Did anyone besides me hear Joe Wright and his commentary on NPR this afternoon? I think it was on All Things Considered. I only heard the very last part including his name and the fact that he was attending Harvard in the Fall.
That is AWESOME!
{Did he toss in a cheap & shameless plug for OPM?}
I will try to catch it this evening…anyone know what channel/station NPR is on? I am clueless!!
Hi guys,
Thanks for noticing! Yes indeed, in what has to be one of the most public calculus procrastination techniques of all times, I did a commentary on NPR that aired tonight. It's about killing mice for science. It should be archived on the web at www.npr.org under the All Things Considered page, or on the Yahoo! forum Larry kindly posted the link to the streaming audio. The archive comes on tonight at, I think, 10 or so Eastern time.
I have to admit that I could not figure out a way to work in OPM.
cheers
Joe
I listened. I'm very impressed. I had forgotten that Joe used to do some sort of film work. It certainly showed.
Nice job, even for a Hahvaad man!
Very good Joe. You are very well spoken. Thank you for sharing this and it is nice to hear a voice rather than just reading your comments. 
P.S. Poor little mice. 
I’ve always told people that if I had to hunt and kill for food I would be vegetarian. Not that I think you eat the mice nor do I take your work lightly. I’m glad someone can do this research; I would have to hire a lab technician to do the “dirty work”.
Hi all,
I’ll be on NPR again tonight (Wed. July 10) at around 5:40; or, if you’re reading this afterwards you can visit www.npr.org, go to the “All Things Considered” section, and then to the July 10 show (Real Audio files are usually up at around 10 pm the day of).
This one is about two topics dear to my heart: HIV vaccine development and needle exchange.
sf/dc joe
Nice piece Joe!
Although in my younger years, when my judgement was clouded by the black-and-white with which I viewed the world, I didn’t agree with needle exchanges. I thought it would encourage more IVDA. However, I then realized that those folks turning in old needles for new were already shooting. Regardless of whether they had new ones or not, they would continue, as it is an addiction.
I do have a question for you though…I understand that by making sterile needles available that it is a way to interrupt the disease vector. One other thing I have supposed is that by interacting with the people in a one on one manner, can THAT have beneficial effects as well? I mean, if the person begins to feel that there are other people that care about their health and welfare, do they sometimes tend to care a bit more about themselves (i.e., eating better, reducing other risk factors for not only HIV, but hepatitis, etc.)?
Just wondering. It is my belief that by showing that you are sincerely interested in their well being, in this case by getting to know them as people, that they they might become more interested in their general well being too.
Ian
Hey Ian,
That point has been a really important one in my life. I think it was when I first started doing exchange in SF that I realized the value of dealing with people one-on-one, and the value of showing care for people. Whether it was valuable for them, I’m not sure, but I know I liked it! And it was a big part of me deciding to become a doctor instead of a public health academic.
But, though that care and concern is really appreciated by people who use needle exchange, I don’t know if they translate it into real changes in their lives. I don’t know the data inside and out, but while I think the case that needle exchange generally reduces infection with blood-borne pathogens and doesn’t increase drug use has been pretty rigorously established by a lot of studies, I think the other potential benefits haven’t been as well established. And I suspect they vary a lot depending on the program, the people involved, etc, etc. (Some programs put more emphasis on referrals to other services than others, just to name one difference.)
So, while I want to agree with you that those additional benefits are there, and I suspect that they sometimes are, I’m not sure how it would be clearly proven. I did a quick look through a couple of PubMed searches and didn’t see this question answered, which doesn’t it mean it hasn’t been looked at… I will try to ask someone who knows more than I do if she knows of any studies along the lines that you’re talking about… and, when she gets back into town, try to get back to you in a while about that, because it’s something I’m really interested in too.
I did find this abstract (below), which I thought was interesting–clearly, I think if you tie needle exchange to other medical services, it can be more powerful along the lines you’re talking about. Unfortunately because exchange has an “outlaw” status in many communities, it doesn’t get connected to stuff like wound care, vaccination, education, etc; and because drug treatment is woefully underfunded in the US generally, the referrals along those lines are usually pretty weak too. So, I think there are some things that could be improved in order to make your hope (and mine) about exchange more true.
