Recently, my mentor asked us to speak to some colleagues in China. I was assigned the easy topic of how to present scientific works in international meetings. Rightfully, GW had to talk about how to lead a successful academic career as a young doctor in Asia.
I was secretly happy that I did not have to do the other task. Above all, if I claim myself successful, I would blush for the entire talk. More importantly, Angelina keeps reminding me that I am no longer young.
Nevertheless, if I have to share my experience, have I learned a thing or two in my career?
Most youngsters would probably be surprised if I say the first thing that came through my mind was rejection. Teachers in medical schools often graduate with flying colors, pass all professional exams with ease, and are respectable clinicians. How can they be associated with failures?
The truth is I cannot count how many times my scientific papers and grant proposals were rejected. I had a paper which had been rejected by five different journals in a row. Some editors were nice and gave constructive comments. Others said the work was crap and should not be done in the first place. Each and every time, I wondered if this was the life I wanted to lead. To the least, if I just do clinical work, most of my patients have been satisfied with my service.
At one point, I asked my mentor what else I needed to improve before I could get my work published in leading medical journals. My hidden message was actually “I have done everything I can but the works all ended up in mediocre journals. I cannot take this any longer.”
He simply answered, “You have already got all the qualities to generate significant works. You have ideas, writing skills and also the patience to wait for the data. As for publications, luck plays a major part. In the current system, your paper will be rejected if just one of the reviewers dislikes your work. Just give it time.”
Looking back, of course I know I did not have the qualities my mentor described. But I did continue and the work was getting better. For those who wish to quit, I must say that rejection is a unique experience to improve oneself and it is worth it.
30 Sept 2010
23 Sept 2010
Offices
At a recent advancement interview, a professor asked a candidate what he had learned in the last two years.
“I learned about the running of huge institutions by the hard way,” the candidate answered. “When I worked in private companies, the important thing was to get things done and procedures could be ignored. In a huge institution like the university, procedures are everything. People do not really care whether things really get done. If I want to do something, I have to stick to steps 1 to 5. If I somehow miss step 4, people would ask me to start from step 1 again. Of course, through the process, I also learned whom to approach.”
You think he failed? Not quite. First, the other potential candidates did not come to the interview. Second, all three interviewers liked his answer. In fact, I must say that after all these years, I still do not understand the administration of the university as well as this young man does. Whenever I look through the directory wondering who is responsible for what, I feel like Barnabas in The Castle.
“Is it even Castle work that Barnabas is doing, we then ask; he certainly does go into the offices, but are the offices actually the Castle? And even if the Castle does have offices, are they the offices Barnabas is permitted to enter? He enters offices, but those are only a portion of the total, then there are barriers and behind them still more offices.”
“I learned about the running of huge institutions by the hard way,” the candidate answered. “When I worked in private companies, the important thing was to get things done and procedures could be ignored. In a huge institution like the university, procedures are everything. People do not really care whether things really get done. If I want to do something, I have to stick to steps 1 to 5. If I somehow miss step 4, people would ask me to start from step 1 again. Of course, through the process, I also learned whom to approach.”
You think he failed? Not quite. First, the other potential candidates did not come to the interview. Second, all three interviewers liked his answer. In fact, I must say that after all these years, I still do not understand the administration of the university as well as this young man does. Whenever I look through the directory wondering who is responsible for what, I feel like Barnabas in The Castle.
“Is it even Castle work that Barnabas is doing, we then ask; he certainly does go into the offices, but are the offices actually the Castle? And even if the Castle does have offices, are they the offices Barnabas is permitted to enter? He enters offices, but those are only a portion of the total, then there are barriers and behind them still more offices.”
16 Sept 2010
The Castle
During this summer holiday, Angelina has read literally hundreds of books.
One day, I was astonished to see her reading The Castle by Franz Kafka. Of course, she was still working on chapter 1, Arrival, then. Thanks to training in phonics, she pronounced most words correctly and understood K. was trying to get a room at an inn.
After talking for a while, I realized that Angelina expected K. to rescue a princess in the castle or do something similar. She found the book too long and urged me to tell her the ending. “You have to find the answer yourself,” I said. But the book was nothing like that and would probably soon spoil her fun.
On second thoughts, I could modify the story a bit. Angelina would feel the conversations similar to those in Alice’s Adventures in Wonderland.
One day, I was astonished to see her reading The Castle by Franz Kafka. Of course, she was still working on chapter 1, Arrival, then. Thanks to training in phonics, she pronounced most words correctly and understood K. was trying to get a room at an inn.
