The right-minded are always telling us to “talk to your doctor”, and become a partner in your own treatment. Fine, but what if you can’t, because you don’t speak the same language, quite literally? The New England Journal of Medicine has an article in the July20 issue on the mischief such mutual incomprehension can cause, and on the need for skilled translators. The use of family or friends as linguistic stand-ins can be risky too, and may only make a bad situation worse. A clinician might be better off in the dark about a patient, than be misinformed by well-intentioned but unskilled attempts at interpreting by family, friends or some guy off the street. Then, too where do you stop? A program to pay interpreters in Spanish might be very useful, almost everywhere. But many people from Latin countries don’t speak or read “Spanish” with real competence. They speak local dialects and Spanish is a second language. What about Chinese? Vietnamese? Igbo? Uzbek? In New York City, maybe yes. But in Lincoln, Nebraska the number of Uzbekis is probably pretty low. I’ve never been to Lincoln and I don’t know any Uzbeks, so I’m guessing. So where do you get “qualified interpreters” and what does that mean? A Spanish major may be able to read Lope de Vega, but can s/he describe the benefits and risks of a procedure? You can put this one in the “Never happen” column. Hospitals are cutting services like mad,things like diabetes counseling, because they don’t pay,and won’t shell out for something like this. If somebody showed up who could speak expertly ten or twelve languages native to, say, three or four geographically distant areas (such as Asia and Latin America) , and who had enough intelligence and sophistication to be useful in handling medical/scientific discourse, and who would be on call, never fail, around the clock throughout the year, and who wouldn’t ask to be paid anything, well then maybe the hostpital would give him/her a “volunteer” status and a free pass to the cafeteria.Maybe. Otherwise, no.
Language Barriers to Health Care in the United States, by Glenn Flores, M.D.
NEJM Volume 355:229-231 July 20, 2006 Number 3.
PS: Before the zombies come after me, I want to make it clear that I think Dr. Flores is right But being right is often not enough.
She did, and very often too. But, it seems that the idea just doesn’t stick somehow, even, or especially, with those who should be most aware of it, doctors and other caregivers. The New England Journal of Medicine in its July 13 issue brings up the matter once again, in an article by Dr. Donald Goldmann. He states that caregiver’s failure to practice effective hand sanitation is contributing to the spread in hospitals of drug resistant micro organisms, especially MRSA. If care providers would reliably and consistently wash their hands before touching a new patient, the incidence of hospital-acquired infections would plumment, he claims. There is some heavy lifting in the article about the complexity of systems and the need for administrators to ensure that their staffs are not over-stressed, that effective antimicrobial washes are reliably available and so forth. This occurs in the explanatory context that claims treatment errors result from “systematic” or “structural” factors that can be addressed by good engineering. But, the good doctor does not lose sight of the basics: handwashing with soap and water before examining a patient is a relatively simple and quite inexpensive means of fighting the transmission of dangerous pathogens. Failure to do it endangers patients. Are you a healer or a killer? Did Semmelweis and Lister and those guys live and suffer for nothing? End of story.
Rice University Press closed in 1996. The usual congeries of factors was responsible…costs, sales, marketing and so forth. But now, like Dracula sitting up in his coffin, RUP is returning and showing some encouraging signs of life, or at least, undeadness. Let’s not get carried away here. University Presses are definintely still on the endangered species list, and they struggle against long odds. It’s an oft-told tale, so the Blogging Grouch won’t get too deeply into it, but flat or declining library budgets, plus spiraling journal subscription costs really put the squeeze on the UPs, which in many cases have to make a profit or at least break even, since their parent schools won’t/can’t carry them. But RUP redivivus is adding a new wrinkle or two. First, all its offering will be available online only. This will get them out of the trap caused by the need to sell a certain number of physical copies to break even, and do this in a very tough market. Anyone can read an RUP book online and download it for a small fee. Second, RUP will operate as a traditional scholarly publisher, with manuscript vetting, editorial services, talent hunting, and peer review. They want to avoid any hint of self-publishing or cheapo vanity press operations. Only serious scholars need apply. Third, RUP will work with CONNEXIONS, an inter-institutional educational “utility’ offering freely accessible modules and courses in varrious academic areas. CONNEXIONS is sometimes touted as a new model in competing with the established textbook publishing industry. It’s early days yet, as the Brits say, but things are looking pretty good. The BG would like to see RUP add a POD feature….publishing on demand. I don’t want to download a book. I hate reading screens, so I’ll wind up printing it, which is tedious and costs me something in paper and toner. So, I’ll pay a reasonable fee to print one from a digital source, give it a decent binding and ship it to me. Push it a little. Why not have POD installations in Tar-Mart or the public library, the way you have “take your own mug shot” photo booths, blood pressure machines and all the other gear we already are accustomed to. Only here, the product would be a warm, nicely bound paperback. In another twenty years, we will look back on these feeble beginnings and laugh at how long it took to realize the obvious possibilities, or at least you will. I’ll probably be finding out the truth of that remark by Borges: “I think that heaven will be something like a Library”. Anyway, welcome back RUP and the best of luck.
