Clinical Conversations

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Dr. Paul Sax writes the closest thing that the NEJM Group has to humor. He’s serious, of course, since his blog “HIV and ID Observations” concerns all things infectious . But he sprinkles in the odd cartoon or links to … dog videos, fer cryin’ out loud.

He scours the ID literature (and we must include the social-media literature in that category) for interesting stuff to write about, seems to have a knack for summarizing whole conferences in 750 words, and often manages to give his readers a reason to smile in these fretful times.

We decided to catch up with him and ask him about his inspirations and for his advice. He doesn’t disappoint.

Running time: 10 minutes

Paul Sax’s latest “HIV and ID Observations” blog: “Carbapenems and Pseudomonas, Lyme and Syphilis Testing, a Bonus Point for Doxycycline, and Some Other ID Stuff We’ve Been Talking About on Rounds”

TRANSCRIPT:

Joe Elia: This is Clinical Conversations. I’m your host, Joe Elia. The current pandemic is leaving its mark all over the place, and one obvious area is in medical research. Clinicians are often hearing about new findings on their car radios on the way home or on social media. The credibility of that information is key.

Our guest, this time, is Dr. Paul Sax. He’s a contributing editor on NEJM Journal Watch Infectious Diseases, Clinical Director of the HIV Program, and Division of Infectious Diseases at Brigham and Women’s Hospital, and also a Professor of Medicine at Harvard Medical School.

Globally, he’s probably best known for his lively blog, “HIV and ID Observations,” which he posts almost every week on the NEJM Journal Watch site.

Welcome, Paul.

Dr. Paul Sax: Thanks, Joe, for inviting me.

Joe Elia: I’ve been reading your most recent blogs, which I’ll remind listeners are all available at Blogs.jwatch.org. One of the most recent is titled “Reaching Out to Infectious Disease Doctors in COVID-19 Hotspots: You must be truly exhausted.”

I get the sense that you’re talking more to working clinicians than policy makers or professors like yourself. Whom do you imagine is reading your observations?

Dr. Paul Sax: Well, I actually meant it for the entire infectious disease community. Kind of, if you think back a million years ago, to March 2020, we were starting to hear about this terrible thing that was coming our way. We all knew it was coming, but we didn’t know exactly when it was going to happen, and then it happened at different times in different parts of the country. So, while we were preparing here in Boston, and New York City was getting slammed, other parts of the United States were preparing, too, but they didn’t get hit the way we did in the Northeast.

So, you know, I have colleagues in Alabama and Atlanta and Florida and Texas and Arizona, and you know, things were pretty quiet there. They did have occasional cases, and what happened was that, unlike here, where we really got hit hard (and we fortunately, at least for now, knock wood, things are very quiet, for them,) they had a period of relative quiet and then, a large number of cases. So, they’ve had to sustain this intense involvement with COVID-19 response right from the beginning. Very tough.

Joe Elia: Yeah. You’ve been at this for just over 12 years, with the stated purpose, and I’ll quote, “Commenting on interesting HIV, infectious diseases, and other medical and not-so-medical news.”

Is that still your purpose and what has the reaction been over the 12 years?

Dr. Paul Sax: Well, it’s been really gratifying — and gratifying in a way that I never could have imagined. You know, I’ve always kind of imagined myself someday becoming a writer. I’m a frustrated comedy writer. Never quite made it to Hollywood, but I went to medical school and I went into this fascinating field, and I thought, you know, “Why not write about infectious diseases?” And I’ll tell you, my inspiration for the format really were some of the great blogging in the early 2000s, mid-2000s, where writing just exploded on the internet and I thought, “Wow, all this great writing available for free. Let me try my hand at it,” and I’ve got to thank Matt O’Rourke at NEJM Journal Watch for giving me the opportunity to do it.

Joe Elia: Well, in the not-so-medical department, you’ve been known to sprinkle in cartoons and lately, dog videos: “Olive and Mabel,” two Labradors. I’ll just say it’s British genius comedy, but what’s that got to do with infectious diseases, Paul?

Dr. Paul Sax: Well, you know, there’s this strategy that every infectious disease doctor does when you’re talking to patients — is you ask them about their exposures, and one of the ways we ask about exposures is you ask about pets, and of course, I wouldn’t probably be so fixated on the dog videos if I didn’t have a dog myself, which I truly love, but there is this sort of funny aspect of infectious diseases where you ask someone about their pet, and then they look at you like, are you out of your mind.

