TB Conference, Day 3
Saturday morning I was more successful at getting onto the right Metro line, though at the Porte Maillot station I had to show my ticket to the transit police (a regular and random occurrence throughout the Metro system). I pulled out probably six or eight cancelled tickets from various pockets until one of them finally proved to be the right one. Not so lucky for the guy in front of me on the escalator, who got one look at the transit police, turned, and booked backwards down the escalator at top speed, knocking asides several other pedestrians along the way. I guess he managed to get on without a ticket, though I’m mystified how people get through the turnstiles without them.
Again I arrived too late to catch the meet-the-experts session, though Anne did make it to the one that we had both wanted to see (from the plenary speaker from Wednesday evening, before either of us got to Paris), which happened to be cancelled. Apparently I didn’t miss anything.
Having missed that session, Anne and I went to see a talk on tobacco and TB, which is an area that I’ve been very curious about given that it’s so little talked about in most of the popular literature on the disease. The presenters gave a very strict review of the major literature, and concluded that there is some amount of moderate evidence that smoking both causes more susceptibility to TB and makes the progress faster once someone’s got it. Many irate audience member stood up and demanded to know how they could be so wishy-washy about what is clinically a very evident problem, as well as why some major studies were not considered (eg. one of the very prominent studies on this topic used death certificate data, which was not considered to be best way to tell if someone really died of TB or something else, and so it was excluded from the analysis). And of course, there one problem with any study on things like smoking and illegal drugs and the like: you can’t randomize people to smoke or not smoke, so randomized controlled trials are out of the picture. Any other study is considered second-rate compared to that type of study, so of course the data on smoking and ANYTHING is going to look wishy-washy. It was an entertaining exchange, in any case.
After a very interesting plenary session on the need to coordinate care for AIDS, asthma, and TB in developing nations (apparently, asthma rates go up as nations industrialize – partly due to industrial pollution, it is thought, but also because the entrance into the global market is inevitably followed by the arrival of cigarettes, which is thought to account for a large proportion of childhood asthma), Anne and I had lunch with Olivia, the former LSHTM student (now from McGill) who we met yesterday. She was scheduled to speak during the last session of the day, which seemed to be mostly graduate students giving a quick spiel on their research. She was nervous to the point of not wanting to admit that it was coming. I guess that’s one thing I’ve got going for me: I may be a mediocre public speaker (no doubt there: I talk too fast, and every other word is “uh,” punctuated periodically with some variety like “um” and “yeah”), but I do not dread public speaking. In fact, I rather like it. I think I discovered somewhere around seventh grade that if I was speaking in front of a group, everyone at least had to pretend they were listening to me, and that was a rare enough event that I kind of dug it. Still do. In any case, Olivia presented her piece very well, occasionally deferring to her advisor in the audience, who had done the literature reviews necessary to create her economic model on whether quantiferon (a blood test that is very sensitive and specific for TB) was an economically viable test for mass screening. Their conclusion was no, it was not. Too bad – a better test for TB is needed, but only if it gets cheaper can it be used on a wide scale.
After Olivia’s talk I snuck out to catch the last part of a session on ethical aspect of TB intervention (which has been a thorn in the side of TB researchers ever since the city of New York started jailing its high-risk resistant TB patients during an outbreak in the 1990s). This turned out mostly to be a discussion of the current situation in the Russian Federation, and it was conducted largely in Russian with English translation. This was a relief after some of the talks, where speakers attempted English but only spoke enough to read off their Power Point slides – it would have been more merciful on everyone just to use translators. The two I saw were interesting, but also pointed to one of the weaknesses of conference like this: many of the presentations are on recent studies and new data, and they tend to read like a chapter out of statistics book. I far prefer talks where the data is presented briefly, but the concepts, context, and larger lessons are emphasized. In any case, I had hit up this session to hear the last speaker, who was the professor from LSHTM who had first told us about the conference last week. I had given up on keeping quiet about ditching class, and figured that if I wanted to work on a TB project this summer, it might be nice to be able to mention to one of the big researchers at LSHTM that I’d heard his speech at the conference. Unfortunately, with the combination of my sleepiness and his pedantic speech (which covered all manner of philosophical approaches I had either never learned or tried to forget), I caught about half of it and spent the rest of the time struggling not to fall asleep. I’m not sure that did me any good in the kissing-up-to-the-experts realm, but at least I can say I was there!
