MD-PhD Smackdown

I've taken quite the hiatus from blogging. Some of you seem to still be hanging around and I admire your persistence.

This last month I've been cramming on a manuscript that I want to go out the door before I get scooped. Now that it's nearly done I've lost all my motivation. The analysis was fun but now the last minute tweaking is a major drag. I hoped to submit it this month but I have been a bit distracted the last 2 days. And now I'm leaving for a few days vacation (Yay!) So I guess it won't be till the following week.

Anywho, the topic of this post is a long-standing rivalry that I face routinely: the MD-PhD fight. As a PhD in a medical field, this is a battle I face routinely in my professional life. I prefer to leave it there and keep it out of my personal life but recently, it crept right in where it didn't belong.

A few weeks ago I went to a ob/gyn I found through a referral hotline. In the past, my criteria for gyns was complicated and I really missed the mark this time by bypassing my usual selection process (involving a tedious internet search process involving the following criteria: faculty member at prestigious medical school, no pending complaints to the medical licensing board, bonus points for board certification, fellowships in family planning, some scientific publications, advocate/user of IUDs, volunteer work at select non-profit organizations, political donations to appropriate candidates, membership in abortion-rights, universal healthcare, and select reproductive health organizations, and editorials and/other other advocacy regarding the above). Come on, you all know I'm obsessive compulsive about research so this should be no surprise.

So I go to this gyn who fits 1 1/2 of the above categories. He was very jovial and had a superb bedside manner. When he found out my line of work, he was very excited and said "That's great! The world needs more people like you!" Well, so far so good. But then he embarked on (an obviously well-rehearsed and un-educated) tirade in which he dismissed ONE OF THE MOST IMPORTANT EPIDEMIOLOGICAL STUDIES ON WOMEN'S HEALTH. Apparently, one of the main reasons this research was so horrible is because they didn't have a single gynecologist on their initial published finding (one of the most highly cited articles in the field, btw), it was all PEOPLE LIKE ME WRITING IT. Also, it was horrible research because it "confuses" his patients and now he has to explain something to them (Why worry the little ladies so much? I know what's best for them!) I won't go a ton of details here but I will tell you this: I knew, immediately, he had absolutely no fucking clue what he was talking about. OTOH, this finding is something I know a thing or two about. I tried, and succeeded, to keep it collegial.

Listen, MDs, I wouldn't presume to tell you how you should conduct a physical exam or prescribe medicine. (Although I will tell you that this guy doesn't practice evidence based medicine on either of those fronts, much to my dismay.) Please don't tell me how to do my job.

On another note about the patriarchy, check out how real princesses live their lives.

Restructuring the University

clipped from www.nytimes.com In other words, young people enroll in graduate programs, work hard for subsistence pay and assume huge debt burdens, all because of the illusory promise of faculty appointments. But their economical presence, coupled with the intransigence of tenure, ensures that there will always be too many candidates for too few openings.

Mark Taylor's NYT's recent editorial calls the graduate education the "Detroit of higher learning." As in, it's doomed. The quote here (below? above? I don't know) sums up a lot of the ambivalence I feel about academia. WAY too many people are churned through a ruthless system.

I like what he says about disciplines and about problem-focused learning and restructuring the university, and even abolishing permanent departments (to a lesser extent). His suggestion of a "water program" was obviously based on (or was strangely coincidental with) a famous course called (you guessed it) Water at my alma mater, The Evergreen State College. But while this is a great idea for undergraduate education I am not convinced this should be the way of graduate education. Disciplines serve as a form of organization, structure, and shared memory for thought and knowledge. Collaboration is great but without any solid grounding in one or many disciplines, all you have is loose and unstructured knowledge. Plus you have no academic lineage and good luck succeeding in academia without lineage. I can say this for a fact because Evergreen had no disciplines and I am missing a lot of the basic grounding in certain fields that would serve me well today. (On the plus side Evergreen, you excel at the promotion of critical and innovative thinking, reading, and writing skills.)

Taylor spends some time bemoaning narrow scholarship. He's right. I can hardly even explain my work to others. But my field is primarily supported by grants from the federal government (primarily NIH). Should they be paying me to do something that everyone else is doing and that is "obvious"? Clearly not. Is the pursuit of new knowledge flawed just because it's obscure? So what if few people ever read my dissertation. Only a few people need to for it to have any actual impact on the world. In this way, it only matters that people who want to move beyond it read it. They learn what is already known. Then, they go farther. Clearly, many paths are dead ends. But you can't learn or discover something new until you ask a new question, something that hasn't been asked or answered before.

