmbacon Interesting that small individual benefit plays the other way in e.g. Palliative chemo(with greater potential harms) #twitjc -8:20 PM

themattmak @amcunningham @fidouglas Exactly! And there's plenty of evidence from secondaryprevention trials in cholesterol lowering #TwitJC -8:20 PM

amcunningham I read Rose as suggesting that it is better to try and improve health of entirepopulation eg more exercise raher than statins #twitjc -8:20 PM

silv24 Primary prevention means treating more people with fairly low benefit to individual, thischanges with secondary prevention #twitjc -8:20 PM

davecurtis314 Could be read as saying give statins to all. #twitjc -8:20 PM

fidouglas@amcunningham Yes, in the last part of the paper he distinguishes been normalisationinterventions and medications. #twitjc -8:20 PM

Trisha_the_doc RT @davecurtis314: I think the paper misses the point is that the high risk patienthas most to gain. #twitjc -8:21 PM

petermbenglish @NHS_GP Yes. And vaccination is a one-off (or at least, occasional) event;whereas statins have to be taken daily. #twitjc -8:21 PM

GabrielScallyThe point is that there are times when either or both strategies are appropriate. Itneeds judgement. #TwitJC -8:21 PM

northern_doctorUsing statins as an example, NNT is 27, NNH (serious events) is 3400! #twitjc -8:21 PM

davecurtis314 Doctors forget that people really _hate_ having injections. #twitjc -8:21 PM

laikas@northern_doctor: @amcunningham Focus should NOT at ALL be on cholesterol = surrogatemarker #twitjc -8:21 PM

fidouglas@davecurtis314 I disagree - he says "consequently we cannot accept long term masspreventive medication" #twitjc -8:21 PM

Trisha_the_doc @davecurtis314 But we need to do both to save more lives... #twitjc -8:21 PM

laikas RT @GabrielScally: The point is that there are times when either or both strategies areappropriate. It needs judgement. #twitjc -8:21 PM

rodedun@anaestheticdoc well said, it's important to remember wilson's screening criteria #twitjc -8:21 PM


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danjrharvey Interventions with limited SE for individual (seat belts) will remain ethical & practicalwhere drugs (statins) will not #twitjc -8:22 PM

carotomeswhat are your thoughts on the polypill? A one-for-all drug which effectively would targetprevention on a population level #twitjc -8:22 PM

davecurtis314 K, point taken. Not what others propose though. #twitjc -8:22 PM

aj0610 @GabrielScally Like everything in medicine, it's essential to look at each case individually#twitjc -8:22 PM

amcunningham I don't think that Rose would argue for polypill without a great deal more evidencethan we have now #twitjc -8:22 PM

pawlu Rose has already been implemented time and again to good use: eg: Fluoride in water supplytoimprove population dentition. #twitJC -8:22 PM

Hamstav If intervention is based on education/peer pressure and benefits are not tangible to theindiv. It can be hacked for other puposes #TwitJC -8:22 PM

fidouglas I think Rose is opposed to wide-scale long-term pharmaceutical intervention, but insteademphasises importance of e.g. lifestyle. #twitjc -8:22 PM

Trisha_the_doc RT @GabrielScally: The point is that there are times when either or both strategiesare appropriate. It needs judgement. #TwitJC -8:23 PM

amitns RT @fidouglas: @amcunningham Yes, in the last part of the paper he distinguishes beennormalisation interventions and medications. #twitjc -8:23 PM

aj0610 @carotomes Healthy diet, exercise, smoking cessation etc would offer same benefits with lessrisk #twitjc -8:23 PM

doctorblogsRT @northern_doctor: Population vs patient risk prevention discussion very

interesting (relevant to many areas of clinical practice) #twitjc -8:23 PM

robhowardspr#TwitJC need to consider cost effectiveness too. -8:23 PM

NHS_GP Seems Rose is suggesting stringent safety data needed before 1 prevention with high NNT.#TwitJC -8:23 PM

petermbenglish It's a shame that Nick Wald couldn't join us #twitjc -8:23 PM

northern_doctor@laikas Yes it's a surrogate marker, but one that is reliably linked (with others)to CV risk. Therefore it should be a focus. #twitjc -8:23 PM

davecurtis314 Sure main point of Rose paper is about aiming at population rather than high riskgroups? #twitjc -8:23 PM

criticalinsight@carotomes Never heard of this paper, a refreshing read despite age. Have we gotmore uptight in the literature ? #twitjc -8:23 PM

northern_doctorRT @GabrielScally: The point is that there are times when either or bothstrategies are appropriate. It needs judgement.


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petermbenglish RT @aj0610: @GabrielScally Like everything in medicine, it's essential to look ateach case individually #twitjc


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davecurtis314 @fidouglas It's the one I cheekily posted earlier. #twitjc -8:27 PM

doctorblogsMT @amcunningham: @fidouglas 4 statins to be beneficial&justifiable,we needevidence that risk of events is correlated w cholesterol #twitjc -8:27 PM

silv24 If we only tackle those at high risk than we miss the majority of cases according to Rose #twitjc-8:27 PM

petermbenglish RT @silv24: If we only tackle those at high risk than we miss the majority of casesaccording to Rose #twitjc Tha't the point I think. -8:27 PM

fidouglasNext topic is risk presentation. How does Rose present risk? And how do doctors presentrisks and risk reductions to patients? #twitjc -8:27 PM

northern_doctor ...but wt loss & smoking cessation likely to confer less risk than starting newmeds, therefore safer for whole population #twitjc -8:27 PM

laikas@northern_doctor but smoking cessation & healthy lifestyle has MORE benefits & doesn't costmuch #twitjc -8:27 PM

davecurtis314 Quite right! RT @silv24: If we only tackle those at high risk than we miss themajority of cases according to Rose #twitjc -8:27 PM

doctorblogsRT @amcunningham for statins to be beneficial&justifiable, we need evidence that riskof events is correlated with cholesterol level #twitjc -8:27 PM

