Considering Genre

If you've trudged along with me this far, then you know it's time to choose a mode of attack for this project. I spent some time debating whether a quick-reference guide or a standard essay format would work best for this project. Ultimately, I chose:

• The Quick Reference Guide! I chose this genre because I'm identifying and describing the different stakeholders in a complicated controversy. Most people haven't done hours of research into why multiple sclerosis medication costs are rising, so they'll need to quickly be brought up to speed. Plus, a QRF will conveniently break down the complex topic into manageable portions. This will significantly ease the burden of writing, and it'll make it easier for my audience to understand what's really going on. 

Peters, Alejandro. "Lights, Camera, Action." 1/31/2016 via flickr. CC Attribution 2.0 Generic.

• I'm going to need to provide the context for what factors are causing drug prices to rise. At the same time, I need to incorporate MS patients and the way these drug costs affect them. That means I'll have to develop my QRF skills in explaining somewhat distinct facets of a complex topic in a single, easy-to-understand document. The humanistic element to this story is very different from the dry facts and charts. Incorporating both into a single story will definitely require some skill. 

• Luckily, QRFs require less equipment preparation than video essays or podcasts. This means there isn't a lot of media equipment I need to check out or hunt down. However, the complexity of my topic will force me to really organize the guide and figure out how my sub-topics should be broken down. There are many different ways I could layout the context for this contreversy, and the method I choose will affect how easily my audience gets the bigger picture. Specifically, this means that the QRF will require more brainstorming and outlining than a typical paper.

Cluster of Stakeholders

I wanted to create a cluster showing the different stakeholders involved in the debate over MS drug pricing. So, in the pursuit of the perfect concept map, I discovered how to use Coggle today.

Arlindi1999. "Eureka Arkimedi."01/31/2016 via Wikimedia Commons. Licensed under CC Attributions-Share-Alike 3.0. 

• The concept map I created divides the players into three distinct groups: those who prefer the price of MS drugs to rise, those who wish it to fall, and those who are neutral. I then subdivided these groups into particular categories, such as journalists, patients with MS or pharmaceutical companies. Once each subgroup was identified, I then wrote a short excerpt explaining the underlying reasons why they would want MS drugs to rise or fall. 

• In case you are interested in checking out the concept map for yourself, I've included it here!

Evaluation of General Sources

I decided to focus my post-mortem analysis on the controversy behind the price of prescription drugs designed for multiple sclerosis. Coming into the debate, I knew that pharmaceuticals argue that R&D investment demands large returns for high risk, and that patients counter that these medications are life-altering yet unobtainable. I wanted to find out more about how much these drugs' costs have risen, and what underlying causes drive their price.

The first article I used to establish context was a 2014 journal article in Neurology. 

• The article's URL was http://www.ncbi.nlm.nih.gov/, a government database housing the National Library of Medicine. This website is the domain for all pubmed articles, and is a database for peer-reviewed journal articles. The site is highly credible because it is government-sponsored and continuously updated. 

• The authors, Daniel Hartung, Dennis Bourdette and Ruth Whitham, are medical researchers at Oregon Health and Sciences University--a prestigious medical school and research facility. This particular manuscript was published on May 25th, 2015, but the PUBMED website was last updated two minutes before my search. Its purpose is definitely to inform, and to provide up-to-date research on the costs and inflation of MS drugs between 1993 and 2013. 

• There are plenty of graphics, and they are disheartening. Costs for MS drugs have grown exponentially, and there are figures showing that they have grown at a much faster clip than prescription drugs generally and even faster than the notoriously overpriced tumor suppressor drugs. As for the position on the subject, two of the researchers acknowledged receiving grant funding from Biogen Idec and Chugai Pharmaceutical. If anything, this may make them biased in favor of drug-makers. However, the research paper primarily highlighted skyrocketing costs of these drugs, and readers walk away with the notion that these drugs are far overvalued. At the end of the article, the works cited page links to forty additional articles for further reading.

Gotskan, Paul. "Scientific Review." 1/31/2016 via Google Images. Licensed under Public Domain Access.

