Joseph F. Clark, Ph.D.

So book two, How I survived my graduate education is done. I’m trying to find a publisher but that means my next project is bubbling up in the queue. Yeah I know, there is never a dull or quiet moment and I do not want there to be. Having nothing to do equals rest and does not last long. So I’m thinking through what my next project should be. I could write about my postdoc in Europe. Writing about 1.5 years in Paris France and several years in Oxford England make for a good story, but I also yearn for something different.

I was actually thinking about a cookbook. What about the concept of “The cheap bachelors cookbook” as a working title and concept cookbook? I’m a 48 year old bachelor who likes to cook but I retain a lot of my frugal ways from grad school. When it comes to cooking; I’m down right cheap. I cook in bulk and freeze stuff to be re-heated later. Nothing goes to waste until it is growing moldy fuzzy stuff that reminds me of some of my more successful lab experiments.

The hook for this book is that it is not just a bunch of recipes, but I will be talking to the bachelor as one lazy, cheap dude to another. Maybe I should change “lazy” to “time constrained” dude. So for example, if I am talking about making a dip I’ll use analogies like the consistency of spackling compound as a frame of reference. Also, I am a huge fan of cast iron cookware and will recommend that to bachelors. Why is cast iron so appropriate to bachelors you ask, well it is because you really aren’t supposed to WASH it. What is more perfect than that for us disgusting non-neat freak bachelors than a pan that you can just wipe out and call clean.

There are a few bachelor cookbooks out there, but I think a useful and slightly humorous book will be well received. The cookbooks that are out there for bachelors are geared towards entertainment. There is a cartoon cookbook, rhyming verse cookbook giving the feel of a bumbling buffoon. Mine will be useful and based on solid cooking principles. This will include how to plan a dinner, how to best utilize and preserve leftovers and preparing and eating well balanced meals at a reasonable price. I will also list the simple equipment and appliances needed for an effective bachelor kitchen.

I can see it now every college bachelor living alone or with friends will use this book to keep them nourished and cost effective. Moms sending sons of to college will want to purchase this book until they read the part about cast iron not being washed.

I was in a meeting recently talking about ways to justify and validate my research. My research is concerning the causes, diagnosis and treatment of neurologic disorders such as stroke and traumatic brain injury. While I think that is important and that the government and people should be throwing money at me to do this critical work, the bean counters need me to justify what I do. We all need to justify our existence. So I explained to them that my research will save lots of lives. Stroke, I went on, is the third leading cause of death in the USA and leading cause of disability. Unimpressed the bean counters need dollars saved as a frame of reference to understand the benefit of my research.

Eventually the conversation and meeting ended with me writing a simple question in my notebook; “What is the Cost of Death?” and the meeting concluded. Medical research and technology development, I am well aware, turns on the dollar. I have calculated the costs of hospital stays and rehabilitation, and I have regularly quoted statistics on the numbers of lives lost and impacted concerning my research. I was not however, ready to answer a question on how much a human life is worth.

Because it is becoming necessary for me to take such questions seriously I have subsequently found out that there are well established metrics for determining the cost of death.
The simple formula is to estimate how much the person would make over their life. The medical community has “borrowed” the formulae used by lawyers, a discussion of which can be found here; http://accident-law.freeadvice.com/wrongful_death/wrongful-death-suit.htm.

A life’s value is based on our ability to earn money. So my mother who is retired and has no earning potential would have no value to her life. Is this the state of technology development and medical research in our society?

Is this where I should say, “That is just sad?” or should we be mad? If that type of rationale and calculation continues it would mean that all medical research geared to aiding institutionalized individuals, paraplegics, mentally retarded citizens and all retirees will need to be discontinued because there is no clear financial benefit from saving the lives of those people.

I for one will continue to do research to save lives as opposed to save money. There needs to a component of humanity from us humans.

I use a notebook computer as my computer at home. It sits on my lap on a little lap desk that I made out of oak and it has a leather covered cushion for comfort. I made it wide enough to hold my computer and a wireless mouse. When I travel my computer comes with me, but I generally leave the mouse at home. Recently I went traveling and came back after the trip to find that my mouse was gone. I looked for it all over the place. You know that search that ends up practically cleaning house because you’re moving things around and rearranging as you go? Well it was like that. Eventually I convinced myself that I must have accidentally packed the mouse and lost it on the trip. I broke down and spent the $25.00 to buy a new one.

The next time I went on a trip I dutifully packed my computer and resolved to put my brand new mouse somewhere safe where I would not lose it. Next to the chair I use for work is a small dresser with 3 drawers in it (one big and 2 small). The big drawer is where I have some papers and stationery for work. The little ones have pens and a little flashlight, mostly junk really, but an adequate size to put the mouse.