NHS_GP I think Rose provides an argument for 1prevention done by public health not GPs. #TwitJC-8:28 PM

drgrumble "Healthy diet, smoking cessation etc would offer same benefits w/ less risk" But less easyto implement than pill! #TwitJC -8:28 PM

pawlu Surely policies are tailored to public health, and then treatment to the individual? Clinician

duty is to tailor protocol to patient #twitjc -8:28 PM

amcunningham@silv24 but you need evidence that the intervention will have some benefit inthose at low wisk- that is KEY #twitjc -8:28 PM

carotomes@GarethEnticott #twitjc public health is both a 'science and art' - social science shouldbe integral to all interventions -8:28 PM

silv24 Should we be aiming for improvement in the patient sat in front of us or the population as awhole? #twitjc -8:28 PM

themattmak @fidouglas I actually think doctors are quite poor at presenting risk, whether it be for

meds or procedures #Twitjc -8:28 PM

laikas@doctorblogs @amcunningham @fidouglas I remember the case of fibrines, where statineswere lowered but no pos effect on MI #twitjc -8:28 PM

amitns RT @pawlu: Surely policies are tailored to public health, and then treatment to theindividual? Clinician duty is to tailor protocol to patient #twitjc -8:28 PM

silv24 Precisely RT @amcunningham: @silv24 but you need evidence that the intervention will havesome benefit in those at low risk-is KEY #twitjc -8:28 PM

davecurtis314 Cool, let's do risk presentation. #twitjc -8:29 PM

northern_doctor@laikas Agreed. Safer too. Just saying will statistically benefit population, butnot every individual. #twitjc -8:29 PM

amcunningham@drgrumble pills aren't easy to implement either.... #twitjc -8:29 PM


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NHS_GP @fidouglas Badly. #TwitJC Or cynically, whichever way we think will lead them to make thechoice we think is best. -8:29 PM

dtwatkin Excellent question Dr. Silvey. #twitjc -8:29 PM

northern_doctor@drgrumble Cynic ;-) #twitjc -8:29 PM

alijmbacon Isn't the public purse a good reason to prevent events? Is this a different discussion in

private system? #twitjc (Ali hospice dr) -8:29 PM

davecurtis314 Though risk presentation a bit disheartening really. #twitjc -8:29 PM

duncautumnstore@GarethEnticott - agree. Plus he hints that we should be aiming at changingsome of the social & economic deteringants of health #twitJC -8:29 PM

fidouglasRelative risk reductions are very misleading in my opinion. #twitjc -8:29 PM

laikas fibrinates I mean #twitjc -8:29 PM

davecurtis314 What to tell patient is benefit of taking statin? #twitjc -8:29 PM

petermbenglish By making a small difference to the population average systolic, you can prevent alot of cases. #twitjc -8:29 PM

petermbenglish To properly understand the benefits of intervention pts need to understand bothAR and RR. #twitjc -8:30 PM

petermbenglish These concepts aren't particularly easy to explain. #twitjc -8:30 PM

davecurtis314 I agree, should present AR not RR. But a very low number. #twitjc -8:30 PM

DrDLittle both? Although easier said than done. @silv24 #TwitJC -8:30 PM

dtwatkin RT @fidouglas: Relative risk reductions are very misleading in my opinion. #twitjc -8:30PM

northern_doctor I would always have to rx the patient in front of me - difficulty is knowingwhether or not they are the ones who benefit from rx #twitjc -8:30 PM

fidouglas@petermbenglish NNT is a much easier to concept to explain to someone with noknowledge of statistics. #twitjc -8:31 PM

petermbenglish ARR probably more important, I agree, for individual patient. #TwitJC -8:31 PM

drgrumble @davecurtis314 Q: What to tell patient is benefit of taking statin? A: For most very little!#TwitJC -8:31 PM

carlylou@petermbenglish yes but how many Drs have time to explain that fully before writing thescript? #TwitJC -8:31 PM

davecurtis314 E.g. Schizophrenia. Smoke cannabis 2%. Don't 1% probability of avoiding SZ if youstop 1%. #twitjc -8:31 PM

amcunningham@themattmak we get very little help with presenting risk ... look at absence ofdecision aids with new nice guidance on ovarian ca #twitjc -8:31 PM

amitns RT @northern_doctor: I would always have to rx the patient in front of me - difficulty isknowing whether or not they are the ones who benefit from rx #twitjc -8:31 PM

laikas RT @amcunningham: @silv24 but you need evidence that the intervention will have somebenefit in those at low wisk- that is KEY #twitjc -8:31 PM


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GabrielScally "No mass disorder afflicting mankind has ever been brought under control oreliminated by attempts at treating the individual" #twitjc -8:31 PM

silv24 We do present risk really badly in my opinion, both for the benefits of treatment and for theharms of treatment #twitjc -8:31 PM

petermbenglish Agreed, NNT also good. #TwitJC -8:31 PM

pawlu@petermbenglish And also, is that within the scope of the 10-minute GP consultation session?#twitjc -8:31 PM

northern_doctorRRR is only useful in context of ARR - both are needed! #twitjc -8:32 PM

petermbenglish RT @carlylou: @petermbenglish yes but how many Drs have time to explain thatfully before writing the script? #TwitJC Good point, but... -8:32 PM

themattmak @laikas @doctorblogs @amcunningham @fidouglas We have to remember some risksare discovered post-hoc e.g rosiglitazone #TwitJC -8:32 PM

fidouglas But this Sheridan paper argues that discussing NNT alone is not good.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1494938/ #twitjc -8:32 PM

amcunninghamRT @GabrielScally: "No mass disorder afflicting mankind has ever been broughtunder control or eliminated by attempts at treating the individual" #twitjc -8:32 PM

davecurtis314 Problem is that effect on individual tiny, effect on population/NHS huge. #twitjc -8:32 PM

criticalinsightAnother interesting point is that Doctors would often choose a different route thanthat they "recommend" see http://bit.ly/ivd0PU #twitjc -8:32 PM

silv24 NNT seems a good way of explaining it to patients but it isnt perfect as @fidouglas hashighlighted #twitjc -8:32 PM

davecurtis314 Argh! Another paper? #twitjc -8:32 PM

silv24 RT @davecurtis314: Problem is that effect on individual tiny, effect on population/NHS huge.#twitjc -8:32 PM

alijmbacon But patients often don't understand simple risk-benefit situations, never mind ones likethis #twitjc -8:32 PM

aj0610 OCP and DVT risk illustrates AR vs RR well, like Fi said re: bisphosphonates and gastric ca,double a v small no is still v small #twitjc -8:33 PM

davecurtis314 Most primary interventions NNT is in order of 1000. #twitjc -8:33 PM

drgrumble NNTT might be high for some immunisations but the Rx is still obviously necessary.#TwitJC -8:33 PM

carotomes@criticalinsight Not always referenced, but yes. Study on metformin v placebo v lifestyleshowed lifestyle = most effective #twitjc -8:33 PM

