Dr Glatter and Dr Samadi - Together in Forbes!

Dr Robert Glatter is a medical doctor who is a regular contributor to Forbes, a huge global print and on line portal for news and opinion.  

He started writing for Forbes in February 2012 and has been contributing on almost a weekly basis.  It was not until December 2013 that he wrote his first piece on prostate cancer entitled "Inflammation Noted In Repeat Prostate Biopsies Linked To Reduced Future Prostate Cancer Risk".  This was actually quite a well written informative piece.

He next wrote about prostate cancer on 7 March 2014.  All of a sudden, prostate cancer has become the flavour of the month with further articles on 6 April 2014, 10 April 2014, 21 April 2014, 4 June 2014 and the most recent piece on 20 September 2014.  

It seems rather odd that there is this sudden interest in prostate cancer.  He does write a lot of articles on other subject matters but the frequency of prostate cancer topics has been disproportionately higher during the course of this year.  This made me wonder as to whether there was some explanation for this.  The most glaringly obvious common binding feature about all of his articles on prostate cancer this year has been the mention of Dr David Samadi.  

Briefly, Dr Samadi is a celebrity urological surgeon who has a program on the Fox Channel called Housecall.  He cites amazing figures for prostate cancer surgery outcomes that defy the academic literature, particularly with his claims of providing a 97% cure rate from prostate cancer. He also earns a great deal of money and was the highest earning doctor in 2012 according to a New York Post investigation stating "The city’s top earner was urologist and prostate-cancer specialist Dr. David ­Samadi, whose 2012 compensation came to $7.6 million."

Okay, back to Dr Glatter.  Who is he?  I have never met him and only discovered him through reading articles on the Forbes website where my friend and colleague Dr Benjamin Davies is also a contributer. The easiest way to start is Google.  The first hit is his work at Forbes.  The second hit is his twitter account.  His bio states the following:- "Emergency Medicine Physician-Lenox Hill Hospital /Media Spokesperson/Forbes Contributor/WebMD Editor/DR 911 housecall practice" and also provides a link to a website.  

Hang on a second - Lenox Hill Hospital?  Isn't this where Dr Samadi does his work?  I don't know the relationship between Dr Glatter and Dr Samadi but if there is any conflict of interest, it should be declared on the Forbes website.  In particular, the fact that Dr Glatter works at Lennox Hill Hospital is not listed anywhere that I can find on the Forbes website. It may be all innocent but in the context of this sudden increase this year in prostate cancer articles, all of which lavishly cite Dr Samadi, raises questions on transparency.

On a final note, the most recent article from 20 September 2014 is a far cry from Dr Glatter's excellent first article on prostate cancer in December 2013 (incidentally, he does not actually mention Dr Samadi at all in this first article).  Not only does he promote the hashtag #samadichallenge but also makes ridiculous comments such as "In case of a positive diagnosis, urge men to seek Treatment immediately" - this demonstrates a lack of insight of the biology and natural history of prostate cancer.  It goes totally against the direction taken by leading urologists which is to be less aggressive in treating clinically significant prostate cancer.

Statements like "Symptoms of prostate cancer may include changes in urinary function including a burning sensation, blood in the urine or semen, frequent urination, as well as a weak or interrupted flow" only create fear and alarm amongst men with urinary symptoms.  It is uncommon for prostate cancer to cause urinary symptoms when clinically localised - any clinician would know that it is the non-cancerous condition of the prostate called benign prostatic hyperplasia (BPH) that causes the symptoms.  It is these symptoms that lead men to get checked by their doctors who then serendipitously diagnose their cancers.  It is not a cause effect relationship.

The hashtag #samadichallenge with a doctors name in it? Is the aim to achieve awareness about the doctor or about prostate cancer? I am happy to be instructed on this. 

And Dr Glatter, is there any relationship of any sort between yourself and Dr Samadi? If so, be transparent and declare.  If not, state that to be the case.  It is hard otherwise to not be suspicious about the sudden interest in prostate cancer articles where Dr Samadi comes across to me as being featured expert in each of them..

Some Tips on Successful Conference Tweeting

Recently, I have heard disappointed comments about the lack of conference tweet activity for given healthcare conferences. On each occasion, it seemed fairly obvious as to why this was the case.  Having participated in quite a number of conferences by the way of Twitter, I have made a number of observations of what seems to make the difference.

