In a letter sent to U.S. clinicians by mail and via Doximity, Surgeon General Dr. Vivek Murthy launches a clinician-led movement to turn the tide on the nation's opioid crisis.

Read Dr. Vivek Murthy's letter (August 25, 2016)

To learn more about the campaign, take the pledge or explore additional resources for clinicians and patients, visit www.TurnTheTideRx.org

Download the Turn The Tide Pocket Guide, adapted from the CDC Opioid Prescribing Guideline

By Dr. Joseph Murray

Since the passage of the National Cancer Act in 1971, overall cancer death rates in the United States for both men and women have declined. Strides have been made over the last 45 years since the beginning of this purported War on Cancer, with particular attention paid to the underlying biology of cancer. Today, the war on cancer has an expanding front, due to knowledge gained from cancer genetics and host interactions. Mutation-specific inhibitors and immunotherapies represent promising and precise targeted therapies in the oncological armamentarium derived from this knowledge.

Independent of our exciting advances in these burgeoning areas of cancer research, declines in cancer mortality can be attributed to a significant decrease in preventable deaths. The decrease in lung cancer deaths, a principle driver of age-adjusted cancer mortality, mirrors decreased rates of tobacco use in the United States. Although informed by carcinogen studies of cigarette smoke, primary prevention through public health advocacy remains a most effective method for decreasing lung cancer mortality. Similarly, the decrease in breast cancer mortality has been attributed to increased mammographic screening, even with the recent controversies in determining recommendations for age at first screening.

However, prevention has been aided by therapeutic advances in reducing cancer mortality. Significant strides in combinatorial therapy, for example surgical, radiological, and hormone-targeted therapy in breast cancer, have dramatically contributed to survival. Bolstered by the Human Genome Project and our ever-expanding trove of “‘omic” – genomic, epigenomic, transcriptomic, proteomic, and metabolomic – data, cancer has never been a more described entity. With the informatic integration of this and clinical data, a more complete understanding of the landscape of cancer continues.

This is the first wave of the War on Cancer. Even with the research gains and notable declines in cancer, malignancy is poised to overtake cardiovascular disease as the most common cause of death in the United States.

Hence, a second wave of the War on Cancer has begun: still targeted, but also personalized and precise.

Perturbations in gene expression in cancer, through mutation or otherwise, have yielded innumerable targets of small molecule, biological, and cellular therapies. In subsets of lung cancer, kinase inhibitors to mutation-specific EGFR and ALK mutations have yielded modest success. In breast cancers, even where targeted therapy to those tumors overexpressing HER2 has failed, new antibodies carrying a potent cytotoxin have improved survival. Other antibody immunotherapies that block the inhibitory effects cancer cells exert on immune responses continue to demonstrate success in melanoma and now other solid malignancies. Cellular therapies using engineered “killer” T cells derived from and infused into patients are demonstrating efficacy in treatment-resistant hematological malignancies, with hopes for efficacy in solid cancers. Looking beyond these advances, cancer-targeted gene expression and direct genetic editing represent the next wave of the War on Cancer.

There is no guarantee that these exciting personalized and precise therapies will yield the magnitude of benefits attained by cancer prevention and combinatorial therapy. Cancer will only become more prevalent as our healthcare system better manages other chronic disease. Whether we “shoot the moon" or not on cancer, it deserves the research and policy attention it garnered in 1971 and, now, in 2016.


Doximity is proud to be a supporting association for The Economist's War on Cancer Forum 2016. On September 28, 2016, over 200 thought leaders from all corners of the healthcare industry will meet in Boston to discuss innovative approaches to combating this deadly disease.

In partnership with The Economist, Doximity is offering 15% off the current registration fee to anyone interested in attending the event. To register, go to https://waroncancer2016.eventbrite.com/?discount=DOXIMITY15 and enter DOXIMITY15.

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By Erin Gray, Product Manager for Doximity Residency Navigator

ERAS opens in less than one month, and fourth year medical students are actively researching programs while program directors are fielding their eager questions. During this time Doximity receives a steady flow of questions and ideas from educators about our research tool, Residency Navigator.

The goal of Doximity Residency Navigator is to assist medical students in the residency exploration process by providing a transparent look at graduate medical programs.

Here are the top 5 questions we are asked about Residency Navigator:

1. What is Residency Navigator?

The Doximity Residency Navigator is an interactive tool designed to help the medical students research and compare residency training programs nationwide based on their unique career interests. We are excited to announce the launch of the 2016-2017 Residency Navigator. Our latest version includes over 4,000 residency programs spanning 27 specialties, providing medical students a more in depth look at the programs in which they’re interested.

