Thoughts on funding and support for medical schools (part 1)

(by potnia theron) Jul 19 2017

Nobody thinks of medical schools as being particularly poor, or in financial trouble. Yet one comment  in an older post, together with a meeting I went to a few weeks ago, got me thinking.

Many people (here, IRL) are outraged that the university would try and make money on postdocs. Although I crashed the meeting to hear about the postdoc stuff, there was another presentation, first, from the chief financial officer. Because this is such a small place, people like the CFO do come talk to the faculty, which was not true of other, larger places. I have found that in MRU, policy, budgets and implementation strategies come down from on high to the plebs. Here, there is at least an effort to share information, although one's ability to actually do anything about it may be just as limited as in the Big Important Universities.

This presentation was based on percentages and compared a number of public medical schools, and some private ones thrown in for contrast. There is an awful lot that can be said about this, stuff that impacts me, the younger faculty I care about, and as a bell weather signal for the future in general. I want to make two points, one data analytic and one substantive about funding. But they're linked.

The statistical point is that he presented percentage data: where the money comes from divided into broad categories. One really needs to see the absolute data as well as the percent data. The broad categories were: tuition, research, state subsidy, and medical income (hospital/professional fees). The biggest difference was the percentages attributable to tuition and state subsidy (large in small schools) vs. research income (large in bigger schools).  The percentages may vary, but the absolute number is close to a constant across schools of all sizes. Tuition and class size are variable. But bigger places tend to have higher tuition and smaller classes, and it works out to a narrow range in the end, certainly the same order of magnitude in dollars. The state subsidy varies, but not greatly. It is a subsidy per student, so while it varies, it will be roughly the same dollar amount. [I want to set clinical income aside for a moment, and just take a look at research. There are many different models, with hospitals separate from med schools, etc etc, and without more information it makes this part of the equation difficult to assess].

So if you look at the percentages, they vary tremendously across Universities, pretty much a function of a size. But I bet that the size of the budgets vary by an order of magnitude. That means if one component is a constant in absolute dollars, that order of magnitude is shifted to the other components. Bad data analysis.

But even looking at the percentages, research is a much smaller part. So the money guys wring their hands and say "the researchers aren't doing enough". But of course, per capita, we are. We are just much fewer in number than at the Big Places. Of course this doesn't translate into policy to either: hire more researchers or provide better support the ones we've got. No, this is part of a justification for developing a two-set faculty: BigDog researchers, who bring in >80% of their salary, and teachers, who teach the equivalent of 18-20 credit hours per term (ie two big med school classes, each term). The model of the teacher/scholar is in danger.

But this is not the end of the analysis. As always, context is important, in this case political context.  States are actively, hostilely, and with total conscious intent, reducing their subsidies to public higher education, including professional schools. It is not a matter of "the states being successful" in reducing contributions. They are being successful at this.

Which actually brings up another point: control of state legislatures is overlooked. But it is critical.  It is critical for being able to call a constitutional convention (and get rid of such pesky things as same sex marriage, birth control, and voting rights). It is critical for support of "extra stuff", like education, clean water, and public prisons. Some of the states, such as Wisconsin, make headlines, when they do headline-making things (like try to get rid of tenure). But as far as I can tell, these trends are pervasive, even in democratic controlled states.

The data for my state, and my tiny medical school are out there with an in your face message: state support has been reduced, consistently, significantly, no matter what percentage or absolute number you look at. If tuition is capped by the states  (which it is here, and in many other states), and the subsidy is being reduced, the difference has to come from somewhere. States, unlike the federal gov't, have bigger problems if they run in the red, and they by and large do not let their univerisities do so. There are many sequellae, many implications, many problems that arise from this. There are people who say that public higher education is not necessary. They say that private schools do a damn good job; let them do it. Private schools have their own issues, which may ultimately translate into the same bottom line issues: the world is changing. We, little ants on the ground, see the part about reduced funding success, NIH grant demographics, extended postdocs. But the issues are greater. As the mother of one of my trainees said at her child's (same-sex) marriage: just because this is possible today, we cannot be complacent.

