Sunday, October 23, 2011

Early history of hospitals ... Happy Deepavilli!

Historically the care for the sick tended to occur within temples and other religious establishments. This I believe was largely related to the tendency to associate illness and healing with spiritual events. Thus the early concept of hospitals in Europe was nothing like what we encounter nowadays.

The earliest evidence of a specially constructed facility for the care of sick was apparently in Sri Lanka. This was early as the 3rd to 4th Century BC. According Wikipedia, the Carakasamhita (Compendium of Caraka) and descriptions by the travelling monk Fa Xian, India probably had the first "organized cosmopolitan system of institutionally-based medical provision" in the world. This was approximately at the turn of the first millenium. Europe continued to develop their hospital concept largely as part of the religious establishment, the modern hospital concept seen in Asia and Persia never really took root until the social and civic reforms following the French Revolution.

This perspective is important to have as we look at the continued evolution of health care provision. The usually eurocentric portrayal of medical history tends to convey the fallacious idea that all things good flowed out of Europe. This is only true to a certain extent because of the renaissance and the industrial revolution. But it is important to recognize that that renaissance was deeply rooted in wisdom that had originally flowed westwards from Asia.

This is a good account to read:
Medicine and Society in the Medieval Hospital by Tatjana Buklijaš (2008)

India was very much where the action was in the development of the modern hospital concept. And they were more than half a millenium ahead of Europe.

Nice to know that....especially as we head towards the Deepavalli celebrations.

Happy Deepavalli all!

Saturday, October 22, 2011

The culture of bandwagons, whale-ariums and the authorship mass-graves

Bandwagons are great things to have in the neighbourhood, but they are not something that Singaporeans are very familiar with. The closest we have to bandwagons would be the floats that used to be paraded across the grandstand during National Day parades. These floats would generally profile the organization and trumpet its most recent achievements. But few personalities ever get to reap any reflected fame by jumping on these bandwagons. Another version of the bandwagon is the local 歌台 ge tai's. Here's where aspiring politicians sometimes flaunt themselves during 'hungry ghosts' season hoping for some public attention.

The version of the bandwagon seen in academic circles is that associated with 'successful' and high profile researchers (or research). If you have one in the neghbourhood, you'd be very blessed indeed. By jumping on such a bandwagon, aspiring wannabe researchers collect instant fame and fortune. In the past, when few bandwagons were apparent in the local scene, we used to have to send aspiring researchers to high profile universities or research insitutes where they get access to high profile bandwagons. These researchers then return covered with reflected glory and certainty of an equivalently high profile career.

Nowadays of course, there's is a lot more money floating around and we can afford to bring in some of the bandwagons instead of sending our novice researchers out to them. Net benefit to us, as not only our young researchers but Singapore gets to bask in the limelight of these bandwagons. In order to not look so crass and obvious, the bandwagons have been camoflaged as travelling whales, as if we were recruiting for an oceanarium in Resorts World Sentosa.

It is of course, nice to have whales in the neighbourhood. Up to a certain point.

It's unfortunately been somewhat overdone. Nevermind that the rest of world also play this game. But the game of cultivating whale-ariums has taken on a life of its own, complete with its own set of KPIs. Senior management of universities, research institutes and other high profile research establishments spend enormous sums of money bidding for top performers for their whale-ariums. These senior management KPIs are based on how many whale Michael Jacksons (or Lady Gaga) they can attract. Don't worry about whether there is real transfer of technology or not, just make sure the whales perform, and as many as possible get to ride the whale.

Too cynical Gigamole is being?

Well, look at our grant agencies, and see how they look disdainfully down on local content. Woe betide your chances should you not have a significant performing whale leashed to your proposal, and are not part of one of these existing whale-ariums. Your career on the other hand, is pretty much secured for life if you can convince the grant agencies to advance you enough credit for you to lease your own whale-arium (otherwise called a programmatic grant) with at least one performing whale on board. All you need to is to sit back and collect the gate fees (otherwise known as research credits).

Correspondingly an entire culture has grown around the bandwagon/whale-arium 'ge tai'. The output of such whale-ariums has become a major KPI. Hence chalking up such research credits through being involved in publications can make or break a young scientist's career. Publication authorship lists have grown exponentially over the years. Endorsements of major performing whales become essential in providing gravitas to these publications. This gravitas is important because it provides better odds in getting your publication into major journals. Such heavy publications are referred to as having 'high impact' and secure much credit for the authors on these publications.

The university actually encourages the formation and farming of these whale-ariums.

Academic staff performances are graded according to their abilities in securing funding to lease a whale-arium or a significant bandwagon. Individual local efforts are frowned upon, regardless on whether they are meritorius (in fact a medical school Dean has been famously quoted as having disparaged his staff "How good can you be?"), or not. Involvement in journal publications are extremely important in the KPIs of academic staff. Here again the university/medical school also encourages long authorship lists to develop. It's a no brainer. Everybody stands to gain from long authorship lists. It's just a mathematical reality. More people benefit from a single publication. Young staff without an established reputation gets ahead on the (coat) tails of senior and more prominent whales. Senior academics without much research output get free rides on the backs of their more energetic and younger colleagues. The university glows with pride as all this light gets reflected back and forth. Of course the university ranking gets to climb a few notches.