DrDLittle If some doctors don't understand these concepts? How can the patients ever be expectedto? #TwitJC -8:33 PM

Trisha_the_doc @GarethEnticott Agreed #twitjc -8:33 PM

fidouglas@davecurtis314 But for many patients, taking a tablet a day is an inconvenience andadherence can be rubbish. #twitjc -8:33 PM

petermbenglish ... perhaps part of the point is that we need better methods to describe NNT, ARRto pts outside the consulting room #TwitJC -8:33 PM


11/29

doctorblogs agree... RT @NHS_GP Seems Rose is suggesting stringent safety data needed before 1prevention with high NNT #TwitJC -8:34 PM

davecurtis314 Who here would take a pill every day if chances of benefit to them were 1/1000?#twitjc -8:34 PM

northern_doctorThe only way around this dilemma is to genetically profile every patient andindividualise rx - we're not there yet #twitjc -8:34 PM

laikas@fidouglas NNT alone not sufficient: depends on the risk of getting the disease (yeah still) andthe kind of risk #twitjc -8:34 PM

fidouglas@petermbenglish I think communication in this respect is very important. #twitjc -8:34PM

silv24 We explain risks and benefits really badly, sometimes to our shame not at all. How is thatinformed consent? #twitjc -8:34 PM

Hamstav RT @davecurtis314: Who here would take a pill every day if chances of benefit to themwere 1/1000? #twitjc -8:34 PM

danjrharvey @davecurtis314 sorry, probably right ought not to start other refs....but maybe peoplewill look back afterwards for more! #twitjc -8:34 PM

Trisha_the_doc Has the whole situation become more complicated than in Rose's day because costbenefit analysis ends up coming in as well? #twitjc -8:35 PM

dtwatkin @DrDLittle I think that in the context of premature babies; if I have doubts myself, howcan parental consent ever be informed? #twitjc -8:35 PM

carotomes@DrDLittle this is my concern with the move towards GP commissioning... do they havethe population-health knowledge? #twitjc -8:35 PM

davecurtis314 We just say "It will reduce risk" and we recommend it and that's that. #twitjc -8:35PM

fidouglas@davecurtis314 Quite a few patients I've interviewed have told me they "just take what thedoctor tells them to take". #twitjc -8:35 PM

GabrielScally If it's a 'mass disorder' prevent it, and also treat. Don't be fooled by medico-industrialcomplex only to do the latter. #twitjc -8:35 PM

duncautumnstore@GabrielScally where is that quote from, it's fantastic #twitJC -8:35 PM

northern_doctorRecent cochrane review discusses how to communicate these stats to patients -

natural frequencies preferred (http://bit.ly/l3WeDi) #twitjc -8:35 PM

danjrharvey Whoops, keep tweeting from both accounts - these 2 both me @criticalinsight@danjrharvey #twitjc -8:35 PM

criticalinsightWhoops, keep tweeting from both accounts - these 2 both me @criticalinsight@danjrharvey #twitjc -8:35 PM

carlylou@petermbenglish definitely. Statistical literacy is a big issue in society generally #TwitJC -8:35 PM

fidouglas@silv24 did you read my blog post?http://occamstypewriter.org/irregulars/2011/01/05/informed-consent/ #twitjc -8:35 PM

kevfrost @petermbenglish is this included in the english pharmacy new medicines service? #twitjc -8:36 PM


12/29

doctorblogsNo! Depends what the harm is RT @fidouglas Can we simplify things down to "Treat aslong as NNT value is smaller than NNH"? #twitjc -8:36 PM

amcunningham #twitjc RT @medskep: Fig 1 in Rose is vry interesting as it shows CHD in US &Aust declining sharply before the widespread use of statins. -8:36 PM

silv24 Are doctors trained well enough to explain risk and benefits to patients? I only vaguelyremember lectures on it #twitjc -8:36 PM

petermbenglish RT @kevfrost: @petermbenglish is this included in the english pharmacy newmedicines service? #twitjc No idea! I'm a CCDC -8:36 PM

fidouglasNext point for discussion: Has the separation between preventive and therapeuticmedicine changed since this paper was published? #twitjc -8:36 PM

DrDLittle not sure I remember having ANY lectures on it?! @silv24 #TwitJC -8:37 PM

doctorblogsRT @themattmak: we have to remember some risks are discovered post-hoc e.grosiglitazone #TwitJC -8:37 PM

petermbenglish QoF is largely based on Rose ideas #TwitJC -8:37 PMdavecurtis314 I think preventive and therapeutic have come closer together? #twitjc -8:37 PM

amcunningham@fidouglas no- it's got even more blurred! many think that when they arepreventing illness they are treating #twitjc -8:37 PM

Trisha_the_doc @Hamstav @davecurtis314 Bizarrely though many do the lottery with odds of14million to 1.... #twitjc -8:37 PM

danjrharvey @northern_doctor yes, I saw that, I thought it was interesting, although limitedunderlying evidence base., no need for RCT for this #twitjc -8:37 PM

DrDLittle@dtwatkin precisely, makes the argument somewhat redundant. #twitJC -8:38 PM

silv24 RT @davecurtis314: I think preventive and therapeutic have come closer together? #twitjc -8:38 PM

pawlu@silv24 Explaining risk to patients is not taught in lectures - role for apprenticeship methodhere. #twitjc -8:38 PM

fidouglas@Trisha_the_doc @Hamstav @davecurtis314 Exactly. People don't make rational choiceswhen it comes to risks. #twitjc -8:38 PM

petermbenglish I think there's a lot more understanding of the psychological issues of becoming a

patient #TwitJC -8:38 PM

amitns RT @silv24: Are doctors trained well enough to explain risk and benefits to patients? I onlyvaguely remember lectures on it #twitjc -8:38 PM

davecurtis314 GPs getting paid for loads of preventative stuff? #twitjc -8:38 PM

dean_jenkins @amcunningham @medskep before a lot of things so why choose 'statins' #twitjc -8:38 PM

petermbenglish RT @pawlu: @silv24 Explaining risk to patients is not taught in lectures - role forapprenticeship method here. #twitjc


13/29

danjrharvey @silv24 Do patients (or drs) actually make rationale decisions though? I think weignore the emotional aspects & fear #twitjc -8:39 PM

fidouglas@pawlu @silv24 We had a lecture series (and exam) on medical stats. Lots of stuff ondifferent ways of presenting risk. #twitjc -8:39 PM

silv24 In hospital most is about secondary prevention - applies more to an individual & their riskrather than a population based approach #twitjc -8:39 PM

