So You Want to Be a… Medical Writer

By Sally Burn, PhD

What can you be with a PhD? So many things! In our new series on post-PhD careers we explore the options out there, providing tips on how to break into different industries and helping you identify jobs your skill set is ideally matched to. Check back every two weeks for the lowdown on becoming, to name but a few, a Publisher, Tech Startup Founder, Medical Science Liaison, Editor, Industry Scientist, Consultant, and Space Pirate (OK, so perhaps not the last one).

Today, in our first post, we chat with Elizabeth Ohneck about her career as a Medical Writer and find out how you can become one too. Elizabeth works for Health Interactions, a medical education and communications agency; she’s also one of our regular Scizzle blog contributors.

 

Hi Elizabeth! So, what exactly does a Medical Writer do?

Medical writers work with research teams in pharmaceutical, nonprofit, and other institutions to develop manuscripts, abstracts, posters, and presentations. In general, our clients send us reports outlining the methods, results, and analysis parameters of their studies, which we use to develop the desired publications or presentations. We also attend conferences and prepare conference summary reports, as well as write literature reviews over current publications in a particular disease or therapeutic area. In addition, we provide support for administrative tasks such as manuscript and abstract submission and the preparation of biosketches for physicians and researchers.

 

How did you get to where you are now?

I have a BS in Biology from the University of Dayton, where I first experienced working in a lab for my honors thesis in microbiology. I enjoyed research at the time, so I decided to go to grad school. I got my PhD from Emory University in Microbiology and Molecular Genetics. I knew I didn’t want to stay in academia, but wasn’t sure what I wanted to do, so I took a postdoc position at NYU while I looked into other career options. I’ve always liked writing and am often frustrated by how poor the communication of science is among researchers and between researchers and the public, so I started looking for opportunities in science communication. My husband is a postdoc at Princeton, and a former postdoc from his department emailed the department saying his company was hiring medical writers and any interested candidates should contact him. My husband sent me his information and I emailed him to set up an informational interview. After our conversation, he sent my CV to the HR department at his company and from there I went through the standard hiring process – phone interview, writing test, in person interview, job offer.

 

What are the key skills needed for this job? Did you develop any of them during your PhD/postdoc?

You really have to love learning and be an effective self-educator. I work in rheumatology and veterinary medicine right now, not areas at all related to my background in microbiology. So I had to learn a lot about new subjects very quickly, and it’s really important to stay up-to-date with the research and developments in the field. And you obviously need to enjoy writing and have strong communication skills. Time management and the ability to meet deadlines and prioritize work are also critical. A PhD and postdoc should help you develop all of these skills through planning your research, preparing publications and presenting your work. The ability to professionally and effectively communicate with clients has probably been the skill I needed to work on the most, since it requires much more formal communication than we usually use in academia.

 

What would be your advice to a PhD wanting a job similar to yours?

Take every opportunity you can to write and present. In addition to your own manuscripts, take advantage of any offers to contribute to book chapters, reviews, commentaries, etc. Write for a research blog (like Scizzle!) or a department or program newsletter. Attend conferences or participate in symposiums or presentation opportunities at your institution to become comfortable and efficient with poster and oral presentations. For entry-level medical writing positions, effective scientific communication skills will really be the key to demonstrate that you are a strongly qualified candidate. And network. I know everyone says that for every position, but it’s true. Create a professional social media presence and look for opportunities to meet people in the field.

 

What are the top three things on your To Do list right now?

Right now, I need to finish editing the monthly rheumatology literature review we prepare for our rheumatology clients, submit a manuscript, and prepare an outline for a new manuscript that we will be kicking off next week.

 

What are your favorite – and least favorite – parts of the job?

My favorite part of the job is writing manuscripts. It’s the most writing-intensive task, and writing is really my passion. I love the feeling of accomplishment that comes with turning a collection of data into an intelligible story. My least favorite part is making slide presentations, but that’s only because I’ve never been particularly fond of the software used to make said presentations. The most challenging part for me is conference coverage. Travel to and from the conference, long days of taking detailed notes during conference sessions and meeting with clients, and tight deadlines for creating conference summary documents afterward can be exhausting. But getting to travel to new places is fun.

 

Is there anything you miss about academia? What was the biggest adjustment or most challenging aspect of moving from academia to your current job?

