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Should you keep politics out of your career?

Advocacy is a core function of many health professions, including nursing and medicine. So why are we socialized not to engage with politically touchy subjects at work?

Funding for much of our work in science, medicine, and education comes from the government. Sometimes it comes from corporations that make pharmaceuticals or devices. Even in democracies like the U.S., legally protected free speech does not prevent organizations from restricting their employee’s participation in political activities or certain kinds of speech while working.

The current global public health crisis is igniting fierce debates around hot-button issues of workforce safety, inequality, prejudice, disparities, and personal freedoms. As the world changes rapidly, I am hearing lots of early-career folks wondering how to balance the call to engagement on divisive topics with the need for career stability. My profession, nursing, has a long history of activism and political engagement. I also work for a large university, where political engagement can rock the boat and raise eyebrows. This is a precarious position.

Here’s the rub: public health issues are inherently political. Think of political advocacy around tobacco and vaping, and food. These are everyday public health concerns and they are steeped in politics, yet they rarely result in career-ending political feuds; this kind of politics is generally tolerated in academic institutions. However, as we are now seeing, the relationship between politics and public health is stronger with rare and catastrophic events like the COVID-19 pandemic. Those of us in science and health professions are facing the ramifications of political decisions daily, such as access to PPE supplies, access to ventilators and medications, guidance to the public about masks and distancing, and travel restrictions. We feel this impact acutely, and many of us feel compelled to voice our opinions.

Yet, we may find ourselves at risk if we speak up about an issue with political implications, either at work or in outside public forums. Voicing dissent to institutional policy, governmental policy, or anything in between can be professionally and personally damaging. In the U.S., hospitals have been ordering staff not to speak to the media and terminating those who do not comply. This behavior can have a chilling effect on others’ willingness to voice concerns about safety. As a result of these gag orders, high-level decision-making is often missing key voices and information. The case of Dr. Li Wenliang, the Chinese physician who sounded early warnings of the dangers of the novel coronavirus, was reprimanded by the Chinese government, and later died of the disease, is a tragic example of just how the stakes are. Navigating the boundaries of political and scientific speech in life-or-death situations is not something we learned in graduate school.

The relationships among scientific data, lived experience, and government messaging are complicated, but that doesn’t mean they are untouchable in a professional context. Medical journals do not universally shy away from political perspectives. The Lancet, for example, recently  published an opinion piece pulling no punches in its assessment of American political leadership: Michael Marmot writes, “Apart from the mendacity, incompetence, narcissism, and disdain for expertise of the man at the top, there may be strong messages about the nature of US society and the response to the pandemic.” Not all professionals and academics are willing to voice such forceful political opinions, but this example shows that even strongly worded opinions can be embraced.

Can mixing politics and work hurt your career? Definitely. Is it possible to practice your profession apolitically? Maybe. Is that something you want to do? You have to decide.

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”

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The Importance of Maintaining the Public’s Trust in Science and Medicine

Often, and especially during the COVID-19 pandemic, there is a plethora of misinformation that is spread. We have all probably seen at least one scientific publication, news article, social media post, or YouTube video that is spreading information that is not accurate. Every day, I am bombarded by conspiracy theories or unfounded scientific claims while skimming through social media. During a time when information is rapidly disseminated through the internet, it is often difficult to extinguish a lie.

Sometimes, misinformation is inadvertently spread by well-meaning individuals who have not had the time or energy to confirm or critically appraise the information shared. “Liking”, “retweeting”, and/or sharing a post from a colleague/friend/relative is facile. We have all probably “retweeted” or shared certain articles and posts that we did not completely critically assess before sharing. Sometimes dissecting truth from fallacy is difficult, especially when information is disseminated widely. Our current technological advances with the internet and social media magnify opinions, good and bad. Occasionally, one may think, if multiple people I know and/or respect are sharing certain information and the number of posts about the false information outnumber those on the truth, then the misinformation must be true.

Occasionally, misinformation about science or medicine is shared by members of our own scientific and/or medical communities, which can sometimes be more damaging to our profession. For example, more assumed credibility may be given to a scientist or healthcare provider, even if his/her expertise is not in the area that is commented on. Conspiracy theorists may continually reference these “experts” to support their arguments. Sometimes, refuting incorrect information requires massive efforts but may never eliminate the long-lasting negative effects of the misinformation. For example, Andrew Wakefield’s infamous, now retracted scientific article that was published in The Lancet and falsely claimed an association between the measles, mumps, and rubella vaccine with autism is unfortunately still being referenced to support arguments against vaccinations even though multiple studies have overwhelmingly refuted the claims made in the retracted article.

