Friday, June 29th 2012

Make Yourself Accountable

A notebook full of writing with a pen resting on top of it.

I wrote this blog post in longhand before typing it. It's nice to shake things up sometimes. Image by tonyhall via Flickr Creative Commons.

My greatest insecurity as an assistant professor is scientific writing and publishing. My training and abilities were already somewhat strong in teaching and mentoring, as well as planning, conducting and analyzing research. Something about that last step from conference presentation or analysis to paper terrifies me, though. While I can identify the various experiences that led to this, it seemed to me the problem wasn’t going to go away with therapy, but action, because for me action itself is a kind of therapy. I find it useful to freewrite, to use my writing as its own kind of inquiry, and that’s from where my comfort with bad first drafts arises. The point where I get stuck tends to be downstream of when I first put that pen, or cursor, to page.

In this job, I found I could avoid writing very easily. I took on teaching and service obligations that I considered important, yet really had no business doing as a junior faculty member. I started a blog (ahem), thinking writing for a different audience would help me get over writing to my peers (it has and hasn’t, a post for another day). I mentored the crap out of a slew of undergraduates. And somehow each day would pass and the writing wouldn’t get done.

The two things that have worked are mentoring and accountability.

A week ago, my husband and I attended a STEM writing retreat. It was largely unstructured writing time while the kiddo attended a science camp, so we had no choice but to approach the retreat as a team if we were to get anything done. We’d discuss our goals for the day at breakfast, reassess at lunch, and at night once the kiddo was down we’d share our writing, usually just a few paragraphs or pages. We’ve only recently gotten back into reading each other’s work, out of desperation more than anything else. And I have to say, it’s been a real pleasure getting reacquainted with my husband’s work (and I like to think he has enjoyed mine). I think we have both gotten better at writing for a broader audience, which is why this trade is working again.

With dual NSF CAREER deadlines approaching, we are still checking in with each other post-retreat. Yet if we were only reading each other’s work it would be accountability without direction.

Enter the two other means of accountability I have – an NSF writing group, and the vicious pen of the Bastard Colleague from Hell (BCH, and yes, that’s what he prefers to be called). Every week or so I meet with a few other social scientists and one of our illustrious Vice Chancellors for Research, here at the University of Illinois. We discuss our projects and exchange a few pages of writing, then get down to business. I appreciate the candid questions my colleagues pose, as much as I fear every time they find one of the problems I was hoping no reader would catch. Then I patch it up, send my work to the BCH, and he tells me I’m Doing It Wrong. Then I start over yet again.

Where the writing exchange with my husband is more about the accessibility of the writing and how well we convey our ideas, the BCH and writing group criticism is all about the science. Their questions and the way they push me are very challenging. I am glad to have this kind of peer and senior mentoring.

Between my husband, BCH and the writing group, four full years into this job, I finally have most of the accountability and mentoring I need. The skills I need to develop relate to how I promote my science to my peers, and how I pitch my study design. The assistance I’m getting helps me inch my way towards my goals. (Ah, and goal setting. I will have to write a whole other post on that one someday.)

Now you: where do you need help? What can you do to get it? And while we’re at it, what would it take to implement better training for grads, postdocs, and early faculty so we hit the ground running?

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Thursday, June 28th 2012

On Bad First Drafts

This post first appeared on my old blog on March 16, 2011. I’m writing a post tomorrow relevant to this topic so thought I would re-post it today, to have it fresh in my reader’s minds. And I’ll just tell you the good news if you are a more recent reader: the book I refer is completed, page proofs are in, and it will be out in a few months! So bad first drafts can turn into better revisions, and great chapters.

My blogging mojo has been channeled almost entirely towards a book project I’ve undertaken with Julienne Rutherford of UIC and Katie Hinde of Harvard. The book is called Building Babies: Primate Development in Proximate and Ultimate Perspective and it will be published by Springer in 2012. Each co-editor has a chapter in there, and then we have a number of other rather fancy-pants contributors as well.

The first drafts of the chapters were due yesterday. I did not submit my chapter (er, to myself). I’m running about a week late. I thought I would come clean with this, because there are a number of elements of the writing process that I think remain obscure for students and other junior scholars. And after I share a few thoughts about academic writing, I thought I would show you some of the draft I’m working on.

