Saturday, July 01, 2006

A University of Montreal researcher was just sentenced for falsifying work in an effort to be awarded federal grants. From our ethics course, we have learned that what this man, Eric Poehlman, has done is unethical. The interesting part of this case is that is marks the first time in the USA that a researcher would serve time in prison for falsifying data to obtain federal grants.

Dr. Poehlman is a specialist in exercise physiology whose work on menopause, aging, hormone replacement, obesity, and Alzheimer's was all manipulated (changed and forged) in an effort to receive federal funding. Dr. Poehlman explained that his actions were a direct result of "pressure to win federal grants, saying the number of grants a researcher received 'determined your academic wealth'". Just as the level of a salesman is determined by how much he sells, the status of a research scientist is determined in part by the type and number of grants they have been awarded.

We certainly know that Dr. Poehlman is not the first US scientist to falsify data but his actions come at a time when people are taking this kind of misconduct very seriously. The first researcher charged with a federal crime for falsifying results to get a federal grant was a Professor at the University of Pittsburgh, who was subsequently convicted in 1988 but escaped jail time.

Poehlam falsified data over the course of his career and used those preliminary findings in applications for 17 grants with funding more than $11 million. Thankfully many of the applications were denied, but a few were accepted and they totaled $2.9 million. As a result of defrauding the federal government, the court has permanently barred Poehlman from getting more federal research grants, and was ordered to write letters of retraction and correction to several scientific journals, in addition to jail time.

The issue at hand here is, even if the research ultimately led to a greater good, the damage he has caused by falsifying data may lead to further setbacks in the field as well as losing the respect of the public who entrusts Scientists with their tax-money. We can be thankful that Dr. Poehlman's deceptions, however small they might be, were caught and can now be corrected. Often deceptions such as these can lead an entire field down the wrong path for decades and compromise the work of other un-affiliated scientists.

For more information on this case, you can read the original article published by the Boston Globe.

The real question is: How often do scientists under academic or other pressures (personal gain, etc.) feel it is justified to falsify (change AND create) data?

My answer: More often than we think.

Friday, June 30, 2006

Introduction for BME 2006 Summer Immersion



Hi, everyone, my name is Jun Wu. First I want to thank the BME department for offering such a interesting summer course. Then I should thanks Dr Yi Wang's organization for this course.
Now I want to briefly introduce my clinical mentor for 2006 BME summer immersion course. His name is John K. Karwowski. Some doctors and nurses just called him little Dr K. The big Dr K is the chief of vascular surgery, Dr K.Craig Kent. Dr Karwowski is the attending surgeon and assistant professor of Surgery Department(vascular surgery division) in the New York Presbyterian Hospital.
Of couese Dr K also did some teaching work, such as giving some lectures to public and MD students. Although he just finished the fellow at Stanford University one year ago.( On Tuesday he told me that it's been just a full year since he left Standford ), he is very good at surgery operation. So he is busy all the time. Sometimes other doctors would introduce some patients with difficulty disease to him. Before my arrving, I did not know how busy he is. I just thought this professor did not reply my email quickly. After one week's observing, I came to know that he is pretty busy all the time.

I would share my experience from the next post.


Jun
So far most of my week has been watching robots remove people's
prostates. Usually that would mean I had been watching bad hollywood
horror movies, but this week seems to be different.

So far I have seen five of these surgeries done, one monday, two tuesday and two
thursday. Probably the biggest part of the week was trying to get over
the shock of the whole thing. I have never been around surgery before.
Somehow I am amazed that I haven't developed post tramatic stress
syndrome watching doctors cut holes in a person to stick robotic arms.
All of the surgeries have gone pretty well though, the patients don't
even bleed nearly as much as I expected. Also the fact that most of the
watching you do is on a 3d video screen makes the situation seem a bit
less real. While I can look over and see the patient, if I look at the
screen it is about the same as if I was watching the discovery channel.

Much of the technology being used I was totally unfamiliar with. Probably
the biggest shock was realizing that the robotic arms were cutting
through tissue using electricity. The arms are like pliars that will
grab onto something they want to cut, then enough electricity is ran
into the robotic arm to cut through the tissue. I just would have
assumed enough electricity to cut you, would be enough to cause your
heart to stop.

If I don't get internet in my room soon I think I may have to be put on methadone!

I still don't know what my project will be. I have started reading my
doctor's papers, but neither of us have came up with a project that
makes sense to do over this short of a time frame. I talk to him on
monday though, so with a little luck things will go better. I found out
that Dr Tewari, and Watt Webb whose group I am in wrote a grant
proposal recently, perhaps I can steal a small part of that project and
work on it. However as most of it is multi photon blah blah blah, it
may not be the sort of project that has subprojects that make sense.

Jesse
My Immersion Experience in NYC
Hello Everyone! Welcome to what I feel will be the experience of a lifetime. I have never been in an operating room or procedure room without being the person to be poked and prodded. I am looking forward to every minute that I am able to spend in the hospital (watching and not being the patient). The trip to Weill was nice. The luxury coach was nicer than I expected. Our driver was really cool which made for a better trip, at least in my estimation. Well, enough with the pleasantries, its time for the meat of this communication.

