Rockstars!

If you’re like me, then there’s nothing more entertaining to you then seeing scientists put on shiny suits and ties and then pose awkwardly with various famous musicians.

Rock Stars of Science from the Geoffrey Beene Foundation is a long overdue acknowledgment of the importance of science and the need to promote interest in it. It's particularly exciting to see this kind of promotion done in an innovative way. Rather than simply profile these scientists as has been done numerous times before, Rock Stars of Science is trying to get people to see science in a new light and they're emphasizing how cool science is, and how cool it should be.

The Geoffrey Beene Foundation has an excellent history of promoting science, and their new program (coming soon to a GQ near you), is exactly what the scientific community needs. In a world in which 74% of people can't name a living scientist, it’s doesn't hurt to take abstract ideas such as “cure for cancer” and “AIDS vaccine” and show the people who are working so hard to make them a reality. These people have devoted their lives to saving the lives of others and they are responsible for some of the greatest discoveries of our lifetime. I think that should earn them the chance to stand next to Sheryl Crow for a photo shoot don’t you?

It’s with this in mind we present the . . .

New Voices Coolest Scientist Ever Tournament

For those basketball fans out there, the New Voices tourney is the science version of March Madness. Our bracket will feature the world's coolest scientists in a geeked-out challenge for title of Coolest Scientist Ever. We will have brackets for past and present scientists, and over the next month narrow the field from 16 to the one, undisputed Coolest Scientist Ever. Keep in mind we are not just comparing the quality of their discovery, but also how they would look in hyper fashionable clothing standing next to Will-i-am.

Take a moment to nominate your favorite scientist in the comments section. Starting next week we will post the brackets and begin the tournament! Followers of this blog will vote for the winners from each challenge (posted on Tuesdays), and the brackets will narrow each week. On July 31st, we will crown the Coolest Scientist Ever.

Silence is the Enemy

Men and women from across the blogosphere have been writing in support of the Silence is the Enemy campaign started by Sheril Kirschenbaum over at The Intersection.

Silence is most assuredly the enemy when it comes to violence. Some quick facts*:

• 1.6 million people worldwide die each year from violence. More than 51,000 are Americans.
• Violence is the leading cause of death among people aged 15-29.
• The U.S. saved $14.8 billion on heath care, police response, lost productivity and death in the first five years of the Violence Against Women Act. In comparison, the investment in the program to prevent violence against women was $1.6 billion over the same time period.

According to a 2008 Research!America survey**, 98% of Americans think that the U.S. should work to prevent violence in the U.S. and 61% think the U.S. should work to prevent violence globally. Either way, that's a lot of Americans who want to stop the violence before it starts.

How will you stand up and make your voice heard so that silence is no longer the enemy?

*Facts from the Investment in research saves lives and money fact sheet on Global Violence.
**See slides 12 & 13

Friday Round-Up

Photo credit: Unhindered by Talent

Our New Voices team has pulled together some suggested reading for those of you trying to beat the heat with a little indoor reading this weekend.

Matt's picks:

• Op-ed: What science deserves its stimulus money
• New sources of stem cell seem to be discovered every week

Takao's picks:

• Richard Posner’s does a cost/benefit analysis of American health care
• Atul Gawande’s brilliant piece detailing the spiraling costs of health in a small Texas town
• Op-ed: Health care reform doesn’t accomplish a thing if it doesn’t support innovation
• Is Hell endothermic or exothermic?

Heather's picks:

• Jerry Zucker discusses the value of the Science and Entertainment Exchange with the National Academies
• Israeli newspaper's experiment results in a pretty unique issue

Happy reading and see you on Monday!

Upcoming Town Hall Meetings

We hope everyone is already scheduling their meetings with members of Congress who'll be home in their districts next week for the 4th of July recess. Many members will also be sponsoring town hall meetings for their constituents to raise issues. So grab a few friends and make your voices heard! Here are some members of Congress who'll be available locally for their constituents in the next week:

Arizona
Rep. Raul Grijalva

California
Rep. Brad Sherman

Connecticut
Rep. John Larson

Delaware
Rep. Mike Castle

Florida
Rep. Bill Posey
Rep. Ileana Ros-Lehtinen

Georgia
Rep. John Barrow

Hawaii
Rep. Neil Abercrombie

Iowa
Sen. Chuck Grassley

Kansas
Rep. Jerry Moran

Mississippi
Rep. Gene Taylor

Missouri
Rep. Sam Graves

Minnesota
Rep. Keith Ellison
Rep. Betty McCollum

New York
Rep. Tim Bishop
Rep. Eric Massa

Oklahoma
Rep. Frank Lucas

Oregon
Sen. Jeff Merkley
Sen. Ron Wyden

Rhode Island
Rep. Jim Langevin
Sen. Sheldon Whitehouse

South Carolina
Rep. Bob Inglis

Texas
Rep. Michael Burgess
Rep. Ciro Rodriguez

Washington
Rep. Cathy McMorris Rodgers

Wisconsin
Sen. Russ Feingold
Rep. F. James Sensenbrenner

How to: Have a Successful Meeting in Your Elected Official's Office

Map of 111th Congressional Districts courtesy of FiveThirtyEight.com

Members of Congress need to hear from you - their constituent - about issues important to your community, such as research. Take advantage of the annual Independence Day congressional recess (June 29 - July 3) and make an appointment to meet with your elected official in their district office.