One thing that I think is really important, that more people are trying to do, is wound care at exchange sites. People who inject can sometimes get really gnarly abscesses (especially on the West Coast, where the heroin is goopy rather than crystalline, and harbors more bacteria), and can end up with serious problems as a result. If we could treat those abcesses before people come in to an emergency room with them, that would be a really good concrete health benefit for the users and for the communty as a whole (because of the savings in costs of surgeries, care, etc). It sounds like that might be part of what the van, below, is doing.
cheers
sf/dc joe
Gen Intern Med 2002 May;17(5):341-8
The Impact of Needle Exchange-based Health Services on Emergency Department Use.
Pollack HA, Khoshnood K, Blankenship KM, Altice FL.
OBJECTIVE: To examine the impact of the New Haven Community Health Care Van (CHCV), a mobile needle exchange-based health car delivery system, in reducing emergency department (ED) use among out-of-treatment injection drug users (IDUs) between January 1, 1996 and December 31, 1998. DESIGN: A pre-post comparison of ED utilization was performed using linked medical records from New Haven’s only two emergency departments. Fixed-effect negative binomial regression analysis was used to explore the impact of the CHCV on ED use within a longitudinal cohort. SETTING: Mobile health clinic in New Haven, Conn. PARTICIPANTS: Out-of-treatment IDUs. INTERVENTION: Acute care, linkages to medical, drug treatment, and social services. MEASUREMENTS AND MAIN RESULTS: Among 373 IDUs, 117 (31%) were CHCV clients, and 256 had not used CHCV services. At baseline, CHCV users were more frequent users of ED services (P <.001). After full-scale implementation, mean ED utilization declined among CHCV clients and increased within the non-CHCV group. CHCV use is associated with statistically significant reductions in ED use, with an incidence rate ratio (IRR) of 0.79 (95% confidence interval [95% CI], 0.66 to 0.95). Subgroup analyses demonstrated significant IRR reductions, notably among Hispanics (0.65; 95% CI, 0.47 to 0.90), men (0.79; 95% CI, 0.64 to 0.98], HIV-negative IDUs (0.79; 95% CI, 0.63 to 0.98), and those with mental illness (0.75; 95% CI, 0.60 to 0.94). CONCLUSION: Needle exchange-based health care services can reduce ED utilization among high-risk injection drug users. Such services may have an important role within communities with high rates of drug use and HIV/AIDS.
Another of my commentaries–this one about holding out hope for patients–is on NPR tonight, in the first segment of All Things Considered (about 19-20 minutes after the start of the show).
sf/dc joe
[ http://www.npr.org/ramfiles/atc/20020723.atc.05.ram
is the real audio file. ]
Joe,
I finally got around to listening to your three ATC commentaries. As always, you did a fantastic job of articulating your point. I am curious to learn more about your experience on ATC. I realize you are busy, but would like to pose a few questions.
How did you prepare for your interview?
Did you have ample time to think about what you were going to say?
Did you write up a script from which you read, or did you outline what you wanted to talk about, then "wing-it?"
Were you given a specific topic on which to talk or were you allowed latitude?
Were you/are you nervous before you go "on the air?"
When you get a chance, I would love to read more about your preparation and your feelings with the process and your experience.
Thanks
– Rachel
Hi Rachel,
I’m honored that you went back and listened to all of them. Thank you. And thanks for the kind words.
As I will explain, your questions are actually even bigger compliments.
You write:
How did you prepare for your interview?
Did you have ample time to think about what you were going to say?
Did you write up a script from which you read, or did you outline what you wanted to talk about, then "wing-it?"
Were you given a specific topic on which to talk or were you allowed latitude?
Were you/are you nervous before you go "on the air?"