He also suggests mandatory retirement. Oh hell no. Seriously? Abolishing tenure? Yeah, that's probably on its way out anyway. I won't get into that here. Transforming the traditional dissertation? It's likely that any changes in the diss won't be as radical as he suggests. I see no problem with writing a long tome that is rarely read by others. It's a learning exercise. Besides, I had to write one.

Taylor suggests expanding the range of professional options for graduate students? YES. YES YES YES. This is a suggestion of his that I adore. To do this, the graduate students need to be taught practical skills and to be taught by non-career-academics.....people who actually work in their field in the real world (if there is one.) This never happened in my graduate school.

There have been plenty of other responses to this. I'll post to them later in a format that takes html.

Till then, publish or perish!

Random Bullets of Postdoclyness

•I just had my first dissertation article accepted. Huzzah! The reviews were the best I’ve ever had. One reviewer says, “ …I can see the paper being accepted almost as-is, and would not be surprised if that were the eventual decision.” WHOA. For the record, this is my first article in a good journal ever. It is also, not so coincidentally, my first good article. The others were mostly remnants from student projects. And it’s damn nice to know someone else thinks it’s good too.

•Can’t believe I’m already 6 months in to a 2 year postdoc.

•Do I just get the bad articles for peer review? Why do they all suck so bad?

•How is 100% soft money not some kind of violation of human rights?

•Why did I get myself volunteered to be a chair for a committee?

•Why has my article been “awaiting reviewer assignment” for 3 months? When it’s a freaking revision and has already been assigned reviewers!

•I can’t code well. I have no attention to detail. I waste a lot of time on fixing my own bad code.

•I hate my cubicle. I feel like it’s some kind of horrible hazing experiment to put the new postdoc in a cubicle with her back and computer screen facing the door.

•I really, really, really want to be a beekeeper. I think my backyard is too small for this right now though. It might upset some neighbors.

•Is it 5 yet?

•Is it normal that every other day I think about changing careers? When I haven’t even technically started this one?

•I am totally cynical. I think 99% of manuscripts in my field are b.s. Do I really want to write tons and tons of b.s?

•A small, optimistic, Pollyanna part of me really did think such existential crises would end post-PhD. The cynical remainder of me is pretty pissed (but not at all surprised) that this was not the case.

New Blog Ideas: Health and Medicine in the Media

I feel strangely empty PD (post dissertation). What the hell should I do with all my free time? I mean, besides writing and submitting all 3 of my dissertation manuscripts in the next 3 months (!!!!!!!!!yes, I know, this is what my advisor wants from me!!)

Perhaps even more importantly, what the hell am I going to blog about? I don't have an adventurous interesting life these days--I spent it either in the cubicle, buried in a book, watching t.v., eating, sleeping, or hanging out with my motley friends.

But I do have an interest that I would like to explore in more depth. I am fascinated by the intersection of media, public opinion, and medical research. I am particularly amazed when normal, seemingly intelligent people take a headline and then suddenly cull themselves from cell phone usage because they think phones cause cancer.

For example, just the other day, during a 15 minute chair massage, my massage therapist, when finding out that I do research, encouraged me to learn more about the groundbreaking discoveries in China and Japan regarding acid/base balance and cancer. Whoa.

So in my feeble attempt at fighting the machine(s), I am thinking about a Health Blog in which I critique medical research that hits the media in a small attempt to give the lay reader some perspective on what it all really means.

I'm not sure where or how I'll start this up or exactly what it'll look like. Friends who know me know I am attracted to the quirky and bizarre, so I'll definitely have to occasionally indulge these interests by highlighting bizarre medical practices or diets. Any other ideas?

Mobile Phone Use and Cancer: BAD RESEARCH

I recently was forwarded an online report stating that a recent study determined that mobile phones are more dangerous than smoking. I have seen the author,Vini Gautam Khurana, M.D. referred online as a "cancer expert" Well, hello internet! I too consider myself a cancer expert. And I would tell you right here and now that you need to stop smoking...but I'm currently on my cell phone.

