UpToDate OutOfDate

Where do most academic medicine providers get their information about the latest understanding of disease and treatment?

A web search engine called UpToDate. This service provides review articles of the medical literature that range from pretty good to excellent.

Imagine the horror medical students, residents and providers across the University of Washington system experienced today when they read this email:

"As a result of extraordinary price increases to provide UpToDate access for our distributed community of UW Health Sciences students, faculty and staff across the Pacific Northwest Region I have had to make the painful decision to cancel this heavily used resource. In spite of extensive negotiations with the publisher over the past two years we simply were unable to negotiate a price that our Health Sciences Libraries budget could afford. The price for UW is much higher than for other institutions, in large part, because we are a regional health sciences center with regular faculty and students across Washington State as well as in other states throughout the WWAMI region. This means that simple onsite access as provided by some Health Sciences Libraries (e.g. walk into the Health Sciences Library physically and access the resource) will not work for many of our students and faculty who would need to get into a car to come here or worse, fly for several hours!"

For more details about the specifics of this situation at the University of Washington, visit the UW UpToDate alert page. As a medical student spending the majority of his third year outside of Seattle, I am particularly aware of the crux of this issue. What I want to know is how they can charge so much money for what is basically a bunch of review articles. Just how much are their writers being paid? Do the authors get paid per hit? I kindof doubt it. The last time I checked, basic science professors don't get paid jack for writing review articles. (Actually, I just (this evening) reviewed the preprint proofs for a review article I was the first author on. Far from being paid, we had to pay the journal because we include color plates...)

Johns Hopkins refused to subscribe last year, and now the UW. As of July 1, 2008, UW students, residents and faculty will no longer have access to the most used resource for medical decision-making. In a way it is too bad, because the articles on UpToDate were the best annotated and easiest to read of any online medical resource. Because I am a (small potatoes) employee of WebMD, I've done a little bit of research in to the reference services provided by that company. So far, I haven't been able to use it for comprehensive reference information as seamlessly as UpToDate, but I think that will have to change. And, the WebMD portfolio includes a large amount of other cool information that is more media-friendly than UpToDate. Other services available to providers in the UW system include:

MDConsult (WebMD's healthcare provider page)
Cline-guide
DynaMed
AccessMedicine

If you are logged into your browser with your UW password, these links will send you directly to all of the subscription services.

Despite the inconvenience it will be for me not to have an UpToDate subscription, I am glad that UW just said no to big publishing. This info should be open access, anyway!

Anyone out there have tips for an UpToDate-free world?

As I discover tips, I'll try to post them under the tag, OutOfDate. But that reminds me, I've got a series about presidential health care politics I was going to write, too...

Dear Reviewer,

Dear Reviewer,

It's only been a few weeks since we last wrote, and we've been talking on and off for a little while now, but I feel like I hardly know you. The space between us is so vast, sometimes I wonder whether our inter-continental attempts to communicate are lost. Your cut and paste letters arrive in my mailbox, dog-eared from forwarding and labeled with a baffling cipher. Even so, seeing the message awaiting my expectant eyes causes my heart to skip a beat. You surprise me every time - always waiting until I've almost forgotten about you to postmark your note. This roller coaster can't be healthy can it? I want to get on the page, reviewer. Help me to be on the same page as you.

When it comes down to it, you and I share a love. You know who I speak of. Beauty and Truth are her nicknames. Maybe you've had a few spats with her, too. For me, every time we make up and move on, she becomes more important to my life. I know I am just one small tool in her quest, but us together, my friend? We empower her! Without yours and my relationship, dear reviewer, she has no legs, no foundation. Her name means to split, to cleave; she is knowledge.

I don't mean to tell you how to be in this relationship. After all, I am many years your junior. Still in the cradle, really. And you! Where to begin? You have everything that I aspire to. The big house, the sweet toys, dutiful admirers... But think about when you were in my shoes. You know: with your name out in front. What was it that you needed from your young flings?

Do you feel the connection between us? You've already taught me a thing or two about life. But I have to admit: I want more out of our relationship. I'm going to make this easy for you. I want you to understand me in little chunks, so I am going to use that mainstay of my generation: the bulleted list.

• You would really help me out if you could write to me in paragraphs. Heck, I'd even take numbered lists. But a single long paragraph makes it hard for me to see you amidst the debris. It's like you don't have time for me or something.
  
