Today’s Calcutta Telegraph carried a nice review/summary of The Body Hunters, published in India by Pearson. I’m thrilled that the Indian press is covering the book, since I did much of my reporting from India, where there is a real problem with unethical clinical trials. Check it out at: http://www.telegraphindia.com/1080328/jsp/opinion/story_9059631.js
The Sepia Mutiny, a very witty blog run mostly by second-generation Indian Americans (like myself) posted a lovely piece about my involvement in CRUDE (the movie) and CRUDE (the book). I’d never read Sepia Mutiny before so took the opportunity to browse and laughed out loud several times. I doubt I’m hip enough to write for them, but knowing they exist makes me happy. If only such things were around in high school…! See http://www.sepiamutiny.com/sepia/archives/004996.html#more The History Channel is re-airing CRUDE on Friday Feb 22 at 8 am. You can also watch it online here.
Crude: The Movie! A few years ago, a documentary fillmmaker from the ABC in Sydney (that’s the Australian public television network) spent a day with me in Boston, talking about oil politics. His film, which he dubbed “Crude” (after kindly discussing it with me), came out in Australia a few years ago, and won a slew of awards. It has some amazing footage in it, the least of which are some clips from that day in Boston with me. (A film crew followed me around at the grocery store while I pretended to shop. Slightly embarassing.) This Sunday, the film airs on the History Channel here in the US. The New York Sun previewed it and mentioned the appearance of yours truly: “The investigative journalist Sonia Shah,who wrote the equally sweeping 2004 book “Crude: The Story of Oil,”lends an ever-so-slight analytic edge with trenchant demonstrations of oil’s inescapability: Plastic-wrapped supermarket veggies from distant farms, for example, pack the double whammy of petroleum-based packaging and gas-guzzling truck transport.” The film CRUDE airs on the History Channel on January 27, 2008 at 8 pm.
In a couple weeks, I’m off to be a guest-in-residence at University of Illinois in Urbana, Illinois. The program that invited me is called Unit One, an educational model established in the 1970s. Basically, some 650 students live, eat, and learn together within the confines of a single facility on campus called Allen Hall. And then they invite journalists, filmmakers, and others to hole up in an apartment in the hall and give nightly presentations about their work. Apparently the fillmmaker behind Hoop Dreams gave a yoga workshop! Not me–straight up lectures, plus film showings and Q&A. I was pleased to learn that all the events in the hall are open to the public. More details here.
Well, kind of. The OHRP shot out an email responding to Gawande this week. They say that the “program” was actually a research study,the results of which were published in the NEJM. That is, the peoplewho impemented the intervention didn’t actually know whether it wouldwork or not. Maybe the patient would start seizing on the table whileall the staff were huddled over the checklist, ticking boxes. Whoknows? With that kind of uncertainty, surely patients had a right to beinformed and consenting. And yet, the researchers had gotten no ethicscommittee review (IRB) or their subject’s informed consent. But that wasn’t quite it, either. The “study” had no control group,because nobody wanted to NOT use the checklists. In other words, theerstwhile researchers felt they knew that it WOULD work. In which case,they were simply trying to improve patient care with a provenintervention and no IRB or informed consent was required. So was it really a “study” or was it actually a “program”? Did they know it would work or didn’t they? How confused were they? Well, in the actual doing of the thing, the clinicians conductedthemselves as if it were a program of improved care, but then when theywrote up their results in the NEJM, they cast their work as anexperimental ‘study.’ That’s not right, either: you can’t have it both ways. Someonecomplained to the OHRP, which opened some kind of investigation, whichthen led to Gawande’s complaint, and a flood of angry letters to theOHRP. Phew! All of which is to say: there’s a shifting line between what we say weknow and what we say we need more research on. When there’s somethingwe want to do, when there’s political will and money to do it, wedispense with “research” quickly and move on to implementation. Inother areas–say, the administration of expensive drugs to poorpeople–there are endless calls for studies and experiments to provethe same thing over and over again, putting subjects at some risk everytime, because intransigent authorities (drug companies, healthministries) find it politically more expedient to say “we need moreresearch” instead of “sorry, no” (or “absolutely not, who cares aboutpoor people who don’t buy lots of stuff.”) Fyi, these were the checklisted items, as reported in the NEJM, used inthe ICU on patients with catheters: hand washing, using full-barrierprecautions during the insertion of central venous catheters, cleaning the skin with chlorhexidine, avoiding the femoral site if possible, andremoving unnecessary catheters. The implementation of these procedurescoincided with a precipitous drop in the number of catheter-relatedinfections, but without the control group, no cause and effect can bedetermined, at least not by this study.
