Friday, 18 Jan 2019

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"A Touch of Humanity": Seven Perspectives on RheumNow

Happy first birthday RheumNow!

In some cultures, the first birthday of a child is quite an auspicious event, with much celebration. Supposedly this hearkens back to older times, when survival of children was much more tenuous than it is at present, so a child surviving a year had by then already lived through myriad challenges to their health and well being. Surviving until age one was not a guarantee that one would live to be an adult, but it was such a good start it was worth celebrating!

Perhaps it is the same for web based enterprises? So many have come and gone and are now but a faint memory. So happy first birthday RheumNow! What is it about RheumNow that makes it special, and gives it great hopes to not only survive, but to thrive?

Of course, it starts at the top. RheumNow is Jack Cush's baby, one he spends countless hours each week on. And it shows. Unlike the other e-mail blasts we get and the websites they take us to, some of which are just excerpted news feeds, RheumNow is of rheumatologists, by rheumatologists and for rheumatologists. Jack and his staff put every single story and bit of data and review up themselves, because they are felt to be important to the rheumatology community. We may not agree with every opinion piece - heck, any of you who know Dr. Cush know that he doesn't agree with himself 100% of the time - but it is always relevant and concise and worth reading. The content is always fresh and new, and it is a resource for our rheumatology community; an aid in keeping up with hot topics and key new information.

So happy birthday RheumNow...those of us who contribute (and I know Dr. Cush is always looking for more people to express their views!) look forward to see how this enterprise grows and develops, and what it evolves into in the future.

--Arthur F. Kavanaugh, MD
Professor of Medicine at the University of California, San Diego School of Medicine
Director of the Center for Innovative Therapy, UCSD Division of Rheumatology, Allergy, and Immunology


Medicine has lost its humanity. We have complacently accepted that government and the insurance industry can define quality medicine. We let them require worthless and meaningless EHR babble instead of patient care. The physician-patient relationship is now the physician- computer relationship. RheumNow has helped bring back a touch of humanity. RheumNow reminds us of the subtleties of the patient interaction. What the complex human patient says, what they wear, where they sit are all clues to better patient care and RheumNow has discussed them all. Their focus on analyzing the research instead of just quoting it, their skills in applying imperfect research to the real life situation, and their highlighting the limits of most sterile controlled trials have helped us to develop the humility that we need. We need these reminders.  Thank you.
--Cody Wasner, MD
Private practice
President, Oregon Rheumatology Alliance


In one year, Jack Cush and RheumNow have established THE paradigm of patient-focused care through the enormity of his beautiful heart and unique mind. While the rheumatologist thirsts for Jack's pearls and nuanced demystification of our field's most complicated issues, RheumNow is, in the end, all about patient care and advocacy. He treats every patient as a partner and, through his brilliant story-telling and evidenced-based delivery, he offers patients straightforward, factual information about their illness and future, enables them to be their own patient advocate, states with clarity what is known and not known, what is real and what is important. No one in rheumatology today has his exceptional ability to make the complex simple, the simple useful and the opaque crystal clear. Jack is the best of us, makes us better doctors and our patients safer and informed. He is the ultimate clinician scholar educator. He models the ideal patient-rheumatologist relationship where the patient is the ultimate manager of their disease making their large and small decisions on a day to day basis that ultimately defines their outcome. The informed patient who works with their informed physicians lead to the best outcomes.
-- Stephen A. Paget, MD
Physician-in-Chief Emeritus
Hospital For Special Surgery


It is amazing how quick a year passes. I was reminded of this when Dr. Cush solicited a comment on his baby RheumNow. As an emeritus professor in Sweden I have the privilege to maintain an office  in my former department, interact with the young people, help organize  meetings, teaching, and on the whole enjoy developments  in the field of science. Covering the avalanche of new information at the root becomes increasingly difficult, not to say impossible. Therefore the risk of missing important news is high and on the rise.

RheumNow in my view fills an useful need. The format of daily updates with a limited number of topics make it an easy read. The weekly summaries cover an amazingly wide number of subjects and should perform a lead for readers to go to the source. But all this would be of  little  help unless  one were to fully trust the Editor’s integrity and quality.

Much of the irrelevant noise mail we all receive daily is easily identified and deleted, but the mere quantity makes it time consuming. On average I spend not less than one hour sorting out incoming messages.

