Marketing Hope

A week ago, one of my great sister-in-laws asked me about an interview she had seen around a Rett Syndrome, as a friend has a daughter with the disorder.  The interview was on the View.  She asked whether the statements about the expectation that ‘there is every reason to be hopeful’ and the cure was ‘not if, but when.’  The basis being that there has been a study in a where the gene associated with Rett was knocked-out in some mice and treatment with a growth factor improved (not cured) the mice.   I suggested that a cure was not imminent, as there are lots of things between that work and treatment, from the simple differences in the mouse response to both the deficiency and treatment and humans, not too mention the vast array of clinical and regulatory issues should there be some possibility of a treatment emerging from this work.  To her further question as to why someone would talk about a cure as a ‘when not if,’ I responded that it was really about marketing.  There are finite resources and a surplus of diseases and disorders.  People will trade money for hope.  Not necessarily a bad thing, but I don’t think folks often think about the daily ‘breakthroughs’ as marketing.  

The other notion that rests under this discussion is that our bodies are somehow simple machines that move in a pretty straight-forward manner, from one ‘biological task’ to another.  If one of those tasks is not being completed well enough, some therapy can be developed to improve that one task.

That very ancient cultural imperative around biology and medicine is appealing, but not congruent with what is really going on.  Think about all the activity in your body as the traffic in Manhattan, or Atlanta, Chicago or Los Angeles.  Your physician determines that your cholesterol is too high, so puts you on a statin.  The city equivalent is a back up on 7th Street, at 42nd Avenue.  The traffic cop standing there  has a remedy, think of it as the statin, to leave the light 7th green longer.  Soon, traffic flow seems to improve.  But that means the light for 42nd Street is now red longer, so all the people trying to turn west on 42nd are slowing down.  And that means the Avenues they are on, waiting to turn, are slowing down.  Soon, there are many new traffic jams.  Too each one, a local ‘solution’ is applied.  And things just get worse.  

We seem to apply the same reductionist ideas at every scale in medicine, from individual treatment to the whole health-care system.  Of course, none of those are really reducible to some independent set of parts.  It is strictly complex.  Nothing more, or less.

A face that toils so close to stones is already stone itself! (Albert Camus)

Anthropologists commonly will seek to be trained as indigenous experts.  So I have colleagues trained as Mayan daykeepers and Culina shaman.  Me, I got trained as a medical scientist (Brown University Medical School, Dept of Community Medicine).  That post-doc gave me a window into how we produce medical scientists and the credentials to function as one.  And so I have.  From a Brown-affiliated start-up in the decision sciences to Chief Science Officer at a public (AMEX and NSADAQ) company, and interesting stops in between.  But the other day I was on the phone with some goofs (chief of surgery and a exercise physiologist) who were quizzing me about statistical validity in a research trial I ran and realized I, too, had become stone.  Rather than laugh at their phenomenally naive questions about p-values, I engaged them.  That’s when I realize I was losing my perspective as a critical thinker.  

But, after a couple of drinks (and reading some Foucault out loud), I came to the few senses I have left.  I know a bit about the medical industry, from the basic ‘science’ perspective, to what it takes to convince investors to join a company and what it can mean to patients who benefit (I have spend many years directly in clinical settings with pretty sick folks).  And all of it is with an anthropologist’s eye to the culture that drives the machine.  You are welcome to take objection with it all, as I am not the best anthropologist, scientist, nor executive.  But I am at least all of them.  Oh, and I am my daughter’s basketball coach, which trumps all that noise.