I pulled open one of the small drawers and much to my surprise was my “lost” mouse. I had put it there for safe keeping. The funny thing is I was not happy, I was kind of mad at myself for not thinking through the problem of where I put the mouse in the first place. I was thinking where would the mouse be, not where would I put it when I was about to go on a trip. When my brain was back in the going on a trip frame of ‘mind’ that little drawer was the logical place to put the mouse – again.

The concept of “state dependent learning” is well established and this story is somewhat like that because I was in the state of preparing for a trip, I repeated the same behavior again.  As a professor of neurology and an educator what that says to me is that our brains live and work in an environment and it can do that work best when the environment is kept constant, consistent and healthy. When learning and studying new and complicated material, every college student needs plenty of sleep, a healthy diet and a routine including exercise and study. Learning and comprehension is improved when the brain has the right ‘environment’ to learn and return that memory. You are spending a lot of time and money as a college student, to get the best value for your money, retain that information by giving your brain the best chance of keeping that information in your head.

Short Sighted Stroke Studies.

Excuse the alliteration in the title but it sums up my sentiments. I recently attended the American Heart Associations’ International Conference on Stroke and am sadly disappointed. The reason is because it seems that everything is geared to very short term immediate returns and little investment in the future.

Please note, I have the greatest respect for the American Heart Association, this post is not about them, but scientists in the stroke field.

Let me explain. I have been attending scientific conferences since the 1980s and over the years attended a lot of conferences in the heart, cardiovascular and cerebral vascular fields. With my personal and professional development I am now able to attend these conferences and see the trends that are cutting edge and will be the technology of the next ten years. This is important because medical research is a pipeline of new research technologies funneling into clinical trials all designed to eventually benefit patients. The reality is that for a discovery in a scientific lab to be a benefit to patients it takes 10 years.

Most of the time when I have been at conferences like the cardiology conferences I could see the drugs and technologies that were coming down the pipeline. At the stroke meeting either I missed the future technologies or they are not there. I admit I did not go to every session in the meeting, it is impossible to be in 4 talks at one time. So maybe I missed the hot topic that will save patients in ten years. But as far as I’m concerned all the new stroke research will be used up on 3 years. In my opinion this is because there is no new/innovative stroke research being done right now. Currently, clinical studies are borrowing drugs and technologies from other disciplines like the heart attack research. Did you ever wonder about the American Heart Association sponsoring the Stroke Conference? Stroke is like Cinderella but we still have yet to get to the ball. Moreover, the brain and heart are not interchangeable and this will cause problems.

Four or five years ago the National Institutes of Health’s Stroke Institute, NINDS, gave a presentation at the stroke meeting on how a series of initiatives would help channel pipeline technologies from discovery, to early clinical research to big clinical trials. This would be done in three steps and funded by the government without the biases that might occur from corporate sponsorship. Well guess what, that initiative was cancelled in 2008 and not supported by the stimulus package (ARRA) in 2009. Part of the initiative was started and that was the two clinical steps, but what was cancelled was the early drug and technology discovery step. What that means is the federal government is not supporting a pipeline of technologies for treating stroke patients. Discovery oriented scientists see this and are drifting away taking with them the future of stroke research.

That is just sad.

Note if you have not noticed, “that is just sad” is a mini mantra that I have been using for a segue to solving the problem being discussed. I’ll continue using it because my hope is that it will be a familiar platform in my blog.

In my opinion the solution is actually contrary to some things I have said before. Several of my proposed solutions have expressly not employed throwing money at a problem. But this is one case where money talks and money is the only language that will be heard. If the government and industry do not invest now into developing new diagnostics, new drugs, new scientists in the most fundamental research into stroke, we will have no medical future in stroke. Not only is more money needed for more research but a lot more money is needed because so much funding has been taken away recently. The poor showing at the “stroke” meeting reflects the poor future for stroke research. Some day very soon you or your loved one may have a stroke and be treated by someone who was trained in cardiology and or using heart drugs. That makes no sense because the heart and brain are not the same. Even the arteries in the heart and brain are drastically different. Stroke research, like Cinderella, needs to be invited to the ball.

I have a cat who is borderline diabetic. So, I do a blood glucose on her every other day. I use one of the off the shelf glucose meters and give her insulin adjusting the dose depending upon her levels. One day her little ear prick produced a large drop of blood and on the same drop of blood I got three tests and three completely different readings of 127, 144 and 181. Now if I have a large drop of blood on her I try to get multiple glucoses on her. Subsequently I have obtained results from a single drop of blood two readings of 134 and 168. For the science geeks out there 100 is normal and the units are mg/dl which is equal to about 4 mM.

