Boomsday, Redux

This morning I heard a startling news item on NPR:

For example, this moment, during President Obama's town meeting yesterday, the meeting was hosted by AARP, and at one point a caller named Mary put this question to the president about something that she had heard is in the House bill.

MARY: I have been told there is a clause in there that everyone that's Medicare age will be visited and told to decide how they wish to die. This bothers me greatly, and I'd like for you to promise me that this is not in this bill.

I knew this was another case of fiction becoming reality!

Last year, Christopher Buckley’s novel Boomsday kept me entertained through a flight somewhere and well into the night after arrival (this explains my drowsiness the next morning). The title refers to the date when the majority of baby boomers retire, precipitating an economic catastrophe for the country.

The heroine is Cassandra Devine, a savvy 29-year-old PR professional working in an agency run by one of the guys from Thank You for Smoking, an earlier Buckley work. She writes a popular blog (a la Dr. Isis), and she inspires her readers to storm golf courses and gated communities to terrorize the Medicare set. One late night she develops a concept of “voluntary transitioning” for boomers; in other words, they get some benefits (free Botox? reduced inheritance taxes?) if they agree to kick the bucket at age 70. Yup, it’s voluntary suicide. She repeatedly tells people that this is a “meta-issue” meant solely to drive the conversation and get the economic mess fixed, but like many ideas, this one develops a life of its own and is soon out of her control.

Unfortunately, this book has one thing completely in common with reality: tough choices don’t get made.

I won’t tell you any more about the book, because you really ought to read it yourself. Hell, you should buy it and help out Mr. Buckley who lost his job at the National Review (founded by his dad) because he endorsed Barak Obama for president!

The truth is no one really wants retirees to “pick their method of death:”

Mr. DAU: The House bill includes a provision that would allow Medicare to pay doctors for taking the time to talk with their patients about the very difficult choices that people face at the end of their life about health care: What kind of interventions you might want in the case of a bad accident or debilitating illness. It would empower individuals to make the best possible health care choices for them and their families and allow doctors to provide their patients with this so that no one's guessing at the end of a person's life.

SIEGEL: Because you're saying that that consultation that the doctor would offer or another health care professional might offer would, under the bill, now become covered by Medicare.

Thus far the debate on health care reform is a mess, driven more by fear than fact. I truly hope that our government can get it together and cover all of our citizens.

In the meantime, I’m waiting for Christopher Buckley to write another book!

The Name of the Game is Blame

I read an interesting post over at DrugMonkey today. The pharmaceutical primate takes Terrified Tabetic (@TTabetic) to task for inaccurate statements about HIV/AIDS. These posts plus the ensuing discussions raise a question for those of us who are healers and investigators:

What do we do when the patient contributes to their own illness?

We may know how we feel. I know that I don’t have much empathy for smokers who get lung cancer or chronic obstructive pulmonary disease. For my entire lifetime, smoking has been linked with these illnesses. Does that mean we shouldn’t study these illnesses? Should we refuse to attempt to treat them because they are self-inflicted? No, I believe we should fund research into these disorders and continue to find ways to ameliorate the suffering associated with them. I am just not the best person to do it (this may be part of the reason I ended up in pediatrics).

Many people in our society seem to have a “blame the victim” mentality for, well, almost every illness. Some magazines would suggest that if we live right/ eat right/ exercise right we will never die! My husband, the director of our diabetes center, lectures medical students on endocrine pathophysiology. A student once asked him after class why so much research was done on type 2 diabetes when it would not be a problem if people quit committing the sin of gluttony. My spouse handled the question tactfully; I am afraid I would not have. You see, my hubby has type 2 diabetes. I would have taken the time to teach that student a lesson s/he would never forget.

The biggest problem in the research arena is the scarcity of resources. I doubt that most people would mind the study of so-called self-inflicted illnesses (although none of these illnesses is due to a single factor; we really don’t understand why some smokers get lung disease but many do not) if all areas of research were money away from what I want to study that I cry foul.

That’s my one gripe with disease-based lobbying. While I belong to groups that do it, ultimately we need to increase all research funds and let the NIH, not congress, sort out where it goes. Otherwise we have politicians micromanaging biomedical research saying where money must or must not go. Special interest groups can raise funds for their own programs, as many have done, and direct research toward their cause that way.

There is nothing in this universe that is unworthy of further study.

Photo courtesy of PhotoXpress.com

My Dry Cleaner Can!

According to a recent Research! America poll:

Americans were asked whether or not they could name a living scientist. 65% said they could not, and another 18% were unable to accurately name a living scientist.

The best know living scientist was Steven Hawking, named by 7% of respondents.

