Paul Sax

Infectious disease specialist Paul Sax, MD, started the HIV and ID Observations blog ten years ago. Since then, he’s written hundreds of posts about infectious diseases, medicine in general, and various other not-so-medical topics. He recently celebrated the tenth anniversary of his blog, which has covered everything from baseball to HIV, doctor attire to Zika. It has generated more than 2 million page views and 3500 comments, with readers from all over the world.

In addition to blogging – which he does in his spare time, usually Sunday mornings after walking his dog Louie — Sax is the clinical director of the Division of Infectious Diseases at BWH. He is also the former editor-in-chief of NEJM Journal Watch HIV/AIDS, and currently serves as editor-in-chief for Open Forum Infectious Diseases, the IDSA open-access journal published by Oxford University Press. He is actively involved in research, clinical practice and teaching.

BWH Clinical & Research News recently caught up with Sax to find out more about his blog’s origins, its most popular posts and his favorite things about blogging.  

Can you take us back to when your blog began?

When writing on the internet exploded around 15-20 years ago, I was reading an increasing amount of incisive and entertaining commentary about baseball – actually an embarrassing amount, since baseball is one of my passions. To give you an idea about how long ago this was, this was back when ads used to include the phrase, “Visit us on the web!” with their URLs. Since I’m also very passionate about my field of medicine, I wondered if I could write something similar to this educational and fun baseball writing, only shifting the topic to infectious diseases. I offered the idea to the Massachusetts Medical Society, who are of course well known as the publishers of The New England Journal of Medicine. Fortunately for me, they agreed. Let the record show that they are much more famous for their flagship journal than my blog, but I’m happy to bask in in their glory.

How would you describe the tone of your blog?

My blog is written in a non-academic style. The tone is casual – I try to make it sound like a conversation rather than what’s published in medical journals. I always enjoy reading authors who take the work out of reading – that’s the tone I’m after in my blog.

Plus, my family all knows that I’m a frustrated comedy writer, and the blog has provided a nice outlet for this urge. In college, I was one of the editors of the Harvard Lampoon, which is a training ground for many successful comedy writers. Yes, pursuing a career as a comedy writer would have been a very different path from medical school, and it honestly crossed my mind at the time. I don’t regret the choice I made – medicine in general and ID in particular have formed a fascinating and rewarding career for me — but at least with the blog, I get the chance to be funny. Or at least to try to be funny, I guess the readers are the judge.

What topics do you like to write about?

Because the field of infectious disease touches all aspects of medicine, I never run out of topics. I’ve written about HIV, of course, since this is my research focus, but also epidemic outbreaks such as Ebola or Zika, antibiotic resistance, the great advances in hepatitis C treatment that took place in the mid 2010s, medical economics, the epidemic of opiate addiction, and grappling with a cumbersome electronic medical record or the fax machine. (I’m pretty sure doctors are the only highly trained professionals in the world who still need fax machines. Sigh.) My wife is a primary care pediatrician, and she regularly helps broaden the perspective on my posts and keep it grounded in the “real world,” not ivory tower academic medicine. One of the great things about blogging is its immediacy – if  groundbreaking research emerges in our field, I can comment on the immediate ways it might affect patient care. On a separate note, I’m also a big fan of dogs, so I try to include content about them, too. Hey, there’s a reason Youtube videos of cute puppies have millions of views!

Are there blog posts that have been particularly popular among your readers?

I wrote a post about the greatest infection risks for people who inject drugs. I think the public perception remains that HIV and hepatitis C are the two biggest risks. But in fact, they really aren’t; we have effective treatments for both of those infections, even a cure for the latter. So I wrote about my experience having seen so many previously healthy young adults in the hospital with life-threatening bacterial infections (in particular endocarditis), and set it in the context of a discussion with my college-aged daughter. The post turned out to touch a nerve. It received very widespread attention.

Other than that, posts about how doctors dress seem to be extremely popular. I also go to all the major HIV conferences and summarize them, and these summaries are very widely distributed on social media. And then there are more controversial topics, like anything to do with Lyme Disease and Chronic Fatigue Syndrome, both very important areas for increased research, but unfortunately highly contentious within the medical world. I try to keep politics out of the blog, but sometimes you just can’t avoid it.

Do you engage in dialogue with your readers?

Absolutely, and I enjoy it – the people who follow the blog seem to be a wonderful community, with a high proportion of ID and medical nerds. One of the early decisions we made was to have a moderated comments section, which means either the editor at Massachusetts Medical Society or I review the comments before they are published. This avoids a lot of the hateful or polemic writing often found in comments section on the internet. I was a real Twitter skeptic initially, but it turns out that Twitter is a great place to learn about new research in your field and communicate with people who share your interest.

The geographic distribution of my readers has been a wonderful surprise. I wrote a post recently about when my dog was attacked at the local park by another dog, which had almost nothing to do with infectious disease. Last week, I was at the International AIDS Conference in Amsterdam, and an Infectious Diseases specialist from Mexico came up to me and said, “I’m so sorry about your dog.”

Is your dog feeling better?

He’s fine now – I’m the one who’s still a wreck!

What is your favorite thing about blogging?

The editing of medical writing by the major journals is very aggressive; they want the prose to be as scientific and objective as possible. That serves an important purpose, but it also means that an individual’s voice is rarely heard. That’s not the case when you write a blog. I think that’s another one of the things I like about it: I can use my own voice.

What would you recommend for people trying to start a blog?

Writing about what you know well and what you find interesting is the key. Readers can tell; they’ll feel your enthusiasm, and that will make it much more dynamic. And write regularly! No one likes reading on-line material that is outdated.