All Publications

  • Addressing Climate Change and Its Effects on Human Health: A Call to Action for Medical Schools. Academic medicine : journal of the Association of American Medical Colleges Goshua, A., Gomez, J., Erny, B., Burke, M., Luby, S., Sokolow, S., LaBeaud, A. D., Auerbach, P., Gisondi, M. A., Nadeau, K. 2020


    Human health is increasingly threatened by rapid and widespread changes in the environment and climate, including rising temperatures, air and water pollution, disease vector migration, floods, and droughts. In the United States, many medical schools, the American Medical Association, and the National Academy of Sciences have published calls for physicians and physicians-in-training to develop a basic knowledge of the science of climate change and an awareness of the associated health risks. The authors--all medical students and educators--argue for the expeditious redesign of medical school curricula to teach students to recognize, diagnose, and treat the many health conditions exacerbated by climate change as well as understanding public health issues. In this Invited Commentary, the authors briefly review the health impacts of climate change, examine current climate change course offerings and proposals, and describe the rationale for promptly and comprehensively including climate science education in medical school curricula. Efforts in training physicians now will benefit those physicians' communities, whose health will be impacted by a period of remarkable climate change. The bottom line is that the health effects of climate reality cannot be ignored, and people everywhere must adapt as quickly as possible.

    View details for DOI 10.1097/ACM.0000000000003861

    View details for PubMedID 33239537

  • Management of Acute Pain From Non-Low Back Musculoskeletal Injuries: A Systematic Review and Network Meta-analysis of Randomized Trials. Annals of internal medicine Busse, J. W., Sadeghirad, B., Oparin, Y., Chen, E., Goshua, A., May, C., Hong, P. J., Agarwal, A., Chang, Y., Ross, S. A., Emary, P., Florez, I. D., Noor, S. T., Yao, W., Lok, A., Ali, S. H., Craigie, S., Couban, R., Morgan, R. L., Culig, K., Brar, S., Akbari-Kelachayeh, K., Pozdnyakov, A., Shergill, Y., Sivananthan, L., Zihayat, B., Das, A., Guyatt, G. H. 2020


    BACKGROUND: Patients and clinicians can choose from several treatment options to address acute pain from non-low back musculoskeletal injuries.PURPOSE: To assess the comparative effectiveness of outpatient treatments for acute pain from non-low back musculoskeletal injuries by performing a network meta-analysis of randomized clinical trials (RCTs).DATA SOURCES: MEDLINE, EMBASE, CINAHL, PEDro (Physiotherapy Evidence Database), and Cochrane Central Register of Controlled Trials to 2 January 2020.STUDY SELECTION: Pairs of reviewers independently identified interventional RCTs that enrolled patients presenting with pain of up to 4 weeks' duration from non-low back musculoskeletal injuries.DATA EXTRACTION: Pairs of reviewers independently extracted data. Certainty of evidence was evaluated by using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach.DATA SYNTHESIS: The 207 eligible studies included 32959 participants and evaluated 45 therapies. Ninety-nine trials (48%) enrolled populations with diverse musculoskeletal injuries, 59 (29%) included patients with sprains, 13 (6%) with whiplash, and 11 (5%) with muscle strains; the remaining trials included various injuries ranging from nonsurgical fractures to contusions. Topical nonsteroidal anti-inflammatory agents (NSAIDs) proved to have the greatest net benefit, followed by oral NSAIDs and acetaminophen with or without diclofenac. Effects of these agents on pain were modest (around 1 cm on a 10-cm visual analogue scale, approximating the minimal important difference). Regarding opioids, compared with placebo, acetaminophen plus an opioid improved intermediate pain (1 to 7 days) but not immediate pain (≤2 hours), tramadol was ineffective, and opioids increased the risk for gastrointestinal and neurologic harms (all moderate-certainty evidence).LIMITATIONS: Only English-language studies were included. The number of head-to-head comparisons was limited.CONCLUSION: Topical NSAIDs, followed by oral NSAIDs and acetaminophen with or without diclofenac, showed the most convincing and attractive benefit-harm ratio for patients with acute pain from non-low back musculoskeletal injuries. No opioid achieved benefit greater than that of NSAIDs, and opioids caused the most harms.PRIMARY FUNDING SOURCE: National Safety Council. (PROSPERO: CRD42018094412).

    View details for DOI 10.7326/M19-3601

    View details for PubMedID 32805127

  • Association between media attention and presentation of vaccination information on Canadian chiropractors' websites: a prospective mixed-methods cohort study. CMAJ open Kim, Y., Akhtar, A. M., Natalwalla, S., Goshua, A., Wilson, K., Busse, J. W. 2020; 8 (2): E338–E345


    BACKGROUND: Historically, some chiropractors have been critical of vaccination, and this has been the subject of recent media attention in Canada. We explored the association between media attention and public dissemination of vaccination information on Canadian chiropractors' websites.METHODS: In 2016, we identified all Canadian chiropractors' websites that provided information on vaccination by extracting details from the regulatory college website for each province using the search engine on their "find a chiropractor" page. We assessed the quality of information using the Web Resource Rating Tool (scores range from 0% [worst] to 100% [best]), determined whether vaccination was portrayed in a positive, neutral or negative manner, and conducted thematic analysis of vaccination content. We revisited all identified websites in 2019 to explore for changes to posted vaccination material.RESULTS: In July 2016, of 3733 chiropractic websites identified, 94 unique websites provided information on vaccination: 59 (63%) gave negative messaging, 19 (20%) were neutral and 16 (17%) were positive. The quality of vaccination content on the websites was generally poor, with a median Web Resource Rating Tool score of 19%. We identified 4 main themes: there are alternatives to vaccination, vaccines are harmful, evidence regarding vaccination and health policy regarding vaccination. From 2012 to 2016, there was 1 Canadian newspaper story concerning antivaccination statements by chiropractors, whereas 51 news articles were published on this topic between 2017 and 2019. In April 2019, 45 (48%) of the 94 websites we had identified in 2016 had removed all vaccination content or had been discontinued.INTERPRETATION: In 2016, a minority of Canadian chiropractors provided vaccination information on their websites, the majority of which portrayed vaccination negatively. After substantial national media attention, about half of all vaccination material on chiropractors' websites was removed within several years.

    View details for DOI 10.9778/cmajo.20190204

    View details for PubMedID 32371527

  • The Weight of the White Coat. JAMA Goshua, A. 2019; 321 (1): 35–36

    View details for PubMedID 30620374