Map of life expectancy at birth from Global Education Project.

Monday, August 27, 2012

In the interest of full disclosure . . .

I personally have a great deal at stake in the November election. But I hope you'll agree that what's at stake for me matters to you also.

If you missed getting a Stayin' Alive post on Friday (and I know the national disappointment was palpable), it happens I was in an all day meeting. Or rather, more like a seminar. We invited colleagues from other institutions to come to the pathetically tiny state of Rhode Island for an interdisciplinary brainstorming about new approaches to the study of effective clinical communication. I'm talking computer science, psychology, sociology, mathematics -- how can we learn how doctors and patients can understand each other better and make the right decisions for each patient, from the patient's point of view.

I'm also working with a colleague at another institution, who is a pediatric oncologist, on a study of pediatric hematopoeitic stem cell transplant, more commonly known as bone marrow transplant although that's really a misnomer. These are kids with leukemia that doesn't respond to chemotherapy, or other serious blood disorders, who have their own immune systems intentionally wiped out and replaced by blood-producing stem cells from a donor. It takes six months to a year for their immune systems to reconstitute, during which time they and their families must follow impossible infection control protocols. The child can't be in crowds - no movies, no birthday parties, no shopping with Mom; the family must follow stringent kitchen hygiene and food handling protocols; no swimming; no playing in the dirt; nobody who has the sniffles can visit; no playing with the dog; no deli meat, yogurt or blue cheese, soft boiled eggs, or raw seafood; and on and on.

Believe it or not, nobody knows how families cope with these requirements or even how well they understand them. A lot of the kids die and we don't know how much failure to follow these guidelines has to do with it. So we want to study that, for the first time.

The problem is, if the Republicans get control of the government, they have promised to make drastic cuts in domestic discretionary spending. In case you think that consists largely of free money for dark-complected deadbeats, you are wrong. Try, for example, the National Institutes of Health, which already has a budget which is the lowest it has been since 2001, in constant dollars. Right now NIH is funding only about 7% of all new grant applications. Because most of its money is already committed to 2, 3 and 5 year projects, if it's budget is cut, it will be unable to make any new grants at all for at least a year, and very few after that. Ergo, I will be unable to do any of this work.

You may not care about me, but you probably do care about making medicine more efficient, and more responsive to patient needs. You probably care about really sick kids with cancer not dying. Unless, of course, you are a disciple of Ayn Rand like Rep. Paul Ryan. In which case you should vote Republican.


Anonymous said...

How can medecine become more effective in the present, and set to continue, US Corporate-fascist system?

How is the US maintaining its ‘advance’ in medecine, social/other ‘soft’ science?

Does it want to?

Kids dying of cancer garner much sympathy and are deserving of research efforts.

But ... 20% or so of children in the US live in conditions of poverty that are so severe that they impact their future, be it thru lack of med. care, bad nutrition, sub standard help or parental care, housing in environmental conditions that are so poor they are dangerous, plus potential abuse/violence, at home or on the street on in school.

Not to mention the lure of gangs (a kind of opposition), drugs (a way of making money or escaping), crime (grandstanding, getting creds), early motherhood (a reason to live), etc.

Nowhere in the OECD or even in many other countries do babies and children have it so bad.


Cervantes said...

Ana, you are as always correct. One of my goals, as I think is clear from my posting on this blog and the mission statement, is to promote public health, and public health is inseparable from justice, and from respecting and valuing all people. Medicine is not the most important determinant of health, but making it more just, more efficient, and more responsive to each individual, is part of the overall program of justice.

Anonymous said...

Oh I know C and I wasn't being critical...just sayin' ;)