With less malicious intent, some misinformation may be spread by the media or others in reference to research articles. Certain conclusions of research papers are sometimes not justified by the data presented due to inadequate sample size, biases, issues with the experimental design, etc. During a pandemic, since rapid dissemination of scientific and medical information is needed, there is frequently a tradeoff with the scientific rigor and reproducibility of the results. Since access to papers in preprint servers are available to the public, the media and public figures may tout certain research findings as truth when they have not been vetted by the peer-review process. A fellow AHA early career blogger, Dr. Allison Webel (@allisonwebelPhD), recently wrote an outstanding blog discussing the importance of the peer-review process (https://earlycareervoice.professional.heart.org/in-defense-of-peer-review/). Of note, even peer-reviewed articles are not free from research misconduct and incorrect conclusions. There are many articles retracted from high impact journals. Before the development of the internet and social media, critiques and feedback of research findings were typically only discussed at scientific meetings or at other selective venues (e.g., local conferences/presentations, journals typically not viewed by lay people, etc.). Now, these debates occur in the public arena with beneficial and negative aspects and frequently with nonexperts. These public debates may dilute the truth when unfounded comments are perpetuated.

What should we do about the spread of misinformation? Propaganda and false information are always going to be spread but we should try to mitigate their breadth and potential damage. On an individual level, researchers should thoroughly assess their results and determine whether their data are valid and whether the claims they make in publications are justified by the data before presenting the findings to the public. Limit overreaching conclusions. Scrutiny of results by authors and the research community is essential to the scientific process. Developments and advances in science often occur when findings are reproduced either within a specific lab/group or by other labs/groups and this is especially important to realize during a time when a deluge of single-center, small sample size papers are published about the COVID-19 pandemic. Dr. Elizabeth Knight (@TheKnightNurse), another fellow AHA early career blogger, recently calls to attention the scientific lessons learned from the current pandemic (https://earlycareervoice.professional.heart.org/evidence-whats-good-whats-good-enough-whats-dangerous-lessons-for-now-and-later/).

How do we influence other people’s opinions? Internal changes are often easier to make than changing other people’s opinions. However, we are all likely an influential source of information within our own social circles and networks. We may feel more comfortable directly communicating with people we know to correct misinformation. Altering the opinions of people who we do not personally know is more challenging. At minimum, as researchers and healthcare providers, we should not intentionally try to deceive the public. Flagrant dishonesty from researchers and/or healthcare providers may erode the public’s trust in our profession, possibly to a greater extent than a nonexpert’s comments. We all make mistakes and honest misunderstandings and misinterpretations can affect all of us. However, deliberately lying and abusing the influence of one’s position as a scientist or healthcare professional is more offensive. I do not know how best to address colleagues who blatantly mislead the public. If an individual we personally know is deceiving others, we can directly communicate with him/her about the impact of the misinformation. Depending on the extent of the damage created by an individual in our professional community who is propagating false information, should we review his/her ability to maintain as a member of our profession?

What are your thoughts on how we can preserve the public’s trust in science and medicine?

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”

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How to Shine the Light on Hidden Figures in Science and Medicine

March is Women’s History month and like last year, I wanted to find a way to use this blog as a way to highlight some amazing women scientists and cardiologists. When writing my piece last year, I had a really hard time finding enough information about trailblazing women in cardiology — which was incredibly frustrating since we all know women are a driving force in our field.

I then came to realize, although I wasn’t surprised, that this isn’t specific to our field. One of the main reasons it was hard to make a list of notable women in cardiology is that less than 20% of Wikipedia articles are about women. Even Marie Curie shared her Wikipedia biography with her husband until recently. If winning a Nobel Prize doesn’t make you worthy of your own Wikipedia page, I’m not sure what does. This bias has become an issue in part because most of Wikipedia editors are men.

So, how do we fix this? What can you do?

It turns out, the answer to these questions is actually really easy! Since anyone can become an editor on Wikipedia, you yourself can edit or write pages for notable women and other under-represented scientists/physicians. This practice has actually become a popular grassroots movement, with Women in STEM Wikipedia-edit-a-thons sprouting up all over the country — I’ve been to three in the last year!

