Does Your OR Have a Black Box? TikTok Drug Influencers; Clashes at Online Journal

Welcome to the latest edition of Investigative Roundup, highlighting some of the best investigative reporting on healthcare each week.

Hospitals Install 'Black Boxes' in Operating Rooms

In an effort to improve performance, 24 hospitals in the U.S., Canada, and Europe are using the what's called the OR Black Box to gather detailed information about what goes on in operating rooms (ORs), the Wall Street Journal reported.

Like the black box on an airplane, this system collects information that can be reviewed later, including video, audio, patient vital signs, and other data from devices in the room. The data can then be used to reduce errors, improve patient safety, and make OR processes more efficient. It also allows hospitals to try to figure out how an operation went wrong if there was an error.

Some OR staff were initially skeptical of a technology that they worried could be used against them, but the chief quality officer at the University of Texas Southwestern Medical Center told the Wall Street Journal that after staff were reassured about the data that would be collected and used, "it quickly became an accepted part of the hospital's culture."

Device maker Surgical Safety Technologies said the system blurs out faces to de-identify patients and personnel.

UT Southwestern Medical Center is using the system to understand what practices high-performing operating teams use. Duke University Hospital is using their black boxes to improve patient positioning and improve skin and nerve injuries. It's not yet clear whether or not the technology could be used in medical malpractice litigation.

TikTok Influencers Give Medical Advice Without Disclosing Pharma Ties

Drug companies pay TikTok "patients" with large followings and little to no medical background to promote their products, but few regulations ensure that the financial relationship in sponsored social media posts is actually disclosed, according to the Guardian.

Influencers' relationships with their followers, and their authenticity in disclosing personal medical journeys, make them particularly attractive to pharmaceutical companies. But in a social media arena with disappearing videos or reels that are later removed, it is harder to track and regulate advertising than it is with television and print, the Guardian reported. In addition, the U.S. already has some of the most permissive laws around drug marketing, being one of only two countries that allows direct-to-consumer ads.

While federal law requires drug companies to disclose how much they pay doctors, there are no such rules for patient influencers, according to the Guardian. If an influencer doesn't reveal that they're being paid by a pharma company, there's no way to tell if an ad should be regulated, the article stated.

Erin Willis, PhD, of the University of Colorado Boulder who studies patient influencers, said that while there are no published figures on the practice, it's clear the industry is booming. At a talk she gave to pharmaceutical marketers, she asked who in the audience used patient influencers, and nearly everyone raised their hands.

Clashes at eLife Over New Policies

When the online life sciences journal eLife announced that it would publish every paper sent out for peer review, the decision was met with both praise and sharp criticism -- the latter coming from the journal's own academic editors, according to Nature.

In an effort to remove some of the more prohibitive aspects of gatekeeping in science, eLife editor-in-chief Michael Eisen said the journal would not reject any of the papers after peer review, but would instead publish the reviewers' reports alongside "a short editorial assessment of the work's significance and rigour."

This had followed an earlier decision to publish all submissions as pre-prints online. These moves are meant to, according to Eisen, promote "the evaluation of scientists based on what, rather than where, they publish."

The changes have been met with significant pushback, including from 30 academic editors who have signed letters with their intent to resign if the no-reject policy is fully implemented.

Editors even wrote to the executive director of the journal's publisher calling for Eisen's removal, saying he had dismissed their concerns and not considered a compromise or a slower move to the model.

"They worried it would diminish the prestige of a brand they'd worked hard to build," Nature reported. Some have asked for more time to, for example, run another journal alongside eLife for less significant papers. They also argued that removing rejections would only put more weight on the step before: sending papers out for review in the first place.

Eisen and a number of supporters argue that journals should not always be the arbiters of what is significant, and that the new system "puts power back in the hands of the authors, who can then publish what they have, instead of having to do ever more experiments to satisfy reviewers." This process can also be expensive. "It's the future, where science is going," senior eLife editor Panayiota Poirazi told Nature.

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