A Break Today

Here's me in a virtual operating theater on the University of Washington medical campus performing a brain examination on a patient I'm about to send into cardiac arrest.

I'm taking a break today from my usual blogging to reset my brain after four days of the Association of Health Care Journalists conference in Seattle. One of the reasons I went there was to expose myself to health issues outside my usual mental health beat and to learn from the people who cover these issues. Just to give you some context, immediately prior to the virtual operating room visit, I was in a lab with top TB and malaria experts. Immediately after, it was the wonders of long distance medical operations over the internet with robotics and functional robotic hands to attach to patients.

There was also lots of stuff on general health issues, such as universal health care coverage and how the environment (which means whatever life throws our way) impacts on our health.

Trust me, every little thing I picked up from the conference gave me new perspective on the issues I cover here at "Knowledge is Necessity" and mcmanweb.com. TB and malaria may seem a long way from mental illness, but I came away with valuable insights on medical research and drug development that would have eluded me otherwise. On and on it went.

Also, I learned a lot simply by hanging out with fellow health journalists. These are people who provide a very vital public service under extremely challenging conditions. Their role generally goes unappreciated, but when you read about how doctors are performing unnecessary liver transplants or that statins may bring down cholesterol but don't actually significantly reduce heart attacks or what a family with a kid with bipolar has to go through - well - you are finding out only because a journalist has bothered to dig out the facts in the first place and report them in plain English. (These were actual stories that received top awards at the conference.)

Anyway, barring something unforeseen, I'll be at the next AHCJ conference.

In the meantime, back to pretending I'm working ...

Tooting From Seattle: Conclusion

Six AM, Sunday Morning: Surprisingly, I’m awake. I wound up in the hotel bar last night with some fellow health journalists. I was the quiet one in the crowd. What is wrong with this picture? (That was a trick question, by the way.) Anyway, more “toots” from the Association of Health Care Journalists conference:

Early Sat Morning: A session on autism. The reason this illness is on the agenda has to do with the considerable media coverage over the years regarding whether vaccinations cause autism in kids. The expert panel informs us this is not the case. The jury is in, the panel informs us, in the form of at least six studies. No causation has been found. Paul Offit MD of the University of Pennsylvania, vaccine expert and author of “Autism’s False Prophets,” reminds us that with scientists in virtual unanimity, the issue can hardly be written up as a “controversy.”

I experience a flashback to the less-than-stellar reporting in the NY Times two years ago in a series of articles similarly describing early-onset bipolar as “controversial” (as if it could be argued that these kids’ behavior were normal, that they were the victims of bad parenting, and that certain researchers in cahoots with Pharma were disease-mongering). Don’t get me started ...

Ignore that last sentence. At lunch, the AHCJ awards Mary Carmichael of Newsweek first prize in the large magazines category for her terrific story, “Growing Up Bipolar.” Had she been in attendance I would have given her a hug. But I’m getting ahead, and I’ll save this for another blog piece. Back to autism ...

Parent advocate Alison Singer informs us that the media has been pitting parents against science, which is “not so.” The studies have been done, she lets us know. “The questions have been asked and answered.” Scarce research money, she concludes, needs to be applied to searching for the underlying mechanism of action for autism and its treatment, not in yet more vaccine investigations.

Late morning: I wander into a sparsely-attended session on “healthy environment,” expecting something along the lines of clean air and clean water. But what the panel means by environment is exactly what the brain science researchers mean by environment - namely, anything out there that impacts health.

Stephen Bezrucha MD of the University of Washington lets us know that mortality rates in the general population actually go down during economic hard times. One reason, he said, may have to do with people having more time to connect with their friends and families.

Naturally, this raises the whole stress-mental illness issue, together with whether work is “tonic or toxic.” Well, actually, I’m the one who raises the issue at question time.

Brief sidebar: In two sessions from Friday, at question time, I mention in passing my diagnosis (as it happened to be germane to the discussion). So for two days fellow journalists are coming up to me and congratulating me on my courage in disclosing.

I feel a bit awkward about this. I’ve been “out there” for 10 years. It’s not like I had been agonizing over the last few days on whether or not to come out. But the conversation serves as a forceful reality check. Our population has good reasons for not disclosing. The stigma out there is fierce. I’ve created a comfortable world for myself as a bipolar “expert patient” journalist. But the world that my fellow patients deal with tends to be a lot harsher. I’m supposed to know that, but how easy it is to forget.

