The Thesis (5 of 7)

A tome well over an inch thick, there we are on the cover as “associate members” of the jury.
Thumbing through it before bed, I see the example pedigree I sent Jamal last week, along with my explanation, word for word. This makes me wonder how much of the rest of the text its author understands. I might read and nod ‘yes, that’s right’, and the student has no clue after all. .
That might in fact be the case. There are a lot of telling mistakes, more than you can just attribute to awkward phrasing. In a section on the epidemiology, the author states that the average age at breast cancer in Algeria is 23.3 years old; that in France 91.1 years. This is obviously not true. Those are the standardized incidence rates from 2001, meaning 23.3 (or 91.1) cases per year per 100,000 population. A typo? The whole paragraph concerns age, so I don’t think so.
What the student has done for her medical thesis is compile all characteristics of 31 of the cases they sent us. That takes up quite a lot of space, because each parameter is both stated in the text and repeated in a table - even if all the cases are in the same category. And we get both the fraction of 31 for each parameter as well as the percentage, calculated to two decimals.
I hope to find in here whether the cases we’ve studied are like the French (because the rates of mutation discovery are the same), or like the Algerians (because the lifestyle is similar). First good thing, all 31 cases here are breast cancer patients. Next thing, they resemble the Algerians overall. So the data is in there. Excellent. It isn’t arranged in a way we can publish, but that should be a question of reorganization. I hope.

All these criticisms are my Western world-view showing through. The Moroccans are starting from nothing. They’re not even set up to extract DNA, let alone analyze it. The genes and mutations I talk about are utterly theoretical to them - I can’t expect them to be expert on the details. It’s actually fabulous that they are interested in getting something going for preventive breast care. They want to learn. They do everything they can to get over to Europe, or the US, to learn.
Putting that learning into practice, however, is another matter. Morocco is dirt poor. Yes, there are some incredible palaces, and an emerging middle class, but on the whole it’s more or less a third-world country trying to pull itself into the 21st century by its bootstraps.
Take every woman at high risk of breast cancer and give her an annual mammogram by a competent radiologist? Only the top few % can afford it, and health insurance is not widely available to the masses. Forget about bi-annual screening for everyone. Switching to MRI’s rather than mammography is just pie in the sky: I’m not sure there’s a single MRI machine in the whole country, much less one available for routine screening of millions of women.

So I have to consider where this thesis is coming from. It isn’t from one of my students, and I need to keep that in mind. At the same time, a diploma is meant to mean that one has acquired a certain body of knowledge, and it’s no favor to anyone to hand degrees out for free.

At the defense in the morning it’s not the kind of thing I’m used to, of course, even though much of the structure is there. The student gives a 15-20 minute talk. The various jurors hold forth on their domains of expertise, offering congratulations as well as criticism. Then the jury retires to deliberate on the “mention”, the grade if you will: Honorable, Very Honorable, Stupendously Honorable, etc. We get to sign all manner of forms. We even get to wear voluminous crimson robes with huge sleeves. What’s different is that, while I can ask questions, they aren’t answered by the student.
?huh?
Whose thesis is it?
No, the person who directed the thesis answers the questions. A rather paternalistic system! The student just stands there at the podium, which is off to the side, while the jurors debate among themselves at the table. Because we’re looking at each other during all this, which takes far longer than the presentation did, we’re not ever looking at her. It’s as if she were just decoration.
One thing I was hoping for here was to see at last the pedigrees of the families under study. It’s my boss who brings it up; we really can’t let it go. The whole point of this thesis is to analyze the cases under study, and this she has done every which way except showing us the reasons for them being included, their genetic risk. Every treatment, every parameter, every detail of the reproductive history of 31 cases are here. Add the 31 pedigrees, and OK for the diploma.

Organized as my lab is, this would be the work of a day. In fact, it would have to be done before anything else, because how else can you decide who to study? In Marrakech, I fear, it could take a while.
In fact, I discover the next day when we meet as a small group, that while the age at diagnosis of each case is known, and there are scattered notes as to other cases in the family, nothing like complete pedigree information has been collected. She’s going to have to recontact every single case and collect that information from scratch. A task indeed. I just hope I have made it clear enough that we need to know who is not sick as well as who is. We’ll see. I’m available for advice, and their new geneticist knows her business. We’ll get this thing out, pronto.