One of the main drivers of this movement is a physicist at Imperial College London, Dr. Jess Wade, has written over 900 biographies on Wikipedia in just the last couple of years. While writing almost a thousand articles seems a bit overwhelming, you can easily edit a page you think deserves to be beefed up or create one of your own by following this beginner’s guide, which also includes information about how to run your own edit-a-thon if you know of others who are interested. Writing with friends is always more fun. The last edit-a-thon focused on creating pages for under-represented scientists that I attended was this past weekend on International Women’s Day and had a wonderful keynote address from Dr.Maryam Zaringhalam, who has been another driver of making Wikipedia a more inclusive space. In just a couple of hours at this edit-a-thon we added 5 new biographies, made over 200 edits and added over 12,000 words to Wikipedia! This was just our group — on this day, there were actually more than 12 other groups working with us virtually and collectively we added over 60,000 words to Wikipedia. You can actually catch the livestream of this event, including Dr. Zaringhalam’s phenomenal keynote here.

So this Women’s History Month, take action to make our community more inclusive by starting with the internet — it’s easy, rewarding and fun, I promise!

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”

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What if? Making the most of your 72 hours at #AHA19

The two most powerful words in the English language are “What If.” These words have created new nations, led to the most memorable books, and landed humans on the moon. They have also inspired almost every scientific breakthrough throughout human history. What if we could isolate radio isotypes? What if we could ultrasound the heart? What if we could transplant heart valves? What if we could create a machine to function like a heart while awaiting transplant? Each breakthrough has led to thousands of additional, and unanticipated, “What If” questions that have formed the foundation of modern cardiology and saved millions of lives.

Dreaming up “What If” questions is the first step of innovation and science is the method of rigorously answering these questions in a reproducible way. At AHA Scientific Sessions (#AHA19) this year, scientific innovation will be on display in every corner of the Philadelphia Convention Center.

In many ways, the entire Health Tech and Innovation Summit is the result of “What If” questions. What if we use artificial intelligence to identify those at risk for heart attacks? What if my K award results in a new Blood Pressure device that can be commercialized? What if we can use our smart watches to detect Atrial Fibrillation? And after smart watches, sensors, medical records and artificial intelligence have been harnessed to their full potential, what nascent technology will next revolutionize cardiovascular health? To find the answers to these questions, and three days’ worth of cutting edge discoveries, please join us in the Health Innovation pavilion, Heart Hub, Science and Technology Hall, Level 2.

And to be truly inspired, please add the AHA competition for best artificial intelligence and machine learning to your itinerary. This year three incredible trailblazers, Dr. Suchi Saria from the Johns Hopkins Bloomberg School of Public Health, Dr. Ramaraju Rudraraju from the University of Alabama at Birmingham, and  Dr. Chun Yuan from the University of Washington, will compete for $10,000 prize sponsored to Amazon Web Service and Circulation: Genomic and Precision Medicine.

This year the World Economic Forum Collaborators will present sessions on big data and deep learning, blockchain in health care, and highlight the value in Healthcare Initiative for cardiovascular practice.

But not every innovation is new or digital. One of the most anticipated late-breaking science presentation is the results of the COLCOT study. The COLCOT study evaluated the impact of colchcine, an anti-inflammatory medication used for hundreds of years, on the recurrence of cardiovascular events in those who have recently experienced a heart attack. Results will be released Saturday morning at 10:45am.

What should you take away from Scientific Sessions this year? Yes, you will see, and hopefully experience, lots of cool and potentially life-changing innovations, develop lifelong networks, and walk a lot. And when you leave Philadelphia, you may be able to apply these innovation to your daily work. But, perhaps more importantly, I encourage you to take a step back and think about these innovations in the aggregate. Think about what prompted the “What If” questions that resulted in the presentations. Then think about your own “What if” questions.

As you attend Scientific Sessions this year, I hope you take away more than just (the important) knowledge about these innovations. I hope you take away the inspiration to ask your own “What If” questions. Let those questions change your practice or your daily work and inspire you to be a relentless force. And next year, or maybe in the next 10 years, bring your innovations back to Scientific Sessions and let them inspire others to dream bigger and see further.

 

The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.

