Monthly Archives: September 2013

A letter for all District Health Board Candidates

Dear District Health Board Candidates

Soon I and thousands like me will cast our votes to choose our District Health Boards.  Given the huge budgets of DHBs and the huge potential to influence health outcomes I want more information from you than a couple of paragraphs I received with the voting packs.  Below are two questions I think are important.  As this is an open letter on a blog site, I invite others to submit their questions too.  I also invite you, the candidates, to state your name, the DHB you are running for and your response to my or other posted questions (ie not just the blurb from your pamphlets).

My questions:

1. What single health intervention do you want to see implemented and what evidence do you have that it would be efficacious?

2. What plans have you for increasing patient participation in research?

Regards

Dr John Pickering

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Teach creationism; undermine theology

My fellow science blogger Alison Campbell recently wrote a blog post entitled “teach creationism, undermine science”  in which she highlighted some of the concerns shared by many scientists.  As a Christian and as a scientist I believe the issue is far worse than the undermining of science.  Because so many teaching creationism are so well meaning it saddens me to say this, but the teaching of creationism is anathema to the Christian gospel.  Three reasons:

1. Creationism misrepresents the Bible.  When the Hebrews were standing on the banks of the Jordan wondering what would befall them should they cross, they were not asking “How did God create the world?” Rather, they were wondering if Yahweh who had led their parents generation out of Egypt, and seemed to be in charge in the desert, actually knew anything about farming across the Jordan.  It seemed to them that the local fertility gods must know something – after all it was a rich land.  The two stories of creation we now find in the book of Genesis speak to the fears of the Hebrews then, and in later generations to fears held when they were in exile.  The message is clear – Yahweh is in charge, and the so called gods (eg the sun and moon) are mere creations of his.  Those stories are definitely not scientific accounts – indeed science writing was not to be invented for thousands of more years. They answer “whose in charge” and “what’s my purpose” questions, not “How” questions.

2. Creationism rejects truth about the workings of creation which science has revealed. Science is a gracious gift which is to be cherished and put to good use.  It is under God’s sovereignty and requires the participation of his people. Indeed, creationism opts out of kingdom building, the task of the Church.  Our destination is not some super-spiritual, non-material eternal existence in heaven (indeed no where does the Bible explicitly say we will “go to heaven”), rather it is a new earth (material) where God dwells amongst us and God’s rule applies (heaven).  How this will come about, no-one can be certain, but our pursuit of knowledge through science and our applying that knowledge as good stewards of the Earth is part of the process of building the kingdom.

3. Creationism puts a stumbling block to faith. Sadly, propagating creationism results in an easy, and sometimes convenient, target for scientists who may otherwise be willing to listen to what Christianity has to say.  To use Paul’s terminology, it is a stumbling block. Many pupils taught creationism as a science will later learn the falsehood when they are exposed to all of science in its full glory. Sadly, many will react against Christianity and throw the baby out with the bathwater.  When this happens, those who taught those pupils creationism as if it were science will become accountable.

What the HRC should have done

The system is broke.  It is no better than a lottery.  The Health Research Council tacitly acknowledged this last year when they introduced a lottery to their grant funding round.  The lottery was for three grants of $150,000 each.  These “Explorer Grants” are available again this year.  The process went thus: HRC announced the grant and requested proposals;  proposals were required to meet simple requirements of transformative, innovative, exploratory or unconventional, and have potential for major impact;  proposals were examined by committees of senior scientists;  all that met the criteria were put in a hat and three winners were drawn out.

116 grants were received, 3 were awarded (2.6%!!!). There were several committees of 4-5 senior scientists. Each committee assessed up to 30 grants.  I’m told it was a couple of days work for each scientist. I’m also told that, not surprisingly given we’ve a damned good science workforce, most proposals met the criteria. WHAT A COLOSSAL WASTE OF TIME AND RESOURCES.

Here is what should have happened:  All proposals should have gone immediately into the hat.  Three should have been drawn out.  Each of these three should have been assessed by a couple of scientists to make sure they meet the criteria.  If not, another should be drawn and assessed.  This would take about a 10th of the time and would enable results to be announced months earlier.