2. Where does all the information come from?

Residency Navigator combines objective data with 260,000 nominations, ratings and reviews from over 52,000 U.S. physicians. Objective data is compiled from a variety of public sources as well as our proprietary Doximity database, which covers all U.S. physicians, regardless of membership with Doximity.

Program pages include:

  • Detailed program statistics: Users can filter programs by alumni subspecialization rates, time spent at affiliated hospitals, gender balance, program size, and more.

  • Satisfaction reviews: Current residents and recent alumni anonymously rated and reviewed aspects of their experience, like career guidance, schedule flexibility for pregnancy and other life events, program culture and clinical diversity.

  • Personalized search options: Students can customize their searches based on their personal interests and career goals.

  • Practice setting: Interactive maps highlight where alumni work, and applicants can find and filter programs by region, urban vs. rural environments, or training at large public hospitals.

  • Clinical reputation: Peer nominations provide insight into which programs board-certified U.S. physicians hold in the highest regard for quality of clinical training.

  • Research publications: Doximity's comprehensive database of physician profiles highlights programs whose alumni publish most extensively, bypassing commonly used proxies for quality of research training such as faculty grant funding.

  • Board pass rates: For specialties such as internal medicine, board pass rates highlight which programs teach to national exam standards. For specialties whose medical boards have yet to release pass rate data, Residency Navigator offers the percentage of board-certified alumni as surrogate.

Program pages may be refreshed throughout the year to account for updated data such as new alumni publications, fellowships, board certifications and practice settings. This may affect the Research Output, Percent Subspecialize and Percent Board Certified rates, as well as their respective sort orders. For more information about these data elements, please view our research methodology.

3. What do med students and current residents think about it?

"The Doximity Residency Navigator has become an oft-cited reference amongst senior medical students evaluating training options. I referred to it during my own residency interview experience and found the data valuable in the assessment of various programs beyond sporadic anecdotal information.”
-Pooyan Rohani, MD

"The Residency Navigator. I love this feature. After our match list came out this year, I was searching all the time for the different programs and their highlights. It was great to find everything about a program listed at once."
-Natalie P., Current Medical Student

4. As a program director, how can I make updates to our page?

Add a description: Many programs have chosen to personalize their page by adding a paragraph that highlight special attributes about their institution. Program administrators are welcome to send a description (150 words or less) to be included on their program’s page.

Review data accuracy: We take the accuracy of Residency Navigator data seriously. If you are a program director or coordinator and notice your program information is incorrect or missing, please let us know.

Encourage resident reviews: Your residents can write a review for your program. Eligible residents and recent alumni can contribute reviews for their residency program until early fall 2016. After logging in, eligible residents and alumni will be prompted to complete the Satisfaction Survey on the Doximity homepage.

To update your program page with a description, or if you have any other questions, you can reach our Residency Navigator team any time at [email protected].

5. How can programs share their Residency Navigator page?
You can include a badge on your email signature or your website that links directly to your Residency Navigator program page.

To add a button or a badge to your residency program page, please fill out the following form: https://goo.gl/forms/8bKgrN8D4OpMVoB52

This article is contributed by Doximity Fellow and medical student Piyush Sharma

Research and innovation are two lasting pillars of medicine. This is clearly the case in drug development, as we watch for the newest medication to break onto the scene and change how we care for patients. But there’s more to drug treatment than simply applying the latest FDA-approved chemical. Trends over the past decade have shown that physicians are increasingly prescribing treatments off label. This type of prescribing has tremendous potential to affect how we treat patients, so why don’t we monitor and study off-label drug use (OLDU) more effectively?

Patients using drugs for unindicated purposes aren’t part of clinical trials. But that doesn’t mean we can’t learn from them. Monitoring and analyzing off-label use, its side effects, and which type of patients do well on a drug is a novel form of clinical research -- an experimental study of drugs already on the market.

AN EXAMPLE IN DERMATOLOGY
A prime example of effective OLDU can be seen with the skin disease vitiligo (a disease I happen to have). Currently, tacrolimus is designated for the treatment of eczema and not as a first-line treatment for vitiligo. However, off label, tacrolimus has shown great results in vitiligo patients. Yet, patients haven’t been educated about this additional option. Information on the drug’s effectiveness isn’t readily available to physicians. After years of unsuccessful vitiligo treatment, I found tacrolimus to be immensely beneficial in my treatment and maintenance of outbreaks. We should be doing more to see if others can reap that benefit.