 

 

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Without fanfare and headlines, some people make a difference

(by potnia theron) Jul 18 2017

This story, obituary, in the NYTimes, about Allen Counter, reminds me that often we do not know, or in this case, for me, forget, about people who have done much to make our world a better place. In short, Counter, a Harvard neurobiologist, did work that took him around the world, to remote places and indigenous people. He was also a POC (although I heard him speak once, and he referred to himself as "black"), and committed to recognizing the histories of POC. In particular, because he did work in Greenland, he was interested in Matthew Henson, who had accompanied Peary on his 1909 North Pole expedition.

As was the case (and yes, there is sexism/imperialism) Henson fathered children in Greenland, and Counter went to find them. He wrote about these children and as the obituary says he then worked at "reclaiming the father's [Henson] reputation".

Long described as Peary’s valet, Henson was actually much more: He was an expert navigator who spoke Inuit, drove sled teams with a skilled hand and knew how to build snow shelters.

In his 1912 memoir, “A Negro Explorer at the North Pole,” Henson recalled Peary explaining to the members of his expedition why Henson would be making the final five-day push to the Pole with him, quoting him as saying: “He must go with me. I cannot make it without him.”

Henson was important and deserves recognition. So does Counter for his work on deafness, his work setting up the "Harvard Foundation for Intercultural and Race Relations" and making sure that Matthew Henson was not lost to history.

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Holding onto your dreams

(by potnia theron) Jul 18 2017

Yesterday's post, allegedly about drug abuse amongst professionals, was also about response to stress. There was one more bit from the original NYT article, a bit I took out of the original post, that got to me. It didn't seem to fit. I looked at it again this morning, and realized that it was more hopeful than the rest.

The article talked about how idealism is lost, frequently in the first year of law school. Most people go to law school, or for that matter grad school, because of dreams of helping others or doing Something Good. The article contends that the stuffing gets kicked out of everyone, or nearly everyone, as some people graduate law school and still go work for legal services and things like the Southern Poverty Law Center.

When I stopped to think of this, I thought of my grad school peers. I was in a department of evolutionary biology, but lots of folks doing ecology, systematics, and really, natural history.  Many scientists, particularly the field oriented ones, the paleontologists, ecologists, evolutionary biologists seem to hold on to their idealism a little better than what the article says about lawyers (they lose it in their first year). Yes, the system, both in grad school and following it up,  is still brutal. If you think NIH is hard now, NSF is still an order of magnitude worse, but in money given out and funding success rates.

The alt-career for these guys was doing something in the then sprouting "environmental" industry. Yes, some of the paleo types went to work for oil companies (invert paleo could usually sell that better than vert paleo types). But, in those days, World Wildlife, and Nature Conservancy were hiring scientists. Not so much, these days, but then, there was the feeling you could make a difference in the world that way.

I checked up on a couple of people from those days. Yes, I'm a lousy correspondent, and didn't stay in touch with people. Some are dead, and that was hard to learn. People who were friends have gone, without either of us saying goodbye. But there are some who are professors, teaching ecology and evolution and, yes, natural history in those biology departments that did not give into the late 20th century impulse to be all-molecular all the time. Some are very active in environmental, eciology, and yes, natural history, causes.

A good friend from those days, someone with whom I've stayed in touch, is a good examnple. Liza walked away from an Ivy League tenured job to work at a large midwestern University. She was a dept chair, and is heading up a named institute that you've probably never heard of because it works at the interface of evolution, ecology and sustainable human use of resources. She could have been a BSD, a scientific intellectual property lawyer, but that's not who she is. She has consistently made the choice to do what she thinks is right. And was married. And had a marvelous kid, now launched in the world doing marvelous things. It's not like her life was a fairy-tale. There was lots of hard stuff along the way, and of course, she didn't get rich, only comfortable.

