Welcome to the August/September 2023 chapter newsletter. CHAPTER NEWS CHAPTER EVENTS FEATURES CHAPTER NEWS New Publications Committee Chair (i.e., Newsletter Editor) By Michael Franklin, MS As a long-time member of AMWA, I’m excited to have the time to return to volunteering as the newsletter editor. Many years ago I was more active in AMWA, even […]
Three Science Fiction Selesctions to Heat Up Your Summer
By Paul W. Mamula, PhD
I suggest 3 books for your summer reading: RedDevil 4, Interface, and The Terminal Man. All have a common theme of state-of the-art medical technology gone wrong. Although they were published over a span of 50+ years, the older ones still hold up and the newest deals with contemporary medical technology. The books came to mind in several ways, and I wanted to suggest the titles, describe how we found them, and share some trivia.
RedDevil 4, A Techno Thriller
The first book is RedDevil4, a medical thriller by Eric C Leuthardt, MD, published in 2014. I discovered it shortly after interviewing Michael C. Park, MD, a neurosurgeon at the University of Minnesota in 2017 for a story about implantable devices to control tremors in Parkinson disease patients. The technology works by implanting electrodes that are connected to a pacemaker-like device. Pacemaker signals stimulate the brain and mitigate the tremors, giving patients a more normal life. While the therapy is new and cutting edge, brain modulating technologies have regularly provided the basis for a genre of science fiction.
Leuthhardt is an active neurosurgeon and biomedical engineer, and his background gives the story a vibe that sets it above the usual murder mystery. The tale is set in 2053 when most people have a neural implant that they use for multiple purposes, including work and messaging. The story unfolds with 3 successive murders, each one perpetrated by a man who has no criminal history and cannot remember any aspects of the crime. The perpetrators lack any obvious connection other than being linked into the system. How Detective Edwin Krantz and his partner find the culprit takes readers on an unexpected romp into the world of artificial intelligence (AI). The book is interesting because experts have begun to warn of potential dangers of AI, which makes such stories a little less like fiction.
Interface, A Technology Misused
Neal Stephenson and J. Frederick George’s Interface has a similar basic plot of medical technology co-opted for malevolent political purposes. The book tells the tale of a presidential candidate who has a stroke and receives an experimental implant that opponents use to control his behavior. This tale is now dated by its technology (no cellphones; use of audio tapes and faxes, limited computer technology) but aside from those details, the story presents a taut thriller. The book was a selection in 2017 for our book club’s September (dinner meeting) selection, and I was pleasantly surprised how well the story held up. I was nervous about suggesting it, some 23 years after first reading it, but our book club readers liked it. It served as a change of pace from our usual selections. (See Book Club Notes, North Central AMWA Newsletter October 2017).
The book’s authorship has an amusing history. The book was republished twice. I read the book in 1994, when it was published as a work by “Stephen Bury.” The book was reissued under its actual authors, Neal Stephenson and George Jewison (pen name of Stephenson’s father-in-law), about 10 years later and again several years later with Neal Stephenson and J Frederick George (his father-in-law’s actual name) as authors. I saw that book published with the authors Neal Stephenson and George Jewison in 2006. A few years later, I purchased and reread the book only to realize that the book was the same one I had read in 1994. Jean Cook, our then newsletter editor, asked me about the different authors when she copyedited my Book Club Notes, and I clarified the odd history. I suppose it pays to check one’s bookshelf and read copyright pages.