I went to find Anne and the end of this session, who was talking to Olivia and her advisor, Dr. M, in the room where their session had just ended. Dr. M’s current research has to do with economic modelling, specifically on the question of whether the first-world recipients of migrating cases of TB from the developing world could save money by investing in health care in those nations themselves, rather than just treating the disease once it crosses the border. Specifically, they had just published an article in the New England Journal of Medicine that looked at costs in the US and several countries that feed immigration (especially Mexico and the Dominican Republic), where their modelling concluded that the US could save lots of cash by helping out those countries to keep TB under control so that it doesn’t leak across the border and into the US budget. Dr. M said they were pursuing lobbying on this front, and that at least in Canada they were getting a sympathetic ear from several federal representatives. I laughed – good luck getting anywhere with that in the States, at least under the current regime, which at the moment seems bent on “helping” the victims of last month’s hurricanes by cutting food stamps and Medicaid budgets.
In any case, Anne was busy finding out if there was any chance of getting together a research project for next summer under this project, and Dr. M was very interested. Part of the economic analysis involves quantifying costs of the disease on the patients who suffer from it (since TB takes months to cure, and is often debilitating before treatment is sought), and both Anne & I saw some intriguing possibilities there. She speaks French, but it turns out that wasn’t a help because the nations that he was analyzing were those that send immigrants to the US, the UK, Canada, and Germany, and though much of Africa speaks French from the colonial days, that’s not the population he wanted to look at.
I had just been standing there, but I saw a chance to interject that I spoke Spanish, and would that be useful somehow in collecting data in areas where Spanish was spoken? Anne told me later that she thought that he did a 180-degree turn when I said this, and was suddenly way more interested in what I had to say. I thought that was kind of funny, because I don’t consider myself a thunder-stealer at all (heh, though I’d like to know how to do that). In any case, we all exchanged email addresses, and Anne and I both left with the feeling that something good might come out of all this that would alleviate the stress of finding a project for this summer.
This whole project thing has been the one shadow over this program. Yes, we should all get some research experience, but the CID program has a big emphasis on sending students overseas to do work. Maybe this will be different because we’re all masters students and reasonably well qualified, but this rings a lot of my days at Prescott College, when the idea seemed to be: take a couple of classes, learn a couple of things, get an overblown sense of your own competence, and then run off to third-world countries to offend the locals. I really, really don’t want to deal with all that again. My suspicion that this was an issue was compounded when we ran into one of Dr. M’s collaborators, a Brit who had been doing work in India for years. Anne caught up with him and asked about doing Dr. M’s data-gathering at the site in India, and he said, without an instant of hesitation: No. Absolutely not. Then he kind of backed up a bit and said that he’d had some trouble years earlier with LSHTM people gathering data down there, sitting on it for years, then publishing it so far after the fact that it made India’s TB program look like it was still in the dark ages. His colleagues down there were offended enough that the refused to work with the school any more, and from then on they decided to use only Indian nationals to do that kind of work. He never said that it was a student that caused the problem, but he didn’t say it wasn’t. It just had that ring to it. So for me, finding a project that is based on tried and true methodology, and for which there are already willing collaborators on-site, would be a very good thing.
Anne had wanted to find something fun to do that night, being Saturday night in Paris, but we couldn’t find an internet café, and without any better direction, I steered us toward Montmartre and Sacre Coeur cathedral. I didn’t think she’d object once we went, since it is worth seeing, just for the spectacul
ar view of Paris if nothing else. We took the Metro to Abesses, hauled our tired selves up those several hundred stairs to the church, and quietly went in among the tourists and the pilgrims. We sat for a while in the pews, the walked around toward the back of the chapel behind the main altar. When we came back around to the front, a host of nuns in pure white had gathered silently along the sides of the altar, and then they began to sing. In their draping robes and with voices floating in the ether of the church’s dome, they seemed closer to pagan worshippers than to modern people of a modern god. Even in the gaudiness of Sacre Coeur (whose stain-glass windows – replaced after their destruction during World War II – look more post-modern than traditional), one could see how religion in Europe forms an unbroken chain back far beyond the year zero, to a time when other worshippers sang to other gods in robes not so different from these.
From there we travelled only a few hundred yards to the Place de Tertre, where we must have spent an hour comparing prices at various crepe stands. I was starting to get an idea of just what a tight budget Anne is on, but I was also getting somewhat tired of walking endless circles around the plaza looking for the crepes that cost 3.50 euros instead of 4 euros. We settled outside on a covered patio, and shortly after we ordered a squall blew through and drenched the square in a torrent of rain as we dashed inside. At one of the highest points in Paris, every flash made me think of lightening, though I’m pretty sure that most of those lights were tourists taking digital photos of the passing storm. We passed the rainy time by eating “chocolate” crepes for desert, which are actually filled with Nutella and are so sweet they make my teeth itch, but which are worth every bite anyways.