The second article was written by a person with multiple sclerosis who was trying to cope with the costs of her medication. 

• The article was posted to the URL msfocus.org, the website of the Multiple Sclerosis Foundation. The organization is non-profit and seeks to better the lives of patients with MS. They are likely much more patient-focused and won't provide a perspective from the pharmaceutical industry.

• The author, Ann Pietrangelo, has MS and must pay her insurance premiums to keep her prescriptions. In this sense, she has primary evidence for how soaring costs affects the lives of MS patients. She also is a freelance writer and focuses on articles relating to multiple sclerosis. This portion of the website was last updated in 2013, making it slightly outdated. Nonetheless, hyperlinks functioned properly, and many self-help articles were available for coping with MS. The purpose of this article was to give an insider perspective to how the raw data affects real people. Yes, drug costs are soaring as a statistical fact, but reading Ann's story was heartbreaking. 

• The article lacked graphics, and this is because its primary purpose wasn't to reveal data or 'hard facts'. There is certainly bias in the author's position, because she approaches the problem from the sole perspective of the consumer/patient. There is no real regard for the economic considerations of a drug manufacturer, because this is the story of an individual. In addition, there are no further links except one to a blog hosted by Ann. This is because the story doesn't refer to specific data--it is humanistic rather than informative. 

Reddit and What I Found There

While on the lookout for controversies in the fields of medicine and chemistry, I decided to forage around Reddit. Reddit, as many of you may know, is an online posting site where users discuss any and all topics. While there, I found the wonderful subreddit r/medicine.

• The r/medicine subreddit had it all. Questions pre-meds had about medical school can be found two links above an in-depth report on the state of oncological research. Most users appear to be current university students who plan to pursue medicine via medical school, physical therapy school, or pharmacy school. Some users are doctors, but most posts did not appear to target this population. 

Blue, Eva. "Reddit Sticker." 1/29/2016 via Flickr. Licensed under CC Attribution 2.0 Generic. 

• Users on the forum were debating the link between vaccines and autism. The topic was started by a user who attempted to debunk the myth started by Dr. Wakefield in the 1990s that high dosages of vaccines could lead to autism. Many users commented that parents who choose not to vaccinate their children are endangering their fellow classmates and potentially exposing their peers to epidemics.  One user pointed out that although Dr. Wakefield's study was invalidated, there was a study showing that mercury levels in vaccines were dangerously high, and that high mercury levels could increase the risk of autism. I thought this was particularly interesting because I had always believe there was NO link between excessive vaccination and autism, but users had a point that a small, indirect connection did seem to exist.  

• Another topic linked to an article from a naturopathic doctor who quit his profession and 'confessed' that his education and career were largely bogus. I was pretty surprised at how one-sided this debate was on Reddit. Very few contributors stuck up for naturopathic doctors, who often play legitimate roles in medical treatment alongside physical and occupational therapists. Most comments, however, focused on the unnecessary labwork usually requested by NDs, and others mentioned specific anecdotes where an ND acted negligently. I think that the role of naturopathic medicine in the larger scheme is extremely important to resolve, and this particular Reddit thread didn't really give naturopathic medicine its fair shot. 

• The debates on Reddit left me feeling that medical students are often unfairly biased against professions outside of allopathic medicine. Reddit users, more so than Twitter users or new media journalists, were particularly biased and demonstrated enormous groupthink. Once one response bashed naturopathic doctors, every subsequent post seemed to do so in nearly identical ways. However, there was one user who adamantly defied this mentality when he or she posted about the link between vaccines and mercury in a thread filled with users who were angry at parents for not vaccinating their children. This unique post, though, was truly an anomaly. 

Evaluation of News Magazine Stories

Today, I read through several news magazines to see if I could find more interesting debate fodder among medical practitioners and scientists. I came across two particularly relevant stories. One, in the Economist, focused on how a new possible cure for MS could upend the market for ultra-expensive MS drug treatments. The other, in The Atlantic, focused on how the health of Latino immigrants tended to disintegrate within the first five years of assimilation into the United States.

