Better Late Than Never: Book Review

(by whizbang) May 15 2015

I reviewed Connection: Hollywood Storytelling Meets Critical Thinking by Randy Olson, Dorie Barton, and Brian Palermo (Prairie Starfish Productions, Los Angeles, 2013) a while back for a newsletter. As the newsletter changed, this review got bumped out several times and seems less relevant right now. However, I still like it! Using the structures recommended for communications in the book to summarize its messages really brought home to me the utility of the methods.

CoverRandy Olson definitely marches to the beat of a different drummer. After becoming a tenured professor, he left for film school at the University of Southern California. What could lead someone to follow this path? He became distressed at the inability of scientists and others who know facts to communicate those to the public, particularly in the area of climate science and evolution. He made some films and wrote his first book, Don’t Be Such a Scientist: Talking Substance in an Age of Style (Island Press 2009) to try and give logical, fact-listing academics some guidance. His ongoing quest to improve our communication skills led to collaboration with others involved with film work, producing this 2013 book.

This volume provides a frame work for storytelling. Think about the last movie trailer you saw. With a short bit of image and words the makers had to tell you about the movie and make you want to see it. If they can learn to boil a two-hour film into a 1 minute trailer packing a punch that makes you want to pay to go to the theater, then we can use these techniques to sell our information to patients and others.

The first component of the framework is a word. What is your message in a single word? This sounds easy, but I found this the trickiest part of the technique. I actually did this part of the exercise last. For an example, I used this structure to review this book. The obvious words include communication, connection, and story. After crafting the rest of the framework, I picked influence. The real goal here goes beyond merely transmitting information; we want to drive people to action, be it changing their health habits or accepting the reality of evolution. Others may pick a somewhat different word, but I stand by my choice.

The second component requires creating a sentence, using the construct “and, but, and therefore (ABT).” For Connection, I created this:

Scientists know a lot of facts that can help people and they need to educate the public, but they often have trouble getting their message understood, accepted, and remembered; therefore, they need to read this book to turn facts and figures into stories that compel behavior changes.

Finally, a more detailed paragraph can be constructed using a logline technique. All story narratives can be boiled down to 9 steps:

  1. In an ordinary world
  2. A flawed hero gets life upended when
  3. A catalytic even happens
  4. After taking stock
  5. The hero commits to action
  6. The stakes get raised
  7. The hero must learn the lesson
  8. To stop the antagonist
  9. So the hero can achieve their goal

Dorie Barton deconstructs Star Wars using this technique. You can fit any story into this structure, even documentaries. I have summarized Randy Olson’s biography using this technique:

A scientist wonders why students accept things they see in movies as reality, even when shown evidence that these things are wrong in the real world. He gets his life upended when he heads to film school to figure out why movies have more impact than scientific fact. After some course work, he realizes that humans are hard-wired for stories, especially those with emotional impact. He begins making films with classic narrative structure. Soon he realizes that all academics need these skills, and all of them cannot go to film school. Alone he cannot give them the skills they need to get their messages heard and remembered. In order to spread the word, he teams up with others who do script writing and acting. They start workshops to teach these storytelling skills. Then they write a book so more scholars learn to get their message out there the right way, the way that will influence people.

In addition to these models (Word-Sentence-Paragraph; And-But-Therefore; and the Logline), the live workshops put on by the group feature some improvisation exercises and actual storytelling. Brian Palermo acts and performs stand-up comedy; he gets to be “the fun instructor” in this group. I would love to participate in one of these live events, but for now I have settled for the book and the apps. Oh, yes, there are apps for Android and iOS devices that let you fill out these templates and then email your results. This work gave me a great starting draft for the material above.

Humans are wired for stories. We remember the narrative events and the emotional reactions to them far more readily than a series of facts. These techniques may help us have more impact in clinics and classrooms if we adapt them.

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The Mirror of Egelivirp

(by whizbang) May 06 2015

Click for source site

Click for source site

In one of the Harry Potter books, the protagonist (I won't say hero; I felt Hermione should have had top billing) finds a mirror. In it, he sees himself and his family. His friends do not see the same image, though. They see other things of their dreams.

Later, he finds out that he has found the Mirror of Erised, one that shows what the viewer most desires.

Desire, backwards as in a mirror, would be erised.

I believe we need a different mirror, The Mirror of Egelivirp.

(I will give you a minute to spell it out)

This mirror shows nothing like what you desire. It will show you things that you get through your privilege of birth, race, ethnicity, gender, etc.

One of my current frustrations involves explaining to white males how much they take for granted. Others in the world do not get the same respect or even the benefit of the doubt in many situations.

Being a lowly muggle, I cannot make this happen. I just hope someone at Hogwart's reads my blog. We could really use a whole bunch of these Mirrors of Egelivirp.

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Random Thoughts: AP Classes

(by whizbang) May 05 2015

I hear things. On the radio or television. Random elevator talk. These bits of information can inspire observations too long for a tweet, but not a substantial blog post. Thus, the Random Thoughts category begins...


Yesterday I heard a story on my local NPR station about advanced placement classes*. The story examined the possibility that schools were expanding the population of students placed into AP work for a variety of reasons. One result would be less "advanced" AP classes, perhaps resulting in fewer students qualifying for college credit.

