Monday, June 30, 2008

We have summer reading! Again! As BH, who is in math grad school (taking classes like "topological algebra" and "partial semi-differential hand-waving") said when I told her: "Buh?"

Last year's summer reading was on The Spirit Catches You and You Fall Down, a rather sad story of cultural clashes. It frustrated me no end, which I suppose was the point. We were supposed to discuss in small group but never actually got around to it, so my understanding of cultural competence, $60k later, is not really much better than what it was around this time last year. (I do, however, have a much better understanding of rotation of the gut, for what it's worth. Everyone has situs inversus.)

This year's summer reading is Mountain Beyond Mountains, Tracy Kidder's biography of Paul Farmer. I'm holding off judgment until I actually receive it (could be a while, given the Fourth of July shipping delays), but it should be an interesting read, if nothing else. I'd like to do international work eventually, and Dr. Farmer's kind of a Big Deal in the global health arena. It is gratifying to see that idealism can actually work.

Thursday, June 26, 2008

Slow day at work?

I've settled into a bit of a summer routine by now. Up at 6:30, out of the house by 7:15. I carpool with my parents, who drop me off outside their office and I walk across to my own. I usually get there well before the office opens, so I duck into a Borders across the street and read till 9. (Currently working on Kate Atkinson's Behind the Scenes at the Museum; highly recommended to anyone who liked Middlesex.)

I go to a lot of Congressional hearings. They are becoming a commonplace now, but when I stop and think about them, it's really a remarkable experience. I always seem to arrive just after a tour group of obese Midwesterners; that's summer in DC for you. After I shuffle out of the oppressive humidity (the city retains the atmosphere of its swampy origins) through metal detectors, I head up a marble circular staircase to whatever committee room the hearing will be in. There's usually a long line for the public; often I have to stand in the back or along the sides. The committee sits at a large dais, Democrats and Republicans on either side of the chairman's throne. Witnesses sit facing the committee at a long table, with microphones and water glasses. After opening statements by committee members and testimony by witnesses, the fun part -- the questioning -- begins. I've seen committee members rip into witnesses, and you can really tell when someone loses their cool or has been "rehearsed." The whole thing takes an hour or six. Then I go back to the office and write up a summary for whoever is in charge of that issue.

What has struck me most about these hearings is the almost total lack of clinical representation. Since these are mostly Health subcommittee hearings, the witness panel usually includes a physician, but generally a researcher rather than a clinician. Lots of MPHs, lots of PhDs. It's a little surprising, given that members of Congress appear to respond better to "clinical vignettes" about anonymized children than statistics about disease prevalence. So why not bring in the people who actually care for these kids? Demands of the profession? Less experience with law? 'Tis unfortunate, because it means that Congress is dictating from on high with very little input from the people who would actually be affected by this legislation.

Grassroots stuff -- letter-writing and phone calls and petitioning -- can work, but there's nothing as effective as sitting in front of ten or fifteen Senators arguing your case.

Wednesday, June 4, 2008

Today for work, I went to scope out the "Green Our Vaccines" autism awareness rally on the steps of the Capitol. A little background: In spite of repeated scientific evidence disproving the purported link between autism and vaccinations, many parents still blame the vaccines for the devastating condition their family has to live with. Thimerosal, a mercury-containing preservative in MMR and other vaccines, has been targeted in the past. Thimerosal was removed as of 2001; autism incidence rates continued to rise. (Now it appears that aluminum is the fashionable suspect, but that's another story entirely.) As I am interning at the American Academy of Pediatrics, they asked me to go over and see just what was going on.

I expected a lot of rhetoric and a lot of emotion at this rally; that was kind of the point, after all. The speeches took a two-pronged approach: "We are not anti-vaccines, we just want to spread them out more" and "There is a big government cover-up."

The cover-up allegation was really not so surprising -- as the saying goes, you can't spit in DC without hitting either a lobbyist or a conspiracy theorist -- but what really struck me was that they had expanded their conspiracy net to include Big Pharma, the media, and physicians.

Here's the clincher: Robert Kennedy, Jr. stepped up the microphone and rehashed a article of his, in which he completely misrepresents a CDC conference in 2000. Skeptico does a solid analysis of the article. In his speech today, RFK Jr went over the same old points: that everyone is sleeping with everyone else and the pillow talk is all about how best to screw over the American public. He then "quoted" from the transcript of the CDC conference with one of the participants, whose name I didn't catch, saying "There is no way to massage the data to eliminate the link [between vaccination and autism]."

Whoa! I thought. That's some damn serious accusation, Senator. That's fraud. So when I got back to the office, I did what any self-respecting scientist would do: went back to the source. In this case, the transcript of the Simpsonwood conference. It's massively long, so after the first ten or so pages, I took advantage of the Handy-Dandy Finder in Adobe Reader and looked for "massage."

No hits. So how's that for fraud?