Each of these pieces are written in the form of essays, about a page long (single-spaced). One of them (the “Mr. Lee” piece) was actually mostly written two years ago. In writing these kinds of essays, I usually go through three or four very distinct drafts, with lots of revision within each of those drafts, so that if I was doing it by typewriter instead of computer, I suspect that it would easily be ten or more drafts. For all that, I am still generally dissatisfied with various things about the writing once the essays are finished. I think this is typical of writing in general.
For the radio, there is the additional challenge of reading it through and realizing that it doesn’t sound good out loud. If you read my OPM posts you will see that one of the faults of my more spontaneous writing is that I don’t always naturally write in short concise conversational sentences. So I have to do a lot of trimming down. I think there is no better way to improve one’s writing than to read it out loud. Not that my OPM posts are likely to be subject to this treatment any time soon!
In general, the idea is to propose essays before writing them. I have now stopped writing essays before talking about them with the producer because she’s rejected a few of them now for reasons that are basic enough that I could have just not started them. So, we talk about the idea; then I write some drafts of it, then we talk and revise some more.
When I actually read them, it is in a quiet studio. The producer sits with me, and an engineer sits in the next room. Before I do this, I’ve gone through a read with the producer on the phone, who coaches me on how I’m approaching the reading, often on a phrase-by-phrase, sometimes word-by-word level. (She doesn’t tell me how to read it, but says things like, “What were you thinking about when that happened?.. OK, so remember that feeling when you read that phrase. You were excited about it, so make that part of how you say it.”)
Then I go to the studio and read it in sections. We discuss as we go, and she continues to coach me (“You’re turning a corner with that sentence. Make us know that you’re turning a corner.”). I go back over the section and reread it, and then we go on to the next section.
Because this is a process where you can do as many takes as you need to, and where we’re talking about how to improve it as we go, I haven’t felt nervous. But I’ve definitely felt that heightened sense of self-consciousness that I get in conversations with someone who I hope will like me. I’ve done two of these sessions now; one for the mouse piece, and the other one for the other two. (They are recorded well in advance, usually, although one was aired later in the day that I recorded it.)
The tape–actually, I think it is a hard drive–is recording that whole time, including during the little breaks to talk about how to revise and redo a particular sentence or paragraph. The producer then cuts the versions of each sentence she thinks work best back together into the essay. NPR producers edit phenomenally carefully; they sometimes move intakes of breath in order to make edited conversations sound continuous. (See the great comic book about radio that This American Life put out–http://www.thisamericanlife.org/ , a little link says “comic book” halfway down the left side–if you’re interested in this process.) I am sure that she edits the different takes of the different sentences of the commentaries back together at that level of detail, but I’ve never sat in on the process. In general, she cuts them back into the essay that I wrote as the final draft; but sometimes there are minor revisions for time purposes.
All of this revision and preparation is designed to make the piece sound almost conversational; and in that sense, your questions couldn’t be a higher compliment.
You ask more generally about my feelings about this. I feel that I am finally doing something I’ve wanted to do for a long time. When I was 14 I took a summer writing class, and I especially loved the essays of George Orwell. My writing teacher told me, “You could be George Orwell, if you keep working at this.” I always treasured this. But my writing ran into a barrier when I was a little older, after college. I would start thinking, immediately, about whether a piece was good enough for the New Yorker. Of course, no writing can live under that pressure so I never finished anything.
Eventually, I started a zine, a little xeroxed thing that I sent to a few people, mostly my friends. That allowed me to write very carefully–even for my circulation of less than 100, I did lots of revisions–but without the paralyzing focus on external rewards. I did that for about three years (and produced just four issues in that time!). The zine helped me find a more natural voice that allows me now to write an essay without thinking too much about who’s going to read it or hear it.
When I considered starting towards medical school, one of the things I worried about was whether I was giving up writing. This year has been one of the worst and best of my life. And on the “best” side of the balance is that I’ve ended up with medical school and writing, both in such a great and unexpected way. I’m not sure whether I’ll get to do more commentaries for NPR–I hope I will–but regardless, doing these three commentaries has allowed me to see a possible future as both a doctor and a writer. In that, I feel incredibly blessed.
best regards,
joe
Hey Joe,
Thanks for taking the time to satisfy my curiosity.
