This post was originally featured in Scientific American Observations on November 30th, 2018 and was posted on The Written Science blog December 5th, 2018.
It was my first week in the lab when I overheard those three forbidden words.
A senior investigator asked a junior scientist about his research. From my lab bench, I heard the junior scientist utter three words that would have ended the conversation in my previous career as a dietitian. “I don’t know,” he admitted.
In the clinic, telling a physician “I don’t know” exacted a high cost: his or her loss of confidence in my expertise. Once I’d uttered those words, I would have to exert much more effort regaining the physician’s confidence than I had spent losing it. Physicians relied on my nutritional expertise to ensure that patients healed quickly. “I don’t know” suggested incompetence.
But in the lab, the words “I don’t know” would often spark lively conversation that led to new ideas and fleshed out hypothetical concepts. That’s when I realized my transition from clinical dietitian to research scientist wasn’t just a change in careers: I was entering a new reality. In this reality, “I don’t know” could indicate brilliance, not incompetence, and ideas, instead of protocols, drove success.
Bridging the Gap
I welcomed these revelations but also repeatedly saw that these differences discourage collaboration between physicians and scientists, impeding the development of clinically relevant innovations. Craig Blackstone, Scientific Director of the MD/PhD Program at the National Institutes of Health, has also encountered this dilemma: “Sometimes [physicians and scientists] just don't have enough commonality in the way they approach things to even be able to talk to one another.” After defending my PhD in biochemistry and molecular biology, I wanted to make conversation between these professionals easier, so I founded The Written Science to support the translation of science into medicine.
Traditionally, physician-scientists have bridged the gap between the clinic and lab. Physician-scientists hold professional degrees related to clinical care (i.e., MD, RN, DVM, MD/PhD) but spend most of their time conducting research. Through their unique combination of clinical and research experience, they look for insight into the molecular discordance that underlies disease etiology. They convert scientific findings into clinically relevant applications and elucidate the mechanisms that cause clinical problems.
Physician-Scientists Translate Research into Clinical Innovations
The discovery of statins—a class of drugs that inhibit cholesterol production—demonstrates the special ability of physician-scientists to connect clinical dilemmas with novel biomedical discoveries. Joseph Goldstein’s experience treating patients with familial hypercholesterolemia (FH) prompted him and Michael Brown to investigate the disease’s molecular etiology during the 1970s. Together, they discovered that patients with FH lack LDL receptors and exhibit increased LDL cholesterol production. Brown and Goldstein proposed that statins may lower the cholesterol level of these patients. Subsequent studies by these two physician-scientists and other researchers confirmed the therapeutic effect of statins in FH and other patient populations. Now, statins are a regular part of clinical care and have saved millions of lives.
The statin story shows the unique ability and opportunity of physician-scientists to connect patient symptoms with biomedical treatments. A life-saving medication was discovered, thanks to the seamless flow of information between the clinic and lab.
Due to a combination of circumstances, this fluidity has diminished over time. From 1980 to 2002, the number of biomedical science doctorates increased by over 50 percent, and spending on academic research and development efforts more than doubled. During this same time period, the clinical physician workforce increased nearly twofold, but the number of physicians choosing research-oriented careers remained steady. Scientists were conducting more studies, but fewer translators were available to facilitate the flow of information between the bench and bedside.
A relative decline in the physician-scientist population threatens crosstalk between the lab and clinic. Researchers are less aware of potential clinical implications for molecular discoveries and are not privy to the clinical observations and needs that fuel clinically relevant research. The flow of information between the lab and clinic slows.
Blackstone and others worry that physician-scientists will become more scarce in the future, restricting this information stream to a trickle (see here, here, and here). With fewer physician-scientists to intercede, cultural and professional differences between physicians and researchers may compromise the flow of information between these worlds, widening the current rift.
The earliest evidence of cultural differences between basic science and clinical practice may appear at the training level: MD students and PhD candidates are visually distinguishable on university campuses. Medical students dress in business clothes, reinforcing their authority and responsibility. Grad students usually wear jeans and t-shirts. These unintentional visual cues encourage the physical separation of lab and clinic in university hallways, where interactions between future physicians and researchers should be the most accessible.
Andrew Schafer, Distinguished Professor and physician at Weill Cornell Medical College, summarizes several of the fundamental professional differences between physicians and scientists, including the following examples, in his book, The Vanishing Physician-Scientist:
Physicians seek certainty: their job and the patient’s life demand succinct, comprehensive solutions. Scientists, on the other hand, thrive on wonder and possibility. The air-tight solutions that ease a physician’s workload are dead-ends for researchers.