Terminal Man, An Early Neuromodulation Tale
The Terminal Man was Michael Crichton’s third novel and second bestseller. It was published in 1972. Crichton, an MD who opted out of a medical career to write fiction, had come into prominence as a new author with his second novel, The Andromeda Strain—He wrote the screenplay for the movie version just before he graduated medical school. The Terminal Man presents the story of a man treated with an implanted electrode and neural stimulation to control violent psychotic attacks. The episodes were triggered by abnormal brain impulses that turned a mild-mannered computer engineer into a violent brawler. How this technology goes awry is the basis of the story, but in the 1970s using electrodes and nerve stimuli in the brain was very new. Crichton included a technical bibliography in The Terminal Man that referenced the research papers he employed writing the book. Although the book is old, the basic story holds up well. (See the movie if you don’t want to read the book). A curious fact: My wife worked for a physician at Cedars-Sinai Medical Center in Los Angeles who was a classmate of Crichton’s at Harvard Medical School and thought that Crichton erred by not going into medicine. Those curious about Crichton’s views about his career choice can read his book, Travels (1988).
Our Book Club Selections and Science Fiction
While RedDevil4 is based on contemporary technologies, The Terminal Man and Interface by Neal Stephenson also employed then-current technology in their stories. (See Book Club Notes, North Central AMWA Newsletter October 2017). Despite their age, the latter 2 books still make entertaining biomedical fiction.
Our book club had begun to select works of medically related science fiction to spice things up a while ago. We chose Interface as a book club selection in 2017, after we read Ticked, a true story about how an implantable device put a patient’s Tourette’s syndrome in remission (See Book Club Notes, North Central AMWA Newsletter October 2016). During our discussion, we thought about other possible science fiction novels and came up with one that served as the basis for a technology-gone-wrong genre—The Terminal Man—although we didn’t select it for the book club. The Terminal Man was initially mentioned by one of our AMWA speakers, Tim Denison, PhD, as the basis for cautions about early implementation of technology and for the rejection of Medtronic’s initial patent for neural modulation as “not an original idea.” (See North Central AMWA Newsletter, December 2014). Coincidentally, while looking through my notes about Dr Denison’s talk for background for this article, I noticed that one of Dr Denison’s slides cited one of Dr Leuthardt’s articles on neuroprosthetics.[1]
So, there you are, 3 science fiction books with a biomedical theme for your summer. Happy reading!
References
By Adam Fix
Every writer has opinions on punctuation. But did you know that the AMWA Essential Skills course includes an entire 172-page guide to proper punctuation? Here are some rules of thumb I learned from Part 2:
This does NOT need a comma after “2001” because “patient” is the subject of both the first and the second part of the sentence. It’s all one clause.
However, be aware that other style guides may recommend en-dashes for this purpose.
Looks like solid advice to me!
Questions, comments or new additions to the newsletter? Please contact the Publications Committee Chair. And remember, you can also read this newsletter on the chapter website. You can find previous newsletters on the website as well.
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Welcome to the July 2023 chapter newsletter. Mark your calendars! The AMWA North Central Chapter will host an in-person event Wednesday, August 16th at 5:30. Please join us at Quang Restaurant (2719 Nicollet Ave, Minneapolis, MN 55408) for a dinner and panel discussion on the habits of highly effective medical writers. Our guest speakers include […]
By LeAnn Stee, North Central Chapter Representative
Mission of the Chapter Advisory Council (CAC)
The CAC serves to maintain a connection between chapter leaders and the AMWA Board of Directors by advising the AMWA board on the organization’s strategic direction as it affects the chapters and acting as a sounding board about issues that have an impact on chapters and the national organization.
Second Quarterly Meeting of 2023
The AMWA CAC meeting scheduled for May 2023 was not held because of a death in the family of one of the council leaders.
The information that follows was taken from the meeting agenda.
Updates from the AMWA Board of Directors: Jen Minarcik
Updates From AMWA Headquarters: Sharon Ruckdeschel, director of membership and systems for AMWA
By Adam Fix
They say English is one of the hardest languages to learn. But you don’t know the half of it until you’ve clawed your way through the AMWA Essential Skills Certificate course. I recently took the course myself, and here are some thoughts on Part 1.
