Year in Review

I first blogged in August 2008. I posted again in September and then called it a year. I wrote a bit more in 2009- today is post #137:

Things started slowly, but in March I discovered ScienceBlogs. Suddenly I had things to say. Sure, some of it was personal. Some of it was pure wackaloonacy. Some of it was practical, like wardrobe advice for traveling to scientific meetings. Some of it was bitchy.

Not enough of it was biomedical.

After my self-study, I am setting some goals for 2010:

1. Three to five posts each week, with an average of 15 per month.
2. At least once each month I will address something of substance from the world of biomedical science.
3. I will continue to FWDAOTI as I see fit.
4. If I want to write about something , I will, because this blog is for me.

Happy New Year!

Stating the Obvious

While waiting for an elevator during rounds today the following arrived in my email box from Principal Investigator E-Alert:

Reader Question: A month ago I was flying to a convention of my research specialty in San Francisco, and in one of my checked bags was my notebook computer and three discs of raw data (non-encrypted) on about 800 patients we have enrolled in a clinical trial. But the airline lost the bag in transit. Of course, I filed a "lost bag" claim with them, but no trace of it yet. Little hope now. I have heard there is some new law called HITECH that applies to lost data. What should I do at this point? Should I already have done anything?

Expert Comments: Brace yourself, we're going to have to deal with some "alphabet soup" of U.S. government acronyms while explaining your situation.

The Health Information Technology for Economic and Clinical Health Act, or HITECH, is the U.S.A. Federal law that requires you take immediate action and notify those affected by a loss of protected health information (PHI).

First, figure out if HITECH applies. In order for it to come into play, HIPAA (Health Insurance Portability of Accountability Act of 1996) has to apply to you. It does if you're working with patients. However, does HIPAA apply to the particular data you've lost? If you took all of the identifiers off the data, then you're ok because de-identified data isn't covered by HIPAA or HITECH.

View the remainder of the expert comments

Comments by Kristen H. West, J.D., Associate V.P. and Director, Office of Research Compliance, Emory University Atlanta

The expert goes on to more details about the relevant laws and notification requirements- you can follow the link above if you want more. Only the commentary addressed the real issue:

Why would you check a laptop?

1. Laptops are fragile. Don’t let that aluminum exterior fool you; that screen is just waiting to be cracked. Have you watched the way checked bags are handled? Remember those Samsonite commercials when they gave apes at the zoo luggage to destroy? You really want folks to play catch with your computer in a tote bag? Really?
2. Laptops are valuable. Even if it is years old and you have to duct-tape the CD drive closed, someone can pick it up and sell it for a few bucks. Your checked bags have to be accessible to TSA for search; do you really think everyone who touches luggage is immune to thievery? Really?
3. Even in puddle-jumper jets like those by Embraer  you can usually keep your laptop. Roll-aboard bags must be gate-checked, but surely you have a padded tote for the laptop that will fit under the seat in front of you or in those tiny overhead bins. Even when the compartments are filled, the attendants can usually check the tote but tuck your laptop in one of their cubbies during take-off and landing.

My next question:

Why were you traveling with all those data?

1. Planning to work in the airport or on the plane? And you checked your laptop?
2. Planning to work during the meeting? Then why are you going? You are supposed to be meeting- learning, networking, and interacting. Not analyzing your own data in your room.
3. Planning to work in the evening? At a convention of your research specialty in San Francisco? Go out and socialize; the best collaborations in science begin in bars!
4. IRBs require data protection plans. At my institution, we specify that data will be coded and password protected on our servers. Any hard copies will be kept in locked areas accessible only to the PI and other approved personnel. So why did you think taking them on a trip was appropriate?
5. If you absolutely need to access large data sets, invest in some sort of cloud computing. Your institution may be able to set up remote server access for you, and other options are out there. I subscribe to DropBox. Up to 2 Gb can be stored for free, and the applet synchronizes the most recent version with all computers you install it on. Other services also allow you to store files and access them via any internet connection with appropriate security measures.

The bottom line: The scenario described should not have occurred for a whole bunch of reasons. Traveling with a laptop often allows me to accomplish something during delays at O’Hare (as well as sharing my ongoing deep insights with readers of this blog), and I love my Lenovo Ideabook S10 netbook. I would never, never, ever check it!

Nostalgic Dreams of Rustic Murder

My husband dreams of a rustic cabin in the woods. He fantasizes about surrounding drifts of snow, with nothing to do but curl next to the fire with a good book. Sometimes he talks of such a home for retirement.

Over my dead body.

For a couple of days after our 18 inch Christmas blizzard, our extended family did not leave our 3000+ square foot home. My husband and son bravely cleared the driveway so we would be ready to go after a plow came through the road. Basically, ten of us sat around by the proverbial fire. We still had heat and electricity (thanks to buried utilities in our suburb) and plenty of food.

I don’t think we could have survived another day inside.

I think about our pioneer forebears who sat through such storms in a one-bedroom log house. I wonder how often they regretted their decision to head west on those long winter afternoons when snow piled above their waists and the long shadows of early night kept the melting sun away. I wonder how many grabbed an axe or shotgun and sent their families into eternity.

The roads have been cleared, and the sun shines today. I am thankful that I live in an age with plows and indoor plumbing.

The print above is by Lori Putnam and is available in a variety of formats at this website. You can also click on the artwork to get there. I will feel much better about posting this image if you visit her site.

Please Quit “Dreaming of a White Christmas”

Please… STOP NOW!

In the movie White Christmas, the entertainers have the right idea. They travel to the small inn in Vermont to visit the snow rather than living with it. And although they sing lovingly about it, we never see them lifting that spade of snow, do we?

Omaha has been “blessed” with a white holiday…14-18 inches of the frozen stuff. More than enough to share with the world.

“It’s a Marshmallow World in the Winter.” Really? So I should just throw a case of Rice Crispies in the driveway?

Bah. Humbug. I’m ready for the pool to open.

Tradition!

More presents than you can imagine surround the tree now, making the current economic climate difficult to fathom. My son has appropriate clothing for all events planned, and my inlaws joined us for the holidays.

And it gets dark really early.

It must be time for Christmas.

Two days ago I spent hours foraging through two stores for supplies for cookies and tomorrow’s feast. Yesterday my daughter and I had our usual cookie bake, complete with Dogma on the kitchen TV. I realize the movie is not holiday traditional, but it is what we do.

This afternoon we move the festivities to my parents’ place (3 whole miles west of here) for dinner. Tomorrow morning the presents will be unwrapped, and Ozzie will get to play with more ribbon than he can imagine.

Happy holidays everyone!

Dear Elsevier

I am writing a grant application. This morning I found a reference I need. You published it. Even though it is 6 years old, you want $34 for the reprint.

Fine, I need it. I will pony up this amount.

