Joseph F. Clark, Ph.D.

As a college student Joe Clark worked on the ambulance in New York City on nights and weekends to pay for his college and graduate school education. My Ambulance Education is Joe’s stories of patient encounters, relationships, and events on the streets that shaped him as a person and guided his career choice to become a medical researcher of the causes and treatments for stroke. About the Book As an EMT in New York City Joe saw it all. He organized the book into thematic chapters around themes like drugs, drunks, suicide, birth, and death. Each chapter is a combination of his parallel worlds – patient calls and college studies. The book is a chronology of his time on the ambulance and Joe shares his thought process of first striving to become a paramedic, then becoming a pre-med student, and then deciding to become a medical researcher. He writes: “I realized a successful physician could treat only one patient at a time … I wanted to do more. I wanted to help people, but a lot of people.” This realization led Joe to pursue a career in neurology and become a leading researcher in the causes and treatments of stroke. Listen to Joe talk more about the book and his research as a guest on the Medical Author Chat podcast. The writing in My Ambulance Education is excellent. The details are vivid and as a reader I could feel his stress and increasing burnout. By writing My Ambulance Education Joe brings the challenges and rewards to a lot of people. EMS professionals toil in relative anonymity. Joe brings the world of EMS to a general audience that is captivating and respectful. Still Involved with EMS Joe’s research keeps him connected with EMS professionals and educators. Joe was a panel member for the EMSEduCast Journal Club , has been a guest on the EMS Garage Podcast , and is presenting the EMS Boot Camp session: A Google Search is Not Research . Premium attendees of this EMS Boot Camp session will receive a signed copy of My Ambulance Education direct from Joe

Check these out

EMSbootcamp

ems garage podcast

The above review is copied without permission from the following site:

http://www.vitaminshealth.net/paramedics/book-review-my-ambulance-education-by-joseph-clark.html

Okay, so I’m on a plane again and it is time to update my blog. I should be working on my next grant, but I need to do some mental calisthenics. Do people even use the word calisthenics anymore? Well, I used it so that is a start. Anyway, I am working on 4 grants simultaneously, writing reviews for 4 publications and reviewing the grants of others. That spells busy. All this is in my inbox and it is getting bigger every day. But the outbox does not grow as quickly as the inbox.

Why on earth did I schedule 4 grants at once you ask? Or, does that number not move you at all? Consider yourself fortunate if “grant” is not a dirty word. Grants are how a large amount of research, especially medical research, is done in the USA. A grant is awarded to researchers from the government, or state or a charity to try to find out something about a disease or medical condition. Without a grant there is no research. Without research there is no improvement in health care or progress in the quality of life.

That just teems wrong to me that people who spend their lives, like my life, working to help people need to go, hat in hand, to the federal government such that we can be allowed to make this country better. But that is the state of things. So, let’s get back to the grants I’m writing. A grant proposal is a work of fiction, in literary terms, because it talks about stuff that has not happened. The difference is that the grant’s author is promising to try to make it happen with the funds being requested.

I spend over 80% of my time writing new grants. Not thinking about how to make the medical advances I’ve promised, but taking a lot of time trying to keep the people in my lab pursuing those advances. It is a slow and painful process. Let me explain how slow:
It takes about 3 months of work to write one grant. The NIH takes about 6 months to review that grant and another 3 to decide if it is going to be funded. An overwhelming majority of grants are not funded. Ninety percent are not funded. So that means another 3 months to try to re-write the grant and the cycle repeats. So on average it takes two years of begging the powers that be to get funding to do any research work. Wow, is that ever a waste of time.

What is kind of funny is that the federal government reports to congress that it funds about 20% of the grants it receives because it counts the first try and the second try as one (research grants only get two strikes). So they double their batting average. The NIH seems to forget that it still takes me 3 months of work each time but they’ll say that 1 in 5 grants is funded so try 5 times to get a grant. Sorry, it is more like 10 times to get one grant. The federal government’s math on funding averages means that my time has no value on the first try. As I’ve said in my blog before, I submit 8 grants a year and hope to get one every 2 years. Last year I duly submitted more than 8 grants (10 I think) and got none. Let me put that in perspective, between myself, my staff and support personnel 10 grants corresponds to about 20 person months of work for no return. I might as well as had a job as a carpenter and demolition man where I demolished all that I built because there was nothing to show for it.