• First, an article in the Economist highlighted how pharmaceutical companies milked exorbitant fees for difficult-to-replicate treatments. The new MS treatment, designed by Richard Burt, could completely obliterate the need for drugs costing $50,000-$60,000 a year that patients currently take for decades. Drug companiess such as Acorda Pharmaceuticals have justified these prices by claiming that the risk of researching and developing novel drugs required large rewards or investors. Otherwise, the story goes, diminished investment in medical research would slow the rate at which medical innovation occurs. On the other hand, these ridiculous prices often  make life-saving treatments unaffordable for many and increase health insurance premiums for millions more. 

• In the Economist's story, Dr. Burt is the hero who realizes that the loss of immune function in patients undergoing chemotherapy could be utilized to halt the progression of MS and other autoimmune disorders. Beyond just helping patients, he is the David who takes on the pharmaceutical Goliath, and prevents them from charging devastating fees for inferior products. When reading the article, I couldn't help but like him. He helps those is need and is doing it in a cost-effective manner.

• In contrast, it's hard to see the pharmaceuticals as anything besides antagonists. Yes, they promote R&D that ultimately provides the medications that help millions. But they do so in the name of corporate greed, and they often charge exorbitant sums along the way. You can't help but hate Acorda, who created a drug (Ampyra) which is more expensive and possibly less effective than the treatment Dr. Burt created. The name Ampyra brings to mind thousands of patients with MS who had a treatment available that they couldn't afford. 

Unknown Author. "Diphtheria Vaccination Poster." 1/30/2016 via Wikimedia Commons. Licensed under Public Domain Access.

• Secondly, an article in The Atlantic claimed that Mexican immigrants' health decline during their first five years in the United states. Their obesity rates jump from 16% to 22%, their risk of diabetes rises by nearly 10%, and rates of high blood pressure spike. Some researchers, like Robert Hummer, believe this may be because the immigrants assimilate into American culture and develop unhealthy lifestyle habits. Other researchers, however, argue that this theory is unfounded and lacks evidence.

• The most sympathetic characters in this story are the Latino immigrants. While the academics argue about whether the negatives outcomes are due to American cultural influence or not, these immigrants bear the burden of increased healthcare costs in a new environment. The U.S. healthcare system is not easy to navigate, and it's hard not to feel sorry for someone having to go through that process within the first five years of arriving in a new country.

• I felt that the proponents of the 'acculturation hypothesis' were the least sympathetic characters in the post. Whether American society at large was to blame for Latino immigrants' health regression seemed like an argument disconnected with reality. We cannot really fix societal influence in a meaningful way quickly. Thus, to try and point the finger at such large establishments seems irrelevant. In the process of doing this, these academics seem to miss the main point: that there is an epidemic of declining health standards among new immigrants that needs to be addressed. The blame game doesn't solve this crisis. 

Twitter and What I Found There

Today, I joined Twitter. Why, you may ask? Well, to sum it up in under 140 characters: I was sleuthing around for trending debates that intersect the fields of chemistry and medicine. Here's what I found:

There's currently major disagreement over whether prescription drug manufacturers should be allowed to market directly to consumers

• The issue is big, and it isn't limited to drugs. Medical devices, nutritional supplements, and many compounds that have significant effect on bodily function are marketed directly to users--often through media channels like T.V. or internet. Many twitter users are quick to point out that there are stringent requirements on such advertising. However, many question the utility of appealing to an uninformed mass audience on medical prescriptions that require a doctor's approval.

• Pharmabuse recently tweeted that the AMA has publicly stated that they are opposed to such advertising when used for pharmaceuticals or medical devices. The AMA (American Medical Association) is the largest network of doctors in the country, and they have yet to take a stance on this issue until today. Other feeds, like those hosted by Pharma Marketing, argue that patient safety is best handled by the patient, and that doctors shouldn't serve as gatekeepers to medical information. 

