Carnival of the Blue

It's that time of the month again... Carnival of the Blue! Strap on your snorkel and head over to Shifting Baselines for an eclectic collection of posts about the ocean.

Stealing Home...

The game is tied in the bottom of the 10th. I'm in graduate school's extra innings - that's the time between defending the PhD and moving on to whatever's next. If you've been there, you know that this period involves putting the finishing touches on the manuscripts, making sure the margins are all spaced correctly on the dissertation, cleaning up hard drive filing systems and making sure the lab notebooks are legible.

In baseball, if you don't score in the bottom of the inning, there's always the next inning. My situation is different. If I don't score right now, that's it. There's no second chance. Soon, a two-headed beast will emerge from the depths of the sea, barge through the bleachers and destroy the very field I am playing on. Lucky for me, I know the beast's schedule. It is due to arrive in 17 hours. Perhaps by the time you read this, the game will be over. I'll be a medical student at Children's Hospital

I'd made it to third base on Friday. My adviser and I had settled on the text for one of my papers and only had one figure to finish up for it. A second paper was in worse shape. I had modified one of my dissertation chapters for half of the paper, and was in the process of filling in the other half with the needed background and appropriate referencing. After fiddling with some of the figures (for too long!), I tied myself to the computer. I knew my adviser (former adviser?) was leaving early Sunday morning and he needed a copy before he left. Last week in a similar situation, I left a document on his doorstep. Hard copies are easier to travel with... This morning, I made sure the document was on his stoop by 5 AM. When I tied myself to my desk, I committed to stealing home. It was do or die. That sea monster was looming.

By midnight, I was in a full sprint. The southpaw pitcher had a deliberate windup, and I was two thirds of the way home by the time the ball left the mound. I just hope the pitch is in the dirt. I've already found weaknesses in the document I finished this morning, and one of my co-authors has already sent back some helpful comments. At least something is written. Today, I've been touching up my figures and combining them into those big panels that folks use so much these days. I'm ready for the imminent maelstrom of dust, dirt, and colliding bodies.

Let's hope that my trip home is as fortunate as this one by the Cubs' Derrick Lee. By the way, I've been tapped a couple of times in the past few days; Kate and Mike have passed on some good memes. You can expect my responses to show up in a few days. Those are two tags I don't plan to slip in under...

Stem Cells in WA: Got Private $?

Saturday's Seattle Post-Intelligencer ran a great article featuring the role of private money in stem cell research in Seattle. The internet version of the story features a nice picture of the Three Amigos of the Seattle stem cell scene. Randy Moon, Chuck Murry and Tony Blau have traveled the state to raise awareness and money for their Institute for Stem Cells and Regenerative Medicine. That's right, the acronym is pronounced, "Ice Cream!" But seriously, these professors have testified before state legislators in Olympia, schmoozed local philanthropists, given tours of their labs, and enlisted their graduate students to do appropriate outreach. As campaigners for ISCRM, they also are delegates for science. For that, they get a tip of the hat from me. (Speaking of hats, I resisted the urge to enhance the above image with sombreros.)

Their efforts have not been in vain. Several large donations have come in so far, including from Orin Smith (Starbucks), Jeff and Susan Brotman (Costco), and Scott and Laurie Oki (Microsoft). And it's not just the private donations... the UW secured a highly competitive $10 million stem cell grant from the NIH earlier this year. By the way, the UW rents its South Lake Union digs from Paul Allen (Microsoft).

The part of the PI story I would like to know more about is the recent visit to Seattle by Robert Klein, co-founder the California Institute for Regenerative Medicine. The CIRM oversees the distribution of $3 billion to stem cell research between 2006 and 2016 that California voters passed in 2005. Is it possible that folks are starting to build an initiative process for stem cells in Washington State? I suppose we will have to wait and see...

Photo Credit: Mike Urban / P-I

Seattle Speaking Science: October 5

Chris Mooney and Matt Nisbet will be in Seattle next week to give their Speaking Science 2.0 talk. The Forum on Science Ethics and Policy is flying them in Thursday, and they will make some presentations on Friday.
Here are the highlights:

• 11:00 A- Matt Nisbet: "Indirect Truths: Research and Public Scholarship in the Nation's Capital" UW HUB 106B
• 12:30 P- Chris Mooney on KUOW "The Conversation" 94.9 FM in Seattle
  
• 3:00 P- Matt Nisbet and Chris Mooney: "When Science turns Political: Tips and Tools for Communicating Science" FOSEP Members (Want to join FOSEP?)
  
• 7:00 P- Matt Nisbet and Chris Mooney: "Speaking Science 2.0" Pacific Science Center Eames IMAX Auditorium
• 8:30 P- Chris Mooney Book Signing
• After: McMenamins Pub
  

Come one, come all. Hopefully, I will not be on call that night...

Policy Fellowships

Last week when I was in DC, I spent a day in lobbies, hallways and coffee shops making a case for funding science. That was from 8 AM to 5 PM. What did I do with the rest of my time? A little personal networking, of course!

It happens that two of my colleagues from the Forum on Science Ethics and Policy are working right now in DC as policy fellows. They let me crash on their couch Wednesday night to help me stay under budget. Here we are at a local Mexican restaurant.I suppose it's not unexpected that such a FOSEP reunion would occur in DC, given what the P in FOSEP stands for... Anyway, this picture is a good lead into what sort of opportunities exist in Washington DC for young scientists interested in policy. Melanie (on the left) started her second AAAS fellowship last week. Last year she was an AAAS Congressional Fellow and was the science policy adviser to Senator Jeff Bingaman (D-NM). This year, she is an AAAS fellow at the National Science Foundation, where among other things, she will be working on some of their broader impact policies. Jennifer (on the right) just started a 10 week fellowship at the National Academy of Sciences. She was selected as a Christine Mirzayan Science and Technology Fellow. For the next 10 weeks, she will be working on issues relating universities to industry start-ups. Both of these fellowships offer a salary or stipend. A third opportunity for medically oriented folks is the Robert Wood Johnson Health Policy Fellowship. And if you just want to get your feet wet, consider applying for travel money from the Joint Steering Committee for Public Policy biomedical science hill day. Post a comment here if you are interested in these fellowships - I can connect you with Jen and Melanie if you like.

