Sleepy surgical students do make more mistakes. That’s the headline of another article in the Globe and Mail. It’s a short article and it basically regurgitates a new study published in the Archives of Surgery. The study looked at the results from routine surgery and concluded that reducing on-call hours for surgical students to 80 hours per week (down from as much as 120 hours per week in some cases) improved patient outcomes. I don’t have access to the study but the results quoted in the paper are hardly earth shattering.

“Before the work restrictions took effect, about 1 per cent of patients experienced a bile duct injury…”

“After the new hours were imposed, the injury rate dropped to 0.4 per cent. What’s more, other surgical complications dipped to 2 per cent from 5 per cent.”

Certainly any improvement in patient outcomes is desired but I wonder if any other factors, beyond on the on-call hours, influenced the outcome. After all, this is one study of one surgical procedure at one teaching hospital.

The article also mentions that some medical professionals argue that less on-call hours prevents surgical students from getting enough on-the-job training.

Those of you who have read some of my previous blog posts might believe that I am in favour of reduced on-call hours for surgical students but the truth is that I am not convinced.

Surgery is one of those careers where the proper training can mean the difference between life and death. While the benefit of more sleep is unquestionable, I have to weigh it against the benefit of more experience. One reason for working surgical students so hard is that surgery is a demanding career, with surgeries that can last for hours. Being able to perform complex surgery regardless of one’s mental or physical fatigue is a requirement for a good surgeon.

So while this study shows how reduced on-call hours result in a minor reduction in surgical complications for a routine surgery, I can’t help but wonder how this will impact those surgeons in the future. Will future generations pay the price by having less experienced and less capable surgeons? I doubt we’ll ever know the answer but I think it is a question that should be asked.

The Globe and Mail continues to provide me with interesting articles. The latest article (Drug makers ignoring key gender differences, immunologist warns) is about the role that gender plays in the drug development process.

The article talks about how immune-system cells respond to infections and states …

“…the profile of that immune response is different in men and women…”

It further highlights the types of diseases that each gender is more susceptible to.

“In general, men are more susceptible to viruses and bacteria and tend to develop more severe infections. Women, however, are more likely to develop autoimmune diseases like rheumatoid arthritis or lupus.”

The role that menstruation plays in the process of immune response and how both menstruation and oral contraceptives can impact how a woman’s immune-system responds to infection and treatment was of particular interest.

“The stage a woman is at in her menstrual cycle can influence how her body responds to invading bacteria, viruses and parasites, such as the one that causes malaria.

It is complicated, because estrogen levels affect different types of immune-system cells in different ways. Oral contraceptives may also have an impact.”

I had a hard time imagining that this was news to anyone involved in the medical field but the article goes on to state …

“… pharmaceutical companies don’t enroll enough women in clinical trials to get an adequate assessment of how this [the stage a woman is at in her menstrual cycle] might affect how well a drug works for women compared to men…”

That piqued my curiosity so I did a little research. The EMEA (European Medicines Agency) has a paper discussing “gender considerations in the conduct of clinical trials” (link opens a PDF file).

“An underlying principle of drug development is that “patients entering clinical trials should be reasonably representative of the population that will be later treated by the drug” as subpopulations may respond differently to a given drug treatment.”

Further information was found on the website for Health Canada in their Therapeutic Products Programme Guidelines. The guideline for Inclusion of Women in Clinical Trials, which dates back to 1997, states that

“It is important to ensure that women are enrolled in clinical trials at all stages of drug development in order to define the risks and benefits associated with drug therapy in this segment of the population. Since physiological changes and hormonal levels during child-bearing years and menopause, as well as the use of oral contraceptives or hormone replacement therapy, may affect the efficacy and safety of a drug, the influence of these parameters should be studied during drug development.”

That seemed fairly straight forward to me but there must be a reason why women are under-represented in clinical trials. I wondered if it had to do with psychological differences, that perhaps men were less concerned about the potential risks involved with participating in a clinical trial. An abstract on the ASCO (American Society of Clinical Oncology) website regarding the ‘Psychological characteristics of patients who enter clinical trials’ indicates that this isn’t true.

“Age, race, gender, marital status, and disease or symptom severity do not affect participation in clinical trials.”

Admittedly these results are for Oncology trials, so perhaps they are skewed because of the seriousness of the disease. Unfortunately it still begs the question as to why not enough women are enrolled in clinical trials. The only reason that I could find relates to reproduction and the unknown teratogenic impact of new drugs, which as any parent knows is reason enough.