Today I randomly came across a long thoughtful pieceabout an essay I wrote over a decade ago…about the issues thatoccupied me for the first five years of my writing life–biculturalism,feminism, and sexuality. Who knew those old essays were still makingthe rounds? Canada.cominterviewed the curator of a new exhibit on energy and oil, who verykindly mentioned my book CRUDE as one of 2 interesting books on thehistory of oil….the other being Yergin’s The Prize! Good company.Thanks for that.
I’ve spent the last month putting together material for a new websiteon the topic of my next book: resurgent malaria. MalariaResurgent.comwill be a provocative, opinionated take on humankind’s oldest disease,why it still plagues us, and what can be done about it. There’ll bestories, history, videos, and most of all, conversation. The site shouldbe live soon after the New Year. Stay tuned for more…
I’m thrilled to report that the Body Hunters has been translated into six languages, besides English (Japanese, Italian, French, German, Portuguese, Korean.) The French edition, in particular, appears to be making a splash. It’s been selected a “book of the month” by a prominent popular science magazine, and was covered in the French version of Time magazine, “Le Nouvel Observateur,” along with coverage in the dailies and national radio. I find this interesting, given that the French actually have some of the very best laws protecting clinical trial subjects in the world. Could reader interest in this topic be viewed as some version of rubbernecking? Perhaps so.
Inhaled insulin: Here’s a great illustration of how disconnected the drug industry has become from public health….or even individual peoples’ health. When I went to a industry conference a few years back, Pfizer execs were gloating over their great new experimental product, a form of inhaled insulin. The drug was still in clinical trials–meaning they couldn’t have known whether it was truly safe and effective or whether it was any better than injected insulin–but they were certain that it would be a blockbuster. Because, of course, whether the drug was effective or any better than what we already have was irrelevant. Inhaled insulin is a great idea, in principle, and the obvious plan was to harangue patients with marketing so they’d switch to it on that basis alone. Well, Pfizer’s drug, Exubera, was a bust. They “only” sold $12 million worth of it, and so now they are going to stop selling it! First it was the best thing since sliced bread, but now…since they aren’t making the billions they foresaw, they’re dumping it. So much for those users who did switch and actually liked it. They’re screwed. Basically, the drug was a bust because it was no better than injected insulin and on top of that, it messed up patients’ lungs. A total disaster. Now, a new company called Mannkind, backed by a billionaire investor, is launching a new inhaled insulin called Technosphere Insulin, similarly gloating–while the drug is still in clinical trials–that they will make billions on the thing. The New York Times business section featured their glossy PR in an article this morning, replete with a large pic of the billionaire investor looking smug in his grand digs. He might as well have had dollar signs tattooed on his eyeballs. Buried near the end of the story we learn that–already!–more patients taking the inhaled insulin have dropped out of clinical trials than patients taking the old standby, injected insulin! “For reasons that are not yet clear”! Well, there can’t be any reason, in my mind, that doesn’t bode poorly for the inhaled insulin. They didn’t like it, they had adverse effects, or whatever. And, the chief medical officer has accused the company of hiding information about the drug from the FDA! The company, in response, fired him. But we’ll never learn about the dirt he found because his wrongful termination suit has been settled out of court! This thing seriously stinks. And it is all the more remarkable for the fact that all of this dirty laundry about the drug is tucked into what is overall a glowing business story. Check it out: http://www.nytimes.com/2007/11/16/business/16mannkind.html?_r=1&oref=slogin
The New York Times ran a piece on distributing insecticide-treated nets for malaria today. It is an old story. There were long and tedious workshops on it at the last malaria conference I went to in Cameroon two years ago. I agree that bednets should be considered a social good, but it isn’t right to assume that every net distributed is a net used (and a life saved). It may be true that the very poorest don’t buy nets, but it is also true that many people (rich and poor) don’t use free nets, either. It isn’t just a technical problem of distribution, there are larger cultural, economic, and health issues. When I went to Cameroon, I visited villages where ExxonMobil had said it had distributed thousands of free nets; and yet the people I met at the malaria clinic there said they didn’t know a single person who actually used one. I got the same response when I asked people at a malaria clinic in Malawi, and in Panama. They said the nets are hot, that people have different priorities (like using the netting for fishing, wedding veils, curtains), that the nets get holes in them, that malaria isn’t taken seriously enough, and so on. It sounds nice for donors to be able to say they distributed lots and lots of free nets (marketing the nets is slower), but they should also track how many people actually use the nets.