Hat tip to Ben on the idea for this post.

Last Night for Wunderkammern

Come celebrate with me at the Shilshole Bay Beach Club. It's the closing of the COCA Inquiry as Collection show and the evening after my wife's psychiatry clerkship final. Thursday night from 5 to 7:30, you can get a plate full of food including a salmon burger for $8. If you just want to stop by to say hi and see my cabinets of curiosity, I should be there from 6:00 to 8:00 just hanging out. There is no charge for viewing the art or the sunset over Puget Sound. Need more information? Here are links to an interview, a map, and a collection of posts about my Wunderkammern.

Update: It looks like there is another event at the gallery Thursday night. Just say you are a friend of an artist in the show, and you won't have to pay what appears to be a $10 cover. My fair warning is that the other event has the potential to be a little scandalous.

My First Patient

Today was the first day I made a decision about a patient's care. It led to an order which was immediately followed. The feelings contrast with any I have felt from designing a sweet experiment or ordering a killer reagent or performing a life-or-death procedure on mice or reviewing a top-secret manuscript. There is something different about decisions made in the hospital. Maybe this same course of action three weeks from now wouldn't even release a single endorphin. For that reason, I write it here:

• A lab result came back that was 'good news.'
  
• Based on that finding, I decided to remove the patient from isolation.
• We switched a drug's administration from intravenous to oral and decreased the dose.

Pretty exciting, huh? Well it was for me. And for the patient. She had been dying to go out to the common area to get a popsicle.

Medical Voice Mail Etiquette

Some of us older* medical students can remember a day without answering machines. If you weren't home or didn't run to the phone in time, whatever the caller on the other end had to say would have to wait. These days, the only reason not to have an answering machine is if you don't have a land line. Furthermore, cell phones record caller identity, the second the incoming message was recorded and the return number. Call me old fashioned, but I still would like you to leave your name, number, time and reason for the call. At least callers still have to wait for the beep...

Leaving a concise phone message is a lost art. This presents a problem for the fledgling medical care provider. What is the best way to communicate with a patient or family member when you have one minute for a message? Leaving a phone message is dangerous territory. On the one hand, you want the patient to know that it is important to call you as soon as possible, but you do not want to unduly alarm them. And leaving a message for a family member can provide more information than the patient would like. I tend to leave overly detailed (read rambling) messages, so am at serious risk for providing too much information. The one minute cutoff some voice mail services enforce in their message recordings is a blessing in disguise. It's a hint that the care provider should leave a short and direct message.

Consider the following situation that happened to me. During the second year of medical school, I volunteered to be a normal healthy subject for a new nasogastric (NG) tube monitoring device. The idea was that an electrical conductance probe just at the lower esophageal sphincter (a muscle that separates the stomach from the esophagus) could better predict gastro-esophageal reflux disease (GERD or heartburn) than other techniques. So this required me to wear an NG tube and a monitoring device for a day. If you know anything about the first two years of medical school, you know that someone with an NG tube will be noticed. I was fine with that - I was getting $200, after all. Anyway, a few weeks after the study, I came home to a message on my answering machine: "Hello this is Dr. NoThink from the GI clinic. We would like you to come in for some more tests. We are really concerned about the results from our study, and think you might have GERD."

Excuse me?!!!?? What went wrong here? Let me count the ways:

1. Delivering a diagnosis this way is like breaking up over the phone. It's just not cool.
2. Coming to a decision about a condition that can lead to cancer based on an untested diagnostic procedure is, well, unscientific.
   
3. Dr. NoThink has no idea who has access to this answering machine. Some options include my medical student roommate, family, my health insurance company. Okay, maybe not the health insurance company...
4. By leaving confidential patient information in an uncontrolled location (including data recordings), Dr. NoThink has broken the law (HIPAA) and opened his hospital to the potential of bad things.

Honestly, Dr. NoThink probably just wasn't thinking. This is a mistake we care providers need to avoid. As such, when making a phone call, here are some tips that can help you comply with HIPAA and avoid embarrassing or ticking off your patient.

1. When you call, expect to leave a message. Be prepared to leave a short and direct statement.
2. Speak in a measured rate and a flat or friendly tone.
   
3. Say your name.
4. Indicate your hospital.
5. Do not say your clinic or specialty. (Unexpected calls from oncology or psychiatry will raise flags for anyone!)
6. Do not leave any information about tests or results.
   
7. Leave your phone number or pager.
8. Ask that the patient contact you as soon as he or she can.
9. Hang up.

If you are ready to leave this information, you can do it for a machine, you can provide it to anyone other than the patient who picks up, and you can introduce yourself to the patient if she or he answers. This seems so straight-forward, it's a wonder that it's so hard to do! As with everything else on the wards, it will take practice. 15 or 20 seconds for this information is my goal. Save the details for a live conversation.

*Interesting... in my most previous post, I argued that I am young for a scientist.

Hill Day Specifics

My readers from last week will recall that I visited Washington DC on behalf of science last Wednesday. The Joint Steering Committee for Public Policy (they really need to work on a name that includes the word biomedical) flies scientists in to walk the halls of Congress. Scientists (mostly young folks like me*) meet with staffers to talk about the importance of funding science. I met with staffers in the offices of Jim Webb (D-VA), Maria Cantwell (D-WA), Gary Kline (R-CA), Jim McDermott (D-WA), and Rosa DeLauro (D-CT). I also had a photo op with Barbara Boxer (D-CA). Check out how slumped over I am in this photo. Note to self: next time straiten up a bit... the back AND the tie. Sheesh!