Every weird quirk of our language is discussed. Did you know that “the number” takes a singular verb but “a number” takes a plural verb? For example:
Every potential grammatical pitfall is exposed. Here’s a puzzler: What’s wrong with the following sentence?
If you said that the participial phrase “based on the test results” lacks a noun to modify, good job! Participial phrases (phrases that begin with a verb form, in this case “based”) can only function as adjectives. In this form, this sentence does not include the modified noun. We might rewrite it as follows:
Here, “based on the test results” is clearly modifying “recommendation.”
All in all, I learned more about language and grammar from this course than from my entire Ph.D. program curriculum. My brain feels like a wrung sponge.
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Welcome to the June 2023 chapter newsletter. Instead of a specific music recommendation, this month I’d like to share with you a very cool internet hidden gem. MNspin is a repository of local Minnesota music that I discovered by accident one morning, happening upon a pile of free bumper stickers while browsing a guitar store […]
By Paul Mamula, PhD
For those curious about current thinking concerning the origins of Homo sapiens and the peopling of the world, Who We Are and How We Got Here: Ancient DNA and the Science of the Human Past by David Reich provides an excellent overview. Reich bases most of his work on analyses of ancient and modern DNA samples but includes archaeological and cultural information when possible. Reich employs DNA from fossil human ancestors to construct how modern humans came to be and analyses of more modern populations to assess human distribution over time. He learned isolation and sequencing procedures from Svante Pääbo, the researcher who perfected the techniques for use on ancient DNA.
The book consists of 3 sections (12 total chapters), each chapter of which begins with a helpful timeline. Each chapter also has multiple maps that highlight the likely population movements. Reich posits a “family bush” that has many intertwined branches rather than the familiar “family tree” with distinct branches. His work explains our African origins, migrations out of Africa, back migrations and interbreeding to describe how modern humans evolved and later spread. Although the analyses are based on relatively few samples, his views become more likely and clearer as the evidence mounts. The book makes a nice summary of human evolution to date. The book also includes an extensive set of chapter notes and references for the curious. I found them helpful to refresh my knowledge of several of the topics discussed.
Reich’s computer analyses of Neanderthal, Denisovan (an Asian contemporary of Neanderthals), and modern humans shows that ancient human ancestors likely interbred. He deftly explains how a hypothetical African origin and many back migrations could yield modern populations. Given that we now have DNA evidence, we can rule out the minor skeletal differences that many early anthropologists used to exclude Neanderthals as direct human ancestors. He also provides population migration scenarios for most regions, including the Near East, the Indian subcontinent, and the Americas. Although data are still being collected, his arguments are compelling.
Of particular interest are his analyses of more recent population movements, notably the peopling of the Americas. I found Chapter 7 fun, because I started out in a physical anthropology PhD program at Arizona State University (I earned an MA there before leaving for a PhD program in medical genetics). Reich does an excellent job of unifying the DNA sequence and cultural data. I found it fascinating because his analyses echo those of many anthropologists—including one of my professors, the late Christy G. Turner II—who proposed 3 migrations into the Americas after glacial melting opened an ice-free corridor. Although some of the fossil material and archaeological evidence suggested these findings, Reich (and Turner) suggest that much of the human fossil (and potential DNA) evidence is likely submerged along the Pacific coast, one of the likely migration routes.
Reich also addresses more recent controversies. He describes Arizona State University’s misuse of Havasupai blood samples without permission for performing studies not mentioned in the informed consent forms. The misuse led to a lawsuit and a fine, big embarrassments for ASU’s anthropology department. The episode provoked resistance to further research among the Havasupai and other Native tribes. He also discusses the impact that the Native American Graves Protection and Repatriation Act (NAGPRA) has had on the field. NAGPRA has led to the return of skeletal material held in museums and universities to original tribes. Many of these skeletal collections were looted from graves, and their possession by non-Native Americans had been a sore point for years. He also spends some time describing the findings that led to the repatriation of the “Kennewick Man’s” skeleton. The 8,500-year-old skeleton had European-like features but predated any known European migration in the continental United States. The skeleton was claimed by 5 tribes in Washington state and its possession was tied up in the courts for several years. DNA ultimately resolved the issue and demonstrated that the skeleton was not of European origin and belonged to a single tribe.
