#6 Dr Prasad!! Why perpetuate the problem?! Fellowship!? We need you to write about the insanity but also try and change it. Or did you already try at the FDA and found the beast to be unconquerable? :( keep up the good fight
Was this man the architect of saying goodbye to loved ones by iPAD at hospitals? Whoever was, deserves a kick.
I would think Fauci could be sued civilly by people who lost their jobs. Yes?
Do you believe that gain of function research was sponsored or encouraged by our own government (we got to have the best and most lethal germs) and the USA is responsible for all these financial losses, hospital expenses, and deaths.
I realize that with the explosion of medical information and the pressure on trainees to start making real salaries, there is a good argument for shortening and focussing the training periods of med school and post-grad residency/fellowship.
However, given the wide spectrum of value of current research reports from meaningless/poorly designed to low impact to well designed, high impact studies, as well as the potentially corrupting influence of industry, it has become essential for doctors to be educated to analyze and assess value when they read a newly published study.
I believe that part of that education can come from participating in original research during their training years.
I went into medicine because I like human biology and physiology and I do believe (i know you are skeptical) that understanding human physiology makes me a better physician. I have done mostly fundamental research throughout my career because I believe there is much that remains to be discovered and making discoveries is really fun. Very few of these findings have made it into medical practice but some do, not in the sense that imatanib transforms a disease but by improving how we use drugs. Thus, my work on tubule hypertrophy influences how we use diuretics to treat heart failure. My work with colleagues discovering the potassium switch we think explains why recent NEJM trials showed life prolonging benefits of high potassium intake. You could say that the latter doesn't depend on understanding physiology but we showed how salt and potassium interact providing information about when more potassium intake should be most strongly recommended. I didn't go into medicine or research to examine process or epidemiology, both of which are important but we in nephrology believe we may now be able to halt much CKD; that is what still makes, when done for the right reasons (certainly not for advancement or to fulfill obligations), science a noble and worthwhile pursuit! I worry that your clearly correct observations can convey a tone of anti-intellectualism, which i think is bad.
Mine isn't quite on your list, though it sits closest to the second: because some questions only get asked by the person standing in a particular spot. We looked at why patients weren't getting discharged on time from an ambulatory surgery center, assuming the answer would be pain. It wasn't. It was nausea — some patients needed an overnight admission for it. Nobody had asked, so nobody knew. And your point about quality over quantity is the one I wish every promotion committee had to read out loud. Reading the underlying papers and quizzing the trainee is so obviously right, and so rarely what actually happens.
You list "To make money from patents/spin offs" as one reason to do research. I am not a health care provider, but I do have a scientific background, having studied physics for several years in the 1960s, and I had a long career as a computer programmer with a specialty in predictive analytics. Since patents are a big concern in the computer industry, I've done some thinking about their legitimacy, and back in the 1990s I decided that the whole idea of patents was problematic, and that there was no good way to fix them by merely tinkering with the rules for granting them. Later a fellow programmer pointed me to a lively and well-reasoned article whose arguments against patents closely matched my own:
You forgot to mention "to learn how to do research" as one of the reasons. I had to do a "research" project/thesis to complete the (MSN) requirements for my CRNP. I think perhaps learning to read research papers would have served me better. Please do not think I am disparaging nursing research. It was nursing research that gave us consistent measurements for pediatric doses of medication (as opposed to the old "teaspoon" - that could be any spoon in the drawer), and confirmed that surgical patients do better with good old fashioned nursing interventions - early walking, turning, cough, deep breathing, etc. I did appreciate the stats class, though - it was a requirement I probably would not have chosen on my own, and I learned a lot.
I did research in the latter part of my career because there are so many gaps in evidence for why we do what we do. One stands out: my patient with decompensating cirrhosis was found to have a gallbladder polyp now measuring 10 mm. Doing his own research and seeing in the surgical literature that there was a higher risk of cancer, he talked a surgeon into operating, despite my pleas to get followup measurements. After bleeding complications left a scarred-in liver, he later died of the inability to do further surgery. This led to a study of 20 years of Kaiser data, showing overall no higher risk of gall bladder cancer with a polyp than without, and that even with growth to 10 mm cancer was exceedingly rare. So much of what we do is habit, clinical questions led to research: why are we doing colonoscopies-endoscopies on asymptomatic premenopausal women with iron deficiency? Do people with hepatitis C have an increased risk of liver flare when they receive chemotherapy? Is there really a high risk of seeding if one biopsies liver cancers? Do those with hepatitis B die in old age of hepatitis B, or of the usual heart disease-cancer causes?
In medicine as in life, “the unexamined life is not worth living”.
So, is there an academic institution where the clinical training is considered excellent that is or might be willing to publicly take a two-pathway approach to residency or fellowship: (1) the "long" path with significant research time OR (2) the shorter, all-clinical path without research? Could such a place even exist?
“Then they care mostly about the exit and not about helping people. You can have a great financial exit for a failed product. Being acquired is the goal.“ - in every single start up, not just medicine. The “Sephora” method.
So Dr. P- Did the FDA advisors do enough research to begin the loosening of compounding peptides? Is there any good research on this? Or is this just political research?
#6 Dr Prasad!! Why perpetuate the problem?! Fellowship!? We need you to write about the insanity but also try and change it. Or did you already try at the FDA and found the beast to be unconquerable? :( keep up the good fight
To ask interesting questions!
Questions that challenge dogma, move science forward, and might make a difference.
It's a requirement of the training program...
Questions:
Was this man the architect of saying goodbye to loved ones by iPAD at hospitals? Whoever was, deserves a kick.