In fact, now couldn't be a better time to reach out to your officials about the hot topic of the summer - health reform. When they get back after all the fireworks and fun, they'll be diving into at least a month of discussion and debate about how to improve the health of Americans.

So how do you have a successful meeting in your member of Congress' office? We asked Research!America board chair and former member of Congress John Edward Porter to share his principles for a successful meeting in your representative or senator's office.

1. Be prompt and patient.

• Be on time and prepared to wait if needed.

2. Start with a thank you.

• Thank the member for their service to you as their constituent and for taking the time to meet with you.

3. Have a specific and singular request. Examples include:

• Support specific legislation.
• Ask your member to sponsor or endorse a “DearColleague” letter.
• Invite members and their staff to come see where you work.

4. Be brief.

• Plan what you want to say and provide essential background information.

5. Speak with passion and personalize the message.

• Tell a story and make it relevant to the member.

6. Follow-up.

• Make sure to send a thank you note that reinforces your request and includes any materials that might be useful to the member/staffer based on your meeting.

You may have noticed that this post isn't titled How to: Have a Successful Meeting with Your Elected Official. That's because you won't always get to meet with the member themselves. When given the opportunity to meet with a congressional staffer, TAKE IT! Treat the staffer as you would treat your member of Congress, and remember that staffers handle most of the day-to-day in an office and have a tremendous amount of influence. Be kind and make yourself available to them as a resource and you're sure to develop a good relationship.

Check out all of Porter's Principles for more on how to make an appointment, have a successful meeting and sample advocacy messages to use during your meeting.

Engaging Audiences

Yesterday I attended the National Academies Communications Fair. Something that one of the panelists, Sue Allen, PhD of the Exploratorium in San Francisco, said really stuck got me thinking and I wanted to hear what you thought about this idea (time was up so the panel didn't actually get to explore the topic).

Dr. Allen had been talking about learning science in informal environments (basically any place that wasn't a traditional classroom). A member of the audience then asked her whether or not she thought it was a good idea to release the message this way - didn't it mean that you lose control over the specificity or accuracy of the scientific argument?

Her response was to define science in broad terms. Here's my stab at a paraphrase:

Science is a culture unto itself that is based on discussion, argumentation and hypothesis.

Based on a definition like this one, how is it that getting the science out there and letting other people decide for themselves what it means a bad idea? Do we really have control over the "message" in science anyway?

As a panelist from the afternoon session, Anne Simon, PhD, explained, science is about what we know at the time. She said she spent years telling her students there was no such thing as cloning mammals - that it wasn't possible. Then Dolly came along, and she started teaching about how cloning was a reality.

When the message can literally change overnight, isn't it time we let people discuss it? Are we actually asking our audiences to engage, or just trust us and regurgitate what we've told them?

I believe that science is an ever changing field improved upon by those who continued to imbibe it with their knowledge and research. For me, that means opening up the discussion to anyone who wants to join in and provide reasoned arguments.

What do you think?

Worst 5 Science Movies

So far, we've talked about science in the film and given some examples of what good science movies look like. Now for the fun part. What differentiates the good films from the bad is simply effort. The good films take a few minutes to think about the universe that they inhabit and make an effort to ponder the implications of their ideas. The bad films have gorilla human hybrids and super giant diamonds in the Earth's crust.

Congo. The movie involves gorilla/human hybrids. Gorilla… Human… hybrids. That’s right. You heard me. I mean, you probably don’t want to think about how these Humorillas were made but apparently they exist somewhere in Africa. But don’t worry, they have a purpose, which is to guard the magical blue diamonds, which can be used to make super lasers. Oh, and the characters eventually make diamond based Humorilla killing super lasers. I don’t think we need to know anything else.

The Day after Tomorrow. You know it’s a bad sign when NASA (who, let’s be honest, could probably use a publicity bump) publicly disavows a movie. So what’s wrong? For one thing, it would require most of Antarctica to melt in order to submerge New York City to the level it is in the movie. If all the rays of the sun were directed at the South Pole, its ice would melt in about two and half years. Naturally, in the movie, this occurs in a couple of days. Duke University paleoclimatologist William Hyde said it best, "This movie is to climate science as Frankenstein is to heart transplant surgery."

Outbreak. While everyone loves this movie, (I do too) there is a glaringly bad science created hole in the plot. Ok, 2 holes. 1. No virus this deadly, with this accelerated a life cycle, would survive for long, because it would burn through its food supply (us) far quicker than is sustainable. Even the Spanish flu of 1918 which killed between 50 and 100 million people spotted you a couple weeks before you died. 2. You can’t make a vaccine or a cure for a disease this deadly in field lab in about 20 minutes. I don’t care if you have the outbreak monkey’s blood. It's fair to say that vaccines cannot be produced in less time than it takes to watch an episode of The Simpsons. Great movie. Bad science.

