May 10, 2010
Fever Series (Challenge 2): 'high temp after travel' What's the diagnosis?
May 07, 2010
Nature Book Reviews: The Vanishing Physician Scientists?
The USA is the birthplace of many prominent physician-scientists and even there, it appears that the numbers of practicing physician-scientists are dwindling. This book, reviewed by the journal Nature, offers possible explanations for the drop in physicians who practice science.
The academic niche for physician-scientists has been degenerating for over three decades. In 1979, the director of the US National Institutes of Health (NIH), James Wyngaarden, initially highlighted an alarming drop-off in the number of physician-scientists and their success rates in NIH funding. Since then, the combined burdens of an increasingly stringent overall NIH budget, educational loans on young physicians (often in the six figures), the procedure-driven nature of modern clinical medicine, and the financial vise of managed care and its follow-on effects on the academic environment have created an increasingly ablative force on the necessary environment to maintain a proper balance in the numbers of physician-scientists. In The Vanishing Physician-Scientist?, edited by Andrew I. Schafer, currently chairman of the Department of Medicine at Weill Cornell Medical College, the fate of the physician-scientist is revisited from multiple angles: renewal versus extinction, the evolution of diverse lineages (MD-PhD, late bloomers with MD degrees alone, PhDs in clinical departments), implications for biotechnology and drug discovery, gender imbalance, pipeline versus attrition effects, role models, financial and modern lifestyle concerns and the fragile microenvironmental niche of academic medicine in general. The result is a fascinating must-read for those of us with a deep interest in the subject that goes beyond conjecture and anecdotal personal experience to recent academic survey data, population analyses, current NIH funding trends, outcome analyses of MD-PhD trainees and, most importantly, onward toward a series of cogent, specific and implementable suggestions for regeneration. As the last page is turned, a more sanguine view of the problem emerges, along with a few surprises.
The book is comprised of 15 chapters written by over twenty leading physician-scientists who offer a number of penetrating insights into the crux of the problem of regenerating a new cadre of leaders in academic medicine. For example, as noted in the book by Tim Ley, a former president of the American Society of Clinical Investigation, the demographics of physician-scientists have been relatively stable since 1990. The bulk of these researchers hold an MD degree alone, and their success rates for NIH funding are similar to others with PhD or MD-PhD joint degrees. A surprising trend of combined MD-PhD trainees moving away from scientific careers is also evident in survey analyses. Interestingly, a case can be made to enhance our focus on designing strategies for renewing the population of physician-scientists. Also, as noted by Ley, the pool of physician-scientists is still overwhelmingly male, despite the near equal number of females in medical school today, indicating a need to address gender-specific issues.
'Translational medicine' has become the mantra for every medical school dean in the US and elsewhere, and, as presented by Barry Coller, the physician-in-chief of Rockefeller University, in his chapter, regenerating the pool of physician-scientists is clearly central to this goal. Increasingly, scientific centers of excellence are forging close networks with leading medical institutions, creating an interactive, nurturing microenvironment for physician-scientists. In this new era, in which humans themselves are models for human disease, technological barriers are rapidly breaking down, as higher-throughput human genotyping, whole exome or genome sequencing and high-content chemical screening on human stem cell model systems are becoming customary. The major discoveries in genomics research coming out of the Broad Institute at the Massachusetts Institute of Technology, in close collaboration with physicians at Massachusetts General Hospital and elsewhere, come to mind. Finding the extreme and rare clinical phenotypes of major interest, and having the capability of calling back the patient for additional information, will be increasingly important going forward. However, as Coller clearly documents, academia must recalibrate how young physicians are recognized, protected and promoted as essential components of these large interdisciplinary teams.
