Conspiracy Theory: Cause What Fun Is Reality?

If you don't live under a rock, you are probably aware that Michael Jackson, the King of Pop, died Thursday in Los Angeles. Regardless of the bizarreness that plagued his recent years, he had tremendous talent and molded the music industry for more than a decade. His music will live on for a long time.

One networked showed photos of MJ in his hyperbaric oxygen "anti-aging" chamber. That worked well, huh?

The predominant theories regarding his death revolve around chronic illnesses and addiction to prescription pain medications. Reliable bloggers in the pharmacology community have helpfully explained cardiotoxic effects of Demerol (meperidine).

Click on this link for another helpful blog.

Self-destructive drug use by a celebrity? Echos of Elvis... Heath Ledger... ?

No, this all seems too easy. There must be more to the story than this. I mean, does anyone really benefit from the death of Michael Jackson, the master of Neverland? Wouldn't those he owed money rather he had finished his upcoming London concerts?

Never fear, for as I have been doing laundry on a Friday evening (yes, my life is this pitiful), my mind has had time to wander over the events of this week. In my prolonged period of drug-free thought, I have identified the one person who has clearly benefited from Michael Jackson's demise:

Yes, the "lost boy" of South Carolina, Mark Sanford. This guy jetted to Argentina for the weekend for an affair. No transfer of power, and apparently he didn't even maintain electronic access with the office. This scandal dominated early in the week. It's gone now.

Coincidence? Do you really believe in coincidence? Or do you want to believe yet another celebrity burned out and died young?

A True Story

Last week I wrote about My Sister’s Keeper, a novel and movie to be released this Friday, June 26. Today I also tell a story about the need for a kidney transplant, but today’s account is true.

The story I tell is not one of my patients; that would violate a number of rules. No, this tale belongs to someone I know through friends and relatives. If she wishes to claim this saga as her own, she may do so by commenting. I will not “out” her.

The girl entered this world 18 years ago into a loving family. She had hypoplastic left heart syndrome, a condition in which the part of the heart that pumps blood to the body is malformed and cannot do its job. The best therapy for this condition, at that time, was cardiac transplantation. On her first roll of the dice she got lucky. An appropriate infant donor was found, and her life continued.

She grew up like most children. Although she required medicines to keep her body from rejecting her heart, she walked and talked and acted like a normal kid. Unfortunately anti-rejection drugs can damage other organs. After a number of years her kidneys were failing. Once again the gods smiled on her, and her mother was able to give her a transplant.

With high school completed, she dreams of going to college this fall and living independent of her parents, and she has been accepted. Finances are tight, but the dream is still in sight. Except…

Except her tranplanted kidney, like most, is not going to last forever. When the damage became apparent, a work-up for a new kidney began. Unfortunately, she has developed antibodies to a number of histocompatibility loci: the things that the body recognizes as self or not-self. The more antibodies the body has formed, the better the match has to be. This girl now requires a virtually perfect match. No one in her extended family fits.

She has already defied the odds. She now faces dialysis and a long wait for a new kidney. She has relatives willing to donate; they hope that someone who is a match will be willing to make a swap (see page 1 article in May Issue here).

She still holds onto her dream of college away from home. It can be done on dialysis, and I suspect she will figure out a way to make it happen. Compromises may be necessary. But she still hopes for that magic kidney.

No Hollywood ending here. Not even a reality TV ending. Just an 18 year old girl with a dream for a new kidney and a normal life.

Every transplant center has similar stories to tell. Please consider being an organ donor after you die, or even before.

Click here for more information on being an organ donor.

Click here or on the logo for more information on the Alliance for Paired Donation.

My Cyborg Name

Get Your Cyborg Name

Good to know my assasinations will be logical and most likely nocturnal.

Career Maintenance in the 21st Century

Today I heard a story on NPR’s Morning Edition about social media and applying for jobs. That resume printed on heavy bond in a matching envelope is so 20th century… and we are almost a decade into the 21st! Sending a printed job application makes you look, well, old, or at least out of touch.

Some folks have found jobs through FaceBook or Twitter, but the most popular professional networking site is LinkedIn. This site allows you to set up a resume with current and past positions, education, more detailed descriptions of interests and job responsibilites, and a short status update similar to those on FaceBook.

The fun is just beginning! You can add links to your blog or other web pages. Apps let you share travel plans, books you are reading, and PowerPoint presentations or other documents.

The real power of LinkedIn is its networking. Using your places of education and employment, email address book, and interests, the site locates people you may know. You then ask them to “join your network” which is like being a “friend” in FaceBook. You can also ask your primary network contacts (your “friends” to continue the analogy) for recommendations. These can be viewed by others on LinkedIn to support your online resume. My public view is shown below:

Those who have joined LinkedIn can generate a bare-bones resume in PDF format as well.

