Doctor’s Share Their Favorite Labor Inducing Wive’s Tale

pregnancy bellyWhat do spicy food, castor oil, and sex have in common? They are the top three most popular labor inducing wive’s tales mentioned by our Sermo members.

We took the holiday Labor Day literally and asked our physician members to share with us their oddest obstetrics tale.  We received over 173 interesting and hilarious comments.

The five most unusual wive’s tales we heard were:

  • Riding a mechanical bull
  • Gymnastics
  • Eggplant Parmesan from Cobb. Co, GA
  • In-laws visiting
  • Shaving legs

These wives’ tales might raise an OB’s eyebrow, but some of them actually have some science, however tenuous, behind them.

Riding a mechanical bull and Gymnastics

One doctor witnessed a woman ride a mechanical bull and go into labor the next day while another doctor had a patient swing from a gymnastics pole she had installed in her room. That patient went into labor just six hours after her gymnastics routine.

How would either of these two ways induce labor? Both methods include moving the body and essentially, ‘exercising’. According to parenting.com, movement to the body may start contractions by irritating the uterus.  Exercise also causes the body to become dehydrated which signals the body to produce a hormone similar to Oxytocin to preserve water in the body. This particular hormone can produce labor-like symptoms which may feel like contractions.

Eggplant Parmesan 

If you were to visit Scalinis, an Italian restaurant, located in Smyrna, Georgia, you would find nearly 300 pictures of babies along their walls. What these ‘Eggplant babies’ have in common is they were all born shortly after their mothers had eaten Scalinis’ famous Eggplant Parmigiana, a plate of breaded eggplant smothered in cheese and thick marinara sauce. There is no scientific explanation to this phenomenon but you can visit their page and read comments from more than 70 happy mothers.  Could it possibly be a simple psychosomatic trigger?

 In-laws Visiting

A few of our doctors credited visiting in-laws for accelerating their labor. Though the presence of in-laws can’t be the sole reason for inducing labor, stress can play a factor. Visiting family and in-laws have long been said to be a component of stress. Corticotropin-releasing hormones(CRH), regulates the length of pregnancy and is also a stress response released when the body is under pressure. While normal to low levels of stress may not greatly affect a pregnancy, high levels can cause premature births as reveled by a 1999 study conducted by the American Journal of Obstetrics and Gynecology measured high levels stress in early births.

Shaving Legs

One of our physicians wrote, “Shaving my legs did it for me. I was so nervous about having hairy legs. Went into labor an hour later. Must have been all the contorted positions I had to get into.”

While we could not find any evidence to support this claim, we reasoned the movements of shaving combined with unusual positions may prompt contractions.

Have you tried any of these methods? Do your own unusual or interesting story to share?  We would love to hear them! If you are an MD or D.O., we will be continuing this conversation in Sermo.

This post is not meant for medical advice. If you are seeking ways to naturally induce labor, please see your doctor for advice. 

 

Becoming a Clinical Investigator – Finding the Studies

happydoctor

In this series, we have discussed why you may want to be a clinical investigator, your qualifications, and your site requirements. Assuming you are still in the game, I will in this installment briefly overview how you may find your initial studies. I am assuming that this series of articles has been mostly for practicing healthcare providers, not for academics who have segued to the private sector. This latter category of physicians often has established areas of research expertise with liaisons to industry and most likely have research projects brought to them.

If you are a clinician without ties to a healthcare system that has active clinical research activity, finding trials as a new clinical investigator is a bit more daunting. Initially, this may be analogous to the “kissing a lot of frogs” model. Much depends on your area of specialization, the size of your practice, and your relationship to your pharmaceutical or device representative. If your specialty is of demographic/financial interest to industry, i.e., an area of active research, and you have a well characterized patient base with suitable numbers of potentially eligible patients, it would be useful to let your industry sales representatives know of your interest. Keep in mind that the marketing/sales side of industry is firewalled from the research/investigative side. This means that one side will not/can not talk about the other side of the fence; their continued employment depends on their adhering to that principle. But the sales side, especially when escalated to the regional manager level, can contact the research side to let them know of your interest. You may then be contacted from someone from the research side who will do a feasibility assessment of you and your site (see prior installments in this series).