1. Must Be Good WiFi

This is perhaps the greatest impediment to the success of conference tweeting. Frequently, the systems are tested when the conference centre is empty and of course everything works fine.  As soon as the conference commences and people are using the system, it comes to a grinding halt.  Once again, there is no greater impediment to conference tweeting than the lack of adequate WiFi.

2. Conference Twitter Account

This account would help define to observers what the conference is and what official conference hashtag has been assigned. This account should tweet out updates, announcements as well as interact with key twitter accounts through replies, favourites and retweeting.  This account can also act as a catalyst for activity if the twitter stream is quiet.  With this comes the assigning of a person to look after this account during the course of the conference.

3. Appropriate Hashtag

The hashtag should appear relevant to the conference and should use the minimum number of characters.  Ideally the number of characters should be no more than 6 or 7 characters.  Any more detracts from the precious 140 character count and would limit the information that can be shared to the hashtag audience.  Only one hashtag should be assigned.  Sub-hashtags only lead to confusion and in combination with the main hashtag, chew up valuable characters.

An example of a misleading hashtag was when the #uro12 was assigned to the American Urological Association meeting when the hashtag of #AUA12 would have made much more sense.  An example of wasted characters is the Royal Australasian College of Surgeons using #RACS2014 when #RACS14 would have been more appropriate.  With the RACS meeting this year, there were no fewer than 4 hashtags being used by various conference tweeters and the twitter stream from this meeting was a disaused the hashtag #CFAConf14.  A long hashtag hampers expression and detracts from participation. Including the space, #CFAConf14 chewed up 10 characters when a simpler #CFA14 would have been appropriate. With the 2014 RACS meeting mentioned above, there were no fewer than 4 different hashtags being used by various conference tweeters and the twitter stream from this meeting was a total mess.  

4. Engage KOL Twitter Users

Conference organisers should seek out the key opinion leaders who are active on twitter in advance of the meeting.  Organisers could consider requesting specific accounts to be assigned to tweet proceedings from specific sessions.  Having predetermined users involved creates a core group of participants.  People are reluctant to be a sole or one of only few tweeters for a conference. 

5. Twitter Boards

Strategically placed monitors showing the twitter feed are often a magnet for the attention of conference attendees.  The most organized meetings will have such monitors outside every meeting room as well as in the registration and trade exhibition areas.

6. Twitter Instruction

At the American Urological Association annual meeting this year, opportunities for small group or one-on-one instruction on twitter basics and how to conference tweet.  Alternatively having a course or conference session on social media as was the case at the European Association of Urology congress (#EAU14) and Urological Society of Australia and New Zealand ASM (#USANZ14) respectively was particular done well. These sessions were not only well attended but also created an explosion of activity on the conference hashtags during these sessions.

7. Publicity

The role of social media at the conference needs to be publicized and prominently implied.  The hashtag should appear on all background slides that appear at the beginning of conference sessions as well as all publications such as the conference proceedings and conference badges as examples.  Such publicity adds negligible if at all any cost to the conference but is returned many times over by increasing the engagement of those attending as well as reaching a much larger global audience in virtual attendance.

8. Register on Symplur

Registering a health conference hashtag with the Symplur Healthcare Hashtag Project is free.  This provides access to basic twitter statistics.  Tweeting these during the conference often generated interest when enormity reach of the conference tweets is realized.

There are probably other ideas that would enhance conference twitter activity that I have forgotten about so please feel free to add your comments.  One example is to allow participants to ask questions via twitter - on occasions I have actually offered this to the audience when I have chaired sessions. A few questions do come in although this is not a deal breaker for twitter engagement at a conference. I look forward to your comments.

Photon Journal is a clear nominee for the worst predatory on line journal

Roger Dmochowski is highly regarded international academic urologist.  His name on a presentation or publication carries weight and implies quality of content.  This is precisely why one of these so called predatory journals would stoop so low to essential steal his credability.  

Lately, I have been receiving numerous emails from an online publisher called Photon Journal.  They have created a journal in my field called the Journal for Urology.  This journal name is rather similar to the established Journal of Urology which is a prestigious journal owned by the American Urological Association.  The header of the email has the Dr Dmochowski’s name with the intent to grab our attention. They know that his name implies that there is content that is worth taking notice of.  

The links in the email take you to a amateur site with no academic content.  Just numerous self grandiose ideas of how professional, established and reputable they are as a publishing group.  