My clinical mentor for the summer is Dr Howard. A. Riina, Associate Professor of Neurological Surgery. On Monday, we had our first meeting and I immediately began refreshing myself on vasculature of the head and neck. There are so many blood vessels and nerves that feed the head and neck. I was given a few pneumonic devices to aid me in remembering the vasculature, however, I will not elaborate at this point. You must inquire in person and I will try to recall.

Over the past week, I have seen many interesting cases. All have been aneurysms but many different types and the approaches taken to correct the problems have been quite different also. Methods used to treat the aneurysms have ranged from Vascular Neurosurgery to using Interventional Radiology. Presently, I have seen 3 craniotomies, one of approach of vascular neurosurgery and 6 interventional cases. On my next blog, I will try to give pictures but I have to wait on my physician for these.

Craniotomies are one of the most invasive techniques and therefore have the longest recovery time. In performing this procedure, the physician cracks the patient's skull and carefully dissects down to the area of the aneurysm, making sure to avoid blood vessels, and finally "clipping" the aneurysm. Clipping emerged has emerged over the last 20 years as being one of the best ways to isolate the aneurysm from impacting the rest of the body. The equipment used for “Clipping” are you guessed it, “clips.” They range from as little as 3 mM. They have both temporary and permanent. The permanent clips are never removed from the patient’s head. I will details “clips” more in depth later.

For Interventional Radiology, the physician places a catheter in the femoral artery and navigates through the vasculature to the level of the aneurysm in the brain. Initially, learning that this could be done to fix disorders in the heart, I was amazed. Now that I know the utility of this in neurosurgery, I am absolutely flabbergasted. With that being said, I am obviously speechless so stay tuned for my next blog.

Julius Korley
BME 2006 Summer Immersion

wellcome everyone to Weill. hope all of you have settled into your clinical areas. try to use this space to share your experience. as writing can help you to digest materials and organize your thoughts, posting here can benefit to you, as well as everyone in the class.

you are required as homework for the class to post at least once per week. obviously we get extra points and recognition the more you post.

regarding materials here, we have to observe copyright laws and patient confidentiality.

see you,

Yi Wang

Wednesday, June 28, 2006

Of Urology and Men (Christine Tan, 6/28/2006)

This is Christine here, I'm currently attached to the Department of Urology in New York Presbyterian Hospital. My mentor is Dr. Douglas Scherr, Assistant Professor of Urology and Clinical Director of Urologic Oncology. Yesterday I was seeing patients with him in the clinic. The following are some interesting experiences:

Patient A had bladder cancer. He has a replacement bladder made from his own intestines in place of his original bladder. Compare this to patient B who is much older and has an urostomy done and a pouch to drain urine. Urostomy is a surgical procedure that creates an opening (stoma) in the abdominal wall through which urine leaves the body. Apparently for younger patients, they use the former method.


Stoma and pouch after urostomy (http://www.cymed-ostomy.com/Products/urostomy.html)

Most male patients were generally comfortable with the idea of having a female intern/student observing, except one. I found patient-doctor dynamics and interaction really interesting. Dr. Scherr did a wonderful job balancing between listening to his patients and getting the important information out of them in a short time and his patients really liked him - New York magazine's 'Best Doctor 2006' award, well deserved!

Apparently, the failure of erection is a common post-operative side effect, especially after bladder or prostate removal, even though special care was taken to spare the nerves. One method (which is the really effective) to overcome this is to inject prostaglandins into the base of the penis, causing vasodilation and hence the increase in blood flow. This was supposed to be therapeutic as well, as increasing the blood flow (and oxygen, nutrients) was supposed to aid surgical recovery. As expected, not many patients liked the idea. Patient compliance as I found out, is a major issue. Getting your patients to cooperate or to subscribe to the idea of a particular treatment is important. There was one patient who really disliked going for a MRI scan (claustrophobic?) and you should see the look on his face when he was told he had to go for another. This patient could not go for the alternative CT scan as his kidney could not excrete the contrast agents.
Fortunately this time, it wasn't a whole body scan and he could split it into 2 separate visits.

Patient C (a lady) has cervical cancer which pressed onto her right ureter, affecting its function. She had to have a stent installed to drain from the kidney into the bladder instead; this stent had to be changed every three months or less, due to encrustations on the stent due to deposition of calcium oxalate. Maneuvering and placement were done using a cystoscope (endoscope, with a camera and fiber optic light). The stent design is pretty elegant - a pigtail coil on both ends that keeps the stent in its place - no other hooks or whatsoever:



http://www.bui.ac.uk/patientinformation/uretericstent/ureteric.htm

This morning I was in the operating theatre watching a robotic prostatectomy (the same kind that Jesse has been watching for the past two days - I'll let him talk more about that). The salesman from Intuitive (the company that makes the da vinci robot to carry out this surgery) was present to take notes as well as train a new surgeon. What I thought could be improved was the feedback to surgeons. Currently the surgeon can only see what's going on (3-D using a special vision screen), but they won't know if they have 'hit' the wall of an organ with their robotic arm. It would be great if the hand controls actually gave them a feedback (like a little sensory jerk) to let them know, something like what's available in computer gaming joysticks. I was also amazed at how fast the whole surgery took - 2.5 hours to remove the prostate and how little blood was lost. Dr. Scherr light-heartedly mentioned the next step would be for me to make a nano-bot to do the whole surgery... :D *lol*

Ah the comfortable scrubs...

That's all for the first 2 days. :p