
Medical researcher discovers integration, gets 75 citations - robertk
http://fliptomato.wordpress.com/2007/03/19/medical-researcher-discovers-integration-gets-75-citations/
======
dmlorenzetti
The author calls out med students for approaching physics through rote
memorization. It reminds me of an experience my older brother and I had with a
doctor friend.

Our friend, an OB/GYN, mentioned how hard her work is, because "the average
baby is born at 3am."

We laughed, but then my brother asked, "What does 'average' mean when you have
a 24-hour clock? It must mean the modal time or something like that."

I contributed that this is an issue in defining average wind directions, as
well. The basic problem is that if you record times on a 0-24 hour scale, or
wind directions on a 0-360 degree scale, and then naively average the numbers,
you get meaningless results (for example, 180 degrees if the wind steadily
rotates through every point of the compass).

A quick glance at our doctor friend showed she had checked out of the
conversation entirely. Possibly she just felt slighted that we were not bowing
down in awe at the terrible hours she keeps. But my main impression was that
she lives in a world where one receives a piece of information, notes it, and
stores it away. And when repeating that received information, one's listeners
duly note and store it away.

Chasing down the source of the information, calling it into question, relating
it to other things in the world-- these just weren't things she seemed to find
pleasurable.

~~~
bluesnowmonkey
Of course you can average times of day, as well as wind directions. Express
them as vectors on a 2-D plane, then separately average the components in each
dimension. Although this is somewhat obvious in the case of wind measurements,
it works for times of day as well if you think of them as points on a 24-hour
clock face.

Your medical friend was not checked out. She was busy stifling impolite
laughter at your unfamiliarity with Cartesian coordinate systems.

~~~
roel_v
For time, what would then be the average of let's say 3 and 9 o'clock? Center
of the clock I presume, but what does that mean in terms of time? Or would you
then need to define the average of several points in time as a non-point in
time?

~~~
DougBTX
Hand waving: I'm guessing that you could make a new vector from the average x
and the average y. The direction would indicate the average time, and the
length would indicate the certainty, so a length of zero would mean total
uncertainty.

~~~
cscheid
That's pretty much exactly right - the variance of the von mises distribution
is essentially the length of the average vector.

<http://en.wikipedia.org/wiki/Von_Mises_distribution>

------
noonespecial
I'd laugh a lot harder when people struggle for days and then reach a half-
assed piece of some algorithm that's completely well know if I hadn't been
there a dozen times myself.

Programmers are especially vulnerable to this. Who hasn't made a 4 page case
statement when 3 lines of recursion would have done it, especially when
starting out? Then again, I've never named my case statements after myself.

No matter how brilliant one is, its ridiculously hard to know what you don't
know. In fact, sometimes being very advanced in one field makes it doubly hard
to think of in one you're poor in.

~~~
kwantam
Sure, it's completely fair. We all reinvent the wheel sometimes.

That hilarious part is that this paper was published in a peer-reviewed
journal--- _and none of the reviewers realized that he'd rediscovered some
17th century math._

~~~
crocowhile
"One could not be a successful scientist without realizing that, in contrast
to the popular conception supported by newspapers and mothers of scientists, a
goodly number of scientists are not only narrow-minded and dull, but also just
stupid." — James D. Watson

~~~
hugh3
To be fair, James D. Watson is a bit of a jerk who delights in calling other
people stupid. Usually winning a Nobel Prize tends to make people more
charitable, since they no longer need to prove themselves to anybody...
apparently it didn't work for Watson.

I wouldn't recommend following Watson's advice on the correct attitude to your
fellow man.

For further information, see <http://en.wikipedia.org/wiki/James_D._Watson>
and scroll down to "Controversies".

~~~
btilly
I would speculate that the reason it didn't work for Watson is the
unacknowledged use of Rosalind Franklin's data, with the resulting belief by
many that Watson couldn't have done it on his own. The fact that Rosalind died
in part due to radiation absorbed during collecting that data adds to the
controversy.