Trisha_the_doc @silv24 And that's before you add in the fact that in the future many of the peoplewe are making decisions with have dementia! #twitjc -8:39 PM

northern_doctor@danjrharvey Yes, and no evidence that it alters behaviour or decision-making!#twitjc -8:39 PM

GabrielScallyThe quote, from John Gorden, continues (bad reading for doctors!) "... nor bytraining large numbers of therapists." #twitjc -8:39 PM

amcunningham@pawlu to explain the risk you have to have access to the stats... should be part ofall guidelines and research papers but aren't #twitjc -8:39 PM

JoBrodie RT @criticalinsight: @carotomes Never heard of this paper, a refreshing read despite age.Have we got more uptight in the literature ? #twitjc -8:39 PM

danjrharvey An example would be food scares, risk tiny but behaviour changed massively (cf diet ingeneral) #twitjc -8:39 PM

davecurtis314 In psychiatry we certainly have emphasis on preventing relapse. Maybe not quitethe same. #twitjc -8:39 PM

DrDLittle@danjrharvey @silv24 not to Mention misunderstanding #TwitJC -8:40 PM

amcunningham@dean_jenkins I'm guessing @medskep mentioned statins cause that's what we

were discussing in #twitjc -8:40 PM

Andrew_Mott@carotomes ...perhaps we (GP commissioners) don't, but we will clearly be needingclose links to public health colleagues. #twitjc -8:40 PM

petermbenglish RT @danjrharvey: An example would be food scares, risk tiny but behaviourchanged massively (cf diet in general) #twitjc


14/29

pawlu@amcunningham Agreed thoroughly - was commenting about method, not content. #twitjc -8:41 PM

silv24 Are some specialities better with preventative medicine than others? Thoughts? #twitjc -8:41PM

Trisha_the_doc @pawlu @silv24 Not sure it's well done out in the real world either! #twitjc -8:41PM

petermbenglish RT @davecurtis314: In psychiatry -emphasis on preventing relapse. - #twitjc Notsame - Rose is about how small popn diff -> big popn diff -8:42 PM

northern_doctorCV events reduction outweighs bleeds if you look at population data, but difficultto predict outcome in individual #twitjc -8:42 PM

davecurtis314 @fidouglas Not right now. Struggling to keep head above water. But sounds aboutright. #twitjc -8:42 PM

dean_jenkins @fidouglas metformin for diabetes prevention #twitjc (not as good as exercise or the'out-of-favour' glitizones) -8:42 PM

laikas just thinking. Prev. medicine often based on observ research 1st, but RCT's often don't confirmefficacy: PC, MC screening; vitamins #twitjc -8:42 PM

dtwatkin @silv24 Paediatrics and vaccination? #twitjc -8:42 PM

fidouglas I think psychiatry is perhaps an area where treatment and prevention do have massiveoverlap. #twitjc -8:42 PM

NHS_GP It not just NNH conventionally, or cost. What about medicalisarion, doctor dependence andinvoked anxiety? For 1 prevention... #TwitJC -8:42 PM

danjrharvey @fidouglas @davecurtis314 could consider anti virals during H1N1 in this regard, aim

as much to damp transmission as treat / prevent #twitjc -8:42 PM

northern_doctorWe use population data to make informed decisions about individual patienttreatment #twitjc -8:42 PM

amcunningham@silv24 real prevention happens outside of medicine- it's about reducing thecauses of inequalitites #twitjc -8:42 PM

CiaranWassonRT @amcunningham: #twitjc RT @medskep: Fig 1 in Rose is vry interesting as itshows CHD in US & Aust declining sharply before the widespread use of statins. -8:42 PM

GabrielScallyRead the Gordon quote in this paper: http://t.co/JQhWvSu I have it on mugs at work

to remind us all! #twitjc -8:43 PM

themattmak @silv24 Public Health, Paediatrics and maybe sometimes GP? #TwitJC -8:43 PM

davecurtis314 TBH, I think other specialties could learn a thing or two from psychiatry. #twitjc -8:43 PM

northern_doctorVery few medical treatments lead to 100% certain outcomes - it's a case ofplaying the odds #twitjc -8:43 PM

alijmbacon Sometimes sold too well - I often have to persuade terminally ill to stop statins,antihypertensives etc! #twitjc -8:43 PM

petermbenglish I mean, small diff to e.g. mean cholesterol or BP -> big diff in popnmortality/morbidity #TwitJC -8:43 PM

fidouglas Lots of screening in women's health. Also increasingly in sexual health. I'd argue thiscounts as prevention (catch illness early). #twitjc -8:43 PM


15/29

silv24 Rose highlights obstetrics & antenatal care as being largely preventative medicine, done well atpopulation level & individual one #twitjc -8:43 PM

laikas@northern_doctor yes but these are stratified according to risk (or ought to be) #twitjc -8:43PM

aj0610 @silv24 Interesting q - depends as in some specialties lifestyle or screening moreimportant/available than meds eg oncology #twitjc -8:43 PM

carlylou RT@amcunningham @silv24 real prevention happens outside of medicine- it's aboutreducing the causes of inequalitites #twitjc


16/29

dean_jenkins @davecurtis314 refer them to the MRFIT trial. #twitjc -8:45 PM

davecurtis314 @davecurtis314 Might be well worth while. #twitjc -8:46 PM

Trisha_the_doc A lot of my elderly have very firm opinions. Want everything or want nothing! Notusually swayed if fixed view! #twitjc -8:46 PM

amitns @fidouglas my understanding is that in psychiatry evidence can be v. v. difficult to inertret