I wrote to Dr Dmochowski to determine if he was aware of these emails.  It was clear from his response that he was. He mentioned that legal recourse has not swayed them at all.  I also forwarded it to the Publications Committee of the AUA who also indicated that they were aware and it was clear that they were frustrated.  To quote

"We have received numerous emails regarding this group and Dr. Dmochowski has even tried to contact them personally about the use of his name but to no avail.  However, thanks for notifying us."

The emails have continued and there was in fact a mini run of them where 4 were sent in the space of about 4 hours, perhaps just in case I did not read the first few.

We have seen a number of these predatory on line journals stoop to pretty low tactics but I think Photon Journals take the prize for the worst offender I have seen to date.  It is one thing to financially rip off scientists and medical researchers but stealing their identity has gone too far.

Let me know if you have had any experience with the Photon Journal group.


Make sure you check out my earlier piece about OMICS 

Great Gigs at the AUA Annual Meeting

I thought that I would share the story of how a group of people attending an Annual Meeting of the American Urological Association managed to score an entry into a Prince concert.

We had been enjoying a wonderful meal at a San Diego restaurant and mention was made that Prince was in town. A couple of our group were from Minnesota which of course is the home town for Prince. As such we were cajoled into walking back to our hotel via the Hard Rock Cafe Hotel for the sake of a possible glimpse of fame.  As we reached the Hard Rock Cafe Hotel, there was a long line on the footpath.  When asked as to why they were lining up, we were told that they were waiting to get into the Prince concert which was starting at around 10pm.  One person in the line mentioned that there might still be tickets at the sales desk in the hotel lobby. 

Upon reaching the ticket sales desk in the hotel lobby, we were advised that no more tickets could be sold because just at that very moment, their printer had completely malfunctioned. A well dressed man with a much younger lady who was literally hanging off him, was not happy. He carried the attitude of “do you know who I am?” and it was suggested to him by one of the bouncers to try using the hotel’s business center to see if tickets could be purchased on line and printed out from there. We decided to follow this couple to the business center to check out whether tickets were available and how much they were going to cost. Once ‘on line,’ it quickly became evident that ticket sales for this show had been discontinued as it was too close to the time of the show’s commencement.  In any case, this was a small and fairly intimate gig with ticket prices being in the vicinity of $250 each.  The pricing pretty much turned us off from pursuing this any further.

The man I mentioned earlier was really unhappy and complained bitterly to bouncer.  The bouncer then suggested that he go to the head bouncer at the entrance door to the venue to try to resolve the situation. My thoughts were that we should tag along in case we could benefit from being in the slipstream and I signalled to the others with my hand to follow.  At the entrance, the story was explained to the head bouncer that an attempt was made to buy tickets in good faith but because of the printer malfunction, attendance to the gig was not going to be possible. The head bouncer went into a huddle with his colleagues and then announced that if $250 cash per person was paid, then entry would be permitted. The couple that we followed coughed up the cash and were granted entry.  We jokingly said how about $250 for the five of us but that was a no go. As we were walking away from the entrance, we bumped into the first bouncer who had been directing us in the hotel lobby.

He asked, ‘how did you go?’  I explained the story of how we had 5 Australians and 2 from loyal Prince fans from Minnesota who had tried in good faith to buy tickets but were not able to as a result of the printer malfunction and then with the closure of the on line ticketing website for sales to this gig.  I explained how as visitors to this town, we simply did not walk around with hundreds of dollars in our pockets and relied on our credit cards.  The bouncer then says. "F**k, I hate when this happens.  Look, come with me."

He leads us down the footpath and around the corner where it was dark.  He pulls our entry wristbands and says to us "just give me what you have in cash and I’ll make sure it goes to Prince’s favourite charity"  Most of us only had about $20 in our wallets and even though it was all that I had left in my wallet, I was happy to part with it. We put on our wristbands and he then lead us through a back way through the hotel into the venue. The next moment we were inside and the doors behind us closed and the bouncer was gone.  It was major high five and it is pretty obvious that it was a fantastic gig.

You never know what is going on in town when you attend an AUA meeting. In the previous year in Atlanta, we were treated to an outdoor concert featuring the Flaming Lips,  This year, the only performers of note were Modest Mouse.  Tickets were available although scarce but at over 5 times the original cost so decided to give it a miss.

Sydney Punching Way Below Its Weight in Academic Urology - A Need For Change

A Canadian urologist who is one of the most prominent academics in the field has often been quoted as stating that the two cities in the world that really punch below their weight in terms of urological publishing and international academic recognition are Sydney and Rome.  Sadly, I must agree with him. I can’t really speak for Rome but I can speak for Sydney.