Given that the HRC Project grants have only about a 7% success rate and that the experience of reviewers is that the vast majority of applications are worthy of funding  I think a similar process of randomly drawing and then reviewing would be much more efficient and no less fair.  Indeed, here is the basis of a randomised controlled trial which I may well put as a project proposal to the HRC.

Null Hypothesis:  Projects assessed after random selection perform no differently to those assessed using the current methodology.

Method:  Randomly divide all incoming project applications into two groups. Group 1: Current assessment methodology.  Group 2: Random assessment methodology.  Group 1: assess as per normal aiming to assign half the allocated budget.  Group 2: Randomly draw 7% of the Group 2 applicants;  assess;  draw more to cover any which fail to meet fundability (only) criteria;  fund all which meet this criteria in order they were drawn until half the allocated budget is used.

Outcome measures:  I need to do a power calculation and think about the most appropriate measure, but this could be either a blinded assessment of final reports or a metric like difference in numbers of publications.

Let’s hope that lessons are learnt when it comes to the processes used to allocate National Science Challenges funds.

Should scientists respond to pseudo-science?

Do not answer a fool according to his folly, or you yourself will be just like him.

Answer a fool according to his folly, or he will be wise in his own eyes. (Proverbs 26:4, 5 NIV)

The editors of this particular list of proverbs were not fools – they knew they appeared contradictory.  Their purpose is to get us chewing over how we decide when we should speak up and when we shouldn’t.  When I heard these proverbs on Sunday my mind wandered (sorry Rev) immediately to my fellow science bloggers and the choices we make to respond or not respond to pseudo-science.  When we respond we do so wth hope.  Hope that the second proverb applies and the fool will recognise their own folly rather than keep on believing in their own wisdom.  A question I have for my fellow bloggers, how often does this actually take place?  I suspect, rarely.  At what point are we casting “pearls before swine”?  How do we know?

Perhaps more importantly, other than wasting our own time, could we be doing more harm than good (the first proverb)? By putting our scientific standing behind our reponses could we be enhancing the reputation of the pseudo-scientist in their own eyes or, worse, the eyes of readers? I think scientists are still paying the price for the over-confidence in science as solution to the world’s problems.  This has lead to some skepticism and a willingness to look at solutions that are not “main-stream” (especially if government funded or big-pharma).  By responding to the obvious nonesense, do we merely spread it further?

Some pseudo-science is addressing issues which also have non-scientific ethical issues that need to be respected.  Furthermore, the pseudo-science proponent may hold similar hopes to their scientist critic – eg hope for improved health.  I’m thinking particularly of issues such as vaccination or additives to food or water in which we need to weigh up the rights individuals with our responsibilites to others. Here, a scientist may express their opinion and their methodology of arriving at that opinion, but they need to tread very carefully not to appeal to Science with a capital “S” as if that is the ultimate standard against which all ethical decisions should be measured.

Here endeth the sermon.  Let us chew.

Don’t call this scientist soft!

I’m a soft money scientist, not because I’m cuddly (I am), or because I’m an easy mark for a fiver (I’m not), but because my job and my scientific output depend on my ability/luck at raising money.  As my 100th blog post I thought it time to describe this precarious state of affairs, especially as your taxes may be contributing to it.  Also, when the penny dropped with some friends of mine, so did their jaws.

Before I get into the description, let me say this: It is the best of jobs, it is the worst of jobs.  It is a privilege to spend most of my time solving the puzzle that are the diseases I study with the hope of making a difference to patients in the future.  It is appallingly frustrating that I cannot conduct long-term research or even rely on having an income next year because of the continued axe floating a few feet above my cranium.

