The Value of Openness: The PatientsLikeMe Blog

This year PatientsLikeMe was the major sponsor of the 18th International ALS/MND Symposium held in Toronto, Canada. Research scientist Paul Wicks, marketing officer Lori Scanlon, and community liaison Emma Willey were all in attendance to tell people about the site. We first started telling the ALS/MND community about us at the Yokohama conference in 2006, with Paul walking doctors and researchers through the site on a laptop. This year we decided to invest more in setting up an eye-catching booth which had people coming up to us to admire our space-age gadgets as much as to see the site!

Over the course of 4 days we spoke to hundreds of conference delegates. Many doctors had said that they had been invited to join the site by their patients and were curious to find out more. We were able to use our new Google Mapping feature to show them where their local patients were, which had people queuing to see who they knew that was registered on the site! Several researchers were also interested in forming collaborations and we hope to be able to get our users involved in more research over the coming year.The most common questions people had for us were:

- Do people really want to know about their progress?: Our answer would be that PatientsLikeMe allows them the option to find out if they choose. Many professionals feel that it is their responsibility to protect patients and carers from distressing information. However, we believe that everyone’s information-seeking preferences are different and by giving people the choice we are empowering them.

- Don’t you get a lot of people pushing their products?: We have a few ways of preventing this. First there is our community of members, who are a very switched-on group. If anybody posts something suspicious or overtly commercial we normally hear about it in a matter of minutes and are able to respond appropriately. Secondly we have a clear emphasis on sharing what has been helpful, but we ask people not to try and persuade others to change their regime; that is a choice for them to make. Finally, by giving patients the tools to look at each other’s outcomes, we encourage people to put their data where their mouth is. If “supplement x” has worked wonders for them, we would encourage them to enter in their data so other people can see for themselves.

- What does this cost patients?: Nothing! Because our business model involves partnering with pharmaceutical companies to encourage their participation in disease communities, we don’t have to rely upon advertising, spam, or subscription fees to sustain our activities. We feel that being a neutral space from the perspective of industry and non-profits is best for everyone.

- Can we tell our patients about this?: Sure! We’d like nothing more. In the new year we’ll be distributing leaflets to all the ALS/MND clinics we can find so that they can invite patients and caregivers to join us.

On the penultimate day of the conference, one of our research team, Paul Wicks, gave a platform presentation describing PatientsLikeMe and presenting some of the research that’s been carried out on the site.

His talk was met with an enthusiastic response and was identified as a highlight of the symposium by several delegates. Click the video below to hear Paul take you through his eight minute presentation.

Without doubt, one of the most inspiring parts of any conference is meeting up with our users, and we were thrilled to see a few of them at the conference. We heard how PatientsLikeMe helped them understand more about their condition, meet other users in their area, and made them feel like they were a part of the fight against ALS/MND. Next year the conference is in Birmingham, UK, and we look forward to having lots of ground-breaking research to show off there!

The first thing we experience about yawning is an urge to do so, one that can be so hard to suppress that we end up gulping down an extra serving of air when we’re trying to appear interested, or polite, or awake. But what if you yawned even if you weren’t tired, or bored? What if you got attacks of yawning six, seven, eight times in a row that you couldn’t stop? This can be a problem for some patients with ALS, and it’s made worse by the fact that due to weak jaw muscles they could dislocate their jaw.

That’s why I was particularly interested when a news report on PatientsLikeMe listed “increased yawning” as a symptom of ALS. It occurred to me then that we had in front of us the perfect way to investigate excessive yawning in more detail. The first step was to set up “excessive yawning” as a primary symptom in ALS, meaning that all new members would be rating whether they felt it was mild, moderate, or severe. Coincidentally, a paper had just come out which reported two patients (not with ALS) with excessive yawning after being prescibred an SSRI antidepressant drug. We now had a couple of different hypotheses we could test out; first that yawning in ALS was associated with respiratory funciton, second that it was associated with SSRI use, and third that it might be something to do with emotional lability. I took the new publication as an opportunity to write a letter to the editor on the subject. I wrote:

254 patients (47%) completed the survey on excessive yawning. Excessive yawning was reported to be absent in 75 patients (30%) mild in 75 (30%), moderate in 81 (32%), and severe in 22 (9%). Using Spearman’s Rho there was no correlation between severity of yawning and age (r = −0.63, P = 0.329, n = 244) months since diagnosis (r = −0.032, P = 0.619, n = 250), or the last recorded measurement of forced vital capacity (r = −0.136, P = 0.99, n = 148). There was no association between yawning severity and anti-depressant usage (χ² = 3.269, P = 0.352). However, there was an association between yawning severity and site of onset (χ² = 18.705, P = 0.028). Patients with a bulbar onset of disease were more likely (57%) to have moderate or severe yawning than patients with an arm onset (42%) or leg onset (31%).

