Like Questions at a Beauty Pagent

When applying for residency, the one portion of the application form with any potential for individual expression was the infamous personal statement. Having reviewed about a million of these now, I appreciate how mundane they can be. It is sort of like asking Miss USA contestants their opinions on world peace.

Now, for the first time in 26 years, I find myself constructing a personal statement.

As part of the recent changes at NIH, this component has been added to the humble biosketch. We now have to “briefly” explain why we are the best-est, most-qualified, ideal person to play our role on the project proposed.

The simple truth, that I am the person interested enough to propose this work, just won’t cut it.

How about “the voices in my head keep telling me to do this.” No?

“I am a gift from the gods about to impart new critical knowledge to your world.” Perhaps a bit over-the-top (although members of my family might find this one completely in character).

I finally played it straight. I listed my experience with the relevant techniques that have not yet been applied to a novel exciting model, and my clinical background that fits the question at hand. So predictable!

It should be bloody obvious from the proposal that I am the ideal person to pursue this question in this manner at this time. If it is not, then I have not written it right.

By the way, I am fully in favor of world peace. May I have a tiara now?

Photo courtesy of PhotoXpress.

“Don’t Be Such a Scientist:” Part Two

Last week I wrote about Randy Olson’s book Don’t Be Such a Scientist. Now that I have finished the read, I want to revisit Chapters 3 (Don’t be such a poor storyteller) and 4 (Don’t be so unlikeable). These chapters touch on current issues in the blogosphere.

In chapter 4, Olson expresses dismay about the foul language and intolerance displayed in evolution posts on ScienceBlogs:

The voice that came through in all of these blog posts, and even more intensely in the comments of fellow evolutionists, was not just offensive; it was also incredibly condescending and arrogant.

In this chapter, Olson concerns himself with likeability of scientists; in other words, maintaining civility within the discussion (a topic at SciOn later this week). He does have a point; people are unlikely to listen after you have called them fuckwits.

Unfortunately, a reasonable civil discussion violates chapter 3; let’s face it, conflict is essential for a good story.  People don’t pay to watch two guys glare and name-call in the ring; they want to see punches! Conflict sells and drives blog traffic (and income); the only way to make this bigger is to make it a nude-mud-wrestling grudge match (although I doubt most of the contributors on ScienceBlogs should be seen nude).

Let’s face it: some of those conflicts in commentary are damn entertaining! Virtual evisceration is sort of like “Shark Week” for readers, especially when you agree with the sharks! The danger, though, is that less aggressive species get scared off, leaving only those voices in complete agreement (see this post by Isis for more on this danger). You end up preaching to the choir (egads, a scientist uses a religious analogy), and you have to work even harder to generate conflict, leading to fights among the choir (this is why there are no longer any moderate republicans).

Unfortunately, I don’t have the solution to this problem (if I did, do you thing I would be plugging away on this post?). I try to stay civil on my little soapbox on the web, and I have to remain civil in ASN Kidney News, the magazine I edit. I do allow my inner snark to appear when I’m commenting on others’ sites.

Perhaps being a medical doctor is good training for this sort of conflict; if a teenager asks me about getting tattoos, I can say no, absolutely not, tattoos are stupid. Or I can talk to them about the safety issues surrounding the procedure, not to do it on the day they get hemodialysis and receive anticoagulation, and then discourage it (in med school I saw the effects of time and gravity on most tattoos, and it isn’t pretty). Most of the time, the latter approach has prevented or delayed the onset of tattooing without alienating my patient. Of course, the first scenario would make a much better story… especially if s/he gets the tattoo and returns to shoot up my clinic.

Photo courtesy of PhotoXpress.

HIPAA Meets Politics Via Twitter

The following story hit my mailbox yesterday, courtesy of HIT News. Seems a worker in Mississippi has lost her job by getting a little snarky with protected health information via twitter:

A simple tweet has sparked a HIPAA compliance and public relations mess at Mississippi’s University Medical Center, and an administrative assistant is out of a job as a result, reports a local TV station.

The controversy began when Mississippi governor Haley Barbour posted this tweet on his Twitter page: ”Glad the Legislature recognizes our dire fiscal situation.  Look forward to hearing their ideas on how to trim expenses.”

“Schedule regular medical exams like everyone else instead of paying UMC employees over time to do it when clinics are usually closed,” tweeted UMC administrative assistant Jennifer Carter. She had heard that the governor had come into UMC for a physical one Saturday three years ago, and that the clinic had to be staffed up with 15-20 workers just for his visit.

