"No matter how ridiculous the summary statement comment, it helps you to write better proposals in the future."
This is a guest appearance of the bluebird of Twitter happiness known as My T Chondria. I am almost positive the bird does some sort of science at some sort of US institution of scientific research. The bird is normally exhausted by typing messages 140 characters at a time so I was skeptical but....well, see for yourself.
MDs and PhDs are considered to be some of the brightest and the most insightful people in the country. Indeed, look no further than the nearest MD or PhD and ask them; they will attest at great length to their exceptional smarts and individual importance in maintaining the sun orbiting the Earth. Yet for all the combined education there remains a fundamental lack of appreciation of how intertwined the fate of these two professions are - ranking right up there on the irony scale with Pakistan threatening to nuke India (they are geographic neighbors, so that’s ironic, you see).
For anyone who has ever worked at a major academic medical center, we are told ad nausea how important we are in understanding human health. Yet we do so almost exclusively in parallel universes. Asked what its like to try to work with an MD, a PhD will often tell you MDs are ‘erratic, ill informed and totally lacking in any understanding of what goes into doing real research’. Conversely, asked what PhDs do, MDs will likely reply ‘they like to present very complex diagrams, write grants and develop models of disease and pathology that have little to do with any case I’ve ever seen.
I get to surf between these groups; my primary appointment in a clinical department affords me a perspective that is unique in that I am able to pass as either an MD or a PhD on any given day. I spend the majority of my time running a research lab but I can scream “House! Put down the scalpel you jackass! All you have to do is order a chest x-ray and look for pulmonary infiltrates to know it’s not sarcoidosis!” with the best of interns.
In drifting between these lands, I noticed the rifts earlier between ‘researchers and doctors’ which seemed vaguely amusing not so much now as first but as the business of academic medical is getting the shitte kicked out of it and PhDs think it has little to do with them.
In previous faculty meetings, I would watch tenure track PhDs glaze over as our beloved leader discussed the ‘blah, blah’ of clinical revenue streams.
Conversely, the MDs would eagerly reengage a new level of Candy Crush Saga as our chair commiserated with PhDs about pay lines and sequestration. (So clueless were the MDs about the recent plight of scientists that the esteemed journal JAMA even had to run an article in their online edition earlier in the year explaining sequestration to the primarily MD audience.)
At our most recent faculty meeting, there seemed to be a moment of real illumination between both groups that everyone in the medical center was screwed and better start making more widgets faster. Our Fearless Leader informed faculty that our hospital budget shortfall was progressing more quickly than we had anticipated even three months ago and vacations were canceled for faculty, more clinical hours were going to need to be booked and the bergermeister was coming to take all our toys (only two of these three have happened so far).Later that day, I took to on Twitter to vent and look for pictures of kittens doing cute things (see Fig 2 as evidence of my hard work). Many of my Twitter followers are porn bots, but at least 2 or 3 are PhD-types and aghast that my medical center was being so aggressive. There were many sad emoji’s sent my way and a flutter of ‘how could they’ and ‘oh, your poor little university’ that made me wonder what planet everyone is on and if donuts were as delicious there as they were here (see Storify by @mrhansaker here).
EVERY medical center in the US is getting carpet bombed into financial oblivion by the economy, Medicare reimbursements and Obamacare. And yes, I assured my Tweeps, the amount of our gross national product that goes to health care is stoopidly high. But, a startling number of my PhD buddies were taken aback by the idea that those pesky ‘high health are cost’ they glaze over in faculty meeting or when listening to NPR is also covering their academic PhD arses.
So, for my PhD pals, whom I shall refer to as ‘People who are doctors only when they book hotel rooms’ (I’m kidding, I’m a kidder!), I wanted to run this down a bit further. If you have a medical center as part of your university, you have been riding clinician’s financial coat tails for a long friggin time. The indirect rate charged to granting organizations in no way covers operating costs for research. That takes an endowment or an additional revenue stream. Endowments usually come from long dead old rich doods. These endowments don't just sit in Scrooge McDucks cave. They get invested in things like the stock market. And the stock market got the shitte kicked out of not too long ago. Billions in endowment money were lost in the economic collapse - most Universities took 25-50% hits on their Scrooge McDuck funds. So, if you’re a PhD, you can take endowments out of the equation as what’s been filling in those pesky financial gaps between costs and expenses. No worries, you’re at a medical center so you have a revenue stream- your clinical enterprise. Sick people. America is ALWAYS good for some damn unhealthy and foolish folks who will make the worst choices possible and rack up a small fortune in insured and uninsured care.
