Taking Slow, Deliberate Baby Steps

I cannot understand why biomedical jounals (with rare exceptions) do not have places online for discussion of articles. How many people actually get their act together to write a formal letter to the editor, especially when that sort of publication counts for next to nothing on your CV?

In contrast, a lively discussion can occur in the blogosphere if you do not place too many barriers to participation.

I think the American Society of Nephrology finally gets it!

In the last couple of weeks they quietly rolled out an interactive blog with Disqus sign-in for comments. Yesterday the ASN overlords tweeted about the site, so it's now fair game for me to blog. Yes, the ASN tweets; over the past year they have established an active social media presence in a number of venues.

Normotensive Dipper (Click to Enlarge)

Hypertensive NonDipper (Click to Enlarge)

Now they've built it, and we should click! The latest post regards a study showing that bedtime administration of blood pressure medications in chronic kidney disease patients significantly reduces the risk of stroke and cardiovascular events. Why should that be? Well, normal people have an overnight "dip" in blood pressure while they sleep (upper image at left). Even patients with hypertension may retain a "dip" and have a better prognosis than patients who lose the dip. Many hypertensive patients lose their "dip" (lower image), sometimes even before their daytime blood pressures become elevated!

Overnight level of hypertension and lack of "dip" indicates greater cardiovascular risk than daytime blood pressure levels. Giving at least one dose of antihypertensive therapy at bedtime can lower overnight blood pressure and restore a more normal physiological (dare I say circadian?) pattern.

So click over and help get some chat going on the site if you care about kidneys and related science and policy. It's also an example of how mainstream journals can open up for discussion without the risk that their official site will get cluttered with spam and trolls.

Keep this effort in mind for ScienceOnline2012. On Saturday at noon I will facilitate (at an un-conference do I un-facilitate or obstruct?) the discussion on the resistance of journals and media to blogging and online post-publication review of the scientific record. See you in North Carolina!

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