Regardless of why women are not fully represented in clinical trials, I found it interesting to see how this supports the concept behind The Gender Divide. It is hard to imagine a modern world where women live longer then men and some people may consider that to be improbable. However it is clear that despite all the advances in medicine, we still don’t fully know how various drugs impact the human body and the role of gender on that impact.

I recently came across an article in the Globe & Mail. It discussed issues facing night-shift workers and included some interesting comments on Work Life Balance.

Ms. Williams wrote that work-life balance “is a self-defined, self-determined state reached by a person able to effectively manage multiple responsibilities at work, at home and in the community.”

‘A self-defined, self-determined state.’ Hmm, an interesting way of saying that it is different for everyone.

This state is difficult for full-time workers to reach at the best of times, she wrote.

Really?

Sarcasm aside, the article discussed how cutting back on sleep is used to squeeze more into a day. This is more prevalent for night shift workers and rotating shift workers, with up to 70 percent of these groups cutting back on sleep to get more done.

I don’t know about you but I find this information concerning, particularly in light of events like the recent tragedy involving Sunrise Propane. Since the explosion occurred at 3:40am, I can’t help but wonder if sleep deprivation played a role in this. How many large and small tragedies can be traced back to human error and how often is sleep deprivation the cause of that error?

Part of this is an individual problem, a conscious choice made by the 70 percent of people who cut back on sleep. However I feel that a larger portion of this problem is societal in nature. More and more, people, businesses, and governments are having to do more with less resources.

The most recent news regarding the Maple Leaf Foods listeriosis recall has now shifted to allocating blame to the Federal Government of Canada and to the Canadian Food Inspection Agency as reports surface indicating that the CFIA had started allowing the industry to play a greater role in the inspection process. This same ‘blame game’ was played regarding the Sunrise Propane explosion.

I don’t pretend to know the answer but in a democracy the buck doesn’t stop with the Prime Minister or President, it stops with the people who elected them. Given the upcoming elections in both Canada and the US this responsibility is something that we should all keep in mind.

Work / Life Balance. It’s a common theme in both life and writing, something that affects everyone. I recently participated in a Webinar that added some extra dimensions to this concept. The definition of balance implies that these are the only two things that you are trying to juggle. The reality is that both of these deceptively simple words encompass significantly more.

Let’s take Work for example. As much as I would like to be a full time author, I do have a full time job. In order for me to be successful, I should spend part of my time at work developing my career. So even when I’m at work, I have to worry about balancing my activities there. Training, updating my skills, networking, things that often take a back seat to just getting the job done.

Similarly in regards to Life. Such a nice, simple word but what does it mean? Well if you take away work, then in order to maintain a balance it must be everything else. 

Community Involvement, Family Relationship, Intellectual Growth, Spiritual Development, Physical Fitness & Health, Financial Security. These are the major components of ‘Life’ in Work / Life balance that were identified at this webinar.

Sounds kind of overwhelming, doesn’t it? I thought so when I first heard it and yet it also made sense.  But how many of us think about it in those terms? More importantly, what does this do to the concept of Work / Life Balance?

If Life encompasses so many other things, then it should take more of our efforts. Yet this is seldom reflected in how people live their lives. Even today, there are too many people who live to work rather than working to live. Admittedly if you enjoy it, it doesn’t feel like work. As an author I can attest to that. There are few things that can match the feeling you get when you are in the groove and the novel is practically writing itself. But it’s still work. My family is still waiting for me to get off the damn computer and I’m certainly not getting any exercise.

“No one on their deathbed ever said, ‘I wish I spent more time at work.’”

It may a cliché but sayings become clichés for a reason.

I’ve been a member of the bar at Baen and interacted with the people in the Science Fiction community long before The Gender Divide was published. I seldom have the time to visit the bar now, something that I miss. However, I have been fortunate enough to ‘meet’ many new people through the process of becoming a published author.

I’ve never actually met any of these people in person though. Through the magic of the Internet, I’ve been able to correspond with people all over the world.

• My publisher is located in Virginia
• One of my fellow authors is also located south of the border (which for Canadians means the United States, not Mexico)
• My editor lives in Japan but was stateside in San Diego part of the time while editing The Gender Divide
• The winner of the contest I was running is working in Brazil
• Many people in various forums who have residences all over the world
• Entrants and visitors to The New Covey Awards spanning more than fifty countries

The other day I had the pleasure of meeting someone face to face through an odd but serendipitous turn of events. Peter Halasz is a book collector, as well as the administrator of and researcher for The Sunburst Award. Since both of us live in the Greater Toronto Area, I was able to hand deliver an autographed copy of The Gender Divide to him, as well as provide him with the copies needed to enter The Sunburst Award. In return, he informed me of a couple of conventions held in Toronto.