So are folks who are attracted to ecology/environment/evolution inherently more likely to hold onto their dreams? Or do these fields promote and encourage people in that direction? These folks aren't perfect, or even always good. To be sure, there are the self-righteous vegetarians, the I-Won't-Own-A-Car so I must live somewhere, have a job  somewhere that will let me be that way (which is a form of privilege to pick where one lives and works with those criteria). I knew people who would only live in California, or in Boston/New York/San Fran (Seattle and Portland at the time did not have the same cachet). They've got lots of the same little problems that you and I havce.

But back to the question, which way did causality run, or is it just my biased dataset?

Or is it just the article and law school and the people who say things like the research shows that in law school students (all, most, some?) focus on external values, like salary and status?  I think of some of the folks I knew when I was at MRU, particularly folks in public health. They were not the BSD's, running 10 post-doc labs. Lots of these folks had an assistant, part data-manager, part logistics organizer, part-clerical assistant, and that was all. They really believed in what they were doing. Lost dreams? Maybe disillusioned as to how the system worked, maybe disillusioned at how quickly change could come. But still following their dreams? They would say yes.

Maybe the selection and sorting that goes into law school, maybe what happens in law school, pushes people away from their dreams. And maybe lots of the pressures in science and public health, to work long and hard hours, to over-produced are there. And maybe a survey of surgeons will find the same disillusionment that the law school surveys find. Heck, maybe a survey of medical students will too. And maybe drug usage in evolutionary biology is a the same level as in law, because there is a genetic predisposition, to people under pressure, from work, from life, from circumstances pushes people in that direction. But I hope there are more people like my friend Liz, people holding onto their dreams and fighting for their dreams of a better world. They just don't make the news.

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today's edition of good things do come to good people

(by potnia theron) Jul 17 2017

Ah, in today's edition of good things do come to good people:

Image result for good things

 

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Lawyers and Scientists and Substance Abuse

(by potnia theron) Jul 17 2017

In the NYTimes on Sunday, there was an article about a BSD/high performing lawyer, who was a substance abuser, and ultimately died of it. It is a sad story, eloquently told by his ex-wife, Eileen Zimmerman, who just didn't know, till after he died.

There were a number of quotes in the article that hit me. The ex- said: "None of this made sense. Not only was Peter one of the smartest people in my life, he had also been a chemist", as if being a chemist or a scientist and knowing what the effects of drug addiction are would make a difference. Substance abuse, proclivity towards substance abuse, genetic or social, probably doesn't respect smartness. It also doesn't seem to respect socio-economic status. As I have said, addiction isn't a moral failing. Its really much more  complicated than that.

But there were a number of criticisms of the social and professional climate of being a lawyer. Lots of these apply to scientists that I found compelling and worth thinking on. The article was very good, in that it tried for statistics, as much as they exist. And the author went and talked to many people who know about the problem. One of the things people said was that law, the practice of law, includes an environment of not telling, not discussing problems. She quotes a psychiatrist as saying "as long as they are performing, its easier to just avoid [talking] about it". Not just drugs and alcohol, but personal problems in general.

There was quote after quote that could be talking about scientists I've known. One thing that hit hard, amongst they many that did, not for lawyers but for all the young scientists I know was this quote: "I can't do this forever, Peter often told me, I can't keep going like this for the next 20  years". The desperation of working like that will take its toll.

In the middle of the article, there was a bit of comic relief, for me, though not necessary for the lawyers.  She quoted a lawyer, Will Miller, a recovering addict from Bellevue, WA, that there are, of course, other stressful occupations, like being a surgeon, but none of them are as bad as being a lawyer. My dear Mr Miller, the most stressful occupation in the world is the one you are in, when its not going well, and the wolf is at your door.

But it is another bit by Mr. Miller, the former addict and prosecutor, that prompted me to write this post. He said that law school encourages students to leave emotion behind, "take it out of their decisions". Sound like something we all know? If the law is not supposed to be based on emotion, neither is science. Science more than the law? Depends, I suppose, on whether you are a scientist or lawyer. And for heavens sake, future physicians are actively taught to distance themselves from feelings, lest they get swept away in the pain and agony of their patients. Being "emotional" in science is attacked on two fronts. The first is that science is logic, exact, empirical and objective. Emotions are none of these. But second, a more subtle thrust, is that certain people, certain ethnicities and genders and other identifiers are considered more "emotional" than others, louder, less "cultured" and "refined". These people aren't going to be as good scientists as others.  It's one more way of  judging the quality of one's work by these kinds of personality markers that are, in the end, orthogonal to what one produces as a scientist.

