Science is a team sport

These days, it is increasingly rare for science to be done by individuals working alone. While scientists have always benefited from discussion with peers, sharing ideas and hypotheses, checking each other’s work, in the past it was possible for much experimental work to be done in individual labs or observatories with perhaps some help from assistants or lab techs. But this just isn’t possible in an increasing number of scientific fields. Theoreticians may still work individually, but experimental science requires teams.

The latest accomplishment, imaging a black hole for the first time, is a prime example of the interdisciplinary teamwork required in fields like astrophysics. An international team of hundreds of scientists, mathematicians, and engineers from a variety of fields worked together – and all were necessary for this success. It involved technological advances, coordination of telescopes on four continents (requiring good weather in all of them for each observation), analyzing tons of data including some that had to be shipped on hard drives from the South Pole and defrosted outside a supercomputer facility at MIT, developing the image using multiple different algorithms from separate groups that worked separately as a form of quality control. The news was even released by the EHT in six simultaneous press conferences held around the world.

In this endeavor, there were myriad parts, all crucial. No one person or group or components was the most important part. It has been wonderful to see everyone give recognition to the team and acknowledge the contributions of all the others. In some ways, that level of teamwork and inter-disciplinary, international cooperation may be the most impressive aspect of this great scientific achievement.

 

 

 

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Getting pediatric treatment as an adult

A few months ago, I was informed that I needed braces if I wanted my front teeth to survive. Having gone through orthodonture at the usual age, this was quite a surprise and not a very welcome one. It has, however, been edifying becoming the patient of a (mostly very nice) orthodontist whose patients are usually kids.

At my appointment last week, I suddenly found myself having things done that I hadn’t been warned of or asked about or had explained to me. I was somewhat stunned as I walked out the door with a very unhappy mouth with sharp metal thingies in it (I chose Invisalign braces precisely to avoid such things). It took a while for me to figure out why I was in such shock – it had been years since I’d had a doctor or dentist do things to me without giving me any explanation or choice. But pediatric providers are used to telling, not asking (though the better ones move to a more collegial mode as children become teens).

This experience has been a good reminder of how much the standards for interactions between doctors and patients have changed in this country in the past few decades. Fifty years ago, doctors expected patients to take their orders and not ask questions; today it is much more common for doctors to expect questions from patients and explain things more than it was back then. Finding myself inadvertently back in that dynamic was a useful reminder of how lucky I have been to be able to choose my doctors and only stay with those who treat me with respect as a partner in a cooperative venture.

For Independence Day: What Patriotism Means to Me

Those of us who were around during the tumult of the 1960s remember those opposing the protesters accusing them of lacking patriotism, with the cry “My country, love it or leave it.” They said patriotism was agreeing with your country, whether it was right or wrong. But to me that is chauvinism, not true patriotism. I believe true patriotism is wanting our country to be the best it can and working to right what’s wrong, fix what’s broken.

President John F. Kennedy famously said “Ask not what your country can do for you – ask what you can do for your country.” To me, that’s the essence of patriotism. In that spirit, I consider the people I know who are marching and protesting and spreading information to be the epitome of patriotic citizens. We may not love what is happening in the U.S. right now, but we love the ideals we believe it should stand for and the people who need us to make it the place it should be.

The Joys of Public Access Articles

The wonderful thing about publishing papers funded by NIH is that journals are required to make them publicly available after one year. The public access version is often the final version the author sent to the journal, before any final editorial tweaks.

It’s exciting when an article you care about reaches the public access stage. I hope some of you find it of interest.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5446272/

The Interaction Between Equipoise and Logistics in Clinical Trials: A Case Study

Meredith G. Warshaw,1 Vincent J. Carey,1,2 Elizabeth J. McFarland,3 Liza Dawson,4 Elaine Abrams,5 Ann Melvin,6Lee Fairlie,7 Hans Spiegel,8 Jonathan Jay,9 and Allison L. Agwu10, for the IMPAACT P1094 Team

Abstract

Introduction

Equipoise is usually discussed as an ethical issue in clinical trials. However, it also has practical implications.

Background

Clinical equipoise is usually construed to mean uncertainty or disagreement amongst the expert clinician community. However, an individual physician’s sense of equipoise may vary by location, based on the local standard of care or availability of specific treatment options, and these differences can affect providers’ willingness to enroll participants into clinical trials. There are also logistical barriers to enrollment in international trials, due to prolonged timelines for approvals by government agencies and ethical review boards.