I recently had a letter published in the Australian and New Zealand Journal of Surgery that quantifies the academic publishing output of Level D and E ‘titled’ academics in Melbourne and Sydney.  This refers to those who hold a position of Associate Professor or Professor respectively.  For some, the position may be honorary and given in return for doing a bit of unpaid teaching to medical students – these honorary titles are usually prefixed by the term Adjunct, Conjoint or Clinical.  Academics who are employed by the universities usually have their title followed by a descriptor such as ‘of surgery’ or ‘of urology.’  The requirements for a paid position are usually significantly greater than for honorary titles but some holders of honorary titles should not be underestimated for their academic contributions which at times may well exceed those in paid positions.

So back to my letter.  What I did was to search and manually identify any academic writings indexed on Pubmed/Medline that could be attributed to authors who carried a Level D or E title and made comparisons between Melbourne and Sydney.  The results were not surprising but also disturbing.  There were a similar number of those with level D or E academic titles in both cities but the overall publication output from Melbourne was more than double that of Sydney overall and per annum.  In Sydney, there was only one urologist who was publishing on average in excess of 5 pieces of academic writing per annum over the past 5 years compared to Melbourne where there were at least 3 with this level of output.

How do we explain this?  Both cities have public hospitals funded by similar models and both have excellent universities with well regarded medical courses.  Both cities have urology departments that are equally poorly funded and poorly supported by the public hospital system and universities.

I do have some thoughts as to why this is the case and of course many will beg to differ.  Some may unkindly suggest that Sydney urologists are so consumed by private practice and making money and to the extent that any academic pursuit is well down the list for matters of importance.  Whilst there might be some truth in this, it is clearly not as simple as this.

Whilst the funding models for public hospitals in Sydney and Melbourne are globally similar, there are some differences in how things have become structured over the years.  As a result of funding cuts to support public outpatient departments in NSW hospitals, the vast majority of patients seeking urological care must see a urologist in their private rooms before being referred to a public hospital for treatment.  This drives work to the private rooms and the high cost of operating a private practice creates this imperative to work hard in the rooms to cover costs.  There is poor separation of private and public consultative practice compared to Melbourne.  In other words, urologists are spending time in their rooms trying to cover their costs are probably too busy to think about academic pursuits.

What of university funded positions? Some surgical specialties such as vascular surgery, colorectal surgery, breast/endocrine surgery and upper gastrointestinal tract surgery will have paid academics in almost all of the teaching hospitals at the expense of subspecialties.  But the situation is no different between Sydney and Melbourne. 

Is anything else different?  The most striking difference is the manner by which public hospital urology units have been established.  There is a common thread amongst all of the key academic centres in Melbourne.  In each of these, the Heads of the Urology Departments were all appointed when relatively young in their careers and these positions tied in with academic appointments.  These urologists were able to carve out academically strong departments in their own style.  To name a few, we have Professors Damien Bolton, Mark Frydenberg and Anthony Costello.  They all built departments from an almost embarrassing levels of infrastructure and nothing more or less than what any department in Sydney would have had when they began their academic tenure.  They have now mentored a fossil layer to whom they can hand over the baton and those mentored, already hold major positions within international organisations and urological journals and are already well established international key opinion leaders.  Can we say the same about Sydney?  Sadly not and hence the comments from our Canadian friend. Within an established academic environment as has been created in Melbourne, it is substantially easier to maintain the academic throughput but if there is none to begin with, as is the case in just about every urological unit in Sydney, what hope is there.

To effect change in Sydney, future academic leaders need to be identified and offered positions of department leadership with associated university positions while they are young energetic and full of bright ideas.  They will make mistakes and will grow as a result of them.  What they do create will outweigh any risk associated with placing a relatively inexperienced leader into the helm.  These leaders need to be supported to grow their departments in their own style and with a long term vision in mind.  To move forward, either current department heads should make way for new leaders or as they retire, appropriate succession planning for a strong academic head should be in place.  Over the years I have seen numerous Sydney trained urologists who could have been great leaders that could have steered Sydney public hospital units to the same level of international recognition as those in Melbourne but have been lost to battlefields of private practice. Following their post fellowship training, they return to public hospital units with no existing academic infrastructure or capacity to develop such infrastructure.

As far as academic urology in Sydney is concerned, we punch way below our weight.  The Melbourne situation demonstrates precisely where we should be and precisely what is possible if there is a will to effect change.