#TwitJC -8:46 PM

davecurtis314 @doctorblogs Per year. #twitjc -8:46 PM

danjrharvey @GabrielScally OK you got me now. What's tertiary prevention? #twitjc -8:46 PM

pawlu By increasing monitoring in labour, we increased (potentially lifethreatening) surgicalintervention, but decreased stillbirths. #twitjc -8:46 PM

aj0610 @davecurtis314 Surely holistic health important?!!! #twitjc -8:46 PM

petermbenglish Tamiflu different altogether #TwitJC -8:46 PM

dean_jenkins @Trisha_the_doc what age cut-off should you use for statins in the elderly? Makesfor interesting debate with trainees. #twitjc -8:46 PM

fidouglasWhat are key points for improving preventive medicine at the present time? Newmedications? Focus on social/lifestyle factors? #twitjc -8:46 PM

petermbenglish Primary prevention is abt reducing risk by eg reducing sodium intake. Effect onindivs small, but effect on overall morbidity large. #TwitJC -8:47 PM

pawlu So introducing something to improve public health AND individual health has its pros andcons. We are still debating that line. #twitjc -8:47 PM

northern_doctor@Trisha_the_doc There are times when I like the pragmatic approach that thelack of evidence affords us! #twitjc -8:47 PM

davecurtis314 Completely ! RT @aj0610: @davecurtis314 Surely holistic health important?!!!#twitjc -8:47 PM

danjrharvey @fidouglas I'd vote for economics as the most powerful mechanism for changing thebehavior of a population #twitjc -8:47 PM

amcunningham@dean_jenkins really? this MRFIT trial? http://is.gd/uJzCKB #twitjc -8:47 PM

duncautumnstoreRT @GabrielScally: "No mass disorder afflicting mankind has ever been

brought under control or eliminated by attempts at treating the individual" #twitjc -8:48 PM

kevfrost @laikas #twitjc sorry tosound pedantic over jargon. Efficacy=does it work in this controlledscenario (eg RCT) (cont) http://tl.gd/b2o4iv -8:48 PM

silv24 Concerns about medicalisation of the public are high, with new medications & lower limits fortreatment we risk increasing that #twitjc -8:48 PM

ian_wac@doctorblogs @davecurtis314 I wear a bike helmet on probably similar benefit #twitjc -8:48 PM

GabrielScallyAbout half of the cigarettes smoked are smoked by people with mental illness. Whichdo you 'treat'? #twitjc -8:48 PM

DrDLittle social and lifestyle factors in my opinion! Very few side effects of stopping smoking@fidouglas #TwitJC -8:48 PM


17/29

Assidens RT @fidouglas: How can we go about deciding on where to draw the line between benefitto the individual vs benefit to the population as a whole? #twitjc -8:48 PM

davecurtis314 @danjrharvey I agree, increase cost of alcohol, tobacco and calories! #twitjc -8:48PM

petermbenglish primary secondary tertriary prevntn described at http://bit.ly/kIyfCW #TwitJC -8:48 PM

fidouglas@danjrharvey Agreed, socioeconomic status is *still* one of (if not the) most importantdeterminants of heath. #twitjc -8:48 PM

GarethEnticott #twitjc BMJ revisited Rose 5 years ago: http://t.co/UKkJHht -8:48 PM

danjrharvey @ian_wac @doctorblogs @davecurtis314 I wear a helmet despite no conclusive proofit helps adult cyclists (only kids). seems sensible #twitjc -8:48 PM

northern_doctor@dean_jenkins @Trisha_the_doc I think life expectancy needs to be 10 yrsbefore statins are of significant benefit...? #twitjc -8:49 PM

NHS_GP Big issue seems to be finding balance between beneficence (NNT) and non malefalence(NNH) Not always clear, and not prioritised #TwitJC -8:49 PM

aj0610 RT @fidouglas: @danjrharvey Agreed, socioeconomic status is *still* one of (if not the) mostimportant determinants of heath. < YES! #twitjc -8:49 PM

petermbenglish RT @ian_wac: @doctorblogs @davecurtis314 I wear a bike helmet on probablysimilar benefit #twitjc Why do you wear it? Social pressure? -8:49 PM

amcunningham@GabrielScally hmm depends how you define mental illness ..... #twitjc -8:49 PM

davecurtis314 But cycle helmets discourage people from cycling. Very interesting debate. #twitjc -8:49 PM

carotomes 1) evaluation evaluation evaluation. This tends to be neglected, and would help guidebest practice and cost effectiveness #twitjc -8:49 PM

danjrharvey @petermbenglish @ian_wac @doctorblogs @davecurtis314 I wear mine 'cos I work ina neuro ICU! #twitjc -8:50 PM

criticalinsight@petermbenglish @ian_wac @doctorblogs @davecurtis314 I wear mine 'cos I workin a neuro ICU! #twitjc -8:50 PM

themattmak RT @danjrharvey: I'd vote for economics as the most powerful mechanism forchanging the behavior of a population #twitjc


18/29

fidouglas@NHS_GP But asking if NNT


19/29

SarahBoydH RT @GabrielScally: To discuss one needs to understand primary, secondary andtertiary prevention. Otherwise confusion reigns. #twitjc -8:53 PM

SarahBoydH RT @GabrielScally: About half of the cigarettes smoked are smoked by people withmental illness. Which do you 'treat'? #twitjc -8:53 PM

DrDLittleRT @petermbenglish: @northern_doctor I think social pressure is the only way it can bedone #TwitJC -8:53 PM

davecurtis314 There is good evidence for doctors creating "social pressure" in individualconsultations. Should do more. #twitjc -8:53 PM

GabrielScallyDoctors did very well on smoking, seatbelts, motorbike helmets etc. The problem isthe tradition has been largely lost. #twitjc -8:54 PM

MsPhelpsRe @silv42 obstetrics/antenatal care: maybe easier b/c defined short timespan (42 weeksmax), highly motivated subjects? #twitjc -8:54 PM

carotomes@Hamstav knowledge transition is problematic. eg we know what is good, but how canwe turn into action #twitjc -8:54 PM

hanswest #TwitJC Statins and primary prevention? I don't get it. The evidence is very poor -8:54PM

northern_doctor Social pressures probably are effective motivators, but should addressing thembe (part of) the role of a doctor? #twitjc -8:54 PM

Trisha_the_doc @carotomes Hard to change that kind of behaviour! #twitjc -8:54 PM

fidouglasDo we think more funding needs to go towards research into preventative interventions?(be that pharmaceutical, public health etc). #twitjc -8:54 PM

danjrharvey @carlylou we can be smarter with the economics, needn't be negative (eg payments) or

discriminatory (proportionality) #TwitJC -8:54 PM

petermbenglish Doctors are probably an important part of creating the social pressure; but weneed to engage the mainstream media #TwitJC -8:55 PM

silv24 I work in gastro - we counsel all our alcoholics to stop drinking etc but know that it doesn'tmake a blind bit of difference #twitjc -8:55 PM

amcunningham social pressure is not about putting pressure on individuals to change behaviour-it's about changing society #twitjc -8:55 PM

laikas RT @hanswest: #TwitJC Statins and primary prevention? I dont get it. The evidence is very

poor thought the same! #twitjc -8:55 PM

GabrielScallyGosh!!!! It was doctors that created ASH for example!!! #twitjc -8:55 PM