Here is a piece of interesting trivia about that. Rosalind Franklin was a true
expert on x-ray diffraction. However there are 230 possible space groups. (See
<http://en.wikipedia.org/wiki/Space_group> for more on that.) The x-ray
diffraction pattern you see depends on the space group, and so one of the
first step is to go through all of the possibilities and identify which one
you have, and only then can you really start figuring out what you have.
Rosalind Franklin knew about all of them. But by luck Watson's PhD thesis had
been on a protein with the exact same set of symmetries that DNA has. As a
result he was in a much better position than she to interpret her data.

------
niels_olson
I'm a doctor who majored in physics, and I agree with this post. Watching
these folks come up with formulas in physiology was excruciating. People get
their names on things that physicists wouldn't even bother noticing as
something other than a single step in a derivation. Hacker News and Python
have been come my group therapy and secret addiction, respectively.

------
alphaoverlord
Just to be clear, and this might be tangential, but she is not a physician - I
think she is a dietitian. I think its a fallacy to assume that only physicians
publish in medical journals and there is a negligible link between over-the-
top premeds and this article.

Mary M. Tai

www.ajcn.org/cgi/reprint/54/5/783.pdf

[http://journals.lww.com/topicsinclinicalnutrition/Citation/1...](http://journals.lww.com/topicsinclinicalnutrition/Citation/1992/09000/Renal_dietitians__responses_to_selected_job.8.aspx)

I can't access the article, so I can't make any comment on the actual methods,
but I think it seems a little presumptuous to flippantly make broad strokes
about a paper from a different field solely by looking at the abstract.

He does make a good point about overeager premeds (and for good reason), but
this post seems to be more airing out grievences and stereotypes than an
argument about education or differences between diciplines.

~~~
mbreese
We found the same link... and you're correct, she isn't a physician.

In the Topics in Clinical Nutrition 1992 paper, she is listed as having an MS
and an EdD. So, it's safe to say that she probably didn't realize that she was
describing integration.

The entire post had a "I'm smarter than you" chip on your shoulder type of
vibe.

It should also be noted that this paper had a number of letters to the editor
about it, so in this case, I'd say that the process works (even if it got by
the editors).

<http://www.ncbi.nlm.nih.gov/pubmed/8137688>

~~~
andolanra
I agree that it seemed to have this "I'm smarter than you" vibe, but the only
reason I half-agreed is that I feel like it takes some nerve to try to name
your discovery after yourself. It wouldn't be so bad if she called it the
"curve-approximation method" or something like that; but coming up with
something and deciding to name it after yourself feels kind of presumptuous
and not exceptionally helpful to boot. (As far as I know, most concepts and
ideas named after people weren't self-named; Dijkstra, arrogant as he was,
published "A note on two problems in connexion with graphs," and never
mentioned "Dijkstra's algorithm.")

~~~
Vivtek
_Everything_ in medicine is named with arbitrary names of discoverers and so
on. That's why you have to be good at rote memorization to get through med
school - you can't even communicate with your colleagues otherwise.

This is a fundamental cultural difference between medicine and engineering.

------
carbocation
For my next New England Journal paper, I'm going to use a random number
generator to simulate whether conditional, probabilistic health outcomes
occurred or not.

I'll cycle through this thousands of times to obtain stable estimates, and
then call this the Monte Carbocation method.

~~~
jrockway
Incidentally, you'll also be able to use this technique to determine the area
under a curve! Let's patent it together and get rich!

~~~
carbocation
Let's trademark it and copyright it, too!

Now we just need to find a coder to implement our great idea.

------
kenjackson
Here's another paper: <http://www.ncbi.nlm.nih.gov/pubmed/7677819>

"Tal's Formula is the Trapezoidal Rule"

A rebuttal doesn't get much blunter than that.

~~~
mbm
It's intriguing that the author's two-page rebuttal is among her 'selected
publications'.