I would think Fauci could be sued civilly by people who lost their jobs. Yes?
Do you believe that gain of function research was sponsored or encouraged by our own government (we got to have the best and most lethal germs) and the USA is responsible for all these financial losses, hospital expenses, and deaths.
I realize that with the explosion of medical information and the pressure on trainees to start making real salaries, there is a good argument for shortening and focussing the training periods of med school and post-grad residency/fellowship.
However, given the wide spectrum of value of current research reports from meaningless/poorly designed to low impact to well designed, high impact studies, as well as the potentially corrupting influence of industry, it has become essential for doctors to be educated to analyze and assess value when they read a newly published study.
I believe that part of that education can come from participating in original research during their training years.
" I would much rather we reward people for being good doctors"
The work is the reward. As my physician father told me when I started medical school, "It's a lousy job but it's a great life".
Any good doctor who is waiting to be rewarded via the academic reward system is waiting in vain.
I went into medicine because I like human biology and physiology and I do believe (i know you are skeptical) that understanding human physiology makes me a better physician. I have done mostly fundamental research throughout my career because I believe there is much that remains to be discovered and making discoveries is really fun. Very few of these findings have made it into medical practice but some do, not in the sense that imatanib transforms a disease but by improving how we use drugs. Thus, my work on tubule hypertrophy influences how we use diuretics to treat heart failure. My work with colleagues discovering the potassium switch we think explains why recent NEJM trials showed life prolonging benefits of high potassium intake. You could say that the latter doesn't depend on understanding physiology but we showed how salt and potassium interact providing information about when more potassium intake should be most strongly recommended. I didn't go into medicine or research to examine process or epidemiology, both of which are important but we in nephrology believe we may now be able to halt much CKD; that is what still makes, when done for the right reasons (certainly not for advancement or to fulfill obligations), science a noble and worthwhile pursuit! I worry that your clearly correct observations can convey a tone of anti-intellectualism, which i think is bad.
Bravo.
Mine isn't quite on your list, though it sits closest to the second: because some questions only get asked by the person standing in a particular spot. We looked at why patients weren't getting discharged on time from an ambulatory surgery center, assuming the answer would be pain. It wasn't. It was nausea — some patients needed an overnight admission for it. Nobody had asked, so nobody knew. And your point about quality over quantity is the one I wish every promotion committee had to read out loud. Reading the underlying papers and quizzing the trainee is so obviously right, and so rarely what actually happens.
Proving annoying ideologists wrong
You list "To make money from patents/spin offs" as one reason to do research. I am not a health care provider, but I do have a scientific background, having studied physics for several years in the 1960s, and I had a long career as a computer programmer with a specialty in predictive analytics. Since patents are a big concern in the computer industry, I've done some thinking about their legitimacy, and back in the 1990s I decided that the whole idea of patents was problematic, and that there was no good way to fix them by merely tinkering with the rules for granting them. Later a fellow programmer pointed me to a lively and well-reasoned article whose arguments against patents closely matched my own:
"The Libertarian Case Against Intellectual Property Rights" by Roderick T. Long: http://freenation.org/a/f31l1.html
It may kill cats but my dad taught me "to be curious in between seeing patients ( p.V, "Finding Einstein's Brain").
In my practice of neuro-ophthalmology, optic neuritis is painful in some patients but not in others and what is the origin of the pain?
A small (unfunded!) study provided the answer.
Don't be afraid to ask deceptively simple questions. You just might find the answer.
You forgot to mention "to learn how to do research" as one of the reasons. I had to do a "research" project/thesis to complete the (MSN) requirements for my CRNP. I think perhaps learning to read research papers would have served me better. Please do not think I am disparaging nursing research. It was nursing research that gave us consistent measurements for pediatric doses of medication (as opposed to the old "teaspoon" - that could be any spoon in the drawer), and confirmed that surgical patients do better with good old fashioned nursing interventions - early walking, turning, cough, deep breathing, etc. I did appreciate the stats class, though - it was a requirement I probably would not have chosen on my own, and I learned a lot.
I did research in the latter part of my career because there are so many gaps in evidence for why we do what we do. One stands out: my patient with decompensating cirrhosis was found to have a gallbladder polyp now measuring 10 mm. Doing his own research and seeing in the surgical literature that there was a higher risk of cancer, he talked a surgeon into operating, despite my pleas to get followup measurements. After bleeding complications left a scarred-in liver, he later died of the inability to do further surgery. This led to a study of 20 years of Kaiser data, showing overall no higher risk of gall bladder cancer with a polyp than without, and that even with growth to 10 mm cancer was exceedingly rare. So much of what we do is habit, clinical questions led to research: why are we doing colonoscopies-endoscopies on asymptomatic premenopausal women with iron deficiency? Do people with hepatitis C have an increased risk of liver flare when they receive chemotherapy? Is there really a high risk of seeding if one biopsies liver cancers? Do those with hepatitis B die in old age of hepatitis B, or of the usual heart disease-cancer causes?
In medicine as in life, “the unexamined life is not worth living”.
So, is there an academic institution where the clinical training is considered excellent that is or might be willing to publicly take a two-pathway approach to residency or fellowship: (1) the "long" path with significant research time OR (2) the shorter, all-clinical path without research? Could such a place even exist?
“Then they care mostly about the exit and not about helping people. You can have a great financial exit for a failed product. Being acquired is the goal.“ - in every single start up, not just medicine. The “Sephora” method.
So Dr. P- Did the FDA advisors do enough research to begin the loosening of compounding peptides? Is there any good research on this? Or is this just political research?