If I wasn't currently working on my dissertation and coming up on my final weeks(!) in my program, I might turn around and change my topic to the media and cancer sensationalism and mythology.

For my due diligence and soapbox needs, I will point out a few things about this "study:"

1. It is not a peer reviewed study. I found it online, and in anything near it's current form, it is NOT going to pass muster for publication in any quality medical journal.

2. The author is a neurosurgeon. Learning how to poke in someone's brain doesn't mean he's ever been taught how to conduct, understand, or report epidemiologic or population-based research or systematic reviews. For example, the author is clearly unfamiliar with current
standards for conducting or writing systematic reviews of the scientific and medical literature.

3. Smoking is really really bad for you. Actual expert organizations like NIH and NCI and peer-reviewed research science has demonstrated smoking to be the leading preventable cause of premature death in the U.S. One of every five deaths can be linked to tobacco-related disease. This is not the case with mobile (cell) phones. While they are linked to road injuries for example, research to date does not demonstrate that cell phones cause cancer.

4. n.b.--This is not new or original research. It is a misinterpretation of existing research.

5. Remember, in the world of risk perception, things we don't clearly understand and are invisible to the eye, like radiation, tend to scare us more than our everyday, prosaic risks (e.g. cigarettes or automobiles) that are far more dangerous.

6. A note to other scientists: just because you're writing for the lay public doesn't mean you should purposefully obscure your scientific methods and fail to discuss your research limitations.

7. The internet is filled with bullshit, lots and lots of incorrect information that is not fact checked or discussed objectively by actual experts. Cancer epidemiology is complex, our bodies are complex and we don't fully understand how they work. Be wary of ANY health information that makes strong claims. Subject any source about the "causes" or "cures" of cancer to suspicion and critique.

For legitimate and trustworthy information on cancer risk and risk factors, including cell phones and cigarette smoking, turn to the National Cancer Institute, International Agency for Research on Cancer, or the American Cancer Society.

More on Epidemiology and the Public's Health

A recent article in the New York Times Magazine profiles the case of hormone replacement therapy as an example of the seemingly endless yo-yo cycle of medical research findings, and discusses whether or not we know what really makes us healthy. It's treatment of epidemiology is informed if a little focused on the negative.

clipped from www.nytimes.com While the tools of epidemiology — comparisons of populations with and without a disease — have proved effective over the centuries in establishing that a disease like cholera is caused by contaminated water, as the British physician John Snow demonstrated in the 1850s, it’s a much more complicated endeavor when those same tools are employed to elucidate the more subtle causes of chronic disease.

A Life of Research

Today I have been working on revisions to a manuscript and it's been like pulling my own teeth out. I have suffered though whole blocks of time in which I have felt utterly despondent and hopeless about the entire enterprise. During these times, I occasionally find myself drifting away into fantasy, surfing the interwebs. I will look for a simple job in the non profit sector, an opportunity to meditate in an Indian ashram, or ponder accepting an offer from a total stranger to accompany him in a wild roadtrip to Alaska in 5 days or less. But these moments of despondency/fantasy alternate with moments of elation, excitement, and a passion for la recherche scientifique.

How is it that I can simultaneously both love and abhor my job so much? What can I do to lessen the despondency and increase the excitement and fun?

The Internets and Productivitiy

From phd comics
via Seeking Academia

Happy Crappy Research

Research can be painstaking and boring. Tedious. Repetitive. But sometimes things happen to upset the balance. Why do they all happen at once? Today I experienced a major happy/crappy collision. See below for a summary.

Happy:
I found out earlier today that an abstract I submitted to a conference next fall has been accepted. Yippee! This is good news, especially because it's important to me to try to get some recognition in this area. I might soon be applying for an open position in this obscure sub-field, so the more I have, the better.

Crappy:
I found out that another paper was accepted at this conference. Having only seen the abstract, this paper appears to be MY PROPOSED DISSERTATION. Yes, this abstract shares my dependent variable of interest, my proposed dataset, AND something seemingly similar to my independent variables of interest. The only catch here is: I DID NOT WRITE THIS ABSTRACT. Panic mode has set in and I have already started making calls to my minions to find out just what the heck is going on. For any of you non academics, it's important to know that we live by a few basic rules including this one: 1. If you do it, you want to do it first. If you don't do it first you look like a chump who can't think of something original. And if you aren't original, why are you an academic?

