Category Archives: Visions

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.

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Getting the users perspective

I can’t possibly expect to be able to comment on what it is like to be on dialysis – I’ve only observed the process.  To try and understand more I have begun to search out some blogs by those on dialysis.  Here are two:

The Facts on The big D. is a blog post by Ellie.  Ellie is a young woman (the same age as my wife) in New York in need of a transplant.  Ellie comes across as a straight shooter.  She’ll tell us when it stinks and she’ll count her blessing aloud.  Sitting in a dialysis centre is the last place she wants to be. Thanks for the honesty Ellie.

D(ialysis) Day   Joe has just begun dialysis for the third time in his life.  This is his first blog post from the chair. He first began dialysis at 15, underwent a transplant from his mother which lasted a couple of years, went back on dialysis for 4 years, underwent a second transplant which lasted 10 years and has now returned to dialysis.  What strikes me is just how long Joe needed to wait for that second transplant.  The same is here in New Zealand.  Folks, it is really very very important that you tell your family if you are prepared to donate your organs – Do not rely on there being something on your driver’s license, this has no legal effect and is often ignored by grieving relatives.  Have that conversation – today.

New visions:

No one will need to wait more than 6 months for a transplant

$100 dialysis will be portable so most will not need to spend 5 hours, 3 days a week, sitting around with tubes in them.

By the way, both these people have End Stage Renal Disease following Chronic Kidney Disease (CKD). Joe’s form of CKD appears to be from a heredity disease.  Ellie does not say.  Neither are overweight or appear to have anything other than a normal life.  CKD affects about 13% of the population (many do not know).  Do not be complacent. If in doubt, get your kidney’s checked.

When doc don’t know

I had my 13th general anaesthetic yesterday for the same thing!  It was, yet another, 50/50 call by the surgeon as to whether this new procedure would work.  50/50 calls are not unusual in medicine – to the contrary they are probably the norm.  Most of us have had the experience of having a doctor state they were not sure of the diagnosis (eg. viral or bacterial?) or of the best treatment option.  In the past they may not have told us, just applied their own prejudice and made a decision for us.   Nowadays, we are given the option and expected to make the decision ourselves…daunting!  One wonders why they are paid the big bucks sometimes!  The reality is that very few of us are well prepared to make the decision ourselves.  Few read the research and even fewer have the skills to understand what the numbers mean (a failing of our school system which places more emphasis on algebra than statistics).  So, is there anything we can do?

The number one thing we can do is insist that we become part of a trial.  Two reasons for this, if we are part of a trial then we are more likely to have better health outcomes (there is research to show this, in the meantime, you will just need to believe me).  Second, only by there being trials will answers be found as to which treatment or diagnosis is better/correct. It is a no-brainer really!

Unfortunaetly there are many barriers to trials – labourious ethics proposals (not all bad, just time consuming), lack of willingness in the medical profession (no time, no financial reward), and too few people engaged in analysing the results (my job). This could change if the politicians insisted that all medical professionals be engaged in research because it is a fundamental right of patients to receive the best health care possible!

To summarise:

Being  in a trial is a right.

Being in a trial means better health outcomes

The vision is for all patients, all of the time, to be enrolled in a trial.

As for me,  I read the research (poorly done), I made a decision based on a balance between no op and certain future multiple operations or having the op and if it were not successful more ops with possible additional problems .  I chose hope rather than the status quo.  I suggested a trial but there was no time to get ethics sorted…I may just write a trial protocol for the surgeons and if I can perrsuade them to do better.

$100 Dialysis – the vision

$100 dialysis will do for health what the $100 computer did for education.

I have no expertise in dialysis, I’ve only published one paper and a letter that address it directly. What I know is that there are millions the world over with kidney failure whose only hope is transplant or dialysis.  What I see is that dialysis is very expensive – machines and treatments cost tens of thousands of dollars, and that it is only those of us in the so called developed world who have access to them.  This was highlighted by the story of a tongan woman who had come to New Zealand for an eye op (funded from Tonga), who was subsequently found to need life saving dialysis. She was not entitled to it in New Zealand.  There were no dialysis machines in Tonga.  Without a machine she would die.  These people are our neighbours in the pacific, asia, and africa.  Dialysis is conceptually simple, it is a way of filtering waste from the blood. Practically so much waste needs to be filtered, very precisely, whilst maintaining the correct proportions of water and salts, that dialysis is also a substantial challenge.  Extraordinary progress in materials science and the ability to manufacture simple pumps using desktop 3D printers give me hope that $100 Dialysis will be a reality.  Social networking and the internet provide the means by which a vision may be propagated and progressed.  My vision is for a dialysis machine that costs just $100 to manufacture and $100 a year to run, a machine that will save a million lives. I do not see myself as leader of a project, there will need to be dozens of projects led by people far more skilled than I – nephrologists, engineers, nanotechnologists, intellectual property lawyers and the like, simply I hope to light a fire.