Reich’s book presents the state of knowledge of human evolution and will probably be reissued as more information and ancient DNA become available. I recommend the book as a “one-stop shop” for anyone interested in human origins.
If you’re feeling uber-nostalgic, check out this blast-from-the-past podcast recommendation courtesy of Carmen Peterson! Old Time Radio Mystery Theater is pretty much what it sounds like: crackly old radio dramas from the era when your radio weighed 100 pounds and took up a corner in your sitting room. Mix an Old Fashioned, sit back in your armchair and listen to some spooky ghost stories, hardboiled detective adventures or whatever else strikes your fancy.
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Welcome to the May 2023 chapter newsletter. Not too much going on this month, but please check out some new member profiles from Julie and Anna below, as well as some book club notes from Paul. For this May’s music, let’s try some cool summer jazz. “Night Dreamer” by Wayne Shorter is a deeply introspective […]
By Paul Mamula, PhD
Our book club met via Zoom on April 24, 2023, and discussed The Illusion of Evidence-Based Medicine: Exposing the Crisis of Credibility in Clinical Research by Jon Jureidini and Leemon B McHenry. The book reviews clinical trials that were used to justify use of antidepressant drugs for children and adolescents that along the way to approval used altered study results, employed ghostwriters, and actively promoted off-label use. These were later discovered and ultimately resulted in criminal proceedings and fines.
About the Book
The book was published in 2020 and reviews 2 clinical trials. Study 329 was conducted by SmithKline Beecham (now known as GlaxoSmithKline [GSK]) for paroxetine (an SSRI antidepressant) and CIT-MD-18 was tested by Forest Laboratories for citalopram and escitalopram. The book is 8 chapters long and walks readers through the studies and their shortcomings. It also includes 12 Appendices of excerpts from interviews, depositions, and letters to the editor. The authors also describe their reevaluation of CIT-MD-18 and efforts to get the reanalysis published. Chapter 8 proposes solutions to the problems in the current clinical trial system. Chapter notes, bibliography, and acknowledgements round out the book.
The Controversy and Outcomes
The controversy in The Illusion of Evidence-Based Medicine revolves around altered criteria used for assessing success in one trial and inclusion of unblinded study participants in the other, both of which changed negative results into positive ones. Both companies also coached marketing staff on how to promote off-label use. Exposing the malfeasance took place over the period 2004 to 2012 and was sparked by investigations in the United States and the United Kingdom. The authors weave the clinical trial irregularities and follow-up but their presentation is a little muddled. Jureidini and McHenry published additional assessments of the trials before their book was published in 2020,1-3 and a summary article in BMJ in 2022.4 Ultimately GSK and Forest had to pay for their irregularities. GSK settled for $3 billion, an amount that also included a $1 billion fine for “preparing, publishing and distributing a misleading medical journal article that misreported that a clinical trial of Paxil demonstrated efficacy in the treatment of depression in patients under age 18, when the study failed to demonstrate efficacy.”5 Forest Laboratories paid $313 million to resolve criminal and civil liabilities for misuse of their drugs6 and another $164 million for criminal violations.7
Complaints and Solutions
The authors make a good case for complaints about the trials that include the companies:
Since these events occurred in the early 2000s, some of these issues, notably ghostwriting, have been partially addressed; however, many issues remain. The authors proposed solutions, but we wondered how much these would cost and how they could be implemented. Nonetheless, more money from independent sources for trials, better study design, and more effective tracking would be welcome.