• I've spent many sleepless nights of internal debate musing meaning, tense and commas; I get dressed up for you (but don't use too much makeup, just how you like); I even show you some of my vulnerabilities - the least you could do is use a spell checker. It would make what you write so much sweeter.
  
• You talk about yourself too much. Sometimes it's like you didn't even listen to me! I know that J. Doe et al did groundbreaking work. That's why I referenced two of their papers. You want another one referenced? I can do that for you. That's how much you mean to me.
  
• I sit at home reading every word of your letters. Take for example the time you said I looked like I was stained with weak grape juice. That really hurt. But I got through it. Acting on the wisdom of your comment, I actually made a discovery. (See figure below. Click to enlarge.) I never did hear what you thought about it. Am I to take this as an answer? Maybe we should both put this behind us.
  

• Why do you have to be so schizophrenic? First you love me. Then you hate me. Then you think you might go to a movie with me, but just as friends. What gives?

Please don't take offense to these comments and questions. It's just that I don't want you to be like my past reviewers. They seemed like mere flings compared to you. I feel like you and I have a special connection. We have the potential for real growth. If this doesn't work out between us, I just don't know if I can take any more rejection. I might have to turn away from it all. Maybe I'll take a vow of abstinence. You know as well as any how that may turn out badly.

Sincerely,

The Author

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.

Organizing Students

Some readers are already familiar with my primary extra-curricular activity during graduate school. The Forum on Science Ethics and Policy (FOSEP) is a very active group of graduate students and post-doctoral fellows at the University of Washington who organize events on and off campus that increase dialogue about science and society in Seattle. I've been involved with FOSEP since I read a little article in Nature (needs subscription) in the fall of 2004, and since October '04 have been one of the group's directors. My involvement as a FOSEP leader is the primary reason I recently received a nice award from the UW Graduate School. FOSEP will very likely be the most career influencing element of my graduate school experience, although maybe the PhD will be nice, too.

Some of my FOSEP highlights include meeting Bill Clinton's Science Advisor Neal Lane, and picking his brain about science policy, organizing a symposium at the National AAAS meeting that included a presentation by Duncan Dallas, founder of the Cafe Scientifique movement, and planning a controversial presentation about the Kitzmiller v. Dover School District intelligent design case. None of these opportunities would have been possible without a well organized team of graduate students.

Tonight, I participated in the last leaders' meeting in my capacity as FOSEP director. In the course of the meeting, I realized that three years of leadership trial and error have resulted in a pretty comprehensive playbook for organizing and motivating a highly functional student group. Student organizations face many of the same tasks of other groups, but have added complexities of volunteerism, rapid member turnover, a lack of permanent space, funding needs and challenging schedules.

One of FOSEP's newer directors, Maris Lemba, suggested I catalogue my tips and tools on this blog. It just so happens that in the last week, three other people (at the UW and elsewhere) have inquired about recommendations I have about science outreach or student group organization. So thanks Maris! Over the next few weeks, I will be posting some of my tips. They will all be categorized under the label, "organizing students." I've put a special link on the right side panel, too. That way, if you want to periodically check back to see my latest additions, they will be easy for you to find.

What are the topics you can expect? They will range from practical to self-help.

• Nurturing Membership
  
• Raising Money
• Personal Leadership Development
• Networking on Behalf of Your Group
• Planning a Good Event
• Getting People to Attend Your Good Event
• Going Out On A Limb
• Using the Media
• Protecting Leaders From Burnout
• Outcomes Assessment
• Interpersonal Skills
• Running a Meeting
• Having Fun
  

Out of respect for everything FOSEP has taught me (and to try and get some of you interested in FOSEP) each of my posts will feature a little FOSEP logo to refer you to their web page. Don't hesitate to ask questions or post comments, either. Especially all you FOSEPers and FOSEP alumni out there.

Final Exam

For those paying attention, there is a change of venue for my dissertation defense.

Reducing Fibrosis and Cell Death in Transplanted Cardiomyocytes
Thomas E. Robey
September 13, 2007
3:00 PM
Hitchcock Hall 132

The previous room had only 48 seats. This auditorium has

150 fixed folding tablet-arm chairs (12 are left-handed).

So feel free to bring your friends! Also of note are the following amenities in the room:

• Boothlet (HCK 132A)
• Carpet (as shown)
• Chalk Board - 31'3"
• Ethernet
• Motorized Screen - 15'x20'

So bring your wireless devices. If my presentation is too boring, you can surf the internets. Maybe you can read my blog!

