The past five years have been a wild ride intellectually and professionally. When I started this postdoc I was a year out of completing a PhD in paleontology. Specifically, I'd been looking at the relationship between bone morphology and mammal ecology in the fossil record of the North American Paleocene-Eocene (roughly the first 20 million years after the extinction of the dinosaurs) to see if it could tell us anything about the role of locomotor specialization in the success of certain groups of mammals. I came to this lab to learn the techniques necessary to do biomechanical work necessary for testing the functional aspects of the correlations between morphology and ecology I based my paleontological work on. I thought, if I thought anything (I wasn't seeing particularly far into the future at that time, for a number of reasons) that I would spend a couple of years learning the techniques in a different system, then go back to my comparative functional morphology work with a little bit of biomechanics thrown in.
Fast forward five years later, and I'm leaving this lab with a completely different research focus. I'm off to start my own lab studying swallowing in the context of neurological disorders. I'm a Co-I on an NIH funded R01 I helped write. I'm increasingly interested in incorporating more explicit neuroscience into my work. I'm still interested in comparative question, but completely different ones based on the ontogeny of musculoskeletal systems and behaviors in mammal feeding. I haven't worked on anything paleontological in 4 years. I haven't touched a fossil since I finished my PhD.
This transition, or, more accurately, this complete change of track, is something I've spent a lot of time thinking about and coming to terms with. I had wanted to be a paleontologist since I was nine. How was it that after having come close to that goal, I was willing to move away from it all of a sudden? Did I really want to give up evolutionary biology and comparative zoology? Was I selling out?
Initially, my worries about this problem were acute, until I began to realise they were based on a false story I had been telling myself about myself. Yes, I'd wanted to be a paleontologist since I was nine, but that wasn't all I'd wanted to be. I'd also wanted to be a librarian, a policeman, and a doctor. More relevantly, I remembered that in my last year at Cambridge the three subjects that had really gripped me were paleontology, physiology, and neural mechanisms of behavior. I had even considered continuing with neuroscience, until I balked at the amount of animal work required (another change I've gone through since that time). So in some ways, the things that were drawing me into my new research direction, the problems and questions, were things that had always interested me as much as paleontology. One of my frustrations as a mammal paleontologist in fact had always been how little we discussed in any detail the unique physiological adaptations of mammals. I am first and foremost a mammal biologist, and that means that their physiology and behavior are interesting to me.
Yet my thinking has now matured even past that recognition into the realisation that what I do now doesn't erase what I have done. My five years working in paleontology, the fossils I collected, the museum collections I measured, the methods I used, the papers I published, the conversations I had, haven't been erased by my years working in mammal feeding physiology. Collapse the time dimension, and I am still a paleontologist, and a physiologist, and a neuroethologist, and a comparative zoologist.
I wanted to be a paleontologist when I was nine, and I am one. That doesn't mean I cannot be anything else as well.
Showing posts with label NIH. Show all posts
Showing posts with label NIH. Show all posts
Tuesday, 11 June 2019
Monday, 25 June 2018
On fallibility, humility, and responsibility in science
It has been a rough seventy two hours in the lab. Things have gone very very wrong. We have lost a lot of animals to an unknown illness that is swift and lethal. All day we have felt powerless, and the day ended in a succession of necropsies. More dispiriting, this is the second attempt we have made at this particular experiment. It started out much more promising than the last, but very suddenly, we were once again confronted with how little power we have over biology.
We work on an animal model of infant physiology, which means we work on infant animals. Few people do. It is difficult and demanding work. Infants have care needs beyond what a university animal facilities can provide (though ours have accommodated ours to an astounding degree). So we must step in to feed animals and care for them. Our bigger problem is this: there is little data on infant mammalian physiology, particularly for large farm animals like we work on. I remember a few years ago when we were having problems with our anesthesia procedure. Every vet and textbook in the country swore by tylezol for inducing our animals. It may have worked in adults, but it was useless in infants.
