Picking up the pace
Sep. 25th, 2001 11:39 pm![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
rivkaLife's getting back to normal, although I'm still following the news with more vigor than usual. I've also been unusually tired. I thought I was coming down with some kind of bug, but now I'm wondering if it was just accumulated stress.
It's a good time for me to be getting back to full alertness and concentration, because things are heating up at work. Lydia and Lauren (the new intern, who is also my new meatspace friend) came up with the idea of studying HIV+ patients' stress and coping in response to the disaster, and seeing whether stress was correlated at all with changes in immune function. So Lauren's trying to get the proposal together, and she's never done anything like that before so I'm shepherding her through the process. I'm dubious about whether she'll come up with anything - I think by the time the study gets approved and off the ground, too much time will have passed since the bombing and our patients won't be stressed about it anymore. Oh well, doesn't cost anything to try, I suppose. And - we're all stepping sort of hesitantly around this, not wanting to say it - if something else happens, we'll already have the study approved.
*shudder* Ick. Ugly things can happen to the minds of people who study stress.
At any rate, that's not the only new project. The Health Department contract finally went through, so Real Soon Now I should be able to start spending two days a week in the clinic. Yay! I have really, really missed having a regular clinic schedule. It keeps me a lot more firmly grounded in what our research is supposed to be for.
And - just as I got the forgiveness project crunching through the IRB - suddenly it turns out that I'm also supposed to be contributing part of my effort to this new IHV pet project on Directly Observed Therapy.
Directly Observed Therapy (DOT): If you have tuberculosis (TB) and don't take your medicine, someone from the local Health Department will come out to your house to watch you take it. If you continue to cause trouble, they can actually go so far as to put you in TB jail. (Really. Maryland has a TB jail on the Eastern Shore. They call it a "sanatorium," but there are bars on the windows.) They do this because TB is a communicable disease with an onerous treatment regimen, and because if the regimen isn't followed exactly your body becomes a breeding ground for drug-resistant TB.
Why haven't they done this with HIV long ago, given that the same characteristics apply? Partly because the HIV treatment regimens aren't curative. You may have to take TB drugs for a long time (usually it's every day for a year), but at the end of that time you can stop. HIV drugs just keep the virus under control - they don't eradicate it. But also because HIV/AIDS has been considered a special category since it was first identified. It's the same reason why your doctor is required to report you to the Health Department if you have syphillis, but not if you have HIV - for very clear historical reasons, people with HIV/AIDS get extra layers of privacy protection. The problem is that drug-resistant HIV is on the rise, and it's being spread to people who are newly infected. (I think I've ranted about this here before.)
So the institute I work for is doing a demonstration project to see whether DOT can help. To give the docs running the study credit, they understood from the start that there were important behavioral/psychological aspects to this type of project - especially in how you go about weaning people off DOT and into managing their own meds without direct supervision. So they tried to write some behavioral stuff into the grant. But, being physicians with standard US physician training, they hadn't the slightest idea of what they were doing. (As![[livejournal.com profile]](https://www.dreamwidth.org/img/external/lj-userinfo.gif)
saoba has trained me to add: Bless their hearts.) So now Lydia and I are trying to come up with some major fixes.
Here's an example of what we're up against: the docs thought it would be a good idea to reward patients for taking their meds correctly, so they want to give them financial incentives for maintaining 95% or greater adherence. How will they tell, you ask? The patients will fill out diary-type record sheets indicating whether they took each dose. Let us all pause to reflect on the likelihood that an extremely poor inner-city patient who has lapsed in adherence will report it, knowing that by doing so zie will lose zir money. Now, let us all pause to reflect on the boundless faith in humanity shown by the docs who wrote the protocol. Bless their hearts. And send in the behavioral medicine cynics, quickly, before they waste $400,000 in foundation money.
It's a good time for me to be getting back to full alertness and concentration, because things are heating up at work. Lydia and Lauren (the new intern, who is also my new meatspace friend) came up with the idea of studying HIV+ patients' stress and coping in response to the disaster, and seeing whether stress was correlated at all with changes in immune function. So Lauren's trying to get the proposal together, and she's never done anything like that before so I'm shepherding her through the process. I'm dubious about whether she'll come up with anything - I think by the time the study gets approved and off the ground, too much time will have passed since the bombing and our patients won't be stressed about it anymore. Oh well, doesn't cost anything to try, I suppose. And - we're all stepping sort of hesitantly around this, not wanting to say it - if something else happens, we'll already have the study approved.
*shudder* Ick. Ugly things can happen to the minds of people who study stress.
At any rate, that's not the only new project. The Health Department contract finally went through, so Real Soon Now I should be able to start spending two days a week in the clinic. Yay! I have really, really missed having a regular clinic schedule. It keeps me a lot more firmly grounded in what our research is supposed to be for.
And - just as I got the forgiveness project crunching through the IRB - suddenly it turns out that I'm also supposed to be contributing part of my effort to this new IHV pet project on Directly Observed Therapy.
Directly Observed Therapy (DOT): If you have tuberculosis (TB) and don't take your medicine, someone from the local Health Department will come out to your house to watch you take it. If you continue to cause trouble, they can actually go so far as to put you in TB jail. (Really. Maryland has a TB jail on the Eastern Shore. They call it a "sanatorium," but there are bars on the windows.) They do this because TB is a communicable disease with an onerous treatment regimen, and because if the regimen isn't followed exactly your body becomes a breeding ground for drug-resistant TB.
Why haven't they done this with HIV long ago, given that the same characteristics apply? Partly because the HIV treatment regimens aren't curative. You may have to take TB drugs for a long time (usually it's every day for a year), but at the end of that time you can stop. HIV drugs just keep the virus under control - they don't eradicate it. But also because HIV/AIDS has been considered a special category since it was first identified. It's the same reason why your doctor is required to report you to the Health Department if you have syphillis, but not if you have HIV - for very clear historical reasons, people with HIV/AIDS get extra layers of privacy protection. The problem is that drug-resistant HIV is on the rise, and it's being spread to people who are newly infected. (I think I've ranted about this here before.)
So the institute I work for is doing a demonstration project to see whether DOT can help. To give the docs running the study credit, they understood from the start that there were important behavioral/psychological aspects to this type of project - especially in how you go about weaning people off DOT and into managing their own meds without direct supervision. So they tried to write some behavioral stuff into the grant. But, being physicians with standard US physician training, they hadn't the slightest idea of what they were doing. (As
saoba has trained me to add: Bless their hearts.) So now Lydia and I are trying to come up with some major fixes.Here's an example of what we're up against: the docs thought it would be a good idea to reward patients for taking their meds correctly, so they want to give them financial incentives for maintaining 95% or greater adherence. How will they tell, you ask? The patients will fill out diary-type record sheets indicating whether they took each dose. Let us all pause to reflect on the likelihood that an extremely poor inner-city patient who has lapsed in adherence will report it, knowing that by doing so zie will lose zir money. Now, let us all pause to reflect on the boundless faith in humanity shown by the docs who wrote the protocol. Bless their hearts. And send in the behavioral medicine cynics, quickly, before they waste $400,000 in foundation money.