UW Stands Up for Science

A few weeks ago, University of Washington researchers issued a press release that they had found evidence that exposing very young children to educational videos actually decreases vocabulary development. From the Seattle PI story (adapted from the press release),

Overuse of baby videos may slow the growth of vocabulary among babies 8 months to 16 months old, but didn't have an effect on children from 17 months to 24 months. There is no reason to panic, researchers said, because babies are resilient, and there isn't evidence that videos cause permanent damage. The study didn't examine the effect of videos on older children.

After checking out the original paper, I concluded this is a very fair representation of the findings. I even made a mental note about the findings should I ever have young children. This news tidbit also came in handy during last weekend's NPR show, "Wait Wait, Don't Tell Me!" That's the typical science news release cycle.

Science to Press Release to National Syndication to Local Coverage to Useless Trivia.

Did the cycle end there? Well... I'm still writing.

It turns out that the researchers used that popular DVD series, "Baby Einstein" as their experimental group. Guess who makes "Baby Einstein." Your favorite multimedia conglomerate, Disney. (News Corporation is your other favorite.) What did Disney have to say about this?

Baby Einstein said its products were designed to spur interaction between parents and their children, not as solitary experiences. "The entire Baby Einstein DVD collection is specifically designed to promote discovery and inspire new ways for parents and babies to interact -- such as clapping, pointing to objects and verbally interacting with their baby," the company said in a statement.

Okay, fair enough. But have you seen the packaging for these videos? That message must not have made it through marketing.

Fortunately for us, Seattle PI reporter Paul Nyham has done a great job following this story. Disney was not content to let some scientists hurt their sales, so what happened next? Strong-armed threats of course! Nyham describes Disney's actions here, but for the full effect, read Disney's letter. Unless you are in no mood for whiners. Disney makes a few minor points, but seems to have misinterpreted the right that scientists have to disseminate knowledge. Furthermore, the study was published after careful peer-review. Sure peer-review has its issues, but one of the best things about it is that it is free from corporate meddling. That's more than the US government can say about how drugs are approved and health guidelines are established!

As an advocate for scientific citizenship, there is no question where I stand on the importance of disseminating science. I am still critical of the press release mechanism for announcing science news, but right now, that's what we've got. As long as researchers have integrity in writing releases and reporters do some amount of background work, the system kindof works. So I was pleased to hear that the University of Washington decided to stand up to Disney's thugs. From a new PI report,

The University of Washington refused to withdraw a press summary of research on baby videos on Thursday, rejecting claims by Baby Einstein owner The Walt Disney Co. that the statement misrepresented the underlying research. "The researchers find no inconsistencies between the content of the news release and their paper. They believe the release accurately reflects the paper's conclusions and their commentary," UW president Mark Emmert wrote in a letter sent to Disney CEO Robert Iger.

If only the UW would stand up to the RIAA and refuse to release private information about students to the multi-billion dollar recording industry.

Open Access Tissue Engineering

Are you curious about the field of tissue engineering? This fall, you have the opportunity to take a course on the subject from your own home. This opportunity is not affiliated with Sally Struthers or the International Correspondence School. The course is offered online by a joint program of Harvard and MIT.

HST 535: The Principles and Practice of Tissue Engineering will be available starting in September, and will be viewable by webcast for half a year. That means you get curriculum and video of the course. The website even says that,

during the lectures, questions can be e-mailed to the Course Coordinator.

MIT has opened its curriculum to the public for the past several years. Using a platform called OpenCourseWare, anyone from around the world can take MIT courses. Well, not exactly. As a resource to "educators, students and self-learners around the world," anyone with an internet connection can dial up the MIT site for course materials from subjects ranging from planetary studies to urban planning and literature to biological engineering.

From the OCW site, MIT OCW:

• Is a publication of MIT course materials
• Does not require any registration
• Is not a degree-granting or certificate-granting activity
• Does not provide access to MIT faculty

I can see motivated undergraduates, interested (and maybe retired) citizens, faculty working on new curriculum, science outreach workers, students at smaller colleges, and anyone needing broad information about a specific topics and even busy graduate students finding this resource useful. Perhaps those with the most to benefit from this program are students in developing countries. In fact, MIT OCW's stated goals are to:

• Provide free, searchable access to MIT's course materials for educators, students, and self-learners around the world.
• Extend the reach and impact of MIT OCW and the "opencourseware" concept.