Back to “tonic vs toxic.” Michael Hayes PhD of Simon Fraser University reminds us of the famous “Whitehall Study” that investigated British civil servants, which found that those high up the managerial food chain - in “high control/low demand” - positions fared a lot better on just about all health measures than the worker bees in “low control/high demand" positions.

Lunch: Oxymoron time. I’m rolling in the aisles listening to a “funny economist.” Uwe Reinhardt PhD of Princeton flashes a slide of a confused Alan Greenspan juxtaposed with “Atlas Shrugged,” and I’m experiencing a Seinfeld moment (think Kramer’s famous one-liner in “The Contest”).

As a financial journalist, I used to write that economists were full of crap (but was never smart enough to prove it), so it’s reassuring to hear one of the world’s leading economists enthusiastically own up to the fact that “my profession has been a complete and total failure,” that “what we say adds up to zilch,” and that economists “build models that only make sense on the planet Vulcan.”

A very sizable percentage of my fellow health journalists have either been business/finance journalists or currently are, so the aisles are clogged with rolling brethren. Health care is as much a business and economics story as it is a medical and health story. Virtually all of us are straddling two fields.

As if to reinforce the point, one of the afternoon sessions involves statistics.

Late afternoon: A panel of AHCJ award winners share with us how they researched and wrote their prize-winning stories. Their presentations amount to mini-masters classes in rooting out hidden information and activity and exposing it to broad daylight. These are extremely hard times for the journalism profession. Even in the best of times, you have to be crazy to enter the field. But listening to the presentations, I am experiencing an outbreak of “rational.”

Yes, I reflect. Now I recall why I became a journalist. I’ll leave out the preaching. You fill in the blanks.

Sunday Morning: Plane to catch. I’m outta here ...

Tooting From Seattle: The Sequel

Friday evening, 9:15 PM: I’m back in my hotel room after placing my aching lower back directly in front of a blasting hot tub jet. It’s been another long day at the Association of Health Care Journalists conference. I’ll wind down for about an hour, and then, to bed ...

But first more “toots” from Tooter:

Thursday Evening: I wrap up yesterday’s blog piece and head down to a conference buffet social. There must be 300 journalists in the room, which is a scary thought only if you don’t know that at least half must be “a little bit” bipolar. Crazy goes with the territory. Seriously, no sane person would ever choose to be a journalist. I grab some food and in nothing flat I’m right at home.

Friday Morning: I head for a session on reporting about disasters. A spokesperson from the Dept of Homeland Security and the local port security director are on the panel. I’ve never been an “on the spot” reporter, but with mental illness location and time are no restrictions. A disaster in Florida, for instance, may cause extreme distress to someone watching it on TV in Kansas, who may not realize something is wrong for another six months.

Later Morning: My second session is on mental health. About 50 other journalists are in attendance. I say hi to Randy Revelle as I walk in. We’ve run into each other at two DBSA conferences. Randy is a prominent area politician, openly bipolar, and was the driving force behind mental health parity in the state of Washington. State parity laws, he said, can only apply to about a third of the people who need coverage. You need a federal law for the other two-thirds. Problem is, he says, the legislation that became law last year is riddled with exemptions and loopholes.

Elizabeth McCauley PhD of the University of Washington talks about adolescent mental health. We used to think that the brain was set for life at ages 3,4,5, she relates. Now we know that “everything changes” beginning in early adolescence. This is the time expectations ratchet up, along with increased risk-taking behavior, plus depression, bipolar, and schizophrenia start rearing their ugly heads.

Meanwhile, the brain is laying the foundation for more sophisticated executive function and problem-solving skills. This includes the completion of brain cell genesis, newer myelination, and dendritic pruning.

Jennifer Stuber PhD of the University of Washington talks about stigma, and how the media can report stories that do not play into the public’s fears and misconceptions. I’m heartened by the high level of questioning from the audience. All the reporters here want to do their job better.

Lunch: Sen Ron Wyden (D Ore) is the speaker. He has 14 senators from both sides of the aisle signed on to a bill that would combine private and universal healthcare into a multi-payer system. It you take the $2.5 trillion US taxpayers currently spend on medical treatment, he said, and divide it by the US population, you would be able to hire a doctor for every seven families.