The authors present suggestions for mitigating the problems in Chapter 8, and these are also highlighted elsewhere.7 These include:
Jureidini and McHenry also explain other problems that include discussions about Cochrane Reviews, restrictions on pharmaceutical marketing, and suggestions about government investigations, litigation, and punitive damages. These measures would go a long way to rectifying the current situation.
Quibbles
We all liked the book but had a few complaints. Kendra Hyland said, ”The book was an informative and eye-opening insight into how pharmaceutical companies manipulate clinical trials and the results to promote drug sales. While the book needed some editing and was redundant at times, it was worth the read.”
I also liked the book but also found multiple editing deficiencies that included 2 reversed figures (5.1 and 5.2), out of order tables, and a few missing and erroneous references. Perhaps this reflects the decision to use a small independent publisher. The book had been accepted by mainstream publishers but the authors decided to use an independent publisher to avoid any possible conflict of interest with the pharmaceutical industry and to reduce costs. One wonders if the editing might have been better with a larger publisher. I read an Australian copy obtained via interlibrary loan that employed an odd typeface that was glaring and hard on the eyes.
We found the book a little hard to follow, particularly because the appendices refer to different trials, include letters to editors, and transcripts from different cases. The authors might have incorporated those in the text for smoother reading. I found it distracting to have to flip back and forth. Readers also felt that the authors generalized broadly. Laura Chapin said, ”At times I felt the authors painted every single person as guilty ‘baddies’ operating maliciously, though I question the reality of so many people taking part intentionally and knowingly. It marked a specific time in history that’s interesting to compare to current writing and publishing practices as I’m familiar with. I found it to be thought provoking read overall. Although I don’t work in the pharmaceutical industry, it encouraged me to view my work in medical devices with a different lens.”
Next Up
Our next book club will meet on September 25, 2023, to discuss Man’s 4th Best Hospital by Samuel Shem. It is a novel that revisits the characters from Shem’ House of God (Book Club selection for April 26, 2010) and Mount Misery (book club selection for April 30, 2012). Man’s 4th Best Hospital follows the physicians as new corporate owners seek to improve the hospital’s ranking. The characters were based on actual people and provide an interesting look at how medicine has evolved since that original novel. Readers can get also get an overview of the novel and the controversy surrounding it in a recent discussion in JAMA.8 Join us for the discussion (even if you haven’t read the book!).
References
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Welcome to the April 2023 chapter newsletter. It is, apparently, Spring. But winter snowstorms returned with a vengeance, and Spring got stuck at the airport. Who knew Spring flew Southwest? To rekindle a spark of hope amidst this Fimbulvetr, please check out this exquisite version of “Imagine,” by Herbie Hancock and a cadre of guest […]
By Kendra Hyland
Radio shows
While working, I enjoy listening to radio stations and programs available through an internet browser, but some of these shows are also available on the radio.
MPR.org
MPR is listener-supported and commercial-free music. Some channels available through MPR.org:
Thistleradio® (thistleradio.com)
Thistleradio® encompasses NPR’s the Thistle & Shamrock® radio shows, along with a Soma FM music channel (https://somafm.com/player/#/now-playing/thistle) and Thistle & Shamrock® playlists. Fiona Ritchie is based in Scotland, and she hosts the Thistle & Shamrock® radio show. Fiona Ritchie was inducted into the Scottish Traditional Music Hall of Fame in 2016. While the music is mainly traditional Scottish and Irish music and some non-traditional music, often music from other parts of the world are played too.
KFAI (KFAI.org)
KFAI is a community radio station that is available through the KFAI app and 90.3 FM in the Twin Cities (Minneapolis). The KFAI station broadcasts a wide variety of music, and airs programming catering to many of the diverse ethnic groups of the area. I learned about this station when they hosted my favorite Twin Cities musical group to perform on the air (Eddies on the River). Podcasts, including MinneCulture, Disability and Progress, and Counter Stories, are available through the KFAI app and on the website.
Here is a short video on YouTube of the Eddies on the River performing.
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