It has been long enough since I registered with “your fine service” that I cannot remember my password. Your automatons were kind enough to reset it to a string of letters and numbers chosen at random.

Now your site still will not let me log in. I’m using the email to which you just sent the reset password. The password was copied directly from the email, and I made sure there was no punctuation to mess things up.

When I try to register as a new customer, I cannot. I am given my username (my email address) and told to login. Your site then tells me that my username and/or password is “not recognized.” Even though your computer just sent them to me.

Maybe I can live without this paper. 

What I really really want to do right now is find my gleaming blade and confront whoever (1)decided to charge for downloads forever and (2)designed your clearly fucked-up online download system. Of course, you’re only hurting yourselves. And I did just save $34 of the university’s money.

Happy Holidays, Elsevier!

Photo courtesy of PhotoXpress.

A Universal Truth

Over at the temple of Isis, she used her experience shopping for empanada supplies to fuel a discussion of white privilege. Now, calling out asshats who do bad things to people of color, women, or other challenged groups is a good thing. That part did not catch my attention. Since reading the post, I have been thinking about tiny meat pies.

As the discussion proceeded, we acknowledged that every culture has its own version of the empanada. The British have pasties. We eat wontons and potstickers. And what is a taco or burrito but seasoned meat in a crust? Online you can order cajun meat pies filled with beef (shown), crawfish, or a breakfast mixture of andouille sausage and eggs. Mix the meat into the batter and you have a dumpling.

Tiny meat pies are a universal truth, a common component of the human experience.

A few years back my daughter composed a report on Malaysia. She wanted to bring in food to go with her presentation. I scoured my Time-Life Foods of the World cookbooks and found this recipe. You can make the pastry from scratch, but refrigerated pie crusts do just fine.

The cookbooks were originally published in 1970 and revised in 1979, but are out of print at this time. Each country or region in the set included a wire-bound kitchen book with just recipes and a larger coffee-table style book with text about the culture and origins of the foods. Some photos are dated, but the set still provides a good culinary overview of the world. Used sets and books can be found  on Amazon.

I will share this recipe with you:

Malaysian Curry Puffs (~3 dozen puffs)

• 6 fresh hot chilies, stemmed and seeded (don’t forget protective gear)
• ~1-inch piece of fresh ginger root, scaped and coarsely chopped
• 2 cloves gralic, peeled
• 2 tablespoons butter
• 2 tablespoons finely chopped onions
• 1/2 lb lean ground beef
• 1/2 teaspoon ground turmeric
• 1/2 teaspoon ground cumin
• 1/4 teaspoon ground coriander
• 2 tablespoons strained fresh lime juice
• Enough pie crust for 2-10-inch shells

Preheat oven to 375. Finely chop together the chilies, ginger, and garlic with a large knife or food processor.

In an 8- to 10-inch skillet, melt the butter over moderate heat. Saute the onions until soft and transparent, but not brown, ~3 minutes. Stir in the chilies, ginger, and garlic, and simmer for 2 to 3 more minutes. Then add the ground beef, breaking up any lumps. When no traces of pink remain in the meat, stir in the spices. Remove the pan from the heat.

On a lightly floured surface cut the crust into ~2.5-inch rounds. Put a scant teaspoon of the beef mixture in the center of a dough round. Moisten the edges with a finger dipped in water. Fold the round in half over the filling, then turn the ends toward each other into a crescent shape. Press the edges together with your finger or a fork.

Arrange the puffs on large ungreased baking sheets and bake for 25 to 30 minutes, until golden brown. May be served hot or at room temperature.

SQUEAK! SQUEAK! SQUEAK!

Earlier this week I expressed displeasure with the status quo in a work-related meeting. Basically, continuing our status is untenable. Unthinkable. And I got little argument from higher up.

So, why has this situation been allowed to persist? Can I work on fixing the issue(s) now? No, because other issues are considered more problematic and “the squeaky wheel” gets the attention. Yes, the squeaky wheel metaphor actually arose.

This wheel does not squeak. Everyone figured out how to live without it or work around it a long time ago. So what if the cart runs better with 4 wheels; at least it isn’t squeaking!

So far, that has been my approach to the problems of the status quo. Work-arounds just do not cut it any longer. Once again, I got no argument on that front.

I guess it’s time to make a lot of noise. Much more than a squeak. I can do that.

It won’t be pretty. Someone may regret this decision.

Photo courtesy of PhotoXpress.

I Know How the Polar Bear Feels

Let me make things clear; this post will not discuss the cold and snow that attacked Omaha last week. My title does not refer to the climate, nor will I address the Copenhagen conference.

This week, while covering the patient care service, I am carting around scads of reprints and the pertinent instructions for the new, improved NIH grant format. I believe I have a project ready (only time will tell if the study section agrees), and my submission date is January 25.

Without a grant, I am a threatened species. Just like the polar bear.

For several years prophets have proclaimed the dangerous plight of the physician-scientist, academics comfortable moving from bench to bedside and back again. We have trouble competing in the current funding wasteland. We can never crank out as many papers as our “pure scientist” brethren (unless we can afford “pure scientists” to run our labs while we see our patients). Clinical and translational work often suffers in study sections that are increasingly dominated by “pure scientists” who may not grasp the difficulties of patient recruitment. Yet all of this occurs at a time when the NIH recognizes the need for improved translational research support.

My “elders” supported me well through my career. Early on they blessed me with protected time which led to a career development award. Ultimately I obtained an R01. A second project received good initial reviews from NIH. I felt unstoppable.

Then I hit the wall. The hypothesis of my funded R01 could not be accepted. That is why we do the experiments, of course. That project veered in a new appropriate direction. Unfortunately, novel techniques were required for the next step. Sometimes the reason something hasn’t been reported is because it can’t be done, at least in the current environment. We continue trying to make this effort fly (the science could be really cool), and today we have had our first taste of success with one essential assay. After almost 2 years of development effort.

The other project never improved sufficiently, in the eyes of the reviewers, to receive a fundable score.

So now, after a decade of continuous extramural funding at a significant level, I find myself “between grants” for an uncomfortable interval. An interval of departmental support that will have to end soon, one way or another.

I am not alone. Several colleagues have closed labs recently, deciding that the pressure to seek funding and the pain of the process surpassed the joys of the science. Ongoing pressure to generate clinical income also factors into the equation, along with the more immediate rewards one receives from patient care. Even patients who receive bad news can be grateful; reviewers’ enthusiasm is always dampened by something in the proposal.

The ongoing climate change dialogue includes the plight of the polar bear, a charismatic creature threatened by the activities of people living continents away. People want to save the wild polar bear, but do they desire it enough to make the hard choices? Our leaders preach the value of the physician-scientist, but will there be enough support to keep our labs open?

Only time will tell for both myself and the polar bear. Wish us luck. Now I have reprints to read.