The crucial role of the environmental academic niche for physician-scientists, and the need for its substantial modification, is a major point of discussion in many chapters. In terms of mentoring, the needs for earlier exposure to research in the core medical curriculum, as well as in post-graduate MD training, the inclusion of off-site mentors and exposure to successful physician-scientists that have managed to balance the scientific and medical demands of their profession with personal family goals are mentioned throughout the book. The need for the institution itself to create a more nurturing infrastructure is also highlighted.
Finally, as noted by the preeminent physician-scientist David Nathan, the former president of the Dana-Farber Cancer Institute and also the physician-in-chief of Children's Hospital in Boston, there has never been a more exciting time to be a physician-scientist. “They must not and will not vanish,” he writes. “Indeed, their future can be as bright as ever if we proactively fashion it with creativity, foresight, and vision.” This future is clearly being empowered by annotated digital medical records, expanding databases on genotype-phenotype disease correlations from global collaborations, and research centers and networks funded by major philanthropic organizations and individuals. Likewise, the ability to study human disease in a dish, offered by recent advances in human stem cell biology, are extraordinary, offering the possibility of studying extremely rare and highly differentiated human cells from people with specific, rare and/or common diseases. Clearly, a resurgence in human physiology is on the horizon, and this need alone is likely to lead to a new breed of physician-scientists. The future of biology might be summed up in three words: human, human and human. Stethoscope, anyone?
You can buy this book from Amazon here.
May 05, 2010
Fever Series (1st Challenge): 'A neck lump, high temp and loose pants' What's the diagnosis?
US Hospital Rankings
USNews:
http://health.usnews.com/best-hospitals
Here is also Thompson Reuters' rankings which is divided into teaching/community hospitals:
Thompson Reuters Top National Hospitals:
http://www.100tophospitals.com/top-national-hospitals/
Neurosurgeons Go Paperless at Annual Meeting With iPod Touch in Their Pockets
Daniel M. Keller, PhD
May 3, 2010 (Philadelphia, Pennsylvania) — Using the iPod Touch isn't brain surgery, but when 1 neurosurgeon saw what his young daughter could do with it, he got a brainstorm. The American Association of Neurological Surgeons (AANS) was looking for something more to offer its members at its annual meeting than the same old shoulder bag filled with weighty program and abstract books.
Michael Oh, MD, associate professor of neurosurgery at Drexel University, Philadelphia, Pennsylvania, and West Virginia University, Morgantown, said his daughter "zooms around [the iPod Touch], and she has access to so much information that it would be a perfect thing to have at a medical meeting." He proposed the idea to AANS president Troy Tippett, MD, who wanted to find a way to make the association's annual meeting more creative in a way that would offer more benefits to members. Dr. Oh then became the chair of the AANS iPod Touch Taskforce Committee.
"The whole purpose of those meetings is to transmit and communicate new information," Dr. Oh said. The idea of adopting the iPod Touch was to make the 2010 scientific meeting "more in your pocket and always available and on demand."
So at this year's AANS annual meeting, held May 1-5 in Philadelphia, attendees are all given an iPod Touch loaded with an AANS application, abstracts, the meeting program, podcasts, videocasts, electronic versions of posters, and clinical guidelines.
They will also be able to instant message their colleagues via Wi-Fi, participate in interactive audience polling during courses and scientific sessions, schedule which sessions to attend, and see maps to find rooms in the convention center and vendor booths on the exhibit floor. If a room number or presentation time changes, their schedules will be automatically updated via dynamic links. They can see a city guide and even make restaurant reservations through the Open Table online service.
This year, the more than 400 posters appear only in electronic form as an abstract and slides, and there are no actual poster sessions. Attendees can search for posters by author name or keyword. If a viewer wants to talk with an author he or she can send an instant message with a question or arrange a time to meet. In the future, Dr. Oh said, viewers may be able to leave comments about each poster.
Getting Up to Speed
Communications director Betsy van Die said AANS has ordered 3500 iPod Touches to be given to all paying attendees. Because the use of this technology is new to them, the AANS has done a year-long program of education through biweekly newsletters and online tutorials. In addition, “marshals” wearing distinctive armbands will be available at the conference to help any attendees with their devices.