I don’t miss anything about being at the bench or the academic environment. The experience helped get me where I am today, but it just wasn’t the right fit for me long term. The biggest adjustment was getting used to not being on my feet all day – I have to remember to get up to walk around and stretch every once in awhile! The biggest challenges were learning the writing style preferred by our clients and adapting to the more formal style of communication required for interaction with clients.

 

How do you see your field developing over the next ten years?

From what I understand, there is a huge demand for people in the medical communications industry, so it seems that it’s a growing field. I imagine this growth will continue, since there is increasing demand for more transparency in scientific research, and medical communications companies can help increase the clarity of publications and the efficiency of the publication process.

 

What kind of positions does someone in your position move on to?

The next step after entry-level Medical Writer is Senior Medical Writer, which involves more projects, more independence and leadership in your projects, and opportunities to mentor newer medical writers. In my company, the next step would then be Associate Scientific Director, which involves more management responsibilities.

 

Finally, the all-important question: In the event of a zombie apocalypse, what skills would a Medical Writer bring to the table?

I imagine we’d be responsible for informing the public about the virus or genetic mutation (it’s always one of those) that’s causing the zombie condition and communicating information about the cure. Although, as far as how we would distribute that information – that might be outside of our job description. If you figure out what career that would be, let me know. It’s never too early to start networking…

A Newly Discovered Bacterium Finds Plastic Fantastic

 

By Elizabeth Ohneck, PhD

We produce over 300 million tons of plastic each year. One of the most abundant forms of plastic is polyethylene terephthalate, or PET, a polyester frequently used in fabrics and the primary component of plastic beverage bottles and other types of food packaging. In 2013, approximately 56 million tons of PET were produced worldwide, but only about 2.2 million tons were recycled. The high demand for PET drives increased production of its monomers, terephthalic acid and ethylene glycol, both of which are industrially derived from petroleum, leading to high consumption of oil. The ubiquitous presence of PET and its resistance to biodegradation – it takes 5 to 10 years to naturally degrade – has led to a massive accumulation of PET in the environment, leaving us searching for ways to clean up the mess.

Nature may have just offered us a helping hand. Researchers from Japan have identified a bacterial species, which they’ve named Ideonella sakaiensis 201-F6, capable of breaking down PET to use as a food source. Their findings were published this month in Science.

The research team collected 250 environmental samples from soil, wastewater, sediment and sludge outside a PET bottle recycling plant and cultured the samples with PET films. One sample contained a bacterium that, when isolated, was able to grow with PET as the sole carbon source and to completely degrade the PET film in 6 weeks at 30°C (86°F). Genome sequencing of Ideonella sakaiensis 201-F6 identified two enzymes, subsequently called PETase and MHETase, with weak homology to enzymes from fungi previously shown to have PET-degradation activity. Purified PETase and MHETase were able to break down PET films to produce terephthalic acid and ethylene glycol. Interestingly, PET has only been produced since the 1940s, meaning the evolutionary window for such a drastic metabolic adaptation is relatively short, particularly since PETase and MHETase bear little resemblance to even the most closely related enzymes known in other species. When and how PETase and MHETase arose thus remain a mystery.

These findings have several important implications. Ideonella sakaiensis 201-F6 is not only able to degrade PET, but can subsequently metabolize the resulting terephthalic acid and ethylene glycol, which, while far more environmentally friendly than PET, are toxic at high levels. By using terephthalic acid and ethylene glycol as a food source, Ideonella sakaiensis 201-F6 is able to remove PET and its breakdown products from the environment. An exciting application would be isolation of the terephthalic acid and ethylene glycol to use in the production of new plastic. Recovering and reusing the PET monomers would drastically reduce the amount of oil needed to produce plastic, and allow true recycling of PET into fresh plastic suitable for packaging, rather than the current recycling tactic of melting and reforming PET plastic into other products.

Obviously, more research remains to be done before Ideonella sakaiensis 201-F6 or its PET-degrading enzymes are useful on a large scale. Reducing the time of PET degradation from decades to weeks could be beneficial in contaminated ecosystems, but adaptations to further speed the process are necessary for practical use at the industrial level. Additionally, the ability of Ideonella sakaiensis 201-F6 to survive in varying habitats and disruptions it might cause to specific ecosystems need to be carefully considered before releasing this bacterium or an adapted version into other environments for PET cleanup.