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Going the Distance: Setbacks and a Meaningful Career in Science

On July 4th, me and 60,000 of my closest friends ran in the 50th Peachtree Road Race in Atlanta, Georgia. This was my first 10K run and as a relatively new runner, my inclination for training for this race was to go hard and go fast – a manta not just for running but possibly for my entire generation. But as I would eventually learn, distance running is not about just getting it done. It is about being patient, listening to (and adjusting) my body, and having a long-term mindset focused on the process as much as the goal.

nih rejectionsThroughout my training, I was struck by how similar distance running is to a career in science and to grant writing in particular. When I finished my PhD 10 years ago, I was confident in my ability to write manuscripts and proposals, secure funding, and ultimately do and disseminate the science that would leave a lasting impact on the health of vulnerable populations. This confidence continued even when, during the last few years of my K award, I submitted grant after grant to the NIH only to have them be not discussed repeatedly.  I understood that NIH success rates were low, with institutes reporting a range of success rates from ~10% to 35% in 2018. Mentors reminded me that failure was part of the process and that everyone has a string of not discussed grants in the early phase of their career. I just needed to keep listening to the reviewers, getting more preliminary data, refining my ideas, developing great teams, and above all writing, and eventually my ideas would hit. However, when my string of not discussed/not funded grants grew to 15 (Figure 1), each set of pink sheets more soul crushing than the last, I knew that statistically I was failing more than I should. And I questioned if I should even be in science or if these past few years were just wasted time.

These setbacks can be devastating – causing approximately 10-15% of early career scientists to leave the field. But what about those who stick it out? What happens to them and, more importantly, what is their long-term impact on science? These are the questions explored in a recent article by Yang Wang, Benjamin Joes, and Dashun Wang, “Early-Career Setbacks and Future Career Impact”. Through a series of pretty cool analyses they examined if early success in obtaining an R01 award from the National Institutes of Health led to more success and a higher impact (measured as highly-cited manuscripts) compared to those who almost, but just missed the funding threshold. Essentially, they wanted to figure out among early career health scientists which perspective is true: Do the “the rich get richer” or will “what doesn’t kill you makes you stronger”?

Unsurprisingly, the results were somewhat mixed but encouraging for an early career scientist who has had many misses. While those with near misses had approximately a 10% chance of leaving the NIH funding system entirely over the next 10 years; of the scientists remaining, those who had an early career funding failure wrote higher impact manuscripts, compared to those who had early funding success. This is a striking finding which needs to be carefully considered (specifically that junior scientists do not need additional roadblocks in their path in order to become “stronger scientists”). Yet, the authors do suggest that for those scientists who persevere, “early failure should not be taken as a negative signal” rather viewed as a chance for refining and improving their program of research.

Wang and colleagues start their manuscript with a quote by Robert Lefkowitz, winner of the 2012 Nobel Prize in Chemistry, “Science is 99 percent failure, and that’s an optimist view.”  While he many have been referring to failed experiments, what Wang’s  new analysis reveals is that even the process of obtaining the funding to support research is likely to be fraught with heartbreaking setbacks. But if you’re in science because you believe in its power to answer important questions which will help us to better understand and improve the human condition, perseverance is necessary.

I finished my first 10K in under 60 minutes. Not a medal-winning time but I preserved through the heat, sun, fatigue, and even a bit of pain to cross the finish line. Similarly, late last year I received the Notice of Award for my first R01 from the NIH- leading a research study that I believe in with a team that inspires me every day.  So whether you are submitting your first or 15th research grant, know that setbacks are common and despite the outcome on any one application, with a long-term mindset you can have a lasting impact on science.

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Storytelling In Science: A Different Way To Communicate

Does it bother you when a news article misinterprets a study finding?

An article published in the British Medical Journal in 2014 described an association between exaggeration in academic press releases and subsequent health-related science news pieces. Exaggerations included “explicit advice not indicated in the journal article” and use of stronger causal language. But don’t bury your head in the sand just yet. In a post about the media and your research, Science Magazine makes a good point: if you don’t tell the story of your science, someone else will – and they won’t do it well. From a more optimistic perspective, engaging the media about your research will “help educate the general public, and promote a more positive attitude towards research.” With that in mind, let’s talk about how to communicate with the media, so that your science gets communicated.