Part of my work is concerning bedside diagnostic devices in medicine; called point of care, and we regularly work with similar device concepts as the glucose meter. I have seen companies and experts in the filed talk about error and failure rates on these devices of 15 to 20 percent. So if on the 3 sample day the true value was 150 the differences would still be in that plus or minus 20 percent range. But is that what we should tolerate? I make insulin dosing decisions based on those answers. Part of me thought it was interesting to see how those errors look from the other side of the point of care fence but another part of me was extremely frustrated because I’m not sure I can trust the results to make dosing decisions.

I feel anxious as to how to best care for my cat. I’ve seen what happens when she gets overdosed on insulin (accidentally and it knots my stomach just thinking about those two horrible days) so I really need to trust the glucose results before giving her insulin. Believe me the glucose meter I purchased is sold to humans with diabetes who need to make those same insulin dosing decisions. When they overdose on the insulin it is their brain who gets starved of glucose and they can suffer greatly. So, why are we putting up with a lack of precision in these devices of 20%? Moreover, do patients and caregivers who make insulin dosing decisions realize how much error there is behind those numbers? Should we all do 3 tests and hope the average is closer to correct?

To tell you the truth, I do not know the answers to any of those questions. But I can tell you that in my research we are trying very hard to minimize the error and maximize the precision and accuracy of what we are developing. I do not want to be the cause of some physicians’ or care givers’ angst when trying to make treatment decisions based on the diagnostic products and answers my research yields. I learned part of the importance of my research by testing my cat’s glucose. My little insulin dependent kitty is named Clawdia, she is 17 years old and this teenager has taught me an important lesson. Thanks Clawdia.

It is Thursday morning and I’m sitting in the doctor’s exam room waiting to see my physician. The appointment was for 9:00 AM; scheduled one year ago. I called this morning to confirm and they said the doctor does not come in at all on Thursdays and claim my appointment was cancelled in December. I ask to reschedule and eventually get to talk to someone in scheduling. I’m rescheduled for TODAY at 11:30 AM – for a doctor that does not come in at all on Thursdays. I said, okay with the caveat that I had a 12:30 PM meeting. The scheduler on the phone acknowledged this and confirmed the appointment.

I show up a few minutes early and sign in to be told that the doctor is running late. Further, the woman at the desk is puzzled. She cannot find my appointment. After consulting with a colleague she proclaims that she could not find my appointment record because I was scheduled today. Well, sort of because I was scheduled for today one year ago, allegedly cancelled in December with no new date given, I called this morning to verify and rescheduled today to be seen today. Oh yeah, I’m seeing a doctor who does not come in on Thursdays but is running late on her patients scheduled today.

Let me provide some additional history. The reason I called to verify my appointment is because last year I showed up on a Thursday for an appointment to be told I was rescheduled the November before and that the doctor no longer sees patients on Thursdays. I rescheduled for a Monday about six weeks later because her calendar was so full and the person who allegedly called me in November to cancel and reschedule failed to note my new appointment. To state the obvious; no one called me in November two years ago and no one called me this last December. Yes, I learned a lesson and am trying to be proactive about my health care by calling to confirm my appointments.

For anyone who does not know, I’m a Professor of Neurology doing research into stroke. I do not see patients, but my office is in the same building as my physician’s office. I’ve chatted with her at faculty conferences and could call or email her directly as a fellow faculty member. But I do not use those opportunities to communicate with her as my physician because I think that would be unfair to her and all the other patients she has. However, when I was informed the doctor was running late, I reminded them that I had told the scheduler of my 12:30 PM appointment. The nurses had no notes to this effect and I said I would wait until 12:30 PM, but would need to leave at that time. Frustrated, they said they would inform the doctor of my timing issues.

The real lesson here is that every patient needs to take charge of their own health care. Also the system is highly flawed so if you are not pro-active you will be lost and that could be bad for your health. I’ll be coming back next year because I like and trust my doctor. That professional bond is important but the support people (nurses, schedulers and administrators) need to make sure physicians and patients are able to get together regularly and efficiently. I got the face time I needed with her and am pleased with the care I eventually got today without needing to be rescheduled two months later. Let’s hope the new appointment is not on a Thursday because we all know she does not see patients on Thursdays.

The answer to the question posed in the title of this blog is; write a blog about how the system is broken.