Nevertheless, the discovery of a bacterium that can degrade PET is promising for our efforts to combat the havoc our plastic-dependent lifestyle is creating in the environment. The PET-metabolizing power of Ideonella sakaiensis 201-F6 is a testament to the adaptability and resiliency of nature. Hopefully this discovery sparks new ideas and research into healthier and more efficient means of plastic production and recycling.

RESIDENT LYMPHOCYTES KEEP A LOOKOUT FOR NASCENT CANCER CELLS

 

By Sophie Balmer, PhD

One of the first questions that comes to my mind when discussing the emergence of cancer cells is how my immune system recognizes that my own cells have been transformed? This process is commonly termed cancer immunosurveillance. In the prevalent model, the adaptive immune system composed of lymphocytes circulating in the blood stream plays the main function. However, recent findings describe specific immune cells already present within the tissue, a.k.a. tissue-resident lymphocytes, and how they trigger the first immune response against cancer cells, allowing a much faster reaction in an attempt to eradicate transformed cells.

 

The cancer immunosurveillance concept hypothesizes that sentinel thymus-derived immune cells constantly survey tissues for the presence of nascent transformed cells. Cancer immunosurveillance was first suggested in the early 1900’s by Dr. Erlich but it took another fifty years for Dr. Thomas and Dr. Burnet to revisit this model and speculate about the presence of transformed cells induced inflammation and antigen-specific lymphocyte responses. Additionally, Dr. Prehn and Dr. Main estimated that chemically-induced tumor triggered the synthesis of antigen at the surface of cancerous cells that could be recognized by the immune system. Countless studies arose from these hypotheses and either validated or disproved these models. The latest attempt was published a little over a month ago, in a paper by Dr. Dadi and colleagues, describing a new mechanism for the immune system to respond to nascent cancer lesions by activating specific resident lymphocytes.

 

In this study, the authors used a genetically-induced tumor model (the MMTV-PyMT spontaneous mammary cancer mouse model) to analyze the in vivo response of the immune system to nascent transformed cells. Most studies have been performed using chemically-induced tumors or tumor transplantation into a healthy host but these do not account for the initial environment of the nascent tumor. The spontaneous model the authors use rapidly exhibits developing cancer lesion (in 8-week old mice), allowing the analysis of cellular populations present near transformed cells.

 

To analyze which immune cell types are present near cancer lesions, the authors performed several analyses. First, they measure the levels of granzyme B, a serine protease found in granules synthesized by cytotoxic lymphocytes to generate apoptosis of targeted cells, and show that PyMT mice have elevated levels of granzyme B when compared to wild-type mouse. Moreover, similar analysis of PyMT secondary lymphoid organs show that this response was restricted to the transformed tissue.

During the first steps of immune responses, conventional natural killer (cNK) cells as well as innate lymphoid cells (ILC) are found in tumor microenvironments. In this model however, sorting of cells located in the vicinity of the lesion identified unconventional populations of immune cells, derived from innate, TCRab and TCRgd lineages. Indeed, their RNA-seq profiling reveal a specific gene signature characterized by high expression of the NK receptor NK1.1 but also the integrins CD49a and CD103. As these newly identified cells share part of their transcriptome with type 1 ILCs, the authors named them type 1-like ILCs (ILC1ls) and type 1 innate-like T cells (ILTC1s). In addition, transcripts encoding several immune effectors as well as apoptosis-inducing factors are upregulated in these cells, likely indicating that they trigger several pathways to eliminate transformed cells.

The authors also suggest that cNK cells are not required for immunosurveillance in this model and the unconventional lymphocytes described in this paper are regulated by the interleukine-15 (IL-15) in a dose-dependent way. Mice overexpressing IL-15 exhibit higher proliferation of these resident lymphocytes and tumor regression. Secretion of IL-15 in the tumor microenvironment might therefore promote cancer immunosurveillance.