From there I thought Anne would want to see the Moulin Rouge, and the neighbourhood called Pigalle was just down the hill, so we headed that way. After the requisite pictures of the neon-red spinning windmill, we stopped for her to get a toothbrush, which she had forgotten in London and was surviving without. Realizing that indeed, everything is less expensive when spending euros rather than pounds, I stocked up on hair care products and the like while she was looking for what she needed. After that we split up, she heading back to Republique and me backtracking only a couple of stations to Lamark, and said our good-byes until we met up again at school on Monday.
Again I arrived too late to catch the meet-the-experts session, though Anne did make it to the one that we had both wanted to see (from the plenary speaker from Wednesday evening, before either of us got to Paris), which happened to be cancelled. Apparently I didn’t miss anything.
Having missed that session, Anne and I went to see a talk on tobacco and TB, which is an area that I’ve been very curious about given that it’s so little talked about in most of the popular literature on the disease. The presenters gave a very strict review of the major literature, and concluded that there is some amount of moderate evidence that smoking both causes more susceptibility to TB and makes the progress faster once someone’s got it. Many irate audience member stood up and demanded to know how they could be so wishy-washy about what is clinically a very evident problem, as well as why some major studies were not considered (eg. one of the very prominent studies on this topic used death certificate data, which was not considered to be best way to tell if someone really died of TB or something else, and so it was excluded from the analysis). And of course, there one problem with any study on things like smoking and illegal drugs and the like: you can’t randomize people to smoke or not smoke, so randomized controlled trials are out of the picture. Any other study is considered second-rate compared to that type of study, so of course the data on smoking and ANYTHING is going to look wishy-washy. It was an entertaining exchange, in any case.
After a very interesting plenary session on the need to coordinate care for AIDS, asthma, and TB in developing nations (apparently, asthma rates go up as nations industrialize – partly due to industrial pollution, it is thought, but also because the entrance into the global market is inevitably followed by the arrival of cigarettes, which is thought to account for a large proportion of childhood asthma), Anne and I had lunch with Olivia, the former LSHTM student (now from McGill) who we met yesterday. She was scheduled to speak during the last session of the day, which seemed to be mostly graduate students giving a quick spiel on their research. She was nervous to the point of not wanting to admit that it was coming. I guess that’s one thing I’ve got going for me: I may be a mediocre public speaker (no doubt there: I talk too fast, and every other word is “uh,” punctuated periodically with some variety like “um” and “yeah”), but I do not dread public speaking. In fact, I rather like it. I think I discovered somewhere around seventh grade that if I was speaking in front of a group, everyone at least had to pretend they were listening to me, and that was a rare enough event that I kind of dug it. Still do. In any case, Olivia presented her piece very well, occasionally deferring to her advisor in the audience, who had done the literature reviews necessary to create her economic model on whether quantiferon (a blood test that is very sensitive and specific for TB) was an economically viable test for mass screening. Their conclusion was no, it was not. Too bad – a better test for TB is needed, but only if it gets cheaper can it be used on a wide scale.
After Olivia’s talk I snuck out to catch the last part of a session on ethical aspect of TB intervention (which has been a thorn in the side of TB researchers ever since the city of New York started jailing its high-risk resistant TB patients during an outbreak in the 1990s). This turned out mostly to be a discussion of the current situation in the Russian Federation, and it was conducted largely in Russian with English translation. This was a relief after some of the talks, where speakers attempted English but only spoke enough to read off their Power Point slides – it would have been more merciful on everyone just to use translators. The two I saw were interesting, but also pointed to one of the weaknesses of conference like this: many of the presentations are on recent studies and new data, and they tend to read like a chapter out of statistics book. I far prefer talks where the data is presented briefly, but the concepts, context, and larger lessons are emphasized. In any case, I had hit up this session to hear the last speaker, who was the professor from LSHTM who had first told us about the conference last week. I had given up on keeping quiet about ditching class, and figured that if I wanted to work on a TB project this summer, it might be nice to be able to mention to one of the big researchers at LSHTM that I’d heard his speech at the conference. Unfortunately, with the combination of my sleepiness and his pedantic speech (which covered all manner of philosophical approaches I had either never learned or tried to forget), I caught about half of it and spent the rest of the time struggling not to fall asleep. I’m not sure that did me any good in the kissing-up-to-the-experts realm, but at least I can say I was there!
I went to find Anne and the end of this session, who was talking to Olivia and her advisor, Dr. M, in the room where their session had just ended. Dr. M’s current research has to do with economic modelling, specifically on the question of whether the first-world recipients of migrating cases of TB from the developing world could save money by investing in health care in those nations themselves, rather than just treating the disease once it crosses the border. Specifically, they had just published an article in the New England Journal of Medicine that looked at costs in the US and several countries that feed immigration (especially Mexico and the Dominican Republic), where their modelling concluded that the US could save lots of cash by helping out those countries to keep TB under control so that it doesn’t leak across the border and into the US budget. Dr. M said they were pursuing lobbying on this front, and that at least in Canada they were getting a sympathetic ear from several federal representatives. I laughed – good luck getting anywhere with that in the States, at least under the current regime, which at the moment seems bent on “helping” the victims of last month’s hurricanes by cutting food stamps and Medicaid budgets.
