Morning Reflection: The Deprivatization of Grief

Do you remember the telephone booth? I do, of course -- I'm old enough. You can still find them in the lobbies some old and elegant hotels and selected aging government buildings. But they are, alas, becoming ever scarcer, as venues such as these gradually undergo their inevitable renovations into congruence with the twenty-first century.

For those of us above a certain age, rather mundane-looking offerings like the one at the left can be unexpectedly evocative. Entering a phone booth -- particularly one of those old polished wooden boxes with its own wooden seat, rubbed to a dull luster through decades of use by miscellaneous bottoms attached (proximally or distally) to miscellaneous minds sealing miscellaneous deals, patching miscellaneous frayed relationships, or making miscellaneous "clean breaks" -- entering such a booth was akin to a brief trip back to a well-ordered, fluorescently lit womb. You would close the door, the booth's overhead light would flicker on, its fan would whirr into action, and there you were: perfectly alone, with only a phone, the White Pages, and your own breathing for company. You might be destitute; you might have just lost a fortune that took a lifetime to win; your entire emotional infrastructure might have just collapsed beneath you, leaving you in free-fall; but in that booth you had one thing that, for a few moments, no one could take away from you. Privacy.

Of course, phone booths of the type I extol above have been undergoing a slow decline for decades. Even twenty years ago, bottom-line pressures had pushed their replacement with more open street-corner phones like the one at right. These didn't have quite the privacy of the old booths, but you could, by pressing yourself in close to the phone, cupping your hand over the mouthpiece, and speaking into the small cave that protected the equipment from the elements, pretend that you still enjoyed some of the old privacy of the free-standing booth. (That is, if you could find a street pay phone that worked.)

You know where this is going, of course.

The cellphone is rapidly making even common street pay phones like this one obsolete. I still don't have a cellphone of my own, but the fact that I now acknowledge that I probably will end up with one (whereas one year ago, I had vowed to live a cell-free life until, untethered by even the wispiest of wireless connections, I crawled into my grave), and the fact that my teenage daughter is now making a very persuasive case that, given the ever-growing scarcity of functioning pay phones, she needs one, says something.

The cellphone has given us a variety of archetypal urban situations. We've all experienced the person on the subway or in the quiet restaurant, jabbering with wild abandon into his cellphone to settle some bit of office complication or arrange his next assignation. The sound of the cellphone ringer playing the tuneless MIDI rendition of Bach's Brandenburg Concerto Number 5 or "In the Hall of the Mountain King" that the cellphone owner downloaded and installed on the phone to express her "personality." The disconcerting experience of walking down the street next to a stranger who appears to be talking to himself, only to realize that he's in fact having a long-distance conversation via one of those cleverly hidden headsets.

And there's more. For example: Has anyone but me noticed the "cellphone stance"? (Apparently, someone has.) At a crowded street corner, you'll sometimes see a man in a business suit, standing still, oriented in no particular direction, but head bent slightly forward, shoulders hunched in. He is apparently staring down, with the unselfconscious absorption of a Talmudic scholar, at something in his hands. You pass him and you realize he's dialing a cellphone, or scrolling through a cellphone menu, or maybe just trying to figure out how the damned thing works. Keep an eye out for this if you haven't seen it already.

So why am I blathering on about this? Actually, because of something that happened yesterday as I bustled into the train station on my way to work. As I came off the first escalator and hurried toward the turnstile and the stairs to the platform, I passed an ordinary young woman in ordinary dress: Blue jeans, a nice T-shirt, sneakers. She stood facing the wall of the corridor, a cellphone to her ear, and was bent slightly forward, completely enveloped in her call. And every once in a while she would let out a sound -- the sound not just of crying, but of pure, unvarnished, inconsolable grief. Along with the rest of the crowd I moved past her quickly, and as I did so I realized that her grief was intensifying; the crying became ever more insistent, ever less admitting of relief, urged on by the cascade of whatever bad news was streaming down from the ether and into her earpiece. By the time I had reached the turnstile, I could hear distantly behind me that her crying had evolved into what can only be described as a howl of anguish.

And we all just kept moving on to our trains.

I will never know what prompted the sorrow that this young woman felt at that moment -- sorrow enough, it's certain, to trump all local circumstance in her mind. But clearly enough, the blowzy, free-talking subway rider, sharing one side of his salacious conversations with a captive audience of passengers, is only part of the picture. Even in a world where electronic communication allows us to share in the horrors of populations of strangers half a world away in Uganda and Sudan, the cellphone, it would appear, offers perhaps the ultimate deprivatization of the most personal grief.

Science Friday (Not)

Lots of interesting stories in the sciences this week . . . but no time to write them up! Maybe tomorrow.

Morning Resumption: The FDA Follies, Continued

Well -- the plot certainly thickens in the FDA antidepressants-and-children story, which seems to be ripening into a genuine scandal.