The sales people may be able to present you with a phase IV (post-marketing) “study”, but these are often marketing strategies as I discussed in prior posts. These are not the research projects you eventually want, but they are the frogs. Assuming you do well in these phase IV studies, or have such a stellar “pre-site visit” interview, the research side may propose your participation in a phase III (late clinical development) project. You will have to perform well, i.e., recruit your agreed number of eligible patients and be “relatively” free of “protocol deviations” and “queries”. That is, you do what you said you would do, and did it well, not causing headaches for the research monitors and sponsor. Success begets success, and non-performance makes you a bad first date.

You can see what trials in your area of interest/specialization are available by checking the listing of recruiting trials. This is an excellent summary of available projects with lists of the studies, eligibility criteria, sponsor information, and study status. One of the reasons why this site exists is to minimize the probability that negative studies will not be published, since once on the site, the sponsor is accountable to the scientific community for the results, good, bad, or neutral (which is the same as bad if you are a sponsor). Although theoretically all studies should be registered, many early phase projects (phases I and II) where the real hard-core science is done, may not be registered so may not be searchable for participation. But the key here is being a successful site in your early trials for which you were selected to participate. Get through the phase IV “frogs” to get to the phase III “prince/princess” trials. Do well there, and you may get offered phase II trials. The intrinsic scientific value and excitement, as well as the potential revenue generation, increases as you move along earlier in the Investigational Product (IP) development cycle.

Once you have done a few trials, you may start getting solicitations from research clearing houses that, for a fee, will offer to introduce you and your wonderful site to sponsors. Although I have no doubt that they may indeed be successful in placing you early in your career as an investigator, I have faith that it will not be a long term requirement based on the principles I have outlined above.

As I have discussed previously, this clinical research series is roughly once a month with a “regular” Cardiology Hub post in between. My next installment will be on how to find the subjects to participate in the trials.

credit:  Irving Kent Loh

Bio:
Dr. Irving Kent Loh
MD, FACC, FAHA (Epidemiology & Prevention), FCCP, FACP is a board certified internist and sub-specialty board certified cardiac specialist with an emphasis on preventive cardiology. He founded and directs the Ventura Heart Institute, which conducts education, research and preventive cardiovascular programs. Dr. Loh is a former Assistant Professor of Medicine at UCLA School of Medicine. He is Chief Medical Officer and Co-founder of Infermedica, an artificial intelligence company for enhancing clinical decision support for patients and healthcare providers.

 

 

Sermo Physician Poll: What Type of Conference Do Doctors Prefer?

medical conferences, physician conferences

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Whether or not you attend medical conferences, they are an embedded part of the American medical system.

We recently polled over 2,500 Sermo physicians and asked what type of medical conference they prefer to attend. The results:

  • 58%  prefer national specialty meetings
  • 45% choose a conference for it’s  location & combined it with a vacation
  • 25%  choose educational conferences of local medical chapters
  • 7% prefer a mix crowd conference; open to multiple specialties
  • 5% do not attend any conferences
  • 4% prefer to attend only medtech conferences

What are the differences between these conferences and why would a physician choose one or the other?

National specialty conferences are usually board specific. The purpose is to bring together physicians in related specialties and sub-specialties.  National meetings offer an array of different workshops, educational tools, and discussions.  Often, there will be buzz of a landmark study released during a conference and you can really feel like you’re part of the action.

Local medical chapter conferences provide the benefits of national conferences but are generally smaller and require less travel time and expense. These are also specialty specific. They focus more on continuing education and provide an opportunity to network with local peers.

Multiple specialty conferences are focused around a specific disease (e.g. diabetes). These conferences are open to physicians, nurses, and other professionals involved with research for the cause.

MedTech conferences focus on innovation in medicine and technology. Think Google Glass for surgery or 3D printers to create body parts.  They are cutting edge and attraction a combination of scientists, researchers and health care practitioners.

How to Choose the Best Conference For You

According to Medpagetoday.com , there are about 100,000 medical conferences a year worldwide. Physicians have the opportunity to work and brainstorm in real time with their peers. Discussions lead to medical advancements and influence the direction of research.

Sciencenews.org wrote “Conferences also can foster a networking among or collegial bonding between people who can afford long-distance travel only on their bosses’ dimes. Chats among these attendees may lead to important collaborations between far-flung labs. And face time with strangers may uncover a new research opportunity or mentor.”