A survey of scientists found that many “worry about being misquoted and find journalists unpredictable.” The lack of formal media training in most scientific programs means when you get a call from a reporter, it’s sink-or-swim. The surge in science communication online brings scientists closer to reporters and closer to the public. Whether you’re interviewed by a journalist, or crafting your own message for the public, learning to communicate your research findings succinctly can help you avoid 3 errors often found in science journalism: errors by simplification, errors by omission, and false statements.

These errors stem from a lack of understanding by both parties – journalists of the research topic, and scientists of the purpose of the article. Simplification is necessary to communicate key findings, and the purpose of science news article is to convey that big idea and the ‘So What?’ implications to the general public. Errors by omission follows, as many details crucial to a research paper just aren’t necessary in the media counterpart. In my last post, I wrote about tips for constructing effective elevator speeches, with the focus on narrowing a project down to the main idea. Being at the center of your research means we’re often surrounded by the details and see them all as important. But distilling the main idea down into that ‘So What?’ implication, and then adding on how you did it, is a key skill that everyone can develop with a little work.

Storytelling in Science

Robin Smith, PhD and science writer, shared her tips for telling a story with your science, at a talk with the Science Writing and Communication club at University of North Carolina at Chapel Hill. Beyond communicating the main idea of your research, telling a story with your science is more effective than our traditional logical format. Don’t believe me? Reading narrative stories engages more regions of your brain compared to reading expository writing. The more parts of your brain engaged, the more you understand, and the more you remember. Michael Dahlstrom says it well in his 2014 paper “Using Narratives and Storytelling to Communicate Science with Nonexpert Audiences:” when we move to data collection to science communication,

AHA ECR May2018 Storytelling in Science

narratives are not only more appropriate but potentially more important.

Here’s Dr. Robin Smith’s 3 tips on telling a story with your science.

1. Lead with the Back Story
 
Ask yourself how you came up with this idea. It’s a great prompt for interviews with journalists or discussion at a family reunion. When we grab on to a research idea, we develop it, we do it, we publish it, and we continue to think forward. But it’s often our previous work that spurs our future work. Back pedal for a moment and start with a brief explanation of what you did, but then elaborate on why you did it. It may seem overly simple, but I guarantee you’ll replace blank stares with nodding heads.
 
2. Begin in the Middle
 
This tip is one of my favorites. When you’re reading a journal article, it’s up to you where you stop and start. But when you’re listening to a talk, you’re stuck. Expository writing provides all the information in that same logical order, but that doesn’t mean it’s the most interesting order. If your research involves a wacky method, or your results were particularly surprising, start there – catch your reader’s interest – and then go back to fill in the earlier parts. I think her example involved camping in a blizzard to study penguin behavior. Pretty wacky, right?
 
3. Pick a Data Point
 
Dr. Smith illustrated this last tip with (you guessed it) a story. She spoke about a man who lost his leg in a work accident, and felt limited by his prosthesis in simple tasks, like standing up from a chair. Our natural limbs, connected to our brain via nerves, anticipate our next movement. But many prostheses lag behind.

Why was she talking about prostheses? A researcher at North Carolina State University, Dr. Helen Huang, uses science to develop advanced control of adaptive, efficient, and safe robotic prostheses.

Picking a data point means describing a person, a place, or an event, that illustrates the problem your research studies or the impact of a solution it points to. Can you think of a ‘data point’ in your research?

Effective Communication = Clinical Impact

Does the idea of storytelling in science still make you cringe? Worried about your work being distorted into a sensationalizing headline? Or that you’ll end up writing to entertain, not inform? Or maybe you barely interact with the media and have no desire to change that in the future. Narrative science writing and story telling may have a bigger role in your science future than you think. Whether you write a guest post on your hospital’s blog, develop new patient communication materials, or you’re presenting at this week’s M&M, engaging your reader will make your science understood, and that’s what you want, right?

Communicating science effectively has direct clinical implications: it can help a patient overcome barriers to seeking treatment; it can provide a role model for behavior change through an anecdote; and the effective delivery of a science-based message via narrative writing will create patient attitudes strengthened by both a cognitive and emotional basis.

How do you communicate science?

Bailey DeBarmore Headshot

Bailey DeBarmore is a cardiovascular epidemiology PhD student at the University of North Carolina at Chapel Hill. Her research focuses on diabetes, stroke, and heart failure. She tweets @BaileyDeBarmore and blogs at baileydebarmore.com. Find her on LinkedIn and Facebook.