As I noted in a previous post, the FDA brass already had some serious explaining to do for suppressing the results of a 2003 meta-analysis that showed an increased suicide risk among children prescribed antidepressants. Yesterday's hearings on the topic before the House Energy and Commerce subcommittee on oversight and investigations uncovered an even greater embarrassment: The agency -- at least to hear drug company executives tell it -- actually urged pharmaceutical manufacturers to weaken labeling that raised warnings about the drugs' risks to minors, and to withhold from doctors and the public the fact that in some clinical trials the antidepressants performed no better than placebos. FDA's rather lame excuse for encouraging the withholding of negative information: the agency didn't want to "scare families and physicians away from the drugs" -- and, the agency asserts, "the jury is still out" on them.

Leaving aside for a moment the fact there are other, non-drug treatments for depression that can be quite effective -- and the question of what kind of society throws Paxil, Prozac, and Zoloft at people too young to have any legal or intellectual say in their own care (11 million antidepressant prescriptions for minors were written in 2002 alone) -- FDA's logic here has to be viewed as little short of astonishing. If "the jury is still out," my vote would have gone to more caution in the labeling rather than less. According to the Post article linked above, more than two-thirds of all studies of antidepressant use among children have failed to show that the drugs are effective -- yet the public would have no way of knowing that, as only the positive trials tend to get published. According to testimony by a Pfizer vice president yesterday, Pfizer had planned to add to labels for Zoloft language noting that two studies of Zoloft involving depressed children had revealed that the medication performed no better than placebos. FDA's response was that the agency "[did] not feel it would be useful to describe these negative trials in labeling, since these may be misinterpreted as evidence that Zoloft does not work."

Which is, of course, exactly what the results of the trials were saying. For these children, it did not work.

Of course, fobbing off the responsibility onto FDA is also a self-serving move for the drug companies, which haven't exactly been eager to promote the negative results of clinical trials -- even when the public has paid big money for them. In the current case, as an inducement for the drug companies to conduct further clinical trials on antidepressants, Congress granted extensions of the companies' patents on these drugs that were worth literally billions of dollars in windfall revenues to the pharmaceutical industry. The extension given to Pfizer alone was worth $1 billion.

It's this kind of tomfoolery that drove the editors of twelve medical journals, including heavyweights like the New England Journal of Medicine, JAMA, and The Lancet, to declare this week that henceforth they would publish pharmaceutical company-sponsored drug research only when all studies related to the research were registered in a public database (such as ClinicalTrials.gov) from the get-go. Registration, of course, merely means divulging the existence of a trial; the companies would not be required to actually post the trial's results. And the drug companies may simply decide not to publish -- though publication in a top-tier journal can greatly boost a drug's sales. In any case, it's a step in the right direction.

Morning Vacuum

Alas, again a morning with no time to post. I promise to be a good boy tomorrow. Meanwhile, I guess we can all lean back and enjoy -- for a day or so, judging from the media's past performance on these matters -- the spectacle of the Shirker-in-Chief's feet finally being held to the fire.

Morning Ramble: The Open-Access "Debate"

A debate that has animated the scientific-publishing world for the past five years or so -- the push by an activist group to promote "open access" to the primary scientific and particularly biomedical literature -- has reached its proverbial tipping point, with the government's proposal to "recommend" that all papers based on NIH-funded research become freely available on the institutes' public archive, PubMed Central, within six months of publication. Numerous press outlets picked up the story -- or, more precisely, picked up and re-ran the highly favorable Washington Post report of the story, which emphasized the righteousness of the NIH cause, the need to empower the huddled masses yearning to read the latest paper on cellular signal transduction, and the callow and panicked response of the venal scientific publishing industry.

All right -- I exaggerate. In any event, the handwriting, as they say, is on the wall: With the recent NIH proposal, congressional support, and the issue's superficial "apple pie and motherhood" appeal, a move to require some kind of open access for NIH-funded scientific research has become pretty much inevitable. Moreover, if the NIH plan is adopted, it's unlikely to remain static -- it's only a matter of time before it's "recommended" that publishers make papers freely available not six months after publication, but three months after, then three weeks, then one -- and, ultimately, insist on free access immediately upon publication. Nor will the move remain confined to biomedicine: sooner or later, other government funding bodies such as NSF will start to ask just why papers reporting the research they fund shouldn't be free to the public as well. The result will be a sea change in the way scientific results are published.

As a "good liberal," I suppose I should be in favor of this. Still, there are two sides to every story, and it seems that the press may be too quick to dismiss the potentially damaging effects of the blunt instrument the NIH proposes to use to "solve" a real problem. I wish that I had more time to devote to this than this brief train ride to work, but a few points seem worth making here. (I would also counsel the reader to trust none of what I say: I have a vested interest in the current system, and am thus merely another mindless tool of a cynical, money-grubbing, albeit nonprofit, scientific publisher.)

First, I'd stress that there is a real problem here; academic libraries and similar institutions have seen subscription costs expand significantly in recent years. A large part of this, however, traces to the activities of a few large, for-profit aggregators that, by acquiring control of large numbers of scientific journals, have amassed quasi-monopolistic power, and have used that market power to boost subscription revenues. Thus an argument could be made (at least from my vantage point) that, rather than dismantling a publishing system that has worked for many years, society might be better served with antitrust action against this kind of abuse of market power.