So what were the meetings like? They varied considerably. From a 5 minute hallway chat to a leisurely discussion on comfy chairs to a conversation in a coffee shop (yes, that was with a staffer from Washington State), the venue changed. The message was the same. My pitch went something like this:

Hello, I'm Thomas Robey and am Washington State's newest bioengineering PhD. While I was a graduate student I was supported by two different NIH research grants, and as a medical student in the NIH funded MD/PhD program am the beneficiary of another. For the last four years I have been working on a project to restore cardiac function after heart attacks using human embryonic stem cells. I used one of the lines approved for federal funding. What is really exciting is that the team I am a part of has been able to grow human heart tissue in mice and rats that have heart attacks. This has helped the injured rodent hearts pump better, too. Unfortunately, we only have access to a very small number of cell lines - smaller even than the 12 or so that are readily available. It turns out that the lines made before August 9 are not the best to do research with. We are looking forward to a policy change about stem cells! Now that I have finished my PhD, I will be looking to a future when fewer young scientists are able to secure funding. It is important for the NIH funding lines to at least keep up with inflation. (We would like to see the bill in conference to accept the Senate's numbers.) The funding trajectory for the NSF should also be maintained to eventually double its allocations. It is important to understand that the money spent on both basic and applied research pays back into the economy several fold. Thank you for your past support for science, and I am happy to be a resource to you or other staffers should you need information about stem cell or medical science issues.

That's about it. Somewhere in there would be the obligatory transfer of business cards, and maybe the staffer would ask a few questions, but 15 minutes later I was on my way. If these meetings were the point of the trip, those would be some pretty expensive minutes. Fortunately, the real value was in training young scientists to speak with congressional staff and creating potentially lasting relationships between scientists and policy-makers. I will touch on that more in a future post, but for now, I need to submit my travel expenses - oh yeah, you can apply for travel awards from the JSCPP...

*I think it's fair in science to categorize 29 as young!

Organizing Students: Schwag

So, you've got an organization together, and it's held a few events. There is a little bit of buzz about the group, but you want it to go a little further. One way to keep your group on the minds of your audience is with free handouts. Any college student these days knows about schwag. You missed out? Check this page for a comprehensive history of "Stuff We All Get." They say,

the term schwag refers to all manner of logoed stuff given away by companies to get people to remember them, feel good about them, have their phone number and website at hand and generally make them think about them before any of their competitors.

My group didn't have any competitors and we don't sell a product, but we definitely want folks to think well of us. Anytime we ask folks to fill out a survey, we give them a free pen with our website on it. And I'd rather carry around a FOSEP pen than some pen hawking the latest statin or ED drug.

The pens have come in handy for other reasons. Just the other day, I was asked about FOSEP by a prospective member. After we talked, I gave him one of my FOSEP pens and referred him to our new members sign up site. Sure, pens are cheap, but that we have and give them out says that the group has its act together. I incorporate the pen pass into my pitch about FOSEP.

I can't think of a better tool to jot down my ideas about the Office of Technology Assessment or responses to young earth creationism than my FOSEP pen!

Here are the obligatory links to FOSEP and my other tips for student organizations.

Oceans in Metro

I knew that DC is a little different than other cities. The convergence of political elite with urban culture is already strange enough for a goateed, granola munching whitey like me who hardly remembers how to put on a tie. Even so, I was surprised to encounter a political issue ad in the Metro tunnels. And this one used the word, 'subsidies.' I'm not sure about you, but I'm neither comfortable lauding subsidies nor excoriating them. So I was happy to check out Oceana's description of how subsidies affect the fishing industry. Granted, we know from the billboard what Oceana thinks of this, but at least they are out there trying to raise awareness.

Oceana is an international advocate for the oceans. They appear to be a well connected, well funded group that takes practical approach to diplomacy and lobbying on behalf of ocean health. The group supports fisheries management, efforts to reduce man-made climate change, and responsible governance of ocean resources. From their website,

OCEANA CAMPAIGNS TO PROTECT AND RESTORE THE WORLD'S OCEANS. Our teams of marine scientists, economists, lawyers and advocates win specific and concrete policy changes to reduce pollution and to prevent the irreversible collapse of fish populations, marine mammals and other sea life.

This sounds like something I could get on board with. It's an advocacy group of citizen scientists.

So what of this lighted billboard? Well, it happened to be in the Capitol South Metro stop. I wonder how many congressional staffers use that station? Are they the ad's intended audience? I also wonder if there is current legislative activity concerning American fisheries on the board. A quick search on THOMAS revealed that fishing subsidies are included in the farm bills in the House and Senate, but finding the specifics is a task outside the scope of this post. What is in the scope of this post is a brief primer on food subsidies.

Hearkening back to our intro economics courses, recall that the definition (Wikipedia) of subsidy is,

financial government assistance, such as a grant, tax break, or trade barrier, that encourages the production or purchase of a good.

Fishing subsidies come in the form of tariffs on imported fish, grants to build boats and pay for fuel, and reduced taxes for fishermen. According to Oceana, this accounts for $30 billion a year given to fishermen that enables the fishing industry to expand capacity beyond its normal capacity. More of the ocean is fished and when fishing occurs in largely unregulated open waters, there is critical damage to fish populations. Oceana's campaign to reel in those subsidies is an effort to improve global fishery sustainability.

The ad's clever graphic hits this home: Government coin raining into the trawlers makes up (in the fisherman's purse) for the fact that no fish are biting. Unfortunately, as long as fishing for fewer fish remains a viable way to make a living, sustainable fisheries will be impossible.

Jena Six Revisited

The best coverage of the Jena Six story I have read so far is on ESPN.com. Why on a sports network? Mychal Bell was a star football player for the high school's team and was being scouted by LSU among other teams. He is still in jail, even though an appellate court has thrown out the charge; nor has Bell been permitted release on bail.

Medical Student's Job

This morning, as I was completing the computer information system orientation for (insert hospital name here), I encountered a stern warning from the chief information officer regarding medical records. Yes, that's really him over there on the left - the web based tutorial was quite well done. He says:

Hospital policy is to respect and support the privacy rights of patients and their families. Only access a patient's chart when it is necessary to do your job.

This begs a question: What is a medical student's job?

You have to grant that this learning module was created for hospital employees, but the 100 medical students and our colleagues from the nursing, PA and pharmacy schools probably compose a sizable contingent of course takers each year. As I see it, our 'job' is to learn. Given that we only see a small number of patients, how do we draw the line between privacy and educational benefit? I am sure this will become clear to me as I am on the wards, so this question is more theoretical than indictment of the system.