In New Zealand, at least, scientists come in many flavours.  There is the industrial scientist earning a salary in a company somewhere who will sink or swim along with the fortunes of the company, there are the scientists in Callaghan Innovation, Ag Research, and other government entities that interface between academia, the commercial world, and the provision of scientific services.  I understand they have a variety of funding sources – in recent years the government side of it has moved from project grant based towards more bulk funding.  Given what is happening with Ag Research, I don’t know if that means more secured tenure for these scientists or not … I’ll let them describe their predicament.  Then, in academic institutions, there are the lecturer scientists who both teach and research.  Traditionally the spend their time 40% teaching, 40% researching, 20% in administration, but there are many variations on the theme. Normally, these people have a more-or-less permanent position (at least as long as students keep coming to do the courses they teach).  To get funding for their research (though not their salary unless they want to “buy out” some teaching time) they need to apply for grants.  In my institution, University of Otago Christchurch, most of the teachers are also active senior medical staff with joint appointments with the CDHB.

Then there are the soft-money scientists.  Most PhD students go on to do a 1 or 2 year post-doc (or two) which is funded by a grant that has been obtained by a senior researcher somewhere.  This is “soft-money” – meaning of limited duration and usually directed at a particularly project.  Most post-docs move into lecturing or leave academia.  A few may pick up additional fellowships or join a group which has the funds to employ them.  To continue in their chosen career they must contribute to the gathering of resources (money money money).  They have no training in this, but after the first few grant rejections begin to learn.  They realise they are competing against scientists who are lecturers or in other entities who already have their salaries covered.  However, the first thing they must put on their grant is their own salary + overheads (113% in my institution).  This, of course, limits what they may be able to say they will do in a grant application as they are not able to write into the grant all the expenses they’d like.  This puts them at a competitive disadvantage.  Another source of income for some groups may be commercial.  This may be the testing in their labs of some equipment  or a new product, or some forensic work etc. Not everyone has that option.

My own sojourn has been a little off the beaten path as six years ago at the age of 40 mumble I returned to the scientific fold after 15 years out of it.  My return was funded for two years initially by a Health Research Council Grant (HRC; your tax dollars) and by a private company who had obtained some government funding for development (Syft).  Since then I’ve had grants from the Australia New Zealand Society of Nephrologists (twice 🙂  ), Lottery Health, University of Otago Research Grant, and the Marsden Foundation.  My current funding till the end of the year is 41% from a Marsden Foundation grant and 59% from the profits of the last project (a commercial one) our lab-based group ran (alas … another long story, there is now no lab-based group).  Having multiple sources of income is not at all unusual for the more senior research scientists.  Indeed, the current funding levels of even the largest of the grants (HRC and Marsden) are not sufficient to fund a full time senior scientist along with all the associated costs of running a larger project (which these are intended for). The application success rates (7%) make it unlikely that anyone, other than in large established groups with broad funding basis whose success breeds grant success (rightly so!), will be able to sustain a long-term career based on grant funding alone.

One source of funding that I’ve not talked about is philanthropy.  This plays a vital, though small, role in New Zealand science.  Most are familiar with the likes of the Heart Foundation or the Cancer Society which take donations and use some of them for research projects.  An intriguing, though seldom visited, new source of funding is so called “crowd sourcing” where someone pitches a project online to raise money – Dr Siouxsie Wiles successfully raised US$4,480 last year doing just that. This, of course, will not sustain a scientist like myself.  What will?  What do you think is reasonable to spend on science and scientists?  How about the same as we spend per classroom?  According to a Principal acquaintance it costs about $17K per pupil p.a. to run a school.  The average class size is about 23 pupils making it a tad under $400K p.a per classroom.  I think what I do has similar value to educating a class full of kids, but right now I’d settle for half the amount.  Governments, of course, must make choices and impose certain limits on spending.  The current NZ government’s moves to increase spend in research are welcome, but this will at best make a small dent in the grant funding success rate.  Individuals with discretionary disposable income, though, may have other priorities.  I believe that for New Zealand to do more than tread water in the scientific world that it will require those individuals who recognise the value of science to be willing to donate substantial amounts towards science, particularly towards supporting scientists (scientists first, projects second). Indeed, for my own growth and survival as a scientist – for me to be able to put the vision I articulated last week into practice, I see that it will only be possible through the generosity of others.