Tuesday, March 31, 2009

Imperial Battle Cruiser

On and off for the past 7 weeks, I've been working at the Seattle Veterans Affairs hospital. Many medical students spend part of their time at VA hospitals, but I was not assigned to one until last month. (I completed my geriatrics rotation and part of my radiology clerkship there.) But as with a lot of things these days, the day has come that I will not return to this place for a while.

The reason I am sharing this is to share a funny (if strange) phenomenon I experienced every day on my morning walk from the bus stop or the parking lot. By the time I approached the entry, I had started humming The Imperial March. It didn't matter if I was reading a book on my way in, listening to music or news radio. In the meters approaching the door, I had moved from the well recognized drumbeat to that catchy progression.

I cannot explain this. I mean, it's not like the hospital looks like an Imperial battle cruiser or anything.Or does it...

If your bandwidth is low, you may experience jumpiness in the music.

Sunday, March 29, 2009

Stem Cells + Media = ???

This post is for students in the Issues and Values in Biology course at Seattle Pacific University. I'll be visiting you later this week to talk about how the media interacts with science. There are a lot of great examples of how science is well represented or misrepresented in the news, but I've picked one story from a field I'm familiar with and that hopefully is interesting to you.

Even before President Bush signed an executive order restricting Federal support of embryonic stem cells, there was considerable attention paid to the differences between adult and embryonic sources of the cells. If you aren't sure what is the difference, I'd encourage you to check out this website sponsored by the National Institutes of Health. Knowing the basics will help you understand why I've chosen the following example. There is still considerable conflict - especially in faith communities - about embryonic or adult stem cells. (See my post about President Obama's recent press conference for more details.) The field of stem cells is very large - there's something in the news every week; I'm focusing on one issue that was in the news about two years ago.

In the January 2007 issue of Nature Biotechnology, a group of scientists from Wake Forest University led by Anthony Atala published an article titled, Isolation of amniotic stem cell lines with potential for therapy. (The link needs a university subscription or an email from Dr. Hunter.) The bottom line in this report is a claim that there are cells in amniotic fluid (the nutrient that fetuses consume/breathe before birth) that have some of the same potential to form tissues as embryonic stem cells.

Nature Publishing Group publishes many of the most respected journals in science, and Nature Biotech is one of their gems. Each issue probably generates 5-6 press releases. The relationship between these top tiered journals and the mass media is important. It is the stock pathway for the dissemination of cutting edge science into public knowledge.

Unfortunately, 'cutting edge' in science rarely equates with 'breaking news.' Breaking news is too dependent on context. In this case, the work presented took about 7 years to complete, AND stem cell funding was near the top of the Dems' political agenda for 2009. And when a news story overlaps with politics, there is invariably hype and hope attached to what the science could someday do. (Some social scientists studied this in relation to stem cells a few years ago. If your'e interested, read this paper - you'll need a school subscription or the email from Dr. Hunter.) Did this get published for the hype?

The lab where I got my PhD held a journal club focusing on this paper about 3 weeks after the news broke. (Journal clubs are opportunities to assess for ourselves the merits of a publication, how our experiments might need to change in light of others' results, etc.) Our lab has a reputation for being one of the most skeptical in the field of cardiovascular stem cell biology. The outcome of this animated discussion was unanimous agreement that these cells were much more like (maybe identical to) a type of adult stem cell (mesenchymal stem cells) that are multipotential, but not pluripotential like embryonic stem cells. I could outline about 8 reasons for this conclusion, but that would distract from the real issue I want to bring up: what happens when 6 pages of dense scientific data is condensed to 500 words?

But fiirst, how did this story hit the press? My first contact with the information was an article in a Seattle newspaper. Later, I read an op/ed by Charles Krauthammer suggesting that Bush's decision to limit progress in embryonic stem cell research might have been vindicated with this publication. Initially, I did not catch (but should have expected) headlines like Vatican official ‘rejoices’ in news of amniotic stem-cell discovery and Bush’s Culture of Life ’Confirmed’ by Stem Cell Announcement. Lost in all of the political fallout from this report was a statement made by Atala that this information should NOT be used to argue against the funding of embryonic stem cell research.