Too cynical Gigamole is being?

Well, look at how the medical school computes research performance credits of it staff. Performance credits get elevated disportionately of the actual impact factors of the journals. These credits are freely awarded to co-authors without the main authors losing out on their own personal credits, resulting in total credit inflation. Hence total credits often exceed 100% of the expected credit score of any publication. Co-authorships are tacitly encouraged even if real participation is minimal. In fact, mathematically, it makes more sense to be a nominal participant on these bandwagons than trying to develop your own ideas and independant research.

Journals are supposed to require authors to decalre their actual involvement in any publication. But they seldom do. According to Wikipedia:
"In the medical field, authorship is defined very narrowly. According to the Uniform Requirements for Manuscripts Submitted to Biomedical Journals, in order to be considered an author, one must have satisfied all three conditions:
Contributed substantially to the conception and design of the study, the acquisition of data, or the analysis and interpretation
Drafting or providing critical revision of the article,and
Provided final approval of the version to be published
The acquisition of funding, or general supervision of the research group alone does not constitute authorship. Many medical journals have abandoned the strict notion of author, with the flexible notion of contributor.

I have never seen these criteria being applied.

Wikipedia further elaborates:
"the U.S. National Academies specify 'an author who is willing to take credit for a paper must also bear responsibility for its contents. Thus, unless a footnote or the text of the paper explicitly assigns responsibility for different parts of the paper to different authors, the authors whose names appear on a paper must share responsibility for all of it.' "


Let's watch the Alirio Melendez story unfold as the investigations continue. The Straits Times recently reported on another investigation of a prominent whale-arium.

These whale-ariums have lives of their own. Time to re-boot the system?

Thursday, October 20, 2011

Bandwagons, clowns, whales and massgraves - perspecting the Alirio Melendez story

The Alirio Melendez story broke sometime last week. In fact the story had for some time, apparently already been quietly whispered about along selected corridors of the YLL Medical School campus. There have been accusations about fabrication of data, and major scientific papers have been withdrawn and investigated. I really don't want to presume I know too much about the case, nor about Professor Melendez's guilt or innocance. But certain things are interesting to reflect upon.

The phrase 'jumping onto the bandwagon', comes readily to mind. The phrase, according to my fav source for info, Wikipedia, apparently came about because of activities related to a less than famous clown-politician in early American history. Apparently he had been extremely successful in exploiting the mass media technology platform of his time, the bandwagon, to exhibit his political ambitions. Soon every other politician wanted to jump onto his bandwagon to share his spotlight. Thus arose the disparaging phrase 'jumping onto the bandwagon'.

What's all that got to do with us?

Well, observers of the Singapore approach towards biomedical research excellence cannot fail to notice that we spend a lot (in fact massive) amounts of money on bandwagons. Some have disguised these bandwagons as whales so as not to be too obvious. Bandwagons are obviously quite useful when you want instant fame and recognition, but it is not based on reality or substance. Coming from our Singaporean success on planting instant trees there is a fallacious thinking among some that there is an 'instant success' equivalent for biomedical research. So we rush about frantically planting those instant whales.... sorry, I meant trees.

Research bandwagons have however been extremely successful in transforming the Singapore research reputation. Suddenly we have a Nobel Prize laureate among us (transplanted, of course). Lots of whales (recently some apparently in migratory mode). And suddenly our local researchers look good, and get to cavort on the world stage. Can't complain too much....since as local guppies we've had many covert opportunities to grow fat off some of the crumbs falling from the mouths of whales.

But the problem is fame gotten from being on bandwagons is not necessarily real, and can be fleeting. And when the bandwagon topples - voila, you have an instant mass grave.

It was an interesting exercising looking up the Melendez publications generated in Sinapore. Anyone can do it. Just go to Pubmed and search for 'Alirio' 'Melendez' 'Singapore'. Or if you are lazy, just click here. You will find a listing of 50 publications generated during his time in Singapore. These publication date between 2002 and 2010.

It was very interesting going through this publication list because you find a lot of research associations in the authorship lists. Apparently all these papers are now under investigation. And all these authors now become somewhat tarnished by their association with Melendez because of these accusations of academic dishonesty. Again, I don't want to presume the outcome of the investigations, and I do hope that it will not uncover any widely endemic dishonesty within the scientific community. But the authorship list for Melendez papers reads almost like a Who's Who in the medical school, and includes heads of departments, Vice Deans and prominent individuals in the office of the NUS Vice President. Interestingly Prof Barry Halliwell, who is NUS Deputy President (Research and Technology), and who has been cited as fronting the investigation into the Melendez publications is himself associated with at least 2 Melendez publications.

Mass graves? These tend to develop when over-populated bandwagons fall over. But more about this in another post.