It is Finished

And so it came to pass that on Nov. 4, 2008, shortly after 11 p.m. Eastern time, the American Civil War ended, as a black man — Barack Hussein Obama — won enough electoral votes to become president of the United States.

Read the rest of Thomas Friedman's editorial here.

Race and Religion in 2008

Barack Obama made a speech this morning about race and religion in America. It cheered me after a rough and tumble day and a half on the wards. On a tip from a friend, I started listening to it in the background while I studied lung cancer. I had to put down the book to consider the elements of our life, culture and nation bigger than the little problems I'm facing today. If you have half an hour, I encourage you to listen. Here's a link to one recording of the speech. Don't worry -it's not a campaign speech until minute 27, and even then, it really doesn't have that feel. His words are part sermon, part lecture, part address to the nation, and yes, part campaign speech.

Insulated

Whatever goes on in the world, there will still be sick people.

Evidently, the world is on the brink of financial collapse. Somehow, I missed that. While folks from Wall St. to Main St. were freaking out about the economy, I was talking with a patient who had been largely unconscious since last Thursday. This is a Gram stain of a sample of that patient's cerebral spinal fluid:

What's your diagnosis, doctor?

I also understand that yesterday was a holiday. Of all the national holidays, Martin Luther King Jr. Day has always been the one with the most regimented for me. Sometimes I would fast on that day, I would always read some of King's writings, often I would participate in a community service project; yesterday I took call. The only nod to the holiday I experienced were some residents questioning whether it was actually a holiday, and a newspaper article about how (unlike 800 other cities) Spokane has no geographical reference to Martin Luther King Jr.

I Hate Washington Racists

The title above is a bad reference to the 1980 classic movie: The Blues Brothers. In one scene, Jake and Elwood (by that point, well entrenched in their "mission from God") encounter a traffic jam caused by a parade of Illinois Nazis. They ask an officer what is going on; he says the Illinois Nazis got a permit for a parade. Elwood scoffs, "Illinois Nazis!" to which Jake replies, "I hate Illinois Nazis." They promptly accelerate through the parade causing the uniformed Nazis to jump from a bridge into a small river. (Was the bridge in Peoria?) For a refresher, see:



I cite this example of intolerance because of something more relevant to 2007: Islamo-Fascism Awareness Week. This was a nationwide series of events sponsored by David Horowitz from the Los Angeles-based Freedom Center, a conservative think tank. I was annoyed about this issue last week when I read that the event was occurring on the University of Washington campus, but Robert Jamieson really got me (and at least one other person) riled up in a recent well-thought column in the Seattle Post-Intelligencer. Chances are good there were events in your city.

Such ignorance as this makes me want to find a 70's vintage police cruiser and drive it through my school's quad (also called Red Square) during one of the events. It's a good thing 1) the 'awareness' week is over, 2) I don't know where to find old police cruisers, and 3) due to medical school, I don't have time for such tomfoolery.

Normative Values in Health Care for Latinos

After finishing my first three weeks of a pediatrics clerkship at Children's Hospital in Seattle, I will spend the next three weeks at the Odessa Brown outpatient pediatrics clinic in Seattle's Central District. Whether your classification is by economic status, race and ethnicity, or language group, this clinic serves a wide diversity of patients. It will be fun to learn there.

I was reading a little about ways that different cultures interface with health care and thought I would share some of my findings about cultural values and medicine in the Latino population.

As with any cultural group, assuming that Latinos are all alike is problematic. Some studies suggest that differences among Latino subgroups (e.g. Guatemalans, Puerto Ricans, and Mexicans) do exist in terms in sociodemographics, health status, and use of health services and may be greater than differences among other major ethnic groups. Despite the differences, normative cultural values seem to exist within this large umbrella of cultural groups. Normative cultural values are beliefs, ideas, and behaviors that a particular cultural group values and expects in interpersonal interactions. Described below are five Latino normative cultural values and their potential clinical consequences.

1) Simpatía - kindness in Spanish; politeness and pleasantness in the face of stress; avoidance of hostile confrontation. Simpatía includes the assumption that physicians have a positive regard for them. The relatively neutral attitude of many US physicians may be viewed as negative, leading to decreased satisfaction with care, an inaccurate history, nonadherence to therapy, and poor follow-up.

2) Personalismo - formal friendliness; the expectation of developing a warm, personal relationship with a clinician. To promote personalismo, consider decreasing the physical distance during interactions with patients, providing contact information such as a beeper number, and showing an interest in patients' lives at each visit.

3) Respeto - respect; deferential behavior based on a position of authority, age, gender, social position, and economic status. Health care providers are viewed as authority figures deserving of respeto. Patients expect reciprocal respeto from the provider, especially if the provider is younger than the patient.