Interestingly, when a paper DOESN'T publish science stories, it raises eyebrows. Science writer Michael Fumento announced a cover-up of this information committed by the New York Times when that paper opted not to publish the report. It turns out that their genetics reporter looked at the Atala paper last week and
deemed it a minor [scientific] development.
Hooray for Times reporter Nicholas Wade and his science editor Laura Chang! Ms. Chang went on to say,
There is so much hope invested in stem cell research that we have grown increasingly concerned about prematurely fanning these hopes.
Fumento lamented on his blog that
it's too bad many editors don't realize they have science writers who don't understand - or worse, misrepresent - science.
Exactly! Isn't it strange when we can agree on a statement but not a sentiment?

I believe there are some key questions left to be answered:
  1. Why did Nature Biotechnology permit publication of a paper that presented mundane data in conjunction with amazing claims?
  2. Is the manner by which science writers collect their information about scientific reports thorough enough?
  3. Since it increases visibility of science in general, could it actually be better for science that the public gets this information? (Misrepresented as it may be.)
I look forward to meeting you in class this week. If you were not able to access the scientific papers linked above, Dr. Hunter will make them available to you as .pdfs. Also, feel free to post questions here if you have any before class.


Last week, the Seattle Post-Intelligencer stopped printing newspapers. It was my favorite Seattle paper. All that's left of the storied news agency in town are a few reporters and an online only paper that is a glorified news feed. It's not even worth posting the link. I wonder if they will keep their offices and the rooftop globe downtown. More importantly, will anyone get paid to serve as public watchdog the way formal reporters were? It's just another newspaper that has bit the dust...


Saturday, March 28, 2009

American Scientific Association

I'm blogging from Ipswitch, MA today. It's a crisp spring day on the New England coast. I'm here for the executive council meeting for the American Scientific Association. You may have seen their booth at the annual AAAS meeting. I'm the early career representative to this organization of scientists who are Christians. This is a relatively small group (~2000) of folks from around the country who are united in the following beliefs:
As an organization, the ASA does not take a position when there is honest disagreement between Christians on an issue. We are committed to providing an open forum where controversies can be discussed without fear of unjust condemnation. Legitimate differences of opinion among Christians who have studied both the Bible and science are freely expressed within the Affiliation in a context of Christian love and concern for truth.

Our platform of faith has four important planks:
  1. We accept the divine inspiration, trustworthiness and authority of the Bible in matters of faith and conduct.
  2. We confess the Triune God affirmed in the Nicene and Apostles' creeds which we accept as brief, faithful statements of Christian doctrine based upon Scripture.
  3. We believe that in creating and preserving the universe God has endowed it with contingent order and intelligibility, the basis of scientific investigation.
  4. We recognize our responsibility, as stewards of God's creation, to use science and technology for the good of humanity and the whole world.
These four statements of faith spell out the distinctive character of the ASA, and we uphold them in every activity and publication of the Affiliation.
The organization's web site aims to provide resources for Christian (especially Evangelicals) who face conflicts between faith and their understanding of science. The executive director also plays a role advising other groups like AAAS's Dialogue on Science Ethics and Religion (DoSER) and other groups. Our latest project is to help produce science materials for home-schoolers that maintain the high level of scientific integrity that the ASA upholds.

If you are interested in learning more, visit the ASA website or feel free to contact me.

Tuesday, March 24, 2009

Obama Flubs on Stem Cells

He did just sign an executive order lifting the August 9, 2001 restrictions on Federal funding for research involving human embryonic stem cell (ESC) lines, but President Obama still doesn't seem to understand the science involved in the decision. Of the thirteen questions he fielded in tonight's press conference, the one he did the worst answering was the one from Washington Times journalist John Ward.