For the past two years we have increased the complexity of our experiments. We now raise the animals from birth, when they are most vulnerable. With full term animals, we had good luck. We got all the data we needed, and felt confident we knew what we were doing.
The grant that was funded however, called for doing the project in premature animals.
There is a very good reason for this. Human premature babies have a host of complications, in particular with regard to feeding and respiration function, which is what we study. Yet it is almost impossible to do the type of research we do on human babies, because it requires X rays. This is doubly the case for premature babies. Crucially, only babies diagnosed with problems can be enrolled in research studies for what we do. As a result, we have no idea what non pathological physiology in this system looks like for newborns, either full term or premature. The work we do addresses a critical gap in pediatric physiology.
Nor did we rush into this blind. We have years experience caring for young animals. Before this project, my PI found a team of researchers who do research in our model on animals far more premature that we were planning. They have come to visit us and us them. We discuss our problems with them regularly. And, thanks to them, our care of full term animals was a resounding success. We were cautiously confident.
The first preterm litter was a disaster. Only a single individual survived past 48 hours. It was pretty much our worst case scenario. We sat back, took stock. We bought better incubators. We developed new protocols for cleanliness and care. We settled on a slightly less premature age for our animals, scaling back our ambition in the face of how much more delicate these preterm animals were.
Again, we thought we were ready.
The delivery of the litter went amazingly. Sixteen healthy newborns in two used medical incubators. For 48 hours, we felt good.
Then they started to fall ill. By Saturday evening, two were refusing food (a very bad sign). By sunday morning, they had started dying. Today was almost like being in a hospital during an outbreak. It was utterly heartbreaking, and sobering.
We pay for our experiments in effort. I have been working well over fifty hours since Wednesday, like everyone in the lab. And we care. Our animals are helpless. And so we try to marshal all our resources to help them when they are ill.
And today I was reminded that we too are helpless.
We are working on a animal model of an incredibly vulnerable patient population. That vulnerability is baked into the very experiments we proposed to undertake.
I understand a little what working in a neonatal ICU must be like now. I understand what realising how little you know, and how little you can do, must feel like now.
As scientists, we plan experiments. We anticipate contingencies. We think about physiology, experimental conditions, confounding factors. Yet when we create animal models of disease, we create, in effect, patients. And we are suddenly faced with the maddening, terrifying, awe full power of illness. The limits of medical science, laid bare in our own research labs.
Hopefully, the remaining animals will survive. We will get data. We will feel our bargain with our animal subjects has been at least partially fulfilled.
But today, I think, I confronted the limits of what I do. Today, I think, we all felt, perhaps, we were getting close to the point where the price of the bargain is too high.
We work on an animal model of infant physiology, which means we work on infant animals. Few people do. It is difficult and demanding work. Infants have care needs beyond what a university animal facilities can provide (though ours have accommodated ours to an astounding degree). So we must step in to feed animals and care for them. Our bigger problem is this: there is little data on infant mammalian physiology, particularly for large farm animals like we work on. I remember a few years ago when we were having problems with our anesthesia procedure. Every vet and textbook in the country swore by tylezol for inducing our animals. It may have worked in adults, but it was useless in infants.
For the past two years we have increased the complexity of our experiments. We now raise the animals from birth, when they are most vulnerable. With full term animals, we had good luck. We got all the data we needed, and felt confident we knew what we were doing.
The grant that was funded however, called for doing the project in premature animals.
There is a very good reason for this. Human premature babies have a host of complications, in particular with regard to feeding and respiration function, which is what we study. Yet it is almost impossible to do the type of research we do on human babies, because it requires X rays. This is doubly the case for premature babies. Crucially, only babies diagnosed with problems can be enrolled in research studies for what we do. As a result, we have no idea what non pathological physiology in this system looks like for newborns, either full term or premature. The work we do addresses a critical gap in pediatric physiology.
Nor did we rush into this blind. We have years experience caring for young animals. Before this project, my PI found a team of researchers who do research in our model on animals far more premature that we were planning. They have come to visit us and us them. We discuss our problems with them regularly. And, thanks to them, our care of full term animals was a resounding success. We were cautiously confident.