This second objective is a noble one. Long regarded as the premier science and engineering university in the world, it is an important statement that MIT is making curriculum resources open to all. Because of its reputation, MIT is probably the only entity that could pull off an attempt to change the way information is available to the interested public. At first, there were some complaints about this policy. What are MIT students paying for if all of the course material is free anyway? The answers are in the caveats above: OCW users have no access to faculty and no record of enrollment.

Can secondary (and tertiary) education really be boiled down to networking and credentialing? I'll wager that the majority of OCW users either passively watch the material or look for specific answers or resources before moving on. Without cramming for exams and office hours to make sure sure you 'get it,' this material is by no means a complete course of study - it is merely another resource. Albeit a free resource from a prestigious institution.

This tissue engineering course however seems to contradict one of OCW's central points. That Professor Myron Spector is available for questions could be his own choice. Maybe this is his way of connecting with the public about science. I like the sound of that.

Open access as a route to citizen scientist.

There's an idea. Can open access (courseware, journals, software, etc.) effectively distribute the building blocks of the ivory tower to the masses and in so doing increase the role of science in society? We shall see.

Too Busy To Read This?

If you are too busy to read this article, then you should definitely read it. Dr. Free-Ride has posted some thoughtful takes on what it means to balance, er... juggle numerous tasks in the context of academia. She makes use of a good metaphor and makes it work really well. I'd say I am in a 'don't throw any more balls up into the air' phase of my life.

Combined Degree Programs

I am part of an NIH-funded program that has been around for more than 30 years. The combined degree MD/PhD training program, called the Medical Scientist Training Program (MSTP, pronounced "messed up" by some of us) serves a need to better bridge basic science with clinical implementation. The idea is to train impressionable young scientists and clinicians in the ways of science AND medicine so that when they grow up, they can speak the same language and navigate the varied cultures of science, medicine and engineering. The result is a long, sometimes grueling path leading to a career in academic medicine. Every year, another 300 or so students sign up for this gig. One benefit of these programs is that we trainees don't have to pay for school, and get a livable stipend. The other side of the coin is that upon graduation we each enter a lifelong fundraising campaign to support our research. The big donors here could be private industry, but usually the benefactor is the Federal Government, via the National Institutes of Health.

Well, the NIH is seeking advice about how to reform the granting process so that the money (your taxes) they spend is most effective. For instructions on how to give advice, switch to this post. To hear one of my 'creative' ideas, keep reading.

I recently entered Seed Magazine's science writing contest. (The topic was science literacy.) Having only this blog as my science writing experience, I do not expect to win anything. For me, the contest helped me form an idea about what is missing in the public science communication complex. At the core of science literacy today is the need for effective translators; between religious folk and scientists; between doctors and newspapermen; between researchers and housewives; between professors and policymakers.

The MSTP has filled a critical need to connect the bench with the bedside. Sure, it takes too long for us to finish, and there is an attrition rate, but MD/PhDs tend to get grants because they understand what is needed on either the medical or the basic science side. Furthermore, several competitive programs exist to fund slightly higher risk efforts in translational medicine. Following these leads, the NIH would do well to support a small and competitive initiative to better train civic scientists. These would be professionals who garner some of their salary support solely to communicate with the public or with policymakers. A small number of students could earn dual degrees in hard science and communications or engineering and political science. These people will be the go-to resource for the public's questions and concerns about controversial topics like stem cell research, nanotechnology, designer genomes and drug safety. They also will be trained to develop innovative mechanisms to instill in Joe Public a scientific sense - that science does more than generate trivia.

This is my charge to the NIH (and other Federal funding agencies, for that matter):

Support Translational Science

Translators to the public and for the public. That will be money that can only feed back into the system.

The NIH wants YOU!

The NIH is seeking comments regarding NIH’s support of the biomedical and behavioral research, including peer review, with the goal of examining the current system to optimize its efficiency and effectiveness. The NIH is especially interested in creative suggestions, even if they involve radical changes to the current approach. Responses will be accepted until August 17, 2007 online or via e-mail (PeerReviewRFI@mail.nih.gov). I hope that all of you reading this - whether you are a grant recipient, a student or a taxpayer - will offer advice to Uncle Sam.