Once you have set up your primary network and, perhaps, joined some groups, you can then arrange “introductions” via the service. Say you want to meet someone from Company X. You can search for Company X and identify people. The service reports those who are linked to your network. Secondary links are those connected to your primary network, and tertiary networks are one more step removed. You can request introductions via these links and eventually make contact with people.

A number of companies and headhunters use the service to find contacts who may want jobs they have or may be able to suggest appropriate candidates. When you sign up you specify what you want to hear about and how you want to be contacted. I am not actively job hunting, but I get at least one inquiry a month this way.

LinkedIn has been called “FaceBook for Professionals.” It is a useful tool for job hunting and career maintenance. If you are over the age of 18, you probably need a profile!

Impossible, Improbable, & Wonderful

Last Friday the first chatter about an upcoming movie began hitting the blogosphere. My Sister’s Keeper got my attention because it involves a kidney donation situation. I picked up the novel Friday and read it to see what was coming.

SPOILER ALERT: I may relate things in this brief plot summary that you don’t want to know before you see the movie. Or better yet, read the book. Consider yourself warned.

This family (Mom is Cameron Diaz) has two children, son Jesse and daughter Kate. The daughter develops a rare form of leukemia. Her best chance to survive involves a transplant from an HLA identical sibling – which her brother is not. The parents select an identical embryo and give birth to a sister, Anna (Abigail Breslin). Her cord blood is used to transplant Kate.

Kate does well for several years, but then relapses. Anna then donates lymphocytes, granulocytes, and bone marrow for further procedures for Kate. After the second transplant the tumor may be licked, but the drugs to control graft-vs-host disease toast Kate’s kidneys. For some reason she has to have an exact HLA match. Her dialysis has “stopped working.” Unless Anna hands over a kidney, Kate will die. She sues for medical emancipation at this point (and gets Alec Baldwin for her lawyer), setting up the conflict for the book.

So let’s start with what is wonderful about this book. It may be the best picture of the effect of chronic illness on a family that I have encountered. Too many depictions have saintly parents working tirelessly to produce a miracle for their child, with no ill effects on others besides the medical establishment. From my read, Anna suffers the physical effects of donating to her sister, but seems to be rather well-adjusted compared to the rest of the family. The whole family exists in a state of readiness, waiting for another crisis or illness to disrupt their lives. The brother feels invisible, and both parents admit they have, at some point, “given up on him.” He brings his own pathology as well. The book makes the family members neither saints nor ogres, but human beings trying to take on a bad situation as best they can. I hope the movie can convey this as well as the prose.

What bothered me about the book is the kidney transplant situation. I cannot name a center in North America that would consider using a 13 year old donor, even if she were willing and the circumstances dire. The descriptions of dialysis would imply in-center hemodialysis. It is unclear why this procedure has “stopped working.” Can’t they do more? I see patients survive hemodialysis, even after cancer treatments, for years. We usually require 5 years cancer-free before we consider survivors as transplant candidates. OK, I understand that the kidney was the appropriate organ to set up the dramatic conflict in the story. I guess I will grant some literary license on this point; however, I can’t figure out where Kate’s nephrologist was in the subsequent proceedings. The emancipation trial presents testimony from a psychiatrist, the head of the hospital ethics committee, and Kate’s oncologist. The latter is who testifies to Kate’s renal needs. Huh? This is a book – you don’t have to pay extra for another character! It would have required a bit more research to bring the nephrologist in and somehow make it realistic, perhaps explaining how this extraordinary set of circumstances came to be.

LAST SPOILER WARNING!!!!! PROCEED AT YOUR OWN RISK!!!!!

So we have covered the wonderful and the impossible. What is improbable? Well, when I first heard the plot summary, my reaction was, “the only way we take 13 year old donors is as cadavers.”

Yup, after the trial, Anna is in a car accident with a massive head injury and ends up giving a kidney to her sister after all. Impossible? No. Improbable? Yes.

There is a lot more to the story than what I’ve discussed here. The book is an excellent read, although as a nephrologist I had to really suspend disbelief and forgive some literary license. I still ended up sobbing into the better part of a box of Kleenex at the end. I am told they altered the ending of the movie, but previewers tell us we will still like it. I guess I will have to wait another 10 days or so to find out with the rest of the world.

Selling Your Poster

Above the three Lanes are shown enjoying a fine meal in a New Orleans establishment, after all of our posters are done.

So you have designed and printed your poster. Now you will have to stand next to it for a period of time. This presents a great opportunity for you to present your work one-on-one to those most interested in it. Some people squander the moment.