EverythingVHost @northern_doctor If not doctors, then who? #twitjc -8:55 PM

carlylou #twitjc social pressure needs to be reinforced by society at large though. Else just a lonevoice -8:55 PM

aj0610 @MsPhelps @silv42 Also responsible for "other person" ie baby, so less likely to say "so what,it was fun at the time"? #twitjc -8:55 PM

NHS_GP @danjrharvey: yep, I agree, which is why I think we don't always make rational decisions,

often based on fear" And QoF points #TwitJC -8:55 PM

adriamarillaRT @petermbenglish: Doctors are probably an important part of creating the socialpressure; but we need to engage the mainstream media #TwitJC -8:55 PM


20/29

northern_doctorRT @petermbenglish: Doctors an important part of creating the social pressure;but we need to engage the mainstream media #twitjc -8:55 PM

DrDLittle@silv24 why do it then? #TwitJC -8:55 PM

Trisha_the_doc @northern_doctor Mind you the Drs might at least be doing it with the rightknowledge base? #twitjc -8:55 PM

laikas well said @amcunningham: social pressure is not about putting pressure on individuals tochange behaviour- its abt changing society #twitjc -8:55 PM

danjrharvey @medskep Good point! (I'm still skiing and banking on new knees before I need onefor instance) #twitjc -8:56 PM

petermbenglish There's a prob in that media often emphasise things that aren't very valuable orwhich are wrong (like MMR is dangerous fallacy). #TwitJC -8:56 PM

fidouglas@laikas @hanswest Think this is the report that shows they're effective. Decent RRR, buttiny ARR = problem. http://bit.ly/iuiBfG #twitjc -8:56 PM

petermbenglish @keirshiels Why aren't you on #TwitJC -8:56 PM

aj0610 @petermbenglish Media aim to sell stories - sensationalism gets published over sensibility!#twitjc -8:56 PM

carlylou@amcunningham yes! #TwitJC -8:57 PM

pawlu@MsPhelps Not necessarily highly motivated - a lot of smoking/drinking going on, anddifficult to change habits. Pressure needed! #twitjc -8:57 PM

carotomes@Trisha_the_doc #twitjc agreed - but does that mean drugs should be default? Difficultbut not impossible with the right support -8:57 PM

harryrutter @GabrielScally challenges now more complex - morally, politically, practically - egdrugs, food, energy. Need different skills #twitjc -8:57 PM

themattmak @silv24 I read a paper once about brief interventions for smoking cessation havingeffect on COPD. Am sure there is same for ETOH #twitjc -8:57 PM

davecurtis314 How do I get this signed off for my CPD? I am wrecked, #twitjc -8:57 PM

silv24 @DrDLittle in the hope that we will get through to someone, its tragic to see young patientsdie from alcohol abuse #twitjc -8:57 PM

Trisha_the_doc @harryrutter Good point re traffic #twitjc -8:57 PM

carlylou@amcunningham but big Q is how do we do that? #TwitJC -8:57 PM

Hamstav RT @petermbenglish: There's a prob in that media often emphasise things that aren't veryvaluable or which are wrong (like MMR is dangerous fallacy). #TwitJC -8:57 PM

DrDLittle@petermbenglish media can't be trusted to do anything useful #TwitJC -8:57 PM

northern_doctor@EverythingVHost Good point - maybe docs (esp in public health) are the bestplaced ones to do it. #twitjc -8:57 PM

dickstarGreat #behaviourchange debate going on at #twitjc hashtag right now -8:57 PM

Trisha_the_doc @davecurtis314: I'm all for creating social pressure, me. #twitjc yup, me too! -8:57 PM

alijmbaconMedia publish what people want to read - don't jab babies better than give up fags andbooze #twitjc -8:58 PM


21/29

aj0610 RT @DrDLittle: @petermbenglish media cant be trusted to do anything useful < sadly true!#twitjc -8:58 PM

northern_doctorRT @Trisha_the_doc: Mind you the Drs might at least be doing it with the rightknowledge base?


22/29

Trisha_the_doc @fidouglas @northern_doctor And in middle class Edinburgh...But there lies atale..the poorer continue to smoke! Despite knowledge. #twitjc -9:00 PM

northern_doctorThe people best positioned to inform strategies for behaviour change on apopulation basis should be PH docs! #twitjc -9:01 PM

carotomes@silv24 is it absolutely cheaper to prevent rather than cure #WanlessReport #twitjc -9:01 PM

silv24 Have to recognise the commercial interest in treating more of the population with medicationto reduce cases of a disease #twitjc -9:01 PM

fidouglas But value-for-money QALY analyses fail to take into account so many important factors.#twitjc -9:01 PM

KP_LD @silv24 in mental health prevention is always cheaper than treatment #twitjc -9:01 PM

doctorblogsMT @NHS_GP: Big issue seems to be finding balance btwn beneficence (NNT) & nonmaleficence (NNH). Not always clear & not prioritised #TwitJC -9:01 PM

dean_jenkins @amcunningham Sorry for the delay MRFIT http://t.co/wk8v9UB #twitjc "Smokingcessation ... substantial effect on subsequent mortality" -9:01 PM

DrDLittle@anaestheticdoc no they don't, most people have no concept of long term benefits or justdon't care #TwitJC -9:01 PM

kevfrost @silv24: Is it cheaper to prevent a case of a disease rather than treating it once it hasoccured? #twitjc


23/29

carotomes@fidouglas QALY not perfect but useful hypothetical construct to guide decision making.What factors concern you? #twitjc -9:02 PM

medicscott@anaestheticdoc There are many with the "Got to die of something" view, wherelifestyle advice will forever fall on deaf ears #TwitJC -9:02 PM

petermbenglish Like Hope-Simpson, http://1.usa.gov/l1RLlj , Rose was ahead of his time.#TwitJC -9:02 PM

endless_psych @northern_doctor Should be? Perhaps. I suspect psychologists are massivelybetter on this though #twitjc -9:02 PM

northern_doctor@GabrielScally My impression is that development & investment in PH posts isbeing neglected - is that accurate? #twitjc -9:03 PM

fidouglas@KP_LD @northern_doctor Agreed - health psychology is a very important field when weconsider public health. #twitjc -9:03 PM

davecurtis314 Anybody know cost to prevent a case of cervical cancer using vaccination? If noanswer in a minute I'll tell you. #twitjc -9:03 PM

leighblue RT @themattmak: RT @danjrharvey: I'd vote for economics as the most powerfulmechanism for changing the behavior of a population #twitjc