Traveling to conferences can be expensive, especially when factoring in cost of a hotel, flight, car, and conference fee. Physicians should look at budget, practical applications to your practice, and time constraints.  You could always do what 25 percent of physicians do and package a conference around a vacation.

Have you attended a conference this year? We would love to hear your experience. If you’re a physician, we’ll be discussing this further inside the community. Come join us.

 

 

Sources

1. Are Medical Conferences Useful http://www.medpagetoday.com/Blogs/GarySchwitzer/32005

2. Weighing The Costs of Conferencing                   https://www.sciencenews.org/blog/science-public/weighing-costs-conferencing

 

 

Primer on Clinical Research – Investigator Qualifications

qualifications

As promised in the previous post, this discussion is the first of several, laying the groundwork for getting engaged in clinical research. This post will discuss the professional characteristics that may make one an attractive candidate for sponsors and contract or academic research organizations (CRO’s/ARO’s) that actually select the investigators. Future posts will discuss the infrastructure required to successfully conduct trials, including staffing and equipment. We will also discuss how to find and procure the clinical trials. And critically, we will look at strategies to successfully recruit and retain subjects for trials.

My Sermo colleagues encouraged me to do this series when it was just a posited idea. My own background as a clinical researcher has been described in prior posts and will not be repeated here.

First, to be a principal investigator one needs to have graduated from an accredited professional school with a doctorate level degree. This may be a M.D., D.O., or in some trials, a Ph.D. or Pharm.D if co-investigators or sub-investigators are M.D. or D.O.’s and responsible for the clinical aspects of the protocol. Board certification in one’s specialty is desirable, but probably not absolutely required. The sponsors and CRO’s/ARO’s are often looking for capable investigators that have access to the subjects of interest to their protocol. A stellar clinical record without adverse major litigation outcome is a plus. In the pre-selection process, the sponsor/CRO/ARO will want to ensure that you have an adequate patient population to support your participation. Although this may be done by questionnaire, they may also actually physically come out to conduct a site-visit to verify that you are whom you say you are and to see your facilities first hand. This is obviously tough to do if you are just out of training and new to practice.

Once you have an established base of patients with the condition of interest, the rest depends on you and your infrastructure. Although it is a bonus to have been engaged in clinical research previously as a resident, fellow or sub-investigator, it is not mandatory. What IS mandatory is that one understand the principles of randomized clinical trials (I did a TED talk for lay audiences on this subject) and be compliant and adherent with the strict rules of clinical care of research subjects as delineated in ICH (The International Conference on Harmonisation of Technical Requirements for Registration of Pharmaceuticals for Human Use) and GCP (Good Clinical Practice) guidelines which are reviewed at almost every principal investigator meeting

Adherence to patient safety and the integrity of the scientific protocol is paramount in clinical research participation. You will be REQUIRED to sign an FDA Form 1572 attesting to your qualifications and your commitment to adhere to the approved protocol.

Although you may be selected to be a principal investigator (PI) on your first try, it is advantageous to affiliate with an established and senior investigator with a good reputation and serve as a sub-investigator (Sub-I) for a few trials to get comfortable with the process and procedures of conducting a trial. It also affords you the opportunity to meet with sponsors, clinical research associates, and medical monitors who may direct future trials your way as a PI. All of these topics will be expanded upon in future posts.

I am sure there are issues and topics that I have left out that other PI’s can add to this conversation on PI qualifications, but I hope that this gives those of you interested in getting engaged in clinical research a first glance in the mirror to see if this is something you would like to pursue.

Next in the series…Clinical Researcher Site Requirements…

credit:  Irving Kent Loh

Bio:
Dr. Irving Kent Loh
MD, FACC, FAHA (Epidemiology & Prevention), FCCP, FACP is a board certified internist and sub-specialty board certified cardiac specialist with an emphasis on preventive cardiology. He founded and directs the Ventura Heart Institute, which conducts education, research and preventive cardiovascular programs. Dr. Loh is a former Assistant Professor of Medicine at UCLA School of Medicine. He is Chief Medical Officer and Co-founder of Infermedica, an artificial intelligence company for enhancing clinical decision support for patients and healthcare providers.