First drafts suck

They really, really do. If you think your first draft is amazing, give it to someone else, and that someone else can’t be a pet, spouse or parent. First drafts suck because we write the most obvious things in them, the most vague. First drafts don’t have enough context. First drafts are where you use cliches because you haven’t figured out how to say what you’re saying in a sophisticated way. They are often under-cited. They are out of order. And, they aren’t that compelling.

This is why so much student writing is bad — but it’s not their fault. Close together deadlines, ones that align with other projects, and little teaching of time management means most students start writing projects just before they are due. So they essentially submit first drafts of papers, with a little copyediting if you’re lucky. Plus, somehow a lot of students have picked up this idea that first drafts are better or more authentic than revisions. This is patently false. They are simply the place our favorite worst stuff goes to die (this is why revision is so often called killing our darlings, to use a term from scio11, though its origin is much older).

But everyone has bad first drafts, so it is absolutely useless to feel bad about them. Give them to your advisor or your colleague if they have said they will read a first draft (otherwise, revise it after consulting with someone else first). They write bad first drafts too. You have to write a first draft in order to get to the revision, and to me, this was a liberating realization. Get it all out now! Don’t worry about using the right word! Just get the words on the page, get about the right content in about the right order, and if something is repetitive, just leave it for now. Because after a little breather away from it, or a look from a trusted colleague or advisor, you will hack it up and remake it into something far better.

Revising only sucks sometimes

Revising sucks when you get your first comments back from a colleague, because it is terrifying to share that vulnerable, bad first draft with another person (ever had that moment after you print it out or hit send when you realize your prized metaphor was a trembling nod to your failed attempt as a fiction writer?). It sucks at those moments when you feel at cross-purposes with the thesis of your paper. And it’s frustrating, also, that revising is the most important yet under-taught skill in academic writing.

But here’s the thing. Revising can be glorious. If you abandon any sense that you own your words, and remember only to own your mind, it allows you to be merciless in cutting out all the badness of that first draft: the cliches, the vague repetition, the jargon. If you return again and again to your outline, or abstract, or data, or whatever materials you keep to help you remember what the paper is about, you will start to see the right shape of the piece. And then you can also build in the context.

The best moments of revision are when you remember why you were writing the piece in the first place. Do you want to produce a fundamental review that will be useful to other practitioners in your field? Do you have an amazing piece of data to share? A well-grounded hypothesis that you want to articulate? What was surprising or compelling about that work when you first set fingers to keyboard?

One last thing I’ll say about revising is that owning your mind is not the same as owning your ideas. You need to be willing to let go of being right, and you need to be willing to change if the evidence is against you. Accepting reality and working with it in an interesting way is the mark of a good scientist, and a good revision.

My first drafts suck

The title of my chapter is: “Inflammatory factors that produce variation in ovarian and endometrial functioning” (eventually, I think, I will need to change the title to better reflect the manuscript). I thought this would be an easy piece for me, since I have been doing a lot of work on C-reactive protein, a biomarker for systemic inflammation, and I have been studying the endometrium and ovaries for many years.

I was wrong. Oh, so wrong.

A few quick searches pulled up an embarrassingly large number of citations for chemokines and cytokines, for toll-like receptors, natural killer cells, and other immunological terms I barely remembered from high school and college. So I re-drafted my outline, set aside a lot of time for reading (as in, several days straight), and then finally set to work.

The problem with the literature on this topic is that it is wholly mechanistic. I can now tell you what interleukins are expressed in the periovulatory phase versus the implantation window, or which ones are suppressed or overexpressed for certain pathologies, but I can’t tell you what that means in a broader sense, or what produces variation in any of these immunological factors in a systemic way that might impact local inflammation in the female reproductive system.

Here is my section on normal endometrial functioning (alas, given the literature, the section on pathology in the endometrium is far, far longer). First draft ahead! Remember, I am sharing this embarrassingly bad prose for the good of SCIENCE.