For me, learning takes place in the midst of action; reading the chart and following a treatment course is one way of systematizing knowledge.

I imagine that I will only interact with the charts for patients for whom I am providing care. Perhaps there will be incidents when I am invited to participate in a chart review or a didactic involving another chart. That will be the practical resolution of this issue. But what of the theoretical?

What is the job of a medical student?

Carbon Footprint: Doha and Dalian

It's been a little while since I wrote anything about carbon footprint. This post will make you think about whether I should even bother. NYTimes correspondent Thomas Friedman is concerned about climate change, but he suggests (as some of my readers have) that the current American approach to the issue (tips about how you and I can reduce our individual consumption) isn't cutting it. By the way, Doha is the capital of Qatar and Dalian is in China's Silicon Valley; both have experienced enormous growth over the past years. Friedman writes:

Hey, I'm really glad you switched to long-lasting compact fluorescent light bulbs in your house. But the growth in Doha and Dalian ate all your energy savings for breakfast. I'm glad you bought a hybrid car. But Doha and Dalian devoured that before noon. I am glad that Congress is debating whether to bring U.S. auto mileage requirements up to European levels by 2020. Doha and Dalian will have those gains for lunch -- maybe just the first course. I'm glad that solar and wind power are "soaring" toward 2 percent of U.S. energy generation, but Doha and Dalian will devour all those gains for dinner. I am thrilled that you are now doing the "20 green things" suggested by your favorite American magazine. Doha and Dalian will snack on them all, like popcorn before bedtime.

A free copy of the entire editorial can be read at today's Seattle Post-Intelligencer. Also, check out a short video of Friedman explaining his views about what he calls the "Power of Green" and industrial growth.

Hirshhorn Nuts

Washington DC.
On the Mall.
9/20/2007.
A revelation.

"Spatial Concept: Nature"
Bronze
Lucio Fontana (Italian)
1965

A Clipboard for the Wards

I recently stumbled across a tool that could be of use for medical students on the wards. I haven't even started my first clerkship in earnest and it's come in handy already! Called the White Coat Clipboard, it's a sturdy aluminum clipboard that folds in the middle so that you can tuck it into one of your white coat's pockets. The part that is different about this one is that there are about a hundred important quick reference items printed onto the waterproof sticker, and the hinge allows for the board to be folded without creasing papers. It costs $29.95 on the website, but if you get a group together of of fellow medical students, you can get the price lower. (I heard about $20.) Here's a picture from the website where you can order the product:
Update 9/25/07: I emailed the folks at whitecoatclipboard.com to ask what their bulk pricing is, and this was their reply:

A bulk discount is available for purchases of 6 clipboards or more. Some students have found that there is enough interest among their classmates to make bulk purchases possible. If so, for any order of 6-10 clipboards the bulk price is $19.95 each. For orders of 11- 20 clipboards the price is $18.95 each. For any order of 21 or more clipboards the price is $17.95 each.

So there you have it.

Hill Day Snippets

I've been working on a nice report for y'all from my visit on Wednesday to Capitol Hill, but before I post the complete digest, I'll share with you a few sound bites and juicy tidbits.

• I think I met Kate from the Anterior Commissure, but didn't even know it at the time.
• "I'm supported by the NIH. We're working on ways that human embryonic stem cells might be used to treat heart attacks. Please vote to keep funding science."
  
• The weather was amazing. 80 degrees, mostly sunny, only a little humid. A beautiful Seattle summer day (but with extra haze).
  
• I learned about the Jena 6.
• Next time, don't use homemade business cards.
  
• FOSEP Director Reunion!
• "Is Representative Cubin in? I attended medical school with her son."
• I recommend the National Museum of the American Indian.
  
• Barbara Boxer patted my arm and told me to "Keep up the good work."
• It's all in the relationships you build on these sorts of trips, not the exact wording of your message.

Anyway, I have a bunch of editing to do on a couple of my manuscripts, so I probably will not roll out my grand summary until later this weekend. Hope you are having a good one!

Jena 6 Freed... Almost

Get ready for a ramble that is partly diatribe, partly lament and partly self-critical assessment of how I have interacted with this story. I didn't hear about the Jena 6 until Wednesday afternoon. You've probably heard by now about the 6 Black students arrested for assault and attempted murder after school yard fights, while their White classmates who engaged in the same activity while using racial epithets received slaps on the wrist. Or have you?

This all makes me wonder why didn't I, a rather attentive new junkie, know about a story that would be of significant interest to me? Here is what I could come up with:

1. I was writing and defending my dissertation the last few weeks.
2. I avoid cable TV news channels and their websites like the plague.
   
3. I was traveling out of town Tuesday through Thursday.
4. I live in Seattle, WA.

The first point would be a good enough reason, except that the incidents that preceded the national coverage of the march in Jena, LA yesterday started one year ago. From the Justice in Jena website:

Last fall, when two Black high school students sat under the "white" tree on their campus, white students responded by hanging nooses from the tree. When Black students protested the light punishment for the students who hung the nooses, District Attorney Reed Walters came to the school and told the students he could "take [their] lives away with a stroke of [his] pen." Racial tension continued to mount in Jena, and the District Attorney did nothing in response to several egregious cases of violence and threats against black students. But when a white student - who had been a vocal supporter of the students who hung the nooses - taunted a black student, allegedly called several black students "nigger", and was beaten up by black students, six black students were charged with second-degree attempted murder. Last month, the first young man to be tried, Mychal Bell, was convicted. He faces up to 22 years in prison for a school fight.

This conviction has been overturned, but Bell remains in jail. The other five students have been released. So while the efforts to initiate a national protest of this situation have been covered recently, I have to still wonder why I did not hear of it before then. For a good op-ed summary and analysis, consider Eugene Robinson's piece from 9/21/07.