Watch the Q&A and then indulge me by reading my take on Obama's response.

Did you catch the sections where Obama displayed a strangely Bush-in-the-headlights look. I'll remind you as we read through it again together.

QUESTION: In your remarks on stem cell research earlier this month, you talked about a majority consensus in determining whether or not this is the right thing to do, to federally fund embryonic stem cell research.

I'm just wondering, though, how much you personally wrestled with the morality or ethics of federally funding this kind of research, especially given the fact that science so far has shown a lot of progress with adult stem cells, but not a lot with embryonic?

PRESIDENT OBAMA: Okay. No, I -- I think it’s a -- I think it’s a legitimate question.

Actually, no! The question is not entirely legitimate. The questioner added on the to the end of his question the words, "especially given the fact that science so far has shown a lot of progress with adult stem cells but not a lot with embryonic." This is horribly misleading. Adult stem cells have been "researched" for half a century. Human embryonic stem cells were first characterized in 1998. The speaker sets up a straw man that the two types of cells are on level ground. So the question isn't legitimate if it isn't true. By calling it legitimate Obama ceded ground because everybody has in their mind that last phrase. To clarify, embryonic stem cells have shown more promise in the past 10 years than adult stem cells did in their first 25.

OBAMA: I -- I wrestle with these issues every day. As I mentioned to -- I think in an interview a couple of days ago, by the time an issue reaches my desk, it’s a hard issue. If it was an easy issue, somebody else would have solved it and it wouldn’t have reached me.

Look, I believe that it is very important for us to have strong moral guidelines, ethical guidelines, when it comes to stem-cell research or anything that touches on,

AWKWARD FUMBLING-FOR-WORDS SILENCE... So this is why you use the teleprompter so much!!! By the way, it's not cool to conflate morals with ethics. Morals can influence ethics, but they are not the same. This confusion is a big reason so many scientists are upset with the religious right. Morals are personal standards. Ethics inform a social standard. By definition, defining ethics is a consensus-dependent activity. Players on both sides of this argument are still not ready to talk with each other.

you know, the issues of possible cloning or issues related to, you know, the human life sciences.

COME ON! "possible cloning or issues related to, you know, the human life sciences?" I would have liked to hear a reference to the main issue here: when do we think humanity begins?

I think those issues are all critical, and I’ve said so before. I wrestle with it on stem cell; I wrestle with it on issues like abortion.
Okay, there it is. Finally, there's a politician willing to call a spade a spade. The reason this debate is so lively is that the pro-life contingent already has a high-functioning political machine... Now we just need some effective communication about how stem cell research isn't the same as abortion.

I think that the guidelines that we provided meet that ethical test. What we have said is that for embryos that are typically about to be discarded, for us to be able to use those in order to find cures for Parkinson’s or for Alzheimer’s or for, you know, all sorts of other debilitating diseases, juvenile diabetes, that -- that it is the right thing to do. And that’s not just my opinion. That is the opinion of a number of people who are also against abortion.
Nooooooooooooooo! Not the C-word! What we scientists are after is understanding that leads to treatments. Politicians LOVE cures. The thing is, there aren't many cures in medicine. (And some ill-informed autism advocates want to take those away from us!) When there is no cure, the adoring crowd supporting research could turn to an angry mob. And another thing: When are the politicians' science advisors going to step in to help them understand which diseases stem cell research is likely to yield treatments for??? Stem cell research might have a chance at curing neurological diseases. There's a chance that Parkinson's could be treated because its a pretty well-defined region of the brain that's affected. Even then, I'm not sure we've figured out how to convince the ESCs to become substantia nigra (that's the region of the brain involved) cells, much less how to get them to integrate. But Alzheimer's Disease (AD)? We still know relatively little about how AD occurs. We know it hits different people differently and have really good tests to identify dementia or to diagnose the disease at autopsy, but even the expensive medicines so many people take hardly work at all. Nancy Reagan pleaded with GW Bush to lift his restrictions because of AD. Politicians who support ESC research use Alzheimer's because 1) a lot of people get it and 2) everyone is scared of it. Okay, so I don't like AD or Parkinson's. What are the diseases that could benefit from ESC research? Try spinal cord injury - the first FDA approved human trial for any ESC therapies is underway already. Diabetes is another good one, though my cynical side believes that disease was thrown in because the Juvenile Diabetes Research Foundation is one of the biggest science lobbying groups. The disease no one talks about is CANCER. What we are learning about reprogramming stem cells will likely inform future treatments for cancer.

