HIV and ID Observations

Last week, Dr. Wendy Armstrong from Emory kindly invited me to spend some time with their smart, energetic ID fellows.

(See if you can pick me out of the group in the photo at right — hint, I’m the old guy on the left.)

Before the trip, Wendy asked them whether they’d rather hear me give a talk entitled “Evolution of Antiretroviral Therapy” — or alternatively, something about writing this blog, which has just celebrated its 10th Birthday (see colorful banner above).

The email I got back from her was unambiguous:

100% chose the blog.

Although their decision might be viewed as a dismissive of my command of HIV treatment (never!), the good news is that giving this talk gave me a chance to reflect on the 10 years of the blog’s existence.

Before going through the data unearthed by our crack team of research scientists, a little bit about its beginnings. Inspired in the late 2000s by the writing that exploded on the internet about everything, I pitched something similar to the folks at NEJM Journal Watch. 

It would be about ID, HIV, and whatever else happened to be swimming around in my head on any given day I had time to write something. That was it.

Fortunately, they said yes — thank you! I am also grateful to the community of readers who show up here regularly, interact in the comments section or on Twitter, and teach me (and other readers) so much.

Let’s move on to the data, all of it 100% verified by the Centers for Disease Control and Prevention and the World Health Organization:

• Proposed blog titles. Infectious Enthusiasms. Infectious Observations. Infectious Insights. Sax, Bugs, and Drugs. Point of View Blog. As you can tell, none of them was a clear winner (and some were pretty terrible), so we went with the current one, bland though it may be!
• Total number of posts = 648. That’s one post every 5.63271604938 days. (Approximately.)
• The most common posting day is Sunday. It’s not particularly close, either. Guess how I spend at least part of my weekends?
• First post, March 20, 2008:  How to Solve at Least One Part of the Healthcare Mess:  ADAP for All. The basic premise here was that with the AIDS Drug Assistance Plan (ADAP) working so well for HIV treatment, why not expand it to other disease areas? Perhaps it was not the most incisive analysis of our troubled healthcare “system” – still, I thought it might raise a few chuckles and generate conversation. Indeed:
• First comment, March 26, 2008:  Comments got off to a bruising start, courtesy of “David”, who wrote: “You propose a National plan that only takes care of the patients in your specialty. This is an amazingly irresponsible, greedy, self centered plan … Wake up — it’s not just about you.” Sorry, David — if you read what I wrote (I know, a challenge) … oh, never mind.
• Total comments: 3,392. Some of you are regulars, and I especially thank you.
• Total spam comments:  37,861. This proves without a shadow of a doubt that spam bots are fascinated with Infectious Diseases. Who can blame them?
• Total number of page views:  1,996,042. I’m pleased to announce that the person responsible for page view number 2 million will win a free subscription to this blog. And yes, I plan on continuing to use that joke whenever possible.
• Where are the readers from? All over! (See map.) An ID physician from Korea once approached me in the airport, and asked me about doctors named Morgan. I kid you not.
• Most viewed posts.  HIV and Hepatitis C Are No Longer the Most Serious Infectious Threats to People Who Inject Drugsis #1. Other big-time favorites:  
  –Why ID/HIV Specialists Rank Last in MD Salaries
  –The Most Common Question About the New HIV Testing Algorithm, Answered
  –Clindamycin vs. TMP/SMX for Soft Tissue Infections: A Clinical Trial That Needs Some Marketing
• Most commented posts:  the ID caption cartoon contests, of course! Thank you Anne Sax for your drawings! But if you subtract those, the most commented is (again) HIV and Hepatitis C Are No Longer the Most Serious Infectious Threats to People Who Inject Drugs, followed by (in order):
  –Mystifying Abbreviations on Daily Medical Rounds, 
  –Should Doctors Still Be Allowed to Wear White Coats? You Decide
  –Are ID Doctors the Worst Dressed Specialists?
  –Can We Solve the Morass of Outpatient Intravenous Antibiotic Therapy?,
  –A Ridiculously Long Post: How EHRs Expose Unspoken Hierarchies Within Medicine — Or Maybe Are Just Bad.
• Common blog topics? ID is a great specialty, with great conferences, and should not be undervalued. ID Learning units (a chance to teach). Rants about EMRs, fax machines, beepers, OPAT, Boston weather, and “HAART” (ugh). ID Link-o-Ramas. Curbside consults, in all their glory. Tributes to ID heroes. Really Rapid Reviews® — which are summaries of the major HIV conferences done (unsurprisingly) really rapidly!
• Most likely posts to generate controversy and negative comments. In ID, the leaders are Lyme Disease and chronic fatigue syndrome, both of which deserve much better research and treatments. Surprisingly, quinolone antibiotics are also a hot-button topic. Of course, anything about politics. Reminder, as a polite and civilized ID blog, we have a moderated forum — which means that nasty, threatening, or hateful comments that don’t adhere to our guidelines get nixed. Sorry.
• Total number of posts that mention baseball and/or dogs? Lots. Amazing how often these subjects (ID and baseball, ID and dogs) can overlap, provided you have the right mindset. Here’s your baseball list. Specifically, all-stars Tom Seaver, Derek Jeter, Nelson Cruz, Alex Rodriguez, Ryan Howard, Ryan Braun, Roberto Alomar, and Edgar Martinez (among others) all found their way onto this blog — no doubt much to their surprise. And here’s your dog list. Louie is a particular favorite — click here, if you dare — what’s not to love?

We’re collaborative and hard-working clinicians.

Of course there have been challenges. Finding good copyright-free images is always tricky. Who wants a frivolous lawsuit because we happened to use a cherished (and legally protected) picture?

This concern explains the 100% legal but strangely artificial stock images that show up here periodically — which I enjoy mocking whenever possible.

Probably the most common question I get asked by colleagues is “Why do you do that?” Usually I answer with a superficial, “Because it’s fun,” but on further thought, it’s more than that.

As you know, most academic writing is quite formal. The writing one does for research papers in particular must include the perspectives of multiple co-authors.

Then, once the journal gets it, it’s further edited to suit their style. By the time of publication, the original text reads like it’s been through a powerful prose homogenizer machine — everyone sounds the same.

Here I can say whatever I like (within reason), include jokes and funny images and videos, and actually sound like myself. It’s a great privilege, and a true joy.

So to Matt O’Rourke, Catherine Ryan, Kristin Kelley, Amy Herman, Kelly Young, and Bob Dall — all at NEJM Journal Watch — I thank you again.

And here’s my latest sports discovery, Flyball.  Hey, what a perfect name!