Thursday was a late starting day and we began some more discussion of the mechanics of what is to come. Then we learned about the Institute of Medicine. Chartered in 1971, the IOM joined the NAS and the NAE as an advisory body, funded a lot by Congress to present them with considered opinions about important stuff, like why are there so many medical errors and what do we know about vaccine injuries. They answer the questions that they are asked, and they do very little original research (ex
cept in military medicine, where they are an indespensable the repository of data). We met five of the Boards:
Children, Youth and Families, Health of Selected Populations, Health Sciences Policy, Food and Nutrition and Population Health and Public Health Practice. There were a number of different studies that relate to children, particularly in CYF and Food and Nutrition. They have some stuff on Children's Mental Health going on, along with obesity stuff and vaccine stuff and - you name it. In a lot of ways, it was overwhelming, and I wasn't able to ingest it all enough to ask a competent question, a sure sign of being overwhelmed. How will I be able to hang onto that many contacts and names? How will I learn what is going on?
Anyway, after 3 hours of Boards and studies, Marie began a talk on the current state of the health reform debate, using it as an means of explaining how our government works. She was brilliant- low key, yet full of facts and interesting stories about how work actually get done around here. I took notes on her slide set- I really want to use her slides. The most important ones, I think, are these:
We look at problems as a way to ask interesting questions- we then collect fresh data and look
to see what questions it raises. Medicine and engineering tend to be bit more practical than the pure scientists, but still, we are interested in a "deep" understanding of things.
Political folks approach problems with a legal eye: What are the Issues? What are the Rules? How have the rules been Applied in the past? What is your Conclusion? A lawyer's notion of fairness, then, is heavily biased toward the status quo. Takes a supple mind to say- we need a different applications. Politicians have more free to change the Rules, but, if they are not going to support the status quo, they have to have a real keen sense of how the power balance is playing out. And always, they have to figure out who will pay for whatever the change is (and does that person or entity have the power to strike back)?
My challenge is to be able to take the stuff we have learned through science and help that information inform the decision process. Not an easy task.
The flip side of this is that I will be functioning in a system that has a completely different value system than the one that I am used to. Marie gave us some ways to think about it, that lend themselves to stereotyping, but are true at the core. The interesting one to me was the high value placed by decision makers on the power of the press. Given everything that has been said about the decline and fall of the media, it is not clear who the media are, only that they are feared.
The other interesting thing about Marie's contemplation was here assessment of the decision making apparatus. There's the Executive Branch, with the POTUS and his many Executive Offices, the Legislative Branch, with its committees and chairman, and the interest groups (Special Interests, Stakeholders) which she parses into Voluntary Health Groups (ACS is king among those), Professional Societies, Trade Associations, and Academe/Think Tanks. The latter is how science intercolates itself into the debate. The key to the process is understanding the players in this complex multimodal process. What have I gotten myself into?
^^^^^
6 hours waiting and no Comcast. They now say that he has a flat tire. Not sure I believe it.
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