Thank God for stoopid and unhealthy people, amirite?? This is even better because our Commander-in-Chief got an electoral mandate to insure everyone’s (ish) stoopid arse. More money for medical centers has got to be a win, yes? Not so much. Show me a medical center meeting its financial goals, hell even one that isn’t heading for a hundreds of millions of dollars of deficit for 2014, and I will show you a for profit medical center (read here: “not academic, so no jobs for you PhDs”).
The proverbial sky has been falling for research scientists for some time now as well documented by my kind host Drug Monkey and others with inferior blogs and better shoes. And indeed, MDs have been hounded into appreciating the genius that is the bench scientist. So valued are the basic researchers that they are sought after to heap more prestige on the medical center and an even better training environment which increases numbers of trainees, blah, blah.
Unlike clinicians, scientists have known the economic sky was falling for some time and have been zealously advocating the importance of science research bracing for impact. To the outside world, that looks a lot like holding your collective sphincters together as tightly as humanly possible and waiting for things to improve. Well-done people. Actually, you sort of sucked at advocating for yourselves as evidenced by the two of you who actually sent @nparmalee letters to hand deliver to your Congress Critters a few weeks ago, but I will need another bottle of wine for that.
The first warning to those PhD types in the 35+-age bracket would have been when Scamp-in-Chief Bill Clinton never quite delivered on his ‘peace dividend’. The one where all those pesky defense dollars would go to building a bigger, better, smarter American work force with futures in STEM (Dumber Bombs! Smarter People!). We would turn in our tanks and churn out better-educated versions of ourselves with outstanding oral hygiene to lead us forth into the new millennium free of disease and with cats with laser vision. Not only did we forget to provide sustainable growth mechanisms for STEM, we also neglected to maintain world peace and not screw the interns. Bill, you lovable rascal, at least you didn’t shoot anyone in the face. Just in the foot. Or both feet.
In the parallel world of MDs, who kindly request you simply refer to them as ‘real doctors’ for the rest of this diatribe, the pesky business of health care in academia has always been a house of cards. About 7% of MDs practice in the rare air that is academic medicine. This affords prestige, time for clinical research, collegiality, security and none of the business hassles of private practice, but about half the salary. Which, to be honest, is still a metric shitte ton of money especially if you do a bit of consulting. But now, there’s no research time, Medicaid is squeezing out every reimbursable dime and you are keeping the same hours as your hapless residents.
My take home from today friends is that the party seems to be winding down. Rather than recognizing that our fates are intertwined, MDs and PhDs frantically see more patients and write more grants and wonder when the sun will shine on us once again and society will appreciate our true worth. I have yet to see any evidence that for all the brain power and letters after peoples names, PhDs are even aware of that medicine money is research money. So you go put your blinders on and find that spear, and I’ll put mine on and grab this rope and no one will call it an elephant.
As you know, Dear Reader, a cyclical vomiting syndrome is often associated with chronic cannabis smoking. I've written about it a few more times (here, here, here) and you can check out additional posts at Addiction Inbox (here, here). I urge you to read through the comments posted under all of these blog entries. The numbers definitely rival the published Case Reports in number of affected individuals. Clearly there continues to be many folks suffering who go initially undiagnosed.
A Reader sent me a link to a medical diagnosis challenge published in the Well section of the New York Times recently which returned my interest to the topic. Mostly due to the following comment in the solution column:
Sure enough, there it was – two recent case reports describing several regular synthetic marijuana users who developed a syndrome that was indistinguishable from cannabinoid hyperemesis caused by the real stuff.
I had not seen any such reports so I went looking and found one of them on PubMed.
Hopkins CY, Gilchrist BL. A case of cannabinoid hyperemesis syndrome caused by synthetic cannabinoids. J Emerg Med. 2013 Oct;45(4):544-6. doi: 10.1016/j.jemermed.2012.11.034. Epub 2013 Jul 26.
By now, the diagnosis sounds very familiar. A 30 year old man presented at the ED with nausea and vomiting. He reported a prior history of such episodes, including gastro-enterology workups, scans, endoscopies, etc. Nothing that would explain his symptoms was ever found. The patient had found that hot showers relieved his pain and took several showers per day.
Naturally the patient had started using cannabis at the age of 13 and had been smoking several times per day for years.
Up until this point, everything is very familiar.
This particular individual had been cannabis free for 6 months due to legal surveillance under parole. After cleverly determining with over-the-counter tests that synthetic marijuana products (brand names of K2 and Spice were popular early in the cycle and have come to be familiar as semi-generic terms) didn't trigger cannabinoid positives:
...he quickly resumed his daily smoking habits and in the month before presentation was often smoking synthetic marijuana hourly, including waking up several times at night to get high.
