Research and biotech: Asking right questions

The Ken is a wonderful resource for myriad issues.The staff at The Ken is constantly churning out some of the highest quality journalistic write ups in India. Their focus is mostly on start ups, biotech and increasingly now on security of digital assets. The reason why I recommend it is to broad-base your reading sources and think laterally beyond our narrow confines. Financial crunching may not be everyone’s cup of tea but it has spurred me on to understand more about it’s complexity. In the end, it is a deep dive learning experience to write effectively. In the sea of otherwise hopeless mediocrity that Indian journalism has seeped itself, The Ken (and to some extent, Business Standard) redeem themselves.

Today’s post was motivated by an excellent coverage of biotech sector and this prodded me on to think about what the research goals ought to be. Biotech companies are chasing the end of the rainbow for the pot of gold. The reason why US remains the “gold standard” for these companies is because of a perverse incentive that pharmaceutical companies and hospital corporations have to milk the consumer. That’s where the big money is. And these companies are pushing themselves to crack the market in order to get the first mover advantage.

I will not name a few companies that I have worked with (due to non-disclosure agreements with them and that included not calling them names publicly). There were some great individuals, that I had the good fortune to learn from, as well. This aside, they are mostly floundering pushing their luck. In proverbial terms, trying to see what sticks to the wall.

In one presentation, they presented a “case scenario” which showed how the medical oncologist based his decision on genomic details for lung cancer. In another, they were keen to show for cool-rectal cancer. All laudable but with one significant omission. They did not have any follow up for outcomes! Not only this, none for any clinical trial, suitability for a vast majority or how the specific gene sets were chosen to be marketed.

Its stupidity compounded by idiocy. Over and over again.

Sadly, the translational science hasn’t made specific progress and now we have the buzz words like “precision medicine”. Pray, what is precision medicine?

Hype fuels another set of hype cycles. It is a good thing that all of this looks great on dossiers or fanning our collective egos in fancy conferences but they remain a collective effort for intellectual masturbation. We need hard core data sets and equally hard nosed questions before we thrust all of this in front of hapless patients.

The company mentioned in The Ken write up hasn’t specifically mentioned as to how they will find out the difference in the genetic mutations (from primary index lesion) to the current state. I had earlier explored this concept in an editorial arguing for liquid core biopsies as means to monitor the course of treatment in lung cancers because of the range of molecular mutations.

Rest assured, I have a healthy disdain for pharma company sponsored trials with results that appear too good to be true. When it is translated into actual clinical practise, it doesn’t live up to it’s hype. Remember the Cetuximab “landmark trial”? Or even for that matter, Bevacizumab?

Lets pause. Think.

There ought to be healthy skepticism. A side note to fellow radoncs- there is a lot that can be achieved in Radiation Therapy. We need to explore different fractionation schedules or even radiation sensitisers. Combination therapies do-not always work out. That is the subject for another blog post.

Social Media: Falsehoods

I was alarmed to read about falsehoods about health spreading through WhatsApp. It is a Facebook-owned application which has millions of users worldwide. It is impossible to get the actual numbers but suffice to say that it is prevalent in emerging economies.

The alarm went off with an excellent article from The Wired which has chronicled the rise in Yellow Fever epidemic in Brazil and the falsehoods surrounding the vaccination. I reproduce some essential bits here.

In recent weeks, rumours of fatal vaccine reactions, mercury preservatives, and government conspiracies have surfaced with alarming speed on the Facebook-owned encrypted messaging service, which is used by 120 million of Brazil’s roughly 200 million residents. The platform has long incubated and proliferated fake news, in Brazil in particular.

The phenomenon of fake news isn’t peculiar to Brazil, but these spread rapidly through the social networks.

“These videos are very sophisticated, with good editing, testimonials from experts, and personal experiences,” Sacramento says. It’s the same journalistic format people see on TV, so it bears the shape of truth. And when people share these videos or news stories within their social networks as personal messages, it changes the calculus of trust.

If you wish to have a scientific basis to why this happens, Science published a great resource.

We classified news as true or false using information from six independent fact-checking organisations that exhibited 95 to 98% agreement on the classifications. Falsehood diffused significantly farther, faster, deeper, and more broadly than the truth in all categories of information, and the effects were more pronounced for false political news than for false news about terrorism, natural disasters, science, urban legends, or financial information. We found that false news was more novel than true news, which suggests that people were more likely to share novel information.

This is an example of a rumour cascade:

The purpose of this post is that physicians should step up their game and have an active social media presence. A lot of sane voices will go a long way to dispel myths and fears about public health initiatives.

That is the reason why I set up Telegram channel to have physician vetted information and a one-stop solution for brain tumour affected patients. We owe people more!

Why blogging is essential

When you face an empty sheet, the hardest part is to define the direction you want to give to your words.

This post was in response to a brilliant blog post on 33charts, which is peddled by an influential paediatrician. I love the way he wraps up his ideas which is both a joy and a delight to read.

I have flirted and experimented with blogging consistently over the past few years (a decade or more). I am aware of how the blogging landscape evolved.

This neuroblog was set up later in response to many recommendations by those who had been there. Blogging is the best way to be able to get your ideas out. It showcases what is on your mind.

If you are clear in your mind, you can set out to do what you wish to achieve. Hence, this blogging platform is essential to categorise as well as firm up the opinion.