I’m due to get one grant this year, I hope, but really scrambling to get that additional grant. Without another grant very soon, less than two months, I will need to start shutting down parts of my research. That is a serious thing to consider. I’m not teaching students, I’m not writing papers, I’m not participating in other faculty duties, I’m trying to keep my research enterprise alive. This is a fight for survival and it irks me that the taking heads for the NIH report that 1 in 5 grants is funded when I’m approaching zero  for 14.

Just tell the truth NIH. You fund less than 1 in 10 grants, and the burden for paying for your unfunded mandate of grant writing is supported by individuals who lose creative time to work on power calculations to get maximum number of data per dollar. Yes, it is about dollars. How many dollars per datum drives part of this enterprise. Also, I am not supposed to be paid by grants to write other grants. So the university is supposed to pay me to write new grants. However, the university expects me to cover 90% of my salary by getting grant funding. Anyone notice a disconnect here? As I’ve said previously the feds have one set of rules and the locals have another and they often do not match. Let me spell out the mismatch. My federal grant funding pays for 90% of my salary and the university pays the other 10%. I spend a majority of my time writing grants for the federal government where I’m not supposed to bill the government for that time. My time should be spent working on drugs to save lives, but it is not. If you want to report me or the university go ahead. The party line that we all spout to the feds is that the grant writing is multipurpose for writing papers, writing reports, federal reporting and publishing educational articles used for teaching.

If you are reading this and are comfortable with the concept that we may all start dying from superbugs because there are no new medications to treat those diseases, than be happy, because you are getting your wish. If you want your children to have better medical care and technologies than you had, tell congress to support your local geek. Let me do my work to help people. After all helping people is the theme of my life as documented in My Ambulance Education and it continues to this day. All I want to do is save your life. Will you let me or am I destined to slog through the governmental paperwork that is grant writing forever?

I’m praying to the NIH Gods is the title of this blog for a big grant such that some of the pressure can be taken off me and I can get some research done as opposed to doing federal paperwork.

Empowered versus non-empowered administrators and managers. This is the incomplete blog that I was working on when I ended up hosting the guest blog a short time ago. Please recall that the discussion included the concept of administrators who sound empowered but are not. They are the biggest risk.

So I want to purchase an upgrade to my excel because the enhanced output is mandated by a federal agency. An administrator does not wish to approve the purchase and suggests I download a free office package that has this one program in it for their version of excel.

Lets skip the whole thing about the time it would take to learn a new office system, a new spread sheet and the upload itself. Plus it is not clear that the new system will produce what the feds require. Within the new system there are strict rules about terms of use and the “free” site terms have the following.

“b. Use at Your Own Risk. You understand that … [we] do not pre-screen Materials, and You agree to assume all risks in Using them. These risks include, but are not limited to, errors, viruses, worms, time-limited software that expires without notice , and the possibility that the Materials infringe or misappropriate the intellectual property rights of others. You agree to assume all such risks.”

My understanding is that I am not supposed put the system at risk of virus’ and cannot okay those terms. My organization has strict rules about taking on such responsibility and my computer is networked to a host of others, so my risk is passed on to those systems, which is not allowed. So if I did what the administrator told me, I would be in serious breach of policy. The person who would get in trouble is me.  Plus, I still do not have the software I need.

That is just sad.

My nephew wanted to visit me on his 18th birthday. Why an 18 year old wants to be with his 47 year old uncle on his birthday I do not know. Maybe it is because I promised to take him to Hooters for the spicy wings. I’m sure it was the wings.

So being the loving uncle I tried to play a practical joke on him. I asked my sister, his mother, if I could give him the zero alcohol beer on his birthday. I had planned on buying bottles and changing the labels to look real. I’d serve it open with frosted mugs so he would not see the bottle cap. She said no. She said it might give him a taste for beer.