Both of my offspring took a number of AP courses and tests. The classes challenged them, and I am sure it looked good on their transcripts. However, these courses would not have saved any significant amount of money in college tuition.

The main advantage I see of coming in with these credits is more rapid advancement of academic rank. In other words, you obtain sophomore, junior, and senior standing sooner if you come in with these credits. This gives the student higher priority in registration for the courses that they want or need.

*Thanks to potnia theron for supplying the link.


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Day Job Interferes with Blogging

(by whizbang) Apr 27 2015

Last week I found out it was my turn to once again give Grand Rounds.

For you nonmedical folk, Grand Rounds is like a seminar for clinical people. We put everyone in a big auditorium and someone updates the audience on a pediatric topic for an hour. We now have mandatory "interactive components" for our sessions, begging the question of why we still have it in a theater space.

I finally picked my topic which should result in a blog post eventually. In the meantime, it just keeps me from commenting on anything else.

Stay tuned; I will emerge soon.

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Things That Make You Think

(by whizbang) Apr 19 2015

On my way to the hospital today, I heard the Top 40 Hits of this week in 1973. For you youngsters, the Top 40 involved the sales of small vinyl records with 1 song you wanted on one side and something completely random on the other. These small discs turned at 45 revolutions per minute and were often called 45's or singles. Based on sales, they ranked the top songs in the US.

Somewhere in the middle of the pack was the song, Dead Skunk in the Middle of the Road :

This begs two questions:

  1. Why would anyone write this song?
  2. How did it make the Top 40?

Thanks to the power of the internet (and Wikipedia), we can answer question 1:

The lyrics describe a dead skunk in the middle of a busy road and the smell it produces for pedestrians. Wainwright said the song was an accident, written in 15 minutes

Question 2 may forever remain a mystery, although I feel it must be a testimony to the economic power of 12-15 year-old boys at the time.

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The River of Knowledge

(by whizbang) Apr 07 2015

While at Experimental Biology, I wrote here about a number of presentations of interest. These studies revolved around cool animal models and very basic mechanisms of disease. None of them will result in a change in patient care in the next year (nor perhaps in the next 5 years). All of them are essential to advancing human health, because each is a drop of water in the river of science.

A river flows along, with new streams pouring into it all the time. All these bits of water run together, sometimes slowing to mix in eddies, other times tumbling over rapids and falls, producing a whole new arrangement of the molecules that make up the river. As new flows come together, the pattern of the river may change, its rate increasing. Sometimes a rockslide or a beaver provides an obstacle that stops flow, although ultimately the river will overcome a blockage.

In science, new facts and ideas constantly flow into the world, sometimes bumping into each other and mixing in unexpected ways. Sometimes a technical issue will prevent progress on an idea; at other times, a new tool will speed the flow and move the information flow forward faster.

The important part of the metaphor is that we have no idea what information will be the critical piece that solves a puzzle, just as we cannot call out a particular raindrop or snowflake as the one that overcomes the dam. If we want to make progress, we have to continue to study it all. Eventually, the critical pieces will fall into place.

That's why it's so important to study lots of different science, even if it appears to have no implications that we can use. Down the road, it may provide that critical information that revolutionizes our world. And we simply cannot know until it happens.

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Acid vs. Base #ExpBio

(by whizbang) Apr 01 2015

Dahl salt-sensitive rats provide a useful model of salt-sensitive hypertension. What if we used something besides NaCl to give them sodium? What happens with sodium bicarbonate, for example?

Bicarbonate Therapy Alleviates Hypertension-Induced Renal Injury in Dahl Salt-Sensitive Rats Independent of System Blood Pressure. D Irsik et al.

Telemetry-monitored rats were treated with NaCl of equimolar NaHCO3 in their drinking water. Blood pressure rose identically in the two groups of rats, so sodium really seems to be the drive of that response. A variety of indices of kidney damage, including glomerulosclerosis tubular casts, and interstitial fibrosis, were significantly reduced in the rats receiving bicarbonate.

Na excretion was similar in both groups, although net acid excretion rose dramatically in the NaCl rats. This consisted of both NH4+ as well as a significant component of titratable acids.

Some of the numbers are rather preliminary, but serum pH and bicarbonate levels were similar in the two groups (7.49 for pH and ~27 for bicarbonate). Potassium was reduced in both groups, although lower with NaCl (3.59 vs 3.33). Numbers in each group are too small for statistical comparisons, but that should be corrected in the near future.

For a clinician, this work from Paul O'Connor's lab raises many interesting points. First, the groups had essentially identical pH and bicarbonate. If these results hold up as they expand their numbers, it has human implications. I would not have targeted either group for bicarbonate therapy based on serum levels.

I would like to see them do a clinically relevant experiment. When we give base (usually as NaBicarbonate) to patients, we are not generally substituting it for NaCl. Rather, we are adding another 30-50% of daily Na intake to their usual NaCl intake. How would doing that in this model change the outcomes? Would the additional sodium have any untoward effects?