24/29

GabrielScallyCancer's very cultural in Bristol too! Difference between West Bristol and South forexample. Courtesy of Imperial Tobacco. #twitjc -9:04 PM

davecurtis314 Introduce a calory tax, that's what I say! #twitjc -9:05 PM

Trisha_the_doc @northern_doctor Need to raise profile of public health I think. At all levels. Theycan save more lives than best intensifiers #twitjc -9:05 PM

petermbenglish RT @northern_doctor: @GabrielScally PH neglected #twitjc


25/29

Trisha_the_doc @DrDLittle @anaestheticdoc Life is so busy most don't think further than nextdays and also don't believe stuff'll happen to them. #twitjc -9:07 PM

endless_psych @fidouglas Should patients be considered patients? #twitjc -9:07 PM

northern_doctorChecking out now everyone - thanks for an interesting debate! #twitjc -9:07 PM

doctorblogs nooooo! RT @fidouglas Should individuals receiving preventive treatment be

considered patients? #twitjc -9:07 PM

adriamarilla I couldn't agree more! #twitjc -9:08 PM

davecurtis314 Prevention of one premature death from cervical cancer through vaccination costsabout 200,000. #twitjc -9:08 PM

fidouglas@endless_psych A person treated for slightly elevated blood pressure isn't ill. Should theyassume the patient role? #twitjc -9:08 PM

anaestheticdoc @amcunningham @anaestheticdoc no #twitjc -9:08 PM

davecurtis314 Taking a pill every day makes you a patient. #twitjc -9:08 PM

kevfrost @fidouglas: Should indivls receiving preventive treatment be considered patients? #twitjc


26/29

amcunningham@carlylou somehow or other we need to do more to draw more attention to thiswithout compromising patient confidentiality #twitjc -9:10 PM

endless_psych @fidouglas I think the patient role in some cases can be harmful. see variations ofStanford prison Exp. Run in wards #twitjc -9:10 PM

EverythingVHost @fidouglas If so, we all are at least one way (e.g. water fluoridation), so nah,guess thats the split in treating risk vs disease? #twitjc -9:10 PM

anaestheticdoc @fidouglas @davecurtis314 isn't that life time prevalence not mortality rate #twitjc-9:10 PM

JoTreharne@davecurtis314 hi interested how much does HPV vacc cost vs. Cancer treatment? Alsowhat is #TwitJC ?? Pls? Interesting discussion!:) -9:10 PM

amcunninghamRT @GabrielScally: If all the paediatricians campaigned for 'safe routes to school'that would do more to reduce childhood obesity that anything else. #twitjc -9:10 PM

EverythingVHost RT @amcunningham: @KP_LD personally I think sociologists at least asimportant as psychologists when thinking about what determines health behaviour #twitjc -9:11 PM

endless_psych @fidouglas Being a patient associated with feelings of a loss of agency and the like.#twitjc -9:11 PM

fidouglas@anaestheticdoc @davecurtis314 Ah, yes, my mistake. #twitjc -9:11 PM

petermbenglish RT @GabrielScally: If all the paeds campaigned 4 'safe routs 2 skool' that wld domore 2 reduce childhd obesity than anything else. #twitjc -9:11 PM

cardio_mattersRT @GabrielScally: If all the paediatricians campaigned for 'safe routes to school'that would do more to reduce childhood obesity that anything else. #twitjc -9:11 PM

davecurtis314 Railways will pay 100-200K to prevent each death. #twitjc -9:11 PM

danjrharvey @fidouglas think you're onto something there. medicine only becomes secondarywhen aim is social! (also weight loss, hair gain etc,) #twitjc -9:11 PM

doctorblogs no! But are they "service users"or customers or clients?RT @endless_psych Shouldpatients be considered patients? #twitjc -9:12 PM

anaestheticdoc @fidouglas @anaestheticdoc @davecurtis314 still you can knock the cost of thattreatment off the vaccine to! #twitjc -9:12 PM

davecurtis314 @JoTreharne Just follow #twitjc and you'll see all gory detail. -9:12 PM

carotomes patient role referred to assumes consensus/compliance... in reality more negotiation.Patients aren't always passive! #twitjc -9:12 PM

petermbenglish Greater emphasis on healthy living cd help. But hard to make it happen. #TwitJC -9:12 PM

danjrharvey @davecurtis314 Airlines pay about $3million I think. Industry's risk aversion directlyrelated to population trust/fear/expectation #twitjc -9:12 PM

dean_jenkins Would you offer a better reference for smoking cessation and reduction in CVD?@dean_jenkins @amcunningham #twitjc -9:13 PM

amcunningham@dean_jenkins i'm just pedantic... of course it is sensible for people to stop

smoking- I just though MRFIT was interesting choice! #twitjc -9:13 PM

shanemuk RT @GabrielScally: If all the paediatricians campaigned for 'safe routes to school' thatwould do more to reduce childhood obesity that anything else. #twitjc -9:13 PM


27/29

carlylou@amcunningham yes, recognition of inequalities often leads to frustration when its outsideyour role to be able to do much about it #TwitJC -9:13 PM

petermbenglish HPV vax is way off topic! Perhaps another time... #TwitJC -9:13 PM

fidouglas@carotomes I do think there has been a shift away from medical paternalism. #twitjc -9:13PM

Trisha_the_doc @silv24 And that's NOT a good thing. (Medicalising healthy people). #twitjc -9:13PM

davecurtis314 If you smoked (I don't and hate it) how much would you want to be paid to stopsmoking? #twitjc -9:13 PM

alijmbacon@endless_psych which patients lose agency in which situation is person specific though#twitjc -9:14 PM

doctorblogswhat on earth characterises "patient role"? MT @fidouglas person treated for bloodpressure isn't ill.Shld they assume patient role? #twitjc -9:14 PM

danjrharvey Right really am off now.#twitjc. Will try to get back to the summary later ! We need athreaded twitter feed, anyone know of such ? #TwitJC -9:14 PM

