Zach London Profile picture
Jul 24 17 tweets 7 min read
In my first and only basic science research experience, I was complicit in scientific fraud.

There was no fabrication of data, per se. No doctoring of images. It was subtle experimental misconduct, and certainly an anomaly in the scientific community. I assumed.)
1/🧵
I had a 4-week summer research position when I was in college. The project had something to do with Na/K channels in pulmonary epithelial cells.

Honestly, I didn’t really understand it then, so I certainly wouldn’t be able to explain it now.
2/🧵
It was a very small lab. I think I met the PI twice… once on my first day, and once for an exit interview a month later. I remember that he wore a little button on his white coat that said, “Science: Invest in the Quest!”
3/🧵
Both of our conversations revolved around him apologizing that he was unable to pay me. But I was in no position to make demands... we both knew that I was hoping to get into med school, and this was just another box to check.
4/🧵
For most of the month, it was just me and the lab tech. We ran experiments on ~20 samples/day.
There were lots of steps, and lots of chances for things to go wrong. Sometimes I would mess up and we would have to throw out the experiment and start over with a new sample.
5/🧵
But sometimes, we weren’t sure if I had messed up, or if the magnitude of the error was enough to justify scrapping the experiment. When I asked the tech what to do, she told me to finish the experiment and we would decide later.

But finishing meant seeing the results.
6/🧵
When the results aligned with the PI’s hypothesis, the tech would declare that I had done everything correctly.
If the results “didn’t make sense,” she would blame human error and throw them out. This happened too many times to count.
7/🧵
At the time, my reaction was more of an eye roll than righteous indignation.
8/🧵
Even with that selective data reporting, those experiments never went anywhere. It was never published, and the lab moved on to other projects after I left.

The only downstream effect was galvanizing my lack of interest in a basic science career.
9/🧵
Fast-forward until last night, when I finally read this article that has been blowing up my feed. It alleges fraudulent images in a series of high-profile publications about the mechanisms of Alzheimer’s disease.
science.org/content/articl…
10/🧵
I don't know enough to discern if this is a genuine whistle-blowing or a hit job. But the author makes a case that publications of dubious integrity caused a Butterfly Effect, driving the financial and philosophical direction of Alzheimer’s research for the last 15 years.
11/🧵
This has my stomach tied in knots. And I started wondering if the gentle data-fudging I witnessed nearly 30 years ago was not so innocuous, after all.
12/🧵
My PI’s button said, “Science: Invest in the Quest.” The analogy to investments is actually quite apt. If you are going to commit time and money, you want to set yourself up for the best possible return on that investment.
13/🧵
Scientists may dream of hitting it big, but I imagine that granting agencies are incentivized to balance their portfolios and focus on… safer investments.
14/🧵
And that means supporting investigators and lines of thinking that have a proven track record. So even small amounts of misinformation can derail those investments and have an enormous negative impact on investment returns. Which, in this case, can have a human toll.
15/🧵
Outing people for potential misconduct is splashy, but the most effective solution must be stopping that noise before it gets into the system.

The scientific community has safeguards to prevent fraud. Those of you in the know, how well do they work? What can we do better?
16/🧵

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More from @zach_london

Apr 8
If you blow on someone’s foot and the toe goes🆙, that’s the London Sign. Sure, you could use a descriptive name, but I invented the maneuver, so I’m naming it after me. Everyone cool with that?
An irreverent/irrelevant #tweetorial on the rise & fall of neurologic eponyms. 1/
So do you say Guillain-Barre syndrome or AIDP?
Broca’s or expressive aphasia?
Kennedy’s disease or SBMA?
Devic’s disease or NMO?
Wilson’s disease or hepatolenticular degeneration?
2/
By digging around in a few neurology textbooks, one of our @UMICHNeuroRes residents found 68 terms (diseases, maneuvers, and signs) that had both eponyms and corresponding non-eponymous terms.
pubmed.ncbi.nlm.nih.gov/33271406/
3/
Read 13 tweets
Feb 27
"What do you see when you're walking HOME from church?"