Those of us who do science in the US are rarely described as scientists. As an MD, I am usually described as a physician, not a scientist. Even though I only do clinical medicine 30% of the time, most people see me as a healer, not an investigator.

Most scientists I know are introduced by their faculty appointment, not as scientists. The US population generally believes that university faculty fill their days with teaching. Unless you have experience in academia beyond obtaining a bachelor’s degree, you probably do not appreciate the role that research plays in that arena.

So why can my dry cleaner tell everyone that I am a scientist?

Well, when our new research building opened, the local paper did a supplement on the facility and all the scientists with lab space. They ran a photo and a brief description of my studies, and the woman who works the 7am shift asked me about it. She knows I am also a physician and has asked me kidney stone questions as well.

We all know the stereotypes: mad, nerdy, consumed, unfashionable. People don’t know anyone who answers these descriptions.

We need better PR.

So let’s take the advice of New Voices for Research. If you’re a scientist, introduce yourself that way. Let’s start breaking those stereotypes. The world should know us better, one person at a time.

Becoming the Authority

This week Michael Vick was cleared to possibly play football again in the NFL. He will be suspended from some games, and no team has yet signed him.

Now, dog fighting is a pretty gross thing. I don’t mind some violence and potential for blood in my sports (I like football and hockey), but I don’t see the point in any sport in which the actual point of the activity is to brain-damage your opponent (boxing) and worse (cage fighting, dog fighting, bull fighting, etc). In no way would I ever condone this activity, but Michael Vick has served his jail time. Were I lucky enough to be an NFL owner, I would not sign him to my football team (mostly because he wasn’t that good), but I do not think he should be banned from the league.

The question I had was after listening to this coverage on NPR:

Part of Michael Vick’s restitution is working on a dog fighting prevention program with the Humane Society of the United States (HSUS). HSUS is not the human society in your community; it is primarily a national organization that seeks to eliminate animal use for food, research, and recreation (pets, hunting, etc). Most of its budget is used for lobbying and publicity, not to save dogs and cats in communities. People for the Ethical Treatment of Animals (PETA) is also quoted in the NPR piece. This is another group with extreme views, promoting humane live insect traps after Obama swatted a housefly on television.

When did these groups become authorities? Where are the more moderate animal support groups who help get pets adopted, prevent unnecessary litters, and assure that animals are treated with care? They are still there; Denver the Wondercat (who just celebrated his 18th birthday) was rescued from the local shelter. My parents and my daughter have also adopted cats.

The truth is your local humane society can barely make ends meet, let alone mount any sort of organized publicity. HSUS and PETA, in contrast, are PR machines, eager to grab a national issue like the exploits of Michael Vick. Unfortunately, every child who is touched by his dog fighting program will now consider HSUS an authority. As I blogged a few months back, volunteer work for PETA is considered in a positive light and publicized as a benevolent thing. These groups are seen as authorities, even though both of these organizations may provide support to more radical organizations engaged in terrorist activities.

How do you fight a machine?

Photo courtesy of PhotoXpress.com.

Lies, Damn Lies, and NO Statistics

Last week I listened to some of the Sotomayor hearings on CNN. The hearings were about as I expected, but the ads between sessions were frightening. A Canadian woman was on the tube telling me how she would have died of a brain tumor if she hadn’t traveled to the US for treatment.

I have a number of Canadian friends and acquaintances, most of whom are physicians. They LOVE the Canadian system. They know that every patient they see is covered. Layers of administration for preapprovals and claim resubmissions have been peeled away from the process (I have spent 45 minutes on the phone to get non-tablet forms of medications approved for a pediatric patient). And they don’t have to inflate their base charges so that the 80% rate someone negotiated will cover the actual costs incurred. A couple of them have said that Michael Moore got their system right in Sicko. Even those who experience the system as patients like it. Yes, they pay for it with taxes, but they don’t have to worry about losing their coverage with their job.

This ad just didn’t sound right. Elective procedures often involve waits (like they can in the US), but I had never seen a documented life-threatening emergency put off that way. Then I heard this interview  with Maureen Taylor, a health reporter for the Canadian Broadcasting Corporation, on NPR’s On the Media. The full clip is available, and I’ve pasted relevant material from the transcript below, just in case you’re the impatient type:

Shona Holmes is a woman in commercials who says that she would have been dead within a year because doctors in Canada were making her wait six months to have her brain tumor removed. Tumor, in its strictest sense, means a swelling or enlargement. In Shona’s case, it was not cancer:

“What she had was actually a cyst in her pituitary gland, which you can call it a tumor if you want, but it’s not a cancerous tumor. And it was causing her some hormonal problems and pressing on her optic nerve to give her some vision problems.