So I contrived with him to tell her that I gave him beer. That way she would think that I might or might not have done the near beer joke. He said no. No one in my family has a sense of humor.

In the end, I took him to Hooters and had the waitresses sing to him and videoed it. Wait until he gets married, that video will come in handy.

Guest Blog: Empowered Versus Non-Empowered Administrators:
This is a guest blog hosted by Joseph F. Clark and written anonymously and redacted to protect the identity of the blogger and their employer. The blog is about a series of interactions between an academic researcher and her administration. Serendipitously, she enquired about how to do an anonymous blog concerning these events when I was formulating my own blog about empowered versus non-empowered administrators. For my blog I had come up with some ideas and wrote preliminary notes that echoed the sentiments expressed by Jane (not her real name). I quickly accepted her offer to host the blog with a request to insert some of my own messages. So below is a story written by Jane and some narration by myself. Because the blog is picked up by a couple of outlets and I’m not sure if different fonts will transfer to other systems, my blurbs are in CAPS from here on.

#+#+#+#+#

I met with administration regarding a small grant to be run. It was deemed to be not worth the time or effort and not given a go ahead. I pushed to get permission to do it and met with continued resistance. I received a verbal message from my boss who said he spoke with the administrator and agreed on the no go.

This all occurred about 3 or 4 years ago when the cash flow was better. I did not push this issue further.

FAST FORWARD TO THE CURRENT ECONOMIC CLIMATE WHEN CASH IS TIGHT, LAYOFFS HAVE OCCURRED AND THE AFORE MENTIONED ADMINISTRATOR IS PUSHING TO INCREASE REVENUE AND CUT COSTS.

Over the subsequent years I kept in touch with my contact person from the previous project concept as she went from job to job up the corporate ranks. Now we are trying to work on another project but a larger one. As with many savvy organizations they are seeking multiple ways to get the job done. In other words we are in competition with the group who did the work we turned down. At this moment our program is being considered but because we turned them down I have little hope of getting the contract.

NOW COMES THE IRONIC PART.

The same administrator who sabotaged the program last time is sending me emails offering all sorts of assistance to get this contract. I want to respond that the help was needed during the last try. That this type of contract goes to organizations with a good track record and we have none (NO TRACK RECORD) with them, thanks to this administrators no go decision 3 plus years ago.

THAT SMALL PROGRAM LOOKS PRETTY GO NOW DOESN’T IT? THIS IS EXACTLY WHAT I WANTED TO TALK ABOUT WHEN I STARTED MY BLOG. THIS ADMINISTRATOR ACTUALLY HAD NO POWER TO MAKE GO NO GO DECISIONS BUT APPARENTLY GOT TO THE BOSS AND “ADVISED” HIM TO NOT SUPPORT THE SMALL PROGRAM.

I CANNOT SAY ONE WAY OR THE OTHER IF THE ORIGINAL PROGRAM WOULD HAVE BEEN A MONEY MAKER, OR NOT. MAYBE IT WOULD HAVE BEEN A MONEY LOSER OR JUST A BREAK EVEN, BUT I LOOK AT THESE SEED CONTRACTS AS ANALOGOUS TO GOING TO A FARMERS MARKET WHERE THEY GIVE OUT TASTES OF THEIR GOODS. IF IT IS GOOD YOU GET A SALE. OUR WORK IS A SERVICE AND SOME ENTITIES WANT TO SAMPLE THE GOODS WITH A SMALL SAMPLE BEFORE TAKING THE PLUNGE WITH A BIG INVESTMENT. RELATIONSHIPS TAKE YEARS TO NURTURE AND TURNING DOWN A PROJECT IS ONE WAY TO TARNISH SUCH RELATIONSHIPS.