She was an older woman with a right MCA syndrome, and I will never forget what she said when my attending asked her that question.

Not a full #tweetorial, just some mind-blowing examples of neglect for neuronerds. 1/🧵
She was admitted on Saturday morning, and she was upset when she realized she would miss church. She only lived two blocks from the church, and walked there every Sunday. She hadn't missed a Sunday sermon in decades. 2/🧵
I was a resident at the time, and the attending was chatting with her on rounds. He asked, "What do you see when you walk to church?"
And she answered, describing everything that would have been on the right side of the street if she was walking from home to church. 3/🧵
Read 8 tweets
Feb 11
1/
We often check SPEP and/or immunofixation in patients with neuropathy. Why bother, and what should I do with the results?
Welcome to Paraproteinemic Neuropathy: A #tweetorial for neurologists who order tests they have no business interpreting.
2/
For starters, let's clear the air about terminology. These are all synonyms:
- Paraproteinemia
- Monoclonal gammopathy
- M-protein
- M component
They all mean identical plasma cells are overproducing identical copies of the same immunoglobulin or immunoglobulin fragments. From AAN Neurobytes: Paraproteinemia and Neuropathy
3/
Paraproteinemia is common as we age. It's usually benign (MGUS) and asymptomatic, but can be associated with almost ANY neuropathy syndrome.

(PSA: If you do a Google image search for Stocking and Glove looking for neuropathy pics, be prepared to find a bunch of S&M sites.)
Read 11 tweets
Feb 2
1/9
Just read the 2021 EAN/PNS diagnostic criteria for CIDP. It's an updated version of the 2010 version, and it's great! It clarifies lots of things and makes practical recs… and one that I think is problematic. Let’s unpack. Part #tweetorial, part rant. tinyurl.com/h7jppwzk
2/9
They use 2 diagnostic categories: CIDP and Possible CIDP. (In the 2010 version, we had Probable CIDP and Definite CIDP, but these have now been rolled into one category: CIDP.)
Both new categories rely heavily on NCS criteria.

BTW, it includes Sensory NCS criteria. Love it! ImageImage
3/9
Now IMO, diagnostic criteria exist to help you decide who to treat. If someone has CIDP or Possible CIDP, you should consider treating them, and IVIG is an established first-line treatment.
If someone has "This Ain't CIDP," don’t give them IVIG. Simple, right?
Read 9 tweets
Jan 22
It gives my great pleasure to announce the release of THE PLEXUS, a new strategy card game about peripheral nervous system localization.

Folks, this may be our only hope to #endplexusphobia!

Click here ➡️theplexusgame.com

And open the 🧵for more surprises.
1/5 www.theplexusgame.com
It’s a 2-3 player game that takes about 20 minutes🕓 to play. And here's the kicker: It's actually fun, and you don’t need to be be a master of brachial plexus anatomy to enjoy it. (In fact, my middle school-age son beat me the first time he played.😯)
2/5 www.theplexusgame.com
I’m selling these at cost from The Game Crafter, thegamecrafter.com/games/the-plex…
and I will donate $3 to the American Neuromuscular Foundation for every copy sold in 2022! neuromuscularfoundation.org/Home
@AmNmFoundation @AANEMorg @aanem @ShirlynAdkins
3/5 www.theplexusgame.com
Read 7 tweets
Jan 4
"A bag with feet."

That's what the patient said he saw when we showed him the cookie jar picture. He was an older man who had been brought to the ED after being found driving his car around a field.

Here is what I think he was seeing:

#neurotwitter #tweetorial #MedEd
He was unable to focus on the whole picture at once.

This is a striking example of simultagnosia, which in his case was related to bilateral parieto-occipital strokes (Balint's syndrome.)
Another way to test for Simultagnosia is to ask a patient what they see in a picture like this. They may only see T's and not the big H.
Read 7 tweets

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