*with apologies to Glenn Tilbrook and Chris Difford of Squeeze
Welcome to Take As Directed, my new blog on drugs and drug safety – pharmacology and toxicology, if you will. Some of you may know me as Abel Pharmboy, the pseudonymous blogger who wrote Terra Sigillata at ScienceBlogs for the last four years. But I’ll be writing here under the name given to me by my parents. (Hi, Mom!)
More broadly, I’m delighted to welcome you to PLoS Blogs, an exciting initiative expertly supported by the world’s premiere open-access publisher to bring together professional scientific writers and scientists who love writing and communicating broadly with professional and public audiences. For some of the well-known scientific writers, this is their first foray into blogging or, in the case of Steve Silberman, a return to blogging after a long absence.
For those of us who come from the lab – more accurately, from writing grants and papers at the computer – this is an opportunity to step up our writing game. I’ll be perfectly honest with you: I’m a bit starry-eyed by writing next to Pulitzer prize-winning author, Deborah Blum, whose book, The Poisoner’s Handbook, was among my two most influential reads over the last two years. I understand also that the chap who edited Scientific American for many years might be rummaging about these parts. (My apologies to the rest of my colleagues here who I will feature at a later date. I love you all – equally.)
What we scientists aim to do here is to delve more deeply into the topics of the day and help you understand the science behind the press releases or, perhaps more importantly, the gems from our own fields that don’t get the high, glossy press but are likely to be of even greater importance or interest. And while I may be impressed by these writers I’ve admired for years, the scientists and students here are remarkable. In particular, don’t underestimate the intellectual power and authority of our University of Toronto physics graduate student, Sarah Kavassalis. I am finally destined to learn about the discipline which afforded me the lowest grade of my collegiate career.
When invited here by PLoS community manager Brian Mossop, himself a Duke-educated biomedical engineer, I had already agreed to move Terra Sigillata to the American Chemical Society’s Chemical & Engineering News platform, CENtral Science. Moving Terra Sig to C&EN just seemed so natural and comfortable and I already had some friends there whose writing I respected immensely.
“No worries,” said Brian. Start a new blog, whatever, we just want your voice here. Brian also stressed that another goal of PLoS Blogs from day one will be to welcome all sorts of network interactions and cross-fertilization. Indeed, the very wise editor who I interacted with for too short of a time at ScienceBlogs, Evan Lerner, reminded me that “the internet is the network.” We all share the common goal of improving the communication of science and medicine to the world, accurately and without sensationalism, to improve scientific literacy and the understanding that science touches every part of daily life. We’ll strive toward the goal that every world citizen needs to have a basic understanding of science and – please, oh please – that the basic tenets of critical, logical thinking are not only the purview of science but should be the foundation of all decisions we make as individuals and a society.
Idealistic? Yes. Necessary? Yes.
So, here I am writing on a platform uniformly associated with open-access evangelism while I was encouraged to pursue writing with CENtral Science, an online effort of one of the most traditional of scientific publishing organizations. My editorial colleagues at C&EN conversely felt it was great for me to have a presence here as well.
Dogs. Cats. Sleeping together.
This, my friends, is free-range blogging in the Wild West tradition.
Why “Take As Directed?” – the ruminations on a blog name
Since I haven’t started a new blog in five years, I gave a great deal of thought and sought counsel worldwide when picking a name for a blog designed to address critical issues of pharmacology, drug safety, and objective information in an arena where marketing is king. I also wanted to pick a name that would get me higher in alphabetical blogrolls of other bloggers (Um, David, it still begins with a “T.”).
I credit my friend and writing mentor, David Dobbs of Neuron Culture, for telling me to not pick another Latin name. Pick something recognizable and “sticky” – sticky in the sense of the “Made to Stick” by the Heath brothers, said he. Dobbs knows that writing is becoming a more important part of my professional, scholarly activities so he also offered that I try to stay away from another Latin name like Terra Sigillata. In fact, the beautiful thing about this blog community is that I was able to draw on such learned expertise from people I’d never meet in real life.
But the name for the blog came from the MD sitting on the couch next to me, my lovely wife and co-author of our upcoming book written with one of her breast cancer patients and oncology fellows. “Take As Directed” was her choice; mine was “Dispense As Written.” (I’ll also note for Dobbs’s sake that my wife’s other suggestion was QOD for “take every other day,” a rather accurate term for my blogging frequency.) But several friends felt that “Dispense As Written” was too specific of a prescribing term that would be familiar to fewer people, especially since more and more people are using generic-branded drugs, an issue we’ll discuss here in future posts.
So, we are “Take As Directed.”
I then had my head illustrator at SaBOR Design of West Redding, CT, take on the banner. Brien O’Reilly is a fantastic commercial illustrator and designer who has recently hung out his own shingle. I’ve had a long-term professional relationship with Brien as he designed the Terra Sigillata blog banner with that so expertly incorporated the portrait of John Jacob Abel and the structures of morphine and epinephrine. Among his other contributions were the designs for CDs released in 1997 and 2001 by my Denver-based original powerfolk band, Dogs in the Yard. Brien won a Connecticut Art Directors’ Guild gold medal for the design of the first. Brien is also the only man in the world I trusted enough to marry my little sister, my only sibling and a tremendous designer in her own right. But I’m not taking advantage of that – I am paying him for his artwork.