This was just a quick meeting, but in a sense it was one more milestone on my journey as an author.

So to me Peter has become the face of Science Fiction in Canada… at least for now.

WARNING! This blog contains possible spoilers for The Gender Divide.

Happily Ever After is a common theme in romance novels, so much so that many of the forums and sites that discuss romance novels refer to it using the acronym HEA.

Although not a romance writer, I have to admit that I am a big fan of Happily Ever After. Part of that may be due to my personality but I also think that it’s inherent in the medium of entertainment. That element of escapism in entertainment is what makes it so popular.

Why am I blogging about this? The Gender Divide just received it’s first less than favorable review. I sent my book to Milady Insansity, a blogger who does book reviews. It appears that she didn’t care for the ending, calling it ”too ’let’s fix everything so that everybody can have a happy ending.’”

So what’s wrong with that? I watch TV, go to movies, and read books in part to get away from the realities of day to day life. If I wasn’t looking for escapism I’d just watch the news or read a newspaper. That’s not to say that everything should be easy and perfect but to me happy endings offer hope for the future.

Admittedly the last chapter of The Gender Divide appears to wrap everything up nice and neatly, but that’s an illusion. I know it, and the characters in the novel know it. In that last chapter they are celebrating the ultimate in hope for the future, as one of the characters is pregnant. If that isn’t a time to feel positive and optimistic, then I don’t know what is. Certainly the issues postulated in The Gender Divide won’t be solved overnight, and some of the solutions envisioned by the characters will likely fail or even backfire, but they, like I do, prefer to look on the bright side.

Amazon’s Kindle debuted almost two months ago to great fanfare, managing to capture the cover of Newsweek. A Google search for “Amazon Kindle” takes only 0.22 seconds to return 4,050,000 search results, although it would take you considerably longer to read them. I have only read a few of these articles and reviews, but a consensus quickly emerges that Amazon got it right in terms of Access but failed in terms of Design.

The concept of Design incorporates both the ‘hardware’ or physical design of the device itself, and the software’ or ease of use aspect. The hardware seems to get consistently failing grades. Ugly is the word used most often in the articles I’ve read, not to mention how often people complain about hitting the forward or back button accidentally. The software seems to be hit and miss depending on the user. A lot of comparisons have been made to Apple, but let’s face it - there is only one Apple, regardless of whether you are a fan or not.

To me, the Access piece actually consists of two components.

The obvious one is the link to Amazon, the quickest and easiest way to get books for the Kindle. Amazon boasts that the Kindle offers ‘instant access to more than 90,000 books, blogs, magazines, and newspapers’. Despite this, a common complaint in many of the articles is that they can’t find the books they are looking for. Obviously there is still more work to be done in this regard. This is a problem that will only be solved with time, as new books are added ‘Kindle ready’ and existing books are converted.

The other aspect of Access is the method used to obtain new books, which is a dedicated cellular connection. This is ground breaking, as it frees the book reader from being tied to a computer. Trust me, this is a very good thing. Anyone who has tried to sync up their MP3 player - or even worse a video player, as I quickly discovered over the holidays - knows what I am talking about.

Much is also made of the fact that there are no monthly fees to use this connection, as if this were a good thing.

But maybe it isn’t.

How many people pay full price for a cell phone? I know I don’t. When I need a new phone, I take advantage of my carrier’s hardware upgrade plan, locking myself into yet another two or three year contract in return for a sharply discounted phone.

Let’s apply this to the Kindle. First you have to purchase the device for almost $400. Then each book you buy costs anywhere from $5 to $10 on average. There are free books available on the web, but purchasing new books would help keep the publishing industry going and sharply increase the number of books available - basic supply and demand.

So let’s do the math. If you read one book a week, it would cost you $20 to $40 a month or $60 to $120 a year. Average the life of a Kindle at an admittedly low estimate of three years, and it works out to $1,180 to $1,960 over this time. That sounds like a lot, but if you look at it on a per book basis that only $7.56 to $12.56 per book. Not a bad deal for the convenience of carrying around a small library with you, or being able to purchase a book wherever you are (airplanes excluded of course). But that initial $400 price tag for an ugly and awkward to use device just seems painful and is a major barrier to entry.

An article on Kindle-nomics in The Library of Economics and Liberty praises the “idea of giving away the connectivity and making you pay for hardware and content”, going so far as to hope that “Amazon starts a trend in the direction of getting rid of monthly bills from network connection services.” There may be valid economic reasons for this hope, but speaking as a cash-flow driven purchaser this doesn’t work for me. I think Amazon should take a cue from the cellular providers and make the Kindle available at a steep discount combined with various data plans.