First of all, dress professionally. This means some sort of suit-like outfit. As I have noted before, if you are showing up on the Nobel short list you can wear jeans to your presentation. Until then, be professional! Read the poster instructions. Show up and stay the whole time.

Those strolling by will generally fall into 3 groups. Most will read the title, perhaps smile at you, and then walk on by. Don't feel bad - they are just looking for another category. Another group are your colleagues. They will come by to see your work, catch up, and otherwise see what you are presenting. The third group are those who are interested in your topic in some way. This is the group for which you prepare.

If someone you don't know spends more than a minute reading your work, smile and say hello. Offer to answer questions. Don't pretend like they aren't there (you would be surprised how often this happens). Try to read their name badge; you may recognize it! Think of this as a golden opportunity to meet those whose work you cite!

Others who decide they are interested in your work will ask you to tell them about it, rather than reading the poster while you watch them. Have the 2 minute summary ready:

• Why we did it
• What we did
• What we found
• What we think it means

Each point requires one or two sentences. "We thought factor X might cause Y. We knocked-out the gene for factor X in mice and found that they didn't develop Y. Factor X may be a new therapeutic target for disease ABC which is characterized by high levels of Y." They can then ask you to clarify what they are most interested in, whether it be how you knocked-out the gene, how you measured Y, or why you think any of this has any relevance to the real world.

Poster presentations present challenges, but they are a great way to have others discuss your work. Remember, this is your chance to present your hot science to the world - not "just a poster."

Scientific Posters: Part deaux

First, the photo at right is from my Louisiana Swamp Tour. He is Big Al, ~13' long and the dominant gator in the Honey Island Swamp. We saw him grab another gator by the tail and toss him 5 feet away. Don't mess with Al...

So you have finished the title and authors for your poster. Now on to the entree, the body of the work. Your poster should be organized into sections like a paper: Introduction, Methods, Results, and Conclusions. Optional sections are references, acknowledgements, and contact information.

For a paper, only the most important results are shown in graphic form; in a poster, anything that can be demonstrated in graphic form should be done that way. I guarantee you will remember the photo of Big Al longer than you recall anything else in this post!

Don't use paragraphs of text. Bullet points, like on a slide, are preferred. There is a scientific basis for this- people can typically read ~65 characters without scanning across a line. Columns of text shouldn't be wider than this, or your viewers can get lost!

Font selection is important, but the "rules" aren't as hard and fast as some would have you believe. Arial is not the only option!

• Sans serif fonts (like Arial or Helvetica) facilitate individual letter recognition
• Serif fonts (like Times) help pull words together and may be easier to read for sentences or bullet points (and especially for documents like manuscripts and grants)
• ALL CAPS ARE TIRESOME
• Avoid "cute" fonts; you lose credibility!

The smallest text on a poster should be at least 5mm in height. This translates to 16pt, and is a good size for captions or other details. Important text in the "meat" of the poster should be 20-24pt.

I usually don't include a bibliography on my posters, but I do acknowledge grant funding and provide contact information. The latter is especially important for people who may view your poster when you are elsewhere! If they want to invite you to speak at their place, they can jot an email into their address book and catch up with you later!

Many organizations "require" that a copy of your abstract be on your poster. I have never seen anyone police their posters this closely, the abstract is a block of text that is hard to read, and the meeting participants have access to the abstract elsewhere. I often omit it from the actual poster. I format my posters to 3'x6' even though the standard poster board is 4'x8'. That way I can stick up a copy of the abstract along side the poster, or a few business cards. I can also stand near my poster without blocking it.

Next post: guidelines for (hu)manning your poster.

Scientific Posters: The Rules

For the last 5 days I have been in New Orleans for the Scientific Sessions of the American Diabetes Association. I feel like I spent about 3 days standing next to my poster (although it was only about 4 hours total). This experience did give me a chance to see a lot of examples of the art of the scientific poster. My daughter, a PR major, also attended the meeting. She was, frankly, appalled by the presentation skills (or lack thereof) demonstrated at the sessions.

One of the pleasures of my current job is giving a talk on poster presentation preparations to our summer research students. Since the biomedical community at large seems to lack these skills (or ignore them), they will be reviewed over the following few posts.

Posters were first introduced in the mid-1970's to increase the number of presentations at scientific meetings, as well as fostering 1 to 1 communication. They do have some disadvantages. First, those interested in a topic are likely to be presenting simultaneously. As the format has multiplied, it is possible to feel overwhelmed by a forest of boards. It is also much easier to walk past a bad poster than to ignore a bad PowerPoint.

Like all presentations, a poster should be thoughtfully prepared following the specifications of the meeting. Yes, you need to read and follow the instructions! It just looks silly (or dumb) to tack a vertical poster on a landscape board. Do you want those reviewing your papers or grants to think you are that careless?

