SciBlogs

Archive December 2012

Deadly ignorance John Pickering Dec 14

How many deaths does it take?  We hear that question asked time and again following a tragic event.  We also hear it with calls for changes to our public health priorities.  Well, I am now asking it with respect to Acute Kidney Injury.

  • Acute Kidney Injury (AKI) is one of the most common hospital events (4-5% of patients get it).
  • The most severe forms of AKI result in emergency dialysis.
  • Research out of the US has shown that there has been a doubling of dialysis for AKI over the past decade (1).
  • Now there are 533 cases of dialysis requiring AKI per million people each year in the US.*
  • 24% of those needing dialysis died in hospital
  • About 10 times the number who need dialysis actually get AKI.
  • Even mild AKI raises the risk of in-hospital death and long term kidney problems.
  • More people each year now have dialysis for AKI than those who start dialysis as a result of a chronic kidney disease.

Comparative New Zealand statistics

I would like to do them but have had problems getting funding.  I especially want to look to see if there are any ethnic biases in the numbers.

If we take the US numbers and apply them to our population of 4.4 Million then there would be:

  • 2350 cases of dialysis-requiring AKI of whom 564 would die.
  • Over 20,000 people each year would have AKI.  Many more than 564 would die.

My gut reaction based on the use of dialysis in the Christchurch hospital intensive care unit is that 2350 is probably too high, maybe two to four times too high.  This may reflect differences in dialysis protocols and admittance to ICU.  It is less likely to reflect a lower incidence of AKI.  My best guestimates are:

  • 4000 to 8000 cases of AKI each year with 400 to 800+ deaths.

These numbers are greater than the road toll – another acute event.

They are comparable with Breast Cancer**.

I would like them not to be guestimates.

Maybe the funding will come next year.

The good news

My research and others over the past few years has:

  • identified new biological markers of injury to the kidney
  • assessed many of these and determined that they are of clinical value
  • come up with better ways of defining the disease
  • determined that some pre-existing tools can be applied in slightly different ways to give early warning of changes in kidney function
  • come up with some promising interventions which may reduce the risk of developing AKI

Here endeth the 2012 report.

___________________________________________________________________________________________

1.  Hsu RK, McCulloch CE, Dudley RA, Lo LJ, Hsu C-Y. Temporal Changes in Incidence of Dialysis-Requiring AKI. J Am Soc Nephrol 2012; Online ahead of print.

* the data was expressed in “million-person-years” but as the data was for one year then it is OK to express it as per million people.

**The difference between AKI and many other diseases is that while AKI causes death it is almost always secondary to another event – heart attack, severe infection, cardiac surgery etc, so it is rarely recorded as THE cause of death.

Tagged: Acute Kidney Injury, AKI, Kidney, Mortality, Nephrolog

Do we talk about the right cancers? John Pickering Dec 12

We all want a cure for cancer.  This is evident in the ideas put forward for the NZ Science Challenges (http://www.thegreatnzscienceproject.co.nz/home).  Will these ideas reflect the true need in New Zealand? Are all cancers equal or are some more equal than others?  Does the public perception of what is most important reflect the true health risks?  To answer this latter question would require a well controlled survey which I don’t have.  What I can do is look at some data from the media.

First the numbers: The Table below gives the number of newly diagnosed registered and of deaths in New Zealand for various cancers for 2009 (I have only considered those with more than 200 deaths).  The percentages are the percentage of all the cancers listed.  The final column is the ratio of the numbers who died to the number of newly diagnosed.  This is not a proper measure of the likelihood of dying of the disease once it is diagnosed, but probably gives an impression of which are the more and which are the less deadly of the cancers.

Cancer Registrations and Deaths in New Zealand (2009: Ministry of Health, http://www.health.govt.nz/publication/cancer-new-registrations-and-deaths-2009)

Cancer Registrations and Deaths in New Zealand (2009: Ministry of Health, http://www.health.govt.nz/publication/cancer-new-registrations-and-deaths-2009)

The graph plots the percentages for new Diagnoses and deaths against the percentage of stories on the Stuff.co.nz web site for each of the cancers (ie relative to the total number of stories (20,757) for all these cancers.  I’m sorry to pick on Stuff, but it conveniently gave a count with a fast search engine.  The area above the dashed line (blue) suggests under reporting in the media, the area below over reporting.  Brain cancer is vastly over reported on this measure relative to other cancer death rates and new registrations.  Breast cancer is also over reported, particularly in relation to other cancer death rates.  Melanoma reporting reflects its deadliness, but not its new registrations.  Colorectal/Bowel cancer and Lung cancer are relatively poorly discussed compared to their relative death rates.

The percentage of new registrations and of deaths of various cancers against the percentage of stories in Stuff.co.nz.  Note, percentages are relative to the total number of new registrations/deaths/stories

The percentage of new registrations and of deaths of various cancers against the percentage of stories in Stuff.co.nz. Note, percentages are relative to the total number of new registrations/deaths/stories

There may well be many better ways to look at this kind of data – I would appreciate any suggestions.  I hope to look at other diseases as well.  However, as I research a disease that affects as many people as breast cancer each year, is just as deadly, and yet is reported on Stuff 1/50th as often, I am a little biased.