The first preterm litter was a disaster. Only a single individual survived past 48 hours. It was pretty much our worst case scenario. We sat back, took stock. We bought better incubators. We developed new protocols for cleanliness and care. We settled on a slightly less premature age for our animals, scaling back our ambition in the face of how much more delicate these preterm animals were.
Again, we thought we were ready.
The delivery of the litter went amazingly. Sixteen healthy newborns in two used medical incubators. For 48 hours, we felt good.
Then they started to fall ill. By Saturday evening, two were refusing food (a very bad sign). By sunday morning, they had started dying. Today was almost like being in a hospital during an outbreak. It was utterly heartbreaking, and sobering.
We pay for our experiments in effort. I have been working well over fifty hours since Wednesday, like everyone in the lab. And we care. Our animals are helpless. And so we try to marshal all our resources to help them when they are ill.
And today I was reminded that we too are helpless.
We are working on a animal model of an incredibly vulnerable patient population. That vulnerability is baked into the very experiments we proposed to undertake.
I understand a little what working in a neonatal ICU must be like now. I understand what realising how little you know, and how little you can do, must feel like now.
As scientists, we plan experiments. We anticipate contingencies. We think about physiology, experimental conditions, confounding factors. Yet when we create animal models of disease, we create, in effect, patients. And we are suddenly faced with the maddening, terrifying, awe full power of illness. The limits of medical science, laid bare in our own research labs.
Hopefully, the remaining animals will survive. We will get data. We will feel our bargain with our animal subjects has been at least partially fulfilled.
But today, I think, I confronted the limits of what I do. Today, I think, we all felt, perhaps, we were getting close to the point where the price of the bargain is too high.
Monday, 20 October 2014
Fat Lesbians need more NIH funding
The usual suspects are going after NIH funding in light of Francis Collins' political own goal on ebola research. As a non US citizen, despite being paid out of an R01 NIH grant, I often feel like my voice is not the most useful in these debates. But as a gay man living in rural Ohio, I can tell you this. Contrary to what fair and balanced news coverage may have you believe, fat lesbians need more NIH funding, not less.
LBGT people are an understudied population in all aspects of clinical intervention, yet what research we have clearly indicates that, as a group, gay and lesbian people have worse health then straight people when you control for income and socio-economic group. Compared to straight men in their thirties, I am more likely to smoke, binge drink, and show signs of psychological distress. Although I am less likely to be overweight, lesbian women are more likely to be so than their straight counterparts. (data from CDC survey of health differences among gay and lesbians).
Crucially, that survey was conducted in 2013, and its results only published this year. It was the first of its kind. We have almost no population wide, systematic data on differences in the health of gay and lesbian individuals. What is more, we know they are less likely to have medical coverage (in part owing to problems with spousal coverage), less likely to have a regular healthcare provider, less likely to seek out medical help regularly and less likely to discuss LBGT specific issues with their healthcare providers.
Conversely, we know that most physicians receive almost no education in LBGT specific healthcare issues in four years od med school. I have a couple of gay doctor friends, and I have watched them advocate tirelessly for years to get LBGT health issues on the medical school radar. It is tough going and change is slow. The medical profession in the US is surprisingly conservative on these matters. LBGT men and women have long known that they have to be their own advocates in the doctor's office. Ask any gay friends you may have, and you're bound to hear some cringe worthy stories. But patient advocacy requires privilege. With my PhD and middle class background and white maleness, I can talk back to a doctor (especially when it comes to anatomy). I can demand treatment. I can argue. A latina teen lesbian who'se been kicked out of her house has no such recourse. A closeted twenty something gay farm boy visiting the same family doctor his whole family and town sees isn't going to be comfortable asking for an HIV test.