The second point is self-explanatory. The story is unfortunately perfect fodder for the cable news mill - sensationalizing the issue so that it is entertaining. The bit I saw on CNN at the Salt Lake airport last night was complete with shocking graphics and polarized point-counterpoint analysis. There was hardly any room for the viewer to think about the story before switching to the O.J. Simpson 'tragedy.' What's a tragedy is that Larry King hosted O.J.'s pseudo ghost-writer for "If I Did It" rather than folks interested in talking about (real) race issues.

My third explanation is an ironic point, because my first encounter with the story was exactly because I traveled. I spent Tuesday night through Thursday afternoon in Washington D.C. My standard point of access for news is the internet and the only microchips I was traveling with were in my cell phone. In D.C., I saw groups of protesters near the capital, on the Mall and in the Metro stations wearing t-shirts and carrying signs calling for release of the Jena 6. I ended up stopping at a terminal in the Library of Congress to look up the issue.

My last point is the one that needs the most addressing: I live in Seattle. Why does that matter? Well, when I moved to Seattle after living in DC and Pittsburgh, I quickly noticed how few Black neighbors and classmates I had. Questioning this (gently of course because I knew no one in the Emerald City and I am White), I was told:

1. Seattle just has a different, and in some ways more diverse, racial and ethnic makeup, and
2. There really aren't race issues out here.

Well, since I have been here, several stories of racial profiling and differential treatment of minorities have come to light - usually to me by way of Robert Jamieson. It seems to me like Seattle doesn't have a lot of 'race problems' because as urban centers go, Seattle doesn't have a lot of race. I mean, sure there's more people of color here than in your standard suburb, exurb or rural community, but many people in Seattle can get through an entire day without any sort of interaction with an underrepresented minority. Even if you travel on public transit! How are you going to learn and talk about race issues without relationships with folks of a different race? I know that my situation has changed tremendously since moving to the Northwest, and that I have done a poor job of cultivating relationships outside of the graduate school/science policy/bioengineering crowd. I'll be working hard to change this as I shift away from hi-tech science to training for a medical career that includes care for the underserved.

But back to the subject at hand, is it a function of a lack of newsworthiness in the Seattle market that the Jena 6 story hasn't made it to the front page on Seattle's newspapers? Or what exactly?

On the Hill

Today, I am in the other Washington visiting the my senators and representative (or their staffs) to advocate for science. My personal points are simple:

1. Continue to increase NIH and NSF funding.
2. Ask that the arbitrary limits on human embryonic stem cell research be removed and more logical system of oversight be instituted.

I will also put in some words for this great organization on the UW campus called FOSEP. McDermott, Murray and Cantwell are already on board with science, but I suppose it is still good for scientists to be known...

I am here with the Joint Steering Committee for Public Policy. You should consider signing up for their email notification list. (They only send one email a quarter.)

Late For Grand Rounds!!!

Hurry up and head over to Grand Rounds before all of the free lunch is gone.

Y'all Just Want Your Hugs!

As I read Kate's digest of a study about the value of hugging among female spider monkeys over at The Anterior Commissure, I couldn't help but remember an incident that occurred a little while back on the wards. I was part of a team taking care of an older arthritic woman who had severe vertigo. She grew up in Alabama and frequently would share with us various stories about Southern tradition.

Anyway, soon after she was admitted, the team went about identifying the cause of her dizziness. One common cause of vertigo is the presence of a little stone in the semicircular canals of the ears. A stone, called an canalith (latin for 'canal stone') can impede fluid movement and interfere with your sense of balance. To see if a stone is the cause, physicians can do what is called the Dix-Hallpike maneuver. This maneuver tests for canalithiasis of the posterior semicircular canal, which is the most common cause of vertigo. The general idea of the Dix-Hallpike is shown in the picture below:If a canalith is present, the patient will get dizzy and his eyes will mover rapidly from side to side. This rhythmic regular oscillation of the eyes has a special medical name: nystagmus. Apart from invoking the emergency evacuation procedure cards on airlines, this image shows how our friendly frail old patient might have trouble completing the maneuver on her own. A good amount of core muscle strength is needed to extend and flex the trunk while the care provider gently twists the head. This is the part of the story that Kate's post reminded me of:

In order to properly conduct this test with the patient, the medical resident sat on the bed to support the patient's body while the attending physician turned her head appropriately. In the process of doing this, the charming, aged, once-southern belle announced, "Now Ah know why y'all er doin' this test. Y'all just want your hugs! If ya'd just sed so in the first place, Ah'd be happy t'oblige y'all."

I suppose that's one way for medical students to get their endorphins on the wards!

Parts of this story have been fictionalized to protect the privacy of persons involved. The elements pertinent for the 'teaching moment' remain. The image is from UpToDate.

Transitions

Now that I am transitioning back to my medical training, I expect my blog to veer in the direction of medical topics. Whenever that happens, there are some new rules in play: namely the Health Insurance Portability and Accessibility Act (HIPAA) regulations. This includes a strict reinforcement of the doctor-patient confidentiality agreement. I've been reading other med blogs to see how they appropriately relay experiences on the 'net without compromising patient privacy. The techniques I have observed include:

• Not revealing identifiable information, including date, name, initials, age or ethnicity.
• Substituting identifiable information with false names.
• Idealizing interactions such that no exact incident could be matched with your story.

Since I use my own name in writing, I am faced with the task of balancing the truth of the situation with the rights of patients I interact with. If ever that balance presents itself, I must always push the balance towards patients' rights. After all, it's a physician's privilege to be permitted access to patients most personal issues. Along the same lines, I wish not to write fiction, which what the third bullet above smacks of. I believe that my compromise will be to present only stories vignettes and reflections that are clearly unrecognizable, and saving others for my personal journal.

Any insight about this that fellow medbloggers can offer would be appreciated. Comments or links would be great!

Update:
Dr. Signout responded to this piece with a nice post. Check it out.

A Doctor For Two Weeks

Well, I passed my final examination yesterday. I tried to approach the presentation like it was any other talk, but that didn't work for me. I was nervous for 40 minutes - up until the Q&A. I came into my own then, and had actually a lot of fun; this extended into the hour long closed meeting with my committee. Perhaps I'm so used to the Seattle tradition of asking questions throughout the talk, I got intimidated by the audience not interrupting me! Reliable sources indicate that I carried on a couple of conversations with myself (three actually) during the presentation, which evidently elicited laughs from the audience. And then there's the complement that goes something like, "I actually understood (insert fraction greater than 1/2) of your talk!" I suppose that bodes well for my interests in communicating science to the public.

