A weekly dose of medical literature
One case involves a middle-aged man who had been experiencing pain just above his wrist. His physician took X-rays and discovered that the lower part of the tibula, the smaller bone of the forearm, had suffered a strange loss of bone material. After pondering a few possible causes, the doctor decided to cover all the bases by X-raying the other arm as well. He was astonished to find the same defect on the other side.
It's late afternoon on a Wednesday and Prof. Friedrich C. Luft is spending it the way he always has, with very few exceptions, over the last 20 years. Fred started the Clinical Journal Club (CJC) shortly after taking up positions at the MDC and Charité as a research group leader working on blood pressure. The original plan was to run a rather typical journal club, in which students read important articles and presented them to their peers. No one has time to keep up with all the important literature in a field; this is an effective way to distribute the effort. But within a few weeks, Fred saw that the traditional format wouldn't work. He could sympathize with the reasons.
"The medical students and clinicians had so much on their plates that they weren't finding the time to prepare a story," he says. "It also meant that they lacked the time to read two journals that every clinician really ought to – the New England Journal of Medicine and the Lancet. So I figured I'd better do it for them."
So for two decades Fred Luft has painstakingly gone through both publications, predigested their contents, prepared slides, and written up a preview that goes out to the staff of the MDC and Charité. If you are staff and haven't seen those e-mails, you should. They advertise the upcoming Wednesday session (which will be "stunning", "exciting", "smashing", or "amazing", depending on his mood). Terse summaries of a lot of material are interspersed with the occasional ironic and sarcastic remarks Fred is known for – they keep his blood pressure down.
In a recent mail, for example, he talks about a review on "...workplace violence against health care workers (Gesundheitsversorgungszulieferer). Political correctness I suppose mitigates against calling people doctors and nurses anymore... Interestingly, the phenomenon of violence against physicians is rampant in China. Insufficient Tai Chi I suppose."
If he can devote one concentrated session to his preparations, he says, the process takes him a little more than half a day. He tries to do it on the weekend; by Wednesday he's got to be ready for his one-man show. The first item is usually a puzzle from the latest edition of NEJM – an X-ray or some other image, taken from a real patient, which poses a diagnostic challenge. A few ideas are tossed around and rejected by the audience before Fred leads them to the solution. Then he moves on to the next slide and the first article, which he summarizes using some of its data and charts.
While the stories change from week to week, there are recurring themes that reflect broader issues. One is the attempt to integrate very new discoveries regarding the molecular causes of disease with medical observations and practices. Are diagnoses obtained through "-omics" technologies really better than those produced by decades of experience and careful observations of patients? Not necessarily. When reporting on drug studies, Fred consistently establishes a connection between the disease, its underlying mechanisms, and the action of the drug. Not always easy.
The journal club usually attracts at least a dozen direct participants, and often the number is larger. Recently the CJC has been expanding through media: it is now regularly broadcast via Webex, which allows Fred to do the show on the road, and the latest editions have been posted on YouTube. The CJC website tells you how to watch a live stream of the show.
Visitors from the molecular side of biomedicine will likely experience a bit of culture shock: most of the attendees sport the white coats that doctors wear on their rounds, and they speak a different lingo. If you've never studied anatomy, trained to be a surgeon, or inspected the labels of common drugs, you'll get lost from time to time. It's also useful to understand the criteria by which patient groups are broken down and the controls that are needed for clinical studies – otherwise, by the time you've figured out the charts, the discussion has moved to the next topic.
Some of the attendees are fans of the band who have been coming since nearly the beginning. They've followed Fred through changes of location – from the first meetings in the old Virchow clinic, on the old campus on the other side of Buch. When it was closed about ten years ago, the group relocated to the MDC campus. As it enters its third decade it has moved again to a seminar room in the HELIOS hospital. That's where most of the participants work.
Crossing the road to the MDC would only take a few minutes, but for the audience of the CJC, time is the most precious of commodities. And in addition to the knowledge and decades of experience that Fred Luft brings to the CJC, its real value lies in all of those days, over all of those weeks and years, that he has sacrificed. Without the club, each individual who attends would have to spend at least that much time reading the material. Estimating conservatively, Fred has probably given at least 450 days to this effort over two decades. In doing so, he has given an entire generation of physicians and scientists an amazing gift.