Back to OBAMA: Now, I am glad to see progress is being made in adult stem cells. And if the science determines that we can completely avoid a set of ethical questions or political disputes, then that’s great. I have -- I have no investment in causing controversy. I’m happy to avoid it if that’s where the science leads us.

Fair enough. In an ideal world, we will be able to learn from ESCs in order to reprogram other stem cells to do the same thing. And that is exactly what a couple of scientists did recently with induced pluripotent cells (IPCs). Read about them at Wikipedia. A future Nobel Prize may be awarded for this work... But this work would not have been possible without ESC research.

OBAMA: But what I don’t want to do is predetermine this based on a very rigid ideological approach. And that’s what I think is reflected in the executive order that I signed.

Way to finish strong. Let science ask the questions, but have a more-or-less consensus ethical framework within to let them work.

QUESTION: I meant to ask as a follow-up, though, do you think that scientific consensus is enough to tell us what we can and cannot do?

PRESIDENT OBAMA: No. I think there’s always an ethical and a moral element that has to be -- be a part of this. And so, as I said, I don’t take decisions like this lightly. They’re ones that I take seriously. And -- and I respect people who have different opinions on this issue.

But I think that this was the right thing to do and the ethical thing to do. And as I said before, my hope is, is that we can find a mechanism ultimately to cure these diseases in a way that gains a hundred percent consensus. And we certainty haven’t achieved that yet. But I think on balance this was the right step to take.
The president wisely ended on the ethics part of the question, so finished strong, but I hope that Mr. Obama's science advisers help him understand this topic so that it's not the science question at his next news conference that he flubs.

And I'll be honest with you: in terms of the potential for the cells to become any tissue in the body, I didn't think that the IPCs would stand a chance against ESCs back when they were first derived. But the great thing about science is that opinions only matter until the data comes back. And if you don't accept the data that everyone else does, you can do the experiment yourself. Unlike politics, the central element of all science is honesty and integrity; when proven wrong, the best scientists dust themselves off and start asking new questions. The investigator who does not will soon be out of a job.

Monday, March 23, 2009

Grand Rounds V. 5, No. 27

Now that I'm posting with a little more frequency, I submitted one of my recent entries to the bloggers' grand rounds. They're up to Vol. 5, No. 27 over at Code Blog, and since I was linked, I'm glad to be able to send some readers in that direction. Enjoy this week's best in medical blogging.

Sunday, March 22, 2009

Back at Clashing Culture

It's been a little while since I've posted anything at the science and religion blog Clashing Culture. But my co-bloggers over there have kept the place free of cobwebs. I spent a little bit reacquainting myself for the ever-present creation vs. evolution issue this weekend. There's a Texas School Board meeting this Friday to decide science standards for the next 10 years. And of course, some last minute insertions by the board's chair have the scientific community worried that creationism will find its way into science text books... It turns out that the chair of the board Don McLeroy has written an anti-evolution book Sowing Atheism and calls clergy who accept evolution morons. Sounds like the typical anti-intellectual name calling that makes this issue so frustrating to folks like me who just want to get along. In not very related news, one of creationism's champions, Ken Ham, has taken to leveling hypocritical complaints about radio interview ambushes. Read more at Clashing Culture.

Read more about the Texas School Board issue here and the Clergy Letter Project here.

