Tuesday, March 22, 2005

Wearing Two Hats (Part 2)

Orac has written a follow up to his fantastic post Wearing two hats. Wearing Two Hats, Part 2 explains some of the challenges that clinician scientists might face which are different than those faced by most basic scientists....

Grand Rounds XXVI

I took a break from packing up my stuff this morning to check out Grand Rounds 26 at The Well Timed Period, and I suggest you take a break from whatever you've got planned today to do the same!

The biologization of psychiatry

Universal Acid has a great post on the use of biologic markers to diagnose psychiatric illness. On one hand, using a gene expression profile to diagnose mental illness is a great leap forward, especially when the diagnosis is not clear cut (Is my child bipolar or adhd?) But, what if you "present with all the classic signs of major depression but then get your blood test and...[are] told that you're not "really" depressed?"

Thursday, March 17, 2005

Fourth Edition of the Skeptic's Circle

The Fourth Edition of the Skeptic's Circleis up! Previous editions can be found at Circular Reasoning

On that note, there really will be lighter blogging for the next week or so. Blogging is just a great form of procrastination for packing, but I must really get down to business!

Wednesday, March 16, 2005

National Problem Gambling Awareness Week

Happy Problem Gambling Awareness Week

The National Council of Problem Gambling has a number of resources to address problem gambling. The Ohio Lottery is running a PSA about problem gambling this week, which is how I learned it was problem gambling awareness week. However, I must say that the spot really made me want to go gambling....

Tuesday, March 15, 2005

Grand Rounds XXV

Grand Rounds XXV is up at Respectful Insolence It is perhaps the most creative set up yet! I threw out this month's TV guide in anticipation of the move, so I'm sure I'll be checking back to find out what's on!

And while I'm promoting carnivals, don't forget the fourth edition of the skeptic's circle thursday at The Two Percent Company

As a final note, congrats to everyone who matched yesterday! I hope that thursday brings everyone one of their top choice matches!

Monday, March 14, 2005

On Isolation and Mudfuds on the Web

Blogborygmi has compiled a list of fellow mudphuds (mudfuds) on the web. You might notice the discrepancy in spelling. At my school, MD/PhD students are generally referred to as MuDPhuDs. However, I was unable to get mudphud.blogspot.com, so I went with the alternative, MudFud.

Nick suggests that one reason MD/PhD students seem to be overrepresented in the medical blogosphere is that md/phd students don't seem to "fit in" with the rest of their md or phd students. I'd have to say that, though I'm not sure this sense of isolation is why I blog, there is definitely a sense of isolation that comes from being an md/phd student. Part of it is that while the first year md/phd class is relatively close, we all got a chance to meet each other well before orientation ever began. Consequently, when those first initial friendships were forming within the rest of the medical school class, we tended to stick together, and probably didn't meet as many people. On a similar note, while having an office is a big plus, it means that we are less likely to be found hanging out in the cafeteria or R&R. Because we are exempt from certain graduate school requirements, there is less opportunity to meet fellow PhD students during orientation or intro classes. And, when an MD/PhD student enters the traditional third year of medical school, they are entering a class of students that have already grown and developed together for 2 years. And, although I'm probably overgeneralizing, I find that most mudfuds are more of a "big picture" or "global thinking" type, rather than of the average "neurotic premed" type. There is always a desire to know more, to reach for a better understanding, and to try and find a better way (this desire seems to be lacking in some of my md "gunner" classmates.)

Obviously, we do have a lot of support within the MD/PhD program both from students and administrators, but being a different program manifests difficulties in all number of ways.

When it was time to get our student ID's, only about half of ours worked properly. When I needed to order a key for the office, it took me a month to "prove" that I was actually a student. Because we are listed seperately in the medical school directory, the first year md/phd students weren't included on the students listserve for over three months (until one of us realized we were missing something) so we missed out on study guides that were sent out, notices for certain events, and even a couple jokes. There is always some uncertainty as to what requirements we have to take care of (generally, in terms of paperwork and such.)

Perhaps I blog and read other's blogs to get a sense of what I should/could be doing with my education, and of course to stay abreast of current topics. I think that Nick got it right when he said,"But why all these new MD/PhD students? I'd like to say that the same qualities that lead one to seek a physician-scientist training program also drive one to blog -- a good mix of analysis and articulation, and a familiarity with explaining things to disparate groups." I blog because I want a forum to analyze things, if only to get my views straight in my own head. I read other blogs because I want to know what others are thinking, and what I can do to make myself a better physician scientist, and even a better person. I blog because I like my study breaks to be stimulating in some way or another (if I totally veg out, I'm done with studying!) I see myself working in academia some day, and so I believe that if I've taught one reader something, or helped them to look at a topic in a different light, I've accomplished something as an educator, and I know that practice make's perfect (or at least better.) I also blog because I tend towards insomnia, and well, there isn't much good television on at 2 am. On that note, I'm going to attempt to get some much needed zz's....