I made this post as part of a pyramid meme initiated by Writedit and sent to me by DrugMonkey, both individuals who know more about the nitty-gritty of NIH grants than myself. If you blog and want to tag yourself to write about this, here are 4 rules:

1. Include in your post the links to the NIH RFI and the comments page.

2. Include the list of six topics the NIH wants information about.

1. Challenges of NIH System of Research Support
   Please describe any specific challenges presented by NIH’s support of biomedical and behavioral research such as the current array of grant mechanisms, number of grants awarded per investigator, and the duration of grants.
2. Challenges of NIH Peer Review Process
   Please describe any specific challenges presented by the current peer review process at NIH.
3. Solutions to Challenges
   Please concisely describe specific approaches or concepts that would address any of the above challenges, even if it involves a radical change to the current approach.
4. Core Values of NIH Peer Review Process
   Please describe the core values of NIH peer review that must be maintained or enhanced.
5. Peer Review Criteria and Scoring
   Are the appropriate criteria and scoring procedures being used by NIH to evaluate applications during peer review? If not, are there changes in either that you would recommend?
6. Career Pathways
   Is the current peer review process for investigators at specific stages in their career appropriate? If not, what changes would you recommend?

3. Comment on one or more of these issues.

4. Decide who the next seven vectors will be for this meme.

I decided to forward this request to 7 other bloggers. The lucky winners here are:

The Daily Transcript
King of the Nerds
The Scientific Activist
Pimm
Science to Life
SeattleJew
Neurotopia

Check their sites to learn more about other folks' ideas, but most importantly, comment to the NIH!

MD/PhD Interest?

I've noticed a surge of referrals from an online forum about folks interested in MD/PhD programs. I am a student in the University of Washington's MSTP, and am happy to answer specific questions about our program or about my take on training the physician scientist. You can find one of my email addresses with only a little digging, OR you can comment on this entry. I am scheduled to defend September 13, and am very happy to be getting back on the wards.

You will probably notice that only a portion of my posts deal explicitly with medical research and graduate school. That's because I believe some physicians and scientists should assume more of a citizen's role - able to communicate about science and medicine in the context of public policy, general understanding and pop culture. This blog is meant to improve my communication skills in those areas.

Thanks for visiting!

Sherley It's Time For An Update

The case of James Sherley's employment at MIT is still one of the most common searches leading to my web site, and there continue to be developments. To catch up, check out my first entry on this topic. (For you bloggers trying to get listed higher on Google, it actually *helps* to make a little spelling error deep in the entry...)

According to a news feature in Science Magazine last month, the biological engineering professor was asked to leave his position on June 30, 2007. Of note is that Frank Douglas resigned because MIT's handling of Sherley's case for tenure creates a hostile environment for African-Americans on campus. Douglas was the director of MIT's Center for Biomedical Innovation. He held faculty appointments in the science, engineering, and management schools.

It sounds to me like MIT has a problem with race. Philip Phillips, another Black scientist, formerly at MIT and now at the University of Illinois, predicts that Douglas will be treated as was Sherley—“as just another irrational person.” This got me thinking: I wonder how many irrational White, South Asian or Hispanic people there are who were denied tenure at MIT. Or is irrational a word only reserved for Black professors. I wonder also, how irrational individuals received appointments at the premier science institution in the world, if they were irrational.

I admit that some of Sherley's actions and his use of hyperbole (on this issue and others) can easily confuse what is the real issue at hand, but it is hard to lay the blame entirely on one man. Is MIT just offering lip service to issues of race? Do they have anything more than official statements to try and improve this situation? Is the environment there really hostile to African-Americans? What will James Sherley do next?

Reflection

There come times in life when we slip into contemplative reflection more than usual. Occasionally, this occurs conveniently - in which case we actually have quality time to reflect. Wise people devote a little time every day to the questions, "What am I learning?" and "What does that mean?" Others of us push these questions aside only to have them burst forth unexpected demanding address. Clearly I am experiencing a bit of 'bursting forth' if you are reading this!

I find myself pressed with some urgent questions these days, and have identified a regiment by which I can begin to answer them. If you are thinking, "Oh great. He's going to subject us to his personal struggles," you are only partially correct. My personal challenge is to wrestle with my questions on this blog in a way that will engage some of you. If anyone out there feels motivated to comment or argue with me, I'd be tickled.

My reflections of late have all been different faces of the question, "What is the meaning of graduate school?"