<http://www.sph.unc.edu/nciph/jane_monaco_1990_1984.html>

~~~
carbocation
The two page rebuttal that was written by Jane Monaco is among Jane Monaco's
selected publications. (You linked us to Jane Monaco's page, not Mary Tai's.)

~~~
pmorici
Just a guess but they only have three total so selected might mean "all"
publications and even then the one you cite only has 2 authors instead of 10
and Jane's name is listed first. It's that something that is important to post
graduate students?

~~~
hugh3
Certainly in most scientific fields it would be unusual to be an assistant
professor with a career stretching back to the early 90s and have a
publication list that sparse, but I suppose things must be different in
medicine?

------
mbm
According to Google Scholar, it's actually been cited 137 times. Another paper
published in '98, cited 499 times, reads:

The integrated area under the curve (AUC) analysis for glucose and insulin was
determined according to the formula of Tai et al.

Damn.

~~~
blasdel
U MAD?

Seems like a great way to both pad out your citations and troll your readers!

------
abhikshah
Peer-review failed here. It might be forgivable that a medical researcher
doesn't know Calculus (maybe..), but if an article is making a mathematical
claim, the journal should find appropriate reviewers. And this is not even
remotely advanced math.

------
philelly
looking up the paper on pubmed reveals a flurry of letters to the editor
published in the subsequent issue that call out the 'tai method' for what it
is. i would actually bet a good number of the 70 citations that so worry 'flip
tomato' are actually criticisms or commentary papers like this, as opposed to
earnest citations.

------
sciboy
I often help (good) researchers with experimental design and statistical
analysis of quasi-experimental data, and it's shocking how little they
understand. It pains me to think how much waste there is in science at the
moment because the researchers do not have the statistical or numerical
background to even know what questions are possible.

------
silverlake
My brother is a medical researcher. Much of his work involves statistics, but
he's never taken a statistics course nor read an intro book. So a lot of his
results are just basic high school stats and pretty graphs, nothing deeper. It
would be funny if it weren't medicine.

~~~
gilesc
I'm a biochemistry grad student, and my school is just now considering
offering a (bio)statistics course for the first time... But parent poster is
right, chi-squared is usually as complex as it gets.

------
manicbovine
As a mathematician, I see this as a sign that my field needs an evangelist.

~~~
whatwhat
Can I ask you a question?

Why is rote memorization frowned upon in math?

I'm a second year math student about to enter his third year. I enter a lot of
the definitions, theorems, etc. into a flash card software (Anki) for
memorization. I combine this with doing tons of proofs and problems from
various textbooks depending upon the course I'm studying. I would say from
personal experience that rote memorization has definitely helped me: (1)
understand the math better; (2) excel in exams, and; (3) able to solve extra
and harder problems from books.

So I'm struggling to see why rote memorization is bad. Is not memory useful
for justifying knowledge? I'm not saying memorization is the only thing. Just
that it seems to build the foundation for everything else, as per Bloom's
cognitive taxonomy:
[https://secure.wikimedia.org/wikipedia/en/wiki/Bloom%27s_Tax...](https://secure.wikimedia.org/wikipedia/en/wiki/Bloom%27s_Taxonomy#Cognitive)

~~~
tel
Not the intended target, but I'll throw in my two c from doing a lot of
applied math.

Math readily has two components. The first is a formulaic, formal component
that can be readily overcome by rote. The second is the more freeform
conceptual understanding that motivates and directs the first. I feel
confident that if you ask anyone familiar with advanced math if they
understand concept/theorem/tool X, they'll say yes if they know it in the
second form and are confident that they can reconstruct the important parts of
it in the first.

I think a lot of why people rebel against rote memorization then is that it,
as a method, is very likely to prevent you from encountering the second side
there. If you honestly use it to improve your fluency with the formal
manipulations, it can be a _great_ tool for learning more math. It's just easy
to lose that honesty.

To really understand math, you need to recognize that it's a language you must
both read and write. I suggest that if you do get strong benefits from rote
memorization, then you should complimen t your reading by attempting to
synthesize mathematical concepts you've not seen before. Read the claim of a
theorem and then prove it yourself without knowing the answer. If you can
honestly complete mathematical synthesis at that level as well, then rote
memorization isn't hurting you in the least.