As those of us at the Gottschalk lecture know, there are complex interactions between Na, H+, and K+ at the epithelial Na Channel in salt-sensitive states. Reducing the presence of acid (H+) in the filtrate may be beneficial, both in preserving potassium levels and, perhaps, other yet unidentified effects.

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Chronic Interactions #ExpBio

(by whizbang) Apr 01 2015

A number of disorders plague us as we age. Blood pressure rises with age, and increasingly so do blood glucose levels. Some argue that hypertension is a component of type 2 diabetes, but other times it precedes the hyperglycemia. Clinically, it is often difficult to sort out consequences of hyperglycemia and hypertension in the kidney. This abstract shows us how it can be done.

Interaction of Hypertension and Diabetes in Progressive Nephropathy: Role of ER Stress. Z Wang et al.

This study, from John Hall's group at Mississippi, starts with Goto-Kakizaki (GK) rats that spontaneously develop type 2 diabetes about 6 months of age. At time zero, they placed a telemtry device to measure blood pressure in the aorta of these animals. After a couple of weeks fro recovery and baseline measurements, they then used an abdominal coarctation model to produce systemic hypertension that one kidney gets exposed to, but the other sees low flow and pressure.

Used with permission of authors

Used with permission of authors

A coarctation of the aorta may occur spontaneously during fetal development, resulting in hypertension because the kidneys both see low blood flow. Their efforts to correct that, through increased production of renin and all of its effects, causes hypertension. By creating the narrowing of the aorta between the left and right kidneys (see diagram), the upper right kidney gets exposed to the elevated pressure, while the left kidney senses a reduced pressure. For those of you who have not seen this anatomy in the rat, this surgery is a pretty neat trick.

After two more weeks for recovery and measurements, they then added treatment with tauroursodioxycholic acid (TUDCA), an inhibitor of endoplasmic reticulum (ER in the title) stress. ER stress disorders protein folding and transport within cells, contributing to disease and scarring.

Functional and structural markers of kidney damage were increased in the hypertensive kidney compared to the one that had normal or low pressure, as were markers of ER stress. TUDCA treatment lowered these markers, as well as reducing kidney dysfunction in the hypertension-exposed organ.

This elegant study shows that hypertension may accelerate kidney injury from hyperglycemia, at least in part through ER stress. Now, if you have high blood pressure and diabetes, don't head online to try and buy TUDCA yet. As with all animal models, this one is not quite ready for translation to the bedside. First, the GK rat is not obese, so not a typical type 2 diabetes model. Of course, obesity adds a whole lot more issues to this equation, but also makes surgery in this area more difficult. Second, the "unexposed" kidney is the source of the trouble. It's cranking out renin, and we know that the renin-angiotensin system is active within the kidney as well as systemically. Many of these components can affect the kidney; however, I would expect that to blunt the difference between the kidneys rather than increase it. However, it will be interesting to see if TUDCA proves as effective in models that do not depend on renin activation.

This lovely study does convince us that hypertension interacts with hyperglycemia in the kidney to accelerate kidney damage. It also confirms the role of pressure in ER stress.

Strong Work!




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More Questions About Kidney Loss #ExpBio

(by whizbang) Mar 31 2015

I'm not donating this kidney to anyone!

I'm not donating this kidney to anyone!

Every day many people in the world volunteer to lose a kidney. It may be to cure a condition, but more often they give a healthy organ for transplantation to someone with permanent kidney failure. In general, kidney donors who have been carefully screened seem to have little kidney morbidity over the long-term.

What are the consequences of uninephrectomy that may not relate directly to kidney function?

Metabolic Consequences of Experimental Uninephrectomy. D Arsenijevic et al

This group (sponsored by Jean-Pierre Montani) performed uninephrectomy or sham procedure in 6-week-old male rats (so an early teenager in human time, an age where removing a functioning kidney is almost unheard of). They then studied body composition and a number of metabolic markers at 1, 2, and 4 weeks following the procedure.

Body weight remained similar between the groups, but fat mass was reduced in the animals that lost a kidney. In addition, there were alterations in circulating lipolytic cytokines, a sign of systemic inflammation.

Systemic inflammation can be bad for your cardiovascular system.

These findings are intriguing, but there are a lot of unanswered questions. First, a 4-week endpoint in a 10-week-old rat is hardly a long-term study. I want to know how these boys do over at least 6 months. Is this an early change that then resolves with time, or one that becomes more pronounced?

What about female rats? I spent too many years considering sex differences to leave that out. Also, it would be interesting to see if uninephrectomy in adult animals (at least 14 weeks of age) has similar effects. That age would be more analogous to the situation in kidney donors.

Since we do so many kidney donor surgeries, there is excellent opportunity to also measure these parameters in people. Measuring fat mass can be expensive and annoying, but drawing blood for lipolytic cytokines would certainly be feasible. Come on - let's get translational!

This abstract is really a teaser, I hope, designed to make us want more answers. In that case, it worked like a charm!

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Gottschalk Lecture 2015: Sensing and Transporting Sodium #ExpBio

(by whizbang) Mar 31 2015

Drum roll, please.

Without further delay, I present my summary of the excellent talk presented by Tom Kleyman:

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