Dr. Oh said that once the AANS started planning uses for the iPod Touch devices, "We realized it wasn't just going to be for the meeting. It will probably transform how our membership really communicates with each other and with the organization.
"It offers...new ways to look at information, transmit information, communicate with our peers...[and] be that sort of common device that transforms our membership into a community. I think that's the long-term exciting part of this project." He expects people to bring their iPod Touches to next year's meeting to have them loaded with new content.
The AANS has budgeted for a 3-year program of using the iPod Touch devices. "Even in a down economic year, we were able to meet and exceed our budget for sponsors," Dr. Oh said, "so we're very pleased with that. I think that it helped that we had something new and novel to offer sponsors."
The cost of the devices is offset by an additional $100 being added to the registration fee. Gone are the old "door drops" of promotional materials from exhibitors. Instead, the AANS has offered exhibitors several forms of advertising on the iPod Touch, ranging in cost from $1000 to $10,000, plus the cost of product give-aways or services (eg, video production for videocasts).
Opportunities include blast emails, splash ads, banner ads, exhibitor Website listings, podcasts, videocasts, iPod Touch cases, AC chargers, iTunes cards, and individual custom applications. Ms van Die said 40 company-sponsored email blasts are scheduled for the meeting.
"Some of them have action items in them, like 'Come to our booth for a raffle drawing.' So there's been a huge amount of enthusiasm from the sponsors on this, and they're very excited that it's more interactive," Ms van Die explained. She said many other medical societies are interested in using the iPod Touch at their meetings, and they have contacted the AANS to see how it has implemented the technology and are waiting to see the outcome.
Dr. Oh and Ms van Die have disclosed no relevant financial relationships.
American Association of Neurological Surgeons (AANS) 2010 Annual Meeting.
May 03, 2010
A Brilliant Meeting for Medical Students with Passion and Interest in Science
The joint meeting of the American Association of Physicians and American Society of Clinical Investigators (AAP-ASCI) synchronized and coordinated by by the American Physician Scientist Association (APSA) takes place in the beautiful city of Chicago every year. I have been lucky to attend this year’s meeting despite extensive disruption of airline services due to the ‘volcanic ash’!!
If you are a medical student interested in research, this meeting should be one of the items in your to-do list! The AAP-ASCI-APSA meeting provides exceptional opportunity for medical students undertaking research or considering a science career in medicine. You get to meet up with first-class physician scientists and important policy makers in medical science.
The meeting started with a keynote lecture by Professor E. Albert Reece (pictured), Dean of the University of Maryland Medical School. His research team is trying to figure out the mechanism of birth defects in fetuses born to mothers with type 2 diabetes mellitus. While summarizing unpublished data, he emphasized the advantage of being a physician scientist whereby the problem is identified in the clinic and taken to the laboratory for thorough investigation.
The Noble Laureate in Medicine and Physiology, professor Joseph Goldstein (pictured) from UT Southwestern Medical Centre inspired the audience as he explained the ingredients of being a good physician scientist. In order to get his message across, he used quotes from noble laureates and other notable scientists. For example, one of the interesting quotes were for Sir Peter Medawar (pictured); ‘the intensity of a conviction that a hypothesis is true has no bearing over whether it is true or not.’
Joseph Goldstein
Professor Goldstein also emphasized the following for those about to embark on science research;
1/ Have focused research strategy
2/ Don’t become wedded to a technical gimmick
3/ Don’t confirm a finding that no longer needs reconfirmation
Sir Peter Medawar
Following the publication of recent figures reflecting inequalities between male and female doctors in respect to a number of features including income and professorship positions, the meeting invited a panel of speakers to address the roots of this happening and how to change it. Deans of New York and Johns Hopkins were among the audience and contributed to the discussion in different ways.