The Core. It’s not original to say this movie is terrible. It’s also not original to say that the science in this movie is somewhere below sub-moronic. However, it’s also not original to say that ice cream is good, but that doesn’t make it any less true. A list of my personal favorite scientific nonsense from this piece of utter dreck…

• The core of the earth stops spinning. AND THIS IS KEPT A SECRET??? Now, I am no physicist, but I’m fairly certain that something like this might show up with simple science equipment like, you know, a compass.
• We’re all going to die because when the core stops spinning we’ll lose Earth’s magnetic field which means that we’ll be exposed to deadly microwave radiation that will cook us all TO DEATH! Leaving aside everything else, try deflecting radiation with a magnet. I’ll wait. Oh wait, no I won’t, because it doesn’t work and I’ll have to wait forever.
• The solution is of course blow up nuclear weapons inside the core. No, really, that’s the solution. So a couple of nuclear weapons (which couldn’t possibly produce enough energy) will hit the core and just start it spinning? Is it like a reset button?
• The ship which will of course tunnel to the center of the earth with movie magic lasers and somehow use MRI TO STEER A SHIP THROUGH SOLID ROCK.
• They’re in radio contact with the surface. While several thousand miles deep into the center of the earth. My cell phone barely works in the basement.
• At one point the ship runs into a “giant diamond” in the middle of the earth
• One of the scientists handles a plutonium fuel rod from an active reactor without a helmet to minimal consequences.

Oh, and it is 2+ hours long. Enjoy.

Look, it is just not that hard to include halfway competent science in a movie. Just a little bit of attention to detail is really all that separates Gattaca from The Core. Ok, there are a lot of things that separate Gattaca from The Core, but most of that has to do with plot, direction, acting and cinematography. The point is that when the effort is made, movies can respect science and still be entertaining and futuristic. Or they can steer a train through solid rock with lasers and an MRI.

Other great discussions of science and culture can be found at:
Bad Science
Insultingly Stupid Movie Physics
USA Today article on Science in Film

This is Part 3 in the New Voices series on Science in the Movies.
Part 1 - Science in Film
Part 2 - Top 5 Science Movies

It's hard work to be this unhealthy

Recently, the American Journal of Medicine published a study showing that virtually all of the lifestyle behaviors that keep us healthy are either in decline or holding steady. A study led by Dana King, professor of family medicine at the Medical College of South Carolina compared population samples from 1988-94 and 2001-2006 and found some unsettling data about American health.


So, in a nutshell, we got fatter, smoked more, ran less and ate worse. Not a ringing endorsement of American health.

While this on its face is cause for concern, another recent study from Peter Kuhn and Fernando Lozano of UC-Santa Barbara and Pomona colleges (respectively) gives me reason to speculate on what has caused such a significant health decline.

In 2006, Kuhn and Lozano published a study based on the work patterns of American men age 25-64. They found a significant increase in the number of people working more than 50 hours a week. Particularly among college educated men where the number had risen from 20% to 30% since 1980. This dovetails with UN International Labor Organization's study which found that Americans work more hours for more days than any other nation.

I can’t help but see at least a correlative effect between the health and work studies. It becomes progressively harder to maintain a healthy life style as you work more and more. It’s hard to find time to go to the grocery store, cook a healthy dinner and go for a run. Whereas, it’s very easy to get Chinese take-out, eat it in 10 minutes while working and then sit on the couch watching television for 3 hours before bed.

I’m not judging anyone, I’m as guilty as anyone when it comes to being lazy, but it's easy to be lazy when leading a healthy life style takes such an enormous commitment. It’s difficult to convince yourself to spend some of your free time on working out and cooking when you have so little of it.

I think it's also difficult to convince people to maintain a healthy life style when the spend all of their time working. The ILO study also points out that Americans take fewer vacation days than anyone else. Just like the challenge of maintaining discipline in the face of a 50 hour work week, I think it's awfully difficult to maintain discipline when you're working 48 weeks a year. There is a reason Europeans tend to live longer than Americans and I suspect it has something to with the fact that they take vacations and try to enjoy life.

I'm not suggesting that there's a clear causal link here as there are a lot of factors that contribute to American health, but I do think that if you want people to engage in life prolonging behavior it helps if they enjoy life enough to want to prolong it.

Just a little food for thought.

Fathers and Health

Happy Fathers Day! In honor of all of our fathers on their day, I thought it would be good to share some facts with you about just how important fathers are to the health of their children. Having an active and involved dad has an enormous impact on a child, from their education to their behavior. So, thanks to the great people at Fathers.com, here are just some of the facts about how a father helps us.

- Father-child interaction has been shown to promote a child's physical well-being, perceptual abilities, and competency for relatedness with others, even at a young age.
Source: Krampe, E.M. and P.D. Fairweather. "Father Presence and Family Formation: A theoretical Reformulation." Journal of Family Issues 14.4 (December 1993): 572-591.

- A fathers’ body mass index (a measurement of the relative composition of fat and muscle mass in the human body) is directly related to a child’s activity level. In a study of 259 toddlers, more active children were more likely to have a father with a lower BMI than less active children.
Source: Finn, Kevin, Neil Johannsen, and Bonny Specker. “Factors associated with physical activity in preschool children.” The Journal of Pediatrics 140 (January 2002): 81-85.

- Children who live apart from their fathers are more likely to be diagnosed with asthma and experience an asthma-related emergency even after taking into account demographic and socioeconomic conditions.
Source: Harknett, Kristin. "Children’s Elevated Risk of Asthma in Unmarried Families: Underlying Structural and Behavioral Mechanisms." Working Paper #2005-01-FF. Princeton, NJ: Center for Research on Child Well-being, 2005: 19-27.

- The U.S. Department of Health and Human Services states, "Fatherless children are at a dramatically greater risk of drug and alcohol abuse."
Source: U.S. Department of Health and Human Services. National Center for Health Statistics. Survey on Child Health. Washington, DC, 1993.