The article doesn't forgive, or even suggest that forgiveness is part of what needs to happen. Nor is it only finding fault with the culture of law as it exists right now. But the brutality, much of it self-inflicted, the requirements to succeed in law, is part of what is at the root of substance abuse. And these same pressures and viciousness of culture, produce substance abusers in all directions in many more fields than law.

None of this is really any different from what I have seen since graduate school, and later as faculty, in my peers, my mentors and my trainees. The article is a good one, and I do not fault it for being about lawyers, for it is a compelling story, both in general and in specific for this person. There is much wrong with the system and there are many things that need fixing. Part of that fixing has to come from all of us, all of us looking beyond our immediate needs and doing what we can to change things.

 

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Update: See this about physicians.

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art, artists and Temple Grandin

(by potnia theron) Jul 14 2017

I once lived in Australia for two years. It changed my life. The beauty of the desert changed my life. The friends I made changed my life. It was over 20 years ago, and I spend a non-trivial amount of money going back every 2-3 years.

I love Aboriginal art. When I was there, one of the emerti professors had a wife who was a sometimes artist and a longtime supporter of the museums and art communities. Tippy and Sam and I became friends and Tippy introduced me to a dealer and gallery owner who, while white, was committed to supporting the Aboriginal artists. I began to save money, and every trip bought some art. Art with known provenance and art, that to the best of my knowledge, supported the artists. It's been more than 20 years, so I've acquired quite a bit (for a scientist as opposed to a Collector). It surrounds me in my life and gives me great joy. It is one the few things I enjoy having. Here are two (rather bad, taken with my phone) pictures of a sculpture of one of my statues. I have many birds.

One thing that became clear to me as I lived with this art, and became friends with the woman who owns the gallery (which also became a studio for artists who did not have resources), is that while there was much information on the artists, I didn't really want it. And that is true of other art forms: I don't want to know about the actors or musicians or writers whose work means so much to me. (Although, I do admit to enjoying the Museum of Music in Vienna, which taught me a lot about Haydn, Mozart, Beethoven, etc).

This is an ongoing  argument I have with my partner, who is a historian of jazz and wants to know about the life and the forces that shaped the music and the people who make it. I just want to listen. Or watch. Or read.

So why Temple Grandin? She has famously said she doesn't get music. I had read her work on animals, for my work, especially on animal emotions. I started doing research in the days before IACUC's and AAALAC inspections and in general, rule about doing animal research. I was frustrated because I wanted to know more about the animals, and when the rules and regs started, including the Animal Welfare Act, I felt I really needed to know more to think about animal distress. In those days, there was nothing easily available, hence Temple Grandin's work.

One of the things Temple Grandin did, could and probably still does, is design things in her head. Enormous things, like 10K sq ft meat processing facilities. I cannot do that. I start at the beginning and work my way through. I realized that there are people who learn to do art in the same way. I was visiting a good friend, giving a talk at his Uni. We didn't talk science, even though we have collaborated in the past, and moved in different, but very interesting directions from that common point. We talked about the Goldberg Variations and how Glenn Gould played them. We talked about how each of us learned music. We talked about all the ways in which people, creative people who are learning to do things, learn how to do them. My friend is not Temple Grandin either. He was struggling, in his words, to master one part of the Variations. I love music, but lacked the precision, the physical knowledge, that is the first necessary step to creating music.  He never gave up.

So, I will never be an artist. But I have realized, at this point in my life, that it is ok to surround oneself with art, with things that make one happy. There is always music in my office (yes, I'm lucky to have my own). There is art on the walls, home and work. And this makes me a better scientist. Even if I'm not Temple Grandin.