Twitter is sorely limited to express both the nuance as well as context. A blogging platform only explains the background, but spoken word or personal interactions best explain nuance.

Each one of these leads to a more vibrant diversity of opinion.

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Can we have a Spotify like model for academic publishing?

I have always disliked the idea of paywalls. If I have to borrow the cliche from silicon valley rags, it amounts to having “friction” in accessing the resources. It is a huge pain, especially, if you don’t have the resources.

Much has been written about the advent of scientific publishing in the internet era. And despite the monopolistic tendencies of publishers in erecting huge barriers, likes of Sci-Hub are winning. A few “pirate” websites have extended its support and currently houses the bulk of published scientific literature. Interestingly, the majority of access happens from university campuses where they have already paid for the access! It is a natural human tendency to look for the most comfortable way out!

This post is not about accessing Sci-Hub, but it reminds me of a bitter battle between pirates and Hollywood executives who had similar issues in 90’s with torrents. They are losing profits, as per their claims (despite mansions/big cars/lavish lifestyles) and are locked in pitched battles with telecom service providers to identify those who “pirate”. Paywalls and digital rights management system did not deter those who were determined to access content. Telegram, for example, has emerged as one of the largest piracy hubs for movie distribution on mobile because of its generous file limits.

This post is not to discuss these nuances, but it set me thinking. Why can’t we have a Spotify/Netflix like model for academic papers? At a monthly cost of around 10 USD with all publishers pooling in their resources, it can be a formidable challenge to a tendency to pirate. Technology has made DRM easier. Do we see pirated Netflix original content? Yes, true. But Netflix/Spotify offers a superior UI. The ratio of people paying up versus those who pirate is larger; hence these companies are profitable.

Publishing houses should accept the writing on the wall. I would be all for a Spotify like model for papers. Every stakeholder stands to gain.

How Twitter enriched me professionally as a radiation oncologist

I am a recent convert to Twitter but have flirted with it in its earlier days of inception when 140 characters were the norm. It wasn’t apparent as to why this service came into existence in the first place. Facebook started off with a similar pretence of “connecting dorm mates”, and it grew viral pretty fast from an invite-only platform to connect a majority of the online population.

I will not go in its politics or how toxic it has become. Its algorithms are an opaque science, and Facebook is a platform for social and psychological manipulation (despite public claims to the contrary). For this write-up, I’ll focus only on Twitter since I am engaging with it on a daily basis.

Twitter offers a place for discussion, sharing links, some media (pictures) and a medium to reach out to other users for marketing. Advertisers see some value in it (because Twitter offers granular options for targeting users). Beyond that, most scientists and doctors have discovered this as a platform to articulate their viewpoints. There’s life beyond academia as well, and most events affect us collectively. However, it blurs lines between personal and professional lives, often. This has prompted several professional organisations coming in with their “recommendations”, but social media is like any other platform which is public.

There is no inherent privacy if you get online. Period. Likewise, all this serves as a construct to showcase or to interact (like presenting a paper in conference or hanging out with colleagues post lunch). This also leads to a considerable scope for confusion because of the inherent limitation of characters. Like any written word, it cannot offer tone, tenor and contextual meanings which leaves things open to interpretation. However, Twitter provides only a limited scope of interaction via “re-tweet” or “like” which signals the intent. Beyond this engagement, it is a very limited platform.

With these caveats, Twitter offers a rich experience in professional interaction. I chanced on pathology colleagues, for example, who could reach out others in the world for a rapid “second opinion”. Pathological inferences usually require objective criteria, and it is not possible to be swayed by “wisdom of the crowd”. It makes it easier to nail the diagnosis for anything that’s obscure. Likewise, I interacted with a radiation oncologist, who advocated “shining the light in the basement”- exhorting fellow oncologists to embrace this medium. Another instance wherein I interacted with someone from the US to discuss the QA for a newer gamma knife machine. The follow-up comments were interesting, and I learned a lot in the process.

Similarly, it was fun to interact with professionals from down under! They are using social media in a very positive way (by dancing!) to target cancer and bring about an attitudinal change for radiation oncology (unstated and underused, like anywhere else in the world). I love their imaginative use of “targeting cancer” pin-ups with the backdrop of landmarks. Cats and dogs are also a part of it, for good measure! The idea is to get the word out to patients, who shouldn’t ever feel that they are alone. We are all a part of the team to take care of them.

These advocacy efforts on behalf of professionals are in addition to a lot of other patient advocates- one who has gone through the trauma of diagnosis and treatment and have lived to tell their stories.It is instructive for us to learn, as doctors, to understand and be empathic to their fears, concerns and how cancer diagnosis fundamentally changes their lives. A prominent patient advocate, for example, even suggested having “lego based models” to show what patients would be going through (radiation therapy mockups). A brilliant idea indeed!

Scientists have also joined in this chorus and have added their might to it. I follow their efforts to bring science to the public domain, how they navigate through government bureaucracy and how translational science can become the cornerstone of “cure”.

So yes, there are multiple positive attributes to being here on social media! For those who are starting out, a quick re-cap. You can follow specific “hashtags” like #btsm (brain tumour social media) or #radonc which are widely used around. Topical conversation happens around these hashtags. If you suffix the character “@“ before anyone’s username, it is like a “shout-out” to draw their attention. (Similar technique works in Telegram).

Join in here for the conversation and enjoy! Remember, you have only one life to make a difference!