Day 1 ended with a number of science talks on areas of cancer biology, mechanism of vascular disease, neurodegeneration and cell biology. Conference delegates were invited for dinner followed by drink receptions with live Jazz music at the Jay Pritzker stage in Chicago’s lively Millennium park.
Jay Prtizker
The Highlight of Day 2 was a speech given by the director of the National Institute of Health (NIH), Francis Collins (pictured) who was nominated by President Barack Obama in July 2009. Professor Collins supervised the Human Genome Project. If you don’t know him, I recommend Google; otherwise you might be able to see few clips of him playing guitar on Youtube !! He described four opportunities for the NIH to contribute to research in the US and worldwide;
1/ Using high throughput technologies to understand basic biology and uncover causes of diseases
2/ Translating basic science discoveries into better treatments
3/ Putting science to work for the benefit of health care
4/ Encouraging a greater focus on global health
Professor Collins PPP slides are available through the following link;
http://www.nih.gov/about/director/04242010presentation_aapasci.pdf
Francis Colllins with President Obama during a visit to the NIH
During dinner, He reflected on his experience as an MD/PhD student facing a high degree of uncertainty and feeling challenged in a lab that no one spokes English very well to offer some help !! Nonetheless, it was one of Winston Churchill’s quotes hanging on the lab wall that kept his enthusiasm going despite negative results and technical difficulty – ‘’ Success is made by moving from failure to failure to failure’’!!! Keeping this in mind, together with a motivating mentor, Collins research made it to shores with a discovery of genetic locus responsible for sickle cell anaemia. Reflection does not stop at this point for Collins as he pulls out his guitar (with a symbol of the DNA helix imprinted on it) and starts singing with talent !
Later talks focused on how a study of worm biology can yield a therapeutic potential in worms, the mechanism of degenerative disease in muscle disorders and genetic strategies to modify disease pathophysiology.
We were broken into three seminars of ‘how to write a grant’, ‘residency planning’ and ‘the transition from being a medic into a scientist’. I attended the later meeting attended by MD/PhD directors of Rochester University and Stanford University. Directors spoke of perseverance as a quality to cultivate in the beginning of one’s academic career. ‘Two important points you need to remember; select a suitable lab and have perseverance’’, one of the speakers said. Choosing a lab depends on the personality of the student and their supervisors – other important points are whether you prefer working in a lab where you prefer to be left alone to do your own experiments and present whenever you have data, or else a lab where you get monitored constantly and shown what to do. Selecting the appropriate supervisor should be an informed decision of the student following a meeting with the supervisor and exploration of what other students thought of the lab.
Exchange of research ideas and critical feedback of one’s own work take place mostly in the poster session. I have been lucky to have breakfast with Dr Germino, Deputy Director of the National Institute of Diabetes and Digestive and Kidney Diseases. He came afterwards to look at my poster and provided very helpful feedback. It got more exciting when I had another prolific discussion with Prof Marcus, a distinguished scientist from Cornell University. The beauty of the meeting is that you get a chance to meet up with successful and bright physician scientists.
The last day of the conference was highlighted by talks from important physician scientists such as John Niederhuber, Director of the National Cancer Institute, and a noble laureate Ferid Murad, the director of the institute of molecular medicine at the University of Texas. In addition, I had opportunity to listen to elegant presentation of interesting science on stem cell research.
The meeting ended with a lunch with residency directors and directors of MD/PhD programmes across the US.
Even though I travelled by myself to the meeting, I felt very welcomed and accommodated by APSA members including very respectable and approachable MD/PhD colleagues. This made my stay in Chicago even more exciting !!
In short, the meeting is highly enjoyable, very educational, mind broadening and full of opportunities for collaboration and exchange of thoughts, scientific criticism and feedback, but most importantly a great way to make friends !!
So you better watch out for the next AAP-ASCI-APSA meeting ; http://meeting.physicianscientists.org/