 

In contradiction with the conventional view that recirculating populations of immune cells survey tissues for cellular transformation, ILC1ls and ILTC1s are tissue-resident lymphocytes. Their gene signature indicates that transcripts encoding motility-related genes are downregulated in these cells. Moreover, parabiosis experiments, during which two congenically marked mice are surgically united and share their blood stream, are performed to determine whether they are resident or circulating cells. The amounts of non-host ILC1s and ILTC1s are much reduced when compared to other recirculating immune cell type demonstrating that these cells are tissue-resident lymphocytes. Single-cell killing assays also determine that ILC1ls and ILTC1s are highly efficient at inducing apoptosis of tumor cells, which is more likely dependent on the lytic granules pathway.

 

Although the cancer immunosurveillance concept has been around for decades, it is still highly debated. Overall, these results shed light on this confusing field and bring up several questions. The signals recognized by this immune response are still unknown. Although the authors suggest that IL-15 might regulate the proliferation and/or activation of these cells, the source of IL-15 remains to be found. In addition, these cells might promote cancer immunosurveillance but are not sufficient to eradicate tumor cells and determining the cascade of signals induced by these resident lymphocytes will be required to ascertain their role. Establishing the limit of their efficiency as well as the mechanisms activated by transformed cell to escape their surveillance will also be crucial. Finally, one of the most important question to consider is how one could manipulate the activity of tissue-resident lymphocytes in cancer immunotherapy.

Rethinking Academic Culture

 

By Rebecca Delker, PhD

At the root of science is a desire to understand ourselves and the world around us. It is this desire that underpins innovations that become world-changing technologies; and it is this desire that fuels scientists. It is the passion for the work that makes the rigors of research – the time commitment necessary, the oftentimes monotony, and the oh-so-many failed experiments – worth it, (mostly) every single day. Put simply, to be a scientist is to love science. But, in our current academic culture where success is measured not by the scientific process but by the product, to be a scientist is also to live and work on the rim of the disconnect between the realities of research and the expectations of academia that so oft ignore them. And it is in this culture where passion for science and for success in science makes scientists susceptible to the culture of shame that is pervasive in academics today.

 

I borrowed that idea – culture of shame – from self-proclaimed shame and vulnerability researcher, Brené Brown – a woman I have only recently discovered but quickly became obsessed with, immersing myself in a Brené Brown-binge of TED talks (here and here), interviews, and books (here and here). A shame-prone culture, as she states, is one where the use of fear is used as a management tool, where self-worth is tied to achievement and productivity, where perfectionism is the way of the land, where narrow standards measure worth, and where creativity and risk-taking are suffocated (Daring Greatly, Chapter 1). I think all of us can recognize at least some of these characteristics in academic science. I certainly can. And it’s this culture, not the science, at the root of my growing frustration with academia. Brown’s words capture perfectly the feelings and thoughts that have been kicking around in my head for the last many years – thoughts that were reinvigorated this past September when a prestigious scientific journal took to Instagram to wish post-docs a “happy and productive Labor Day.” September is long gone and the post’s mildly humorous take on #postdoclife buried in the ‘gram archives, but our broken culture, of which that post is a mere symptom, persists.

 

This culture, as Brown deftly identified, is one of scarcity – or more simply put, the never enough culture. Through seeking the unifying, head-nodding laughs of a truth widely understood, the aforementioned post very accurately identified a well-known downside of academic life: the expectation for long hours, even on the weekends and national holidays, because it’s just never enough. Without necessarily intending to, this post, written by one of the leading publications in biomedical research, was perpetuating the shame felt by post docs and other scientists derived from feelings of not having accomplished enough – essentially of having failed.

 

In the collective mind of academia – though without much evidence to support the claim – quality and quantity tend toward equivalence such that success is linked to the quantity of hours spent in the lab. While more often than not those extra hours prove to not be essential, we have all felt the pressure to choose work over another aspect of life. I aim not to downplay the vast amount of work that research requires – it’s a lot – but rather to highlight how time has surpassed itself as a measure of seconds ticking by to a metric by which the quality of a scientist is determined. By reducing the outcomes, especially failures, of experiments down to time spent in the lab (or vacations and holidays skipped), we are in effect placing the responsibility of those failures on the scientist. The result is a culture in which the sum of hours worked (greater than the norm) is worn as a badge of honor and feelings of pride and accomplishment go hand-in-hand with feelings of being overworked and exhausted.