Tagged: brain cancer, breast cancer, cancer, lung cancer, media, melanoma

Nuclear war v Climate change John Pickering Dec 11

A nice little post by Peter Griffen on people preparing for doomsday reminded me of an ngram I generated a few weeks ago … we seem to talk as frequently about climate change now as we did nuclear war 25 years ago…ahhh, those were the days.

Frequency of appearance of the phrases "climate change" & "nuclear winter" in books written in English.

Frequency of appearance of the phrases “climate change” & “nuclear war” in books written in English.

Tagged: climate, climate change, doomsday, ngram, nuclear war

The minister missed the point John Pickering Dec 10

Last week Radio NZ put together a piece on grant funding.  The audio can be downloaded from here http://www.radionz.co.nz/national/programmes/morningreport/audio/2540317/scientists,-minister-at-odds-over-research-funding

Prof Juliet Gerrard, Dr Mark Green, Dr Robin Olds, Dr David Baddeley and myself all pointed out that the government grant funding system is in crisis because only 7-8% of applications are funded.  We also noted this made long science careers in this country almost impossible.  If I may add one other name, that of Sir Peter Gluckman, the government’s science advisor, who at a talk at the University of Otago Christchurch in 2009 called the time following the post-doctoral period of a scientists career as the “valley of the shadow.”  Many of today’s Professors went through that valley when there was considerably more light and less shadow.  Now, the shadows have grown long and dark and few make it through the valley.

Minister Joyce pointed out that we train twice as many science PhD’s as a few years ago and that most who go overseas “come back.”  I doubt the latter very much.  However, I am unable to find data on that.  What I did find was that the MOE themselves note the low rate of employment of PhD Natural and Physical Sciences PhD graduates.

“By field of study, graduates from ‘Natural and physical sciences’ had the lowest rate of employment [57%], while graduates from ‘Society and culture’ had the highest [65%]. Once again, this may reflect the limited employment opportunities for science researchers in New Zealand.”   (http://www.educationcounts.govt.nz/__data/assets/pdf_file/0019/104275/Do-People-with-Doctoral-Degrees-get-Jobs-in-NZ-Post-Study.pdf)

The research was based on those who graduated in 2003.  There were 199 students in this group in 2003 and 262 in 2010 (http://www.educationcounts.govt.nz/statistics/tertiary_education/research). I wonder what the rate of employment is?

Minister Joyce, as one would expect, pointed out all that the present government has done for science in this country.  To be fair, they have done more than other recent governments.  Minister Joyce repeatedly pointed to the increases in science funding for various schemes.  These amount to about a 24% increase in total science funding since 2009. ie about 5 to 6% per year.  This may be compared to a consumer price index increase of about 10% over 4 years.  In other words, total government spend on science has increased at faster than the rate of inflation. Minister Joyce called this dramatic.  I wouldn’t go this far, but it is positive and good.  In the Christhurch Press, Dec 1, in an article about Sir Peter Gluckmann. Sir David Skegg, president of the Royal Society, describes the government increase for science as “modest”  and notes that “the much needed step-change in our national investment in research and development has not yet occurred…”  I couldn’t agree more.  What is needed is not 5% a year, but 50%.

Innovation is but a fraction of the tip of the iceberg.  (Work by Uwe Kils) http://www.ecoscope.com/iceberg/

Innovation is but a fraction of the tip of the iceberg. (Work by Uwe Kils) http://www.ecoscope.com/iceberg/

A few other thoughts:

The metamorphosis of the Ministry of Research, Science and Technology into the Ministry of Business Innovation and Employment is symptomatic of a fundamental misunderstanding of both science and innovation.  Innovation for commercial gain is but a fraction of the visible fraction of the iceberg of science.  Innovation is built on decades of science in which the foundations are assembled molecule by molecule.  The results are a vast array of knowledge, largely freely accessible, which enables much social good and, yes, occasional commercial ventures.  The current pursuit of innovation innovation innovation threatens the very stability of the system.  If there are not scientists building the foundations, there will be little left for businesses to build on.

The grant funding system is broke.  It is time for politicians of all stripes to acknowledge that.  While additional funding is an essential element in saving our science, it is only part of the solution.  Fund scientists first, projects second.  To do otherwise is to commit the fallacy of picking winners in science – of trying to anticipate where science will be in 1, 2, 5 years.  It’s not possible and ignores that science is inherently unpredictable because it deals with what we don’t know, not with what we do.

Tagged: grants, Science, Stephen Joyce

The science funding story continues John Pickering Dec 01

Heads up.  A few weeks ago I posted about the crisis in grant funding in NZ.  This led to a number of discussions with a journalist from Radio New Zealand.  Laura Bootham has shown great persistance in tracking down facts and people.  I look forward to hearing what she has come up with. She tells me:
 ”The story on science funding airs on Monday around 7:20am but I recommend listening from 7:10am until 7:30am news as things are liable to change depending on what happens new-wise in the interim.”

Tagged: grants, meia, radio new zealand, Science funding

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