After talking for a while, I realized that Angelina expected K. to rescue a princess in the castle or do something similar. She found the book too long and urged me to tell her the ending. “You have to find the answer yourself,” I said. But the book was nothing like that and would probably soon spoil her fun.
On second thoughts, I could modify the story a bit. Angelina would feel the conversations similar to those in Alice’s Adventures in Wonderland.
9 Sept 2010
Universal Studios
The next day, our family traveled to Singapore. As expected, we visited the Universal Studios.
We found many similarities between the Universal Studios and Hong Kong Disneyland. Both are small and not too well attended – compared to the same theme parks in other countries; you still need to wait around 10 minutes for each attraction. If you buy Universal Express (48 Singaporean dollars for each person) on top of the admission tickets, you do not need to wait at all. On the day of our visit, we could not see a single soul paying for fast pass.
If you think this means the Studios is no good, you are mistaken. When one travels with a four-year old girl, short waiting time is the most important. Few attractions are not our concern at all. We would not be able to hang around for the whole day anyway. Thus, despite of what many Hong Kong people have remarked, I think the Hong Kong Disney is a nice place. Nevertheless, I would not recommend the Treasure Hunters. This is a motor car ride in the Ancient Egypt area. There is little to see and the ride ends shortly.
The nicest attraction was Lights, Camera, Action! This illustrates how an empty soundstage can become the setting of a Category 5 hurricane in New York. The stormy scene ends with the destruction and collapse of the boathouse where you are standing.
Although technology must have progressed a lot, I felt the King Kong and Backdraft scenes that I saw 20 years ago at Universal Studios Hollywood were much better. Well, no canvas absorbs color like memory.
We found many similarities between the Universal Studios and Hong Kong Disneyland. Both are small and not too well attended – compared to the same theme parks in other countries; you still need to wait around 10 minutes for each attraction. If you buy Universal Express (48 Singaporean dollars for each person) on top of the admission tickets, you do not need to wait at all. On the day of our visit, we could not see a single soul paying for fast pass.
If you think this means the Studios is no good, you are mistaken. When one travels with a four-year old girl, short waiting time is the most important. Few attractions are not our concern at all. We would not be able to hang around for the whole day anyway. Thus, despite of what many Hong Kong people have remarked, I think the Hong Kong Disney is a nice place. Nevertheless, I would not recommend the Treasure Hunters. This is a motor car ride in the Ancient Egypt area. There is little to see and the ride ends shortly.
The nicest attraction was Lights, Camera, Action! This illustrates how an empty soundstage can become the setting of a Category 5 hurricane in New York. The stormy scene ends with the destruction and collapse of the boathouse where you are standing.
Although technology must have progressed a lot, I felt the King Kong and Backdraft scenes that I saw 20 years ago at Universal Studios Hollywood were much better. Well, no canvas absorbs color like memory.
2 Sept 2010
Metro
I promised some of my colleagues to report on my recent trips to Shenzhen and Singapore.
The trip to Shenzhen was to deliver a talk at a meeting organized by an international cancer organization. I took the opportunity to try the Shenzhen Metro. The Metro was jointly run by the Hong Kong MTR Corporation and China. It was indeed convenient. The Metro station was connected to the Lok Ma Chau MTR station. Both the station and the trains were clean and tidy.
As I came out from the conference center station, I thought the venue would be easy to find. I was wrong. I looked around and found that all the giant complexes looked like conference centers. In the end, I still need to ask a policeman.
That was the first time the international cancer organization held a meeting in China. As most people are aware, China has the money and patients. Where else would pharmaceutical sponsors want the meeting to be? Nevertheless, the organizer somehow overestimated the situation and arranged seven concurrent sessions at the same time. Each room ended up hosting around twenty people, including chairmen and speakers. It is alright. My university promotes small group teaching anyway.
The trip to Shenzhen was to deliver a talk at a meeting organized by an international cancer organization. I took the opportunity to try the Shenzhen Metro. The Metro was jointly run by the Hong Kong MTR Corporation and China. It was indeed convenient. The Metro station was connected to the Lok Ma Chau MTR station. Both the station and the trains were clean and tidy.
As I came out from the conference center station, I thought the venue would be easy to find. I was wrong. I looked around and found that all the giant complexes looked like conference centers. In the end, I still need to ask a policeman.
That was the first time the international cancer organization held a meeting in China. As most people are aware, China has the money and patients. Where else would pharmaceutical sponsors want the meeting to be? Nevertheless, the organizer somehow overestimated the situation and arranged seven concurrent sessions at the same time. Each room ended up hosting around twenty people, including chairmen and speakers. It is alright. My university promotes small group teaching anyway.