I can't say that I feel much different this morning than 24 hours ago. I'll try to put the PhD to good use in the next two weeks before I start the third year of medical school, as I finalize two papers and one resubmission. Then I will have to put the PhD in my back pocket for a couple of years while I assume the mantle of humble & helpful medical student.

O Fortuna!

O Fortuna,

velut Luna
statu variabilis,
semper crescis
aut decrescis

Organizing Students: Annual Reports

This post is another in a series I am using to document my experiences and advice for students interested in operating high-functioning campus organizations. So far, I have written about, the role of food in hosting events, how to balance commitments between school and extra-curriculars and the importance of keeping track of members. Read my intent for this series here. I draw my opinions from experience with several student groups, but mostly with the Forum on Science Ethics and Policy - a group with a self explanatory name that plans many events each year.

Today I want to talk about the importance of history. Just as a scientist must keep good notes of her experiments, a student group must document its meetings and events. Please allow me to extend this metaphor. Why does our scientist keep notes? For several reasons: 1) For the sake of knowledge... the lab notebook is the formal (and legal) record of her work. If anyone ever wants to revisit this work, the lab notebook could be the first place he starts. 2) For reproducibility... when someone comes to a different conclusion, it must be possible to repeat our scientist's work to get to the bottom of the differences. 3) For utility... it may be a year before our scientist has enough data to publish her discoveries. (Maybe longer if she's a graduate student!) It is hard to remember everything so long ago. I should know, I just wrote a dissertation based on 4 years' work. I am glad that at least I could decipher my records. 4) For posterity... This reason is closely ties to the other three. Our scientist may be in Kenya or Spokane the next time someone has an idea about her work. It is important that the record be in the lab in case the scientist is not.

My point here is not a lesson in research skills; it is that records are important. Each of the reasons the scientist keeps her notes can apply to student groups. The goal for record keeping should be organizational memory. Future group members and leaders should be able to go back to previous years' events and see how they were planned, who partnered with the group, which leads showed promise but did not quite come to fruition, and what were the lessons learned from the event.

One way to think about record-keeping is to keep a tradition of producing an annual report. I can think of several reasons to keep an annual record of events, and go figure, the first four line up with our scientist's reasons for keeping a good lab notebook.

1. What your group does is important. That should be recorded.
2. Student groups have more turnover than most non-profit and volunteer groups. There needs to be a mechanism to help new folks remember the organization's past.
3. Once a year is a good cycle to go back and organize the group's lab notebook into a readable story. It fits with leadership cycles and you do not forget as much in a year.
4. Group sustainability is one of the most critical elements of a student organization. A permanent record is one way to keep track of the group's accomplishments when its past leaders are in Spokane or Kenya.
5. FUNDRAISING. FUNDRAISING. FUNDRAISING. What better way to ask for financial support than by showing all of the great things you did last year? Folks (in FOSEP's case: academic departments) are more likely to give financial support if they know what kind of work you do.

In a nutshell, annual reports are good for fundraising and organizational sustainability. New members can learn a lot from past annual reports, donors can assess your success, and the group has something to show for all of its hard work.

Now that I've convinced you to make an annual report each year, I will give you some tips on how to actually MAKE one. I have heard from other groups that you can find graphic design students to help you with layout. They need it for their portfolio, and you need it to look good. Not everyone is good with design. Graphic design students ARE. FOSEP has gotten along fine without outside help by keeping the layout simple. Our two annual reports from 2004-05 and 2005-06 have a different look to them, but the layout is similar, as is the content. This year, we are building our report in Microsoft Word. It is useful to use something like Adobe PageMaker or MS Publisher, but you do not need to do so, especially if you do not know how to use those programs. It helps to have pictures and quotations to intersperse throughout the report. Keep a running collection of those during the year.

Lets talk about content. FOSEP's report follows a logical progression with the following sections:

• Executive Summary: for the reader who doesn't know anything about your group
• Introduction: What you have done in abstract form
• Mission: Remind readers that what you are doing is important
• Your Group's History: Emphasize growth and accomplishment
• A letter from the Directors: Here is where you can philosophize a bit
• Membership: Who is in your group? Build connections between members and potential donors
• Honors and Recognition: List awards, publications, presentations or press coverage, for the group and its members
• Events: What have you done? Be specific here... Present complete listing of titles and dates, and then go into more depth about how your events fit with your mission. For FOSEP, we use headings such as:
• Interaction among scholars and community - Public Forums
• Foster scientist-citizens - Seminars, Public policy
• Provide leadership - Conferences, Meetings, Presentations
• Increase dialogue among experts - Discussion Sections, Academic Outreach
• Act as a clearinghouse of information - Website Info www.fosep.org

• Collaborations: Who did you partner with to hold your events?
• Future Plans: What is the vision for the coming year?
• Leadership: Who is responsible for this group? Include contact information and department
• Finances: Who donated last year? Include a detailed account of how you spent the money you received and what your goals for the coming year are.
• Appendix: Here we include letters of support. For example, this year FOSEP got a letter from Neal Lane, President Clinton's science adviser.

This is the order that works for FOSEP. You should develop your own strategy that fits your group. In the end, take the file to a print shop and print it on decent paper with a card stock cover and bind it with tape. You want to be able to send it in an envelop, so avoid the spirals.

Your annual report should be something you are proud of. Send it to potential donors, take it you events for people to read, and post a .pdf on your website. It may take a lot of effort to make the thing, but in the end, you will have a record of your years that is both a fundraising tool and a mechanism for organization sustainability.

Canning Season

I hope y'all don't mind me posting all of these 'less thoughtful' entries. My mind has been elsewhere the past few weeks.


I lifted this image from Greg Laden and added my own words. For more, visit lolcats.com or ICHC.