This is not a life-threatening thing. I don't deny that it would be very disturbing to have vision problems and be told that we're not going to be able to operate on that for six months. So she went to the States and had this done. But nobody at the Mayo Clinic is claiming that they saved her life, yet this is being reported in the American media as a woman with brain cancer who would have been dead had she let the Canadian health care system prevail.

It just makes me angry that the media isn't looking into this a little more. It wasn't hard for me to find out what she actually had and do a little research on it. People, I'm not walking over a lot of dead bodies here on my way into the studio.”

Many of the other commercials feature patients seeking experimental or nonstandard treatments which would generally not be covered under present private insurance in the US.

Healthcare should be a right, not a privilege. Calling what we have in the US a “system” is generally inappropriate, because “system” implies some sort of order or sense. Most healthcare workers will tell you that rhyme and reason are not part of the way we fund medicine in the US.

Forty years ago, we put men on the moon. Today, we still have people who can’t get basic healthcare. Embarrassing, really. Yet we are listening to lies about a real system that works. Even more embarrassing.

The Contents of My Bag

I have now progressed to the third Aimee Leduc mystery, Murder in the Sentier. Below is one of my favorite passages thus far that will illustrate the pull these stories have for me. She has been out on a Vespa chasing crime when she has to enter an upscale venue. Aimee is always prepared:

"A block away, she entered a deserted courtyard, set down her backpack, and got to work. She stood on the cobbles, reapplying her Chanel-red lipstick in a window. Looking in a tall truck's side-view mirror, she reapplied mascara. She flattened her spiky hair with gel, then slid into the heels she carried, along with a new cryptography manual, calcium biscuits for Miles Davis [her dog, pronounced Meels Dahvees], and black silk underwear crushed at the bottom of her bag.

One never knew."

Her bag contents always include Chanel lipstick, ultrablack mascara, and high heels (unless she is wearing heels or boots, and then her red high-tops are there). And black silk underwear, because you just never know what might happen.

I wish I were that prepared for my life.

My bag contents:

Wallet and keys

Assorted lipsticks and glosses

Toothbrush and stuff for my braces

Hospital IDs

Chargers for BlackBerry & iPod

Earphones for iPod

Pens in various states of usability

BlackBerry & iPod

Given the size of the bag I carry, this seems pitiful. I certainly couldn't make myself ready for a hot club with my present contents, let alone chase bad guys and make the world a safer place.

But then, I don't have to!

What I’m Reading

My father loves France. His PhD is in French history, and I am named after an actress (Pascale Petit) he saw in the 1950’s while working on his dissertation in that country. He is also a murder mystery fan(like me), so Cara Black’s series set in present day Paris appealed to him. He has been after me to read one for months, so I loaded up a couple for my latest trip.

Murder in the Marais, the first book in the Aimee Leduc mysteries, involves present day murders as well as crimes during the Nazi occupation. The heroine has limited herself to computer investigations since her father’s death by terrorism, but impending financial difficulties and curiosity push her back undercover to infiltrate a skinhead group. Eventually she uncovers not only the original crimes during the war, but also ongoing conspiracies that threaten Europe in the present.

I have never been to Paris, so I cannot comment on the authenticity of the prose; however, there are enough references to designer clothes and upscale venues (and hot sex) to satisfy a chick-lit craving. I’ve already got the second book on deck…

How I’m Wired

I just read a column about how anyone who is cool has an iPhone. Now, as a 48-year-old woman, I doubt that I meet the definition of “cool” in any way. However, I am as wired (or more so) than my 16- and 21-year-old offspring!

My workhorse is a year-old BlackBerry Pearl (I would picture it here, but I can’t take a picture of it with it so…). It works seamlessly with the BlackBerry server at my work, keeps me up to date with FaceBook and Twitter (seriously, if you don’t have UberTwitter, download it NOW), and runs the clinical software for one of my hospitals. I have tweaked available apps to do my patient billing, I get weather and real-time sports updates, and I can carry around photos of my kids, pets, and husband. I would like to be able to double its memory, and there are downsides to the compressed keyboard, but I love the little gizmo.

What my Pearl could not do was read Kindle files. It’s screen was pretty small for reading anyway. And I have a netbook I can use for documents. Why did I need another e-toy?

Then my boss showed me the Kindle app on his iPhone. The screen is big enough to read clearly, and an iPod Touch is at least $100 less than a Kindle. My old iPod’s battery was only lasting about 20 minutes, and I just got a $200 honorarium. The stars were aligned for the purchase of the bad boy at right, now wrapped in a purple silicone case.

I downloaded a bunch of books, and some “fun” apps (none of which cost more than $2.99). I then packed my bags and took off for a 4-day business meeting.

The Kindle reader is a blessing. I became aware of a book I wanted to read soon immediately, so I downloaded via the hotel’s lobby hotspot. In a package smaller than a paperback I brought 3 novels along. And I can listen to music while I read.