Think about it. It would be much easier to rationalize and come up with $30 to $50 a month, Amazon would have guaranteed sales for the next three years, and authors and publishers would benefit. No doubt Amazon would ding the publishers for listing their titles in Kindle format, but if people know that they are entitled to a certain number of books each month, they will be more likely to buy new books. I can’t tell you how many times I’ve stood there in the local bookstore, waffling about whether or not I should buy whatever book I’m currently looking at. With a subscription model I’d probably just go ahead and download it.

Not only that, but when you are walking around with your Kindle in hand and your best friend tells you about this great book he or she just read, you’ll be more likely to go ahead and download it. As it stands now, the Kindle makes it easy to do just that, but you still have to pay for the book. A subscription plan would make you more likely to listen to that recommendation and make an impulse buy.

I’m certainly not an expert but I am a fairly tech literate author. More importantly I’m an avid reader , the very person that Amazon is hoping to target. To me, Kindle has missed the mark.

So here’s my 2¢ worth. Hire some ex-Apple designers or Apple fanboys/girls and pretty up the device so people will want to be seen with it. Once that has been accomplished, figure out a way to either sell a subscription plan or partner with someone who already has experience in that area. Not everyone will want to avail themselves of a subscription plan, but the number of people who do might surprise you.

I recently had a conversation with my father, who wanted me to explain eBooks. He couldn’t understand how it worked or why people would want to do that.

As an author, I embrace eBooks. They allow me to reach a broader audience. Anyone with a computer, no matter where they are, can purchase The Gender Divide as an eBook and read it on their computer or eBook reader. eBooks are also less expensive, so it’s also a benefit financially. Finally eBooks are environmentally friendly. No paper or ink is needed, nor is any significant energy required for printing or distribution.

So lets see. Faster? Yes. Cheaper? Yes. Better? Hmm.

At less than 1% of the total book market, the eBook market is still nascent. Admittedly, the market is growing but that is more of a push model than a pull model. The industry is starting to push eBooks to consumers, rather than consumers demanding eBooks, so much so that many new publishers today are eBook only publishers. Few of the big publishing companies (apart from Baen) embrace eBooks but there are more than enough other smaller publishers out there to take up the slack, not to mention the burgeoning self-publishing industry.

Why is this so different from the music industry? Perhaps it relates to how the different mediums are experienced. For many people, music is something that they experience viscerally. Books are experienced intellectually. Books stimulate the imagination . Music is easily portable because you can listen to it anywhere, regardless of what you are doing. Books are different. Many readers ‘lose themselves’ in a book. You can’t do this while driving or working out.

Perhaps that is a lot of why eBooks and eBook readers haven’t become more popular. Opportunities to read aren’t as readily available as are the opportunities for listening to music. When we read, we usually read someplace we find relaxing, someplace where we can allow ourselves to ‘get lost in the story’. Where ever that place is - your favorite chair at home, relaxing in bed, sitting in the sun poolside, or even in the bathtub - it’s quicker and easier to grab a book, not to mention that books left sitting around at the beach are rarely stolen.

Once the technology matures and the price point of eBook readers comes down, eBooks will become more popular, but they will never completely replace printed books. Case in point. I provided eBooks to all the winners of my Contest. Although two of them will be receiving printed copies, I wanted them to have the eBook as an option while I wait to receive the printed copies. Despite this, at least one of those winners indicated their preference to wait for the printed copy.

So eBooks are Faster and Cheaper and they have a lot of advantages but they still aren’t Better, and perhaps they won’t ever be. After all, whether you are an author or a reader, there is nothing like the satisfaction of holding a printed copy.

You may wonder why I am posting a link to this blog entry by Mr. Modesitt. I don’t normally do this but this is something that I found very exciting.

As some of you may know, L. E. Modesitt Jr. is one of my major influences. I have a large number of his novels, starting with his Ecolitan and Forever Hero series and continuing from there. Looking at his site, the date of publication for some of these novels dates back to 1987. Given that we are now in 2007, that means that I have been reading his work for close to twenty years.

I’ve always been partial to his Science Fiction novels, as they address issues in a context that is relevant to society. So when I recently came across an article discussing plants that had been genetically modified to remove environmental pollutants, I recalled Mr. Modesitt using this concept in Adiamante. After a little thought, I emailed him a link to the article. While I did not expect a reply, given what I know about him from his writing and his website I was not surprised when I did receive an email from him.