Photos courtesy of PhotoXpress.

When Snow Becomes Snirt

Yesterday we had a refresher snow, just enough to cover the mixture of snow and dirt (snirt) left from last week’s blizzard. It did freshen things up, but left me with a wardrobe dilemma.

Today I participate in a clinic that requires parking in an outdoor lot. What’s a doc to do when she wants to remain a fashionista, presentable for patients, but has to wade through half-frozen muck?

Answer: booties.

I get way too warm in knee- or thigh- high boots (no menopause jokes, please). The just-above-the-ankle reach of these is plenty to keep the slush away from my tootsies in the civilized world. They rock with trousers or skirts, and prove practical as well as professional. The heel measures only 2.75 inches, and they slip on and off with a bit of effort; I would not hesitate to wear them through airport security for winter travel.

I acquired these [Hanley from BX by Bronx] at my local DSW; online DSW only has them in size 10 black, so you probably want to shop around.

Not In a Blogging Mood

Oh, yes, FWDAOTI is always there.

But I'm just not up for it tonight.

I have to go wrap a gift, and then go out with my husband and some friends on, like, a "date."

I hope everyone else enjoys their evening as much as I will.

By the way, if you are anywhere near Omaha, go see Silent Night of the Lambs at the Blue Barn Theatre.

It is over-the-top (Silence of the Lambs meets Rudolf, the Red-Nosed Reindeer) and of questionable taste (XXX-rated live nativity scene), so, of course, I loved it.

Happy Holidays, Everyone!

How Much Can You Cram In a 12-Page Limit?

The gold standard for funding of biomedical research in the US, the National Institutes of Health (NIH), changes it forms in 2010.

Formerly 25 page applications will be shortened to 12, supposedly to make grant preparation and review kinder and friendlier. Makes NIH seem all warm and fuzzy, doesn’t it?

Yesterday, a blogger over at The Scientist raised concerns about the new format.

According to Robert Kalb, a University of Pennsylvania neurologist who is also the chair of the NIH's cellular and molecular biology of neurodegeneration study section, the changes may favor senior scientist:

"it frees the experienced investigator to not provide as much feasibility and preliminary data because they can just cite their previous publications."
This, Kalb told The Scientist, means that applicants with robust publication histories, proven track records of scientific accomplishment, and more experience writing tersely about their research may have the edge over their younger, less experienced counterparts.

First, senior investigators do not always write well. I have reviewed plenty of proposals from “giants in the field” that were unholy messes of grammatical and contextual errors. Often there would be something good in the application- these are successful investigators- but poor communication skills made it excruciating to sift out. The contention that senior investigators are more likely to have published work with their techniques and data they can reference has more validity; however, a junior investigator without a paper citing most of the techniques in their proposal  is very unlikely to get a fundable score anyway. Even for programs that do not require preliminary data, lack of a publication record often “reduced enthusiasm” for the proposal.

As The Scientist blog, posted by Bob Grant, also points out:

The NIH has made efforts to make the peer-review process easier on young scientists, recently announcing guidelines that more generously rank applications submitted by younger investigators

My interest in this topic is, of course, selfish; I hope to submit a proposal in January 2010. I spent the past 2 days at an NIH-sponsored conference, gathering background applicable to my proposal. The changes provoke anxiety; I’m a “big-picture'” person, and reviewers have never felt my proposals include enough detail about experimental minutiae. Where am I going to write that stuff now? I guess I will just learn to deal with it, same as everyone else in my world.

Photo courtesy of PhotoXpress.

This post got delayed a day because my internet connection at Washington National Airport refused to let it upload; then we barely got home because of blizzard conditions in Omaha.

It’s a Four Letter Word

I have received several emails and texts from my family, wishing me well:

Did you hear Omaha is getting up to 12 inches of snow tomorrow?

They have already cancelled school!

Think you’ll get home? We’re supposed to have blizzard conditions by the time you land!

S.N.O.W.

Four letters that may ground me tomorrow evening. Of course, my “well-wishers” keep “warning” me about this coming onslaught.

I wonder what they want me to do about it?

I can’t leave earlier. If I could, I would not have a direct flight. A layover in Chicago or Milwaukee is unlikely to improve my chances of landing in Omaha.

And it’s not like I can control the weather. If I could, Omaha would be perfect. Like 72 degrees from mid-January through May, then 85 and sunny for June-August. Autumn would bring 70 degree days with a touch of crispness in the evenings for football games. We would have 2 to 3 weeks of “winter” with just enough snow to dust the evergreens over Christmas and New Year days.

Think what the NCAA would pay me to guarantee a College World Series with no rain-outs!

Since I can’t make this happen, I will just have to go with the flow of snow tomorrow. Now quit telling me about it; I can get weather reports in DC!

Photo courtesy of PhotoXpress.

“All of the easy experiments have been done”*

I am attending a great meeting right now. About 110 participants are gathered in a nondescript conference room in the DC area. The morning session provided valuable background information for my next proposal. Multiple speakers reviewed the embryology and gene expression of genitourinary development. I am amazed at how many things must go right for the urinary tract to form correctly. Yet, most of the time, it works out!

My brain is really, really full right now.

Overlapping phenotype (clinical presentation) seems to be a huge problem within this field. Very few identified mutations consistently produce the same clinical picture, even within members of the same kindred. This is true for some mouse models also! Trying to find genes of interest with a variable phenotype  will be problematic. Throw in environmental influences, like intrauterine exposures or post-natal infections, and you have a real mess to sort out. Like most diseases, what we identify as a single diagnosis likely results from numerous different causes. A single causative factor or gene may produce multiple diagnoses as well.

For example, we know the genetic defect in branchio-oto-renal syndrome (BOR), an autosomal dominant mutation in the gene EYA1. I know of an affected family where one member was born with a single kidney (unilateral renal agenesis). The other kidney is normal, and the patient’s renal function remains normal at adulthood. This patient had no extrarenal manifestations of the syndrome. Another child was born with only one kidney, and it showed dysplasia (small with cysts and areas that appear abnormal on ultrasound). Eventually this child required a kidney transplant. Other children in the family failed to form kidneys at all and died in utero. These variable phenotypes all resulted from the exact same genetic mutation. What modifies this mutation to make it milder in some cases and more severe in others? If only one of the living children had been born, and there had been no family history, how would we have classified them for gene association studies?

Part of the meeting is devoted to discussing strategies to scan large populations for gene associations. Lucky for me that part occurs tomorrow; I will have a chance to empty a bit of my brain by then!

Congenital renal anomalies cause ~40% of end-stage kidney failure in children throughout the world. Clearly, we need a better understanding of this spectrum of disorders. Small, intense meetings such as this one are a great way to focus parties of interest on a common goal and make things happen.