So, how can collaboration between these diverse worlds be improved to ensure that scientific discoveries address clinical deficits? Partnerships between physicians and scientists are an essential part of the solution. For these partnerships to be successful, information must flow freely between these professions. Modifications to traditional institutional structures, effective communication tactics, and integrated training techniques will cultivate a shared language that facilitates fluid information exchange and productive collaboration.
Redefine and Support the Physician-Scientist
Today’s physicians face different professional and personal demands and workflows than those of previous generations. For example, recent changes in institutional demands (e.g., the Affordable Care Act) have altered physician responsibilities. Blackstone believes the structure of traditional academic medical centers does not support the needs and priorities of modern physician-scientists. A fresh model for physician involvement in research may stimulate clinical innovation.
Physicians may find collaborative research with basic scientists who have complimentary expertise to be more feasible than independent efforts. Complementary partnerships between clinical physicians and lab-based scientists will fortify the connection between these worlds.
Even collaborative studies require a significant time commitment. Blackstone believes that departmental and institutional leaders can create a supportive research environment for physicians by providing financial assistance and/or reduced patient loads to those involved in scientific studies, offsetting the cost (financial and time) required for these efforts. Institutions that champion physician research fuel biomedical innovation.
Acknowledge the Difference
Successful communication is essential for physicians and scientists to collaborate productively, especially as each field’s body of knowledge grows. To improve the flow of scientific discoveries out of the lab, researchers should succinctly summarize their findings for physicians. Physicians must learn to ponder the clinical application of basic science discoveries. As these professionals honor each other’s unique realities, their conversations about the unknown will catalyze clinically relevant innovations.
Training is a prime opportunity for future physicians and scientists to develop valuable communication techniques that foster cross-profession collaboration. Modifications to established training procedures will chip away at the foundational differences between these professionals.
Medical school classes are broad and disease-based. In contrast, PhD classes are specific (i.e., molecular) and often technique-based. Cross-training would provide physicians and researchers with a common language, facilitating collaborative studies.
Some universities have already begun to cross-train PhD and MD students. An increasing number of biomedical PhD programs are intentionally exposing graduate students to clinical medicine. Problem-based learning approaches are used to nurture wonder in medical students, and some programs offer research opportunities to those who are not on the MD/PhD track, cultivating a physician workforce that appreciates and participates in research. As these students become practicing physicians and research scientists, they will share a common language that enables better communication and more productive cross-profession collaboration.
My grad school class had one MD/PhD student. Others constantly sought his insight into the clinical relevance of reported findings, which was dependably enlightening. Once, he rightly questioned the clinical validity of an ex vivo cardiovascular model that flushed fluid through the heart in the opposite direction of blood flow. This perspective encourages clinically relevant discoveries; universities should support environments where MD and PhD student interactions are the norm, not an anomaly.
Embrace the Change
Slight tweaks to traditional research structures, effective communication skills, and a more integrated training approach will empower physicians and scientists to establish successful partnerships that generate clinically relevant applications. Together, these two professions can turn scientific “I don’t knows” into transformative solutions.
By Rachel Lane
Posted July 10, 2018
"Five mikes." I repeated the words to myself, closing my eyes and hoping a clear picture of "five mikes" would materialize from the darkness.
By the grace of one benevolent scientist, I was finally working in a lab. A month before, I had been hustling hospital hallways writing nutritional care plans for patients. The only thing I knew about the research world was that I desperately wanted to be a part of it -- to scratch the questions itching my mind.
I had to answer those burning questions, but first, I needed to figure out what "mikes" were. I had been talking with a scientist about an assay (even "assay" was a new word to me at that time!) I wanted to perform, and he told me to add "five mikes" of reagent. My own pride kept me from clarifying what he meant by "mike." Microliter? Micromolar? Microgram? The information had been casually tossed into my hand without any preceding contextual questions, so I assumed I should know exactly what a "mike" was.
I asked another scientist what "mike" meant, but he didn't know either.
Eventually, I determined that "mike" was short for "microliter," which helped me...in no way at all. Now, I had to return to the scientist with more questions: what is the initial concentration of the reagent? What is the final reaction volume/reagent concentration? Each question provided helpful information, but the experimental timeline would have been expedited if the scientist had initially said "The final reagent concentration should be 5 micromolar, Rachel."
Critical information hides behind assumptions
The final concentration was the useful, applicable information that I needed. However, the scientist and I both made critical assumptions. I assumed that the information he provided was basic knowledge, not colloquial shorthand, and the scientist made assumptions about my initial level of knowledge, my experimental system, and the commonality of "mike" as an abbreviation for microliter.