Science Through Glass

A couple of months ago, my wife and I took a glass fusing class at the Pratt Fine Arts Center. I was in the process of finishing my experiments and writing my dissertation, so the first few pieces that I made were well within the "science nerd" category. Some of the other people in the class eventually asked me if I was a scientist. That was nice, because we got to talk a bit about science and society with non-scientists. Anyway, here are some of my pieces, in order of increasing complexity.

DNA


Blastocyst


Heart

I put some more thorough descriptions up on my art home page.

Science MadMen

Have you been over to LabLit.com yet? Here's a reason: a little humor piece by yours truly was just published on the site. While you're there, check out other folks' contributions. A collection of work tied together by the genre of lab literature, LabLit.com seeks to document "the culture of science in fiction and fact." The brains behind the operation is Jennifer Rohn, a UW PhD recipient who now lives in the UK.

Thanks Meg

I am grateful to Madeline L'Engle for inspiring in me a lifelong love of reading. She died yesterday at age 88.

You provided to a little boy an example of a

“faith that the universe has meaning, that our little human lives are not irrelevant, that what we choose or say or do matters, matters cosmically.”

You'll be missed, Meg.

Dissertating

I have received some comments back from my reading committee regarding my dissertation and will be occupied in addressing them over the next week or so. I do not think I will be able to post anything here until Monday evening at the earliest. In the mean time, you can explore some of the categories listed in the 'Favorites' section at right. Or click on some of the ads for stem cell companies...

Completely Different

Initially, I decided to post this photo of Washingtonian Burke Kenney for the sole enjoyment of my sister, who was already a fan of the World Beard and Moustache Championship. But upon further consideration, I decided that this beard reminded me of the most famous bearded science blogger in the world, PZ Myers. First there's the fact that PZ is bearded and proud, and then there's the little cephalopod cartoon (at left) he signs all of his posts with. Combine these two, and voila: you get a world champion beard!

Photo Credit: Phil Olsen, Beard Team USA

Seattle Stem Cells

The University of Washington is in the news again for stem cell research. This time it's for what might happen in the future rather than positive outcomes from previous work. The large $10 million grant is a type of award called a program project grant (PPG in grant lingo) that is split up between several professors (including my advisor) and labs. The idea is that the different groups share resources and engage in collaborative projects bigger and better than a single lab could conduct. An article in the Seattle P-I describes this in more detail, and the Stranger's Dear Science presents a more interesting opinion. The UW was one of two recipients of this grant. Hopefully, by the time most of this money can be spent, a new administration in the White House will have permitted use of embryonic stem cell lines that aren't outdated like those approved August 9, 2001.

Truth

In case you were not aware, truth is now available from a small Canadian outfit seeking to improve science literacy by increasing the amount and quality of science writing. Think McSweeney's but for scientists and science bloggers. You can get merit badges there too!

Organizing Students: Food

This one is almost a no-brainer: In order to get students to participate in a group, it is always helpful to provide food. Keep in mind that there are two types of food: free food and cheap food. Both are important.

Let's talk about free food first. Free food gets people in the door. In weighing the cost-benefit of catching an early bus home or stopping by for a light dinner at an evening members' meeting, the free food always tips the scales in the same direction. Graduate students are notorious vultures: some of us keep close track of all of the seminars that provide food. For me, it is cardiovascular breakfast club Tuesday morning, medicine grand grounds Tuesday noon, pathology presents Wednesday afternoon and South Lake Union tapas seminar Thursday late afternoon. And those are only the seminars that pertain to my education! If your student group reliably provides pizza or subs at its evening meetings, you will develop a reputation for being a friendly place. For recruitment meetings, I like to mix it up. Pizza or sandwiches are nice, but something different will elicit positive comments and good feelings. A spread of Trader Joe's hor'd'oeuvres is popular and cheap. It's best if you put the food inside the room where you are meeting - even in the back. This keeps the vultures from flying away! Also, at public events (FOSEP holds monthly seminars), get snacks and coffee and your attendance will increase. And be sure to advertise that there will be snacks provided!

But where does money for this food come from? Securing cash for food is notoriously difficult for campus student groups - especially at public universities. At the University of Washington, the main institutional funding sources say "NO WAY!" for proposals for food. For the Husky readers, this includes the ASUW, the GPSS and the LLC. If you want money for food, you have to raise it yourself. Fundraising is a topic that I will cover at length in the near future, but for the purposes of this post you should know that when you ask for money, make sure you ask for money that can be spent on food. Or, if you ever get a donation of cash or check, be sure to deposit it into an account that can be spent on food. This can be set up through the school's budgeting system.

Free food is one way to get people to feel like your group is there for them. If it works for drug reps, furniture salesmen and job recruitment, it will probably work for your student group. The other important type of food is cheap food. This applies when funds are tight or when some of the group's leaders hold planning meetings. Chipping in $5-7 for gourmet pizza, takeout Indian food or the like provides the opportunity to create a congenial environment to get the work done. There is a reason families try to eat meals together and friends get together for dinner: breaking bread is an age old tradition that unifies individuals. On a more practical side, sometimes the best time slots for students meetings are in the dinner hour, at lunch, or even breakfast. In Seattle, getting coffee can even turn into a working meeting.
Cartoon by Adam York Gregory. Check out his other comics at The Flowfield Unity. This post brought to you by our friends at FOSEP. Other student organization tips can be found here.

Breakthrough for Schizophrenia, or Why Angel Dust is Good for Society

This weekend, Nature Medicine published results from a small trial for a new drug for schizophrenia. Since my wife is in her psychiatry clerkship, I've been learning about psychiatric conditions and drugs, so it was nice to encounter this NYTimes article about the report. The entire text in Nature Medicine is available to institutional subscribers. The Times article quotes heavily form the journal's press release, and is more business-oriented.

The bottom line is that schizophrenia afflicts almost 1% of adults worldwide, it first presents in early adulthood, and due to its leading to cognitive impairment and social withdrawal, is overrepresented in homeless and indigent populations. Current drugs are good at reducing schizophrenia symptoms, but side effects like weight gain cause patients to stop taking them.

