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Old 07-09-2010, 09:45 AM   #4
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Re: Finding a Surgeon

Hi kcon,

I'll quote your question in a brief excerpt and then answer in green. It's a good one.

Originally Posted by kcon View Post
Hi Dave, and welcome,

Jim, by the way, I saw in your reply below you wrote [bold added]:

Ive published in a (non-medical) technical journal with multiple authors and also have a US Patent with multiple inventors, and in both cases the first listed author/inventor is primary, not the last. Was your (last) a typo, or do you know medical journals to be sequenced this way?

Yes, as in your experience, the first author is usually the "primary" - the guy or gal who really quarterbacked the effort and had the most input. However, the last author is usually the "senior" person, often taking a "producer" type role, often the director of the particular laboratory team/facility that provided the key infrastructure and institutional backing for the study, or whose patients constitute the data for the study, and also bearing a large share of the overall responsibility reputation wise, along with the first author.

The senior person, in the case of surgery studies, is often the surgeon whose results provide the data, while the first author is often the one who conceives of the study and designs it, makes sure the data set is appropriate for the study, does the statistical analysis or oversees it, often writes most of the study, performs quality control, shepherds it through the submission, review and journal acceptance process, and serves as point of contact for correspondence - clearly deserving the lion's share of the credit (or sometimes blame). (I get the sense that sometimes others do some of this work.) I think you see that a lot in research involving Dr. Patrick Walsh, MD, of Johns Hopkins or Dr. William Catalona, MD, now of Northwestern, or Dr. Peter Scardino, MD, now of Memorial Sloan Kettering, for instance, but I haven't verified that.

It's my impression that sometimes you have the Edison or Benjamin Franklin pattern - the study is the brain child of the senior guy and so important that the senior guy also does the first author work, as in some of the D'Amico teams' work on the importance of a rise in PSA of more than 2, for patients diagnosed with prostate cancer, in estimating aggressiveness. I think that's so because studies often become known by the first author, so papers expected to be major advances will often be led by very senior and respected physicians/researchers.

In the experiences I've had as a "consumer reviewer" (meaning survivor representative) of prostate cancer research proposals for the Congressional Directed Medical Research Program (CDMRP), I've gotten a strong sense that the professional medical researchers pay attention to the number of publications for which a proposing "principal investigator" is listed as the first or last author, with somewhat more emphasis on first author papers. The in between author positions are of course important, but they are clearly quite secondary to the first and last positions. Glancing at the authors lists has become a habit with me; when I see a list of multiple authors, I automatically check at least the first and last to see if they are names I recognize, and that helps provide me with context for the study.

I'm thinking this explanation is probably consistent with your experience. Is that so? It took me a while to catch on, and I'm still trying to figure out if there are customs for determining who is listed earlier in the middle author positions. For instance, is being the second author considered much preferable to being the fourth? These matters don't seem important to us layman survivors, but they are the building blocks of reputations for researchers.

I'm disappointed that I have not yet been invited as a reviewer this year for the CDMRP's prostate cancer proposals. I believe it is now too late as the review panels will meet in early August and the review agreements and packages are usually provided about a month in advance of the panels. I had set aside this month for doing the work, but at least I'll now have more time for this board. This would have been my fourth year as a reviewer, and the CDMRP has a fairly flexible goal of three years of service in order to allow a substantial influx of new reviewers each year. It's a tradeoff of experience versus freshness, with both being important. Doing the CDMRP reviews - helping decide how the $80,000,000 is spent - has been profoundly fulfilling for me. I've found it demanding and a lot of work - probably my lowest pay ever per hour of reviewing/panel work for the $1,250 stipend provided, but I would do it again in a heartbeat! (Also, having all expenses paid and a very nice hotel is cool!)

Take care,