Thoughts and Prayers

There are some news stories that demand your attention. Those of us who gather information online are used to seeing the eye-catching news stories (like in the column of story links on CNN's webpage) that keep you from surfing to the next site. It says a lot about the media that headlines like Woman on horse shops at Target are adjacent to 3 Oakland police officers killed in shootings. I admit that I typically avoid the news stories about killings equally with the stupid sounding ones. So why did I read the articles about the tragedy in Oakland?

I think it was the personal connection.
  1. In my career as an EM doc, I will see plenty of shootings.
  2. I've already been a part of care for a man down.
  3. I admire how firemen, police officers and medics put themselves at risk for a greater good.
  4. In the recent match, I ranked the emergency medicine residency at Highland Hospital (in Oakland) very high on my list.
That I had already imagined myself living in Oakland, working at Highland and being a part of the trauma team that received victims like this struck a chord with me. Unfortunately this is not the last time I will face a situation such as this. Part of me believes that reading about this, reflecting on it and greiving in absentia will help me prepare for when I'm the one applying pressure, pushing fluids and wheeling the patient to the operating room as soon as possible. Would I also be among this group? Police officers, ministers, community organizers, political leaders and concerned citizens are gathered all around Oakland in groups shown in this photo. This scene just happens to be in an ER waiting room that I've walked through. A different kind of mourning was no doubt going on behind the waiting room walls.

Photo: Justin Sullivan/Getty Images

Is there is also a role for EM docs outside in the community talking about violence, safety and emergency response? I'm sure the answer is yes. I wonder what that would look like.

Saturday, March 21, 2009

In Case You've Not Seen It...

This video has surfaced at several of the blogs I read. In case YOU haven't seen it, this is worth a few minutes of your time...

There's really no reason for me to post this here except that I tend to post things that I think are interesting...

Thursday, March 19, 2009

Match Day

We have 3 months to finish medical school and move to New Haven. Ready, get set, GO!!!

Is Match Day Overrated?

I think it is. We're waiting the extra hour to check my results from the comfort of home. So be patient, family! Since I believe in both free speech and the possibility of reform, I went ahead and listed a few reasons why the emphasis on the Match (even I use a capital letter) could be misplaced. You'll have to go over to The Differential to read it. And yes, you will still need your free login.

One of my blog friends recently asked me if the same computer that compares my rank list with 30,000 other lists and the lists from thousands of programs was the same that made Bowl Championship Series calculations. I am inclined to think that this present figuring very well could be an off-season task for the BCS brain. Like the bowl placements, there will be folks happy with the outcome and folks that are not.

By the way, which are the other professions than medicine that use similar systems for job placement as that for medical residents?
  • The Military
  • Professional Sports
  • Anything else?
Match, Smatch... They should just call it what it is. Today is Draft Day!

Wednesday, March 18, 2009

Gifts From Patients

Last week, one of my patients gave me some elk jerky cured from a buck his 14 year old grandson shot last season. Read about my experience at the Medscape blog. Of course you'll need to use or sign up for a free login to read it.

Monday, March 09, 2009

Better Than Stem Cells

I don't mean any direct offense to John Marburger by re-posting this cartoon by David Horsey, but today's stem cell announcement reminded me just how lame science had become in the executive branch over the four years.

The coolest part about Obama's speech today was not the stem cell part. It was:
Promoting science isn't just about providing resources -- it's also about protecting free and open inquiry. It's about letting scientists like those who are here today do their jobs, free from manipulation or coercion, and listening to what they tell us, even when it's inconvenient -- especially when it's inconvenient. It is about ensuring that scientific data is never distorted or concealed to serve a political agenda -- and that we make scientific decisions based on facts, not ideology.
That's the part that will actually change how politics uses the information science offers.

Sunday, March 08, 2009

Bad Economy = Abuse

It troubled me to learn that rates of non-accidental trauma has risen by more than 2-fold at Seattle Children's Hospital. Non-accidental trauma is the medicalized word that describes injuries incurred by children that are the result of abuse. This trend is evident across the country.