Rice University Press
All the big players…the Times, the Post, NYRB etc. do it, and we will too. They release a list of books thought suitable for readers to enjoy while on their summer vacations. Typically, the lists contain ligher fare, or works of a frankly escapist character, and the implication is that you can go ahead and reward yourself for being such a solid citizen the rest of the year by reading some trasho production you wouldn’t want to be seen with in public, if you want to retain your street cred as a Serious Person. Well, Laurence A. Marschall, writing in Natural History magazine, made the Blogging Grouch’s life a bit easier by publishing a list, with synopses, of some detective novels which showcase science and scientists. To make Coach Marschall’s cut, there has to be some real science, which actually fits into or even drives the narrative. It’s not enough to have somebody say: “Oh, that’s Pansy. She’s, like, a scientist or something”. A real mystery and a plausible resolution help too. Several of the books he features sound really good, such as Unnatural Selection with sleuth Gideon Oliver uncovering a modern day murder when one of the victim’s bones turns up in a Bronze Age exhibit. The Darwin Conspiracy tries to figure out why CD sailed away on HMS Beagle a healthy, vigorous young man and came back a physical wreck with health problems that plagued him for the rest of his life. The BG thinks that five years at sea in a very small ship, often wet, often seasick ( Darwin was a poor sailor) and cold, eating Royal Navy food, could all account for a lot of that, but why he should not recover when back home is a mystery of sorts, I guess. I remember reading something about Chagas disease, which CD might have picked up on one of his many and extended inland tours in South America. Quarry mixes geology and murder. Cold Dark Matter is set in a mountain top observatory and involves a detective whose specialty is research fraud. In all, Mr. Marschall has filled his little basket with some treats. And he has pointed out the existence of an interesting sub-genre in the taxonomy of detective stories. For more information:
Well, don’t be. At least, wait until you have read The Rock from Mars: A Detective Story on Two Planets. by Kathy Sawyer. She details the science and the politics surrounding the gradual elucidation of the mystery surrounding meteorite ALH84001, found in Antarctica in 1984. The object could claim a Martian origin, based on the analysis of trapped gases very similar to those in the Red Planet’s atmosphere. David McKay, a NASA geologist, formed a group to investigate the characteristics of the meteorite, and came up with results at the microscopic level that suggested the presence of life at some time on Mars. The McKay group were extremely careful, meticulous in their work and prudent in utterance, but the “Life on Mars” thing was dynamite, and railroad carloads of prudence could not have prevented sensationalist misrepresentation. That was bad enough, but the problems within the scientifiic “community” were even worse. Claims, counterclaims, and a rapid descent into personalities and invective soon made the poor little Mars rock look like the assassin’s pistol at Sarajevo; something that started a much bigger conflict. Much of it all got ironed out, in the time-honored way. But it all cost the McKay group plenty in terms of stress and upset. The review in American Scientist continues that publication’s honorable tradition of lengthy and informative discussions of important scientific books. The reviewer suggests that paradigm-busting is not for everyone, and that most scientists are probably better off not doing it. Even if you turn out to be right, a lot of people will call you a charlatan or a fool.