Physician records of tacrolimus (and any other OLDU drug) could provide the FDA with data on populations that have benefited from the alternative use of market-approved drugs. With enough data, drugs deemed safe and beneficial for unindicated diseases could go through an expedited FDA approval process for additional uses.

HOW IT CAN WORK
The most efficient way to monitor, record, and track OLDU is through EMRs. We could use the system to mark prescriptions “OLDU,” use the database to document their success, and share the information with others. In medicine, percentages and numbers speak volumes. Providing OLDU candidates with stats on successfully treated patients can help them understand the process.

A collection of OLDU statistics would allow physicians to know how often a medication is prescribed off label and help them determine if it could benefit a patient. This type of data is crucial not only to current disease prognosis but to future treatment as well.

Monitoring OLDU, in association with data collection and analysis, provides significant opportunity. It could reduce risk in hospitals, inform current and future patient treatment, and provide a foundation for medico-legal issues that may stem from drugs being prescribed off label.

OLDU hasn’t spent much time under the microscope for fear of bringing attention to what some may consider drug misuse. But, working with available therapies may be one of the safest ways a physician can experiment with treatments. It also helps to skirt the high costs new drug development.

OBSTACLES & LIABILITY
Of course, OLDU is not without its barriers. Physicians who prescribe off label subject themselves to liability. If an OLDU treatment doesn’t work, the responsibility falls squarely on the physician’s shoulders. Physicians must justify the use of a drug and its dosage in a particular scenario, which is a challenge without guidelines. To deal with this, some OLDU prescribers start small and increase the dosage gradually if the treatment works.

The current OLDU set-up will need to be adjusted. In order to maximize a standardized OLDU database, physicians must initiate a low dosage regimen and record any adverse effects thoroughly. Once an off-label treatment is deemed successful, those results can be repeated with high internal validity.

USING THE TOOLS WE HAVE
New epidemics spread rapidly, and testing and approving experimental drugs takes up vital time. Why not use drugs that have already gone through regulatory vigilance? Environmental influences, population dynamics, and other factors change over the course of time it takes the FDA to approve a drug for a disease. By using EMRs to implement OLDU databases, we can take positive steps to provide safe and effective treatment options more quickly.

Let’s make more of what we have. It’s time.

Disclaimer: The views and opinions expressed here are solely those of the author and do not necessarily represent Doximity’s views.

This article is contributed by Dr. Mahboob Alam, Doximity Fellow and Assistant Professor of Medicine-Cardiology at Baylor College of Medicine

In medicine, expressing our thoughts and findings in the form of research papers is of utmost importance. Our research helps spread knowledge and may both directly and indirectly impact patient care. Through published research, we learn from each other’s experiences -- whether the outcomes are desired or adverse.

When writing papers, our co-authors are a vital source of ideas and support. Writing a manuscript and getting it through the rigorous process of peer review and publication can be painstaking. Co-authors are closely involved with manuscript from the beginning, and they’re the best peer reviewers one can have. I’ve been fortunate to work with co-authors who are well known in academic medicine. They were essential to our papers’ successes and made each one better, which ultimately led to faster publication.

Since research and co-authorship are so important, it’s worth wondering: When are doctors most likely to meet their co-authors? And how do they shape our trajectory in academia? To find out, let’s take a look at some data.

According to new Doximity research, 60% of co-authors who trained together first did so in residency training. Of the rest, 20% were medical school classmates, 18.5% met during fellowship, and 1.5% met during internship.

This data highlights an important fact about our training as physicians and the paths we take as we advance in our careers. Internship is an extremely busy year of one’s training and, more so, it’s a critical year in which we lay the foundations for our future in clinical medicine.

Based on my personal experience, I was least productive in terms of writing papers during my internship year. This was mostly due to extended work-hours and call schedules. Despite the fact that 20% of my classmates from intern year ended up in the same specialty (cardiovascular medicine), I hardly remember collaborating with one of my co-interns on a research paper or a project. Internship year, however, helped me plan for the future. It also helped me meet seniors and faculty members who were actively engaged in clinical research and who would later become my co-authors.

As I write this, our new interns have recently started and finished their orientation week. The year ahead is going to be a busy one, and the race towards excellence in academic medicine starts on day one. Identifying your co-authors starts right away too! Remember, there’s a high probability you’ll meet your co-authors early in your career. It all starts with an idea that blossoms into a research abstract and ultimately, with the help of right minds, into an outstanding research publication.