Trisha_the_doc @fidouglas Though supposedly if we get it right we can empower people to lookafter their own health more? #twitjc -9:14 PM

endless_psych @KP_LD Most probably, things are changing however. Patient role and doctorsrole vastly changed over last 50 years or so #twitjc -9:14 PM

endless_psych @doctorblogs People? #twitjc -9:14 PM

fidouglas@doctorblogs What it says on the tin really, but from quite a paternalistic viewpoint.#twitjc -9:15 PM

dean_jenkins @amcunningham what would be your choice of reference for our friend thepsychiatrist on smoking cessation and CVD? #twitjc -9:15 PM

petermbenglish @danjrharvey Tweetdeck. Have a column for #TwitJC search. -9:15 PM

endless_psych @alijmbacon Indeed. #twitjc -9:15 PM

carlylou@davecurtis314 does it? Think the concept of patient is v nebulous. Diff ppl decide they arept at diff points #TwitJC -9:15 PM

davecurtis314 I think there's a real conflict between risk/benefit to the individual and to

society/NHS. #twitjc -9:15 PM

Trisha_the_doc @fidouglas Perhaps go back to the concept of partnership with our patients?Doesn't work for everyone! #twitjc -9:15 PM

GabrielScallyLook at the great medical campaigning in Cardiff to introduce shatterproof glasses inpubs. That's doctors doing prevention! #twitjc -9:15 PM

NHS_GP @carotomes I don't think patients are ever passive in #1care. #TwitJC -9:15 PM

dean_jenkins @northern_doctor @Trisha_the_doc yes that's a good figure so what's the upper agelimit for prescribing them then? #twitjc -9:16 PM

endless_psych @doctorblogs Historically submissive and there to be told what will happen #twitjc-9:16 PM

carlylou@davecurtis314 probably more on a Saturday night than a Sunday morning! #TwitJC -9:16PM


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danjrharvey @petermbenglish yep, got that, but need something to summarize the conversationafter wards in readable format #TwitJC -9:16 PM

carotomes@anaestheticdoc not Q of privatisation, but motivation. Short-term benefits should bepromoted eg self esteem, social approval #twitjc -9:16 PM

Trisha_the_doc @anaestheticdoc Excellent point! #twitjc -9:16 PM

amcunningham@dean_jenkins not quite primary prevention as they already have chdhttp://is.gd/j9pnde #twitjc -9:16 PM

endless_psych @doctorblogs Now very much awareness of multiple "patient roles" and many farmore equal #twitjc -9:16 PM

fidouglas Thanks everyone for joining, I think we'll officially bring things to a close, but feel free tokeep chatting. #twitjc -9:17 PM

GabrielScally It took Rose years to actually start campaigning on cardiac prevention. Stepping awayfrom medical way of doing things is not easy. #twitjc -9:17 PM

welsh_gas_doc You can't save people from themselves. If they want to smoke, drink, take drugsetc they will. No about of education will stop them #TwitJC -9:17 PM

amcunningham@dean_jenkins this really is about primary prevention http://is.gd/b5O9pA -benefits of smoking cessation #twitjc -9:18 PM

fidouglas (Don't want to run too late). We've yet to decide on next week's paper, but will do so thisevening & tweet & blog to let you know. #twitjc -9:18 PM

psweetman It's easier to change society if you are paternalistic & society listens. Much harder to getgrassroots opinion driving change #twitjc -9:18 PM

twitjournalclubThank you all for an informative and extremely interesting discussion - it has been

excellent yet again #twitjc -9:18 PM

themattmak @fidouglas @silv24 Congratulations again on a great #twitjc. Definitely morecontroversial and debate generating than last week's! -9:18 PM

Assidens RT @GabrielScally: Look at the great medical campaigning in Cardiff to introduceshatterproof glasses in pubs. That's doctors doing prevention! #twitjc -9:18 PM

carotomes RT @GabrielScally: If all the paediatricians campaigned for 'safe routes to school' thatwould do more to reduce childhood obesity that anything else. #twitjc -9:18 PM

davecurtis314 Thanks for great job running this. Where do I get my certificate? #twitjc -9:19 PM

Trisha_the_doc #twitjc My dinner is ready and footballer husband is home. Signing out to sharemeal and wine. But we've both done our exercise today! Bye! -9:19 PM

twitjournalclubA summary will be posted on the blog like last week and please feel free tocomment and continue the debate there #twitjc - ns -9:19 PM

danjrharvey @petermbenglish hm, you can get a list out easy, but would be good to organise tweetsunder "replies" etc to see conversation #TwitJC -9:19 PM

carotomes@psweetman starts w/ listening and understanding drivers/barriers/perceptions andmotivations. Social marketing has a lot to offer #twitjc -9:19 PM

amcunningham@welsh_gas_doc #twitjc we could try & do something abt the inequalities insociety that make poorer ppl more likely 2 smoke/take drugs etc -9:20 PM

fidouglas@danjrharvey @petermbenglish That would also be horrendously time consuming for me,I'm afraid. :-( #twitjc -9:20 PM


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twitjournalclubThe paper for next week will be announced tomorrow (when we have had time tochoose one), please keep suggesting papers on the blog #twitjc -9:20 PM

danjrharvey WARNING! My mention of diet and hair loss earlier has resulted in Twitter spamavalanche! #twitjc -9:20 PM

medicscott@welsh_gas_doc What should role of medics be? To save people from themselves orpatch them up to live their life as they want to? #TwitJC -9:20 PM

carlylou Thanks it's been really interesting #TwitJC -9:20 PM

danjrharvey @fidouglas of course, we need an automated option....software developers listening ?#twitjc -9:21 PM

carotomes@welsh_gas_doc nudging is an interesting concept... suggests role of autonomy can beoverridden. So you can help people #twitjc -9:21 PM

endless_psych @doctorblogs In some, but not all cases, doubt and perceives indecision in a fewconditions and for a few individuals bad. #twitjc -9:21 PM

psweetman@carotomes Yes, complex but well proven methods exist #twitjc -9:21 PM

doctorblogs time for historical change then? MT @endless_psych Patients: "Historically submissive&there to be told what will happen" #twitjc -9:21 PM

welsh_gas_doc The Medical Profession can't save society, no matter how much it likes to thinkthat it can. Needs input from SO many more sources #TwitJC -9:21 PM

twitjournalclubA transcript will also be posted, thank you all yet again for such a fantastic andinteresting discussion #twitjc - ns -9:21 PM

TwitJC Transcript 12-6-11

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