In any case, Anne was busy finding out if there was any chance of getting together a research project for next summer under this project, and Dr. M was very interested. Part of the economic analysis involves quantifying costs of the disease on the patients who suffer from it (since TB takes months to cure, and is often debilitating before treatment is sought), and both Anne & I saw some intriguing possibilities there. She speaks French, but it turns out that wasn’t a help because the nations that he was analyzing were those that send immigrants to the US, the UK, Canada, and Germany, and though much of Africa speaks French from the colonial days, that’s not the population he wanted to look at.
I had just been standing there, but I saw a chance to interject that I spoke Spanish, and would that be useful somehow in collecting data in areas where Spanish was spoken? Anne told me later that she thought that he did a 180-degree turn when I said this, and was suddenly way more interested in what I had to say. I thought that was kind of funny, because I don’t consider myself a thunder-stealer at all (heh, though I’d like to know how to do that). In any case, we all exchanged email addresses, and Anne and I both left with the feeling that something good might come out of all this that would alleviate the stress of finding a project for this summer.
This whole project thing has been the one shadow over this program. Yes, we should all get some research experience, but the CID program has a big emphasis on sending students overseas to do work. Maybe this will be different because we’re all masters students and reasonably well qualified, but this rings a lot of my days at Prescott College, when the idea seemed to be: take a couple of classes, learn a couple of things, get an overblown sense of your own competence, and then run off to third-world countries to offend the locals. I really, really don’t want to deal with all that again. My suspicion that this was an issue was compounded when we ran into one of Dr. M’s collaborators, a Brit who had been doing work in India for years. Anne caught up with him and asked about doing Dr. M’s data-gathering at the site in India, and he said, without an instant of hesitation: No. Absolutely not. Then he kind of backed up a bit and said that he’d had some trouble years earlier with LSHTM people gathering data down there, sitting on it for years, then publishing it so far after the fact that it made India’s TB program look like it was still in the dark ages. His colleagues down there were offended enough that the refused to work with the school any more, and from then on they decided to use only Indian nationals to do that kind of work. He never said that it was a student that caused the problem, but he didn’t say it wasn’t. It just had that ring to it. So for me, finding a project that is based on tried and true methodology, and for which there are already willing collaborators on-site, would be a very good thing.
Anne had wanted to find something fun to do that night, being Saturday night in Paris, but we couldn’t find an internet café, and without any better direction, I steered us toward Montmartre and Sacre Coeur cathedral. I didn’t think she’d object once we went, since it is worth seeing, just for the spectacul
ar view of Paris if nothing else. We took the Metro to Abesses, hauled our tired selves up those several hundred stairs to the church, and quietly went in among the tourists and the pilgrims. We sat for a while in the pews, the walked around toward the back of the chapel behind the main altar. When we came back around to the front, a host of nuns in pure white had gathered silently along the sides of the altar, and then they began to sing. In their draping robes and with voices floating in the ether of the church’s dome, they seemed closer to pagan worshippers than to modern people of a modern god. Even in the gaudiness of Sacre Coeur (whose stain-glass windows – replaced after their destruction during World War II – look more post-modern than traditional), one could see how religion in Europe forms an unbroken chain back far beyond the year zero, to a time when other worshippers sang to other gods in robes not so different from these.From there we travelled only a few hundred yards to the Place de Tertre, where we must have spent an hour comparing prices at various crepe stands. I was starting to get an idea of just what a tight budget Anne is on, but I was also getting somewhat tired of walking endless circles around the plaza looking for the crepes that cost 3.50 euros instead of 4 euros. We settled outside on a covered patio, and shortly after we ordered a squall blew through and drenched the square in a torrent of rain as we dashed inside. At one of the highest points in Paris, every flash made me think of lightening, though I’m pretty sure that most of those lights were tourists taking digital photos of the passing storm. We passed the rainy time by eating “chocolate” crepes for desert, which are actually filled with Nutella and are so sweet they make my teeth itch, but which are worth every bite anyways.
From there I thought Anne would want to see the Moulin Rouge, and the neighbourhood called Pigalle was just down the hill, so we headed that way. After the requisite pictures of the neon-red spinning windmill, we stopped for her to get a toothbrush, which she had forgotten in London and was surviving without. Realizing that indeed, everything is less expensive when spending euros rather than pounds, I stocked up on hair care products and the like while she was looking for what she needed. After that we split up, she heading back to Republique and me backtracking only a couple of stations to Lamark, and said our good-byes until we met up again at school on Monday.
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