Free Open Access Medical Education (FOAM or #FOAMed) has always had a bit of a rebellious streak. The prototypical FOAMite enjoys ostentatiously taking on unproven dogma (ie, “received wisdom”), skeptically appraising seemingly sacred literature, and vociferously bragging about being an early adaptor. Now, however, some prominent FOAMites are going mainstream and showing up in some of medicine’s top peer-reviewed journals. At least some FOAMites are making the transition from health care influencers to health care innovators.

The first famous example of this precedes even the coining of the term FOAM. Back in 2011, Richard Levitan, MD, FACEP (@airwaycam), and Scott Weingart, MD, FCCM (@emcrit), published their review of the concept of apneic oxygenation during preparation for endotracheal intubation, which they cleverly named NODESAT (nasal oxygen during efforts securing a tube), in Annals of Emergency Medicine. By the time the article was finally published, bloggers and online learners were well aware of its contents and were lauding the protocol as a simple, inexpensive, and effective intervention. However, this wasn’t a randomized, controlled trial.

This fall, an active FOAMite on Twitter became the first person to be first author in two separate prospective randomized controlled trials in two of medicine’s top journals: The New England Journal of Medicine (NEJM) and JAMA. The NEJM was the so-called HEAT Trial, “Acetaminophen for Fever in Critically Ill Patients with Suspected Infection.” This study showed that dosing ICU patients with 1 gram of acetaminophen when a fever >38°C was present did not change the number of days a patient avoided an ICU or mortality.

The JAMA trial, “Effect of a Buffered Crystalloid Solution vs. Saline on Acute Kidney Injury Among Patients in the Intensive Care Unit: The SPLIT Randomized Clinical Trial,” showed no difference in the incidence of renal replacement therapy (ie, dialysis) or mortality over 90 days in ICU patients who received moderate amounts of fluid (approximately 2 liters) regardless of whether that fluid was normal saline or buffered crystalloid.

Amazingly, both studies had the same first author, New Zealand intensive care physician Paul Young, BSc, MB ChB. Dr. Young, equally known for his presence on Twitter (@DogICUma), his informative contributions to the emergency medicine mega-blog LifeintheFastlane.com, and his well-attended lectures this past June at the Social Media and Critical Care Conference in Chicago (#SMACCus), has set the bar high for budding FOAMites-researchers. Within hours of online publication, Twitter was abuzz with these new trials.