~~~
jacobolus
To elaborate on this, a working knowledge of some area of mathematics is not
like a set of historical facts to be familiar with, or a list of fundamental
particles and their properties, or a group of plays or novels to be quoted
from, or a set of pigments and their interactions with brushes and paper, or
even a code library’s API.

Mathematics is, fundamentally, about model building. The study of mathematics
is about learning _how to make maps_ even more than it is about the _specific
territory_ being mapped. In my opinion the largest part of mathematical
fluency is the constant willingness to test mathematical structures and ideas
against each other and against new data, to figure out how parts work at their
deepest levels and then to go back and try to see how each one fits with all
those known before. What matters in understanding a mathematical concept is
not whether you can repeat a witnessed proof step by step or write down a
formula, but whether you have an intuitive grasp of the abstraction(s) in
question, whether you can explain them to yourself (an ability to explain them
to others also recommended), and whether you can apply them to new problems
which arise.

It is my belief that this kind of deep understanding and fluency can only be
obtained by repeatedly interacting with these abstractions in a wide variety
of problems and contexts, writing down the patterns and working through the
proofs, questioning the axioms underlying them, asking how they generalize or
how they apply to specific cases, and so on. Very little of this work can be
done on flash cards, at least for me personally. Indeed, I believe it is
precisely the teaching of mathematics as something which can be learned from
flash cards which most impedes mathematical education and understanding.

See <http://www.maa.org/devlin/LockhartsLament.pdf>

~~~
whatwhat
Thanks.

------
rue
Come on now, many of you proudly tout how you were _taught_ integration in
secondary education. Big deal. This person discovered it for themselves, and
that is an achievement to be celebrated.

~~~
mhartl
Rediscovering integration is wonderful. Managing to get it published in a
peer-reviewed medical journal is not.

------
brianlash
I think Michael Williams (third comment) has the right idea when he says "I’m
sure you can find plenty of physicists saying spectacularly naive things about
medicine...". Of course OP's discovery is amusing - even alarming - but
approaching it with an air of condescension won't do much to advance either
field.

~~~
frisco
Calculus is taught in _high school_ and expected to be basic knowledge for any
physician, even if they don't use it often, and _especially_ so for
researchers. Calculus is fair game on their admissions exam, even! On the
other hand, there's never an expectation that physicists know medicine.

~~~
Leptosiphon
Calculus is not taught to everyone in high school. Many students only make it
as far as precalculus and many more, even if they take calculus in high school
do not learn integration. At the college level, many biology students do not
take calculus. As far as calculus being a requirement for entrance into med
school, in many cases I am afraid you are incorrect.

<http://www.cse.emory.edu/sciencenet/additional_math_reqs.pdf>

Most pre-meds do not have the time in their undergraduate careers to take a
two semester series in calculus, especially if they need to also take remedial
courses such as precalculus first, and many do.

~~~
mbreese
Calculus, per se, isn't a requirement, but physics is covered pretty heavily
on the MCAT. And last I checked, you needed calculus for college level
physics.

