I love Ending Medical Reversal and have cited that book many times. I used to always have my students do a failure CV. It was great and we had fun with it too. This American Life has a great episode on this called Plan Z. check it out! Also if you want a good editor (me) to help with unpubbed books, reach out. My work has been slowwwww due to funding craziness.
This is a beautiful essay, as always. You have inspired me to put together my own CV of Failures. It may be longer than yours.
This recounting of failures and comebacks is actually a theme of part of my usual first day of class presentation for undergraduate students. One noteworthy example is that I applied for 22 academic jobs after completing my PhD and clinical internship in clinical psychology, and did not even get a single interview. That failure redirected me into what turned out to be a fabulous opportunity--taking an NIA funded postdoctoral fellowship in geriatric clinical psychology, getting to work at one of the first memory disorders clinics in the United States (in 1981), and discovering a passion and huge research opportunity to study family caregivers of people with dementia. All of my subsequent career success was based on a door being slammed shut, and another door opening. I hit another series of bumps, including being turned down for tenure twice, being turned down for promotion to professor once--and all of that leading to a move to another university where I have thrived. think this is an especially good lesson for undergraduate students to hear. They should know that they will hit dead ends and rough patches but through perseverance and being open to alternatives, they are likely to flourish.
I've been sending information about arachidonic acid, eicosanoid, and endocannabinoid system research to physicians, nutritionists, journalists, and researchers on an almost daily basis for upwards of 20 years. Why? Because these aspects of scientific research have yet to be translated into practcal usefulness. For example: (1996) "Excessive signaling of arachidonic acid (AA) metabolites has been associated with various chronic degenerative or autoimmune diseases, and intervention with the metabolism of AA is widely employed therapeutically in these afflictions. In essence, AA is the most biologically active unsaturated fatty acid in higher animals. Its concentration in membranes and its magnitude of effects depend on its amount, or that of its precursors and analogues, in the diet. The tendency of the field of nutrition to ignore the role of dietary AA will optimistically be reversed in the future." The article also said, "The underlying rationale for this symposium is that dietary AA is perhaps the single most important nutritional determinant in regulating AA levels in Americans. This may ultimately account in part for the striking differences in chronic diseases between strict vegetarians and the bulk of the omnivorous population." (web search - Biological Effects of Arachidonic Acid: Introduction)
Eicosanoid production: (2011) "Eicosanoids are major players in the pathogenesis of several common diseases, with either overproduction or imbalance (e.g. between thromboxanes and prostacyclins) often leading to worsening of disease symptoms. Both the total rate of eicosanoid production and the balance between eicosanoids with opposite effects are strongly dependent on dietary factors, such as the daily intakes of various eicosanoid precursor fatty acids, and also on the intakes of several antioxidant nutrients including selenium and sulphur amino acids. Even though the underlying biochemical mechanisms have been thoroughly studied for more than 30 years, neither the agricultural sector nor medical practitioners have shown much interest in making practical use of the abundant high-quality research data now available." (web search - Anna Haug Animal Products)
Endocannabinoid system: (2019) "The tissue composition of polyunsaturated fatty acids (PUFA) is important to health and depends on both dietary intake and metabolism controlled by genetic polymorphisms that should be taken into consideration in the determination of nutritional requirements, obesity and chronic disease risk. Experimental and clinical intervention studies suggest that omega-6 and omega-3 fatty acids have opposing physiological and metabolic properties and elicit divergent effects on body fat gain through mechanisms of adipogenesis, browning of adipose tissue, lipid homeostasis, systemic inflammation and an increase in the tone of the endocannabinoid system. Overweight and obese individuals have higher levels of the arachidonic acid (AA) derived endocannabinoid N-arachidonoylethanolamine (AEA) and 2-arachidonoylglycerol (2-AG) and an altered pattern of receptor expression. Since endocannabinoids are products of dietary fats, modification of the omega-6 and omega-3 fatty acid intake modulates the endocannabinoids, with eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) displacing AA from cell membranes, reducing AEA and 2-AG production, resulting in decrease in appetite and food intake leading to weight loss." (web search - omega-3/6 ratio endocannabinoid system)
Biomedical science is all about discovering molecules that can be used to treat disease conditions. For example, the latest advancement in obesity treatment is appetite medications known as GLP-1 receptor agonists. Rather than go on about this, I recommend these web searches:
Medicine has become corrupted by “ political science”….even when it is obvious that a cause and effect did not occur politics arrives to not just over-rule the findings but pay the illegal person for a surgery he had denied ever was a part of his previous history. To see HCQ banned as a lethal drug when it had been approved and used many times for USAF pilots made it obvious a scam was afoot during covid.
I think the stent vs medical therapy was only for clinically stable patients, and reportedly did equally well. Haven’t vetted it yet. Any patients with an acute syndrome were excluded, as they should be.
Applaud you for revisiting those refusals that I'm sure were often a hard pill to swallow at the time. I am an RN for 35+ years and in my varied experiences it's a rare thing for most docs to step down from their pedestals. Bravo!