The daily RheumNow messages belong to the popular content of the  inbox, because the  information is brief and well categorized. It provides  information from sources I am  not familiar with and do not usually consult. In particular I look forward to the summary  of the week. I can not really suggest any improvements and only hope that RheumNow will continue in its present shape, and hope that it will attract contributions from a good number colleagues like David Pisetsky and others.

Being a “simple clinician”, contributions  like the  one  on the discrepancy between patient’s and physician’s estimate of the disease control, are very appreciated. Some material on geographic differences in treatment strategies and traditions could be  useful. One example: Is a penicillamine derivative bucillamine still a widely used DMRD in China?
--Frank A Wollheim, Emeritus professor
Department  of Rheumatology, Lund University


In rheumatology, there have been unprecedented advances in understanding the biological and molecular mechanisms underlying the broad spectrum of disorders that we manage. Although this began decades ago with basic disciplines such as immunology and molecular biology, it has only been recently that this understanding has translated into great therapeutic advances, especially for immune mediated inflammatory disorders such as RA and lupus. Increasingly, new treatment strategies are based on a sound fundamental understanding of the molecular and cellular mechanisms underpinning the observed clinical phenomenology. Getting an understanding of these mechanisms and how they relate to clinical rheumatology practice requires expert synthesis of a large volume of rapidly evolving literature.

RheumNow addresses this niche particularly effectively. The expertly curated updates span the full spectrum between basic science to clinical practice. Syntheses of new information are concisely presented by internationally acclaimed opinion leaders. The updates are equally relevant to practicing clinicians and clinician scientists. Although there are multiple online and social media sources available that undertake this challenge, Dr. Jack Cush and his colleagues are particularly effective in presenting state of the art information in a concise and accessible manner. One is reminded of the highlight session that Dr. Cush undertakes with Dr. Kavanaugh on the final day of the annual ACR scientific meeting. Scientific highlights from the meeting are presented in an engaging manner, with basic advances seamlessly juxtaposed with clinical advances.  

In today’s deluge of information on the web and on social media, we need to be highly selective in choosing information sources that keep us up to date. RheumNow, which is available on popular and accessible social media formats such as Twitter, Facebook, and Linkedin, presents new information in the way I want to see it presented. This is because it is edited by highly knowledgeable and trustworthy colleagues who filter and process information the same way I do. Thanks RheumNow!  
--Hani El-Gabalawy, MD, FRCPC
Scientific Director | Institute of Musculoskeletal Health and Arthritis
Canadian Institutes of Health Research/ Government of Canada
Professor of Medicine and Immunology
Endowed Rheumatology Research Chair
University of Manitoba

In my role as physician scientist and Division Chief, time is of the essence so I am interested in sources of rheumatology content that are informative yet focused. RheumNow meets those needs  in several ways. I find the majority of stories in the Featured section of interest. I can even hone in on areas of specific interest on the tool bar. I particularly enjoy the videos that review recent developments which are wide-ranging in content. It is always a pleasure to read the wine blog by Len Calabrese, and David Pisetsky always enlightens me with great pieces that are well written like the absence of photos of early autoimmune and inflammatory diseases on Google Images. The Downloads are also great for fellows and residents and even a few of us more senior attendings! Lastly, the social page is a great way to get the pulse of other rheumatologists on a variety of topics and issue. In summary, RheumNow is a great resource for the  practicing and academic rheumatologist.  Jack- you hit a homer on this one.
-- Christopher Ritchlin, MD
Professor and Chief Allergy, Immunology & Rheumatology Division
University of Rochester
Rochester, NY

Jack Cush’s RheumNow daily digest is, in my opinion, a must read. Some may find this statement strange coming from a non-rheumatologist. But being one of the founding fathers of cytokine biology, and particularly IL-1, the use of biologics in the treatment of autoimmune and autoinflammatory disease has validated cytokine biology in clinical practice more than any other medical subspecialty. Jack was from the very beginning a key opinion leader on the use of biologics. My personal experience with Jack at meetings were always a learning experience for me. So this learning experience continues each time I read RheumNow. I almost never miss reading the whole issue. Its layout is easy. Congratulations, Jack!
--Charles A. Dinarello, MD
Professor of Medicine, multi h.c.
Member, United States National Academy of Sciences
Foreign Member, Royal Netherlands Academy of Science

The author has no conflicts of interest to disclose related to this subject

Rheumatologists' Comments

Seriously, RheumNow is my favorite daily... Who other than Jack would allow me to write about Wine and Rheumatology, Ooops I owe you a few blogs Len Calabrese