Case Study

A multinational clinical trial of bridging strategies for treatment of non-adherent HIV-infected youth, experienced differing perceptions of equipoise due to disparities in availability of treatment options by country. Unfortunately, the countries with most demand for the trial were those where the approval process was most delayed, and the study was closed early due to slow accrual.

Discussion

When planning multicenter clinical trials, it is important to take into account heterogeneity among research sites and try to anticipate differences in equipoise and logistical factors between sites, in order to plan to address these issues at the design stage.

ADHD is real and we don’t need clickbait headlines about “beating” it

Because of the headline, I almost didn’t read an article about the good results schools are getting when they greatly increasing the amount of unstructured recess time for young kids.

Texas School Beats ADHD by Tripling Recess Time

I have no doubt that this is beneficial for kids, but saying it “beats” ADHD is nonsense – and the article itself doesn’t claim that it does.  It says that the kids are “less fidgety, less distracted, more engaged in learning and make more eye contact” and I’ve no doubt that’s true. I would expect the increased activity to ameliorate many ADHD symptoms and prevent normal active kids from looking like they have ADHD.

What the article leaves out is that increasing recess is only part of the program, called Liink. It also involves restructuring the school day, including character development in the curriculum, and changing the way we assess kids.

The article says benefits of the Liink program include:

  • Increased attentional focus
  • Improved academics
  • Improved attendance
  • Decreased behavioral diagnoses (anxiety, ADHD, anger)
  • Improved creativity and social skill development

and I won’t be surprised if research supports that. But decreasing behavioral diagnoses is not the same thing as “beating” ADHD. Therapist Marsha Mandel, LMHC, says it perfectly:

For not just ADHD but all mental health issues that may be inherent for some – trying to “beat” it”, get rid of it, stuff it, ignore it etc. is harmful – because it’s still there. Though it may feel counter-intuitive, the healthiest thing is to turn towards it, accept it’s there, roll up our sleeves and look for ways to manage or decrease its negative effect. Change our relationship with it. Additional recess can be part of that

So, yes, let’s increase recess – young kids need lots of activity. But let’s also recognize that some kids (and adults) really have ADHD and not pretend they won’t if they just get enough recess.

 

The March for Our Lives

There isn’t much I can say that hasn’t already been said, but I couldn’t let this event go unmentioned.

I’m very proud of these young people, not only for organizing against gun violence but also for very explicitly recognizing that this is not just a problem of school shootings and that it’s important to recognize the toll gun violence takes on minority communities. I’ve been very impressed with how the Parkland kids have worked to be inclusive. “We recognize that Parkland received more attention because of its affluence,” Jaclyn Corin, a survivor of the Parkland shooting, said during her speech. “But we share this stage today and forever with those communities who have always stared down the barrel of a gun.” And I’m also impressed by the voter registration drives that have accompanied local marches, and the kids reminding politicians that they’ll soon be voters.

As someone who grew up in the era of anti-Vietnam war demonstrations and the Civil Rights movement, I’m feeling as much déjà vu as amazement. Watching these kids, I see an echo of our generation and think of what would have been different if we’d had social media and the internet with its immediate access to communication. Online, I see my classmates reacting with pride and admiration, but not astonishment that teens are so thoughtful and aware of the world around them and are fighting so hard to change things. I hope they will keep fighting, and will turn out for elections (we couldn’t, the voting age was 21), and carry this fervor into their adult lives.

Remembering my history teacher

The student walk-out today made me think of my high school history teacher, Sylvia Gordon, and how happy it would have made her to see students organizing and getting politically involved, even as she would have been devastated by the cause. Because Mrs. Gordon cared – she was passionate about her students and their ideas, and always respectful in her interactions with them.

Screenshot-2018-3-25 Sylvia Gordon at UNIS

When I was in 9th grade, Mrs. Gordon’s mention of arriving in England as a child fleeing Nazi Austria was the first time I heard about the Kindertransport. She made history come alive by making it personal. When we discussed the McCarthy era, she talked about her fear that she wouldn’t be able to follow her American husband to the U.S. because (like most students of her day) she had joined the Communist Party while at university.

Mrs. Gordon would have been so proud of the students who mobilized and planned today’s walk-out and the planned #MarchForOurLives on March 20th. She would have discussed them with her students and encouraged them to express their thoughts and make their plans. Those of us fortunate enough to have had her as a teacher will always remember her with great appreciation and respect.