• All sides are heavily engaged in actively tweeting about this debate. This shouldn't shock anyone. There are vested interests among both medical service providers and pharmaceutical companies, and this makes it particularly difficult to identify trustworthy sources of information. Every side in this debate agrees that patient safety comes first, but they disagree on what practices are safest. Should a patient be as informed as possible? Does a marketing campaign by Pfizer really increase patient awareness, or does it merely bias their opinions? Should doctors serve as the patriarchal gatekeepers who decide what prescriptions or services are appropriate for their patients, or do the patients themselves have a say, too? There's no easy answer, but Twitter is flooded with opinions on the topic.

I also wanted to focus on the niches related to my own research involving patients with diabetes and peripheral neuropathy. After logging into Twitter, I searched for trends in "diabetic foot care," and found:

Podiatrists are currently debating whether total contact casts or ankle orthotics are better at minimizing ulceration risk among diabetic patients

• To be fair, this is a more specialized arena, wither fewer average retweets. However, there's a major question about how to reduce ulceration risk for patients who recently had foot wounds. Total contact casts (TCTs) are known to do the trick quite well, because they keep patients off their feet and allow the wounds to heal. However, the primary way they achieve these benefits is by not allowing the patient to ever take them off: they're a cast! This is seen as somewhat intrusive by some, and the question of how much more effective TCT are is still an open debate.

• Some twitter users favor TCT, while others believe alternative orthotics are nearly as effective and far less intrusive. Some, like the Gulf Diabetic Foot Group, argue that the TCT has proven effective in reducing ulceration risk and improving wound healing time. So, why not use it? At the end of the day, minimizing pressure on the soles is the surest path to wound healing, so forcing the patient to properly offload by using a cast seems like a no-brainer to them. Others have argued that custom orthotics can be 3-D printed to effectively redistribute plantar pressure without such a bulky cast placed on the foot. 

• I personally was surprised at some of the hype existing surrounding a fairly niche area within the world of podiatry. There were many recent tweets, and some argued that podiatrists who weren't using TCTs were doing their patients a great disservice. I found these topics particularly interesting because they related directly to what I am working on day in and day out. I even saw several tweets from my PI when I searched twitter for diabetic foot care feeds. 

Evaluation of New York Times Stories

It's pre-production time for the course's first project: the Controversy Post-Mortem. So, to kick things off, I browsed through some New York Times articles to start getting a sense of what controversies are out there. I'm particularly interested in chemistry and medicine, which naturally led me to focus on health and science. Below, I've recapped the debate and essence of two different articles, one relating to health and another to science. These topics have several articles that overlap, so I followed the New York Times' lead when choosing how to categorize each article.

Davidy, Paul. "This is what a research paper looks like." 1/26/2016 via Google Images. CC-BY-NC-SA 2.0

First, in Science news: we're beginning to understand the possible biological causes of schizophrenia. Psychiatric disorders are notoriously difficult to pinpoint to a particular set of faulty genes or a particular malfunction in a specific bodily response. So, how did this discovery play out? Well,

• The main players were a group of neurology researchers at Harvard and Boston Children's Hospital. These were the sleuths looking to explain why abnormalities in the MHC portion of the genome correlated strongly with a risk for developing schizophrenia. Their theory, that the gene C4-A coded for proteins that pruned neural connections, helped tie together many known facts about the disease. Without their contributions, there would be no story to tell. Yet, the story isn't truly about them. They are hidden protagonists, lying behind a possible scientific discovery that is, in some ways, bigger than themselves.

• This is the story of science and how it slowly plods along, every day coming one step closer to improving people's lives. The researchers tied together disparate, seemingly unconnected facts regarding schizophrenia and made them a holistic picture with interconnected dots. For example, we knew that schizophrenia tends to develop in adolescence and is associated with fewer neurons in the frontal cortex. Their explanation, that C4-A is primarily expressed as children mature, and its effects include excessive pruning, ties these facts together. 

• There is still debate as to how close this brings us to helping patients with schizophrenia. There is common agreement, among the researchers and critics alike, that this is only one small step towards the ultimate goal of preventing schizophrenia from developing. However, some critics claimed that this helped us understand schizophrenia's root causes, but did nothing towards finding a solution. Nearly everyone mentioned in the article, however, agreed that this was one of the most important advances to understanding schizophrenia in a long time. 