- Using nationally representative data on over 2,600 adults born in the inner city, it was found that children who lived with both parents were more likely to have finished high school, be economically self-sufficient, and to have a healthier life style than their peers who grew up in a broken home.
Source: Hardy, Janet B. et al. "Self Sufficiency at Ages 27 to 33 Years: Factors Present between Birth and 18 Years that Predict Educational Attainment Among children Born to Inner-city Families." Pediatrics 99 (1997): 80-87.

So thanks for the health benefits dads. Have a happy Father's Day!

How To: Greet Others

As a professional, from time to time you'll find yourself in situations where you need to greet others. This seems simple, right? A nice, "Hello, how are you? I'm ...." should suffice.

Well, except that you maybe met that person at a conference three months ago. Your colleague must have introduced you to twenty people that day, and you can't remember who was who. No worries, though. There are some quick and easy tricks to greeting others to not embarrass yourself or them.

Typical introduction: "It's nice to meet you."
Networking substitute: "It's nice to see you."
By replacing 'meet' with 'see' you are saying the same thing, but allowing for the fact that you may have previously met this person.

Other good substitutes are: "How are you?" or "How have you been?"
Both are perfectly benign questions that let people feel comfortable (and get them talking) without necessarily indicating whether you've met before.

So what if you are SURE you met them before but cannot, for the life of you, remember their name or where they work? First, relax. This happens to everybody. Play it smooth.

Assuming you are at an event where the hosts have been a bit inconsiderate and not provided nametags, try to grab a colleague. Use the above lines (hey, they might not remember you either!), and then introduce your colleague (or anyone you're talking to). Try: "This is so-and-so. They ...." With any luck, the other person will stick out their hand and say their name.

If you're at the event alone, and standing alone (which if you're networking, you probably shouldn't be), the above trick won't work. The good news is, you don't need someone's name to talk to them. Just work through the conversation and then offer them your card. If you think you may have done this before, flip it over and write something about your conversation on the back and hand it to the other person. With any luck, they'll reciprocate with their card.

Any other greeting tips?

Combating Cancer

Today on New Voices, we want to present a new occasional format: Point/Counterpoint. We'll introduce a topic that has been getting a bunch of traction and then discuss in the comments section. We ask that all comments be on "point" and that there are no personal attacks.

Without further ado, our topic today is combating cancer using increased federal funds. In President Obama's April 27, 2009 speech to the National Academy of Sciences he said,

"We will devote more than 3 percent of our GDP to research and development. We will not just meet, but we will exceed the level achieved at the height of the space race, through policies that invest in basic and applied research, create new incentives for private innovation, promote breakthroughs in energy and medicine, and improve education in math and science."

He also said,

"Because of recent progress –- not just in biology, genetics and medicine, but also in physics, chemistry, computer science, and engineering –- we have the potential to make enormous progress against diseases in the coming decades. And that's why my administration is committed to increasing funding for the National Institutes of Health, including $6 billion to support cancer research -- part of a sustained, multi-year plan to double cancer research in our country."

However, a month later CQ [paid subscription necessary] reported that:

During a hearing Tuesday, House Appropriations Chairman David R. Obey, D-Wis., told Health and Human Services Secretary Kathleen Sebelius that he would not agree to dedicate extra money to cancer research in the National Institutes of Health's fiscal 2010 budget. He said he believes it is inappropriate for lawmakers to decide to fund research on one disease at the expense of others. "The result will be political chaos in an area that ought to be determined by science," he said.

That's a point and a counterpoint. Where do you stand?

Top 5 Science Movies

As we discussed last Tuesday, there are good science movies and bad science movies. You’ll have to wait a bit to hear me wail about the bad ones, but here are some of the better examples of science in film.

Gattaca: I’ll admit I’m biased because I enjoy this movie, but it’s still fairly scientifically sound. Presenting a future in which parents can control the genetics of their children is neither absurd nor far fetched. The science of screening for genetic defects is already present and it’s not that much of a technological leap to assume that the technology to not only screen but prevent genetic disorders will someday happen and it’s sadly even less of a leap to assume that it will be abused to craft children’s genetic destiny. If you were going to be a parent and you could make your child a star, would you have the will to say no? In the end, this movie presents interesting a realistic ethical question regarding scientific advances we could see in our lifetime. You can’t ask for more than that.

The Right Stuff. This is not the most scientifically rigorous movie, but it really isn’t trying to be. That said, it does an excellent job of depicting the historical, events and discoveries related to the Mercury 7. It’s always so rare to see a movie that says “based on a true story” actually trust that story to be interesting on it’s own..

Blade Runner. Another example of doing a good job with a reasonably imaginative future. No outlandish technological leaps. No one fires a laser pistol. Okay, so there are flying cars, but there will be flying cars any day now (don’t destroy my dream and while we’re at it there will also be jet packs any day). The other reason Blade Runner goes on this list is that it represents an excellent example of quasi super humans (the replicants) who obey the laws of physics. There are innumerable reasons that you can’t rip a steel door apart and to this film’s credit, the superior biological organisms never do.

Contact. Bear with me, I am aware of how ridiculous the giant black gyroscope is. That’s not why the movie is listed. It’s listed because this movie does a respectable job of presenting not only its science, but also the complexity of a discovery like this. You have to get and keep funding which is not an easy task. You have to work in teams, there is rarely if ever a lone scientist making every discovery themselves. Any international project will be complicated and political. But, most importantly, you have to believe in your work. Even in the face of doubters and funding cuts, you have to have absolute unwavering belief in your project, otherwise you are doomed to failure. Also, bonus points for the fact that aliens totally exist.

