Category: blog

The ECTH 2016 in The Hague

~ BS

My first conference experience (ISTH 2008, Boston) got me hooked on science. All these people doing the same thing, speaking the same language, and looking to show and share their knowledge. This is true when you are involved in the organisation. Organising the international soccer match at the Olympic stadium in Amsterdam linked to the ISTH 2013 to celebrate the 25th anniversary of the NVTH was fun. But lets not forget the exciting challenge of organising the WEON 2014.

And now, the birth of a new conference, the European Congress of Thrombosis and Hemostasis, which will be held in The Hague in Netherlands (28-30 sept 2016). I am very excited for several reasons: First of all, this conference will fill in the gap of the bi-annual ISTH conferences. Second, I have the honor to help out as the chair of the junior advisory board. Third, the Hague! My old home town!

So, we have 10 months to organise some interesting meetings and activities, primary focussed on the young researchers. Time to get started!

First results from the RATIO follow up study

~ BS

Another article got published today in the JAMA Int Med, this time the results from the first analyses of the RATIO follow-up data. For these data, we linked the RATIO study to the dutch national bureau of statistics (CBS), to obtain 20 years of follow-up on cardiovascular morbidity and mortality. We first submitted a full paper, but later we downsized to a research letter with only 600 words. This means that only the main message (i.e. cardiovascular recurrence is high, persistent over time and disease specific) is left.

It is a “Leiden publication”, where I worked together with AM and FP from Milano. Most of the credit of course goes to AM, who is the first author of this piece. The cool thing about this publication is that the team worked very hard on it for a long time (data linking and analyses where not an easy thing to do, as well as changing from 3000 words to 600 in just a week or so), and that in the end all the hard work paid off. But next to the hard work, it is also nice to see results being picked up by the media. The JAMA Int Med put out an international press release, whereas the LUMC is going to publish its own Dutch version. In the days before the ‘online first’ publication I already answered some emails from writers for medical news sites, some with up to 5.000K views per month. I do not know if you think that’s a lot, but for me it is. The websites that cover this story can be found here (dagensmedisin.se, healio.com, medicaldaily.com, medpagetoday.com, medonline.at, drugs.com / healthday.com / webmd.com /  usnews.com / doctorslounge.com, medicalxpress.com, medicalnewstoday.com, eurekalert.org and perhaps more to come. Why not just take a look at the Altmetric of this article).

– edit 26.11.2015: a dutch press release from the LUMC can be found here) – edit: oops, medpagetoday.com has a published great report/interview, but used a wrong title…”Repeat MI and Stroke Risks Defined in ‘Younger’ Women on Oral Contraceptives”. not all women were on OC of course.

Of course, @JAMAInternalMed tweeted about it

 

The article, with the full title “Recurrence and Mortality in Young Women With Myocardial Infarction or Ischemic Stroke: Long-term Follow-up of the Risk of Arterial Thrombosis in Relation to Oral Contraceptives (RATIO) Study“ can be found via JAMA Internal Medicine or via my personal Mendeley page.

As I reported earlier, this project is supported by a grant from the LUF den Dulk-Moermans foundation, for which we are grateful.

A year in Berlin

~ BS

teamfoto-ag-siegerink

So, it is just over a year since I started here in Berlin. In this year I had the opportunity to start some great projects. Some of these projects have already resulted in some handsome -upcoming- publications.

For those who wonder, the picture gives a somewhat inflated impression of the size of the team, as we decided to include all people who currently work with us. This includes two of our five students and 2 virchow scholars that are visiting from Amsterdam and Hamburg. I included them all in the picture, as I enjoy my work here in Berlin because of all team members. Now, let’s do some science!

Spectrum of cerebral spinal fluid findings in patients with posterior reversible encephalopathy syndrome

~ BS
source: http://www.springer.com

This is one of the first projects that I was involved with from start to finish since my start in Berlin to be published, so I’m quite content with it. A cool landmark after a year in Berlin.

Together with TL and LN I supervised a student from the Netherlands (JH). This publication is the result of all the work JH did, together with the great medical knowledge from the rest of the team. About the research: Posterior reversible encephalopathy syndrome, or PRES, is a syndrome that can have stroke like symptoms, but in fact has got nothing to do with it. The syndrome was recognised as a separate entity only a couple of years ago, and this group of patients that we collected from the Charite is one of the largest collections in the world.

It is a syndrome characterised by edema (being either vasogenic or cytotoxic), suggesting there is something wrong with the fluid balance in the brain. A good way to learn more about the fluids in the brain is to take a look at the different things you can measure in the cerebrospinal fluid. The aim of this paper was therefore to see to what extend the edema, but also other patients characteristics, was associated with CSF parameters.

Our main conclusion is indeed the total amount of protein in the CSF is elevated in most PRES patients, and that severe edema grade was associated with more CSF. Remind yourself that this is basically a case series (with some follow up) but CSF is therefore measured during diagnosis and only in a selection of the patients. Selection bias is therefore likely to be affecting our results as well as the possibility of reverse causation. Next to that, research into “syndromes” is always complicated as they are a man-made concept. This problem we also encountered in the RATIO analyses about the antiphospholipid syndrome (Urbanus, Lancet Neurol 2009): a real syndrome diagnosis could not be given, as that requires two blood draws with 3 months time in between which is not possible in this case-control study. But still, there is a whole lot of stuff to learn about the syndromes in our clinical research projects.

I think this is also true for the PRES study: I think that our results show that it is justified to do a prospective and rigorous and standardised analyses of these patients with the dangerous syndrome. More knowledge on the causes and consequences is needed!