I should include the one complaint about me to my state medical board which alleges that I am engaged in baby human trafficking while I work on the night shift in the hospital. Look it up!
The board wrote to me letting me know they will not investigate that claim and that I was free to read the text of the complaint.
You sum it all up here: “What we end up doing is dictated by uninformed choice, random selection, position availability, successes, and failures.”
Probably the reason it is almost impossible to explain or decipher some occurrences unless in retrospect with the results at our disposal. I hope this will inspire me to muster the courage to write about my CV of failures before the time it took you to narrate yours. Beautiful write up from a physician par excellence, that motivates the ones that are coming up!
I think I may have to put one of these together to share with our residents. This would be a great way to role model the idea that it's okay (in fact, helpful) to be open about your shortcomings!
Dr. Cifu, regarding your CV of failures, I should add that in my own case the most resounding ones have often come precisely from challenging the establishment, prevailing editorial policies, or the reigning paradigm. One such instance occurred when BMJ summarily rejected an essay of mine—born from a critical review of the literature and supported by solid scientific arguments—arguing that Evidence-Based Medicine itself is entering a phase of decline, having been progressively “hacked,” much like medical practice, by vested interests.
Under those circumstances, and just to lighten the negative balance a bit (ha ha ha), I might suggest removing from your list those rejections that fall into this particular category.
In that spirit, I once proposed imagining a different intellectual movement: Sense-Based Medicine—where prudence, judgment, and clinical sensibility prevail over methodological dogma, and where the physician’s primary allegiance is restored to its rightful place: the well-being of the patient.
Of course, Sensible Medicine seems to be moving in that direction. Congratulations.
"prudence, judgment, and clinical sensibility prevail over methodological dogma, and where the physician’s primary allegiance is restored to its rightful place: the well-being of the patient."
Oh Adam, what a great exercise! I found myself giggling as I continued to read down the list. Ugh. Everyone should be brave enough to list their perceived failures and take a look back at the winding path that got us here today. You are the man you're supposed to be, so congratulations on all that personal development. Truly, none of it was failure.
I love Ending Medical Reversal and have cited that book many times. I used to always have my students do a failure CV. It was great and we had fun with it too. This American Life has a great episode on this called Plan Z. check it out! Also if you want a good editor (me) to help with unpubbed books, reach out. My work has been slowwwww due to funding craziness.
TM Henderson
Really enjoyed your article on CV of Failures -I've decided to record my own
Can’t wait see it!
This is a beautiful essay, as always. You have inspired me to put together my own CV of Failures. It may be longer than yours.
This recounting of failures and comebacks is actually a theme of part of my usual first day of class presentation for undergraduate students. One noteworthy example is that I applied for 22 academic jobs after completing my PhD and clinical internship in clinical psychology, and did not even get a single interview. That failure redirected me into what turned out to be a fabulous opportunity--taking an NIA funded postdoctoral fellowship in geriatric clinical psychology, getting to work at one of the first memory disorders clinics in the United States (in 1981), and discovering a passion and huge research opportunity to study family caregivers of people with dementia. All of my subsequent career success was based on a door being slammed shut, and another door opening. I hit another series of bumps, including being turned down for tenure twice, being turned down for promotion to professor once--and all of that leading to a move to another university where I have thrived. think this is an especially good lesson for undergraduate students to hear. They should know that they will hit dead ends and rough patches but through perseverance and being open to alternatives, they are likely to flourish.
I've been sending information about arachidonic acid, eicosanoid, and endocannabinoid system research to physicians, nutritionists, journalists, and researchers on an almost daily basis for upwards of 20 years. Why? Because these aspects of scientific research have yet to be translated into practcal usefulness. For example: (1996) "Excessive signaling of arachidonic acid (AA) metabolites has been associated with various chronic degenerative or autoimmune diseases, and intervention with the metabolism of AA is widely employed therapeutically in these afflictions. In essence, AA is the most biologically active unsaturated fatty acid in higher animals. Its concentration in membranes and its magnitude of effects depend on its amount, or that of its precursors and analogues, in the diet. The tendency of the field of nutrition to ignore the role of dietary AA will optimistically be reversed in the future." The article also said, "The underlying rationale for this symposium is that dietary AA is perhaps the single most important nutritional determinant in regulating AA levels in Americans. This may ultimately account in part for the striking differences in chronic diseases between strict vegetarians and the bulk of the omnivorous population." (web search - Biological Effects of Arachidonic Acid: Introduction)