The patient claimed that in the 2 months prior to presentation he'd been using "Scooby Snacks (sic)*" brand exclusively and provided some to the research team. This is cool because the team identified the cannabinoids in the product. It contained several, "JWH-018, JWH-073, JWH-122, AM-
2201, and AM-694" and they also found the patient's urine to be positive for JWH-018, JWH-073 and AM-2201.
As a bit of a sidebar, I really don't know why particular combinations are included in various synthetic cannabis products. It is unclear if it is accident of supply, illicit manufacturers who just throw stuff together at random, the end of the batches or something more intentional. There is an interesting paper from the Fantegrossi group (Brents et al, 2013) that suggests the possibility of synergistic effects.
Returning to the case report, on three month followup it was found the patient manged to remain abstinent and reported remission of his symptoms after the first 2 weeks.
Okay, so typical story for cannabinoid hyperemesis syndrome and in this case the patient had been exposed to multiple cannabinoid full agonists instead of delta-9-tetrahydrocannabinol prior to current episode. Of course his history suggests strongly that it was cannabis smoking that created his liability for the episodes in the first place.
One take-away message over the past several years is that we've rapidly gone from a point where nobody knows cannabis can cause a vomiting syndrome to some reasonable awareness. This is fantastic. The greater awareness, the greater the chances of rapid and accurate diagnosis. If you read the case reports you will see extensive and expensive gastrointestinal testing and diagnostic work in the history of many individual patients. Realization on the part of the patients that they should mention their cannabis smoking helps. Realization on the part of medical staff that they should ask about cannabis helps.
Knowledge can be a powerful bit of assistance for health care.
*more likely Scooby Snax?
This is important enough to elevate to an entry.
I had a recent post discussing some analysis Jeremy Berg posted at ASBMB Today ("The impact of the sequester: 1,000 fewer funded investigators") looking at some NIH data on the number of PIs who entered and exited the R-mech funded population across FY11-13.
He came by and left this comment:
I would welcome any suggestions about other longitudinal aspects of the NIH grantee pool that might be high priorities for analysis. Post here, at http://www.asbmb.org/asbmbtoday/201403/PresidentsMessage/ or email me at email@example.com.
So if you can clearly specify some sort of examination of the extramural PI population go to it! He's apparently the guy who can actually make it happen.
In this interview, Nobel Laureate Brenner says:
Today the Americans have developed a new culture in science based on the slavery of graduate students. Now graduate students of American institutions are afraid. He just performs. He’s got to perform. The post-doc is an indentured labourer. We now have labs that don’t work in the same way as the early labs where people were independent, where they could have their own ideas and could pursue them.
The most important thing today is for young people to take responsibility, to actually know how to formulate an idea and how to work on it. Not to buy into the so-called apprenticeship. I think you can only foster that by having sort of deviant studies. That is, you go on and do something really different. Then I think you will be able to foster it.
But today there is no way to do this without money. That’s the difficulty. In order to do science you have to have it supported. The supporters now, the bureaucrats of science, do not wish to take any risks. So in order to get it supported, they want to know from the start that it will work. This means you have to have preliminary information, which means that you are bound to follow the straight and narrow.
I saw some comment that he was bashing peer review but if you look carefully, you'll see he's talking about the GlamourGame with professional, not-working-scientist, editors:
I think peer review is hindering science. In fact, I think it has become a completely corrupt system. It’s corrupt in many ways, in that scientists and academics have handed over to the editors of these journals the ability to make judgment on science and scientists. There are universities in America, and I’ve heard from many committees, that we won’t consider people’s publications in low impact factor journals.
In other words it puts the judgment in the hands of people who really have no reason to exercise judgment at all.
The original version of the blog remains up at
I have recently attempted an import of the Scientopia content and it appears to have gone well.
This question is mostly for the more experienced of the PItariat in my audience. I'm curious as to whether you see your grant scores as being very similar over the long haul?
That is, do you believe that a given PI and research program is going to be mostly a "X %ile" grant proposer? Do your good ones always seem to be right around 15%ile? Or for that matter in the same relative position vis a vis the presumed payline at a given time?
Or do you move around? Sometimes getting 1-2%ile, sometimes midway to the payline, sometimes at the payline, etc?
This latter describes my funded grants better. A lot of relative score (i.e., percentile) diversity.
It strikes me today that this very experience may be what reinforces much of my belief about the random nature of grant review. Naturally, I think I put up more or less the same strength of proposal each time. And naturally, I think each and every one should be funded.