The paper can be cited as:

Neeb L, Hoekstra J, Endres M, Siegerink B, Siebert E, Liman TG. Spectrum of cerebral spinal fluid findings in patients with posterior reversible encephalopathy syndrome. J Neurol; 2015; (e-pub) and can be found on pubmed or on my mendeley profile

New article: Lipoprotein (a) as a risk factor for ischemic stroke: a meta-analysis

~ BS

source: atherosclerosis-journal.com

Together with several co-authors, with first author AN in the lead, we did a meta analyses on the role of Lp(a) as a risk factor of stroke. Bottomline, Lp(a) seems to be a risk factor for stroke, which was most prominently seen in the young.

The results are not the only reason why I am so enthusiastic by this article. It is also about the epidemiological problem that AN encountered and we ended up discussing over coffee. The problem: the different studies use different categorisations (tertiles, quartiles, quintiles). How to use these data and pool them in a way to get a valid and precise answer to the research question? In the end we ended up using the technique proposed used by D Danesh et al. JAMA. 1998;279(18):1477-1482 that uses the normal distribution and the distances in SD. A neat technique, even though it assumes a couple of things about the uniformity of the effect over the range of the exposure. An IPD would be better, as we would be free to investigate the dose relationship and we would be able to keep adjustment for confounding uniform, but hey… this is cool in itself!

The article can be found on pubmed and on my mendeley profile.

Fellow of the European Stroke Organisation

~ BS
 www.eso-sss-2012.med.unideb.hu

I just got word that I am elected as fellow of the European Stroke Organisation. Well, elected sounds more cool then it really is… I applied myself by sending in an application letter, resume, some form to show my experience in stroke research and two letters of recommendation of two active fellows and that’s that. So what does this mean? Basically, the fellows of the ESO are those who want to put some of their time to good use in name of the ESO, such as being active in one fo the committees. I chose to get active in teaching epidemiology (teaching courses during the ESOC conferences, or in the winter/summer schools, perhaps in the to be founded ESO scientific journal), but how is as of this moment not completely clear yet. Nonetheless, I am glad that I can work with and through this organisation to improve the epidemiological knowledge in the field of stroke.

New articles published: hypercoagulability and the risk of ischaemic stroke and myocardial infarction

~ BS

Ischaemic stroke + myocardial infarction = arterial thrombosis. Are these two diseases just two sides of the side coin? Well, most if the research I did in the last couple of years tell a different story: most times,hypercoagulability has a stronger impact on the risk of ischaemic stroke at least when compared to myocardial infarction. And when in some cases this was not the case, at least it as clear that the impact was differential. But these papers I published were all single data dots, so we needed to provide an overview of all these data points to get the whole picture. And we did so by publishing two papers, one in the JTH and one in PLOS ONE.

The first paper is a general discussion of the results from the RATIO study, basically an adaptation from my discussion chapter of my thesis (yes it took some time to get to the point of publication, but that’s a whole different story), with a more in-depth discussion to what extent we can draw conclusions from these data. We tried to fill in the caveats (limited number of markers, only young women, only case-control, basically single study) of the first study with our second publication. Here we did the same trick, but in a systematic review.This way, our results have more external validity, while we ensured the internal validity by only including studies that studied both diseases and thus ruling out large biases due to differences in study design. I love these two publications!

You can find these publications through their PMID 26178535 and 26178535, or via my mendeley account.

PS the JTH paper has PAFs in them. Cool!

 

ISTH 2015 Toronto

~ BS

The ISTH is a bi-annual conference on thrombosis and haemostasis, and this year it convenes in Toronto. We started yesterday with the SSCs which were interesting, but  I am mainly looking forward to some of the sessions in the normal program. As is in line with the announcement 2 years ago, the organising committee strived to include more fields of medicine into the program, one being stroke. There even a couple of stroke themed sessions. Good!

Another topic that has my interest is the link between inflammation and coagulation. This link, perhaps through the intrinsic coagulation proteins, or perhaps through extracellular nucleic acids is quite interesting, as it might provide insight into the link between these two major biological systems that interact in the acute phase of stroke. Next to the SSC meeting this morning and yesterday, there are some plenaries and symposia on this topic; Tuesday seems to be the day for this!

I contributed to three papers that will be presented here, being:

ADAMTS13 AND THE RISK OF MYOCARDIAL INFARCTION: AN INDIVIDUAL PATIENT DATA META-ANALYSIS Alberto Maino*, Bob Siegerink, Luca Lotta, James Crawley, Saskia le Cessie, Frank Leebeek, David Lane, Gordon Lowe, Flora Peyvandi, Frits Rosendaal (Italy)

RECURRENCE AND MORTALITY IN YOUNG WOMEN WITH MYOCARDIAL INFARCTION OR ISCHEMIC STROKE: 19-YEAR FOLLOW-UP OF THE RISK OF ARTERIAL THROMBOSIS IN RELATION TO ORAL CONTRACEPTIVES (RATIO) STUDY. Alberto Maino*, Bob Siegerink, Ale Algra, Flora Peyvandi, Frits Rosendaal (Italy)

STATIN USE AND RISK OF RECURRENT VENOUS THROMBOSIS: RESULTS FROM THE MEGA FOLLOW-UP STUDY Willem Lijfering*, Sigrid Braekkan, Camilla Caram-Deeelder, Bob Siegerink, Astrid van Hylckama Vlieg, Saskia le Cessie, Frits Rosendaal, Suzanne Cannegieter (The Netherlands)

As a last thing: It was a last decision to join this conference, but I am happy I did. the scientific program helps, but more importantly, the Barenaked Ladies are going to perform at the conference party!