By the end of this series of posts, I expect to either:

1. tire of this topic
2. find a robust answer to the question or
   
3. defend my dissertation.

It is possible that all three of these will occur, as my scheduled defense is September 13, 2007.

I can identify a few reasons why I have not been able to silence my thoughts about this question. They include:

1. scheduling my defense and selecting a time line that resulted in a 40 day flood of experiments.
2. receiving a call from the labor relations office about my non-compliant status in the collective bargaining unit of graduate students at the University of Washington, and the subsequent discussions I had with folks about that.
3. my tendency to need numerous intellectual distractions whenever I am working hard on particular tasks.
4. the observation that if I don't comment on being a graduate student now, when will I?
5. a personal belief that questions that keep me awake for more than three nights are as close to any sign as I will ever experience.
   

I will still post entries similar to those you've been reading, but will spend a little bit of time on my latest burning question:

What is the meaning of graduate school?

Making a Dent in Academia

One year ago, the former Dean of Engineering at the University of Washington committed suicide. For nine years, Denise Denton worked to increase gender and racial diversity in science and technology and devoted great energy to improving engineering education. She was the first woman to hold a deanship at an NRC-designated Research One university. Her final employer (University of California) now hosts a memorial web site, and today Dr. Free Ride posted a tribute to her.

Much can be done to build upon her legacy of making science and engineering a better place for women.

Ombudsman

Tomorrow I meet with the University of Washington's ombudsman. Don't worry, it's nothing serious, and is of my own prerogative. If it is appropriate, I will certainly post more specifics in the future.

Just out of curiosity, does anyone out there have any experience interacting with ombudsmen?

Universities have come to rely on this person as a resource for personal conflict mediation and for processing claims of scientific misconduct (neither is the reason I am meeting with her). One prominent use of ombudsmen is the James Sherely tenure dispute at MIT. I also bet that legislation like the Whistleblower Protection Enhancement Act (HR 985) probably comes to bear on this office. The nature of ombudsmen's work is usually confidential, so it will be interesting to learn more about what the office does.

I figure that at the least, I will come away from our meeting with a better sense of how the ombudsman can factor into the academic structure. And maybe by the end of this I will be able to pronounce ombudsman without twisting my tongue.

Carbon Footprint: Stay Grounded

An editorial in today's Seattle Post-Intelligencer induced my choice of this week's Carbon Footprint series. Kathleen Braden, a professor of geography at Seattle Pacific University, relayed her reasoning for not supporting the Sierra Club's efforts to combat global warming because of duplicity between the group's positions and its member services. Don't worry, she doesn't spare other conservation groups that are as two-faced as Janus.

Braden is familiar with the consequences of international travel: she recently gave a seminar about ecotourism in Russia. (The 30 minute talk is available for podcast.) But the central premise of her P-I column was something else - carbon emissions from airplane travel. By offering members vacation travel packages to remote destinations around the world, she calculates that the Sierra Club will add 689 metric tons of carbon dioxide to the atmosphere this year, just so that members can enjoy nature in Nepal or Peru. The same duplicity comes from groups that send plush toys, t-shirts and other packages overnight by air freight to new members.

So what's the take home from this? Are we to take fewer plane trips? Reduce the number of overnight orders? Visit distant family less? The culture of academia is dependent on travel. Just like salesmen, professors travel the country to present their research and ideas to colleagues via conferences or invited seminars. NIH grant review occurs in study sections in Washington DC. Some societies plan 'destination conferences' in Waikiki or Sydney or Venice. On a more personal note, I expect to fly to eight to ten cities next year to interview for residencies. What are we to do about this culture of travel? Whatever it is, it will require system-wide changes in behavior. I am going to start by not worrying whether I will make 'MVP' this year on my Alaska Air frequent flier number. A 14 hour drive to visit my parents? That would be more difficult. And visiting my in-laws in Hawaii... Right now, we are limited by time and finances, so making that trip is still infrequent. Are there any frequent travelers out there - in business or academics - that have found ways to reduce their carbon impact without 'suffering' lost productivity or professional standing?

There's another little pearl from this column that I don't want to overlook, and it ties nicely with a recent post of mine. Here is a Christian - a professor at a Christian college - who is a member of the Sierra Club, the Ocean Conservancy, and probably others that sees no problem between the scientific claims made by these groups and her personal faith. I bet that Kathleen Braden sees her public scholarship on this issue as part of a Christian imperative to be good stewards of the Earth.