Eicosanoid production: (2011) "Eicosanoids are major players in the pathogenesis of several common diseases, with either overproduction or imbalance (e.g. between thromboxanes and prostacyclins) often leading to worsening of disease symptoms. Both the total rate of eicosanoid production and the balance between eicosanoids with opposite effects are strongly dependent on dietary factors, such as the daily intakes of various eicosanoid precursor fatty acids, and also on the intakes of several antioxidant nutrients including selenium and sulphur amino acids. Even though the underlying biochemical mechanisms have been thoroughly studied for more than 30 years, neither the agricultural sector nor medical practitioners have shown much interest in making practical use of the abundant high-quality research data now available." (web search - Anna Haug Animal Products)
Endocannabinoid system: (2019) "The tissue composition of polyunsaturated fatty acids (PUFA) is important to health and depends on both dietary intake and metabolism controlled by genetic polymorphisms that should be taken into consideration in the determination of nutritional requirements, obesity and chronic disease risk. Experimental and clinical intervention studies suggest that omega-6 and omega-3 fatty acids have opposing physiological and metabolic properties and elicit divergent effects on body fat gain through mechanisms of adipogenesis, browning of adipose tissue, lipid homeostasis, systemic inflammation and an increase in the tone of the endocannabinoid system. Overweight and obese individuals have higher levels of the arachidonic acid (AA) derived endocannabinoid N-arachidonoylethanolamine (AEA) and 2-arachidonoylglycerol (2-AG) and an altered pattern of receptor expression. Since endocannabinoids are products of dietary fats, modification of the omega-6 and omega-3 fatty acid intake modulates the endocannabinoids, with eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) displacing AA from cell membranes, reducing AEA and 2-AG production, resulting in decrease in appetite and food intake leading to weight loss." (web search - omega-3/6 ratio endocannabinoid system)
Biomedical science is all about discovering molecules that can be used to treat disease conditions. For example, the latest advancement in obesity treatment is appetite medications known as GLP-1 receptor agonists. Rather than go on about this, I recommend these web searches:
GLP-1 receptor agonist adipose tissue arachidonic acid
Adipose tissue arachidonic acid metabolic syndrome
Medicine has become corrupted by “ political science”….even when it is obvious that a cause and effect did not occur politics arrives to not just over-rule the findings but pay the illegal person for a surgery he had denied ever was a part of his previous history. To see HCQ banned as a lethal drug when it had been approved and used many times for USAF pilots made it obvious a scam was afoot during covid.
Thanks for the reference; purchasing. BTW, 4.6/5 stars on Amazon.
I think the stent vs medical therapy was only for clinically stable patients, and reportedly did equally well. Haven’t vetted it yet. Any patients with an acute syndrome were excluded, as they should be.
?
Sorry; don’t have time to look for the link, but I thought that was the study to which you were referring. Am I wrong?
I do think that our cholesterol hypothesis is wrong.
Applaud you for revisiting those refusals that I'm sure were often a hard pill to swallow at the time. I am an RN for 35+ years and in my varied experiences it's a rare thing for most docs to step down from their pedestals. Bravo!
You still Rock!!!!
I should include the one complaint about me to my state medical board which alleges that I am engaged in baby human trafficking while I work on the night shift in the hospital. Look it up!
The board wrote to me letting me know they will not investigate that claim and that I was free to read the text of the complaint.
You sum it all up here: “What we end up doing is dictated by uninformed choice, random selection, position availability, successes, and failures.”
Probably the reason it is almost impossible to explain or decipher some occurrences unless in retrospect with the results at our disposal. I hope this will inspire me to muster the courage to write about my CV of failures before the time it took you to narrate yours. Beautiful write up from a physician par excellence, that motivates the ones that are coming up!
Wow, I love this, Adam.
I think I may have to put one of these together to share with our residents. This would be a great way to role model the idea that it's okay (in fact, helpful) to be open about your shortcomings!
Humor and humility - what a wonderful way to start the day, and a stark reminder how little there is of each on display today. Thanks for the piece!
Dr. Cifu, regarding your CV of failures, I should add that in my own case the most resounding ones have often come precisely from challenging the establishment, prevailing editorial policies, or the reigning paradigm. One such instance occurred when BMJ summarily rejected an essay of mine—born from a critical review of the literature and supported by solid scientific arguments—arguing that Evidence-Based Medicine itself is entering a phase of decline, having been progressively “hacked,” much like medical practice, by vested interests.
Under those circumstances, and just to lighten the negative balance a bit (ha ha ha), I might suggest removing from your list those rejections that fall into this particular category.
In that spirit, I once proposed imagining a different intellectual movement: Sense-Based Medicine—where prudence, judgment, and clinical sensibility prevail over methodological dogma, and where the physician’s primary allegiance is restored to its rightful place: the well-being of the patient.
Of course, Sensible Medicine seems to be moving in that direction. Congratulations.
"prudence, judgment, and clinical sensibility prevail over methodological dogma, and where the physician’s primary allegiance is restored to its rightful place: the well-being of the patient."
Nice
The knowledge gained from failures in virtually all fields is prodigious and permanent.
Success massages the ego,
but is ephemeral.
Ben Hourani, MD, MBA
Oh Adam, what a great exercise! I found myself giggling as I continued to read down the list. Ugh. Everyone should be brave enough to list their perceived failures and take a look back at the winding path that got us here today. You are the man you're supposed to be, so congratulations on all that personal development. Truly, none of it was failure.