I have found some games I like, but most of the apps available don’t appeal to me. That’s OK, I am not their target market. I don’t need iBeer to feel cool; I can buy real beer when I want to feel cool! Web sites are easier to read on the bigger screen, though, especially in landscape format.

I still prefer an actual keyboard to the on-screen version. Even with the compressed one on the Pearl, I’m a fairly fast thumb-typist. With the iPod Touch, I am reduced to one-finger work with lots of errors, even in landscape mode. Way slower, for me, than the Pearl interface.

For right now, I am OK with two devices. Together they take up less space than my first cell phone! I don’t have enough memory on a BlackBerry to ditch my iPod, and it’s screen is too small for ebooks. My weeks with the Touch confirms the keyboard difficulties I experienced in the store when the iPhone debuted. Besides, there are apps for work that I just can’t do with an iPhone!

I am due for a new device about the time the BlackBerry Magnum is supposed to debut. Now there’s a cool device for a hot, middle-aged babe like me!

Some gains aren’t worth it

My son attends an excellent high school, recently ranked #1 in Nebraska by a national publication. He has great academic opportunities, and he takes advantage of these. He is out doing some volunteer work for his National Honor Society application as I write these words. He also loves sports.

His first love is baseball (homerun shown), and he plays all summer. Since 8th grade he has played football as well (it’s the state religion of Nebraska). He has played offense and defense on the freshman and sophomore teams, and he got to suit up with the varsity as a long-snapper for one game last year.

He will not be playing this fall.

Oh, he has gone to weight training almost every weekday at 8am all summer long. He even attended football camp. He finally decided that the payoff was not worth the effort required.

Or the pressure to gain weight.

No one offered him steroids. No one offered any nutritional advice. No one suggested supplements, other than other kids on the team. But coaches did mention that he should try to put on 30 lbs or so if he wanted to play a position besides snapper.

He is currently between 90th-95th percentiles for height, and just above the 90th percentile for weight with rippling muscles I never imagined anyone with my genes could possess. Adding 30 lbs to his frame would increase his body mass index from a healthy 27.2 to an obese 31.8.

He came to this decision on his own. He did not want to get fat because that would mess up his baseball game, not to mention setting him up for health problems later in life (his father has type 2 diabetes). He plans on academic scholarships and achievements, not sports, for his future.

I wonder how many boys on his team could make this decision? I wonder how many of them would pack on pounds in hopes of football glory and a chance to go to college with the sport? I wonder what happens to them, metabolically, when their playing days end?

My daughter quit her dance major because of the pressure to lose weight when she had no body fat to shed. Now my son is giving up a sport  because he refuses to become obese.

I am proud of both of them. But I am worried about all our children.

The Truth About Scientific Research

I remember attending my 10th high school reunion. I was in my fellowship in pediatric nephrology, and my former classmates were amazed that I was “a real MD.” When I confided that I really liked doing research, they asked what discoveries I had made.

Science doesn’t work like that.

Yes, I know, people win Nobel prizes for “discovering” something or other. It may not be exactly what they set out to find, and it is very likely that their “discovery” is different from their original hypothesis. Novel data also get dissed. The first descriptions of many phenomena are relegated to “low-impact-factor” journals because reviewers refuse to believe something that is truly novel.

Science proceeds nonlinearly and incrementally. Only in retrospect can the path from A to B be seen. Several experiments may suggest a direction, but the overriding truth comes from a body of work. At other times an incidental part of the study proves to be more important than what was originally the goal.

For example, I start out interested in condition X which is known to be associated with factor A. I believe that factor A produces factor B which promotes condition X. I do an experiment that shows A produces B; however, my follow-up shows that B produces D in the presence of C. Someone else has shown that D causes condition Y. We now show that blocking C can prevent condition Y. Not what I set out to prove, but perhaps an important “discovery” if Y is a major health issue.

Advances depend on one thing: money. Generous sources of funding allow us to perform experiments and learn more about how life works. At the present time only 20% of studies are getting money from NIH. Peer review is a pretty good system, but you never know where a critical observation will come from. Reviewers also tend to favor more conservative work that is expected to go as planned rather than stuff that may provide novel break-through results. The NIH has tried to get around this issue, but hasn’t solved the problem yet.

Science is like a river of facts. As it flows and eddies form, seemingly unrelated streams from different sources may come together, making a whole that is more than the sum of its parts. And you never know which creek upstream will provide the critical drop.

Photos courtesy of PhotoXpress.com

More Questions Than Answers

I wrote my weekly “What I’m Reading” post and scheduled it to publish on Sunday… July 26. The bad news: I wanted to push it out there on July 19. The good news: there will definitely be a post this coming Sunday since I can’t figure out how to reschedule its publication date!