Brain Awareness Week

It's Brain Awareness Week! I had meant to write a post commemorating this event, but alas, I forgot, and in this late night blogging session, I'll direct you to Saint Nate instead. So, check out Saint Nates fabulous list of brain facts, and a description of brain awareness week activities here and here And, if you haven't gotten your hands on a copy of Brain Facts I highly suggest you get one sent your way. I've found it a very handy resource when trying to explain brain related facts to friends, especially when my previous knowledge wasn't quite enough to explain in layman's terms.

Friday, March 11, 2005

Lighter Blogging

Just want to warn my few readers out there that blogging will be lighter over the next two weeks as I finish up a few things at school and move into the new house!

Wednesday, March 09, 2005

What's the Deal with Neuromarketing?

Neuromarketing, a marketing research technique that uses brain imaging to assess marketing messages was born at Harvard in the late 1990's when Gerry Zaltman (a marketing professor) began scanning people's brains for corporations. From the corporation's standpoint, neuromarketing allows for more concrete data to be collected that is free from problems that plague other types of marketing research, such as self-reporting biases.

As neuromarketing has grown in popularity (and publicity), certain corporations have become decidedly more secretive about their use of the technique. Some institutions who have participated in neuromarketing research have removed any mention of those studies from their websites. There are definitely several ethical issues involved, as well as methodological issues (which I'm sure will decrease if the technique is more widely used.)

First, is it even ethical? While fMRI research is generally considered to be very safe, there are definitely more potential risks than, say, participating in a traditional focus group. Does the end-product of neuromarketing research contribute enough to society to balance out the risks? Is using a medical technology appropriate for something that could lead to increased air pollution after we all buy SUV's? And, in the case of neuromarketing research being done at academic institutions, is it ethical to use research funds and resources to pay for this type of research instead doing a study on schizophrenia?

Commericial Alert is concerned, that if neuromarketing actually works, it will lead to an "increased incidence of marketing-related diseases" such as diabetes and obesity. While you could have the same concern with traditional marketing research, some consider an effective neuromarketing approach to be akin to brainwashing.

One major problem in the field right now is that the early work is being done by people who are not experienced in both marketing and neuroscience. A neuroscientist may not be able to select the best subject pool for collecting marketing data. Also, a neuroscientist will be more likely to design an experiment that minimizes known confounds in fMRI research, but may not minimize marketing confounds appropriately. Similarly, a marketing person may not design the experiment such that any good conclusions can be made from the neuroimaging data.

When reviewing the studies that have been published in scientific journals and mentioned in the news media, I was struck by how the results seemed to be presented in a trivialized manner. For example, in There's a Sucker Born in Every Medial Prefrontal Cortex, Clint Kilts (the director of the BrightHouse Institute) explained "the magic spot -- the medial prefrontal cortex. If that area is firing, a consumer isn't deliberating, he said: he's itching to buy. 'At that point, it's intuitive. You say: 'I'm going to do it. I want it.' " Now, the medial prefrontal cortex is associated with reward processing, goal based behavior, certain types of memory, and sometimes, the sense of "self." I haven't seen anything in the literature that suggests that activation in the medial prefrontal cortex means that someone is going to buy a product, or even that they want to buy it. You could argue that, because the medial prefrontal cortex is a "goal area" that the subject has made the "goal" of buying the product he is responding to. But in traditional reward processing and goal-oriented research, there is a built-in expectation of getting a reward or achieving a goal. In neuromarketing, there is no such built-in expectation. Are the researchers going to give everyone a Porsche because their brain lit up in a certain area when they saw a picture of one?

And in this note, will neuromarketing ever turn out to be a viable marketing tool?

Other questions on the efficacy of neuromarketing abound; this news article also questions whether neuromarketing will even work. An article in The Lancet Neurology highlights privacy concerns inherent in neuromarketing research.

Obviously, there are more issues than presented here. I highly suggest that you check out the articles on the Commercial Alert site, which, though definitely biased against neuromarketing and lacking in scientific analysis, provides some great food for thought.

Tuesday, March 08, 2005

Grand Rounds 24

Grand Rounds 24 is up at Hospice Blog! I'm a regular reader of the hospice blog--I know that hospice is something I know little about, and it is something that everyone, doctor or not, should know about!

Monday, March 07, 2005

Long Hours in Residency

Dr Tony has a great post commenting on public perception of long hours in residency. I highly recommend reading all of the comments on the posts written by Megan McArdle. Definitely some food for thought, and some insight on the opinions of those not already wrapped up in the medical world.

