Drug rash, what exactly do you mean? from jonathan rees on Vimeo.

Lectures: ne quid nimis (no more than enough), adding, “If an angel was to preach for two hours, unless his hearers were angels likewise, I believe the greater part of them would wish he had done.” Quoted in the THE

Pattern of access to my online material. The exams are held three times per year, but I think you can see that.

What has changed in dermatology in one clinician’s lifetime from jonathan rees on Vimeo.

From an article in this week’s NEJM. I am surprised, but I suppose I shouldn’t be:

Pharmaceutical companies currently spend 25% of their marketing budgets on digital technologies, such as websites and social media.

For example, when physicians use mobile applications to look up clinical information, they generate trackable data that can inform advertising. The best example is Epocrates, a widely used mobile application for physicians that provides information about drug indications, interactions, and insurance coverage. Individual physicians’ search patterns are tracked and used to target “DocAlerts” (often industry-sponsored) that appear on the screen.5

“He responded, as most people do, by saying that his college education provided him the basics, which I always take as a kind of religious remark.” Roger Schank

Like most people I find writing hard. I like have written (as they say) but struggle with getting the words out. Getting the words out does however often help get some of the thoughts out, and the attraction of a blog is, well, ‘This is just a blog post: TIJABP’. No pesky editors, and in the areas which now interest me, I learn more from blogs than I do the formal academic literature.

I have been meaning to write something about medical academic careers for a long time, partly because I have been asked to give three lectures on this topic (one local, one national and one international) over the last year. I keeping putting writing off, because of course, I feel I will only get it right, not now, but next week. And next week is always next week, so I have decided to put fingers to keyboard, accepting it is all a little messy and unfinished.
A couple of things I need to say up front. First, I have been a clinical academic for most of the last 32 years since I graduated in medicine (1982), so I find it hard to compare with other careers (although I am married to a physician who thinks being an academic would be hell on earth— fortunately she seems OK about being married to one, for the moment anyway). In other words I’ve never really done a proper job since 1986, and any comparison with other careers is problematic. Then again, all knowledge is imperfect. Second, an issue critical to any attempt to distil advice: I have spent most of my career in a time when things were very different. If you go back to the classic writings of Robert Merton, and subsequent work by John Ziman (Real Science, and see an article in Nature here by Ziman), you will see that science for most practitioners is no longer the same as it once was only 30 years ago. The social norms really have changed (see Peter Lawrence on this). A generation or two ago, most current job adverts for clinical academic positions, and claims by research funders, would have been viewed as vulgar. I sympathise. I remember one of the brightest and successful non-clinical academics I knew under the age of 35 saying that whereas he has happy to be paid poorly, he was not happy to be paid poorly and have his life run according to HRs excel charts and performance management. He left, and whereas he was soon much the richer (in one sense), science was very much the poorer. 

My most recent talk was in Madrid last week at a wonderful small meeting run by the European Society for Dermatological Research (ESDR), a society that nurtured my career and of which I was privileged to be president of just over 10 years ago. Now, I should add, I am just an ordinary member, once again. The format was intense, comprising about ten mentors and 30 mentees chosen from all over Europe—Croatia to Ireland and all stops in between. Mentees presented some of their work and mentors were given free reign (within 20 minutes) to talk about their career, subject and any tips they would like to offer. Rather than the dreaded Excel spreadsheet, mentors interpreted their task with some individuality. I don’t want to post my slides, but I want to list the sorts of things I talked about, very much in the format of a set of notes, rather than as one coherent essay. Here we go.

Point 1: the right place at the right time
I started with a story told by Paul Graham (I think) in his book Hackers and Painters. Having done computing and art at university in the US, Graham recalls how he went to live in Florence, to continue his painting. Showing a wonderful sense of irony and self-deprecation, he then points out that he was five hundred years too late. Florence and painting made sense in the 15th and 16th centuries, but as he realised, an exciting edge of culture was not now Florence, but Silicon valley, in the here and now. He returned, and his many successes since attest to how being at the right place at the right time matters. Nature and nurture; seed and soil.

Point 2: somebody to help you climb out of the shit.
I learned the importance of having somebody who can smooth the world for you a long time ago in an essay James D Watson wrote in Science (Succeeding in Science: Some Rule of Thumb). Watson has lots of good advice in this article. If you try and do anything worth doing you will upset people, and some of those people might not be too generous to you. Understatement. So, you need a supporter to help you rise above the shit, usually by pulling you out. Headfirst is preferable. Watson has lots of other advice including only working on things that you are passionate about, because succeeding in science is really hard, and it is next to impossible to excel at something that you are not wildly excited about (i.e. you do have to be driven, even if you are quietly driven in an introverted sort of way — and yes, we need more introverts).Related to some of this, see Francis Crick on the Gossip test. Watson also points out that you have to seek out people who are smarter than you: it is the only way you get better. Next time you pick up a plectrum, listen to Ralph Towner, if you don’t know what Watson means. Or read anything, and I mean anything, Sydney Brenner writes. (For me, most of the qualities necessary described above, were provided by Sam Shuster). 

Point 3: you can only join up the dots with hindsight.
OK, ok, this is a steal from the prophet Steve Jobs, but often you really can only join the dots looking backwards. If the search space is large, random walks may be necessary, but I would still prefer to follow random monomaniacal interests. For my intercalated degree, I did masses of stats and some very basic computing (FORTRAN) on an IBM 360. I could not have made a career in either. My reasons at the time were that I wanted to become a psychiatrist, and that I though population based studies were then more likely than the then endless rat brain dopamine studies  to take the field further. I am not certain that was a sensible line of reasoning, but with hindsight, since I have spent much of my research career in what is now termed genetic epidemiology, and more latterly informatics, the choice was an opportune one. I just didn’t know that at the time.

Point 4: Migration drives human advance
I was lucky to spend a short (clinical) period in Vienna under Klaus Wolff, and then a few years later, some research time in Strasbourg, in Pierre Chambon’s rather large laboratory. Lots more I can say, good (and bad), but moving from your home environment to a new one is a great idea. I think you can go back to such advice from Peter Medawar and others on this score: don’t do a post-doc in the same lab as you did your PhD etc. Exceptions there may be, but culture and geography are intertwined and culture has overtaken genes in our evolution. In my case, migration meant 3 months notice to move a young family to another country, all without telling my funding agency— an example of how you need a supporter to help you did yourself out of the shit, when you got found out. Fortunately, the UK MRC were more respectful of individuality in those days.

To be continued…….

I read in the BMJ ( BMJ Careers page 2, November 1st 2014) that “From autumn 2015 students enrolling on healthcare courses at universities in England will undergo face to face interviews to assess whether they display values including ‘respect and dignity’, ‘commitment to quality of care,’ ‘compassion,’ ‘improving lives,’ ‘working together for patients,’ and ‘everyone counts.’” To which I would  respond, everyone counts but some count more than others (with apologies to Orwell). Facile stuff from those who think of human culture as a giant Excel spreadsheet.

In Clayton Christenson’s “How Would yo measure your life,” he writes: Enron had a “Vision and Values” statement. It aimed to conduct itself in line with four Values (each starting with a capital letter): Respect, Integrity, Communication, and Excellence. Respect, for example, had the following detail (as reported in the New York Times): “We treat others as we would like to be treated ourselves. We do not tolerate abusive or disrespectful treatment. Ruthlessness, callousness, and arrogance don’t belong here.” A cursory reading of the attempt to instil  or select the right values amongst law or business students when it is the environment they find themselves in in the world of work that is the problem, would suggest such attempts are doomed to failure.