Why MD/PhD?

Med school is SO long - why spend another few years getting a PhD?  I've gotten this question a lot since I started med school.  Like applying to straight MD programs - there are plenty of good BS reasons to apply to MD PhD programs.  [The REAL reason I want to go to med school]

MD/PhD - the rough outline by year

Sidenote - if you're wondering what MD/PhD programs are - see image on right - they are essentially med school (MD) and school for scientists (PhD) so we combine medical and scientist training.  We exchange spending a few extra years in school with free tuition.  

Here on sidenote, we give the people what they want.  Once we pare away all the BS of med school admissions, there are 3 reasons why I chose to pursue two doctorates, when I would have been equally as useful with an MD.  

1- The incredible tution bill of med school.  The average 2010 med school graduate left with $160,000 in debt.  15% of all med school graduates left with a quarter million dollars of loan money.  And when you graduate med school you're still a resident which means you make in the neighborhood of $50,000, not quite doctor money.  And don't forget that loan money is definitely not interest protected.  It keeps growing and growing and..  

As an MD/PhD student, the government pays my medical school tuition bill.  Thanks tax dollars!  

running gels gets a bad rap.. but I love science

During my admissions year I kept hearing that the financial incentive to pursue an MD/PhD wasn't worth it, but it still seems smart to me.  Spend 3-4 years working in a lab, which I love, and come out with a free MD, which my wife loves.  Everyone wins.

2- I needed a backup plan.  One day, I really want to be a scientist and run a mega lab to the tune of 20+ scientists, Cell papers by the month, and grant money flowing in like Brandon Roy's bank account.  The point is - I only want to be a scientist if I can be a good one.  

If you've ever worked in a lab you know the 40 year old burned out postdoc that's bitter at the research world for screwing over his opportunities to publish in Science/Nature/Cell and get independent grants.  You also know that guy questions his life on a daily basis - should he quit and go into advertising?  teaching?  

great book

I didn't want that to be me, but frankly it's only so much in my hands.  Science is a volatile career, and a high impact publication is usually the result of right-place-right-time phenomenon.  (See Malcolm Gladwell's Outliers).  

I really want to have a family some day - preferably sooner rather than later - so I wanted to make sure I had a viable backup plan before I tried to launch a risky career in science/academia.  At the end of the day I want to do science so I can use my brain to help people, so I figured being a doctor would be a good alternative - still intellectual and still helps people.

3- I believe I do things right and other people don't.  Don't hate me for it. I despise med school because all we're doing right now is learning the status quo and how medicine has been done for years.  I know we have to learn this because we need to pass boards.. but it is BORING.  Sidenote - when I run academic medicine we will be done with standardized tests and memorizing rote BS. Instead med students will learn, you know, actual medicine.  

I'm a cynical med student, and I know in 6 yrs I won't be the kind of intern that's going to see the medical world and accept it at face value.  I know I'll be a pissed off resident, and a pissed off attending.  There's a lot to be cynical about in science, but at least science is trying to come up with new solutions.  I wanted to be part of a world that asked, what if we could come up with a better way to do this?

Overall conclusions.. perks to the MD/PhD - it saves $ and you get to do science.

See you on the other side,

from ken

Proof-of-principle

I work in a research lab at Oregon Health & Science University. There, I study the cellular mechanisms underlying iron homeostasis, but OHSU is best known as the home of Gleevec.

Brain Druker, an oncologist-researcher at OHSU, discovered Gleevec. It’s a drug that completely cures a type of leukemia (white blood cell cancer) with few side effects. This is a stark contrast to other cancers, that are attacked by surgery, radiation, and chemotherapy that kill healthy cells and have deadly side effects.

Cancer is scary. It can be activated by external factors like smoking, but it is a disease caused by your own body. Tumors are caused by your own cells that grow uncontrollably. Cancer differs from say, diseases of poverty, or diseases of gender, because it is caused by the cellular mechanisms that are common to every human being.

As a result, cancer does not bias itself, and it has a tendency to pick the most devastating targets. Katie’s friend from home was recently diagnosed with a malignant brain tumor. Said friend is only thirty, has a wife, two kids, and another on the way.

For years, scientists that study the cellular mechanisms responsible for cancer had been convinced that you could target cancer in ways other than blindly killing cells, by just targeting the mechanisms that cause cancer growth. Insert Gleevec, which targets a specific mechanism of leukemia cells, and only kills cancerous white blood cells.

Gleevec is a miracle of a cancer drug, and it will probably win Druker a Nobel Prize one day, but it’s greatest strength is as a proof-of-principle experiment. I recently came across the idea of proof-of-principle, and I’ve been intrigued by it.

Here’s a sidenote to explain proof-of-principle:

Before Pixar started its series of computer animated movies like Toy Story and Finding Nemo, it first launched a mini-movie to test out the principle of animating human facial expressions. It was a success, and Pixar went ahead and produced larger projects like Toy Story. The mini-movie wasn’t the ultimate goal, but it was necessary to open the door for a whole genre/type of movies.

The type of leukemia that Gleevec cures is a relatively rare cancer, but it has single-handedly proven that it’s possible to hone in and eliminate cancerous cells without harming healthy cells. It is, simply, the proof to all scientists, doctors, and thirty year old brain tumor patients, that cancer can be cured.

As a scientist, I’m interested in Gleevec as a proof-of-principle experiment in cancer research.

But my real interest in science is bigger.

Before Gleevec, everyone was satisfied with the marginal gains of traditional chemotherapy or surgery. After Gleevec, the paradigm has completely shifted, and there is an entirely new option for cancer therapy. It’s still a little bit hazy in trying to get on that road, but Gleevec has proved to the doubters that the road exists and that cancer can be cured.

Cancer researchers everywhere are hot on the trail for the next Gleevec, and I see them as the scientists trying to get on the Gleevec road. But I also see other scientists who are looking for the roads that lead to the Gleevec road.

And I think that’s what I’m interested in.

Are there shortcuts?

Are all roads leading there uphill?

Can you wander around with no maps and end up there?

As a scientist, I want to know what leads people to insights like Gleevec. What environments, what K through PhD educational programs, what sorts of communities foster these scientists?

Is it dumb luck?

Is it once in an eon creative geniuses given a touch and vision that cannot be taught?

I’m a scientist, so I think everything can be figured out. So I guess I am one to believe that it can’t be dumb luck, or an unteachable magic touch. So I want to know. I want to know the system that creates these great scientists and then set them loose.

from ken

Feel free to comment! I would love to hear your thoughts.