 

The presence of self in our science is not unexpected. If someone were to ask me to choose words that best describe me, scientist would be at the top of the list. It is part of my identity both in and out of the lab and I imagine the same is true for many of my colleagues. The problem arises when experimental failures become personal failures, and in our current culture the equation between scientific success and self-worth is too often made. As a start, simply look at the language we use to describe technical finesse: good hands produce successful experiments; bad hands do not. It’s as if the fate of the experiment was genetically encoded. In reality, though, even the best hands can’t always generate the desired results because often we (and our hands) can’t comprehend all of the unknowns at play.

 

What is paramount to understanding how this culture of shame was created and persists is our definition of success and of failure. There is a growing misunderstanding in our culture-at-large of what science actually is. The way we educate, and thus what expectations have become, is that science is a series of facts – untouchable, black and white conclusions. An emphasis on information revealed by experiments, rather than the process, strengthens this misunderstanding by glossing over the critical thinking required to interpret what is often very nuanced data.

 

While scientists may not fall victim to this mentality to such an extreme, we are not innocent either. Within academic circles, too, the process of science often comes second to the findings; and this can largely be explained by the product-driven nature of science these days. In an environment with decreased funding and insufficient academic positions for the growing number of scientists, the product, that is publications, becomes the focus. It also becomes the means by which success and failure are defined. In this culture, success, measured by nominally quantitative metrics that rank the importance of scientific work and the quality of scientists, relies on publishing a paper – a big one, preferably, and quickly. Everything else may as well be called failure.

 

“I saw the results, and I wanted to throw myself off a bridge” (The Antidote: Happiness for People Who Can’t Stand Positive Thinking, Chapter 7). This is an actual quote from an interview with a biochemist conducted by researcher Kevin Dunbar who wanted to understand exactly how science works. His findings, which would surprise no practicing scientist, reveal that most experiments fail; they “rarely tell us what we think they’re going to tell us.” The quote from the biochemist above is an exaggerated example, but it illustrates the point that unanticipated results that are inconsistent with initial hypotheses – the majority of the results we deal with— are treated as failures even though they may reveal a new (not yet understood) fact. Dunbar went on to show that this response is due in part to the human tendency to focus in on evidence that is consistent with current theories. I would argue, though, that the product-driven nature of academic science that exclusively rewards publishable, positive results only strengthens this. As Dunbar states, “the problem with science, then, isn’t that most experiments fail – its that most failures are ignored.”

 

Stuart Firestein, neuroscientist at Columbia University and author of two books (here and here), takes this idea a step farther and reminds us that not only is science a process teeming with failure, but that failure is just as necessary as success to move science forward. “This iterative process – weaving from failure to failure, each one sufficiently better than the last – is how science often progresses,” he says. To forget this, as we often do, is not only psychologically damaging to the people conducting the science but horribly detrimental to the science itself. Not only does every failure pushed aside represent a lost opportunity to explore new terrain, but our narrow definition of success stifles creativity – an endeavor that requires enough time for missteps and recalculations.

 

So how do we fix our culture of shame? On this, we can extract some sage advice from Firestein and Brown: we need to become a lot more comfortable with uncertainty. Firestein advocates for an emphasis on ignorance – not stupidity, but simply the absence of knowledge – in science. Rather than obsessing over our quest to find an answer and eliminate any remnant of not knowing, we must embrace the idea that it is this not-knowing that drives science. “Answers don’t merely resolve questions; they provoke new ones.” And in doing so, drive innovation. Brown would call this same idea vulnerability. While most of us associate vulnerability with weakness, it is, as Brown defines it, uncertainty, risk, and emotional exposure; it is the courage to accept not-knowing, failure and imperfection that serves as a prerequisite for creativity in science and many other endeavors.

 

In an attempt to discover the ingredients required in making a successful team, Google uncovered that the cultural norms of the group matter more than the individual intelligence of its members. Creating an environment founded in empathy, which allows each member the freedom to take risks and expose their insecurities without fear of negative consequences, improved the success of teams more than any other individual or group characteristic. In other words, they found that allowing individuals the space to be vulnerable actually improved the output of the group. To make a perfect team, it seems, requires accepting the “usefulness of imperfection.” With this in mind we can hope to move away from a culture where shame is coupled with experimental failures.

