Improving research and practice-changing pearls

3 minute read

Dr Mike Putman talks about his research interests, including meta research, and Dr Tina Ko shares some clinical learnings.

Today it was my great honour to have one of my personal heroes here on the podcast, rheumatologist Dr Mike Putman.

Mike is based at the Medical College of Wisconsin, where he’s an assistant professor. He has a clinical interest in vasculitis and also does some epidemiology work.

“I’m working on some database studies, I’m very interested in big data. So that’s my growth area and I have two or three abstracts here using various datasets.”

Mike talks about his vasculitis research and other research projects, which include PJP pneumonia and meta research – researching research.

“What we do is we ask questions, like: how good is our research agenda? How successful are we at what we’re doing? What are we doing wrong, we could be doing better. And so I have a couple of abstracts on those projects here as well.”

As for what would make better research?

“If I had a vision for the future that I could just impose, it would be that all of us joined big pragmatic trials, where we would randomise people to therapeutic interventions and see how they work.

“I mean, if you ask yourself in sarcoidosis, what is the first line therapy? Nobody knows. Ask yourself in myositis – should I lead with methotrexate, azathioprine, mycophenolate, tacrolimus or IVIG? Or some combination of the above? Nobody knows. It’s kind of unconscionable that we don’t know the answer to those questions, and I think that we could answer them.”

Mike also runs his own podcast, the Evidence Based Medicine – Rheumatology podcast.

“I started it as a project when I was a fellow, because I wanted to make sure that I was still reading the medical literature and I loved listening to podcasts. I said, maybe I’ll read a study and then podcast on it. So I started doing that when I was a fellow and found that I really enjoyed it.

“As a doctor, it’s helped me stay current and kind of challenged me to be better at reading trials and better at understanding where the evidence sets.”

Despite envisioning an Australia where dingoes run riot, he’s keen to come out if anyone wants to host him?

Dr Tina Ko is a consultant rheumatologist at Monash, and was particularly keen to attend sessions on connective tissue conditions.

“There’s been a couple of good myositis sessions and scleroderma sessions, I listened to a really good scleroderma talk this morning.

“The main take home message from the talk was microvascular manifestations about the pathogenesis of scleroderma, how that affects a lot of sort of unseen, silent conditions, and how we should probably be thinking about combination therapy in terms of immunomodulatory as well as vascular management. So that was quite interesting.”

As for learnings that may change practice, Tina found the Pearls and Myths session, run by John Stone, useful.

“One of the myths that he was debunking was that ACE inhibitors should be used as prophylaxis for scleroderma renal crisis. In fact, using ACE as a prophylactic therapy may set up a chronic, less reversible process. So, we probably shouldn’t be using that.”

And in good news at last for the Philly cheesesteak, after queuing for 20 minutes Tina reckons “it was worth the wait”.

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