“Take as directed” is a timeworn admonition of pharmacy and medicine that is three simple words, so common that the phrase is in the public domain (although I was able to get @takeasdirected on Twitter and takeasdirected for my Gmail account). We take “Take As Directed” for granted, not realizing the years of study that went into the discovery, development, and dosing of a given drug product. But what we sometimes forget – particularly among the general public – is that science is dynamic and directions change over time as information on drug effectiveness and safety become available. What is directed today may not be directed tomorrow. The complex interplay of science, medicine, regulatory authorities, and marketing (well-meaning or otherwise) direct how we are directed to use drug products. We’ll pay particular attention on this blog to how those directions come about and explore cases where those directions change and why.
Take with a grain of salt
However, I want the readers to know exactly where I am coming from and what biases I may have, recognized or unrecognized. Any writer who tells you they are unbiased is also delusional, or at least lacking in self-awareness. Our experiences, even those not driven by financial compensation, can influence our viewpoints. My aim is to make you as aware as possible of my biases and potential conflicts of interest as transparently as possible. When I’m reviewing a book or product, I will make you aware as to whether the item in question was provided free-of-charge or whether I purchased it with personal funds.
This – blogging – is my hobby, one that could be construed as the outreach component of my professional duties as a state university professor. In fact, I reach orders of magnitude more people daily through blogging than I do in even my largest classes. But as such, my income is derived from the State of North Carolina and grants from the National Institutes of Health (NIH). My wife is currently a resident in preventive medicine and master’s of public health student whose income is supported by a grant from the American Cancer Society. We have no substantive holdings in pharmaceutical industry or dietary supplement company stock but I’m certain that if I looked closely in my TIAA-CREF retirement account, I will find drug companies and health food retailers large and small.
Regular readers know that my boyhood years were spent within view of the Roche pharmaceutical research and development facility in Nutley, NJ, and I once aspired to work there. More than 75% of US pharmaceutical companies have a presence in New Jersey, Pennsylvania, and Delaware so you can’t throw a stone at a family gathering without hitting someone who works for a drug company in some capacity. I also now live in the Research Triangle Park area of North Carolina, an area that owes its growth to pharma, chemistry, and other technology-based corporations.
As an undergraduate at the Philadelphia College of Pharmacy and Science, I interned for pay ($16/hour, I believe) in the Department of Drug Metabolism at then-SmithKline & French Laboratories and cleaned lab animal cages on work-study from the college. My graduate work was supported entirely by NIH grants and support from the State of Florida. Most of my postdoctoral fellowship was supported by NIH grants but one year was supported ($23,000) by Invitrogen Corporation, a molecular biology reagents company.
As a faculty member at the University of Colorado, my income came entirely from the State of Colorado and grants from NIH and the American Chemical Society. When I came to Duke University on sabbatical in 2000, I contracted for $10,000 with Bayer One-A-Day as an advisor on their line of herbal dietary supplements. I like to think that my harsh report on the safety risks of their St. John’s wort/Kava product led to it no longer being sold.
Throughout my career, the trajectory of my trainees has been split roughly between academia and small and large pharmaceutical and chemical companies. I am currently associated with an academic program supported by the State of North Carolina to provide economic and workforce development to the state’s 500 biotechnology companies. I am a tenured full professor and have, and intend to continue, speaking my mind as objectively as possible about drugs and the pharmaceutical industry.
Many readers also know that I am a natural products pharmacologist who conducts research on herbal dietary supplements. During the 1990s and early 2000s, some of my speaking fees in this area ($250-$1,000) were supported by herbal or dietary supplement manufacturers. My research, however, has never been supported by the dietary supplement industry and our current work on the supplement, milk thistle, is funded by NIH.
As a patient, I’ve had a few bad run-ins with medical products. As a graduate student having dental work, I had a severe oral hypersensitivity reaction to a polyether dental impression medium that is now off the market. Most recently, I lost my voice almost completely as a result of aggressive oral and inhaled corticosteroid use following my bout with pneumonia during the first part of 2010. I’ve had a friend suffer Achilles’ tendon rupture from the use of a fluoroquinoline antibiotic and another set of friends who lost a parent due to mismanagement of a medicine while hospitalized.
I belabor this issue for you because one rarely has the opportunity to read of a career-long history of the boyhood influences and adulthood financial track record of a professor, much less one who writes a blog and purports to be objective. I am a scientist, first and foremost, and I’m excited about discovering new compounds that may treat cancer regardless of whether they come from nature or a synthetic chemistry laboratory. I am committed to patient access to drugs in compassionate distribution programs, clinical trials, and the US FDA accelerated approval process. I’ll also tell you the shortcomings of each of these avenues. Moreover, I’ll also freely share with you places where I feel that self-medication, off-label medication, or dietary supplements might be unwise.
Take this as directed
But please be aware that I am a PhD laboratory scientist who, while lecturing widely and commenting in legacy media outlet, is NOT a practicing physician or otherwise trained or licensed health care professional. The content provided here is for information and discussion. With regard to your own health and medications, the number one source for advice and direction is your physician and other licensed healthcare professionals.
However, this is a discussion – all viewpoints are welcome and no question is too simple. I very much welcome direction from you and I always know I can count on pharmacology colleagues such as Dr Ian Musgrave of the University of Adelaide to keep me honest and accurate.
I am not blogging here to simply pontificate to other scientists. Again, we’re at PLoS. “Open access” means that information is free to all, not just to read but a venue to participate and engage in discourse in a manner that may not be available to you in daily life. In fact, the greatest compliments I’ve received have come from folks outside of science who tell me that they find our posts interesting even though they may not fully understand every detail of the science. I’d love to see more of you here. Tell your friends.
This is a blog for all and I hope you will join us.