Next: Carter paid dearly …

Two days later, Carter was in UMC’s compliance office for violating HIPAA’s privacy provisions. The Compliance Department told her the Governor’s Office had tracked her down and told them to deal with her,” according to WLBT.

Carter says she was suspended without pay for three days and “strongly encouraged to resign,” which she did. She says she ”wasn’t really jabbing” at the governor.  ”That’s just what people do on Twitter.”

I explored a number of the links provided on the site, yet I have one big unanswered questions about the event:

Did the governor publicly acknowledge his physical or its results at the time of this appointment? Those in the public eye, especially in an election year(Barbour is up for re-election in 2011, so this event took place during his last quest for office), often have their physicals and then assure the public that they are in great health. If it was public knowledge that he had the physical, then I am confused about where the break in protected information occurred. Carter said nothing about his health, merely commented on the “unnecessary” costs the state may have incurred. Given security issues with a prominent government official, the situation described may have been the least disruptive for the medical center’s other patients. It could even have been a cost-effective measure when all other factors were considered.

If the appointment was not publicly acknowledged, then Carter’s tweet was clearly a violation of HIPAA, since knowing the date and circumstances of a medical procedure can compromise one’s privacy. Her defense- she ”wasn’t really jabbing” at the governor- seems silly. Clearly, she was questioning the governor’s judgment and priorities. Such “jabbing” would be protected speech… if a healthcare appointment weren’t involved.

Social media, like twitter, allow us to find our audience as never before. We all must remember our legal and moral responsibilities, and use these freedoms wisely.

What I’m Reading (& EVERYONE Should Read)

A few years back EB featured a movie, Flock of Dodos. This film exploring the “debate” between evolution and intelligent design was captivating, educational, and entertaining. Its creator, Randy Olson, inspires me. A tenured professor, he left academia, attended film school at USC, and now makes movies about science.

Think Michael Moore with a PhD. In short, this is the career path of my dreams. That or writing the Great American Novel, developing the screenplay, and winning the Oscar for it. But I digress.

When I saw Olson’s book on communicating science, I had to read it immediately. Yesterday I read a review, downloaded it to my Kindle, and devoured about 40% of its virtual pages already.

Don’t Be Such a Scientist provides the answer to the real question facing science today!

A number of scientists with good communication skills kvetch about the public’s lack of literacy. Most seem focused on educational policy and getting “the facts” out there in an accessible way. If we provide the data, the public will “get it.”

Dr. Olson debunks this attitude almost immediately. Through amusing stories of his experiences in acting and film classes, as well as life under the Hollywood sign, he illustrates a major problem: most of the public engages in issues through feelings, not through thought, something similar to my prior post on the book Unscientific America:

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.

Olson’s book discusses ways to relate to the public on this visceral level so they care about the science. Important issues need to be more visual and emotional; the opposite tactic that most scientific groups pursue!

It brought to mind several other books I have read dealing with science and exploration around the turn of the last century. Thunderstruck was the most recent of these, a story of the invention of wireless communication by Marconi intertwined with a murder mystery and transatlantic flight. What these books all had in common?

Scientists had to put on a show.

Federal funding for science? Just not there except for weapons in time of war. No, those who “discovered” stuff had to be independently wealthy or appeal to wealthy donors. Explorers and inventers would give demonstrations of their discoveries in hopes of acquiring funds for their next venture.

I am trying to imagine the last manuscript I read as a show. It would never make it to Broadway… As a movie, it would not even hit the direct to DVD market. On YouTube? Fuggedaboutit!

I have always acknowledged my creative streak, my desire to “put on a show.” Editing a magazine has been a much better fit than a journal, simply because we have to make it visually exciting (getting doctors and scientists to write for a magazine has been a bit of a challenge, but that’s another story). Olson’s book fits with my own, admittedly biased, viewpoint on the problem with science dissemination. If I didn’t have a grant to write (speaking of boring scientese), I would finish perusing the book right now.

By the way, Dr. Olson, I would love to work on a movie. Call me- we’ll do lunch (isn’t that the Hollywood way?).

Radiation Safety

A question arose this morning about the risks of radiation from backscatter imagers.