I’m not asking you to read my blog, but please continue. I wanted to share an excellent story from another blogger who hit the EMS Emotions on the head. I tried to do this when writing My Ambulance Education and this is a great example of the reality of real life the EMS folks experience. Warning, you may not want to read about the sadness, but if you can, it will be an “education.”
http://lifeunderthelights.com/2010/02/splashed-sadness-%E2%80%93-a-look-at-negative-emotions-in-ems/

I write and submit about eight grant applications per year to get the funding in need to keep the lab running. Ten years ago I could get two grants per year or about 25% of my grant applications would be funded. Now however, I am lucky to get one grant every two years. So my success rate is now 1 out of 16 submissions being funded. That fall in my batting average is a reflection of the economy and state of research in the USA. What is bizarre however is that with fewer grants I am still expected to publish papers. Annually I publish about 6 papers a year and that number remains the same despite a 75% fall in grants received.

I am forced to increase the number of papers per study to maintain status quos. The way I do that is I now write and publish more papers using smaller data sets. Smaller data sets mean the papers are often incomplete pictures of the story being told. Now, it takes several papers to tell the story. I also write multiple review articles to increase my output. This is the infamous publish or perish doctrine of academia. Review articles generally do not have new data in them but summarize the data from 3 to 5 of my previous papers. I now write one review per 3 papers when previously it was more like one review per 5 research articles.

The overall impact on the state of grant funding has resulted in a decrease in the quality and content of the papers I am publishing. Because administrators only count the papers produced a backlash is at risk of occurring because they seem to be implying that if I can maintain 6 papers per grant I should therefore be able to double the papers if I double my grant funding. This is assuming that I survive the down turn and get back to having 1 in 4 grants funded. However, I’m hoping to return to the quality of the science reported should funding normalize again. Please understand the quality of the science is not changed, it is how thin the science is per paper published that has occurred by squeezing out more with less.

The real victim of this degradation of paper quality is that my students are beginning to think that writing and publishing small simple papers is an acceptable way to convey scientific information. They learn by example and the example I am setting is not the one I would normally want to convey to them. I’ve been in discussions with colleagues while students are present and we take a solid scientific series of data and break it up into little parts to publish two papers, when one substantial paper would contain a more complete message. This makes intuitive sense to students who have been educated in the E-generation where tweets and texts tell all that is needed in 140 character soundbites. So the micro paper publication is here to stay and with it goes a generation of scientists, like myself, who were taught to tell a complete story. Now we will be getting data soundbites and are losing the ability to synthesize data into a cohesive message.

The death of the scientific story teller is just sad.

I have been looking for a good, portable food for camping and disaster kits recently. I’m well aware of the US military’s famous MRE’s. I’ve tried them and they are marginally palatable, last for years and are easy to carry while camping or storing for an emergency. My problem with them is that they are so heavily processed that I’m concerned with them as a nutrition source for more than one meal on any given trek. Hence my search for a tasty, healthy food item that could cover both camping and disaster contingencies.

I was doing some soft searches on the internet and came across Pemmican. Pemmican is a truly North American food used and discovered by Native Americans. It was used as a winter food source of meat that could be stored without refrigeration or excessive salt. I read multiple articles on pemmican and discovered that Europeans had largely ignored it as a source of nutrition for travelers. Except that is, for Arctic and Antarctic explorers, such as Robert Falcon Scott and Roald Amundsen who used it as a source of calories, with 16 oz per day supplying all the nutrition needed a hardworking explorer. While I’ve come across many variants for making pemmican it can best be described as 60% dried beef (jerky) and 40% tallow. Commercial jerky is too salty so I use home made with 1/4 to 1/5th the seasoning called for in the recipe and make sure the beef is dry and brittle. Some recipes call for no salt or seasoning, but I like having some seasoning.

The recipe for the aforementioned pemmican is simple. Pulverize dried meat into a coarse powder and add warm (<60C) tallow and mix well. The meat needs to be very dry. A way to check dryness is if you have a strip of dried meat, it should break when you bend it. You do not need to homogenize the mixture in a blender, it just needs to be well mixed. Spread on a cookie sheet about ½ inch thick and chill. Cut into bars and bring on your next expedition with confidence it will satisfy on the trail. The taste and texture reminds me of pepperoni. Some factoids I’ve learned about pemmican: There are a lot of stories explaining that the meat needs to be as dry as possible and not salted at all to taste good and preserve well. Definately keep the Pemmican dry. The tallow can be rendered suet or lard, but rendering the fat source is important. Also whatever fat source you use it should be a solid at room temperature. Using a liquid fat source like cooking oil would change the consistency of the Pemmican. Also adding dried fruit and dried flavorings and spices such as cinnamon or pepper can help mix up the flavors.