Ps one thing that is also quite interesting, but i only saw one oral communication on this, is the authophagy of clots… how cool is that! Keep the blood flowing in the microvasculature!

New article published: the relationship between ADAMTS13 and MI

~ BS

2015-06-16 14_26_12-Plasma ADAMTS13 levels and the risk of myocardial infarction_ an individual pati

this article is a collaboration with a lot of guys. initiated from the Milan group, we ended up with a quite diverse group of researchers to answers this question because of the methods that we used: the individual patient data meta-analysis. The best thing about this approach: you can pool the data from different studies, even while you can adjusted for potential sources of confounding in a similar manner (given that the data are available, that is). On themselves, these studies showed some mixed results. But in the end, we were able to use the combined data to show that there was an increase MI risk but only for those with very low levels of ADAMTS13. So, here you see the power of IPD meta-analysis!

The credits for this work go primarily to AM who did a great job of getting all PI’s on board, analysing the data and writing a god manuscript. The final version is not online, but you find the pre-publication on pubmed

 

 

Changing stroke incidence and prevalence

~ BS

changing stroke population

Lower changing incidences of disease over time do not necessarily mean that the number of patients in care also goes down, as the prevalence of the disease is a function of incidence and mortality. “Death Cures”. Combine this notion with the fact that both the incidence and mortality rates of the different stroke subtypes change different over time, and you will see that the group of patients that suffer from stroke will be quite different from the current one.

I made this picture to accompany a small text on declining stroke incidences which I have written for the newsletter of the Kompetenznetz Schlaganfall. which can be found in this pdf.

New article published – Conducting your own research: a revised recipe for a clinical research training project

~ BS
2015-06-07 15_38_24-Mendeley Desktop
source: https://www.ntvg.nl/artikelen/zelf-onderzoek-doen

A quick update on a new article that was published on friday in the NTVG. This article with the title

“Conducting your own research: a revised recipe for a clinical research training project”

– gives a couple of suggestions for young clinicians/researchers on how they should organise their epidemiological research projects. This paper was written to commemorate the retirement of prof JvdB, who wrote the original article back in 1989. I am quite grew quite fond of this article, as it combines insights from 25 years back as well as quite recent insights (e.g. STROBE and cie Schuyt and resulted in a article that will help young research to rethink how they plan and execute their own research project.

There are 5 key suggestions that form the backbone of this article i.e. limit the research question, conduct a pilot study, write the article before you collect the data, streamline the research process and be accountable. As the article is in Dutch only at this moment, I will work on an English version. First drafts of this ms, each discussing each of the 5 recommendations might appear on this website. And how about a German version?

Anyway, it has to be mentioned that if it not was for JvdB, this article would have never come to light. Not only because he wrote the original, but mostly because he is one of the most inspiring teachers of epidemiology.

Conference season 2015: ESOC in Glasgow

~ BS

source: eso-stroke.org

Conference season just had its first kick off with the new ESOC, the new conference by the European Stroke Organisation. The organisation of the was well done, and most sessions were quite interesting. Not only the big plenary sessions (i will talk about them later, but also the smaller sessions where nice. Particularly, it was nice to see some sessions on patient and caregiver centers research. This theme fits well with our “Schalganfall Betroffene hilfen forschen” project, where people affected by stroke (both patients and their caregiver, help us in identifying the need, value and possible ROI of some of our research plans.

The most striking things, as most of the times in conferences on with a strong clinical focus, were presented in the plenary sessions. The bottom line: endovascular treatment where doctors go in and try to pull out the blood clot, seem to be quite effective. This really could revolutionize the acute treatment for stroke patients. Think about the possibilities when we combine this concept with our STEMO?

I was involved in 3 posters that were presented at the ESOC. Their topics: cancer prevalence among stroke patients, coagulation FVIII as a risk factor for ischaemic stroke in young women, and the a history of pregnancy loss as a proxy of high stroke risk. These topics are being converted to articles and the moment we have them published I will get into the details of them. The CERHIS team from the CSB also had another 3 posters, showing our results of evaluation of the user group, the service point and an evaluation of how standardised education of stroke sticks with a lay public.

Next to these posters of work almost finished, I had a lot of conversation about work to be done. All these things to investigate, and so little time! Back to work!

Next meeting to attend: ISTH in Toronto!

ILS conference in Leiden the Netherlands

~ BS
source leidenuniv.edu

I am back in the Netherlands this week. I’ve got some meetings planned, catching up with former colleagues, meeting some new people interested in working together on new projects I am starting up in Berlin, and of course I am meeting some friends along the way. But there is one more reason for me to go to the Netherlands this week: I was invited to the Interaction between legal systems conference. This international conference is organized by the Law faculty in Leiden and is focused on how different legal  systems interact, but also how legal systems interact with other fields of research and areas of expertise (e.g. psychology, statistics and epidemiology). More information on the conference can be found here.