The biggest challenge for reform, he said, is to unpack that 2.5 trillion and redeploy it.

Sen Wyden is addressing a very tough audience, hard-boiled health journalists who have heard it all, but I see lots of pens scratching across lots of notebooks. Lots of nodding heads and knowing smiles. The Senator is clearly making a very good impression.

Late afternoon: A nice long walk along Seattle’s harbor front, a cheeseburger in a local dive, and back to the hotel for a soak in the hot tub. To bed ...

Tooting From Seattle

My second “Tooter” installment, with more “toots.”

The present, 6 PM, Thurs: Just woke up in my hotel room from a much-needed nap. To recount:

Yesterday, 3 PM: On the airport shuttle headed into Seattle, I meet two journalists headed for the same conference I will be attending - the Association of Health Care Journalists conference - and a Biblical Studies teacher. Somehow, talking about journalism fits right in with the Bible, not to mention mental health. You have to be crazy to be a journalist - we’re simply recycled Biblical Prophets living out of time.

3:15 PM: I ask the other two health journalists what is the big story on their beats. Without hesitation, health coverage. Twenty-five percent of the people in the state of Texas are without insurance, Jason from Dallas tells me. Add to that all those with crappy coverage, I reply.

3:20 PM: I’m just getting going. You know, I say, some people from Canada may opt to get operated on in the US, but you never hear any serious conversation in Canada along the lines of: Let’s switch to US-style health care. You never hear in New Zealand: Let’s switch to US-style health care.

Don’t get me started.

Today: 6 AM. I get out of bed to answer my wake-up call. Suddenly, I realize I executed the maneuver without my lower back screaming out in pain. Then, on cue, I feel moderate pain. I can work with that.

7 AM: I register for the conference. At the table, I run into a journalist I met at the American Psychiatric Association annual meeting three years back. Over breakfast, he tells me of a cardio conference where the attendees were eating cheeseburgers.

8:30 AM: 40 or so journalists take off on a bus for a day-long field trip.

Fifteen minutes later: We get out at the Seattle Biomedical Research Institute, a nonprofit organization with Bill Gates and Paul Allen money in it. Among other things, the Institute is working on vaccines for TB and Malaria. Unlike Big Pharma, this is “discovery-based,” research moving toward “translational” research. Big Pharma only gets interested much further down the development path.

TB has never gone away from the global scene, with 16 million active cases in the world. Two billion people actually carry live TB, which amounts to a ticking time bomb, Dr David Sherman, who heads up the Institute’s TB research, tells us.

A little later: We learn that the Institute has a malaria vaccine that has been successfully tested on rats and will be tested on humans soon. Dr Stephan Kappe, who is developing the vaccine, tells us that many malaria parasites have developed a resistance to drugs. In his opinion, the only way to eradicate malaria (there are 3 to 5 million cases a year, worldwide) is with a vaccine, like smallpox).

Late morning: I’m in a virtual operating room on the medical campus of the University of Washington applying my stethoscope to the skull of a virtual (robotic) patient. (What is wrong with that sentence? Not telling.) We are about to apply anesthesia to the “patient,” who is to be operated on for an ankle injury. The doctor (a real one) asks the patient how he hurt his ankle.

“I was dancing,” the patient replies.

“What was a white man doing dancing?” I ask.

“I was trying to get a groove on,” he replies. This robot is good.

Later, we send the patient into cardiac arrest. I perform a magnificent job applying the paddles backward.

Lunch: Another part of the UW campus. It’s all about surgical robots and performing surgery over the internet. A doctor live from Munich moves small objects from pegs in a room two stories down from us. Way cool.

A little later: MacArthur Foundation “genius award” winner Yoky Matsuoka shows us the robotic hand she and her team have in development. Super way cool. More Paul Allen money

Late afternoon: Last stop, the Allen Institute of Brain Science. Yes, that Paul Allen. I get to see brain tissue for the first time. I’m about to get out my camera, then put it back. This is not just tissue. The others in the room sense it, too. Cameras go back in the bags.

The scientists here are mapping out the human brain, along with the genes expressed in the brain. Last year, they finished mapping the mouse brain. They’re looking to finish mapping the human brain in 2010.

Back to the hotel, nap, function right now.

More “toots” later ...