Scientists and clinicians speak different languages
My own inexperience undoubtedly contributed to this specific miscommunication, but I encountered multiple interactions like this throughout my graduate career and observed similar exchanges between proficient scientists. After experiencing and observing the awkwardness and inefficiency of these conversations, I learned how to ask the right question to extract the information I needed.
These interactions reveal why translating science into medical applications can be so difficult: clinicians and scientists have just enough in common and just enough crossover that many assumptions are made by these well intentioned, competent experts. Each of these vocations has a distinct language, fueled by unique training environments and realities. Scientists are challenged to explore deep into the unknown, and unfortunately, this practice may cause scientists to become disconnected from what not only the general public but also their peers know.
Just start talking
Fortunately, collaboration among scientists is becoming more valued, but physicians and scientists must also start conversing on a regular basis.(1,2) Scientists must learn to ask questions that elicit necessary information from clinicians. The conversation may be messy at first, but it's the only place to start. Scientists need to hear the unresolved problems and suboptimal solutions that clinicians encounter. From this information, scientists can create new solutions or repurpose known technology to satisfy clinical deficits. Communicating these efforts and breakthroughs will empower clinicians to advocate for research - testifying that basic science is a valuable source of beneficial interventions. Just like I did, scientists must learn to ask the important questions that improve their research.
1. Mediati D. Science is the name but collaboration is the game | PLOS ECR Community. PLOS Blogs: Early Career Research Community. http://blogs.plos.org/thestudentblog/2017/04/14/science-is-the-name-but-collaboration-is-the-game/. Published 2017. Accessed July 10, 2018.
2. Hsiehchen D, Espinoza M, Hsieh A. Multinational teams and diseconomies of scale in collaborative research. Sci Adv. 2015;1(8):e1500211-e1500211. doi:10.1126/sciadv.1500211
Image created from the following Noun Project pictures: long hair by Kirby Wu; drop by Tami Nova; sand by Ana MarÃa Lora Macias; and Human by Alex Muravev.
By Rachel Lane
Posted May 7, 2018
If you are considering establishing a limited liability corporation (LLC), this article will simplify that process. Recently, I transitioned from a full-time employment position to freelance writing/consulting. I never thought I would be a business owner, so when I knew the transition was imminent, I began scouring online resources, searching for a cohesive article that explained the sequential steps for establishing an LLC. My search was unsuccessful. Many online companies offered to complete the filing for a fee, but I felt a responsibility to directly experience and understand the process. This article summarizes what I learned during that process and provides a list of steps to form a single-member LLC.
1. Decide between forming a sole proprietorship or single-member LLC
To make this decision, two main issues must be considered: responsibility and convenience.
Responsibility - How risky is your work? In a sole proprietorship, your (and your spouse's) personal belongings (house, car, etc.) are at risk in work-related lawsuits, but in an LLC, your personal belongings are protected. This protection provides a peace of mind for you and your family, even if you do not foresee any legal issues associated with your work. Business advisors also informed me that businesses prefer to write checks to companies rather than individuals, which is another benefit of creating an LLC.
A special note for medical writers: I have been advised that pharmaceutical companies prefer to contract with LLCs.
Convenience - Are you willing to operate a separate bank account? If you establish an LLC, you must open a business bank account. This banking setup is less convenient than a sole proprietorship, where freelance income can be deposited into your personal banking account. In an LLC, client payments must be deposited into the business account first and then transferred to your personal account. A business account adds a couple extra steps between you and pay day.
For federal taxes, if you are the only member of the LLC (i.e., no partners), filing taxes for the LLC will be the same as for a sole proprietorship. A single-member LLC is considered a "disregarded entity," which is a good thing! Your LLC will be treated as a sole proprietorship for federal tax purposes. Instead of filing separate taxes for your LLC, you can fill out and attach a schedule C form to your personal taxes.
2. Schedule an appointment with your local small business development center (SBDC)
If you decide an LLC is right for your business, schedule a business counseling appointment at your local SBDC. The SBDC offers complimentary business consulting, led by trained volunteer counselors, to new businesses. When I met with an SBDC counselor, I received information on how to establish an LLC at the state and federal level, and the counselor answered general questions regarding state taxes and recommended local networking opportunities specific to my business.
Note: The SBDC is not a tax authority. For tax questions, contact a CPA.
3. Decide on a business name and reserve it
Choosing a business name is very personal, and consulting with a marketing team may be worthwhile. I did not consult with a marketing team. Instead, I chose a business name, The Written Science, that clearly indicates the service I offer: science writing. With a straightforward name, my purpose is clear, and I am less likely to be overlooked by potential clients.