When I’ve made it my best results have been with beef and rendered beef suet. I have the dry meat shredded and ready to go when the tallow is done. Once the tallow is cool enough to handle I mix with the meat. Some reading on pemmican can be found at http://www.natureskills.com/pemmican_recipe.html.

After learning about and feeling productive by making several batches of Pemmican in preparation for my next camping trip I got a bit cocky and adventurous and decided to try to make something sweet that would compliment pepperoni-esque Pemmican. I did not want a dessert, but something like a peanut butter and jelly sandwich. So I played around with some simple ingredients that I had in the kitchen.

Believe me when I say I made multiple versions of what I am calling my peanut butter and jelly bars; but I came up with something that tastes great and nutritionally is compatible with the Pemmican bars and will also keep for extended periods. I am still trying to see how long they will last as a disaster food, but they will be a great source of nutrition and energy on the trail.

All I use is;
1 part peanut butter,
1 part dried unflavored breadcrumbs, and
2 parts raisons.

Blend the dry ingredients until they are a coarse meal consistency. Then add the peanut butter and blend until it rolls like a light dough. Caution if you have a blender with < 500 Watts of power you may wish to use a meat grinder or food processor. This mixture can overload a weaker blender – I fried one of my blenders. Layer the “dough” on a baking sheet like the Pemmican and chill; once chilled cut into bars.

I have noticed that some peanut butters seem to be excessively oily for the recipe. So if the bars feel tacky, I roll the freshly cut bars in a 1 to 1 mixture of breadcrumbs and cinnamon. This makes them easier to handle and adds a pleasant flavor. With the nutritional value of the peanut butter bars partnered with the Pemmican, it is a nice balance to meals on the trail and I will be letting some bars age to see how they keep.

Post script. I really want to emphasize a few things about the concept of eating an energy bar that is 40% fat. While many people have much too much fat in their diet, if you are hiking you want to carry as little weight as possible and get maximum energy from what you can fit in your bag. Also, if you are on an extended trek a lack of fat in the diet can lead to protein toxicity; sometimes called rabbit starvation. I am not advocating this as a permanent diet at all. However, it will be on the trail for me the next time I’m in the mountains of Kentucky.

I fully believe that the science suggesting that humans are killing the earth’s environment is right on. Even if all humanity suddenly started behaving in ways to protect the environment it would be many generations before real benefits would be seen. Some things, however, are changing. The water purity of many of the US’s lakes and rivers are substantially better than they were in the 1960s.

I also fully support the education of the masses to try to behave in a cogent and environmentally conscious way. But please let me emphasize the cogent part. There are several examples where some ill informed planner comes up will an unvalidated ‘green’ plan that completely backfires. Let me give a couple of examples, there is fantastic evidence that grass and green lawns are not a benefit to the environment. They often require fertilizer and mechanical maintenance to maintain that has a huge boost to their carbon footprint. Low maintenance trees or a rock garden is often better than a bright green, nicely trimmed lawn.

The so called green buildings where the lights and heat goes on and off based on the presence of people. That is a nightmare because I can supply the reader with numerous examples of times where the temperature in such buildings have produced frost on winders leading to cracking and structural failure. Also, where workers are at work stations and suddenly lights go out, sometimes disturbing power to computers and work is lost or heat goes off so frequently staff bring in portable heaters. Such heaters are fire hazard and have caused fires. So where is the green benefit?

Most workers that I know prefer to not work in a signature green building because it has been designed for form and press releases, and not function. Thus I can assure you there are green buildings where space and services need to be duplicated in functional space. Thus the green benefit is not only gone, but it is worse because traditional resources need to be duplicated. The administrators say the building is a success because it costs so little to run. Yes, if you have a big building with no one working in it, that is a cheap building to maintain. It may never wear out because there is no one producing ware.

Our government at the city, state and federal government has one method for tackling a problem. That is throw money at a problem and brag about all the money spent and or saved.

That is just sad.

What is needed is to throw smart people at a problem and to use resources smart and effectively. It has been less than one year since the big stimulus package has been launched and hundreds of billions of dollars has been documented as wasted. It will be touted as a success however, no matter what the real result because some of that huge pot of money will do some good. A 6 million dollar bonus to a bank executive will help that exec, but that same amount of money might also go to someone doing research to treat a disease that causes mental retardation and cure thousands of people. Why politicians with law degrees from Harvard cannot seem to see which choice for those millions are the smarter choices is beyond me. But history will always tell how the problem was solved by whoever was lucky enough to be in office when the job is done.