(Footnote - some grammatical corrections have been made since first published. I really should proof read a little better)

Tips For Junior Surgical Registrars by Dr Kesley Pedler

This is the first ever guest blog piece on "Surgical Opinion."  It is written by Dr Kesley Pedler who has just completed the Surgical Education & Training (SET) in Urology.  We are on the brink of seeing her enter urological practice and in this piece she shares tips on the day to day work as a surgical trainee.  I think you will all quickly gather that Dr Pedler is going to be one of those individuals who will create their own luck. - Henry Woo

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Tips for junior registrars (SET 1 to 3): things I wish I knew when I started my training

This week I completed my SET Urology training! It has been quite a journey and I have learnt a great deal from my many mentors over the last six years.  I have decided to share a few tips which I have figured out over the last few years which I have found helpful in performing my day to day job as a urology registrar. 

These tips will help you become an organised, competent, efficient and mature registrar which means your consultants will be more likely to increase your level of responsibility both inside and outside theatre which will allow you to learn more!

Be organised! ( especially for operating lists)

·       Know the cases beforehand:

o   This includes the indication for the procedure and results of relevant investigations .

o   This will help you understand the decision making process that has lead to your consultant bringing the patient to theatre.

o   Make sure you review the relevant imaging beforehand and display in the theatre (e.g. for a radical nephrectomy- make sure the CT is displayed demonstrating the tumour and also the vascular anatomy)

·       Know what major cases are coming up a few weeks in advance

o    Your consultants will expect you to know

o   This also gives you time to prepare for the case and read-up in advance. If you demonstrate understanding and knowledge of the operative steps, your consultant will feel a lot more comfortable letting you perform a significant part of the operation.

o   Befriend the administration staff in the bookings office in order to preview lists ahead of time.

·       Be punctual

o   Ensure you allow enough time to arrive on time (or even early) to theatres

o   This means scheduling enough time beforehand to complete ward rounds

o   Unless there has been an unforseen emergency elsewhere, avoid arriving at your theatre list after your consultant (and they will take note especially if this is a recurring occurrence).

Keep a notebook of details of operations

·       I have found it useful to keep a record of the particulars of certain procedures. This includes pre-op preparation, patient positioning, intra-operative details of each step including details such as particular sutures used and post operative management.

·       This can either be in the form of a notebook or keeping copies of select operation reports

·       This is invaluable since it will be a good reference to read before doing the particular case next time

o   Your consultant will be impressed you recall the details of the procedure and will be more likely to let you do more the next time.

o   You will often find that different consultants will perform the same procedure slightly differently and you will be expected to perform the procedure in their specific fashion.

·       This is also a useful resource in preparation for the operative viva in the fellowship examination.

·       It may also be useful when starting consultant practice- you can pick and choose which way you will perform a particular procedure according to what you have seen work well during your training.

Be organised outside the operating theatre

·       Keep a list of your inpatients close at hand

o   It is impossible to remember all details

o   I use this to record important information such as drain outputs, salient blood results and pending investigations.

o   I then refer to it when speaking to consultants about their patients (and jot down instructions and changes to the plan)

Think before calling your consultant

·       Have a definite purpose to your phone call

·       Think about how you will present your case before dialling.

·       Articulate your plan of management (even if you are not sure, suggest what you think is appropriate, it will help your learning even if you are incorrect)

·       Have a list of all your consultants patients plus any other issues you need to discuss so that all issues are dealt with in one phone call

Think beyond the acute hospital admission

·       This can take a little time to develop since as junior doctors we are only exposed to the acute hospital setting which is predominantly focused upon discharging patients

·       Think about what long term follow-up, investigations and future procedures are required. This will help you learn to manage the patient completely- a skill necessary in consultant practice and this will be assessed in the exam.

Look after yourself

·       Try to get enough sleep, eat and exercise when you can (although this is not always possible)

·       Have a proper holiday (i.e. going away and not thinking about study or work) at least once a year.

Remember that there is more to life than just urology!

·       Don’t neglect the significant people in your life (family, partners, friends). This is what is really important in life and it can be difficult to keep this a priority when your work and training often clash with other life events. 

·       The last thing you want is for the significant people in your life to feel of lesser importance than your work.

     (This piece was originally published in the USANZ Training Newsletter called "Bridges" in  February 2014. Dr Pedler has been kind enough to allow this piece to be reproduced here)