I follow a number of bloggers on ScienceBlogs. Recently a tidal wave of “discussion” about Unscientific America has left me dismayed by the lack of civility and the comments by people who haven’t read the book.

I downloaded the tome to my new iPod Touch with Kindle reader, and whipped through it in a day. My reaction overall is mixed. I do not see the problem as a lack of science literacy (has the general public ever really understood much about science? Or history? Or literature?) No, I see a lack of respect for science and scientists as the real issue. We need to regain public trust!

Adding communication classes to PhD work seems unlikely to solve the problem of a lack of respect for science. As much as I loved the work of Carl Sagan, having his clone about today would probably do little to reassure the general public. We were promised “better living through chemistry.” While DDT could zap mosquitoes and eliminate malaria, it had detrimental effects on the environment. The green revolution that has allowed the overpopulated world to be fed has taken its toll on the land. People now mistrust the agribusiness industry. In medicine, it seems like papers trumpet polar opposite results; the public can’t decide what to believe, and thus decides to believe no one.

The major complaint about the book over on ScienceBlogs regards religion. Mooney and Kirshenbaum take PZ Myers (Pharyngula) to task for “crackergate.” I have only been hanging out in the blogosphere for about 6 months, so I missed the original escapade. Basically, PZ, an atheist, showed photos of a defiled communion wafer on the blog a few years back. I remember hearing a bit about this in the mainstream media at the time. My reaction: (1) I guess he really wanted to piss people off; and (2) don’t the people whining about his “blasphemy” have something bigger to worry about? The chapter also discusses others in the blogosphere who are referred to as “the new atheists,” an in-your-face breed of nonbelievers. I have to agree with the contention that aggressive atheists turn off the holy rollers, especially when their faith is mocked. That is not the way to earn their respect; however, even if Carl Sagan came back from the dead to poetically tell them that the beliefs of their faith (creationism, etc) are wrong, it is unlikely that they will budge.

Ultimately, two antithetical forces are at work here. Science demands testable facts to support its theories. Religion is based on faith which requires belief without proof. Having grown up in the bible belt, I can tell you that new earth creationists are not swayed by the fossil record or any other evidence you present regarding the reality of evolution. They believe.

The book raised some interesting points and gave me things to think about on the airplane. It’s a good starting point for the discussion on attitudes toward science in the US, but I don’t believe it provides the complete answer we seek.

Another Value to Scientific Meetings

So I have been in intense morning science sessions, followed by relaxing poolside, and then dinner and 1-2 hours of PM science. Most of what I have heard over the past 3 days has not been relevant to the current projects in my lab.

So what good does being here do me?

Well, my scientific creative juices are flowing. This morning I sketched out the general strategy to make one of my projects potentially fundable. We still have some technical kinks to work through, and we need to generate some key data points, but all in all I am ready to go back and research again.

Unfortunately, I will start covering the inpatient service Monday morning. It will slow me down… but I am ready to rock!

By the way, my impersonation of a neuroscience did not result in horrible amounts of embarrassment. Some of the real neuroscience people thought our work was really interesting. I hope my colleague has her family situation calmed and is ready to write!

Joys of Seniority

For those of you who don’t follow me on Twitter (@PHLane):

1. Shame on you! You’re missing the wittiest 140 character updates available!
2. An update: due to a family medical emergency, the colleague working in my lab is not at the current meeting to present her work in about 90 minutes.

The poster arrived by FedEx this morning. I pinned it up and read it. And I’m in trouble.

See, Claudia Chaperon is interested in circadian rhythm and its potential relationship to cardiovascular and renal risk factors, especially in relationship to menopause. She was looking for a lab with the equipment she needed that could also help her learn RT-PCR techniques. I fit the bill, and i have a deepening interest in menopause from a personal standpoint.

I did suggest that she sample kidneys as well as the SCN, that teeny weeny part of the brain she samples for gene expression. And there is rhythmic gene expression with a 4 hour lag behind SCN expression. But I can’t say much more than that…

The great joy of seniority is I DON”T HAVE TO EVEN TRY. I can explain the situation and give them Claudia’s email for other “neurosciencey” questions. If I were a bit juinior, I would have spent my afternoon cramming, not enjoying a lovely day by the pool.

Now this is the real joy of tenure!

Photo courtesy of PhotoXpress.

The Toughest Loss

Yesterday the first word in my daily email from The Scientist was “renal” so I had to read on; unfortunately, the next words were “researchers faked data.”