So, from this data it looks like we can reject hypothesis one (breathing) and hypothesis two (SSRI use). But what about emotional lability? The reason I thought it might be a factor is that, much like uncontrollable laughter and crying, people yawned even when they weren’t sleepy and had difficulty with inhibition. Emotional lability is also found to be much more common in the bulbar-onset form of ALS relative to limb onset forms. Our own stats show a moderate but significant correlation between the two symptoms (r=~0.3) , and at the recent ALS/MND International Symposium in Toronto one of the speakers mentioned that they also consider yawning a sign of lability.

Why is all of this important? For one thing, the fact that yawning can be painful for ALS patients means we should try and stop it, but our discussions on PatientsLikeMe brought to light another reason entirely: people were losing friends because of it as they were intepreting their frequent yawning as a sign of boredom or rudeness! So, my interest now is for two things to happen; first for patients and healthcare professionals to be more sensitive to the presence of excessive yawning and clarify to patients that it can be a symptom, and second for researchers to investigate potential treatments that might target emotional lability and excessive yawning in order to improve the quality of life of our patients.

At PatientsLikeMe, we believe in getting to know the person, not just the “patient.” That’s why we’ve decided to interview a PALS each month to find out more about how he or she approaches life. This month we are pleased to feature Edwin, a three-star member.

What inspires you?
For me, it is not what but who, and the answers are completely different now than they were before my MND diagnosis, because prior to my diagnosis I let materialism rule my life. God inspires me in more ways than I can possibly say. With today’s technology we have the good fortune to not only be able to appreciate and enjoy all of the magic, splendors, and wonders of our own planet, but those of the universe too. Every morning I wake up and thank God for my creation/existence, knowing that this lifetime is an opportunity for me to experience, learn, and give, and that it is just “a blink of the eye” of my eternity. Many of my fellow humans on the planet inspire me. I speak of those who, without any hidden agenda, give of themselves for the betterment of others. I still have much to learn from these people as I strive (hopefully) to be like them.

What’s the funniest thing that has ever happened to you?
To set this up right, first you have to understand that while I enjoy having a good time, I’ve always been the kind of person (stiff) that has had to be in control at all times. Back in the early 1980s while we were living in Southern California, Patty (my wife/better half) and I were out on a Saturday driving around doing a bit of furniture shopping. I had an excellent sense for getting/driving around since at the time I was doing on-site computer fix-it stuff for a living. We had finished our shopping and were headed for home when I simply drew a blank on where I was and how to get home. So, I pulled to the curb, looked over at Patty and asked, “Where the hell am I, and how do we get home from here?” Think about it, guys never stop to ask for directions and here I was asking my wife! Through the years Patty has enjoyed telling this story to people that have gotten to know me. Of course now with what I have going, there will be plenty of opportunities along the way to ask for help and laugh about it (continuing learning opportunities/experiences for me).

What is your favorite place and why?
There is a stretch of road here in Colorado over in the southwestern part of the state that runs from Silverton to Ouray (part of US 550, also called the “Million Dollar Highway”). For some reason that I can not explain I have always felt closest to God when driving/riding this road. My intent when I’m gone is to have my ashes spread at Red Mountain Pass along this route.

What do you like best about PatientsLikeMe?
The fact that it gives all PALS the opportunity to share all of their experiences (profile of condition, treatments, and symptoms) while also providing an open forum for discussion and support of PALS and CALS. Who could possibly ask for more?

PatientsLikeMe, the leading treatment and outcomes sharing website for people with life-changing diseases, is proud to announce its first scientific poster award. Today, at the 20th anniversary meeting of the British Neuropsychiatry Association (BNPA), Dr. Paul Wicks, resident researcher at PatientsLikeMe.com received the Association’s first prize for the best poster presentation, entitled “Telesocial medicine for neurological disorders: PatientsLikeMe.com”.

“This is the first time that PatientsLikeMe.com has been formally presented at an academic conference and it’s great that the site has received the recognition it deserves,” says Dr. Wicks. “Over the two days of the conference I’ve spoken to neurologists, psychiatrists, and patients, all of whom were enthusiastic about the concept and interested in the development of the site as it branches out to include conditions as diverse as ALS/MND, Parkinson’s disease, and multiple sclerosis.”

The poster illustrates the power of PatientsLikeMe and how it can help patients with neurological disorders take control of their diseases and improve their understanding and knowledge of treatments.