The endometrium is composed of the functionalis and basalis layers; the functionalis comprises two thirds of the endometrium and is the part that proliferates and sheds each reproductive cycle. The basalis is adjacent to the myometrium, and is the place from which the endometrium regenerates after menses. The proliferative (also known as follicular) phase is when estradiol promotes proliferation of endometrial tissue, where the secretory (also known as luteal) phase is characterized by progesterone control of decidualization and menstruation. The endometrium typically proliferates with narrow, straight glands and a thin surface epithelium, and angiongenesis continues as ovulation nears (King and Critchley 2010). After ovulation and during the secretory phase, the endometrium differentiates: endometrial glands become increasingly secretory, and by the late secretory phase spiral arterioles form. If implantation does not occur, the corpus luteum degrades, progesterone declines, and this triggers a cascade of events to produce menstruation.

Menstruation is a key inflammatory process of the endometrium. Menstruation is when the functionalis are shed at the end of the human reproductive cycle. The basalis regenerates over the course of the next cycle. The demise of the corpus luteum and the associated withdrawal of progesterone precipitate inflammatory mediators that cause tissue degradation. For instance, progesterone inhibits nuclear factor κ B (NF-κB), which increases the expression of inflammatory cytokines like IL-1 and IL-6 (Maybin et al. 2011). The withdrawal of progesterone is also associated with an increase in endometrial leukocytes and IL-8, which regulate the repair process (Maybin et al. 2011). At this time other inflammatory factors promote MMP production to break down endometrial tissue (Maybin et al. 2011). Further, it is thought that progesterone withdrawal, not an increase in estradiol concentrations, leads to the repair of the endometrium so that it can resume activity for the next cycle (Maybin et al. 2011). Thus, variation in progesterone concentrations may lead to variation in inflammatory activity, degradation, repair and cycling in the endometrium.

First question: why should I care about any of the above? So what if any of this happens? Then, you might not know this, but I do: the only two citations in these two paragraphs are both review papers, and one of the authors overlap between them. Therefore, it’s quite under-cited. To be fair, in this section it is less important that I demonstrate the depth of the literature, but a review that only cites two other reviews isn’t doing its job.

Do I inspire excitement in my field? No. Do I provide an appropriate context for this material in order to situate the reader? Not so much. Right now, these two paragraphs contain the exact information I wanted them to contain, based on what was in my outline. That is, I’ve described the basic functioning of the endometrium, and menstruation. It’s flat because that’s all that I did.

My job in this chapter is to take this vast reproductive immunological literature, pair it with what little we have in anthropology and ecology that helps us understand the way genes and environment might produce this variation, and then describe the necessary context in future work to understand these mechanisms. In some places, a lack of context may help me make my case, because it will demonstrate why anthropologists need to be in the field. But if my whole manuscript looks like the two paragraphs above, it will be an unreadable yawnfest that doesn’t contribute a thing to anthropology.

So, I guess I would expand the “kill your darlings” advice. First, accept your darlings. Accept that you have them like everyone else, and that darlings aren’t just turns of phrase but entire ideas, hypotheses, fields of thought. Then, once you have accepted that your darlings make you just like every other academic writer out there, from the middle schooler to the full professor, kill them. With fire. Finally, make sure you provide what is left with context or else there is no reason to read what you wrote.

And now, I have been sufficiently inspired to go finish my bad first draft.


King, A., & Critchley, H. (2010). Oestrogen and progesterone regulation of inflammatory processes in the human endometrium The Journal of Steroid Biochemistry and Molecular Biology, 120 (2-3), 116-126 DOI: 10.1016/j.jsbmb.2010.01.003

Maybin JA, Critchley HO, & Jabbour HN (2011). Inflammatory pathways in endometrial disorders. Molecular and cellular endocrinology, 335 (1), 42-51 PMID: 20723578

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Friday, June 15th 2012

What the CDC and WHO Know about Young Girls and Hormonal Contraceptives

Birth control pills via nateOne on Flickr Creative Commons.

Birth control pills via nateOne on Flickr Creative Commons.

I am slowly working on a book chapter on adolescent hormonal contraception, based on this blog post and conference presentation. I wanted to share some findings for your perusal. I’ve intentionally left out much analysis in favor of keeping things open-ended.