Awakenings. An all around excellent film that details some very real aspects of a clinical trial and in particular the applicability of drugs to multiple conditions (A Parkinson’s drug is used to “awaken” some patients) and the nature of success and failure. This is an incredibly powerful film about the possibilities of discovery. Plus it makes you cry. It makes everyone cry.

Looking at these movies you can see the common themes. Realistic science, an examination of the philosophical implications of that science and the existence of physics are present in all these films. The science in a good film isn’t always real, but it usually makes a certain kind of sense. Unlike the terrible, terrible films to be discussed next Tuesday.

How can we move medical innovation forward?

Chronicles of a Science Policy Intern

How can we move medical innovation forward? This was the focus of an event last Friday hosted by the Council for American Medical Innovation and the Aspen Institute in Washington, D.C. Sen. Arlen Specter (D-PA) (note: that’s the first time I’ve typed D-PA next to Sen. Specter’s name!) keynoted the event to provide insight about the perspectives on medical innovation from Capitol Hill. I have to give the Senator from Pennsylvania high marks for being one of the most personable, approachable senator’s I’ve listened to in person. When he solicited questions from the audience, and no one responded, he walked off the stage in to the room like he was going to cold call someone for a question. That perked people up and the questions started flowing like a conversation.

Sen. Specter charged the conference attendees with developing new ideas for advancing medical innovation. Here is a summary of some of the ideas that were generated:

• Form a blue-ribbon commission to make recommendations about medical innovation. This was a very “inside-the-beltway” solution suggested by Billy Tauzin, President and CEO of PhRMA. This seems like low-hanging fruit to me. How often do commission suggestions get implemented anyways? Does anyone have a statistic here?
• Allow Congress to create a capital expenditure budget for R&D spending. Here is a gross simplification of Accounting 3001: the current spending model, PAYGO (pay-as-you-go), demands paying for R&D spending with funds available while the programs are in place. A capital expenditure budget, referred to as CAP EX, would allow Congress to invest in R&D similar to a corporation—spend now in anticipation of future benefits.
• Make being a scientist “cool” again. The proposed suggestion: plop the to-be-created ‘Scientist of the Year’ award recipient next to First Lady Michelle Obama during the next State of the Union Address. Doesn't she make everything cool?!

CNN political contributor Paul Begala made a statement that should serve as a resounding call to action for all the New Voices for Research out there: (I’m paraphrasing here)

Politicians don’t lead—they follow the public.

Coming from a former White House advisor, this is all the more a reason to make our voices for research louder.

Friday Round-Up

Image from: survivingtheworld.net

First, congratulations to FlyGal, who's farewell post So long and thanks for all the fish was published in the June Scientiae blog carnival. The theme this month was moving forward and we've heard rumors that FlyGal is indeed moving forward the way she hoped. Stop by the carnival to read other inspirational stories as well.

Some other interesting reads for you this weekend include:

• A New England Journal of Medicine piece on the FDA as a public health agency written by the new FDA director, Margaret Hamburg and Joshua Sharfstein, the principal deputy commissioner.
• The WSJ Health Blog is live blogging details about the H1N1 virus and Ed Yong over at Not Exactly Rocket Science has a good breakdown on the origins of the now pandemic swine flu.
• El Nino may be upon us again.
  
• If your pocket periodic table is wearing around the edges (you know you have one), it may be time for an upgrade. Welcome super-heavy element 112.

Have a great weekend everyone and we'll see you next week!

CER's definitive maybe

Comparative Effectiveness Research. CER. It’s coming soon and to believe some of the things that have been written about it, one would expect it to loom on the horizon like a dark storm cloud, spitting lightning and damaging medical care wherever it goes.

Some hate its impact on the growth of personalized medicine and some think it represents the first step to an invasive and paternalistic regulatory system in which the government controls every doctor’s decision. Being the die hard skeptic that I am, hearing this kind of wailing tends to lead towards asking the question of whether any of this is true. In the case of CER I can answer with a definitive… it depends.

I say "it depends" because CER is not attatched to any policy platform yet. Right now, it's a study to see what kind of data we can get. It isn't definitely one thing or the other until we see what the government chooses to do with that data. The concerns being expressed are policy problems based on what might be done with the CER data.

Personalized Medicine
When people look at CER they see a world in which studies determine what the best mode of care for 51% of the people and apply it to 100% of the population. This would appear to be a rollback of all of the gains made in individualized care. However, this fear makes strong assumptions about what the goals and means of CER.

Rather than assuming CER is a monolithic study designed to produce only one “effective” treatment, it is also possible to view CER as being a large scale work of clinical epidemiology. It can be used as a way to determine which of the myriad personalized medicine options are going to be more effective. Viewed in this light, CER becomes a tool that would allow physicians to spend less time on unproductive treatments. It COULD be a monolithic means of determining best care, but it hardly has to be.

Dr. Big Brother
The idea that CER will be used to dictate medical care is based on a similarly unfounded assumption. It assumes that the data from CER studies will be used by both the government and private insurers to dictate an exact plan of care by reimbursing patients only for CER rated “best” treatments.

This fear again assumes that CER will be used to rate “best” treatments and also makes some assumptions about the present and the future. It assumes that in the present these health entities don’t already make reimbursement decisions based on effectiveness data and assumes that there would be no protection of personalized medicine in the future.