I COMMEND JANE ON TRYING TO KEEP THE RELATIONSHIP SHE HAD FOR THE SUBSEQUENT YEARS AND HOPE SHE GETS THE CONTRACT. THE ADMINISTRATOR SHE IS TALKING ABOUT NEEDS AN EDUCATION, IN MY OPINION, ABOUT BUILDING RELATIONSHIPS. I’D LIKE TO KNOW WHAT INFORMATION WAS PASSED TO JANE’S BOSS TO MAKE HIM SIDE WITH ADMIN VERSUS A PRODUCTIVE EMPLOYEE. THAT WE MAY NEVER KNOW. BUT, IT GOES TO THE HEART OF THE ISSUE, WHERE SOME ADMINISTRATORS WHO HAVE NO REAL POWER SHOULD REALIZE THAT THEIR JOB IS TO ACT AS LUBRICATION NOT A DOOR.

JANE, I FEEL YOUR PAIN.

My favorite entity is of course administrators. But every once in a while administration tries to work with the grunts in the work force. The following really happened; names were changed and details redacted to ensure my future employment.

Admin: You’ve not documented the frequency for performing this compliance task.
Grunt: it is done when needed.
Admin: we require documentation that it be done very two weeks.
Grunt: I’m familiar with the policies and checked the last time you were here and there is no policy stating every two weeks. Until you show me in writing the policy I’ll do it my way.
Admin: We’ve been requesting two weeks for years.
Grunt: I do it when needed and will do that until a policy is put in front of me.
A fellow admin gets involved.
Actually here is the federal policy that states it must be done every week. According to my records you were advised previously to change it to every two weeks, which you acknowledge refusing to do. Now we need you to file a compliance and incident report for not following federal guidelines.

Silence.

The problem with this story, other than its truth, is that there are local, state and federal policies, rules and guidelines and they often do not match. Further it is really hard to follow all of them and keep up with all of them.

I have to battle admin like the grunt above and am prone to wanting to see policy chapter and verse, but changing policy sources, which happened above is a constant risk because some obtuse policies are out there.

This is a follow up to my post of http://www.josephfclark.com/blog/?p=333, which I posted as a comment to that blog and wanted to post as a mini follow up blog here too.

My Catch 22 in academia is concerning a conflict between federal laws and local laws/policy. Recently, I am happy to say, I am not the only one who suffers through such conflict. In order to avoid embarrassment I have redacted details that might be embarrassing or inflammatory. Sorry if this makes it hard to read, but please look at the humor.

Here is the local policy.

- Employees are not permitted to access their own records.
- Employees are not permitted to access any member of their family’s records.
- Employees are not permitted to access any person’s electronic records except as part of their job.

There is a no-tolerance policy now in effect for employees for inappropriate access of records. First offenses will result in immediate termination.

That policy had numerous responses from people talking about typographical errors and also a requirement to scan records to ensure they are the correctly requested records. Three people stated that accidental searches had led them to access to erroneous records since the time of the policy was instituted (without comment or discussion) and asked if they were terminated.

Here is the funny part. It is against federal law to forbid access of one’s own records. Immediate termination is against most union contracts.

This is all a symptom of myopic administrators and non-practitioners making policy and wielding power capriciously. I have a suggestion. Come out of your ivory tower and talk to people doing work for and with humanity.

Why I think Oprah should promote My Ambulance Education.
It has all the characteristics she tends to promote. In it there is a great human interest concerning people helping people. There is a solid foundation of the common man working to improve his life and overcoming adversity. This is overlaid in it a touching love story and other real life emotions that everyone has to deal with in life.

Despite dealing with life and death, human tragedy and lost love there is always hope and an eventual happy ending.

These things all form a nice cadre of emotions that will be attractive to Oprah fans, but what makes this book especially resonant for Oprah is that it is a testament to the men and woman who risk their lives to save our lives. The heroes of the emergency services were somewhat highlighted during the September 11th tragedy and this book takes the reader on a cogent and emotional ride behind the scenes to help us all appreciate the terrific job that goes on under the cover of the lights and sirens we see racing through the city streets. The time to acknowledge these people has come and this book is one avenue for saying thanks.

Happy Birthday to you.
Happy Birthday to you.
Happy Birthday My Ambulance Education.