But what am I doing there? I am going to talk about my interdisciplinary project on how civil law, and especially liability cases, relate to causal inference in epidemiology. This project, together with ILS conference organiser PWdH, is one of my pet projects in which we compare the concepts behind causal inference in both clinical epidemiology as well as legal systems. Both systems rely on the condicio sine qua non principle, where the idea is that the consequence of a cause would not have happened if the cause would not have been present. This idea is of course known as the counter factual theory in epidemiology, and is related to the potential outcomes approach. But this is only the start, as there are several problems and challenges that come up: although epidemiology has recognized the idea of multi causality for some time (think component causes), legal systems have only been working with  this  only for a couple of years and with some hesitance. A way to use this in liability claims is to use proportional liability, where the claim should be proportional to the number of factors the defendant is responsible for.  Sounds cool, but how to get to a fair division? How to interpret evidence? And can we use population measures like the population attributable fraction to substantiate a ruling on individual level?

I am invited to talk about this project, bust mostly and to tell the story of interdisciplinary research. It goes without saying that working on something so far from your own comfort zone brings along a lot of challenges and problems. For example since you can only oversee the quality and relevance of part of the project, you have might have the feeling that what you are working on is kind of useless (really, is this interesting?). But on the other hand, the questions that came up during this project also provided me with some insight into the concepts of epidemiology. Explaining why the things in your field are as they are will confront you will inconsistencies in your field and in your own thinking. I noticed that this project learned me a lot about the things I thought I understood, and that is for me the true added value of interdisciplinary research.

 – update jan 26: I uploaded a pdf version of the presentation, which can be found here (pdf)
– update march 17:I visited Leiden again, now on the invitation of the dept of criminal law to talk about the concept of multi causality. We decided that we might need to braoden this into a dutch publication, with e viewpoint from both tort law and criminal law. Interesting!

The professor as an entrepeneur

~ BS
picture: onderzoeksredactie.nl

Today, I’ve read a long read from the onderzoekdsredactie, which is a Dutch initiative for high quality research journalism. In this article they present their results from their research into the conflicts of interest of profs in the Netherlands. They were very thorough: they published a summary in article from, but also made sure that all methodological choices, the questionnaire they used, the results etc are all available for further scrutiny of the reader. It is a shame though that the complete dataset is not available for further analyses (what characteristics make that some prof do not disclose their COI?)

The results are, although unpleasant to realise, not new. At least not to me. I can imagine that for most people the idea of prof with COI is indeed a rarity, but working in academia I’ve seen numbers of cases to know that this is not the case. The article that I’ve read was thorough in their analyses: it is not only because profs just want to get rich, but this concept of the prof as an entrepreneur is even supported by the Dutch government. Recent changes in the funding structure of research makes that ‘valorisation’, spinn-offs and collaboration with industry partners are promoted. this is all to further enlarge the ‘societal impact’ of science. These changes mightinded enforce such a thing, but I think that the academic freedom that researchers have should never be the victim.

CSB Virchow stipend

~ BS

Are you a young researcher? Want to learn epidemiology? In Berlin? By doing a research project on stroke? Then boy, have I got news for you. The Center for stroke research has made funds available for young scientist to visit Berlin and work on a epidemiological project. From the website strokecenter.de

The Center for Stroke research Berlin (CSB) started the CSB – Virchow Stipend to encourage young stroke researchers to broaden or deepen their knowledge of epidemiology in the field of cerebrovascular disease through the execution of an epidemiological project. The stipend is aimed to stimulate (inter)national collaborations and therefore applicants are encouraged to collaborate with a CSB researcher on a joint project that can be executed during the stay in Berlin.

The stipend allows the awardee to travel to Berlin to work at the CSB for up to 3 months. The stipend covers all costs related to this visit with a maximum of € 4000 (€ 1000 for travel and 3 × € 1000 for accommodation).

Enthusiastic? Apply now for the first round (deadline is 12.12) or perhaps wait for the next call! Please find more information here.

New article published – but did I deserve it?

~ BS
One of these dots is me standing on a platform waiting for my train! Source: GNCnet.nl

This website is to keep track of all things that sound ‘sciency’, and so all the papers that I contributed end up here with a short description. Normally this means that I am one of the authors and I know well ahead of time that an article will be published online or in print. Today, however, I got a little surprise: I got notice that I am a co-author on a paper (pdf) which I knew was coming, but I didn’t know that I was a co-author. And my amazement grew even more the moment that I discovered that I was placed as the last author, a place reserved for senior authorship in most medical journals.

However , there is a catch… I had to share my ‘last authorship’ position with 3186 others, an unprecedented number!

You might have guessed that this is not just a normal paper and that there is something weird going on here. Well weird is not the right word. Unusual is the word I would like to use since this paper is an example of something that I hope will happen more often! Citizen scientists. A citizen scientist is where ordinary people without any background or training can help in a scientific experiment of some sorts by helping just a little to obtain the data after some minimal instruction. This is wonderfully explained by this project, the iSpex project, where I contributed not as an epidemiologist, but as a citizen scientist. If you want to know more, just read what I have written  previously on this blog in the post ‘measuring aerosols with your iPhone’.

So the researcher who initiated the iSpex project have now analysed their data and submitted the results to the journal Geophysical research letters, and as a bonus made all contributing citizen scientist co-author. Cool!

Now lets get back to the question stated in the title… Did I deserve an authorship on this paper? Basically no: none of the 3187 citizen scientist do not fulfil the criteria of authorship that I am used to (i.e. ICMJE), nor fulfil the criteria of the journal itself. I am no exception. However, I do believe that it is quite clear for any reader what the role of these citizen scientist was in this project. So this new form of a authorship, i.e. ‘gift authorship to a group of citizen scientists’ is a cool way to keep the public engaged to science. A job well done!

