Tobias Hohl MD, PhD Profile picture
Apr 27 18 tweets 4 min read Twitter logo Read on Twitter
1/ One of the privileges and duties of becoming a full professor is to write letters of evaluation for junior faculty in the promotions process at outside institutions. I give these a lot of thought and have completed 6-8 per year in the past three years.
2/ Usually, I receive an e-mail inquiry from an outside departmental administrator. When I agree to the evaluation, I am sent a promotion package prepared by the faculty member as well as a letter/document with promotions criteria by the host institution.
3/ I am increasingly troubled by requests for comparative evaluations:

Here's an example from one request letter (redactions to maintain anonymity):

• Estimate their (Dr. X's) standing in the field and compare them with other faculty of roughly the same cohort.
4/ Here's a 2nd (worse) example:

• Comparative evaluations play a central role in our effort to appoint outstanding scholars and teachers. Thus, it will aid our deliberations if you would compare Dr. X to the following scholars (Dr. A, Dr. B, and Dr. C – at peer institutions),
5/ both in absolute and relative terms, taking into account any differences in career stage when framing your reflections. … Even if you are not familiar with the work of everyone on the list, we would still be interested in your views on those whose work you do know,
6/ or others you believe to be of equal or greater merit.

These letters come from the highly prestigious and respected institutions in the US that would be considered world leaders in biomedical research.

Why do I highlight this problem?
7/ In the first letter, the request is entirely vague, includes no criteria for "standing in the field", and asks for a comparison with faculty (unnamed) of roughly the same cohort (how would you define this?)

The second letter is worse, because it asks for direct comparisons
8/ with three named scientists at peer institutions (unbeknownst to the named scientists or their institutions). As a reviewer, I only have access to the promotions package of the candidate faculty and no comparable information on the three "comparator" faculty.
9/ I have no idea how these three were chosen. I am troubled by these requests.

To promotions committees: It is not the job of outside evaluators to compare your faculty candidate with faculty at other institutions - it is our job to provide an evaluation of how faculty
10/ candidates meet the stated criteria for promotion at your institution. Please provide reviewers with objective, clearly defined criteria (level of support, publications, teaching, mentorship, etc...) and not with requests for comparisons with faculty at other institutions.
11/ These evaluations are not akin to evaluations for a scientific prize in which all candidates have the opportunity to fill out a standard application, ensuring that comparisons are meaningful (but may still contain biases).
12/ I responded in the following way to the first request:
"Please note that I do not include individual comparisons of scientists in any promotion evaluations. I believe that it is impossible to do so without having access to equivalent information about all individuals
13/ to be compared and that such requests are prone to eliciting unconscious bias in faculty evaluations."

To the second request:
"I object in the strongest terms to comparing named candidates at different institutions and to assigning absolute and relative rankings.
14/ I do not have the same information package available for all named faculty and I do not feel that it should fall on a reviewer to compile this information. Moreover, the named scientists are not all in the same field of investigation. This comparison cannot be done in an
15/ unbiased manner, and I am concerned that this format can perpetuate structural inequalities. Thus, I am not comfortable in partaking in this exercise, even if it led to the conclusion that Dr. Y is the strongest candidate."
16/ Comment: I want to support junior faculty and the promotion process. I do not have that including person-to-person comparisons achieves this goal. believe it to be harmful, and that it introduces biases, particularly against members of groups that are historically
17/ underrepresented in biomedical research. IMHO, it's time to take a stand.
My pledge: I will write letters to support faculty who are going through the promotions process, but will not compare scientists head-to-head.
18/fin
Another way to help is to serve on promotions committee who make up the rules of promotion and evaluate candidates (full disclosure: I serve on a promotions advisory committee at @MSKCancerCenter).
#MedTwitter #IDTWitter @UshmaNeill @RuthGotian @MSKCancerCenter

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More from @tmhohl71

Dec 22, 2021
1/ I'm really excited that the @US_FDA has granted an EUA for #Paxlovid - this is a terrific new option for #OmicronVariant and kudos to the scientists, researchers, and developers at Pfizer. So timely, and so necessary as we face a wave of new #COVID19 infections globally.
2/ I went through the fact sheet and it is critical to highlight that many patients with cancer and organ transplant recipients are on medications that will be effected by the #ritonavir component of #paxlovid.
3/ Note black box warning - Co-administration of ritonavir with sedative hypnotics, anti-arrthythmics, or ergot alkaloids are contraindicated.