~~~
carbocation
Calculus-based physics is not tested on the MCAT. Or, at least, no calculus is
required for the physics portion of the exam.

~~~
realitygrill
To my utter shock - I thought it'd be one of the last bulwarks against premed
memorization. When I learned otherwise, it was sad to think that those
students who flocked to non-calc physics (and floundered; the classes are of
course curved) really _would_ have a good shot at medical school.

------
jasonkester
Or, as your Engineering professors used to say:

"A week in the lab will save you an hour in the library every time."

------
finton
My outsider's opinion is that I think that a lot of cited articles are not
always thoroughly examined, or of they are examined they are used to confirm
the biases of a particular researcher.

I recently became interested in the idea of possible anesthetic neurotoxicity
in infants and looked at a number of papers. The basic research seems solid,
but the conclusions drawn are strangely inconsistent.

Neonatal rat, mouse and pregnant guinea pig models are used, and recent
studies have been done on monkeys. It appears that there is a high incidence
of cell death after exposure to anesthesia, but there is a relatively narrow
window of vulnerability, which apparently peaks at 7 days postnatal in rats
and rapidly diminishes. 5 day old monkeys were affected by prolonged exposure
to ketamine, and 35 day old monkeys were not. Similar results were seen in
guinea pigs.

What strikes me, is that this window of vulnerability is differently equated
to human development by researchers, despite years of research into ethanol
neurotoxicity (anesthetic studies seem to be more recent). Estimates for 7 to
14 day old rat-human equivalents range from pre-term infants to full-term
newborns, to mid-gestation human fetuses and to children up to 3 years old.
Two monkey papers, one using ketamine, and another using isoflurane also came
up with different vulnerability periods based on similar data by using
different sources of information on neurodevelopment, one published in the
1970's and one more recent.

I cannot understand how so many studies could have statements about possible
windows of human neurotoxicity, without any certainty about what phase in
neurodevelopment they were dealing with. And, oddly enough, the paper
describing the model that is used to claim a mid-gestation vulnerability
(based on a "bioinformatics approach") clearly states that it cannot be used
to predict the "coordinated surge in synaptogenesis just prior to birth in
primates", which is hypothesized to be the peak period of vulnerability to
anesthetic-induced cell death. So why is it used as a source?

~~~
finton
To extend my comment, there are dozens of citations for the 1970's era paper
that assert that the "brain growth spurt" extends from the third trimester to
the first few years of life. It is then equated with synaptogenesis or "peak
synaptogenesis", even though this association may be unclear. The papers then
further equate peak synaptogenesis with the period of vulnerability to
anesthesia. Many then postulate mechanisms for anesthesia-related
neurotoxicity in infants related to mechanisms of synaptogenesis. Not being an
expert in the field, I can't refute this argument, but I do find the links
between these phenomena to be rather shaky, especially when based on a
throwaway reference to a decades old paper.

------
pge
The lack of interdisciplinary collaboration is one of the major flaws of the
US university system (I can't speak to other countries). The grad students I
knew each had a specific toolkit that they had learned in their field but
there was little or no sharing of those toolkits from domain to domain. That
is unfortunate. Of particular importance in today's world are a toolkit of
mathematical techniques (calculus, statistics, differential equations are
probably the top three categories) and a category of basic programming skills
(the ability to automate routine number crunching in particular, maybe
"scripting" is a more appropriate word than "programming" - even recording and
writing macros in Excel VB would go a long way).

------
nickolai
To be fair, this letter followed soon afterwards :

<http://www.ncbi.nlm.nih.gov/pubmed/7677819>

Tai's formula is the trapezoidal rule.

Monaco JH, Anderson RL.

Comment on:

    
    
        * Diabetes Care. 1994 Feb;17(2):152-4.

------
praptak
Tai's model? Naming things after oneself is +20 points in The Crackpot Index.

------
roel_v
Slightly off topic, but the other day someone asked how to do well in
academia. Well, interdisciplinary work like this is a great way to get many
well-cited papers - be well-versed in two or three fields (a lot of work, but
not very hard) and apply things from one to the other(s). Don't call it '<your
name>'s Method' but just present it as something groundbreaking (which it even
may be, in that new field).

You can generate a paper mill out of this after 10 or 15 years of studying the
various fields (including undergrad and grad school) - it doesn't require much
hard thinking, just a lot of work.

------
Shorel
Given that this is Obesity research, I'm just a little more inclined to
believe all the claims of the NIH syndrome and biased analysis as described in
Good Calories, Bad Calories.

------
SeanDav
Wow, I just dicovered gravity :) In all seriousness though this does highlight
a problem with modern research - the sheer volume of information out there.