26 Aug 2010
Guidelines
But people who draft management guidelines are conscientious and world-renowned experts. They would not allow their potential conflicts of interest interfere with their judgment and recommendations, right?
Yes and no. I tend to trust that most guidelines reflect what the authors believe and are not for financial and political gains. Nevertheless, the recommendations can still be biased. In our field, colonoscopy surveillance for colorectal cancer prevention is a big business. In some countries, there are clinicians who would call themselves colonoscopists, more or less telling you that they would not do much else. However, one cannot ignore the fact that the effect of colonoscopy surveillance on overall and cancer-related mortality has not been tested by randomized controlled trials. In addition, there is accumulating evidence to show that colonoscopy does not save more lives than flexible sigmoidoscopy, a simpler procedure that does not require thorough bowel cleansing and sedation, not to mention the lower complication rate.
With this background, you probably would expect that experts should support the simpler procedure. Nevertheless, searching through the literature, many experts (notably gastroenterologists) still state colonoscopy as the preferred surveillance method.[N Engl J Med 2009;361:1179-87] The rationales such as more thorough examination and the inclusion of proximal colon are more theoretical than evidence-based. Again, in this particular case I do not doubt the experts recommend colonoscopy for their own benefits. They are so senior that I cannot imagine they are still making a living by doing endoscopies. The biased view merely stems from their background and thus health beliefs.
Therefore, the medical committee is suggesting a revisit of the guideline drafting process. In essence, experts in one particular field should mainly provide relevant evidence but not have overwhelming influence on the final recommendation statements.
P.S. If you search PubMed for articles on CT colonography, it would be funny to note that around half of the articles said that this new radiological technique is extremely good and half said its performance is suboptimal and not ready for routine clinical use. If you note the affiliations of the first authors, the former articles were all written by radiologists and the latter were by, you got it, gastroenterologists. This time, we are talking about real business.
Yes and no. I tend to trust that most guidelines reflect what the authors believe and are not for financial and political gains. Nevertheless, the recommendations can still be biased. In our field, colonoscopy surveillance for colorectal cancer prevention is a big business. In some countries, there are clinicians who would call themselves colonoscopists, more or less telling you that they would not do much else. However, one cannot ignore the fact that the effect of colonoscopy surveillance on overall and cancer-related mortality has not been tested by randomized controlled trials. In addition, there is accumulating evidence to show that colonoscopy does not save more lives than flexible sigmoidoscopy, a simpler procedure that does not require thorough bowel cleansing and sedation, not to mention the lower complication rate.
With this background, you probably would expect that experts should support the simpler procedure. Nevertheless, searching through the literature, many experts (notably gastroenterologists) still state colonoscopy as the preferred surveillance method.[N Engl J Med 2009;361:1179-87] The rationales such as more thorough examination and the inclusion of proximal colon are more theoretical than evidence-based. Again, in this particular case I do not doubt the experts recommend colonoscopy for their own benefits. They are so senior that I cannot imagine they are still making a living by doing endoscopies. The biased view merely stems from their background and thus health beliefs.
Therefore, the medical committee is suggesting a revisit of the guideline drafting process. In essence, experts in one particular field should mainly provide relevant evidence but not have overwhelming influence on the final recommendation statements.
P.S. If you search PubMed for articles on CT colonography, it would be funny to note that around half of the articles said that this new radiological technique is extremely good and half said its performance is suboptimal and not ready for routine clinical use. If you note the affiliations of the first authors, the former articles were all written by radiologists and the latter were by, you got it, gastroenterologists. This time, we are talking about real business.
19 Aug 2010
Conflict
Recently, our managers are striving to control the drug budget. Every team is requested to submit an innovative idea to reduce expenditure.
At lunch, AT complained that even an inexpensive drug was tightly controlled although current guidelines had already recommended the most expensive agent as first-line treatment.
“Mind you,” S replied, “most guidelines are written by international experts with much conflict of interest. Not surprisingly, companies selling the newest and most expensive drugs have a lot of influence.”
“You don’t have conflict of interest. You should sit in those panels,” EW suggested.
“Oh, it doesn’t work this way,” said S. “In their eyes, the very fact that I do not have conflict of interest is good enough proof that I am not an expert.”
At lunch, AT complained that even an inexpensive drug was tightly controlled although current guidelines had already recommended the most expensive agent as first-line treatment.
“Mind you,” S replied, “most guidelines are written by international experts with much conflict of interest. Not surprisingly, companies selling the newest and most expensive drugs have a lot of influence.”
“You don’t have conflict of interest. You should sit in those panels,” EW suggested.
“Oh, it doesn’t work this way,” said S. “In their eyes, the very fact that I do not have conflict of interest is good enough proof that I am not an expert.”
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