By far the most important part of the poster is the title. The actual words were determined when preparing the abstract; now you have to present them so the audience sees and understands them. Title fonts should be 90 point minimum, and dark type on a light background is most readable. The title is one place on the poster where some liberties can be taken; light font on a dark background can be used here to grab attention. Most meetings then specify that the authors and institutions follow below the title in a smaller type.

For example:

Logos or other artwork flanking the title are often attention grabbing and may help in identification of you and your institution. I actually designed a logo for my lab that incorporates the University's current logo:

A poster across from me at ADA listed a title and beneath it listed no authors; instead it was from "The Children's Hospital and Rich Donor Institute." No academic institution or city was named. Now, they may be named "The Children's Hospital" but I have to tell you, many places share these vague names. "Rich Donor Institute" may be world famous, but I had no clue where it was. I know the instructions for the posters said to list the institution and city where the work was done. Leaving this information off made me think that this group was

(1) incredibly arrogant

(2) somewhat stupid, or

(3) all of the above.

Those are the nuts and bolts of poster titles. You have about 10 seconds to catch someone's attention as they stroll through the rows of presentations - make sure your title doesn't drive them away!

Long time, no post...

It has been 5 days since my last post, and I have been having a great time in New Orleans! One thing about this city, you just don't get the opportunity to be hungry or thirsty for long.

It has also helped that in addition to my loving spouse (who is faithfully attending sessions, but he is primarily a diabetes doc) my 21 year old daughter has come along. As she is currently a PR intern for the local ADA chapter, the meeting has been educational for her as well. And she has been great company when I have played hookey to shop or sight-see!

One thing that has appalled her is the lack of presentation skills, both on the platform and the poster. Over the next few posts I will highlight some of the common mistakes we have observed, as well as reviewing the literature (yup, there is a scientific literature) on poster presentations.

In the meantime, the good times continue to roll in the Crescent City.

Flight Time: More Jambalaya

Tomorrow we fly to New Orleans for the annual meeting of the American Diabetes Association. I will be accompanied by my loving spouse, the director of our diabetes center, and my 21 year old daughter who is doing a public relations internship with our local chapter. My son and his grandparents will hold down the home front.

Let the good times roll!

Photo: Nebraska Tour de Cure, May 31, 2009

Google oops!

Yesterday I wrote about how amazed I was that our local movie theatre was touting Pamela Anderson's work for PETA, an organization that would deprive people with uncurable health problems of advances that rely on animal research. I also wrote about the hypocrisy of someone who has undergone so much elective surgery wanting to eliminate animal research. Implants, injectables, anesthetics, modern analgesics, and current surgical technique were all developed through work in animal models.

Today I checked in to see if any new comments were in place. I was surprised (astonished, gobsmacked.... I don't know if there is a better word for it) to see an ad below my posting:

I have only recently signed up with Google AdSense. I did understand that labels and key words would be used to target ads to my posts. I did not realize that they would be this.... ironic.

What to do now? Do I contact AdSense and see if they can restrict the ads on my site? Or do I let it be. I mean, I could even encourage my followers to click on the HSUS link so their funds can go to an animal researcher.

What do you, my loyal readers, think?

Photo courtesy of PhotoXpress.com

A Scientist Goes to the Movies

My hubby and I went to the movies Saturday night. We saw Angels and Demons. We had both read the book several years back and really liked it. We both thought it was far better than The Da Vinci Code. The movies works this time. Not Oscar material, but a great date night!

Before the movie, our theatre, like most, shows a looped slide show of ads and "entertaining factoids." These include some movie trivia "Q&As." Saturday the "As" were disconnected from the appropriate "Qs," leading to some wacky humor. For example:

Q: In this film, Miley Cyrus tries to escape fame as a pop singer on her family farm.

A: X-men Origins: Wolverine

Of course, a photo of the Wolverine cast was shown. Trying to decide which character was Miley was a time-passing hoot.

A more disturbing slide presented a factoid:

Did you know Pamela Anderson is an animal rights activist and volunteers for PETA?

Why is this something that got noted? I mean, you must be living under a rock if you don't already know this factoid. I'm sure someone got this placed for promotional purposes. It seems PETA is something they believe audiences will admire - not possibly associate with the elimination of meat and dairy consumption, pet ownership, and scientific research!

I am also left with the hypocrisy of someone who has altered her body surgically being an opponent of animal research. How many animals were required to make sure she could safely enlarge her lips and breasts? Not to mention ongoing procedures for "maintenance" that most Hollywood types now get.

Young people are big audiences for movies. If they see things like this factoid, they get a positive message about PETA and no words about the downsides of this movement. Of course, it's very difficult to get out complex messages in a 15 second slide, but we may need to try if we want to preserve scientific animal research.