I'll keep everybody posted as this develops....

Yes!

How does it feel to submit a manuscript? A few weeks ago I got a revise and resubmit for an article. And today I actually finished the revision and submitted it online. Now I am gladly signing the copyright agreement!!! Yippeeee!

How does it feel to go away for the holiday weekend and pack swimsuits and shorts and flip flops after submitting it?

Awesome.

No link between abortion and breast cancer

A recently released prospective study from the Harvard Medical School has concluded that neither abortions nor miscarriages increase the risk of breast cancer.

I am not surprised; this is not the first high quality study to refute the hypothesized link between abortion and breast cancer. Despite the lack of evidence, in 2002 the National Cancer Institute posted information on the link on its web site. In addition, several states, including Texas, require clinicians to warn women seeking abortions that they may be increasing their risk of breast cancer by going through with an abortion.

I hope that with this study the issue can be laid to rest. But I seriously, seriously doubt that this will be the final word.

The abstract and full text are available in the
Archives of Internal Medicine.

The Ethics of Profiting From Your Unethical Actions of the Past

Alan Milstein (blog.bioethics.net) on Professor Phillip Zimbardo's recent appearance on Jon Stewart and the ethics of promoting and profiting from a book based on what Alan claims most bioethicists believe to be fundamentally unethical research.

Our Infinite Capacity for Evil: A Stanford Psychology Experiment and the Virginia Tech Shooting

A few weeks ago I caught an interview on Democracy Now with the psychologist Philip Zimbardo in which he discussed, among other things, his new book, The Lucifer Effect: Understanding How Good People Turn Evil Professor Zimbardo also had an appearance recently on the Daily Show.

The majority of this interview, and much of the book, chronicles the 1971 Stanford Prison Experiment. In this study, healthy college students were randomly assigned to play the roles of prison guards or prisoners while ensconced in fabricated prison. The experiment was terminated early, after only 6 days, when the principal investigators realized that their fabricated prison filled with normal young adults had transformed into a cruel reality in which sadistic guards and depressed prisoners went head to head in a malicious power struggle that culminated in scenes much like those captured on film at Abu Ghraib.

In a debriefing dialogue that occurred 2 months after the conclusion of the study, a prisoner confronted a guard about how much he was harmed by the experience. The guard refers to his behaviors as an act and justifies his actions as his successful execution of the study condition. The prisoner, despite his own experiences of transformation, is incapable of understanding how a nice college student was able to be so dehumanizing and degrading; he can’t imagine that he too has the capacity for such cruelty. In fact, he believes that there is something inherently different about the college student who treated him so cruelly:

GUARD: Well, you in my position, what would you have done?
PRISONER 416: I don't know. I can't tell you that I’d know what I’d do. I don't think, I don't believe I would have been as inventive as you. I don't believe I would have applied as much imagination to what I was doing. Do you understand?
GUARD: Yes, I understand.
PRISONER 416: I think I would have been a guard, I don't think it would have been such a masterpiece.
GUARD: I didn't see where it was really harmful. It was degrading…

Some thirty years later, Professor Zimbardo testified on the behalf of one of the officers implicated in the Abu Ghraib prisoner abuse scandal. He states, “…I testified, essentially talking about how the situation he was in and the other seven soldiers were in, in the basement of that dungeon, how that corrupted him and made him lose his moral compass.” Zimbardo continues in the discussion to discuss the role of the system in creating evil and corrupting good soldiers and recommends a certain amount of leniency or empathy for individuals transformed by a stressful, unhealthy, and inhumane system and a correspondingly hard hand for the architects that created and managed that system.

I highly recommend listening to the Democracy Now program, which was probably one of the best Amy Goodman interviews I have ever heard. I was so enthralled by this story that I had a major “driveway moment” in which I sat in my parking garage at work for…well, a long time.

When discussing the purpose of his new book, Zimbardo states “…what I try to capture in the The Lucifer Effect is that, it’s really a celebration of the human mind infinite capacity to be kind, or cruel, caring or selfish, creative or destructive.” After events like the shooting yesterday at Virginia Tech, I am certain that many of us are struggling with thoughts about human nature, the senselessness of such violence, and the meaning of evil. As human beings, our infinite capacity for hatred, despair, and violence, and our correspondingly powerful abilities to care, empathize, and love, is something we all need to consider.