For the present, given that insurance entities are already making these same determinations, it seems possible that their information would be better with a comprehensive CER regime. The concern for the future is a valid one and does require that, if CER expands in the future, there will be some necessary protections based on the data that comes out, but to assume that it will be used in the most underhanded manner has no basis in the current legislation.

Conclusions
So that’s a very clear maybe. My point in this is not suggest that those people concerned about CER have no point, but rather to show that it’s based on sizeable assumptions about a program that hasn’t even gotten off the ground yet. It’s this indeterminacy which suggests that, rather than fight against CER, these groups should be active in shaping the future of it. Yes, it could be disastrous for American health care, but it doesn’t have to be. CER is coming, but what it does depends on what we do… maybe.


This is Part 2 in the New Voices discussion of comparative effectiveness research (CER).
Part 1 - What is Comparative Effectiveness Research?

Experiences with H1N1 in China

Chronicles of a Science Policy Intern
Shortly before starting my summer in Washington DC, I traveled to the People’s Republic of China for 2 weeks to complete a course in international entrepreneurship. All in all, it was a great trip. I learned a lot and would highly recommend a visit to China for anyone interested in learning more about this developing country.

Arriving in China by plane revealed the first of the unexpected experiences. The H1N1 virus (swine flu) is still a very real concern in China. Upon landing in Shanghai, the entire plane was considered to be “in quarantine.” Chinese health officials boarded the plane wearing complete biohazard suits including goggles and respirators. Each passenger was individually screened for fever or other signs of the H1N1 virus. The Chinese health officials walked up and down each row and took the temperature of every passenger by holding a thermal imaging scanner to our foreheads. This went one-by-one in an A330 with almost 300 people on board. Someone several rows behind me apparently did not pass the quarantine exam, because all the health officials gathered around this unfortunate soul. Soon, several seats in the near vicinity had large red stickers on them and those people didn’t get off the plane when the rest of the passengers were allowed to deplane over 60 minutes later. Luckily, no one in my group was quarantined.

While this was an interesting experience, it raised a larger question: is this really the most effective way to prevent a public health crisis? Considering the fact that there is rarely antibacterial soap in any restroom in China, hand sanitizer is not provided in public areas, and many Chinese citizens readily spit in public, I question whether the resources spent to screen an entire plane could be spent more wisely on public health initiatives to prevent the spread of disease. Before I arrived in China there had only been a few documented cases of H1N1, so apparently the Chinese method of keeping H1N1 from entering the country has been effective so far. This seemed like a “wall” approach. If the country could keep H1N1 out, there wouldn’t be a problem. But what happens if the “wall” develops a crack? Without the internal infrastructure (antibacterial soap, hand sanitizer, hygiene) in place, China is taking a huge gamble with the health of its citizens. I’d argue that in addition to keeping H1N1 out of China, the government should also work to develop internal measures to prevent the spread of the virus in the event that H1N1 or a mutated form does enter the country.

I’m curious about the differences in public health initiatives between the United States, China, and the rest of the world. What experiences with public health and H1N1 have you had? Does anyone have experiences with the public health responses of other countries to H1N1?

Science in Film

We’ve all had the experience. You’re sitting watching an otherwise entertaining movie or TV show and all of a sudden it happens. The Terrible Science Moment. It could be anything from a discovery to the way a hospital or a lab is presented. Or it could be CSI. The point is that we’ve all experienced that moment where our natural suspension of disbelief is shattered and we’re left with no choice but to change the channel and watch something else. Maybe The Simpsons is on.

So, what characterizes the best science films? A question that anyone associated with the sciences will answer differently. We all have our own personal things that we’re willing to suspend disbelief for just as we all have our personal views that, when violated by movie science cause us to howl out cries of “I can’t BELIEVE they got it so WROOOOOONG”.

For me, I don’t ask that everything be accurate. Partially because accuracy is rarely if ever dramatic, and partially because I, like many people, live in the real “accurate” world and it is not especially exciting. What I do ask, is that films approach science honestly and with some respect. I can live with dramatic choices as long as science isn’t used as the equivalent of magic. A generic example of the difference…

Film 1. The protagonist has been attacked by the villain with a poison for which there is no known cure. They seek out the eccentric scientist who has an untested potentially lethal cure that she’s been working on for years. The protagonist demands the cure regardless of the risk. The scientist injects him with it and there is a dramatic scene as the protagonist hovers near death and screams and thrashes around a lot. Then he opens his eyes and slowly reaches out a hand to his true love. The cure has worked. He is saved.

Film 2. Same scenario as above. Except now the protagonist rushes to a lab to INVENT the cure. She is seen pouring various oddly colored liquids into oddly shaped plastic tubes until days (or hours) later there is a single test tube of “cure” that is an even stranger color, which she then drinks. The same painful curing scene as above with the same ending.

Film 1 is moderately absurd but within the realm of possibility. I have met many eccentric scientists and I like to think that many of them have strange labs and are working on unusual projects. Film 2 makes me insane. I think the process of discovery is amazing and yet I’m quite certain you would be hard pressed to cure disease with a couple of days in a generic lab with no lab techs and absolutely no testing. Both of these films are ridiculous but at least one acknowledges some reality of science.

It’s a question of respect and it’s also the difference between a good science film like Gattaca and The Worst Science Film Ever In History… The Core. I don’t know how accurate Gattaca is, but I know it aspires to be realistic and it has a respect for both the process of science and the ethical dilemmas that it creates.