I’m glad I’m here. And I hope I can help!

*The title of this post is the first of “Carmines Laws of Science.” Credit must go to Pamela Carmines, PhD, a colleague in Cellular and Integrative Physiology at the University of Nebraska Medical Center.

STEM or Leaf or Something Else?

Over at Terra Sigillata, one of my favorite bloggers, Abel Pharmboy, asked if medicine and allied health fields should be considered STEM (science, technology, engineering, and mathematics) careers. The post and replies got me thinking (a dangerous occurrence), and my reply became too long for the comments. Thus, my own post.

Classifying professions is almost as difficult as classifying ethnicity; self-report is the gold standard.

In my own case, my advanced degree is an MD (even though mentors advised me to figure out a way to get a PhD). So 30% of my professional time is seeing patients; however, I play well with physiologists and study kidney disease in rats. So I would qualify as STEM, in that sense. Some would say that my work is not STEM in the government sense, because my funding source is NIH. I say science is science, whoever funds it. I know MD PIs who have had both NIH and NSF funding; where would they be classified?

If an allied health professional works in a clinical research center, is s/he STEM? The same skill set applies to those who work in purely caregiving settings- so why wouldn’t they be STEM? All have a certain background training in science; is that sufficient to qualify?

Finally, I wish to illustrate some parallels between clinical medicine and science. Healthcare is hypothesis driven, just as science is…

A scientist gets an idea and then

• Collects background data
• Develops a hypothesis
• Experiments
• Evaluates results of experiments and adjusts hypothesis accordingly

A healthcare provider sees a patient and then

• Collects background data (history & physical)
• Develops a differential diagnosis
• Tests the diagnosis, either through diagnostic tests or through response to treatment
• Evaluates the results of tests/treatment and adjusts diagnostic possibilities accordingly

There simply is not a firm boundary between healthcare and STEM. I will be interested to see what AbelPharmboy’s  poll shows [at this writing, the poll is in favor of healthcare=STEM, but the commentary is running the other direction]. Frankly I just don’t know that it matters. Except to those wishing to make a statistical point of some sort…

Photo courtesy of PhotoXpress.

What I’m Reading

I have not addressed this topic for a while. I have been reading, but books  best described as mental marshmallow fluff. Not something worth putting pen to paper (pixel to screen?) about, really.

Last week I received a review of this new tome, and I had to check it out. Those who know me understand that I am a bitch, a woman who has goals and tries to achieve them. I believe we should embrace this term, rather than giving it the power to derail us.

I just finished the first part of am-BITCH-ous. Thus far Debra Condren, a psychologist and career coach, provides numerous anecdotes of women who gave up their own dreams to support those of their significant others and family members. For those of us living with these pressures, this section is repetitive and, at first, seems rather unnecessary. However, given the radical argument that Dr. Condren makes, it ultimately proves its value. What is that argument?

As professional women, we are being hoodwinked into believing that life-work balance is our dream.

I can hear you out there now. “But that is what I want- a great job with time for other things like my significant other, kids, hobbies, whatever.” The anecdotes provided illustrate how often women get shunted from a successful career to something else that seems more noble because it puts the needs of others first. And not just their needs; their desires and dreams and comfort. These women are applauded for putting the needs of others first, but they may later find out that they volunteered for the shaft.

Living with others, no matter how much you love them or what their relationship, requires compromises and hard choices. I realize that, and my family has negotiated such issues in the past. Never did I feel that I had to give up all of my dreams for my husband or children. I maybe didn’t get 100% of what I wanted, but I never felt like I got skunked.

It’s that time of year when stations start trotting out Frank Capra’s It’s a Wonderful Life. A few years back I heard this movie discussed by a psychiatrist  who really didn’t like its message. Yes, everyone loves George Bailey and bails him out at the end of the movie, but giving up one’s dreams and being so self-sacrificing is ultimately unhealthy. [I wish I could find the interview] Of course, this movie is FICTION. In real life, Mary Bailey would have been giving up her dreams of a career. Of course, all she wanted was George and a house full of kids…

Women who “make the correct choice” always seem to give up themselves for others. A few years of that would make one a desperate housewife…

I just now reached the meat of the book on how to avoid the trap. So far the exercises appear helpful, although I am guessing it will take a lot of work to get most women out of the martyr game. Especially since women are so applauded for successful martyrdom.

Timeless Advice from Calvin

Some days a comic strip ~20 years old just sums it all up: Substitute the words “paper, grant, or talk” for “book report.”

Substitute the words “subject you haven’t researched” for “book you haven’t read.”

OK, so I have started researching everything on my to do list, but none of it is ready to be organized into its final form. I know I will get everything done on time, so I have decided to stop worrying about it today. Just like Calvin.

I deserve a bit of happiness today.

Comic strip was “borrowed” from Gocomics.com; I hope this attribution is sufficient to keep their lawyers from calling. I mean, they offer free access to online comics, so what’s the diff if I post it here and give them credit, really?

Solstice Celebrations & Smiting Darkness

Since ancient times, every culture in the northern hemisphere has acknowledged the winter solstice. December 21 marks the shortest day of the year, a period of darkness that heralds the cold of winter. As we approach a period of cold and, in the past, dependence on stored foods and our ability to hunt those animals still out and about, what better show of faith could there be than a great big party? Eat up, because we know our deity will provide!

As someone whose mood falls with the shortening day, Solstice Holiday (Christmas) preparations provide a great distraction. Decking the halls with greenery and lights makes those long evenings more cheerful. I love knowing that these “Christian” traditions have their roots in ancient pagan traditions as well.

My family went a little insane with Christmas when I was growing up. I have restricted my home to a single really big tree. This year a 12-foot Frasier fir is decked with 800 lights. We almost have all of the ornaments on it (I collect them anywhere I travel, and I can’t resist any shiny piece of blown glass, especially if fashioned by Christopher Radko).

What better way to smite the darkness than putting up a few thousand lights and other shiny things?

Art courtesy of PhotoXpress.

Thanks, Shopping, and Goats…

I gave thanks for many things last week. For football, family, friends, and my health, especially my kidneys. We also gave thanks for living in a land of plenty where a feast can be had and children can be educated.

Today is “Cyber Monday.” We all know about Black Friday, the “official” kick-off of the solstice-holiday shopping season. Cyber Monday began a few years back when most homes had mere dial-up connections for their computers. Monday at work, with a high-speed internet connection, folks would e-shop via those computers during lunch hour and other breaks (never on the company’s time, I’m sure).

Black Friday sales were up 11% this year, perhaps the result of steep discounts and promotions (although something really great would have to be free to get me dressed and at the store by 5am). Cyber Monday is unlikely to overtake Black Friday (or Christmas Eve) as the busiest shopping day of the year, in part because high-speed internet access is everywhere now. As Allan Sloan said on the radio this morning:

Black Friday is a sport and Christmas Eve is always the biggest day in terms of dollars, and that's just panic-driven. So Cyber Monday or Cyber-whatever will move up, but it's not going to rival these other things. But it's a great invention, and the marketing people who invented it should be proud of themselves, cause we're talking about it.