I’ve been curious about whether there are general guidelines out there for medical doctors in prescribing hormonal contraception to girls. Do they discuss the consequences of adult concentrations of hormones on girls’ immature hypothalamic-pituitary-ovarian axis? To the fact that hormonal contraception is almost exclusively tested on adult women in their twenties, thirties and forties? Do they discuss discontinuation rates, side effects?

In my first sweep of the literature, not really.

Today I’ll share with you a document by the CDC entitled U.S. Medical Eligibility Criteria for Contraceptive Use, 2010 (this appears to be the most recent version). This is based on the WHO Medical Eligibility Criteria for Contraceptive Use, 4th edition. You can access a copy of this yourself here.

According to its summary statement, the purpose of this document is to “assist health-care providers when they counsel women, men, and couples about contraceptive method choice” (p. 3). They also emphasize later in the document that it is not intended to inform on off-label use, just contraceptive use, of contraceptives. And I do appreciate the existence of this document at all, and the hard work that must have gone into it, from the research that went into the literature, the literature that was reviewed, the experts that made determinations about what constitutes acceptable risk, and the work of putting the whole thing together. I’m glad this exists.

The way this document is organized is that each appendix looks at one type of hormonal contraceptive, and the possible contraindications for taking it if you have a particular characteristic or medical condition. So “age” is a category for some appendices, and sometimes within a characteristic like smoking or condition like migraines, age is a sub-category.

So first, I also want to give the experts on this panel a giant shout-out for the following two statements, in the category “vaginal bleeding patterns:”

On vaginal bleeding patterns: “Irregular menstrual bleeding patterns are common among healthy women.”

On adolescent menstrual cycles: “Menstrual irregularities are common in postmenarche and perimenopause and might complicate the use of [fertility awareness-based] methods.”

Yes, this! This is something many doctors do know, yet somehow it doesn’t always get conveyed to patients… or when it is conveyed to patients, the patients are unsatisfied with the explanation and want a prescription to become “regular.” I would love for all of us to think on what it would take to produce better doctor-patient communication in a way that gets fewer women on hormonal contraception if the only reason they are on it is because they think they need a “regulator.”

Adolescents: We Are More than Our Bone Mineral Density

I read through the “age” sections in each appendix to see what contraindications were expressed, and I put it together in a handy little table for you. Here are the recommendation categories used so that you understand what the table means.

  1. A condition for which there is no restriction for the use of the contraceptive method.
  2. A condition for which the advantages of using the method generally outweigh the theoretical or proven risks.
  3. A condition for which the theoretical or proven risks usually outweigh the advantages of using the method.
  4. A condition that represents an unacceptable health risk if the contraceptive method is used.

I also searched the document for the following words: girls, juvenile, adolescent, and young. Girls turned up a handful of hits, but only in the references, juvenile did not appear at all, adolescent appeared three times in the document, and young only twice. I’ll share the three adolescent and two young findings.

Page 11: Bone mineral density is lower in adolescent girls using combined hormonal contraceptives, but bone mineral density may not predict postmenopausal fracture risk.

Page 34: Bone mineral density and fracture risk is unknown in adolescents using depo medroxyprogesterone acetate, or Depo Provera.

Page 37: Obese adolescents are more likely to gain weight than nonobese adolescents on depo medroxyprogesterone acetate.

Page 54: I will share this quote on the use of intra-uterine devices, because I think the wording is interesting, as well as the lack of a citation: “Concern exists about both the risk for expulsion from nulliparity and for STIs from sexual behavior in younger age groups.”

Page 77: Younger women are more likely to regret sterilization than older women.

So there you have it. Two discussions of bone mineral density, one on weight gain, one uncited concern about IUD expulsion or STIs, and mention of a study that younger women may regret sterilization.

What do you make of this? What other concerns might an adolescent have who is considering hormonal contraception? What research should be done to better understand this age group? And finally, what would it take to produce recommendations that take into account non-contraceptive uses of hormonal contraception (this seems especially important to me to produce more inclusive criteria that looks at off-label use, but also people with different sexual identities)?

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