Contrast this with TWSFEIH The Core, where science is like magic… only dumber. I could go on about the differences, but instead I think it’s best to give examples. So tune in next Tuesday to see what I think a good science film looks like and watch me yell, scream and wave my arms over the worst science films I have ever seen. Including TWSFEIH The Core.

What is Comparative Effectiveness Research?

One of the fascinating (and much debated) new programs contained within ARRA (American Recovery and Reinvestment Act) is 1.1 billion dollars to be spent on comparative effectiveness research (CER). CER immediately became a much debated topic with government supporters strongly in favor of it and many coming out just as strongly against it. Naturally, like most controversial topics, there has been minimal discussion of what it is. According to the department of health and human services CER is:

“Comparative effectiveness research is the conduct and synthesis of systematic research comparing different interventions and strategies to prevent, diagnose, treat and monitor health conditions.”

Right, so in lay speak, that means that CER will evaluate procedures and medicines and see which ones are going to have the most value to patients. It is a program that is designed to cut waste from the process of patient care.

HHS also lists the criteria on which medicines and treatments will compared...

1. Potential impact (based on prevalence of condition, burden of disease, variability in outcomes, and costs of care).
2. Potential to evaluate comparative effectiveness in diverse populations and patient sub-populations.
3. Uncertainty within the clinical and public health communities regarding management decisions.
4. Addresses need or gap unlikely to be addressed through other funding mechanisms.
5. Potential for multiplicative effect (e.g. lays foundation for future CER or generates additional investment outside government).
   

Or to put it into simpler terms...

1. Will this significantly help a serious problem?
2. Will this have an impact across a broad range of population?
3. Will this make treatment decisions easier?
4. Will this help where no one else is helping?
5. Will this help future research on CER?
   

So why do we need this? Well, in traditional clinical trials medicines are compared only against placebos (a.k.a. nothing). The idea behind CER is that we'll be able to make better decisions if these medicines are tested against each other. In theory, we will be able to determine which medicines and treatments are most effective and we will be able to determine if specific medicines should be targeted for specific patients. The goals of CER are to provide better care at a lower price. Whether it can do that is up for significant debate.

Why do we need the government to do this? One of the primary reasons why the government would be involved in this is because the private sector lacks sufficient incentive to engage in this research. Any discoveries regarding the comparative effectiveness of medicines could have unpredictable benefits and costs across industry. It's difficult to incentivize a business to do research which could show their product is the least effective one on the market. This leaves the government, in its role as representative of the public interest, as the most neutral entity to do the research.

But what does this all mean in the end? One major concern is that each party in the health care field is going to have a very different definition of what constitutes waste; and the costs and benefits of an expanded CER program are going to depend entirely on which definition of waste you use.

There is the potential for very real problems with CER. It has the potential to be as wasteful and bureaucratic as any of the worst government programs (Medicare I'm looking at you...). Also, HOW you run the program (and not the program itself) is going to determine whether CER is a miracle or a monster.

We'll examine these key criticisms - and any others you suggest in the comments section - on Thursday.

Welcome Two New Voices

Here at New Voices, we're excited to announce that we have two new regular bloggers joining us for the summer, Takao Yamada and Matt Hanzlik.

Name: Takao Yamada
Position: Research!America Science Policy Intern
Education: Georgetown University Law Center c/o 2010
BA in Political Science & English, Hobart College
Previous experience: Takao has worked in industry and been an entrepreneuring restaurateur. Aside from all those college English papers, he has writing experience as a freelance sports reporter.
Fun fact: If the picture doesn't give it away, Takao likes food. He even won a pie eating contest when he was eight.

Some posts you may have seen by Takao so far include: Soda as Sin and Sensationalizing Science Journalism.

Name: Matt Hanzlik
Position: Research!America Science Policy Intern
Education: University of Minnesota c/o 2010
Studying: Public/Non-Profit Management & Entrepreneurial Management
Previous experience: Matt has a strong advocacy background having served as the National Advocacy & Government Affairs Coordinator for the Student Society for Stem Cell Research and as a business and outreach intern at the American Parkinson Disease Association of Minnesota.
Fun fact: Even though he's from a land-locked state (minus all those lakes), Matt wants to learn to barefoot water-ski before the end of the summer.

Matt previously joined New Voices as a guest blogger in January to discuss President Obama's executive order on stem cells.

We're looking forward to Takao and Matt's perspectives and hope you'll welcome them to the New Voices community!

Climate Change and Health: Extreme Weather Events

Image from: www.climatechangeconnection.org

Throughout this series we've talked about a number of ways that climate change effects human health. Anyone familiar with the topic of climate change has heard the horror stories about the catastrophic events that are in store for out planet if we don't curb carbon emissions. Today we're going to look at how those extreme weather events could alter human health.

A few recent examples of extreme weather events include the tornadoes in Oklahoma in February - outside of regular tornado season - and the floods in North Dakota in March, caused by heavy rains and blizzards, which President Obama cited as an example of the need to act on global warming. Additionally, we are likely to see more intense and frequent hurricanes, windstorms, and mudslides.

A particularly horrific example of how climate change can intensify natural disasters is the wildfires in Australia. Though the fires were caused by arson, they were spurred on – at least in part – by global warming, which had caused excessive drought and heat in the region.

The NASA map below shows land surface temperature across Australia from January 25 to February 1, 2009 compared to the average mid-summer temperatures the continent experienced between 2000-2008. During this time period, temperatures differed up to 10 degrees Celsius: cooler in blue regions, normal temperatures in white regions, and hotter temperatures in red regions.