The HIV crisis fundamentally damaged the (already shaky) relationship between LBGT people and the medical profession. Not helped by the fact that homosexuality was considered a disease until 1973. Many gay men and lesbian women in big cities set up parallel networks of healthcare providers, because they neither trusted the medical establishment, nor had access to insurers. These voluntary outfits do amazing work for outreach, education and testing, but they do not provide the follow through a established family doctor does. And in the rural areas of the US, these services are few and far between. I know this first hand. In my old city, I could get free HIV tests several times a week at several locations. Here in Ohio, my family doctor seems surprised when I order one, and my other options are a monthly clinic half an hour away, or planned parenthood, which my insurance will not cover. And again, I am an out, educated, financially independent male. I'm not afraid of my doctor's looks, or the village gossips, or who sees me come in and out of the planned parenthood offices. I don't think that experience generalises to my LBGT friends who grew up here.
When Fox news goes after the paltry amount of money NIH is willing to give to investigating LBGT health issues, they are attacking vulnerable men and women in precisely the place where they are most exposed: their relationship with their healthcare provider. It is low and callous even by their standards. Fat lesbians and gay men who drink too much deserve NIH money. And remember, one day you may be grateful on behalf of your son or daughter that they got it.
PS: Hat tip to drungmonkey for alerting me to this.
LBGT people are an understudied population in all aspects of clinical intervention, yet what research we have clearly indicates that, as a group, gay and lesbian people have worse health then straight people when you control for income and socio-economic group. Compared to straight men in their thirties, I am more likely to smoke, binge drink, and show signs of psychological distress. Although I am less likely to be overweight, lesbian women are more likely to be so than their straight counterparts. (data from CDC survey of health differences among gay and lesbians).
Crucially, that survey was conducted in 2013, and its results only published this year. It was the first of its kind. We have almost no population wide, systematic data on differences in the health of gay and lesbian individuals. What is more, we know they are less likely to have medical coverage (in part owing to problems with spousal coverage), less likely to have a regular healthcare provider, less likely to seek out medical help regularly and less likely to discuss LBGT specific issues with their healthcare providers.
Conversely, we know that most physicians receive almost no education in LBGT specific healthcare issues in four years od med school. I have a couple of gay doctor friends, and I have watched them advocate tirelessly for years to get LBGT health issues on the medical school radar. It is tough going and change is slow. The medical profession in the US is surprisingly conservative on these matters. LBGT men and women have long known that they have to be their own advocates in the doctor's office. Ask any gay friends you may have, and you're bound to hear some cringe worthy stories. But patient advocacy requires privilege. With my PhD and middle class background and white maleness, I can talk back to a doctor (especially when it comes to anatomy). I can demand treatment. I can argue. A latina teen lesbian who'se been kicked out of her house has no such recourse. A closeted twenty something gay farm boy visiting the same family doctor his whole family and town sees isn't going to be comfortable asking for an HIV test.
The HIV crisis fundamentally damaged the (already shaky) relationship between LBGT people and the medical profession. Not helped by the fact that homosexuality was considered a disease until 1973. Many gay men and lesbian women in big cities set up parallel networks of healthcare providers, because they neither trusted the medical establishment, nor had access to insurers. These voluntary outfits do amazing work for outreach, education and testing, but they do not provide the follow through a established family doctor does. And in the rural areas of the US, these services are few and far between. I know this first hand. In my old city, I could get free HIV tests several times a week at several locations. Here in Ohio, my family doctor seems surprised when I order one, and my other options are a monthly clinic half an hour away, or planned parenthood, which my insurance will not cover. And again, I am an out, educated, financially independent male. I'm not afraid of my doctor's looks, or the village gossips, or who sees me come in and out of the planned parenthood offices. I don't think that experience generalises to my LBGT friends who grew up here.
When Fox news goes after the paltry amount of money NIH is willing to give to investigating LBGT health issues, they are attacking vulnerable men and women in precisely the place where they are most exposed: their relationship with their healthcare provider. It is low and callous even by their standards. Fat lesbians and gay men who drink too much deserve NIH money. And remember, one day you may be grateful on behalf of your son or daughter that they got it.
PS: Hat tip to drungmonkey for alerting me to this.
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