These researchers violated their experimental protocol, resulting in 16 papers with results that may be better than they should be (according to the post, 14 have been withdrawn and the other 2 are being withdrawn). The really scary part buzzed through the comments, namely that this fraud came to light because the investigators had a falling-out. How many fake papers out there will never come to light because those involved will not “kiss and tell?” I wonder about this every time I get different results from the established paradigm. Did I do something wrong? Were their published methods incomplete? Or did they present “edited” data? Let’s face it; you can Photoshop damn near anything!

What were these “scientists” thinking?

The sanctions officially leveled in this case seem mild, at least to me; 10 years of exclusion from federal research activities for the PI and 3 years for the post-doc/junior person. They have also lost their academic positions. Perhaps the most damning punishment is that they have lost their reputations.

This group was researching novel immunosuppressant drugs for kidney transplantation. This is not my research area (and rumors about this team have apparently been circulating in the transplant immunology community for some time), but I suspect many in this world will have the same reaction I do whenever a paper is retracted: never to trust any data from these people again. Once lost, a reputation is the most difficult thing to regain. There will always be a question mark in the back of peoples’ minds, even if it is never spoken.

While various levels of supervision and the peer review process can help weed out fraud, ultimately editors (and readers) have to trust what the researcher says. If you can’t be trusted, then your research career is over.

Art courtesy of PhotoXpress.

On Meetings Large & Small

For the next few days I will be communicating from a conference on the role sex plays in the kidney and in cardiovascular disease in general.

I have commented at length on planning and packing for meetings, and on various aspects of larger meetings I have attended. These included Experimental Biology and the Scientific Sessions of the American Diabetes Association.

Smaller meetings are different (duh). For about 3 days I will be with a group of people with very similar interests. We will talk together, eat together, drink together, and sleep together (in the same hotel, not the same room). These meetings are a great “breeding ground” for new ideas and approaches. While big meetings should generally include a personal session of touristy behavior, smaller meetings are more intense. And, ultimately, more valuable, even though some may see them as less prestigious than their larger brethren.

When I get bored, I will twitter about random thoughts (@phlane), and I will try to update the blog once or twice. I just finished my last book, About Face, and I should post another What I’m Reading on Sunday. After all, I will have time to burn in airports!

Diversity Rules

A few years ago I was privileged to partake of the Executive Leadership in Academic Medicine (ELAM) program for women. This course was a year-long, highly selective experience for women embarking on administrative careers in medical and dental schools in North America. It was one of the best professional experiences of my life. The content was not particularly novel; I had learned a lot of stuff in my earlier forays into leadership training. No, by far the best part was the network of like-minded women that I encountered. I have stayed in touch with many of them through the present time. When I have questions about something at work, I know I will be able to find an appropriate colleague to engage in discussion.

My husband asked one question about my experience: Why are men excluded? The short answer: there are lots and lots of white male chairs, deans, and chancellors, but far fewer females in these positions. While men could use this training (hubby wanted to nominate a few who could use some skills), they have other venues through which they can obtain it, and it doesn’t seem like they need the boost to get these positions.

I am reminded again today, as I listen to the senate judiciary hearings on the Sotomayor nomination, of how crazy our government can be. We all bring our own experiences and point of view to everything we do. The only way to eliminate our memories and emotions from decisions is to eliminate the human factor, to turn them over to a computer. After all, those white males do not all agree on everything! There is diversity within the white males of congress!

Being a Latina who grew up in the Bronx might color her judgment? But being an ivory league legacy who grew up with a silver spoon in your mouth doesn’t?

For years we had a paternalistic government and court we had to trust to look out for everyone’s needs. I am glad we have government and courts that look more like the US now. I hope that this continues, and that every sector of society can follow suit. I am not talking about promoting incompetent individuals just because of their sex or ethnicity. I just can’t believe that this country hasn’t produced enough competent individuals of every sex, color, and creed to provide truly representative government and industry.

OK, my rant is over. The bottom line is that we all should remember that our perceptions are colored by our experiences. We should value the perceptions and experiences of those who have followed a different path; we may learn something in the process.

Art courtesy of www.photoXpress.com

What I’m Reading

The Whiskey Rebels was a great read. Now I’m back to the present era, but in a different country. My father, also a mystery reader, has lent me his Kindle so I can partake of the newest from Donna Leon, About Face.

This book features Commissario Guido Brunetti, a detective in the Venetian police. The series involves regular murders and crimes, not serial killers leaving trails of tortured victims. Brunetti has a boss who is more politician than crime-fighter, but the secretary to the boss, Signorina Elettra, is a beautiful, stylish, and idealistic computer nerd who can find almost any information needed to solve a crime. She can also work the Vice-Questore to get what she and her comrades need to solve each crime.