In that email he expressed his surprise about why this has taken so long, stating:

Over thirty years ago, it was known that various plant species could remove various impurities and toxins, including heavy metals, and sewage engineers were working with such “natural” systems in lagoons to purify waste water.

I responded back to him, citing one of his earlier posts regarding Homo Irrationalis. I also mentioned the current trend of embracing technological solutions, as well as the concerns regarding genetically modified plants.

This time I was surprised to receive a reply back. In that reply he discussed the irrational application of the profit motive, something that he has touched upon in some of his novels. I read the reply and found it interesting but I decided not to respond back to him, fearing that he would view me as a some sort of cyber-stalker.

Imagine my surprise when a new item appeared in my Google Reader newsfeed for his blog with my name in it. To me, it was the equivalent of the moment when I first found out that The Gender Divide was going to be published. I know that this is silly, that this has nothing to do with me or my novel but it was very exciting nonetheless.

So here is the link to the blog entry in question. Apart from the aforementioned reference, it is, as is typical of Mr. Modesitt’s blog entries, an articulate and insightful commentary on an issue that affects us now and in the future.

 Economics and the Future of Biotech.

This is part two of an nine part blog chain posted by Mark Terrence Chapman, author the The Imperative Chronicles. The first two books, The Mars Imperative and The Tesserene Imperative, have been published, and Mark is currently hard at work finishing the third and final book.

 »»»»»»»»»»

MY LONG, STRANGE ROAD TO BECOMING A PUBLISHED NOVELIST (PART II)

By Mark Terrence Chapman

(This entry is a continuation of the Blog Chain begun on author Gabriella Hewitt’s blog. Click here to return to Part I.)

For the first few years I worked for IBM, I spent most of my time learning. By my fourth year, I’d become an expert in some areas, and people came to me for help. Later that year (1983), IBM introduced the IBM PC XT, the first business personal computer with a hard disk drive (a whopping 10 megabytes—woo-hoo!). I volunteered to be the lead guy for the support of that product, and soon came to know quite a bit about it. 

By 1984, I had transitioned from supporting the bigger computers I’d started with to PCs-only. This was when writing first re-entered the scene for me. Because so many people came to me for answers, it soon became obvious that answering the questions on a one-to-one basis was inefficient. So I began typing how-to tips and Q&As into a support database set up for that purpose. This proved popular, so I kept doing it. After a couple of years, I’d created more than 400 such support documents on a variety of topics.

Then in 1987, IBM introduced the OS/2 operating system. (Anyone remember it?) It was a major improvement in operating systems at the time (Windows was still an add-on to DOS at the time, and very inefficient and slow). Thus began the next phase in my writing career.

Two of us in the IBM HelpCenter were given the assignment of supporting OS/2. We quickly became experts on the subject. The demands on our time were such that if we didn’t have a database of answers to refer others to, we’d never have time to research new problems. So I started writing OS/2-related database items like mad. These were useful, but only the support people in the HelpCenter had access to the database. We needed a way to reach a broader audience so that people could answer their own questions without having to call the HelpCenter.

In 1989, IBM released the second version of OS/2. To me, the best new feature was something called IPF (Information Presentation Facility). Basically it was a precursor to Adobe Acrobat. It gave me a way to create online books that people could download and use locally, offline. Before long, I had converted hundreds of Q&As and tips into a series of online books. Both customers and IBMers gobbled them up and demanded more.

So I complied. I kept writing and expanding and publishing those online books (eventually totaling 12 volumes). In 1990, curious to find out how many people were using them, I took to including a survey inside each book, asking such questions as how many tech support calls a week they avoided having to make because of the books, whether they bought any IBM products they wouldn’t have otherwise, and so on. The results were staggering. According to the surveys returned (which were from a small percentage of the users), more than 2,000 phone calls a week were prevented, and more than $3M a year in additional sales revenues were generated by IBM as a result.

What does any of this have to do with my becoming a novelist? Keep reading. I’ll get there, I promise.

I submitted the survey results to my manager, who bumped it up to higher management. Later, I was told that I might have an award coming for my work. It took a year for the right people to agree and settle on an amount, but in September 1991, I received a plaque and a check for six-figures. (Okay, after Uncle Sam was done with it, I got to keep something in the upper five-figures.)

As you can imagine, this sort of recognition piqued my interest. I wondered if there was any other way I could leverage all that work I’d done. But I wasn’t sure how to go about it, or if IBM would let me.

My long journey to becoming a novelist takes a detour through nonfiction first.

Click here to read the next segment of the story, on author Joyce A. Anthony’s blog, and find out what happens next.