I do have to say that I hope they figure out how to maximize learning and care while protecting residents by the time I get to a residency program. Although I should also add that pulling 36 hour days is not uncommon for 3rd and 4th year medical students as well. At 23, I can feel the difference in how I function after 24 hours sleep compared to when I was 18. I can only imagine that it will be much, much worse at 30. And, I'm not a great driver when I'm even a little tired, so I do worry about being able to drive home on no sleep. Those apartments right across the street from the hospital are looking so much more inviting!

What exactly is a MD/PhD program?

Because I've gotten the question more than once, I thought I'd write a quick post on what exactly a md/phd program, mstp (medical scientist training program), or pstp (physician scientist training program) entails. (I should note that those three names usually refer to the same thing.)

Generally, a md/phd program will take 7-8 years. The first two years are made up of the preclinical years of medical school (this is where I am now.) Summers during these first two years are often used for research rotations in order to learn new skills, and decide upon the lab that you are going to work in. The next three to four years (and sometimes more) are spent in a graduate program in pursuit of a PhD. At my program, we pretty much have the option of entering any graduate program offered here, (though they may not be too pleased if we choose to study English) and we don't have to choose the exact program until we are ready to start working on the PhD. After successful completion of a PhD, the student then goes back to medical school to complete the clinical rotations.

In order to get this all done, most schools have a few things in place to make things a bit easier on the student. Generally, the medical school coursework will "count" for most of the required graduate coursework, though students sometimes have to take a couple classes to cover things not addressed in medical school, such as statistics. Many schools will allow MD/PhD students to have one less paper published than a regular PhD student. For the clinical years, electives are often not required (mostly to allow for a flexible start time into the third year of medical school). My school requires us to do a "senior project" in the final year (fourth year of medical school) to keep in touch with research. The senior project is often more clinically based than the graduate work, or can be used to explore a different area of research. Coming out of school, there are many different options in residencies/fellowships that allow for protected research time, and some tracks are even shortened from what "normal" residencies might be (this is often done under the assumption that most md/phd's will spend, on average, less time doing clinical work during their careers.)

Programs vary in size from one or two students per medical school class to up to 25 students at Washington University in St. Louis. As a medical student in an MD/PhD program, we have several perks, such as an office, a weekly journal club, career retreats (our spring retreat will be held at an amusement park), extra social activities, and the fact that we are considered "special." (Though sometimes this is a disadvantage when everyone looks to you as the "smart one!") Being in a program within a program gives a built-in support network, and often the opportunity to get free/cheap books.

Funding for MD/PhD programs vary by institution. There are currently 39 schools that receive funding from the NIH. Some schools use purely institutional support. Many programs fully fund all years in the program, which means that a student will not pay any tuition, and will receive a modest stipend throughout the 7-8 years. Some programs only fund the graduate portion, and still others don't fund students at all. (Some institutions do a combination of all three, depending on the student.)

Obviously, due to the small nature of most programs, and the availability of funding, admission to one of these programs is highly competitive. I've heard that 33 is the magic number on the MCAT, along with excellent undergraduate grades and substantial research experience to be a competitive candidate (although this is a big generalization; it is possible to get into a program with much less, or be rejected with much more.) One thing that is really important when preparing an application to a MD/PhD program is finding a balance between clinical work and research. Otherwise, why wouldn't you pursue a straight MD or PhD?

Obviously, doing a formal program like this is not the only way to get both your MD and PhD; many people have done them years apart. Also, having both degrees isn't always necessary to pursue clinical research, but in my experience, having both degrees opens a lot of doors in terms of professional opportunities, grant competitiveness, and more.

For your information, you can see a list of all of the U.S. MD/PhD programs here.

And in closing, for an idea of how md/phd's can spend their time, see Speaking two languages and Wearing two hats at Orac Knows (Do you know of any other good explainatory md/phd posts in the blogosphere? Please send me a link!)

Thursday, March 03, 2005

Third Skeptic's Circle

The third edition of the skeptic's circle is up at Redagast.

And with this publicity blurb, I make a promise to Saint Nate, I'll have a great post ready for round four!

Searching for the Why of the Buy

Thanks to Saint Nate for passing along this great article, "Searching for the Why of the Buy"

I actually had the opportunity to read the Baylor Pepsi Challenge paper (mentioned at the end of the article) for a journal club in the fall, and the conclusions were questionable to say the least. There were so many problems with the methodology that the results that they claimed about brand recognition could never be applied to a larger population. The sad thing is, that done properly, the study could have been a really novel way of looking at reward circuits in the brain, rather than assessing marketing techniques, which is something that the authors may not have understood to begin with.

I haven't read the other papers mentioned in the LA Times article, but I can only imagine that most of them are riddled with methodological problems as well. Not to say that all the other neuroimaging papers out there are perfect, but you have to wonder why people and corporations would invest money in expensive marketing research that doesn't really tell you anything about how effective a particular brand's marketing really is.

Tuesday, March 01, 2005

Grand Rounds 23

Hungry? Check out the delectable menu served up at Grand Rounds XXIII