Happy Birthday to you.

One year ago today My Ambulance Education was published by Firefly. All I can say is that it is still an education. Check it out here: My Ambulance Education.

Since that time I’ve been able to reconnect with several people from those days on the ambulance. I have also been able to get more actively engaged in the prehospital community. While my research has, for years, been concerning neurologic emergencies such as stroke, including in the ambulance, the publication of the book has helped get me in contact with the leaders in the EMS field. The ambulance is a unique place to do medicine and research and there are those of us who are trying to do research that improves medicine in the ambulance.

Some day soon we will have a star trek tricorder being used in the ambulance. With luck, I’ll be involved with getting it onto the ambulance.

Translational research – what is it, who does it and why should we do it?

A buzz word that comes around in medical research is, “translational” research. While translational is used all time by researchers, no one seems to have a good definition for it. To borrow a famous quote: “I cannot define it, but I know it when I see it.” Wikipedia attempts to define it by saying, “Translational research is a way of thinking about and conducting scientific research to make the results of research applicable to the population.” The problem with this abbreviated definition is that population could be the scientific population, the medical population or the population of the world. But as definitions go, it is a good start.

In the medical research community the population we are often talking about is patients. But does that mean if a person is doing research on patients that it is translational? Not really because clinical research on patients may be applied research or only to some patients. See how it gets complicated.

The definition of translational research is not really what I wanted to talk about but the difficulty in defining it highlights part of the reason why it is difficult to do. If a scientist wants to do research that meets a clinical need how does one go about doing that? A good first step is to determine what the clinical needs are and if this hypothetical scientist is not a medical doctor that first step will require talking to some physicians. Here is where the fun begins.

Should that scientist talk to one physician or one thousand? One physician’s perspective might be too narrow and one thousand will take to long. Yes, this is sounding like the three bears and we want the porridge that is just right. What scientist knows and has time to talk to one thousand physicians? Just as importantly, what if the doctors you talk to have (research) needs that do not meet the skills the scientist has. Does that mean the scientist should give up research and start flipping burgers? I think not.

Okay, so I’ve posed a lot of questions and some are rhetorical. My opinion is that research, even translational research, is not a popularity contest. Everyone wants to cure cancer, but we scientists all know that there is no one cure to cancer there need to be many, so we have to carve out pieces of the research pie and some may be more “tasty” than others. Sometimes life is a crap shoot and being lucky is just as important as being good.

Back to the scientist who wants to do translational research. Now he/she is trying to meet and chat with an experienced doctor about some translational research. This would be a meeting to decide upon what that scientist might be doing and submitting a research grant to work with that physician and improve the way he/she does business when treating patients. For the scientist, this is a 5 or 10 year commitment. For the physician, it is painful to carve out ten minutes for such a meeting.

I ask the reader to ponder the above mentioned numbers for a second. A translational research scientist will commit 5 to 10 years of research to study a subject and in part base those decisions on information concerning clinical relevance from physicians. Notoriously those same physicians are hesitant to take ten minutes to participate in those discussions. They are too busy treating patients to be engaged in research to determine better ways to treat those patients.

Need I say it? That is just sad.

I do not blame the physicians; it is the system. Medical doctors are not trained to be researchers and they are generally not paid to do research. Research scientists are not trained to be physicians, so to do translational research these two groups of doctorates; MDs and Ph.Ds.,  need to meet and talk. But said meetings can be difficult to organize. The compromise that needs to be done at the level of the doctors (Ph.D., MD, DVM, D.Phil etc) is to make time to let the creative ideas flow in both directions. That time may carve into important work or need to be at less than convenient times. As an example, I have literally had a face to face with a surgeon outside of the operating room while a patient is being prepped. The nurse kept coming out to brief him on the status of the patient and he left when he was needed. I’m willing to do that as Ph.D. scientist and the surgeon was willing to squeeze out time in his schedule, which happened to be 7:00 AM on a Saturday. While non-traditional, it did give me time to talk to him and also some fodder for this blog.