[HSF] Why cardiac surgeons dont do NIH research

Tea Acuff tacuff at swbell.net
Thu May 29 21:31:00 EDT 2008 

If I may suggest a behavioral or biologic format for thinking about how these things work out, we might be less confused than with competing "proper" world views or counter culture cynical views. 
 
All of these issues: selection of funding or correct practice, etc are information based or communication problems. Whether we are a cell replicating another protein or a researcher applying for an NIH grant, we need to transmit information in an understandable format. Also if we do not communicate into a receptive format our information is lost. Why waste out time? (Why write this anyway, tea?)
 
Some of the discussions I have had on HSF have led me to organize my thinking about how this occurs into three (at least) levels or systems all of which are operative at the same time. None of these ideas are new, but regardless, formal thought using all of them is frequently absent and the emphasis of this interaction is almost always misplaced causing senseless communication. (yes, an oxymoron but common occurrence).
 
The most fundamental communication in humans occurs on a preverbal or mammalian relational level. It is not about the things that we discuss, but the relation we are having with that person which will decide how we deal with the "data" about the thing (even if it is a relationship) in discussion. Who is top dog and second dog and runt. I have come to believe many of the discussions in committees or therapy, be they scientific or economic, are 90% (that is highly) understandable on this level. This is especially true if there are questions of fact or complex issues without clear and ready consensus. If there is ready consensus the relational part is already worked out, eg it is your job to fix it or my job to agree. Otherwise the discussion is most about who decides. This is regardless of the verbiage in the discussion.
 
However, most of the discussion of things (eg medicine) is at a verbal level. Like our hands, our language and its symbols are designed specifically to manipulate things. Although this language ultimately also can be applied to people it is poorly so done, as people are a special case of thing in that they are (sometimes) free to counter manipulate. Again if we are already on the same relational page and the verbal symbols are readily translated into manipulable and similar things, much can be understood at this level. The problem is that we think as if everything is explainable at this level. Thus for example we think that we can justify that there is no need for research on RSV, refusing blood, or your successful or thoughtful approach does not meet proper standards. In training or the stereotypical German system everything is discussed at the verbal level and decided at relational level. (This system is efficiently very good or very bad!) No
 wonder we are confused as young surgeons and become cynical: the specific (of often many) choices is not about the things it is about the relations. The chief tells us why, but the particular why is really because he is chief. It is well documented from brain injury studies that patients (people) with completely intact cognitive skills but injured affective anatomy (relational in my interpretation; that is, how does this affect me) are completely disabled in decision making. Data alone solves no dilemma without its affective or relational connection. If the chief in our head is dead, we literally can not choose.
 
Lastly, and usually incidentally there is the integrity level. As the use of this ambiguous word implies, integrity is a system word. Its use as ethics demand being "outside" the system. While it would be integral to follow ones self interest or other internal relational logic this is not the ethical meaning for this word. Integrity of self means immanent from the whole or transcendent to the whole (depending one one's sensibility), not complicit with part of the system. Technically, I believe, integrity is not just following the facts either despite our tendency to think that the data alone explains everything. In other discussions I have shown how this is better described as adaption as it dismisses choice, and as above neurologically is actually impossible.
 
I have said nothing new, but until we explicitly use these ideas and logical levels, we will continue to communicate nonsense even if earnestly so. 
 
tea
 



----- Original Message ----
From: "rwmfglycar at aol.com" <rwmfglycar at aol.com>
To: OpenHeart-L at lists.hsforum.com
Sent: Thursday, May 29, 2008 9:58:32 AM
Subject: Re: [HSF] Why cardiac surgeons dont do NIH research

Adam you are quite right in what you say. During the coronary bonanza (or gold rush or whatever you want to call it) we stopped applying for NIH grants and used a part of? our private practice earnings to fund research. Both the medical school and the hospital were already gathering their taxes but because the few big earners we had did not feel they needed every dollar left over and did not mind that we had non surgeons on our payroll they were content . The academic scientists working in the cardiothoracic division were relieved of the burden of 
grant applications and grant reports and were very productive.We for a period of ten or more years had more papers and abstracts selected for the ACCC and AHA each year than the Cardiology division. But when the Health Care Tsars, trying to control costs, launched an easy?attack on reimbursement for cardiac surgey, and the Medical School missed their customary 60% NIH overhead we were accused of doing "hobby research" and it all came to an end. When there is a pot of gold anywhere there are always those who are quite certain that they have more right than those who earned? it to use and control it. From time to time they will let a little of it trickle through their fingers to the earners. (Kurt Vonnegut).
Bob


-----Original Message-----
From: Adam Saltman <aes.md.phd at hotmail.com>
To: openheart-l at lists.hsforum.com
Sent: Thu, 29 May 2008 8:27 am
Subject: RE: [HSF] Why cardiac surgeons dont do NIH research



This is a vicious cycle, and unfortunately we are trapped in it. I have tried 4 
times (yes, 4) for R01 grants and been denied, despite "improving" the grant 
each time according to the study section's comments...

The issue is that there are no surgeons are the study sections because to be on 
a study section you need to have NIH ("or equivalent") funding, and dollars are 
tight so the PhDs protect each others' livelihoods and say, "That surgeon can 
just go do some more cases to pay his bills. We only have our grants for 
income..."





> Date: Wed, 28 May 2008 12:08:58 -0400
> From: msfirst at gmail.com
> To: OpenHeart-L at lists.hsforum.com
> CC: 
> Subject: [HSF] Why cardiac surgeons dont do NIH research
> 
> Ugh!
> 
> So I was working with our research group and submitted an RO1 gant to the
> NIH looking at a proposed mechanism for vein graft failure (vs arteries).
> The grant did not even get scored on the primary comment that "
> 
> *we shouldn't study saphenous veins since they are not used clinically
> anymore*".  So according to whoever at the NIH reviewed this - not only are
> there no vein bypasses being performed, but this is obviously not even a
> problem worth studying......
> 
> 
> 
> 
> 
> 
> 
> -michael
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