New publication “Graphical presentation of confounding in directed acyclic graphs”

~ BS
source: wikimedia.org

A new publication became available, again an ‘educational’. However, this time the topic is new. It is about the application of directed acyclic graphs, a technique widely used in different areas of science. Ranging from computer science, mathematics, psychology, economics and epidemiology, this specific type of graphs has shown to be useful to describe the underlying causal structure of mechanisms of interest. This comes in very handy, since it can help to determine the sources of confounding for a specific epidemiological research question.

But, isn’t that what epidemiologist do all the time? What is new about these graphs, except for the fancy concepts as colliders, edges, and backdoor paths? Well, the idea behind DAGs are not new, there have been diagrams in epidemiology since years, but each epidemiologist has his own specific ways to draw the different relationship between various variables factors. Did you ever got stuck in a discussion about if something is a confounder or not? If you don’t get it resolved by talking, you might want to draw out the your point of view in a diagram, only to see that your colleagues is used to a different way of drawing epidemiological diagrams. DAGs resolve this. There is a clear set on rules that each DAG should comply with and if they do, they provides a clear overview of the sources of confounding and identify the minimal set of variables to account for all confounding present.

So that’s it… DAGs are a nifty method to talk the same idiom while discussing the causal questions you want to resolve. The only thing that you and your colleague now can fight over is the validity of the assumptions made by the DAG you just drew. And that is called good science!

The paper, with first author MMS, appeared in the methodology series of the journal Nephrology Dialysis and Transplantation, can be found here in pdf, and also on my mendeley account.

Quackery conference kicked out of LUMC

~ BS

So I got a newsarticle in my RSS reader from the Dutch society against quackery describing the story how a quack conference was banned from the lecture halls from the LUMC. This is an interesting item, because it shows what happens when there are non scientific groups working in an academic environment. With that I mean that the guys from the Boerhaave committee, which is the LUMCs own conference bureau, can be approached by anyone to organise a conference. But a conference ‘organised by the LUMC’, held in the LUMC lecture halls has a different feel to it then just some guys who booked a room in a hotel somewhere. It feels like the content is sanctioned by the LUMC. Academia and academics must be aware of their status and not just lend their name(s) to anyone, even if you can earn an honest buck or two. This important understanding of the role of academia in society will become ever more important with valorisation and industry-academia partnerships.

Now I know that there are safeguards in place to prevent this from happening with the Boerhaave committee and apparently this kind of works, since the guys from the Society for Scientific Exploration (SSE) are no longer welcome in the Halls of the LUMC. Although I did not study the scientific validity of ‘biophotons’ completely, what I have been reading is not pretty.

Full disclaimer: I am a member of Dutch the society against quackery, I am an employee of the LUMC and I have worked with the Boerhaave committee in the organisation of the WEON.

Moving to Berlin!

~ BS

After about 8 years learning and working in Leiden at the LUMC, it is time for something new. I’ve got a new job as the head of the ‘Clinical Epidemiology and Health Services Research in Stroke’ unit at the Center for Stroke research in Berlin (CSB, http://www.schlaganfallcentrum.de). This a very exciting opportunity for me: working with new colleagues on new projects, learning more about stroke research and strengthen the epidemiological studies that are executed at the CSB. I am looking forward to work with these brilliant and creative minds especially the guys from the CEHRIS team.

With moving to Berlin I will have to leave Leiden, which do regret. Not only because of the great research, but also because of the students and co-workers. Fortunately, I think that this new chapter in my academic life will provide ample opportunity to start new collaborations between Berlin and Leiden.

“BKO”

~ BS

Today I got a letter stating that I have fulfilled all requirements for my BKO certificate. “BKO” is the Dutch acronym of the University Teaching Qualification certificate. It is the cornerstone of a nationwide effort to ensure that all teachers at the university have a basic understanding of everything related to teaching. Or, as is stated at the website of the Leiden University

Good teaching is of critical importance to the University. Good teaching is a skill in itself and it is one that you must develop and maintain. Only then can the University offer the quality that students deserve. The Dutch universities therefore introduced the University Teaching Qualification (UTQ) in 2008. The UTQ is a mark of quality for lecturers who have thus proven that they have mastered the craft. It is a basis from which they can further develop their skills. Show what you can do!

 

Although it is a bit of a hassle to do all courses and assignments, I believe that ensuring a basic teaching quality for university teachers is in principle a good thing… But is “BKO” enough? Only time will tell.

Honours Class ‘academic entrepeneurship’

~ BS

Yesterday I was part of the Honours Class ‘academic entrepeneurship’, organised by the Leiden University in the ‘Living Lab’ | center for innovation. Together with 15 students we discussed how a scientist should be aware of the contect he is working in. From their website

 

Als wetenschapper communiceer je met veel uiteenlopende groepen: mede-wetenschappers, maar ook ‘het brede publiek’: je wilt hen informeren over jouw onderzoeksresultaten, en het is belangrijk dat je duidelijk maakt waarom jouw onderzoek belangrijk is. Verschillende vaardigheden zijn dan van belang: schrijven, presenteren, omgaan met ‘de media’ etc. Met sommige van deze vaardigheden zul je kennis maken in een (gast)college, met andere, zoals schrijven, ga je zelf aan de slag.

Om onderzoek te doen, is geld nodig en de hedendaagse wetenschapper moet daarom ook  ‘academisch ondernemerschap’ ontwikkelen: subsidies aanvragen en budgetteren zijn daarbij belangrijk.