Second, we need to ask ourselves who is really likely to benefit here, and how much. One ironic thing about this debate, to me, is that access to scientific literature is now more open than it has ever been before. Working scientists now can call up an unprecedented range of primary research from their computer desktops -- usually for free (at least to them), owing to the prevalence of online library subscriptions. Articles such as the Post item linked above invariably, and anecdotally, cite the desire of patients and the public to read the primary literature. But are most people even going understand that literature? Here's an example of the kind of thing the public is missing under the current "closed" system:

Hh signal transduction is unusual in that the unbound receptor (Ptc) is the active form (that is, it keeps the pathway switched 'off' by inhibiting the transducer (Smo)). Binding by the ligand (Hh) inactivates the receptor, releasing Smo from inhibition and turning the pathway on. The cell's perception of the amount of ambient Hh has been proposed to be determined solely by the number of unliganded (active) Ptc molecules. Thus, as Hh rises from nil to peak concentrations, Smo activity would increase merely as a consequence of the progressive depletion of the pool of active Ptc protein. According to this depletion model, liganded Ptc would be functionally equivalent to the absence of Ptc. Alternatively, liganded Ptc might titrate the inhibitory activity of unliganded Ptc so that a cell's perception of Hh concentration would depend on the ratio of the two forms.

Granted, less arcane material exists in the scientific literature (as does more arcane material). The point is that, arguably, what the public needs is not better access to primary scientific research; it needs better science journalism, better plain-language explanations, better value-added material to put scientific work into context -- and these are not things it will get from the open-access movement. (Indeed, to the extent that the move toward making research papers freely available puts pressure on the bottom lines of marginal players, it could limit those players' efforts/ability to devote scarce resources to publicity, press relations, and explanatory material, thereby limiting rather than broadening public access to these important gateways to the scientific world.) In light of the library crisis mentioned above, there may indeed be excellent arguments for some kind of open access. But for the sake of intellectual honesty, proponents of the idea should stop fronting the emotionally appealing but specious arguments about the public masses clamoring for instant desktop access to the latest papers on NF-κB.

Third, I think the argument of small scientific societies that they depend on their publishing revenues to fund their other operations shouldn't be tossed to the side in quite so cavalier a fashion as some in the OA community are wont to do. Many of these small nonprofits do fine work for their constituencies, but they operate on the financial razor's edge -- and arguably don't have the luxury of experimenting with an untested business model. (And make no mistake -- author-pays open access is an untested model. Remember that PLOS Biology, often cited as the shining example of open-access publishing "success," still enjoys the financial advantage of huge grants from the Gordon and Betty Moore Foundation and the Open Society Institute, and others.)

Fourth, open access (under an author-pays framework) seems unlikely to work outside of the exalted realms of biomedical research. There are many ironies in the open-access movement; one of the richest is that the arguments for free access are pushed most forcefully by privileged scientific castes in biomedicine whose funding is secure, who can attract large grants, and who are no longer in the stage of trying to build a career with limited funding that is premised on developing a publication record in top-tier, high-quality journals. For a front-rank researcher in molecular biology, pushing open access has no real risks; for workers in more marginal areas with limited funding, author-pays open access could effectively foreclose the opportunity to publish in first-rank journals -- which, the free market being what it is, would likely command the highest author fees for publication.

There is actually much, much more to this issue than I have time to write about now -- and I fear that I haven't really expressed myself well in what I have written. Time to shut up before doing myself any more damage.

Morning Despair

Once again, I find myself with little time to post today -- and, frankly, little interesting to say. I suppose I could talk about the polls that suddenly seem to be showing Kerry ten points behind Bush, or link to the articles now openly asking if Kerry can come back, or even ask whether the fact that I seem to see a pro-Bush photo on the New York Times homepage every day is part of a real pattern or just my fevered, paranoid imagination. But all of that's old hat.

Dirty politics once again seems to be winning. A Republican Convention that, by all accounts, was appallingly mean spirited seems to have trumped a Democratic Convention that went out of its way to minimize cheap shots against an Administration that richly deserves them. The punditry will now sit back in their leather chairs and pontificate about how this turn of the poll numbers is Kerry's fault, about Kerry's lack of dynamism, about how Kerry hasn't fought back hard enough, yadda yadda yadda.

I'm getting a bit tired of all of that. Perhaps they're right; perhaps it is Kerry's fault. Or perhaps the truth is a little bit harsher: Perhaps an electorate (and a press) that's moronic enough to swallow every Administration lie, from the Saddam-Osama Shuffle to the Swift Boats, doesn't deserve good government after all.

Take a look at Elizabeth Drew's new piece in the New York Review of Books, where she dissects the 9/11 Commission report, and, unlike so many others in the media, has the courage to conclude that the report -- notwithstanding is efforts to be "balanced and measured" -- actually paints a picture of breathtaking incompetence on the part of the Bushites in the months and days before 9/11. And then take a look at Krugman's piece in the New York Times this morning, about how skillfully Bush has used perpetual warfare to buoy his popularity since 9/11.

Shameless.