My spouse and I shopped yesterday, crossing a number of gifts off our list. I also made a decision to get my office people something small for a personal gift, but then do something charitable as well. 

I bought a goat.

This urge began last week when I heard a story about a girl in Uganda. Her family received a goat from Heifer International. That goat gave birth to 2 kids that they sold to build a home. The goat produced milk that the family sold to generate income. Soon they were earning enough money that they could send their daughter, Beatrice, to school. She did well, and has now become the first college graduate from her community. The goat subsequently produced a female kid that was passed on to another family in need (a Heifer tradition).

The Heifer International gift catalog includes livestock at all price points. In addition to the animals, the organization provides educational seminars so the families can care for the animals in an ecologically responsible way. They now include bees among their gift choices, as well as tree seedlings for reforestation programs.

Your kids will likely prefer Mr. Squiggles, a hot-selling Zhu Zhu hamster. But someone on your list might prefer a water buffalo…

A Nephrologist Gives Thanks

Tomorrow, The Great American Pig-Out, is not just a day for food and football. We should count our blessings and be thankful for them.

I am thankful for my loving husband, 2 healthy happy kids, and other supportive family members.

I have a career I (usually) love, that gives me fulfillment and allows me to participate in the progression of knowledge.

Most of all, be thankful that you pee. Until you cannot, you won’t realize how great it is to urinate.

Golden Thanksgiving, All!

Art courtesy of PhotoXpress.

Musical Meanderings

Over at the literary temple of the goddess, Isis has entertained her loyal subjects with a number of Lady Gaga videos in the past week. I also saw Lady Gaga on some awards show on Sunday (as my husband clicked through every station available in some lame attempt to watch… nothing long enough to understand it). He actually flipped back when he realized “some chick wearing almost nothing was playing a flaming piano.” He seemed worried when I knew it had to be Lady Gaga without any help from captions or the announcers (are you really listening to this stuff? And watching it online, honey!).

During my brief morning commute I enjoyed Christmas music from a station that goes 24/7 holiday this week through December 25. It’s often corny, but you just can’t help blasting out Rudolph and feeling alive! I now drive a car with a radio that let’s you know who is performing most songs, and I am often surprised by the artists who have burned Christmas albums. That, of course, got me thinking:

Will Lady Gaga do a Christmas album?

Turns out she has done a Christmas song,:

Christmas Tree by Lady Gaga

Play song from iLike.com

 

 

I think some other traditional songs need the Gaga touch. For example, I Want a Hippopotamus for Christmas.

Just imagine what the Lady could do with this part:

“There's lots of room for him in our two-car garage
I'd feed him there and wash him there and give him his massage”

I suspect Lady Gaga wouldn’t be nude, but would wear chain mail and/or leather. And hot stilettos.

I guess I should do some work now. But once you get “Lady Gaga and a hippo video” in your brain, you have to let it out before you can accomplish anything else.

Clicking on the photo will take you to its original posting site.

Moral Psychology and Political Leanings

Over the weekend I relaxed with the December issue of Scientific American. The Skeptic column by Michael Shermer explored the psychological differences between liberal and conservatives. We all know the stereotypes of these political entities; research can now explain some of the differences:

Like many other stereotypes, each of these contains an element of truth that reflects an emphasis on different moral values. Jonathan Haidt, who is a psychologist at the University of Virginia, explains such stereotypes in terms of his Moral Foundations Theory (see www.moralfoundations.org), which he developed “to understand why morality varies so much across cultures yet still shows so many similarities and recurrent themes.” Haidt proposes that the foundations of our sense of right and wrong rest within “five innate and universally available psychological systems” that might be summarized as follows: 

1. Harm/care: Evolved mammalian attachment systems mean we can feel the pain of others, giving rise to the virtues of kindness, gentleness and nurturance.
2. Fairness/reciprocity: Evolved reciprocal altruism generates a sense of justice.
3. Ingroup/loyalty: Evolved in-group tribalism leads to patriotism.
4. Authority/respect: Evolved hierarchical social structures translate to respect for authority and tradition.
5. Purity/sanctity: Evolved emotion of disgust related to disease and contamination underlies our sense of bodily purity.

Liberals generally score high on 1 and 2 with lower scores on components 3, 4, and 5. Conservatives usually have similar scores for all 5 themes, with 1 and 2 lower than self-reported liberals.

Want to know how you stack up? Go to www.yourmorals.org and take the quiz! There are 5 “morality” quizzes (the one summarized above is fifth on the list). After taking each brief quiz you see your results and how they compare to others in the study population. A number of other studies and tests are included on the site as well.

An “informed consent” check box precedes each question set, so the site generates data for the group. Assist a psychologist with their research today!

My results? I am an admitted liberal who provided further validation of their findings.

Photo courtesy of PhotoXpress.

Pesky Patients Prevent Prose

I came back from a couple of national meetings with a bunch of ideas for this blog. One involved Varmus’ comments on the impact factor; I actually wrote that one last week.

Then my inpatient care service ballooned beyond one patient. Kids were coming out of the woodwork wanting to see a nephrologist.

I hate when that happens.

Since handing over the service last night at 5, I have been trying to recover from 48 hours of everybody wanting my attention, and all wanting it NOW. I am just now feeling like I have my brain back.

It wasn’t enough to have a whole bunch of patients at once, though. We had our furnaces and hot water heater replaced during the same 48 hours. That just made those 2 days that much more special.

I will get my head back together and write more meaningful input. I promise.

Photo courtesy of PhotoXpress.

Valuing The Written Word

I recently attended an interesting lecture at the Annual Meeting of the Association of American Medical Colleges in Boston. Harold E. Varmus, MD, gave the Robert G. Petersdorf Lecture, entitled Publication Practices and Academic Values. The talk addressed the increasing pressure to publish in glamour journals, both for funding and academic advancement. Dr. Varmus pointed out that many of his most significant works appeared in “lesser” journals that served the appropriate audience for the science. Discussions after the formal talk centered on judging academic achievement on that standard.

How did some scientific journals acquire biblical reputations?

Some have been around a long, long time. I have not found anyone who can remember a time when The New England Journal of Medicine was not the premier clinical research carrier.

How do we determine a journal’s worth? At the present time, the index of choice is the Impact Factor (IF). There is an excellent description of IF and its calculation on Wikipedia:

The impact factor, often abbreviated IF, is a measure reflecting the average number of citations to articles published in science and social science journals. It is frequently used as a proxy for the relative importance of a journal within its field, with journals with higher impact factors deemed to be more important than those with lower ones. The impact factor was devised by Eugene Garfield, the founder of the Institute for Scientific Information (ISI), now part of Thomson Reuters. Impact factors are calculated yearly for those journals that are indexed in Thomson Reuter's Journal Citation Reports.