 

It is obvious that academics is due for some much needed structural changes – from shifting away from our reliance on impact factors and other indices to judge the quality of science and scientists, to forging a deeper connection with the public and improving funding, to increasing (and respecting!) alternate pathways for successful scientists. I wholeheartedly believe that these structural changes won’t come unless we start adjusting our culture now. We must widen our definition of success and move away from a fact-based version of science to that of inquiry and ignorance. But most importantly, we must allow ourselves and our science to be vulnerable, make space for failure, and in doing so, breathe life back into the scientific process, which has been eclipsed by a results-driven culture. As Brown advises in Daring Greatly, our approach to research ought not be guided by a fear of the possibility of failure but rather by asking ourselves the question: “What’s worth doing even if I fail?”

 

Ripples in The Pond: Psychological Interventions can Spread to the Whole Group

 

By Celine Cammarata

In light of frightening outbreak of preventable diseases like measles, the impact that an individual can have on the community in terms of biological intervention – in this case, immunization – has become pressingly clear. Less obvious is that analogous ideas may apply to psychological treatments: a recent paper in the journal Psychological Sciences reports that an intervention to fight stereotype threat among minority middle schoolers actually changed the academic outcomes of their entire classrooms.

The authors’ findings stemmed from two previous studies in which 7th grade students in a largely lower- and middle-class middle school engaged in affirmative writing exercises designed to combat stereotype threat – the fear of confirming negative stereotypes about a group one belongs to. In both original experiments, students (regardless of race) were randomly assigned to an experimental or a control condition; all students completed short writing assignments in class, with those in the experimental group prompted to write about their most important values and those in the control asked to write about their least important values. Writing about important values was hypothesized to combat stereotype threat and associated stress, and thus foster higher academic achievement.

 

In both original experiments, these hypotheses appeared to be supported, with students in the experimental condition achieving significantly higher final grades than those in the control condition if those students were African American. In line with the assumption that European Americans would be suffering negligible reduction in potential achievement due to stereotype threat, no effect of the intervention vs. control was seen among these racial majority students (although a small number of students of other races participated in the experiments, the authors focused on African American vs. European American children).

 

In the present paper, the same authors reanalyzed data from these two experiments, but now asked whether, independently from the individual impacts seen, the density of African American experimental-condition students in a classroom had any impact on the performance of students in that classroom as a whole. Although the original experiments had already demonstrated that among European American students the experimental group did no better than the control, it remained possible that on average all students benefitted by some having had positive impact from the intervention. The authors used the difference in number of African American students who had been in the experimental vs. the control group, multiplied by the percentage these two groups of students together times the total proportion of students in the classroom who had participated in the study at all; in an attempt to quantify the possible presence of a “cluster” of treated students (i.e. African Americans in the experimental group).

 

The results indicated that, above and beyond the impacts at an individual level on those students who received the experimental intervention, the density of treated students was strongly predictive of final grades throughout the class room. This in turn lead to the exciting conclusion that the benefits of the psychological intervention were somehow transferring from the treated individuals to others in their environment – revealing a previously unappreciated, and potentially very meaningful, ecological power of this comparatively small intervention.

 

So how were effects from the treated students spreading to their classmates? The authors ruled out direct impacts of stereotype threat reduction; for instance, it did not appear to be the case that the improved academic performance of African American students who received the intervention in turn reduced negative stereotypes felt by other African Americans, because the benefits of treatment density in a classroom were spread to other students regardless of race. Furthermore, a separate experiment on subliminal stereotyping did not suggest a general reduction in stereotype presence and consequent stereotype threat. Instead, it appears that the bolstering the treated students’ academic success – rather than how that bolstering was achieved – may have driven the transmissible benefits. The authors suggest that these students’ higher performance might have changed behavioral norms in the classroom in ways that fostered success; additionally, where the treatment was experienced by students who had previously been struggling and who were subsequently able to boost their performance, this may have freed up teachers to focus on other struggling students, thus improving performance overall. This was supported by the finding that the treatment density in a classroom had the greatest positive impact on students in the lower end on academic performance.

 

While much remains to be clarified about the mechanisms, this paper provides exciting evidence that targeted psychological interventions can result in significant ecological changes: from an epicenter of treated individuals, benefits can spread to everyone like ripples in a pond.