A few years ago I worked in a lab that, because of where it was located, only received three radio stations. The only station on which all of us could agree was the university’s public radio. Needless to say, I heard ATC often, well that and bluegrass music…but I digress.
Anyway, I’d always had a passing interest in the process of the ATC interview. I assumed they were taped, but I did not realize how much editing took place. It always seemed like a casual conversation, which is very appealing to me. In today’s era of aggressive talk radio and TV slamfests, listening to one person’s opinion for three minutes (without interruption) is a novelty.
As you mention, writing does not always lend itself to being read. So, I was surprised to learn you’d first written an essay and read from that. You also mention that the essay about “Mr. Lee” was written years ago. Which begs the question…did you write about “Mr. Lee” with the intent of making such an essay public? Or do you write essays as a way of “journaling” and writing a snapshot of your life at the time?
Thanks again for entertaining my questions
– Rachel
I’m not sure of the answer to your question, actually. I can say that my journal is useless as a source of writing. (I do keep one but only write in it erratically, generally in times of stress or when I’m on planes or trains or sitting in coffeeshops. It’s a cheap psychiatrist who doesn’t talk back–which is different than writing for writing’s sake.)
I think I had the idea that I would put the Mr. Lee piece on my website ( http://www.mindspring.com/~jmwright/ ) and a vague sense that maybe I would try to get it published but not with any plan. There is another piece I wrote at the same time called “Grief Mop” which is still there. But since no one looked at my website, I think I really just wrote them to write them, because I enjoy writing these things. I guess there is a bit of the journal impulse in there too: working in the emergency dept. had made such an impact on me that I had to somehow explain it to myself. But to do that to my own satisfaction, I had to frame it more coherently than I would in a journal.
Usually whoever I’m dating has to read these things, and sometimes my friends are kind enough to read them too. Maybe this is sort of like if you’re friends with someone who likes to paint, you have to go look at their paintings when you go over to their house. My website became the paintings I had sitting around my house that I forced on my guests.
cheers
sf/dc joe
http://www.npr.org/ramfiles/atc/20020918.atc.10.ram
is the link for the newest one, which ran Wed. Sept. 18… It’s my second commentary about lab mice. This one is about a schoolteacher-turned-mouse-rancher who bred many of the first lab mice, at the beginning of the twentieth century.
cheers
sf/boston joe
I heard you for the second time on NPR yesterday, and thought “how cool is that!” – nice piece, Joe. 
I haven’t checked into OPM in a couple of weeks – so, how are things going for you at Hahvahd?
Hi, things are going well–so well, in fact, that I don't have time to write too much about it! But, in brief: The faculty–especially the anatomy faculty, actually–have been great. I'm going to erect a shrine to the anatomy course director, I think. I'm totally overwhelmed, wonder if I'm ever going to learn what I need to learn, feel completely behind, and am alternately freaked and amazed to be cutting up a dead person, but apparently all that is par for the course.
I'm one of the oldest students here, but not the oldest. My classmates are a pretty interesting group, and there are some of them I'm really excited about. I seem to be getting along pretty well with most of them, and I think living in the dorm was a really good decision for that reason–I feel at the social center of things, and that is nice. (I also drank more alcohol in the first two weeks than in the previous six months, because of all the parties and get-togethers, etc–but I'm putting a stop to that!) I got into a heated debate today about ethical concerns in directly-observed therapy for tuberculosis with a doctor who is a widely-recognized global expert in the field, which freaked me out but also is exciting in that it's part of what I came here for. I'm taking an elective about health and global environmental change, which looks like it will be really interesting–looking at the effects of things like pollution, global warming and habitat change on disease. Since I'm interested in the ecology of infectious disease–that is, looking at how microbes live in a larger context–this should be great for me.
In fact, when I write it all down, I realize that in between being absolutely terrified, I'm delighted and having as much fun as I've had in years.
cheers
sf/boston joe