Academics, especially scientists, love an objective numerical datapoint. During the 20 years or so that I have participated in these endeavors [has it really been that long?], the IF has risen dramatically in importance because it seems so objective. However, like all numbers, the IF can be gamed, and its validity has been questioned:

The impact factor refers to the average number of citations per paper, but this is not a normal distribution. It is rather a Bradford distribution, as predicted by theory. Being an arithmetic mean, the impact factor therefore is not a valid representation of this distribution and unfit for citation evaluation.^[6]

Most journals try to improve IF by providing more review articles. Reviews receive more citations than original research, thus improving the IF. Other manipulations may also inflate IF:

Journals may change the fraction of "citable items" compared to front-matter in the denominator of the IF equation. Which types of articles are considered "citable" is largely a matter of negotiation between journals and Thomson Scientific. As a result of such negotiations, impact factor variations of more than 300% have been observed.^[12] For instance, editorials in a journal are not considered to be citable items and therefore do not enter into the denominator of the impact factor. However, citations to such items will still enter into the numerator, thereby inflating the impact factor. In addition, if such items cite other articles (often even from the same journal), those citations will be counted and will increase the citation count for the cited journal. This effect is hard to evaluate, for the distinction between editorial comment and short original articles is not always obvious. "Letters to the editor" might refer to either class.

 

Several methods, not necessarily with nefarious intent, exist for a journal to cite articles in the same journal which will increase the journal's impact factor.^[13]

 

In 2007 a specialist journal with an impact factor of 0.66 published an editorial that cited all its articles from 2005 to 2006 in a protest against the absurd use of the impact factor.^[14] The large number of citations meant that the impact factor for that journal increased to 1.44. As a result of the increase, the journal was not included in the 2008 Journal Citation Report. ^[15]

The Wiki lists a number of alternatives to IF; however, complexity plagues them. PageRank algorithms (such as used by Google) cannot be explained in a simple equation. Increasing complexity may improve validity, but it zaps intuitive understanding.

Dr. Varmus plead for an end to IF insanity. He also works on open access, and has been a a major proponent of freely available online science. In 2006, Chris Surridge of Public Library of Science (PLoS) blogged on the IF and its irrelevancy to PLoS following an editorial in PLoS Medicine. In the Petersdorf lecture, Varmus bragged about reported the IF for PLoS Medicine (amusing but irrelevant, I guess).

So what is the answer? Clearly, the IF can be too easily manipulated. Other alternatives should be considered. Or, perhaps, we need to get over the idea of ranking stuff. Ranking journals and schools (that pesky US News and World Report thing) results in game-playing. We all know which ones are elite. The IF works about as well right now as the Bowl Championship Series algorithm does for college football.

In this internet-connected, computerized age, any paper in a peer-reviewed, indexed journal can readily be retrieved by interested parties. “Elite” journals increase early exposure, but those who need to see the work can easily retrieve it without personal subscriptions or press releases. Today, more than ever, the content should be the point.

Photo courtesy of PhotoXpress.

Masks, Hot or Not

“Why do you use your real name?”

Eventually most people who read my blog ask me this question. We all read other blogs written under pseudonyms, be they  a goddess or another fictional name. Many commenters also use pseudonyms. Working behind the veil of a screen name allows people to discuss things with candor; otherwise they might not feel free to open up for fear of reprisal or embarrassment.

Within my world of academic medicine, most bloggers hide their identity, at least to some degree. Some posts, although pseudonymous, include the author’s identity, or enough clues to figure it out. Others work hard to separate their real name from their blogosphere self.

Online identity is one of the first thing a new blogger decides. My own rationale for blogging came about because of my work. In starting a new magazine for the American Society of Nephrology, I needed to learn about social media and the role it could play with traditional media. The best way to learn this stuff is to jump in and do it. It did not make sense to have an anonymous online identity when I wanted these activities to compliment stuff I do offline under my real name.

Isis has posted her rules for pseudonymous blogging:

Anyone who could fire me/prevent my career advancement knows about my blog. I write with the knowledge that they may be reading it.  Some of them do.

I never, ever, ever write about my students.  Ever.

I never write about a colleague without their knowledge.  My immediate colleagues and collaborators know about my blog. 

I never write things about another scientist that I would not say to them openly and in public.

I don't divulge top secret MRU-related stuff.

These are good rules for any blogger no matter how they handle their identity, and ones to which I generally adhere. Given these rules, I feel completely comfortable being “out” on the web. Occasionally I get snarky, but not in a way that will cause irreparable harm to myself or my relationships.

I still remember the sense of freedom I felt when I turned 40. About that age I realized that other people really could not do that much to harm me. I bring that same attitude online now. Of course, I still have enough fear to give proper attribution to the photo-art supplier… cause FWDAOTI is cool, but stealing intellectual property is not.

Photo courtesy of PhotoXpress.

That “Special” Time of Year

‘Tis the season when a doctor’s fancy turns toward… re-credentialing. Not roasted turkey with family and football. Not jingle bells and candles. Just packet after packet from insurers and hospitals wanting to know all about you.

They all want the same information in different order:

• Are you still licensed?
• Are you still board certified?
• Has anyone sued you?
• Are you impaired in your ability to practice?
• Have you kept up your skills?
• Are you insured for malpractice?

Copies of your CV, your license, your DEA certificate, and your continuing medical education coursework accompany each form. You must also supply 3 to 5 peer references who are familiar with your practice. Also, your original signature (NO STAMPS) in 3 to 7 places.

Perhaps they would like a note from my kindergarten teacher? I believe she died, but a séance wouldn’t be much more work…

Repeat this process for each hospital or clinic at which you see patients. Fill out similar forms for every insurer. Then have your secretary make and keep copies (because at least one application will be lost).

As I struggle through this quagmire of paperwork, I wonder why this cumbersome process still exists. All of these parties request the same information; perhaps they could get together and come up with a single universal form. Even better, we could put that universal process form online. The amount of paper I am required to submit boggles the mind. The requirements can be interesting as well; some parties want only black ink while others specify only blue pens be used. (One year I used purple just to, perhaps, cause a bit of trouble.)

When you add up the cost in paper, time, and postage, we could put together a national online web-based process. Collecting these sorts of data is not rocket science. Of course, it would require some cooperation among competitors, but it is within reach. A bit of government guidance could make this reality! It would reduce administrative costs and reduce the hassle factor with a learning-curve less-steep than the electronic medical records funded by the stimulus plan!