The books paint a beautiful, yet disturbing, portrait of life in Venice. Brunetti is married to the daughter of a wealthy count; of course, she is a communist who teaches literature and loves Henry James. They have two children who have grown up through the series. Leon details daily life in Venice, from morning espresso to after-dinner grappa. The disturbing part involves the corruption of Italian society and government. Bribery and abuse of power seem to figure in many stories, and may prevent the truth from surfacing.

I am only a couple of chapters into the present book, but the detailed characters have already drawn me back into the Commissario’s world. Once again, I will post an after-read review on my LinkedIn reading list. In the meantime, I highly recommend this series to anyone who likes mysteries.

Ears vs. Eyes: Learning to Love Podcasts

I am a visual person. I remember faces and I remember names, but I can’t always put them together again. I often find the very act of making a list allows me to remember what I need, even though the list gets left in the car. I can still see what I have written in my mind.

The popularity of audio books escapes me. I read fast, and I process things so much easier by seeing them than by hearing them. A multi-chapter book would require a recap at the start of each commuter session (or a long enough trip to listen to the whole book in one session).

A couple of years ago, I won an Ipod Nano. I quickly transferred a bunch of CDs and set up my Itunes account. I am not fond of listening through headphones, but my new car has a Ipod jack. The podcast, however, has only recently gotten my attention.

Other faculty have been creating podcasts that physicians can download to answer specific questions. I didn’t get it, because I wouldn’t remember what I listened to long enough to benefit (see first two paragraphs). I far prefer to access an online “written” reference, especially if its presentation is friendly for my BlackBerry screen. Other physicians began downloading these short updates, though, and they still seem to be popular.

Now I have become a podcast personality. ASN Kidney News, the magazine I edit, started producing these with the May issue. I chat with the author(s) of something in the magazine, and we post it on the ASN web site and in Itunes. I was thrilled when the first one was downloaded more than 700 times. After all, kidneys are a niche audience. We just posted the second Kidney News podcast; in 10 days it has received >4,000 unique visits and >12,000 total visits!

I have also wandered around the Itunes store to see what other podcasts are out there. I am especially delighted to find my favorite NPR shows. I often miss Fresh Air on my local station; now I subscribe and listen the next morning at work (or on my way home in the car, if I have to do something away from my desk)! For the past year, I have planned Saturday morning rounds so I could hear as much of Wait, Wait, Don’t Tell Me as possible. If you haven’t tried this one, you do not know what you are missing; it is roll-on-the-floor, pee-your-pants funny. While this level of humor has, on occasion, proved problematic while driving, it is always appreciated. Now my patients don’t have to “wait, wait” while I laugh!

I still don’t remember as much of what I hear as what I read or see. I do appreciate what podcasts can do for the world, though.

By the way, I am a member of KIOS, the Omaha NPR station. Have you joined your local NPR affiliate?

Questioning a Paradigm

Mostly I post my personal musings on science, healthcare, and other nonsense that catches my eye. Today I am going to post about a medical study that was just published in the July 2 issue of New England Journal of Medicine.

The first author is Michael Mauer, a pediatric nephrologist at the University of Minnesota and my research mentor during my fellowship (consider this my disclaimer of potential bias). The study examines changes in kidney function and structure over 5 years in patients with type 1 diabetes, the type most common in young children. This study examined primary prevention of diabetic kidney disease; patients without albuminuria (thought to be the earliest manifestation of the problem) or hypertension (high blood pressure), and with normal kidney function (glomerular filtration rate) were assigned to receive enalapril (which inhibits angiotensin converting enzyme), losartan (which blocks the angiotensin II receptor), or placebo. They not only examined all of these functional studies before and after 5 years of treatment, but also performed kidney biopsies with morphometric studies for the lesions seen in diabetic nephropathy (primarily expansion of the mesangium of the glomerulus).

Drugs that block the renin-angiotensin system, like enalapril and losartan, have been shown to benefit patients with advanced kidney disease from diabetes (shown in photo) and other causes. They also seem to benefit patients with early type 2 diabetes (the type seen more commonly in adults and associated with obesity). It has been hoped that they would prevent kidney disease entirely, although smaller, shorter studies have failed to demonstrate this phenomenon. Thus, the hope that this study would answer the question: should all patients with type 1 diabetes be put on these drugs at the time of diagnosis of diabetes?

The answer seems to be no for now. Neither drug showed a clear benefit over placebo in any parameter measured. The study is not perfect; a number of questions arise with careful reading of the article and the supplementary material. Like most studies, the results will breed discussion, more questions, and more experiments.

Probably the most important point I can make here is that

paradigms are meant to be shifted.

We cannot prove anything merely by arguing its logic or making observations from other situations. Logic and other situations suggest that these drugs would work!

 We must do the appropriate experiment if we really want to answer the question.