My contribution was that the surrounding of a scientist also influences his actions and choices. We discussed the concept of scientific integrity and how integer behaviour might (or might not) be dependent on the context. In the end the students have to think how they can or might even should be aware of the threats to their scientific independence they might encounter while doing their research… I am curious what their answers are going to be!

preconference workshop ‘crash course peer review’ cancelled

~ BS

I worked together with some partners on a new workshop for young epidemiologist. The title says it all: WEON preconference workshop ‘crash course peer review’.

Unfortunately, we had to cancel the workshop because the number of participants was to low to justify the effort of not only myself, but especially all the other teachers. I think it is a pity that we had to cancel, but by cancelling we still have a fresh start whenever we want to try again in a different format.

Whilst preparing this workshop I noticed that peer review, or a better term would be refereeing, is not popular. It is seen as a task that task up to much time, with too much political consequences and little reward etc. New initiatives like Pubmed commons and other post publication peer review systems are regarded by some as answers to some of these problems. But what is the future of refereeing, when young epidemiologist are not intrinsically motivated to contribute time and effort to the publication process? Only time will tell.

For those who are still interested in this crash course, please contact me via email.

 

New article: the intrinsic coagulation proteins and the risk of arterial thrombosis

~ BS

I got good news today! A manuscript on the role of the intrinsic coagulation factors in the causal mechanisms leading to myocardial infarction and ischaemic stroke has been accepted for publication by the JTH. It took sometime, but in the end I’m very glad that this paper was published in the JTH because its readership is both clinical as well as biomedical: just the place where I feel most at home.

The basic message? These factors do contribute to ischaemic risk, but not to the risk of myocardial infarction. This is mostly the case for coagulation factor XI, which is a nice finding, because it could be a new target for anti-thrombotic therapies.

The article is now in print and will be made available soon. In the mean time, you can refer to my thesis, in which this research was also described.

On being a scientist – second meeting planned

~ BS

After our first pilot of our workshop ‘on being a scientist’ it is time for the second installment. The date has been set (feb 19th), and the location remains unchanged. Slight changes to the programme though! Afterall, whats the use of a pilot if you don’t learn from it. The main program remains the same, as you can see below:

  • Introduction
  • A short history of scientific misconduct, the case of the Netherlands
  • From Fishy to fraud – a discussion about the grey area
  • PhD candidates: a special case?
  • Closing remarks

Hope to see you there!

credit and accountability: new authorship rules by ICMJE

~ BS

The international consortium of medical journal editors (ICMJE) have issued a new version of their recommadations.The most important change is the addition of a fourth aspect to the list of authorship criteria. According to their motivation , this addition was inspired by cases of scientific misconduct investigation in which authors denied responsibility (e.g. “I didn’t participate in that part of the study or in writing that part of the paper; ask someone else”). According to the ICMJE, authorship requires:

1 | Substantial contributions to: the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND

2 | Drafting the work or revising it critically for important intellectual content; AND

3 |Final approval of the version to be published; AND

4 | Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved

To my opinion, this addition is a good way to help researchers think about their role in the writing process: am I involved enough to justify an authorship?

However, denying responsibility of a case of scientific misconduct is in my book not the same as being responsible of the misconduct. This addition could lead to the situation where such a denial equals scientific misconduct. Isn’t that a bit to harsh? Also, the fourth criterion reflects your actions in a situation in the future, not the work that has already been done as is the case is criteria 1-3.  It is possible to compare your actions of the past to the criteria, but this is more problematic for the future. For example, a researcher might be willing, but unable to help in an investigation (e.g. change of lab). This might lead to several problems in the future, especially for young scientist who often change research groups. To make this fourth criterion work, the idea of the fourth criterion should lie in the willingness to help, the act of helping itself.

The pharmaceutical industry, both good AND bad

~ BS

As said, I spoke at the “Gezondheidszorg in Vogelvlucht” symposium, organised by the Leidse Co-raad for all students doing their clinical rotations on the topic of the role of the pharmaceutical industry in medicine.

Previously I told you that I wondered what kind of presentation it would be. During the preparation the story became clear to me… there is no way to choose between good or bad… they are both. How come? There are some serious problems in the way medicine is organised how it comes to new decisions on treatments. Missing data from trials indeed hamper the way doctors can decide what treatment to give and which not. So, I did talk about the book Bad Pharma and our Bad Pharma Symposium. But this was not all. Science has taken a beating lately, for example in the Economist article from October. And while preparing this talk I learned that Science and pharmaceutcal companies can learn a lot from each other. 

During the presentation I used two books: Bad Pharma, which can be bought everywhere, or borrowed from the Walaeus Library of the LUMC, and Arrowsmith, a great coming of age novel by Sinclair Lewis, about a young scientist doctor who is struggling with the questions young doctors/scientist all encounter. I will write a longer post on that novel somewhat later, but in the mean time you can download the free e-book here. 

A pdf from my lecture can be downloaded here: Big Pharma co raad symposium  2013 (pdf)

Bad Pharma 2013 – a great succes

~ BS

bad pharma skype

300 students reading one book, summarising it contents and discussing three propositions in order to grasp the essence of the book. This might sound a bit boring perhaps…But what if it Goldacres book Bad Pharma, you only have to read 30 pages and still get the content of the complete book, and get to Skype with the author? Great fun!

And we weren’t the only who had fun: Ben Goldacre addressed 300 students, all with critical questions, and apparently he enjoyed the whole debate:

We also invited AV, a spokesperson of NEFARMA an organisation who represents most pharmaceutical companies in the Netherlands. With him we discussed whether the AllTrials campaign was a waste of time and money. Also, BB  a reporter from the Mare, who has knowledge on conflict of interest of professors joined in on the discussion whether professors should declare their COI before each lecture. All in all, it was a great day in which some of the students were shocked by the message of Ben Goldacre, whereas other students were not impressed and doubted whether there view is too one-sided… The debate still continues!