One thing I did not consider was name length. My business name is composed of three words, but a name with two words or less may be easier for clients to remember and potentially shortens social media handles. For cohesive branding, consider a name that can be used consistently across all media and marketing platforms. The resources listed here may be useful in this decision process.
Once you identify a potential name, peruse social media and Google to ensure the business name is unique and does not already have a web presence. As soon as I had a company name I liked, I reserved the ".com" domain, the Instagram and Twitter handles, and the entity name with my state. The official name registered with the state must include "LLC."
To reserve your business name with the state, a quick Google search (e.g., "reserve entity name in <your state>") should locate the appropriate secretary of state webpage. For example, here is Alabama's webpage for entity name reservation. Reserving the name requires a small annual fee (approximately $30 in Alabama). The reservation will need to be renewed every year until the LLC is officially established with the secretary of state: if you decide on the perfect name for your business three years before you file as an LLC, you will need to renew the reservation each year.
Note: Should a comma be placed between your business name and "LLC"? When applying for an employee identification number (EIN), you will NOT be allowed to use a comma. For consistency, I would NOT use a comma in your state filing (i.e., use "My Company LLC" not "My Company, LLC").
4. Register your company as an LLC with the secretary of state
To start doing business, you need register your company as an LLC with the secretary of state. If you are filing in the state you reside in, you can do this step yourself. Some counties allow this process to be completed online. My county allowed me to prefile the paperwork online. To complete the filing, I took a printed copy of the paperwork to the courthouse. At the courthouse, the clerk scanned the barcode on my papers, I paid the filing fees (about $200), and then, my company was official. I spent less than 10 minutes at the courthouse. Approximately 2 weeks later, I received my state tax information in the mail.
Check your state tax laws and pay attention to all notification/handouts you receive. In Alabama, the LLC owner is required to pay the minimum company tax within the first 2.5 months of formation (e.g., if you formed the LLC during the first of June, the tax would be due mid-August). Most sources recommend filing quarterly taxes, and this may be required in your state.
Note: If you want to establish the LLC in a state where you do not reside, you will need to hire a local agent to file for you.
5. Obtain an employer identification number (EIN)
After filing with the state, you may need to obtain an EIN. Although single-member LLCs do not need an EIN to file federal taxes, an EIN is usually required to open a business checking account and will be necessary if employees are hired. The EIN is obtained by filling out an online application. The application will ask how many members are included in the LLC. If the LLC has only one member (you), the LLC will be filed as a single-member LLC and thus is considered a "disregarded entity." The application will clearly notify you of this status, and if you wish to be taxed as a corporation, you can fill out an additional form. This status qualifies you to file taxes as a sole proprietor: instead of filing a separate federal tax form for your LLC, you can attach a schedule C form to your 1040, using your social security number or taxpayer identification number instead of your EIN.
6. Choose a bank
Choosing a bank can be overwhelming. A few points to consider are listed below.
Are you willing to pay for business checking? Complimentary business accounts do exist. Consider the questions below to determine which features are most important to you and your business. If you are unwilling to pay for a business account, some features may not be available.
How many transactions do you anticipate? The number of allowed transactions seems to be a major discriminating factor among different tiers of business checking accounts. Transactions include deposits and withdrawals. For an LLC, you are likely to have multiple deposits from different clients each month and at least one withdrawal to pay yourself, maybe more for work-related purchases. Estimate the number of transactions you anticipate per month and ensure that the bank you choose can accommodate that transaction volume. Exceeding the transaction limit can incur fees.
What is the minimum balance? How much money are you willing to tie up in the business account? As a freelancer with minimal overhead and a simple business model, I did not want $500 tied-up in maintaining a minimum account balance.
Is mobile banking offered? Mobile banking is another key discriminator among business checking accounts. The ability to quickly deposit client checks and transfer funds from my business account to my personal account was important to me. My goal is to maintain maximum flexibility during working hours so that I can accommodate client schedules: I do not want to squeeze a bank trip between client meetings.
Is a debit card provided? A debit card is essential for online work-related purchases and makes in-store purchases simpler.
Does the bank have a local presence? A bank with a local brick-and-mortar presence gives you the opportunity to personally meet with an individual about your account questions or concerns. Local banks can also offer insight into the local community and provide connections for community involvement - an added benefit that I did not expect but found very desirable.
The above information summarizes what I learned while establishing my LLC. Since initially writing this article, I found this resource, which provides detailed, state-specific information. I am not a tax or business expert. While I believe this information is useful and correct, I am not inerrant, and regulations likely vary among states. Please consult with a tax or business expert when setting up your LLC.
