Joseph F. Clark, Ph.D.

I think President Obama needs to present a state of the sciences in the union address. Yes, of course, I’m biased in this subject, but times are desperate. I work in a university hospital and train physicians and scientists at the cutting edge of technology. What we do is discover new ways to diagnose brain disorders and new was to treat them etc. But we cannot find the students to engage in doing this work or to train for the future. The average age of the nation’s scientists is increasing. We are going to lose a generation of scientists because new people are not learning from experienced scientists.

Why are the bright young students shying away from science and technology? Well, because they are smart. Teaching science in high schools and colleges pays very poorly. Plus because of dwindling enrollment those programs are being cut. Moreover, many types of research are seen as socially unacceptable. Medical research to save lives, may involve animal research and that is perceived as cruel. Scientists are called vivisectionists and targeted by animal rights groups with bombs and smear campaigns. Other technologies are sometimes associated with environmental accidents or global warming. Who wants to be associated with such negative connotations?

Research funding has dried up. Less than 1 out of every 10 grants submitted to the National Institutes of Health get’s funded. The recent stimulus package funded less than 1 in 100 grants.  ”Researcher” as a career is a misnomer because all one’s time is spent writing grants. Ask the average Nobel Prize winner in chemistry if they did their prize winning experiments and many will say no it was a student or technician they supervised.

The average scientific researcher will spend 10 or more years learning laboratory skills. Some of these difficult skills can be exceedingly technical. But in today’s research environment many of those so called “successful” scientists will abandon those skills and write grants and papers often without adequately training the next generation in those skills. New students see senior scientists locked in offices writing grant after grant followed by research papers etc and choose another discipline.

So we need to keep science in the lab and off the grant administrators table. This can only be done by a paradigm shift in society. We need to remember that the future of a creative and productive society is with scientists and technologists and that these people are trying to improve society. Second, we need to ensure that scientists can, and should, do science. This means that administrators and paperwork that prevents a researcher from his or her research needs to be drastically cut if not eliminated. This is not a problem that needs a trillion dollar fix. This needs intelligent minds to find some simple solutions. In the short term and long run it will save society money and bring great advances in our future. Mr. Obama, do not throw money at this problem capriciously, improve the process and image of research in our nation. Intervene now or productive geeks will vanish.

The National Institutes of Health fund about 40,000 grants to do medical research. Of those funded projects only 14 have to do with medical research in the pre-hospital setting. This is just sad.

Over 50% of all medical emergencies that come to hospitals arrive via the ambulance. Paramedics, firefighters, EMTs, Police and a host of paramedically trained professionals can give quality care to patients in emergency situations when time is critical.

Machiavellian principals clearly state the earlier something can be identified and treated the better the likelihood of successful treatment. Ambulance personal are the people with the first opportunity to start treatments. So why are we NOT doing substantial research to treat patients in the ambulance? I do not know the answer to that question. But I do know ways to change that situation. First we need to tell the politicians that our tax dollars need to benefit this area of society. Call, email and write letters to your federal, state and local agencies to support medical research focused in improving care in the ambulance. Only community action will change this situation.

There are also barriers to improving care in the ambulance. These need to be addressed by grassroots actions. Some physicians are hesitant to have ambulance personal ‘diagnose’ and treat some conditions in the ambulance. This may be a quality of care concern or a medical legal issue. Either way the best avenue to address this concern is with evidenced based medicine, which means to do the research studies to prove what can and can’t be done in the ambulance. This is an educational issue as well as a research issue that can be best answered with the help of the NIH and some solid research projects.

Finally when time is critical such as in an ambulance action has ramifications and this causes concern for law suits. Everyone is concerned that if a person has something done to them in an ambulance some ambulance chasing lawyer will sue everyone. Lawyers are costing lives in the ambulance and hospital arenas because no one will diagnose, treat or take any action without mitigating law suit risk. That is just sad. We need to limit the extent to which medical legal issues dictated research, development, diagnosis and treatment of medical emergencies in the ambulance.

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.