4) Familismo - collective loyalty to the extended family that outweighs the needs of the individual. Extended families, not individuals, make decisions on important issues such as healthcare. When possible, provide ample time and opportunities for the extended family to gather to discuss important medical decisions.

5) Fatalismo - fatalism, belief that an individual can do little to alter fate. Can lead to less preventive screening and avoidance of effective therapies.

It seems to me like the suggestions to address simpatía, respeto and familismo are good for the majority of patient encounters. Fatalismo seems like a more subtle aspect of a care encounter, and would be harder to address; personalismo is something that I've been working on with colleagues and friends - a pat on the shoulder or elbow and a warm smile seem to draw friends closer. I am a little tentative to try this with strangers, but will consider it.

Flores G. Culture and the patient-physician relationship: achieving cultural competency in health care. Journal of Pediatrics. 2000;136(1):14-23. Link (may need institutional access)

Jena Six Revisited

The best coverage of the Jena Six story I have read so far is on ESPN.com. Why on a sports network? Mychal Bell was a star football player for the high school's team and was being scouted by LSU among other teams. He is still in jail, even though an appellate court has thrown out the charge; nor has Bell been permitted release on bail.

Jena 6 Freed... Almost

Get ready for a ramble that is partly diatribe, partly lament and partly self-critical assessment of how I have interacted with this story. I didn't hear about the Jena 6 until Wednesday afternoon. You've probably heard by now about the 6 Black students arrested for assault and attempted murder after school yard fights, while their White classmates who engaged in the same activity while using racial epithets received slaps on the wrist. Or have you?

This all makes me wonder why didn't I, a rather attentive new junkie, know about a story that would be of significant interest to me? Here is what I could come up with:

1. I was writing and defending my dissertation the last few weeks.
2. I avoid cable TV news channels and their websites like the plague.
   
3. I was traveling out of town Tuesday through Thursday.
4. I live in Seattle, WA.

The first point would be a good enough reason, except that the incidents that preceded the national coverage of the march in Jena, LA yesterday started one year ago. From the Justice in Jena website:

Last fall, when two Black high school students sat under the "white" tree on their campus, white students responded by hanging nooses from the tree. When Black students protested the light punishment for the students who hung the nooses, District Attorney Reed Walters came to the school and told the students he could "take [their] lives away with a stroke of [his] pen." Racial tension continued to mount in Jena, and the District Attorney did nothing in response to several egregious cases of violence and threats against black students. But when a white student - who had been a vocal supporter of the students who hung the nooses - taunted a black student, allegedly called several black students "nigger", and was beaten up by black students, six black students were charged with second-degree attempted murder. Last month, the first young man to be tried, Mychal Bell, was convicted. He faces up to 22 years in prison for a school fight.

This conviction has been overturned, but Bell remains in jail. The other five students have been released. So while the efforts to initiate a national protest of this situation have been covered recently, I have to still wonder why I did not hear of it before then. For a good op-ed summary and analysis, consider Eugene Robinson's piece from 9/21/07.

The second point is self-explanatory. The story is unfortunately perfect fodder for the cable news mill - sensationalizing the issue so that it is entertaining. The bit I saw on CNN at the Salt Lake airport last night was complete with shocking graphics and polarized point-counterpoint analysis. There was hardly any room for the viewer to think about the story before switching to the O.J. Simpson 'tragedy.' What's a tragedy is that Larry King hosted O.J.'s pseudo ghost-writer for "If I Did It" rather than folks interested in talking about (real) race issues.

My third explanation is an ironic point, because my first encounter with the story was exactly because I traveled. I spent Tuesday night through Thursday afternoon in Washington D.C. My standard point of access for news is the internet and the only microchips I was traveling with were in my cell phone. In D.C., I saw groups of protesters near the capital, on the Mall and in the Metro stations wearing t-shirts and carrying signs calling for release of the Jena 6. I ended up stopping at a terminal in the Library of Congress to look up the issue.

My last point is the one that needs the most addressing: I live in Seattle. Why does that matter? Well, when I moved to Seattle after living in DC and Pittsburgh, I quickly noticed how few Black neighbors and classmates I had. Questioning this (gently of course because I knew no one in the Emerald City and I am White), I was told:

1. Seattle just has a different, and in some ways more diverse, racial and ethnic makeup, and
2. There really aren't race issues out here.