By Rachel Lane
May 7, 2018
The phrase "publish or perish" is commonly used in academic settings and implies the imperative need for scientists to both generate and communicate publication-worthy research in order to continue practicing science. Every day, scientists confront this twofold pressure to generate quality research and adequately communicate the significance of their findings. If the scientist fails on either account, the lab will be unable to procure funding and will eventually shut down.
This phrase is also true outside of academia. If science is not communicated well, it will not gain the public or clinical support needed to progress into relevant applications. Well-communicated science engages public interest, facilitates collaboration among scientists, and expedites the translation of research findings into clinical uses. While an increasing number of resources, such as the "Friends of Joe's Big Idea" network and "Communicating Science" workshops offered by the American Academy for the Advancement of Science (AAAS), help scientists improve their communication skills, collaborations between scientists and science writers are vital for science to progress in today's world and for the significance of research findings to be translated between disciplines and to nontraditional audiences.
Scientists and science writers have a similar background, as both professionals have successfully completed a PhD in a science-based field (although a PhD is not required for science writers). During the PhD training process, both professionals learn to identify important unanswered questions, hypothesize potential connections between the known and unknown, and devise methods that test these hypotheses. This common experience means both experts understand and appreciate the challenges and triumphs associated with research. However, the career tracks of these two professionals begin to diverge after the PhD has been defended. At this step, the scientist enters a postdoctoral fellowship to continue developing research skills, while the science writer may choose a communication-centered position or begin freelance writing/editing.
During a postdoc, the scientist's technical expertise and personal perspective grow and become more specific, creating an irreplaceable skill set that cannot be replicated. However, when a scientist opens a lab or joins a biotech after completing one or more postdocs, this skill set often takes a backseat to new responsibilities. Funding and managing the lab become an academic scientist's top priorities, and biotech scientists must promote the technology to investors and end-users while continuing to refine the current science and develop new applications. The scientist spends more time at the desktop and computer screen than at the benchtop applying her specialized skill set. In this paradigm, the research catalyst, the scientist, is removed from the lab, slowing the progression of science. In addition to impairing the accumulation and dissemination of a scientist's experiential knowledge, this shift in responsibilities decreases job satisfaction, as the scientist's first passion is generally for lab work, not writing.
Like scientists, science writers have a unique skill set, with a combination of scientific and communication expertise. Science writers have the training and capacity to efficiently and effectively communicate intended scientific messages among different disciplines and audiences through traditional and nontraditional vehicles, including manuscripts, blog posts, books, and podcasts. Scientists are pulled in many different directions that often take precedence over effective science communication, slowing the dissemination and application of science. When a scientist relinquishes communication responsibilities to a writer, the scientist is free to maximize her unique skill set and spend more time in the lab, applying her specialized knowledge to solve the unknown and ensure research continuity and quality. The resulting findings are then clearly and effectively communicated by the science writer. These two factors synergistically facilitate science progression, benefiting both the scientific community and the public.
Collaborations between scientists and science writers promote science progression by enabling each expert to fully apply their specialized skill set: scientists spend more time in the lab, generating results that provide insight into the unknown, and the significance of those scientific findings are more effectively communicated and, thus, more likely to be translated into relevant applications. The career satisfaction of both experts is also increased. However, challenges do exist in this relationship. Mutual respect is essential in the scientist/science writer relationship. Each expert's insight must be fully revered: if a writer says the message is unclear, the two should work together to clarify the meaning while maintaining scientific accuracy. When the writer lacks specific scientific knowledge, she should work directly with the scientist to cultivate her subject knowledge and ability to accurately communicate the intended material and message. An open, honest collaboration will expedite future projects, creating a dynamic, fruitful, and efficient working relationship.
Scientists must also continue to refine their own ability to communicate science, especially to the public. The scientist is more likely than the science writer to discuss their work on public platforms, such as radio, television, or social media. To be effective, scientists must establish trust with their audience (for more see here and here), identify the jargon that commonly enters scientific descriptions, and poignantly highlight the most important relevant and relatable scientific findings. Working with a science writer to develop an "elevator speech," a five-minute summary of the research focus and potential relatable applications, may help scientists maximize these opportunities. These collaborations between scientists and science writers promote scientific progress and the translation of science into medicine.
Note: This article was written for biomedical sciences specifically, but the benefits are relevant to all areas of science. The more scientists use their unique skill set, the more connections between the known and unknown are uncovered, and when these findings are clearly communicated by science writers, the receiving audience is empowered to apply the results to policy or other interventions and applications.
Revised May 12, 2018