Diabetes is the most common cause of kidney failure in the United States, although most patients have type 2 diabetes. Drugs like enalapril and losartan still play an important role in the management of this disorder, especially in patients with type 2 disease and more advanced kidney problems. For now, though, we will not be starting these drugs along with insulin in newly diagnosed type 1 patients. And we must keep looking for treatments and cures.

Click below to link to the abstract:

Why I Take Time To Blog

Isis over at ScienceBlogs posted yesterday about blogging and one’s career. Her post first discusses Alex Coturnix and his rules for blogging: (1) A blog post is not a scientific publication; (2) It doesn't count if you publish your data in a blog post; and (3) Your blog usually doesn't generate novel data.

These are important points to keep in mind. While I am a physician-scientist (see photo for proof) I do not discuss my data in Golden Thoughts. If you want to know about my science, you can pull my papers. Or email me, cause I will talk about my hypotheses till the cows come home. Given the frustrations of obtaining funding and running the reviewer mill, no one does science for kicks. Science is a labor of love.

I have on occasion done the “lay science” thing when a topic grabs my attention, and I present it for a different, more general audience. Some folks do this regularly and well (see Uremic Frost for a fine example in Nephrology).

Ultimately, a blog is a personal thing. I love to write. Here I can tell tales or expound on the injustice of the world without annoying anyone (my drinking buddies are quick to point out that my bar stories are waaaay too long). Readers can just click away from my page when they get annoyed. My blog gives voice to thoughts in my head that get in the way of everything else. In a way, it helps me get focused by letting that other stuff out.

I don’t blog everyday because I wish to remain employed. I have stuff to do if I want to be clothed and if I want to eat. But I can’t imagine life without Golden Thoughts anymore.

What I’m Reading

I encountered David Liss through his novel A Conspiracy of Paper. It brought the economic bubble collapse of the East India Trading Company in 1700s London to life. I have tried to read all of his subsequent novels with their rich, well-researched historical backgrounds.

His latest moves to the infant United States and the presidency of George Washington. Two of his government, Jefferson and Hamilton, are jockeying for power. Others are finding ways to make fortunes, legally and not-so-legally.

The story is told from the perspective of two characters, a patriot spy and a frontier woman. The woman hopes to write an American novel, and draws from her experiences just west of Pittsburgh where her husband helps develop a novel whiskey. Whiskey is the coin of the frontier (which was Pittsburgh), and the only way to transport crops through the roadless wilderness back to sell on the coast.

I’m not quite halfway through this book, and it is already wonderful. In addition to painting a deep tonal portrait of another time, David Liss always brings strong female characters to his work. I have always wondered how women such as myself existed in these periods, so this factor appeals to me.

When I finish, I will update my thoughts on my LInkedIn reading list.

Holidays in the Hospital

University of Nebraska considers July 3 a holiday. The city of Omaha does as well.

Unfortunately, my patients missed the memo.

So I’m at my desk. I have just finished rounding on the patients at one hospital. The new admission has finally gotten to the other one, so I can head on over there and finish rounds.

There are a lot of people working on holidays, and not just doctors. Waiters, retail clerks, and others are all out there plugging away.

If you go to a restaurant or drop by a store this weekend, think about saying thanks to the people working through the holiday.

And have a happy Independence Day – even if you only see the fireworks through a plate glass window or on TV!

Photo courtesy of Photoexpress.com.

A Woman of a Certain Age

Earlier today I was lusting over the shoes de jour at the blog of Isis when this ad showed up alongside her words of wisdom:

So we have a woman with gray hair writing on the chalkboard (how old school!) touting online educational opportunities (how… inexplicable).

And then you look to see which programs are being highlighted: Education, Nursing, Health Management, General Studies, and Financial Planning. How… traditional!

Now I grew up in Missouri and got my degrees (BA & MD) from one of the MU campuses (Kansas City). I suspect “women of a certain age” are a growth industry for universities, especially for online education. I suspect these may be popular programs amenable to online learning as well, but I can’t help noticing that they are very traditional pink collar fields.

The whole thing just made me feel, well, weird. I would have shown the potential student at a kitchen table, NOT in an obvious classroom situation. That is sort of the whole point of online education… it’s NOT in the classroom. The tiger tracks are cool, but surely the student could have been standing by a desk at home, perhaps in house slippers.

I also would have liked to see the “mature woman” looking a little nicer. The sweatshirt and jeans with runners is so “Early-bird special at Country Kitchen.” Surely a woman improving her mind and working toward an advanced degree would look a little more put together. Jeans, ballet flats, and a nice fitted jacket?

As a 48-year-old woman whose nest will be empty in a couple of years, I am near the age group this ad targets. I would think one that projects the desired image of an older, professional woman would be more successful.

But what do I know: I’m a doctor, not an advertising guru.