 

 

 

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Small amusement of the morning: expectant publications

(by potnia theron) Jul 06 2017

I know lots of people get weird publication requests from sketchy journals. But the subject line of this one was the best in a long time:

From: Gastroenterlogy & Hepatology: Open Access [mailto:gh@medcraveonline.org] Sent: Thursday, July 06, 2017 8:12 AM To: Potnia Theron

Subject: Expectant submission

 

 

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More interesting webinar from SfN

(by potnia theron) Jul 05 2017

Affirmative Attention: Advancing Science Through Diversity

Speaker Spotlight: Hannah Valantine, MD, MRCP, FACC
Registration is now open for Affirmative Attention: Advancing Science Through Diversity, a live video discussion on the current state of scientific workforce diversity and what individuals at institutions can do to foster more inclusive cultures and hiring practices.

The discussion will take place on Monday, July 17, from 11 a.m. to 12 p.m. EDT. Registration is free and open to the scientific community at large.

Presenting on the panel will be Dr. Hannah Valantine, the first NIH chief officer for scientific workforce diversity and a senior investigator in the intramural research program at the National Heart, Lung, and Blood Institute. Valantine is nationally recognized for her transformative approaches to diversity and is a recipient of the NIH Director’s Pathfinder Award for Diversity in the Scientific Workforce. She is currently leading NIH efforts to promote diversity through innovation across the NIH-funded biomedical workforce.

Learn more about Valantine and other speakers at this event, and register today.

 

Questions? Contact nextgenleaders@sfn.org.

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Radio Silence

(by potnia theron) Jul 03 2017

I am sorry, but I am actually doing science! And my science becomes a 24 hr thing for about a week, and then drops Image result for synapse multiple cellsto about 12-14 hr/day for the next two. I love you all dearly, and will return when I have three brain cells to synapse together.

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Comments, and respect and support for our friends

(by potnia theron) Jun 25 2017

I do not remember that I ever had to remove a comment. But I will remind us all of the guiding principle for at least this blog: respect for individuals even when we disagree with their positions. If someone's position is so egregious that you need to critique them as opposed to what they say, then its probably time to leave this corner of the blogosphere.

I want to say a few words about DocBecca and some of the comments directed her way, posted here.

I do not think the sympathy to her situation, of which there has been much, especially on the tweets, is inappropriate. She has been a leading figure, here, and elsewhere in our e-community. She has done a great deal for others (her TT aggregator page, for example, was of incredible value to many people). As I have often said, this kind of resource was not available to me when I was young, and it would have made a difference. The kind of support she is receiving was not available before social media.

Further, knowing DocBecca IRL, and knowing her research which is in the large tent of neuroscience, as is some of my work, I know her work is good. I've read some of her papers, and I'd be very glad of having her as a colleague. I am guessing that some of the support for her, and outrage at her situation comes from people who like me, know enough to see  what she does. But flaunting that information has not been part of the discussions, as is appropriate.

One of the tools to keep people "in their place" is isolation. It's historically true, and is still true. Doing what we can to help others is a fundamental task, in my world, and in the world of people who are in this community. So one step we take in the comments/posts/tweets that say to DB: what happened to you is hurtful, and I am sorry.

It is another matter to dissect what happened to her. We don't know beyond the details she provided (as she has said, I put this out there): her department voted unanimously to support her, the Dean turned her down, the  next level (Provost, I believe) said "get funding and I will reverse". But, none of us (that I know of) are in her dept, are the Dean, the Provost, part of the SS that evaluated her proposal, or the NIH PO that did not help her. And speculating what happened there might be satisfying, but I think not useful.

On the other hand, the posts that I (and others) have put up are about the system and the process in general. They were catalyzed by DocBecca, but they are not about her.  The goal of these is less to help one person in particular, but top provide insight that might be useful to a larger group of people.  These posts attract comments. Some have been comments that I interpreted as being general, but other people interpreted differently, as being about DB in specific.

There are difficult to draw lines between attacking someone, and criticizing them. The internet is having some problems with this issue. I do not want this blog and the comments to posts to become part of those problems; my goals are much more modest.

The ocean in which we swim is large, and cold and dangerous. Part of my goal is to help minnows navigate these waters. I invite you to do the same.

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