I remember one unfortunate person who had a motorcycle accident and we got to the point where we were asking about pets and he then acknowledged that, yes, he did have a new parakeet, and then our infectious disease fellow I was working with said, “What’s your parakeet’s name?” And he told us: Fruit Loop. And I thought, that’s a very funny name. Of course, it had nothing to do with his motorcycle accident, or why we were seeing him, but there are times when it is highly relevant, and you know, there have been many times when we’ve seen people, and for example, they’ve acquired an infection from their pet and sadly, sometimes it is their beloved dog.

Joe Elia: Now you’ve confessed, already in this interview, to wanting to be a comedy writer, perhaps, and maybe even a standup comic when you were younger. What deflected you from that noble cause and was there a book or an experience, an infection or something that deflected you?

Dr. Paul Sax: So, yeah, well, probably the thing that deflected me the most, and I’m going to say this because I’ve acknowledged this on the site, is my father. My father, who is a physician himself, comes from a long line of physicians, and his attitude, essentially, was, if you’re okay in science, then you become a doctor. And he could not understand why his son, who was okay in science (that’s me) would consider doing something like comedy writing. He basically said, “Just go to medical school and then after that, if you still want to be a comedy writer, see if you can make it work.”

So, thanks, Dad. I mean I really love my field. I find infectious diseases fascinating from A to Z and beyond, and it’s always challenging, never more so than today, and you know, I get to do somethings that are sort of vaguely related to comedy writing.

I do want to also say, that in college I had some truly outstandingly talented friends who became professional comedy writers and frankly, I don’t have their chops.

Joe Elia: You can drop some names if you’d like.

Dr. Paul Sax: Yes, well, he was very kind t let me interview him about his own experience with a life-threatening disease, but one of my friends was Andy Borowitz. Andy Borowitz, of course, is a prolific writer writer now for the New Yorker mostly, political satire, but he’s just an extraordinarily talented person. And then another brush with greatness is Conan O’Brien. Conan O’Brien was a college friend of mine, and his father actually is an infectious disease specialist, so it all comes round, eventually.

Joe Elia: Now you serve as a kind of medical-cultural reporter on rather mysterious viral infections — HIV and COVID-19. Information on these diseases — and especially now, COVID-19 — comes at us unremittingly. Is it a hopeless task to try to keep up, or is it essential to try to keep up, and how do you, as a reporter, keep up for other clinicians?

Dr. Paul Sax: Well, I would say it’s essential to keep up and the way that we keep up is different from the way it used to be. You know, it used to be, you would get your journal mailed to you every week or every month, depending on the frequency, and you would pore over the table of contents, and read the abstracts, and the interesting papers. You’d read the methods, et cetera, and then the results.

Now, rapid fire medical information comes at you really quickly. I want to say that there are some good things about Twitter. Twitter actually is a great place to see medical information very quickly, but it’s not adjudicated, so the next step, after seeing that information, is to try to look at it critically

And I think a really good example of that is the dexamethasone treatment for COVID-19. The first I head of that was, of course, on Twitter. This group in Britain was promoting their results and it was very exciting that they had a press release showing a randomized clinical trial had improved survival with dexamethasone, and I kind of made the point after seeing their summary, that it should become standard of care for people with COVID-9 and met the criteria that used in their trial. And as a result, practice-changing. Their study was practice-changing and now it has been given the blessing of the New England Journal of Medicine, and I think we can say without much risk of bias that that is very high praise indeed, to be accepted as a paper in that journal.

Joe Elia: Yes. I think you’re right. And finally, as a reporter yourself, is there a question you wished I’d asked that I didn’t?

Dr. Paul Sax: Well, you know, one thing I do on my blog, is I try to write in my own voice, and that is something that I feel like medical journals could use a bit more of, and if I were to give some feedback to some of the medical journals, it would be this, it would be that there is a role for the human beings voice in the august pages of these journals. It doesn’t all have to be edited to fit the house style. So, that’s one pitch for that.

Joe Elia: Okay. That’s good advice, I’ll pass it on.

Dr. Paul Sax: Please do. To my good friend, Dr. Eric Rubin.

Joe Elia: Thank you, Dr. Sax, for talking with us today.

Dr. Paul Sax: Thanks, very much, Joe.

Joe Elia: That was our 272nd episode. All of which are available free at podcast.jwatch.org. Our executive producer is Kristin Kelley, and we come to you from the NEJM Group. I’m Joe Elia. Thank you for listening.