Well, since I have been here, several stories of racial profiling and differential treatment of minorities have come to light - usually to me by way of Robert Jamieson. It seems to me like Seattle doesn't have a lot of 'race problems' because as urban centers go, Seattle doesn't have a lot of race. I mean, sure there's more people of color here than in your standard suburb, exurb or rural community, but many people in Seattle can get through an entire day without any sort of interaction with an underrepresented minority. Even if you travel on public transit! How are you going to learn and talk about race issues without relationships with folks of a different race? I know that my situation has changed tremendously since moving to the Northwest, and that I have done a poor job of cultivating relationships outside of the graduate school/science policy/bioengineering crowd. I'll be working hard to change this as I shift away from hi-tech science to training for a medical career that includes care for the underserved.

But back to the subject at hand, is it a function of a lack of newsworthiness in the Seattle market that the Jena 6 story hasn't made it to the front page on Seattle's newspapers? Or what exactly?

Sherley It's Time For An Update

The case of James Sherley's employment at MIT is still one of the most common searches leading to my web site, and there continue to be developments. To catch up, check out my first entry on this topic. (For you bloggers trying to get listed higher on Google, it actually *helps* to make a little spelling error deep in the entry...)

According to a news feature in Science Magazine last month, the biological engineering professor was asked to leave his position on June 30, 2007. Of note is that Frank Douglas resigned because MIT's handling of Sherley's case for tenure creates a hostile environment for African-Americans on campus. Douglas was the director of MIT's Center for Biomedical Innovation. He held faculty appointments in the science, engineering, and management schools.

It sounds to me like MIT has a problem with race. Philip Phillips, another Black scientist, formerly at MIT and now at the University of Illinois, predicts that Douglas will be treated as was Sherley—“as just another irrational person.” This got me thinking: I wonder how many irrational White, South Asian or Hispanic people there are who were denied tenure at MIT. Or is irrational a word only reserved for Black professors. I wonder also, how irrational individuals received appointments at the premier science institution in the world, if they were irrational.

I admit that some of Sherley's actions and his use of hyperbole (on this issue and others) can easily confuse what is the real issue at hand, but it is hard to lay the blame entirely on one man. Is MIT just offering lip service to issues of race? Do they have anything more than official statements to try and improve this situation? Is the environment there really hostile to African-Americans? What will James Sherley do next?

Tenure and Behavior

There's a lively group of posts over at ScienceBlogs regarding astronomer Guillermo Gonzalez's denial of tenure at Iowa State. He and others claim it is because he supports intelligent design (ID) . His critics claim that Gonzalez's work was beginning to market ISU as an "intelligent design school."

This reminds me of another publicized tenure dispute in February. So far, James Sherley's efforts to earn tenure at MIT have been unsuccessful. He endured a 12 day fast over claims of racism in the tenure process before ending it in February. From an outsider's perspective, these claims do not seem without merit, but this case may not simply be a matter of racism. (Don't misunderstand me, racism is NEVER simple.)

Last June, Dr. Sherely wrote an opinion piece for the Boston Globe offering a perspective that embryonic stem cell research is untenable, immoral and a waste of money. Sherley's research focuses on the proliferative capacity of certain kinds of adult stem cells. I saw him give an interview talk at the University of Washington last year, was skeptical of some of his claims, but also identified some important findings from his work. By being vocal about the stem cell issue, he has assumed a position of scientist and public commentator on science - this is a role I would like to pursue! (Clearly, I have a different perspective on this issue than he.) As I understand it, every other faculty member in his department supports embryonic stem cell research, and Sherley has had personal clashes with them (including with the department chair's wife) about his views.

It is admirable that he is willing to take a minority viewpoint on a controversial issue. Especially since this viewpoint is based on a personal religious faith that is sometimes viewed as a weakness in science. I wonder if Sherley's minority views were actually more important in this decision than his minority race. That the tenure process is closed-door suggests that we will never know.

A talk I attended yesterday afternoon might shed some light on this issue. Brian Martinson, the first author of a highly cited Nature article titled, "Scientists Behaving Badly," spoke about how the supply and demand for science workers is heavily skewed toward the supply side. There is material in that talk sufficient for several more posts, but one of his central theses is that science has reached a level of detrimental competitiveness. this does not just play out at the tenure-granting level, but in the funding process, publications and even in areas of research integrity. I wonder if we are only at the front end of controversial and highly publicized cases of claims of injustice. If so, maybe we all had better look at whether the practice of science is prepared for a cultural sea change.

---Update 5/18/07; 2100 hrs PDT---

I've noticed a good amount of traffic to this post. If you are interested in reading some of the original correspondence by and to Dr. Sherley, visit this file directory. Of particular note are his open letters for support and the tenure committee's statement of facts about Sherley's tenure seeking process. Other letters detail such information as lab space square footage and details from Sherley's hunger strike. Thanks to the commenter (below) for leading me to this reference.