Pfizer did a great job in compiling potential drug-drug interactions:
Read 15 tweets
Dec 21, 2021
With #Omicron rapidly spreading nationwide, I am concerned about all the members of our communities with damage and injury in the immune system, particularly to cell-mediated injury (to T cells and Ab-producing cells). In neutralization studies, most monoclonal Abs used to date
2/ have lost activity to #Omicron and are no longer useful in areas with high attack rates (pretty much everywhere in US right now). There are two possible exceptions. The first is #sotrovimab which was originally isolated from an individual with
3/ #SARSCoV1 (not a typo) back in 2003. The Ab recognizes a conserved glycan motif at the base of the Spike protein (away from the ACE-2 receptor-binding domain). Extremely limited supplies and fairly narrow emergency use authorization, as follows:
Read 14 tweets
Jan 10, 2021
If @NYGovCuomo had widened eligibility first, as in: nytimes.com/2021/01/08/nyr…
Note that this happened on January 8th, 2021.

(1/n)
then NY Hospitals would have acted differently to his prior order of "Use it or Lose it, and Get Fined", issued on January 4, 2021. At this time, hospitals were NOT allowed to vaccinate patients, even though many were clamoring to do so. (2/n)

nytimes.com/video/us/polit…
As a consequence, it is not surprising (and entirely predictable based on the incentive created by @NYGovCuomo) that many academic medical centers vaccinated lower-risk and non-patient facing staff, as outlined today in the @nytimes by @apoorva_nyc (3/n) nytimes.com/video/us/polit…
Read 9 tweets
Jan 10, 2021
1/n I read this article with tremendous interest and have some comments on this situation. Why are we in this situation? Conflicting forces are driving the vaccination process. At Elite Medical Centers, Even Workers Who Don’t Qualify Are Vaccinated nytimes.com/2021/01/10/hea…
2/n @sloan_kettering there was a deliberative and transparent process to identify and prioritize vaccination among patient-facing healthcare workers. However, hospitals in NY State were not yet allowed to offer vaccine to high-risk patients. Vaccine uptake is not uniform
3/n among priority patient-facing vaccine groups and since substantial financial repercussions were threatened if the vaccine was not administered very rapidly, this created an incentive to administer vaccine to other (lower risk) workers at academic medical centers. Remember
Read 10 tweets
Jan 3, 2021
Concerned about the #COVID19 vaccines and autoimmune disease?

Both the #Moderna and #Pfizer vaccines do not contain an attenuated virus or instructions (via mRNA) to make viral particles that could replicate in vaccine recipients. (1/n)
I have psoriatic arthritis (on #methotrexate for about a decade) and had no hesitation to receive the vaccine @sloan_kettering. I am fortunate and was able to stop methotrexate for one month prior - this is atypical for most patients with autoimmune diseases - and will (2/n)
resume the medication a month after the second shot. I stress that this is not a medical recommendation for other patients with psoriatic arthritis or any other autoimmune disease. Patients should discuss how treatments for autoimmune conditions may impact vaccine immunity (3/n)
Read 9 tweets
Apr 5, 2020
1/n Much will be made about this case report. I am very pleased that the patient did well and survived #COVID19 after a difficult course. On the heels of tweeting about anti IL-6 therapy (tocilizumab) I'm taking a stab at this case report. ashpublications.org/bloodadvances/…
2/n It is a purely correlative, observational study. The title is misleading though. An alternate, equally valid title would be: First case of COVID-19 in a patient with multiple myeloma successfully treated with methylprednisolone. The patient received corticosteroid (MP)
3/n therapy on five consecutive days (day +2 to day +6). On day +9 the patient received tocilizumab. He continued to improve and was released from the hospital 10 days later. Did tocilizumab cause this improvement? It is impossible to tell. However, I conclude that it is safe to
Read 8 tweets

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