The excitement over this new type of drug is that it targets an entirely different system in the brain. In stead of blocking dopamine, the new drug blocks glutamate an amino acid that is also a neurotransmitter. You might remember hearing that dopamine is active in the pleasure centers of the brain, but it also is used for balance control, memory and attention. Glutamate is no less important than dopamine, and is important for personality control, learning and memory.

With glutamate's importance, why weren't there the same side effects for this drug? The answer lies in how the drug works. It targets a specific receptor for glutamate, the mGlu2/3 receptor, which accroding to the Nature press release,

is involved in a feedback loop controlling glutamate release, and therefore only works when the glutamate system is very active — bouts of high activity in this system are suspected to be one of the hallmarks of the disease.

Other than this, the scientists don't know exactly how the new drug produces its antipsychotic actions. I expect this is usual with new phych meds. What of the link to angel dust? Evidently, scientists clued into glutamate as a target for schizophrenia because PCP can induce psychotic symptoms in those that are not schizophrenic. PCP was also known to interfere with the glutamate signaling system.

SellING Out

Are you familiar with the ING Bank? They have a high-interest online savings account. It's not as good as HSBC's or EmigrantDirect, but you wouldn't know it from all of the marketing ING does. Well, call me shallow, but I fell for one of their gimmicks. Last month, they ran a promotion called "Adventures on the Road to Happiness," and I decided to enter. Sure, there were probably thousands of entries, but I am guessing none are as nerdy as mine. One $10K prize and 25 $1K prizes will be given out, so I figured as long as I had fun with it, there's nothing to loose. Boy did I have fun with this one! To enter, you needed a 250 word entry about why you save money, and a photograph representing that goal. Your representation had to include the color orange. Here is my essay:

As an MD/PhD student, I am training for a career in which I convert scientific discoveries into solutions for better health care. It’s not enough for me to toil away in a laboratory. My dream is to found a non-profit organization that connects universities and technology companies to the public using innovative mechanisms that go beyond science journalism, museum exhibits and corporate lobbying. I want to translate scientific knowledge and medical care into accessible ideas that society can use to solve problems of energy use, hunger and disease. To do this, I will expand on the techniques of a student group I started and have led for the past three years called the Forum on Science Ethics and Policy (see www.fosep.org). I see the potential for nationwide impact of interactive techniques we use in Seattle, including informal science conversations in coffee shops. My experience suggests I will need about $10,000 in personal seed money to build an infrastructure to initiate partnerships and raise additional support. Why personal money? Science outreach is my passion. My plan is to save using INGDirect’s high-interest savings account over the next 5 years while I finish medical residency. My salary will increase as I progress in my training, so I will be able to save more per month. Along the way, I may use some of the money saved to that point to pursue appropriate educational and networking opportunities. Eventually, I hope to work half-time as a physician and full-time as a citizen scientist.

And here is my photo:

Those who know me from my days at Pitt are not surprised about the painted head. Yes, I was one of those fans...

Organizing Students: Commitments

This is the second in a series of posts providing insight into the organization of student groups. It is offered by me, an outgoing director of the graduate student-led Forum on Science Ethics and Policy at the University of Washington. The last entry dealt with membership and the importance of remembering members' names.

One of the enduring challenges for student groups of any type or size is achieving the right balance between members' contribution to the group and commitment to their own studies. After all, students go to college for an education; the goal of which is often a degree. It is important for a student group to recognize its role as a supportive element to the college experience, but not the central one. It is easy for organization leaders (due their own investments of time and energy) to think of the group more highly than most of its members. Because of this, extreme care must be taken not to force members into tasks they resent. If the organization is ordered such that members agree with the mission, they will be willing to volunteer for tasks that are supportive. Often these supportive tasks are not time-intensive and enable members to contribute to the group without a large commitment. Once a part of the organization, many folks decide to take on larger responsibilities as leaders.

For a relatively small student group (25 active members), FOSEP plans a large number of events each year. There is usually one large public event (involving an audience > 250), 3-5 medium sized seminars (~125 attend) and many small events that range from journal clubs to happy hours. You can imagine that the time commitment to plan an event at the Pacific Science Center with media tie-ins and peripheral campus events differs significantly from announcing a monthly happy hour. But neither is less important than the other. For us, the happy hour is the main place where we socialize with each other and meet potential members. Therefore, the 'happy hour officer' is a crucial job, but one that can be done by a single individual. Members identify with our mission, and that serves as the common ground for all of our activities (outwardly and behind the scenes).

Larger events carry more stress and more tasks. FOSEP handles this by dividing leadership responsibility. We are a big advocate for co-positions: co-chairs, co-directors, etc. When there is a busy week of experiments or if one person is away at a conference, it is useful to have another leader who can cover if tasks need to be done. Such a leadership structure does a number of good things:

• It encourages consensus by removing a final decision from one person
• It enables members to cycle in and out of leadership positions as others graduate
• One leader can cover for another if needed
• Co-leaders have room to discover elements of the organization that they prefer or want to improve.

The main potential problem here is if co-leaders do not communicate well. We have observed that individuals united in a vision or that agree on a mission can overcome obstacles of personality.

Finally, there must be a transparency of commitment. This is difficult to establish early on, since it is often unknown just how much work running the organization will be. As the structure becomes more defined, members should know about both the tasks and the time commitments undertaken by current leaders. Incomplete disclosure of 'just how much time I thought I was devoting to this' can result in hard feelings down the road. We prefer that new leaders realize in advance that they may spend 5 hours one week, 1 hour the next and 10-15 on the week leading up to an event. Then, after the audience leaves and the positive responses come back, they can feel the reward of having planned a meaningful seminar. In a way, that some events have large time commitments demands that the presentations are good!

For members of a student-led organization, there are always more important priorities than the group or club. Occasionally, a member puts the organization near the top of her list. These usually end up being the group's directors; in FOSEP's case these folks sometimes choose careers more related to their FOSEP roles than what they did in the laboratory. But this cannot be expected of everyone. Any member's commitment should be welcomed, none should be scorned, and leaders should look out for each others' priorities. In the end this will make for a healthier, more sustainable organization that people feel good about contributing to.