Background radiation exposure in the US is ~3mSv (milli-Sieverts, equivalent to ~300 mrem). The lifetime risk of a lethal malignancy from all causes in the US is ~20%. A single 10mSv exposure at age 25 years increases the lifetime risk to 20.05%; however, the cumulative risks of repeated exposures are unclear.

A CT scan of the abdomen and pelvis exposes a person to 4.5 – 18 mSv of radiation; a plain film of the same area involve 0.7 mSv (See Adv Chronic Kidney Dis 16:48, 2009 for more on these types of studies).

So what is the danger from these new scanners? According to a posting at How Stuff Works:

According to the Health Physics Society (HPS), a person undergoing a backscatter scan receives approximately 0.005 millirems (mrem, a unit of absorbed radiation). American Science and Engineering, Inc., actually puts that number slightly higher, in the area of .009 mrem. According to U.S. regulatory agencies, 1 mrem per year is a negligible dose of radiation, and 25 mrem per year from a single source is the upper limit of safe radiation exposure. Using the HPS numbers, it would take 200 backscatter scans in a year to reach a negligible dose -- 1 mrem -- of radiation. You receive 1 mrem from three hours on an airplane, from two days in Denver or from three days in Atlanta. And it would take 5,000 scans in a year to reach the upper limit of safety. A traveler would have to get 100 backscatter scans per week, every week, for a year, in order to be in real danger from the radiation. Few frequent flyers fly that frequently.

These scanners appear to offer little danger from radioactivity. The posting referenced above is from 2007 when these devices underwent initial testing in the Phoenix airport. The scanner program generated the cartoon image to the left, although its capabilities are more dramatic as shown on the right-hand portion of the image.

Regarding the diminished image used, the following comment was raised in the article:

Some wonder how, then, the system can actually boost security. And the manufacturer, American Science and Engineering, Inc., admits that distorting the image does decrease the machine's usefulness. What if someone tapes a vial of liquid explosives to his scrotum?

Like deja vu, huh?

Only on the Roof, Please

Last week my parents asked me a medical question (I’m a doctor- it happens). A friend of theirs just had shingles and suffered. A lot.

My parents now wanted to know “if the shingles vaccine is worth it.”

Shingles, or varicella-zoster, occurs in individuals sometime after chickenpox. After the immune system “conquers” the varicella (chickenpox) virus, this wily pathogen lies in our nerve cells, waiting. Waiting. Waiting…

As we age or develop problems with immunity, the virus can be reactivated, producing blistering lesions along a nerve root. Like chicken pox on steroids…

If the zoster (shingles) weren’t bad enough, severe pain may persist in the affected area for months after the rash heals. My parents’ friend has such pain that she cannot drive 3 months after the flare.

I have not suffered shingles personally, but I have seen it in my immunosuppressed patient population. The vaccine reduces the risk of shingles by ~50%, and post-herpetic pain (the fancy doctor-talk name for the nerve pain) by ~2/3.

I told my parents to get that vaccine. Even though the level of protection is not as good as with childhood vaccines (which are 95+% effective in preventing most infections), shingles is a bitch.

The CDC has a great site with FAQs and podcasts about this topic for patients and healthcare workers.

Photo courtesy of PhotoXpress.

Sad Times

This morning The Scientist sent out its top 5 articles of 2009, according to the number of page views. The list appears below:

1. Merck published fake journal

Our investigative report of how the company paid Elsevier to produce a publication that looked like a peer-reviewed medical journal but contained no disclosure of sponsorship

2. OA publisher accepts fake paper

The experiment tested whether a nonsensical article written by a computer program could pass peer review and be accepted. The experiment worked

3. iPhone apps every biologist needs

A PhD student's top 10 smart phone applications that boost his efficiency and help his research

4. Elsevier published 6 fake journals

In a follow-up to our #1 story of the year, the publisher admits to putting out a total of six publications that looked like peer reviewed medical journals, but did not disclose sponsorship by pharmaceutical companies

5. Viral cause for prostate cancer?

Prostate cancer is increasingly looking like an infectious disease, and may be sexually transmitted

Bad publishing ruled. Two sordid tales feature Elsevier’s sins (#1 and #4), while story #2 demonstrates the lax standards of some Open Access publishers.

I am also saddened that only one of these stories is really science. Apps for the iPhone are hot, and I certainly clicked on that one as well. But it seems what really gets our attention is scandal.

Scientists click on dirt and gossip the same way we all read the headlines on the tabloids while waiting in the check-out line.

I wonder if Elsevier can spin this into a fake journal reality show?