Bad Pharma Symposium on the front page of Mare

~ BS

Mare 2013 11 28 Bad Pharma - front pageThis week, the Mare decided to run a story on Bad Pharma book by Ben Goldacre and our related symposium. The author, BB did an outstanding job in describing the argument Goldacre brings forward in his book. As you might know, we are organising a symposium for our 300 students that are following our course “academic and scientific training”, because I believe that doctors should learn about their field that they will graduate in once they have graduated. A quote from me in the Mare (in Dutch)

Dokter zijn gaat verder dan alleen het behandelen van één patiënt. Onze beroepsgroep heeft een bijzondere positie in de samenleving; mensen leggen letterlijk hun leven in je handen. Naast je arts-patiëntrelatie heb je ook te maken met de wetenschap, beleidsmakers en de farmaceutische industrie. Aankomende artsen moeten daarvan bewust worden en goed op de hoogte zijn van de ontwikkelingen in hun veld. Dit boek sloeg de spijker op zijn kop.

one little error slipped in… I am not a doctor and therefore it is officially not ‘onze beroepsgroep’ but i think people will grasp the point that I try to make. The complete article can be read here.

The pharmaceutical industry, a blessing in disguise?

~ BS

I will speak at the “Gezondheidszorg in Vogelvlucht” symposium, organised by the Leidse Co-raad for all students doing their clinical rotations on the topic of the role of the pharmaceutical industry in medicine. Although I do not have any experience with working with commercial partners, I do have an opinion on such collaborations. The stories that were published before on this website might give you a hint: The Diane-35 story (part 1, 2 and 3) and the “Bad Pharma” the book by Ben Goldacre.

However, in the preparation of the course that started today I keep on wondering whether it’s all that bad. I guess it’s not. Sure, there is a lot to change in the way new medications find their way to their patients. Also, I believe that at some level commercial interest should not be the driving force of medicine. But there are lessons to learn from pharmaceutical companies: their R&D departments are highly effective and come up with great stuff. Also, companies like these have adopted strict protocols which might be used as a template to order the flow of data in academia to minimise sloppy science! These thoughts will keep me busy for the next couple of days while i prepare for my talk. To be continued!

Academic and scientific training about to start

~ BS

After 7 months of preparation the new and improved version of the second year course ‘Academic and Scientific Training’ is about to start. Tomorrow, 300 students will come together for two weeks to learn the how and why of clinical epidemiology. We emphasize on testing new treatments in RCT, and how doctors should critically appraise the articles that describe these studies.

Together with AvHV, JS and others we were able to secure funding to buy 400 copies of the book “Bad Pharma” (click for more background) In order to organise a ‘Bad Pharma Symposium’. In this symposium, all students will read the whole book, do some research on three topics which will be debated in the final debate. This will take a lot of commitment of all students, but what to think of the 40+ Teaching Assistants that we need for this course!

All in all, it’s time to start!

On being a scientist – first pilot was a succes

~ BS

Last week we had our first pilot of our workshop ‘on being a scientist’. When I first wrote about this I was talking about a LUMC workshop, but we’ve got an upgrade: the workshop is now targeted at PhD candidates from all over the university. This way ll participants can learn from the dfiferences and similarities between areas of research. Exciting stuff!

We started last week with a small group of 12 PhD candidates from all over the university. This pilot included candidates from law, physics, psychology, medicine and the campus The Hague were all present. Also present were TdC as a co-organiser and KS as our guest.

Although the formal evaluation forms have not been processed I guess we can establish that the pilot was succesful and with that I mean that the pilot showed that we are on the right track: of course some of the content needs to be changed, but the general flow of the workshop was great. The same goes for the participants and the location.

Below a short programme

  • Introduction
  • A short history of scientific misconduct, the case of the Netherlands
  • From Fishy to fraud – a discussion about the grey area
  • PhD candidates: a special case?
  • Closing remarks

The guys from the human resource department who are responsible for the general eduction programme of all PhD who start at the Leiden University have decided that this workshop is a great way to get this topic to the attention of young researchers. The first thought is to take this workshop as a compulsory part of the eduction programme. To cater to all the 400 new PhD students the university has, we need more scientist from all over the university who can teach this course. This means we need to work on the reproducibillity of the course. with more generic examples and a clear descrition of the reason why some parts are included etc. But if we succeed, I believe that this workshop is a great way to let PhD candidates talk and think about this subject matter, which hopefully will be of help in their scientific career.

journalclub: change in program

~ BS

The articles that need to be read for the journalclub meeting #7 and #8 are switched! See below for an update.

7 5-nov Ovaska MT, Madanat R, Huotari K, et al. Risk Factors for Deep Surgical Site Infection. 2013;348–353.
8 12-nov Hernán M a., Hernández-Díaz S, Robins JM. A Structural Approach to Selection Bias. Epidemiology. 2004;15(5):615–625.

How science goes wrong? we’re improving!