At least, that’s what the Chronicle of Higher Education says. Digital technology is generating such a mass of data that merely finding it again, much less figuring out what it all means and how it might fit into a greater interperative matrix, is getting to be a very tough job. Who will ride to rescue scientists from the threat of being overwhelmed by the data they derive from their own experiments? Librarians, that’s who. You got a problem wit dat, as the expression goes? The Chronicle piece, written by Scott Carlson,says: “librarians will have to step forward to define, categorize and archive the voluminous and detailed streams of data”. Librarians at Hopkins, Purdue and UCSD are already moving into the gap to see what can be done. Some of the efforts are interesting and seem promising. At Hopkins, librarians are working with astronomers, attempting to create an archive of the images created from the scans of the night sky. These are important, because comparison of images taken over time is crucial to discovery. Purdue librarians are striving to create and apply metadata to the various records stored on faculty computers, or deposited on the TeraGrid, a large scale, university based computing project. This distributed approach is a departure from previous positions, which all more or less envisioned some kind of super-archive or data library, in the form of a centralized facility. But the Purdue group is doubtful whether the funding for such an approach can be found and guaranteed over time, especially once administrators figure what the costs would be. There are other problems… such as getting academics to part with the data in the first place, or agree to do something with it other than discard it, once the papers have been accepted and published. This apparent insouciance on the part of scientists to the fate of the data they create is even more upsetting when Carlson notes, quoting Chris Greer, an advisor to the NSF, that many contemporary research projects are born from imagining new uses for data created by somebody else in some other context. It seems to these old eyes that too many people have been ducking this question for too long, and a situation has emerged which may be beyond redemption. I’m the last one to knock librarians, but what, exactly, are they supposed to do? In the time it takes me to scratch my nose, another avalanche of data has fallen from sensors of all sorts onto recording devices of all sorts. Who did the work? Why? How? Can anybody remember? The implications are really upsetting. Even the projects that are mentioned in Carlson’s article seem quite daunting. Librarians can’t do this on a part-time basis, and lots of academic librarians are entering the retirement/death bracket, with fewer replacements in the pipeline. We may be entering an era in which we get ever better informed about the world, for about five minutes, and become ever less sure what we know. Retirement is sounding better and better.
Lost in data
The Association of American Publishers (AAP) has issued a statement detailing the objections it has to Senate Bill 2695, also known as the Federal Research Public Access Act (FRPAA) of 2006. AAP’s objections were pretty much those that have been aired before in this context: Federal intrusion in an area which is doing very nicely, thank you, and don’t need no gummint intervention; costs to the taxpayers will be high, the burden on publishers crushing, and the End of Civilization As We Know It is right around the next corner. No librarian will take seriously the breezy assurances about how nicely everything is running. Publishers are anxious to protect toll access, which is the basis of their very, very handsome profit statements. Anything like FRPAA is obviously a threat. In the past, I would have shoved all the chips onto whatever square the AAP was betting on, but now I’m not so sure. This time around, AAP and associated interests are facing a new dealer and a new hand. It’s interesting to note that FRPAA arose in the Senate, where the compromises (or sell-outs, depending on your perspective) with a much tougher House bill were made last year. Voluntarism has not worked well enough, and everybody on the Hill sees this as either real trouble or an opportunity. Who in Congress wants to be seen as opposing public access to research that might eventuatally result in cures for Alzheimer’s, Parkinson, Cystic fibrosis, solutions the energy crisis, global warming and on and on? Nobody. Publishers will also have to face the “equity/justice” argument that many people find persuasive: we, citizens, paid for this once already. Why should we pay again?” We can expect AAP and friends to do their utmost, but it may not work. A compromise was fielded last year, and it pleased nobody. This year the stakes have gone up and the wiggle room has disappeared, very largely. For what it’s worth, I think FRPAA is pretty weak in the details and vulnerable on a number of practical issues. But the question of principle has already been decided. Publishers better get their ox ready for a major goring.
The Institutional Review Board (IRB) was introduced into research activities in the USA as part of a set of measures designed to ensure the safety and ethical treatment of patient volunteers participating in trials and experiments. A fruit of the 1979 Belmont Report on the protection of human subjects, the IRB structure has worked very well. Now, however, some observers are claiming the the IRB is, in a way, a victim of its own success. These critics claim that IRB’s increasingly are being asked to supervise matters which have little or no connection to human research subject protection. As a result, IRB’s are spending more and more time meeting to consider matters which are important, but far from the area of concern the IRB was created to address. The documentation burden and the attention to procedures and protocols is sapping the effectiveness of IRBs, which were supposed to give mature, reflective opinions on whether certain suggested research projects should go forward or not, and if they should, how they should be supervised. A group from the University of Illinois, Champagne-Urbana, published an article in Science outlining their view of the current situation of the IRB and suggesting some improvements.
PubMed has established itself as a major searching service for health science investigators and clinicians, since its version of the MEDLINE database is available on the web at any time of day or night, at no charge. The National Center for Biotechnology Information (NCBI) has steadily improved the system over the years, but recently the pace of innovation has quickened. Major changes have been introduced, especially in the manner in which searchers can set limit elements, such as language, age group of subjects, and year of publication. A new display format called “Abstract plus”shows the searcher the narrative abstract of the original articles plus abbreviated citations to the first five references in the Related Articles array which accompanies each PubMed record. NCBI’s managers are determined to help the PubMed searcher derive as much information from searching sessions as possible, in order to help biological discovery. The new features in PubMed are discussed in the New and Noteworthy section of the service’s web page.
New at PubMed