Imagine filling out this stuff once… That would leave a lot more time for myself and my staff to enjoy family and football and bells and candles, not to mention actually taking care of patients and performing the rest of our academic duties.

A Dish Served Cold

I rose before the sun this morning to get to the airport. The cab ride lasted all of 15 minutes- about a third of the duration inbound to Boston. I checked into the lounge for a bite of breakfast and a leisurely blog post.

Instead I read emails that have made me angry. I hate when another professional questions my knowledge. I really hate when I provide data to validate my knowledge and I am ignored by said professional. I REALLY REALLY HATE an email showing that said “professional” still seeks an opinion that shows me up.

My plane will board soon. I usually fall asleep quickly in a moving vehicle not under my control.

Today I may will plan revenge.

More Information About GWIMS

In last evening’s post I described GWIMS, the Group on Women in Medicine and Science of the AAMC. Becoming an official group recognizes the importance of women’s participation in our academic enterprise. I now have some more “official”language about the role of GWIMS:

The GWIMS will serve as a national forum to advance women’s success in medicine and science by addressing gender equity, career advancement, awards and recognition, and recruitment and retention. Deans have been directed to designate institutional representatives who advocate for women’s advancement in leadership, education, research, clinical practice and administration to join the GWIMS. This new forum replaces the former AAMC Women Liaison Officer (WLO) network.

Each school should have one primary GWIMS representative serving as a point of contact to the AAMC. GWIMS is open to anyone who has an interest in advancing women’s success in medicine and science. If you are interested in becoming a member of the GWIMS or are a former WLO, please communicate with your dean that you wish to become a member of the GWIMS and have the dean’s office forward a comprehensive list of all those interested to the GWIMS office at gwims@aamc.org.

For more information about GWIMS, please visit www.aamc.org/gwims or call 202-828-0647.

A Group Becomes a Group

I serve lots of professional roles in my job. I see patients, try to run a lab, and edit a magazine. In another role, I design and implement development programs for our faculty to improve their skills in teaching, administration, and writing. As part of this role, I attend the meeting of the Association of American Medical Colleges (AAMC).

Today I attended an amazing gathering. In 1976 the AAMC gathered its first participants to discuss women in medicine. Over the past 30+ years women have gradually become half of all medical students. We are finally making some inroads into senior leadership positions as well. In all this time, Women in Medicine and their representatives, the Women’s Liaison Officers, have remained a lesser organization within the AAMC.

This year, we officially became a “group,” a formally recognized part of the AAMC. Moving from WIM to GWIMS (Group on Women In Medicine and Science) is a big step, and one long overdue. The additional “S” is welcome as well; many women serve in basic science departments, and their needs should also be served.

Each medical school dean appoints an official representative to GWIMS. Find out who represents your school and make your concerns known.

Someday sexism, overt and unintended, may be gone; until then, we need to pay attention to the needs of women.

What I Am Reading

I have been saving this one for a trip. A few years back my spouse handed me a tattered paperback he had just finished- Angels and Demons. I took it to the airport, and I did not close my eyes until I finished it. The mix of history, symbolism, science, and some anti-papacy undertones kept me reading into the wee hours of the morning. I then devoured The Da Vinci Code, a much weaker book that still kept me turning pages. I have been waiting since then for Dan Brown’s next efforts.

If you liked the first two novels, The Lost Symbol will provide a lot of the same. Massive conspiracies that could end civilization as we know it all come together along with Robert Langdon. The Harvard Symbologist (can you really get a degree in that?) has less than 24 hours to decode a complex mystery to save his friends and the world as we know it. Substitute the Masons for various Roman Catholic groups… you get the picture.

Sometimes I pick up sequels because I want more of the same. The Lincoln Rhyme novels provide procedural murder mysteries with a familiar cast but novel twists in each one. The Lost Symbol is too much of the same.

However, I did enjoy one aspect of this novel immensely. When I was a freshman in high school, during the year of our bicentennial, I researched a year-long report on the signers of the Declaration of Independence. What struck me, growing up in the heart of the Bible Belt, was the lack of traditional religion among this group of men. Most were deists; a creator exists but has little to do with the day-to-day issues of human beings. They believed in intellectual curiosity and seeking answers to the way the world worked, that the creator wanted us to seek these answers for ourselves.

In Angels and Demons, one early scene in the book (not included in the movie for some inexplicable reason) sticks with me. The dead physicist-priest and his adopted daughter have been using particle physics to attempt to provide scientific proof of the existence of god (sound familiar?). This hot female yoga-master physicist demonstrates the interaction of a teensy bit of anti-matter with matter, resulting in a brilliant explosion. After witnessing this feat, Robert Langton utters, “My god!” The woman replies, “Exactly.” I loved this scene because it suggests that the creator is a source of energy and initiation, not some judgmental bearded guy on some heavenly throne. Much more believable than anything I have heard in church.

The Lost Symbol entertained me through a couple of airports and plane rides, but the plot was too familiar. Robert Langdon still appeals, and there are still symbols to unravel. Freshen something up next time, please.

Sometimes You Have To Vent

On needs surveys, our faculty at University of Nebraska Medical Center consistently requested help developing writing skills. Given that the peer-reviewed paper is the coin of the realm, you might think that all training programs would include this skill. You would be wrong.

Research degrees include lots of writing (although more of a sink-or-swim approach is the rule), but your average medical school faculty member has not had to write anything more technical than a patient discharge summary.

A few years back some of us on the faculty development committee put together a workshop on manuscripts. Nearly 100 faculty participated, and they wanted more. The next workshop attracted nearly the same number of participants. We had a successful program on our hands.

The problem with success is that you are asked to repeat it, and the message here was pretty basic- write a lot. Keep writing. Get people to critique your writing. Never give up. Keep writing. Write some more.

Sometimes a message needs a different messenger. For our next effort, an expert will deliver the keynote. Paul Silvia, PhD, is an associate professor of psychology and author of How to Write a Lot. His research interests include motivation and goal setting, making him a perfect expert on faculty writing.

Before the workshop commences in 2010, I loaded up his book in the Kindle Reader in my iPod and used some airport time to read it (yes, I am reading the book before the speaker comes). The information is nothing new; its delivery includes enough humor to make it a quick read with a lighter feel than the usual writing manual.

So far, I have only found one portion I take exception to:

Sometimes, rejections are unfair, mean, and poorly reasoned. Sometimes you can tell that the editor or reviewers didn’t read your paper carefully. Resist the urge to complain to the editor. I have heard of people writing the editor an angry letter that denounced the reviewers as lazy incompetents. Those letters never work, probably because the editor is often friends with one or more of the reviewers. Some people recommend writing this embittered letter but not mailing it. That’s even more irrational—why waste your scheduled writing time with fruitless venting? Spend your time revising your paper instead. The world is unfair (p<0.001), so take what you can from the reviews, revise your paper, and send it somewhere else.