~ BS

econ

Fraud, shoddy and sloppy science, conflicts of interest… Who said a science career is boring? When I write on these topics I sometimes have the feeling that I am doing science more harm than good; am I doing science a favor by showing its weaknesses and caveats? The answer still remains yes, for I believe that we need problems need to be identified before you can act on them. This is also the theme of this post: What is all being done on these topics in the last couple of days. A point by point list:

  • AllTrials: The AllTrials initiative which I support is going into its next round.Pharmaceutical companies are opening up (LEO, GSK), there are hearings in brussels and the debate in Medical journals (especially the BMJ, as one of the founders of AllTrials) is going on. Great stuff!
  • PubMed commons (a commenting system in PubMed, as a new post publication peer review) got online. It’s still a trial, but boy this is cool. I love its punchline: “A forum for scientific discourse”.
  • We organised a try out of our ‘on being a scientist’ workshop on which i wrote earlier this post. IN this post i say that is if going to be a LUMC workshop, but this changed to a workshop for all starting PhD students from the university Leiden, thus including all faculties. I am truly exciting and it our first run in november works out, this workshop might even become part of the official PhD education program of the university Leiden. The economist published a coverstory on How science goes wrong. It tells how science, peer review, statistical false positives etc work. It is a good read, especially when you are interested in science as a social process. Some remarks can be made: it’s not all that bad because scientist tend to be familiar with how the system works… the system might not be perfect, but it is at the moment the best we can do… luckily there are ways to get better, ways that are also discussed in the article.It is good that the economist and other media shares these concerns, because now this might up to build to critical mass to really change some of the weak points in the system. I thought about using the graph published next to the paper, but once I discovered the animated version of the graph i fell in love. See for yourself below. (PS false positives: another reason why not only to rely on statistical testing!)
  •  – edit: i changed the title of the pot… the first title was a bit pretentious –

Continue reading “How science goes wrong? we’re improving!” →

Diane 35 and thrombosis risk – Zembla broadcast

~ BS

The oral contraceptive pill ‘Diane 35- was’ in the news again. I wrote about the diane-35 pill on this website before, even twice,  when there was a broadcast of the radio show Argos.

The first time I wrote:

[…] this is a bit strange: there is nothing new about the information that third and fourth generation oral contraceptives have an increased risk of thrombosis compared to the risk conveyed by second generation oral contraceptives. Because the desired effects of the older and newer generation pills are similar (not getting pregnant, preventing or curing acne) there is limited, if any, reason to prescribe the newest and more expensive pills. See also the recent comment by Helmerhorst and Rosendaal in the BMJ. However, still 160.000+ (Diane 35) 500.000 (third generation) women take these newer pills. […]

Those words also fit the broadcast of the TV show Zembla last week. Zembla has a reputation to be ‘activist reporters’ and some of the broadcast is not to my taste. It is however good to see that Zembla tried to figure out how it is possible that Diane-35, which is not registered as an anti-conception pill, still gets prescribed as such. However, the broadcast leaves me unsatisfied for it does not provide answers, or even get to talk to everybody they wanted to? (Why did they reporters did not proceed to work on their WOB? a missed change!)

As in the previous two blog posts on this topic, I feel like these story are important but they also need to have the proper amount of nuance. Therefore, also this time I conclude with saying that the absolute risk of thrombosis in young women (both venous and arterial) is very low, even when using oral contraceptives. But all unnecessary risk without any benefit that can be avoided should be avoided. As always, consult your GP if you have any questions.

Diederik stapel on TEDx Maastricht BrainTrain

~ BS

I am a frequent reader of the retraction watch blog. Today they’ve put up a video from a TEDx event called, TEDxbraintrain. From their website:

“TEDx BrainTrain is a side event of TEDx Maastricht and is organised in collaboration with Dutch Railways and the SocialCoupé. In the intercity train between Maastricht and Amsterdam Central Station, inspiring talks by interesting speakers will be held in the same way as the main TEDx Maastricht event in the theatre at the Vrijthof”

Interestingly, one of the speakers is Diederick Stapel, a former clinical social psychology researcher with so far 54 retracted publications. The speech is quite similar to his book, which i’ve read out of interest in his part of the story: it sounds nice, but I don’t really understand what the message is. What struck me most is the part where he describes why he “invented research data and blew up his career as a scientist”:

“I became detached from myself (…) I lost my passion and desires… my personal goals became less important than my professional goals, and my professional goals completely overtook me”

This sounds weird to me…is good research practice not a ‘professional goal’? I am lost with this guy…

Edit: on the LUMC PhD-day, a day long PhD fun organised by the VAO, I will give an interactive workshop (together with TdC) on scientific integrity to the PhD students of the LUMC. This workshop is titles “How NOT to become the next Diederick Stapel”. Lesson 1: don’t think that inventing research data to get published is the right way to adhere to your professional goals!

Nacht van Kunst en Kennis

~ BS

On the 14th of september (a saturday) the Nacht van Kunst en Kennis will be organised in Leiden. During this festival, the differences and similarities between arts and science will be explored on several locations. A great initiative, which might just increase the public awareness of the necessity of interest free research.The program is quite interesting with inspiring scientist and great artists!

I will also be helping out during this festival night: I will host the section that is organised by science cafe leiden. This organisation tries to bridge the presumed gap between science and the lay person. We will be discussing several themes which are still subject to change… currently we are thinking along the lines of bounderies… Where is the line between just the right amount and to much. More information on this special section can be found here

Journal club 2013: application form is now available

~ BS

Just like the last 2 years I will organise a journal club together with RAvA. Students of the LUMC who want to participate please use this form to apply. Since there is only a limited number of places available, application does not guarantee participation.

During this journal club students will learn how to read and be critical of articles that describe clinical research: from crossover trials to nested case-control studies. We will read the good, the bad and the ugly. And off course, some methodology will also be present!

The level of knowledge needed to participate is high: students in doubt of their knowledge and experience  in clinical research should note this in the application form.