So I wonder how many people experience more similarity in their scores, particularly for their funded or near-miss applications. Are you *always* coming in right at the payline? Or are you *always* at X %ile?
In a way this goes to the question of whether certain types of grant applications are under greater stress when the paylines tighten. The hypothesis being that perhaps a certain type of proposal is never going to do better than about 15%ile. So in times past, no problem, these would be funded right along with the 1%ile AMAZING proposals. But in the current environment, a change in payline makes certain types of grants struggle more.
I don't. I just don't. I cannot in anyway understand scientists who are offended that they have to some up with some thin veneer of health-relevance to justify the grant award they are seeking. The H in NIH stands for "Health". The mission statement reads:
NIH’s mission is to seek fundamental knowledge about the nature and behavior of living systems and the application of that knowledge to enhance health, lengthen life, and reduce illness and disability.
Yeah, sure, if you end at the seventh word, you can convince yourself that the NIH is about basic research. Maybe you get to continue on to the fifteenth. But this is a highly selective reading. I just don't see where it is a burden to think for a minute or two about whether you are doing anything to address the second half of the statement.
After all, you are asking the taxpayers of the US to front you some serious cash. Millions of dollars for many of the PIs who are complaining about how hard it is to get basic research grants funded (BRAINI proponents, I'm looking at you). It really isn't that much of an insult to ask you to pay something back on the matter of public health.
I have decided, after 40 years as a lab scientist and 24 years running my own lab, to shut it down and leave. I write this to explain why, for those of my friends and colleagues who’d like to know. The short answer is that I’m tired of being a professor.
Okay, no problem. No problem whatsoever. Dude was appointed in 1990 and has been working his tail off for 24 years at the NIH funded extramural grant game. He's burned out. I get this.
I have never liked being a boss. My happiest years as a scientist were when I was a student and then a postdoc. I knew I wouldn’t like running a lab, and I didn’t like it. This has always been true.
My immediate plans are to go back to school and get a degree in Mathematics. This too has been a passion of mine ever since high-school sophomore Geometry, when I first learned what math is really about. And my love of it has increased in recent years as I have learned more. It will be tremendous fun to go back and learn those things that I didn’t have the time or the money to study as an undergrad.
GREAT! This is awesome. You do one thing until you tire of it and then, apparently, you have the ability to retire into a life of the mind. This is FANTASTIC!
So what's the problem? Well, he can't resist taking a few swipes at NIH funded extramural science, even as he admits he was never cut out for this PI stuff from the beginning. And after a long and easy gig (more on that below) he is distressed by the NIH funding situation. And feels like his way of doing science is under specific attack.
For many years NIH was interested in funding basic research as well as research aimed directly at curing diseases. With the tightening funding has come a focus on so-called “translational research”. Now when we apply for funding we have to explain what diseases our work is going to cure.
Ok, actually, this is the "truthy" part that is launching a thousand discussions of the "real problem" at NIH. So I'm going to address this part to make it very clear to his fans and back thumpers what we are talking about. On RePORTER (link above) we find that Dr Avery had one grant for 22 years. Awarded in April of 1991 and his CV lists 1990 as his first appointment. So within 15 mo (but likely 9 mo given typical academic start dates from about July through Sept) he had R01 support that he maintained through his career. In the final 5 years, he was awarded the R37 which means he has ten years of non-competing renewal. I see another R21 and one more R01. This latter was awarded on the A1. So as far as we can tell, Professor Avery never had to work too hard for his NIH grant funding. I mean sure, maybe he was putting in three grants a round for 20 years and never managed to land anything more than what I have reviewed. Somehow I doubt this. I bet his difficulties getting the necessary grant funding to run his laboratory were not all that steep compared to most of the rest of us plebes.
And actually, his Facebook post backs it up a tiny bit.
And I’ve been lucky that the world was willing to pay me to do it. Now it is hard for me to explain the diseases my work will cure. It feels like selling snake oil. I don’t want to do it any more.
I think the people enthusiastically passing along this Fb post of his maybe should focus on the key bits about his personal desires and tolerance for the job. Instead of turning this into yet another round of: "successful scientist bashes the NIH system now that finally, after all this time of a sweet, sweet ride s/he experiences a bare minimal taster of what the rest of us have faced our entire careers".
Final note on the title: Dude, by all means. Anyone who has had a nice little run with NIH funding and is no longer entused....LEAVE. We'll keep citing you, don't worry. Leave the grants to those of us who still give a crap, though, eh?
UPDATE (comment from @boehninglab):
— Darren Boehning (@boehninglab) February 10, 2014
Thanks Readers, the past seven years have been fun to share with all of you.