In general, this is great advice. You never want to send “that letter.” You should always make some revisions after a review, even if it just clarifies points the first reviewers missed. After all, they may be tapped to review the next version by the next journal editor. I know people who, upon receiving a request to review a completely unrevised manuscript for another journal, have submitted the content of all reviews from the first journal (so that pesky author can’t figure out which initial reviewer is repeating) and merely added “please revise as above.” Ouch.

No, my beef concerns not wasting time writing “that letter.” Sometimes authors get hung up and need to vent. If an hour or so putting these negative thoughts on paper (including your assumptions about the parentage of the reviewers and the quality of their eyesight) gets you over the hump and back to work, I say it is time well spent. [Of course, I usually just go shoe shopping as my stress-buster, but we all have our personal vices.]

If you need some help with your writing, or a book to recommend to your students, How to Write a Lot will likely fit your needs. I suspect Dr. Silvia will provide a motivating, mirthful workshop for us next spring.

Learning Never Stops

Once again, I find myself in the Omaha airport using their free wi-fi to update my blog. Today I travel to Boston for the Annual Meeting of the Association of American Medical Colleges (AAMC).

This meeting is not sciencey.

This meeting features my hobby, faculty development. If we want faculty to perform functions not featured in their degree training, then we must provide opportunities to further their skills.  For example, no physician or scientist I know received administrative training during their formative years. Instead, the traditional route has been to promote them until they fail. This strategy actually worked out pretty well for awhile; if you can run a big lab or clinical section, you probably have the skills to lead a department. Unfortunately, the strategy also leads some people to failure.

I serve on a couple of committees that implement faculty development programs. Topics include educational techniques, leadership skills, hot topics like programmatic assessment, and more basic skills like writing. The chancellor provides a generous budget, and our sessions receive good ratings from faculty who attend. A 90 minute lunch-&-learn typically brings in 50 attendees, while the all-day institutes often draw larger crowds.

So I am off to ponder being a better faculty  member for a few days. Boston is usually fun, although nippy, and I know I will learn stuff. Stay tuned for updates.

Here is a question for any academic readers who wander by: What is the most important thing your institution needs to help you learn to succeed in all aspects of your job? Leave a comment and I will find programs that address the issue.

Observations In The Media

An ad shows up on TV while I prepared dinner this week. The first 30 callers are “guaranteed participation in this clinical trial.” The voice over goes on to describe how blood sugars may fluctuate “through no fault of yours” in diabetes, as well as the miraculous way this “natural” product will level them out.

The spot goes on for a bit about this breakthrough treatment to stabilize blood sugars.

I tried to find out more on the internet, but I can’t remember the exact name of the stuff.

I suspect there is no true clinical trial; they are likely “trying” to get you to buy this stuff. I mean, can you imagine writing this into an IRB application:

Entry criteria: Adult with diabetes who uses telephone quickly.

Exclusion criteria: Dials phone too slow.

?

Sometimes I am tempted to call the number. I don’t, though.

I have to get dinner ready.

Random Thoughts Between Road Trips

I feel a little overwhelmed right now. I just returned from Renal Week 2009, the major US nephrology meeting.

• Work accomplished? Check-
• New ideas generated? Check-
• Good time had? Check-

Back at the homestead in Omaha, one might think I kicked back and relaxed; however, I find myself trapped between my dirty laundry and my empty suitcase. Yup, I head for Boston and the AAMC meeting this Friday.

Of course, distractions presented themselves as well. My new glasses arrived, and yesterday the braces came off a whole 2 months early.

Last night we saw the stage show, Irving Berlin’s White Christmas. I truly believe that all of the world’s ills would be fixed if life were more like a musical. Of course, bursting into song at critical moments will likely get you committed- and those around you rarely join in and dance with you! White Christmas, the movie, does not make a lot of sense (a general retiring on the eve of battle? Give me a freakin’ break!), yet every Thanksgiving it goes in the DVD player while we wash the good dishes. The music swings,you feel warm and fuzzy, and who can resist those dance numbers with Vera-Ellen and Bob Fosse?

The stage version eliminates some of the movie’s problematic elements. General Waverly ships stateside for a war wound, and the minstrel show number is eliminated (though it is more politically correct than the black-face number in Holiday Inn, the flick in which White Christmas, the song, originally debuted). More pieces from the Irving Berlin songbook show up. The result is an evening that not only generates that warm-fuzzy holiday feeling, but leaves you humming and toe-tapping.

This fall I began tap lessons for the first time in my life. I now recognize the steps on the stage, and I have an idea how difficult those production numbers can be. Given the sweating after my hour class in shorts, I cannot imagine how hot those poor cast members are in ski sweaters and lights.

I should probably work now, or at least plan my wardrobe for Boston. A Big Thanks to the touring company of White Christmas- you made my evening! I will keep you in mind while I shuffle-hop-step tonight.

Photocollage created with images from PhotoXpress.

The Personal Paradigm and Peer Review

RenalWeek 2009 in San Diego is underway. I just enjoyed a forum on conflict of interest in medicine. One talk, by Rober M. Califf, MD, of Duke University, discussed bias in clinical trial reporting. Most of the speakers focused on financial conflicts of interest. Dr. Califf described a number of nonmonetary conflicts of interest as well.

One of these nonfinancial conflicts involved scientific hubris. For example, you review a paper or a grant and its (potential) results shoot down your own research and ideas. Do you accept the possibility that you are wrong? This work has the potential to make your prior work irrelevant, as well as decreasing your ability to get funding and promotion. The document is well-written and convincing, at least to the other reviewers. Do you allow it to proceed, or do you demand further work to reconcile it with your current hypothesis? Data that may not be feasible, if your personal paradigm is wrong?

We scientific types supposedly worship at the alter of truth and knowledge. We are human, though, and humans like to have explanations for everything. As nature abhors a vacuum, our brains hate missing information or pieces. In other words, we are biologically predisposed to develop hypotheses and patterns for everything around us. We also seem predisposed to defending views in which we are invested.

This source of conflict is rampant in peer review. Qualified peers must have knowledge of the subject area in question, and they will have pre-formed hypotheses about the material. Most reviewers can accept new experiments that advance their ideas, even if the world moves in a new direction. When those pre-formed ideas quash legitimate questions, then they become a source of conflict of interest.

What can one do? One can exclude reviewers based on probable bias. This practice is commonplace for manuscript submission. If a member of your study section could be trouble, you can request that they not review your grant. You should send your stuff to lots of different funding agencies as well; the same proposal may be funded by one agency and triaged by another, just because peer review is subjective and biased in this way.

Human nature simply will not allow all sources of bias to be removed from the world. I hope we in science can consider our own intellectual prejudices and overcome this conflict of interest.

Photos courtesy of PhotoXpress.