Sunday, November 3, 2013

Zeitgeist of IBD

IBD Terms Over Time

The evolution of inflammatory bowel disease can be tracked using Google’s ngram viewer.  In addition to providing the frequency of words and phrases appearing in books, the viewer can be used to identify trends and the uptake of new concepts in the literature (which largely mirrors practice).  The medical establishment has always been one of the more vivacious adopters of the written word for disseminating their ideas, and the evolution of inflammatory bowel disease is no exception.

Aside from IBD, there are general, positive trends in medicine that can be extracted.  Look at the difference between the terms “Case History” and “Clinical Trial”, and you can see the positive movement toward evidence-based medicine.  While the trend was present, the term “evidence based medicine” didn’t really take off until the 1990s, but is showing a growing popularity.

This blog is called “Evidence Based IBD”, but the term inflammatory bowel disease is relatively new.  Originally, the term “Regional Enteritis” was the used for both ulcerative colitis and Crohn’s Disease, but has fallen out of favor.  Dr. Crohn’s description occurred in the 1932, but the linking of the disease to his name didn’t really take off until the 1960’s,  whereas ulcerative colitis was well known in the 1800’s. 

The treatments for Crohn’s and IBD are similarly mapped to their dates of identification and their dates of greatest usage.  As new treatments arise, older treatments become less prominent in the literature.  Some of this is due to the treatments falling out of favor, but some of it is simply due to a lack of interest in new clinical trials proving already proven treatments (though they still frequently appear as comparisons to new modalities).  The decline in prednisone, methotrexate, and aminosalicylic acid (5-ASA) against the growth of the anti-TNF agents can be shown below.

Similar to the above, the use of terms can signify their relative importance within a class.  Generally, the first arriver ends up being the most cited (for an extended period).  This can be seen by comparing Remicade (infliximab) to Humira (adalimumab) and Cimzia (not approved until 2008).

The basic ngram analysis is fun, and Google can be used to show large trends, but too much should not be read into the results.  That said, it is an interesting respite from some of the more detailed recent blog postings.

Bottom Line

·         Google ngram analysis is a fun research tool that shows the changes in the wording around IBD and can be used as a basic popularity tool over time.

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