As we approach hurricane season (Cyclone Aila has already made landfall) and the dog days of summer more and more people will be talking about climate change. The question is, what changes will we fight for to help save our planet and our health?


For more on this topic, check out these Science Progress resources: Global Ailing, The Human Toll of Climate Change, and this map.


This is Part 7 of 7 in our Climate Change and Health series.
Part 1 - Climate Change and Health
Part 2 - Heat-Related Issues
Part 3 - Malaria
Part 4 - Lyme Disease
Part 5 - Mental Health
Part 6 - Water-borne Disease
Part 7 - Extreme Weather Events

Sensationalizing Science Journalism

Say it with me people… “Correlation is NOT causation”

Frequent Moves Increase Suicide Risk in Teens

This was from the New York Times health section on June 1st and I can’t tell if it offends me more from a scientific or a journalistic standpoint. The article details a Danish study examining the links between teenage suicide and moving. A fine study that could yield some interesting results with the potential to give us an indicator of when parents should be concerned. But, given the research on suicide to date, it would be somewhat ridiculous to suggest that moving has clear, causal links to suicide.

To her credit the author of the study Dr. Ping Qin of the Centre for Register-Based Research at Aarhus University in Denmark points at that nothing in the study suggests whether moving is a causal risk factor or an intermediate variable, but the article then drops this quote from a professor not involved with the study….

“The evidence is becoming quite compelling that there is a causal effect of children’s residential mobility on a variety of negative behavioral outcomes…”

Now, it’s possible that there is some link between moving and teenage suicide, but the evidence in this study doesn’t suggest it. This quote is particularly problematic because the study did not control for poverty, family instability or distance moved. So an impoverished child who has to move across the country following the divorce of his parents is treated the same as a wealthy child whose whole family moves across town. I cannot speak for everyone, but that strikes me as a serious problem with anyone claiming that there is a causal link between suicide and moving.

Suicide is an incredibly serious problem in this country with 1.3 million deaths annually. It’s the third leading cause of death among Americans age 15-24. Articles like this is they continue to promote magic bullet theories to teen suicide instead of a thorough examination of all the causes of suicide. When you see that 90% of people who die by suicide have a treatable mental illness or a substance abuse disorder and then imagine the claim that it’s really about moving, you can understand why this article upset me.

It’s Dr. Qin's fault that her study was used in this manner (although the adjustment failures within it are), and I hope that science journalists will keep their focus on the details rather than sensationalism (which isn't selling papers anyway). Perhaps I’m overreacting, but I find it frustrating when things like this are promoted in the stead of research into depression and social anxiety disorder that actually helps save lives.

For some real details about suicide check out the following resources:

• National Institute of Mental Health
• Suicide fact sheet
  

Flowing Scientific Knowledge

Victoria Falls, Zimbabwe by only_point_five

"Advances in science when put to practical use mean more jobs, higher wages, shorter hours, more abundant crops, more leisure for recreation, for study, for learning how to live without the deadening drudgery which has been the burden of the common man for ages past. Advances in science will also bring higher standards of living, will lead to the prevention or cure of diseases, will promote conservation of our limited national resources, and will assure means of defense against aggression.But to achieve these objectives - to secure a high level of employment, to maintain a position of world leadership - the flow of new scientific knowledge must be both continuous and substantial. "

from Science the Endless Frontier by Vannevar Bush

How can we assure that "the flow of new scientific knowledge" is both "continuous and substantial"? The discussion is open in the comments section ...


This is Part 2 in our ongoing discussion of Science the Endless Frontier.
Part 1 - Introduction
Part 2 - Flowing Scientific Knowledge
Part 3 - The Importance of Basic Research
Part 4 - The Need for Federal Support for Research

TV Science is Not Real Science

(Click here for full strip) Credit: PhD comics

I don't watch a lot of popular shows, but after some prodding by a colleague here at New Voices, I watched an episode of House. I know it's TV. I know the show is only an hour long and I know they have to take some artistic liberties, but two things bothered me:

1. The smart guy in the show was neurotic, anti-social, white and male (which does nothing to stop the already popular misconception that scientists are largely Caucasian males who are weird and socially awkward creatures).

2. The time line for solving the medical mystery was completely unrealistic, since right now, the time line for going from basic research breakthroughs to applied therapies/pills is about 10-15 years.

It made me think,

"No wonder people are mad that we still don't have a cure for cancer or whatever other disease. If people think that breakthroughs in medicine and science can be achieved just like that - hey presto- then we are in real trouble."

In some ways I am happy that TV and mass media is showing images of scientists- at least we have a presence out there. But, it would be nice for people to know how real scientists operate in the real world.

I wish there was a reality show that followed grad-students and post-docs around to show people what really happens. The slow grind of grant proposals, experiments (most of them failing, or worse, a positive result that can't be reproduced), Internal Review Boards (IRBs), manuscript submissions, the review process etc. And then , if you are lucky enough to be in translational medicine or manage to collaborate with folks over in clinical/translational medicine, maybe the product goes into clinical trials, FDA approval, marketing....

What do you think? Would you watch a show like that?


Related resources:

• Naturally Obsessed: The making of a scientist- a documentary about life in a molecular biology lab.
• Post about Grey's Anatomy's misleading finale at Framing Science
• Post about Science on TV at Science Progress