This reminds me of a theory I once read about kids born in the Great Depression. When money got tight, parents fought and drank more, leaving children bewildered and often alone. Many kids' childhoods were remembered as periods of unpredictability; in their high school years they lacked direction or a sense of confidence.

Childhood depends on a sense of security. I'm guessing there are a lot of parents who will need to work extra hard to provide that emotional support even as the financial backing has failed.

Saturday, March 07, 2009

The Open Laboratory 2008

As you may recall, one of my posts from last year was selected for the Open Laboratory 2008 compilation, which gathered 50 posts from the science blogoverse for a print edition that you can buy. It may seem backwards to take internet material and print it on paper, but there's a good reason for it. The collection's proceeds go toward supporting ScienceOnline'10, a science blogging conference next January. The book is also a nice way to see how bloggers make legitimate literary and journalistic contributions to whatever conversations are being held on matters relevant to science, society and beyond. I've had only a few sciencey things published thus far, so will probably permit vanity to reach into my wallet to buy a print version. It's also available in .pdf. And if you wish to read each post in its original context, each one is linked at A Blog Around the Clock. If you do buy it, do so from lulu.com. The conference organizers get more funding that way.

What's Wrong?

If you couldn't tell from my post yesterday, I approve of the president's impending action to lift funding restrictions on human embryonic stem cells. While, I've not had the time to post much about this issue, I have been reading others' takes. The Washington Post has a nice blog/column about religion and gives good time to science and religion bits. A piece likening stem cell ethics to organ transplantation caught my eye, because I've thought about this connection before and wanted to read what an 'expert' would say about it. I'd recommend you check out the article by Susan Brooks Thistlewaite, and the counterpoint by Thomas J. Reese, but what I did a doubletake on was this image:
This type of tube is commonly used to store frozen cells, including stem cells. The tube is thawed, because the red media is clearly not a chunk of ice. I'm thinking the photographer wanted an illusion of pipetting into the vial. But in the picture, the scientist is actually pipetting into the cap. There is a good chance that the diagonal tube is a forceps (tweezers), but with the cinematic techniques used so often on CSI and other science-enriched TV shows, I'm still putting my money on the theory that we're supposed to think there's pipet action going on.

Which is all to say, LOL.

Friday, March 06, 2009

This Just In!

Obama to Lift Ban on Funding for Embryonic Stem Cell Research.

Evidently, he will sign an order on Monday to reopen federal funds for ES Cell work. Read all about it in the Washington Post.

Tuesday, March 03, 2009

Access to Care

The five or six readers who have stuck with me these last few months and haven't banished me from their readers will know that the claim to health care is one of my personal, ethical and political interests. Which reminds me that I need to read up about Health and Human Services nominee Kathleen Sebelius. But one of the reasons I've not been able to do my homework on her, or write in this blog is the Ethics in the ER course I'm teaching this quarter. I've been using a blog to move the discussion beyond the classroom. I think it's been working. The students who post comments have shown great insight and offered poignant reflections.

Anyway, while researching this week's topic, I ran across a couple of media clips that could be interesting to folks who think health care reimbursement needs to be reformed. Remember Harry and Louise? They were the middle class couple in the mid '90s who didn't take very kindly to the Clinton health care plan. Last year, a consortium of lobbying groups turned that technique on its head. I think they even found the same actors. It's worth heating over to the Ethics in the ER blog to check them out side by side!


My latest essay at The Differential makes the rounds on rounds. For this emergency medicine bound medical student, I am glad that rounds will not be a big component of my future career. They make me dizzy.
Rounds is an element of medical culture that is core to medical education, but in my opinion is rarely done well. Fortunately for you, I don't go into my criticisms in this piece...

If you haven't yet, you'll need to sign up for a free account with Medscape. Sorry about that. And if you have had trouble with the links before, I think that problem's been fixed, too!