What about Health? It turns out that exercise may relieve back pain to a much greater extent than commonly used orthotics. First off, to be clear, an orthotic is any external device that realigns or alters body or limb positions to improve your mobility and overall bodily function. So, who claims this, and what's the main point?

• This is a story about a systematic review that gauged whether orthotics are as effective as education or exercise in reducing the frequency of back pain episodes. There's no clear human protagonist here, because the focus is on the analysis performed. Chris Maher, though, led the review. As with any review, the data wasn't his and no original primary research was presented. Instead, his team analyzed all methodologically rigorous studies to see what conclusions the currently available studies supported. 

• The story spans many places and times. In essence, the story is supposed to capture everyone, everywhere that has had back problems and has been part of a study trying to reduce those pain symptoms. The article takes us all the way from a 1991 Swedish study showing that workouts led to 90s pop tunes significantly reduced back pain to an analysis of 23 studies using back belts, shoe orthotics, and educational seminars. All non-exercise interventions were essentially ineffective.

          In some sense, the story is about something that transcends the setting of any individu experiment. It is about helping people overcome symptoms that notoriously linger and remain untreated for years. Whether this happens in Sweden or Germany or the United States, the goals of this research are often identical. Of course, every player in this game has their own unique career ambitions, but this is not addressed in the article.

• Custom orthotics are still used ubiquitously, suggesting that this article is far from ending the debate. Lower back pain is frequently treated with braces, back belts, and insoles that redistribute plantar load. This is unlikely to change anytime soon. However, the article is trying to add its own voice to the debate by suggesting that these treatments are far less effective than physical therapists and other clinicans may believe. Instead, it hopes to add an authoritative argument in favor of treating back pain with exercise regimens. In the field of academia, debate points are often backed with plenty of data that is scrutinized by critics. So, these contenders brought a systematic review that gathered all available studies as evidence for their side of the story. 

Course Projects

I just finished reading the outline of each of the four major projects we'll be completing this semesters in English 109. Between the four Google Docs describing the projects, there's a lot of content. I'm still digesting it all, but I walked away with more questions than I expected:

• First, it's a bit nerve-wracking that the projects are so open-ended. No project description included any mention of a topic or general theme. The genre used to present the topic and the general type of investigation is explained, but the topic itself is completely up to us. Less structure requires more preparation, but hopefully the final outcomes will be more personalized and relevant to us because of it. I'm also not clear: do these projects get explained more thoroughly as we progress through the modules--or is this all the information we have?

Por, Andres. "Super Nervous" 1/21/2016 via Flickr. Create Commons BY-NC-SA 2.0 License

• For the good news: the topics are diverse and interesting. We get to analyze debates, create our own argument, talk to working professionals in our field, and overall immerse ourselves in topics that interest us. With this in mind, the open-ended nature of the projects can be a major plus. I'll get to study what I care about--not what my professor coincidentally finds interesting to him.

• The projects themselves require a lot of preparation and research. To analyze a debate in full, you need to thoroughly understand the topic. To gather primary sources of evidence from your field, you need to schedule interviews with professors or graduate students well in advance of the due date. These projects require a lot of pre-planning, because they simply cannot be completed a few days before they're due.

• I last took an English writing course in 2008, so I certainly wouldn't consider myself adequately prepared from high school or college-level English courses. Any information I learned then has largely been forgotten. However, the basic skills of how to write informatively and how to properly manage my time have been embedded in everything I do for years. I've had a chance to do a multi-year research project and work on semester-long chemistry reports. This type of work always involves taking a major challenge and chipping away at it bit by bit. I expect these English assignments to be similar in that regard. 

Reflections:
After reading posts by Jianna and Nicki, I got a sense that they too felt a bit of apprehension at the prospect of cold-calling faculty or graduate students to set up one-on-one interviews. I think that will take us out of our comfort zones, which could be a good thing. Jianna, in particular, seemed to add a lot of personal backstory into her posts, which really helped me--as a reader--better understand the author. I hope to incorporate some of that strategy into my own future blog posts!

Investigating Genres

For this post, I focused on quick reference guides. I wanted to know what these guides were designed to do, and how they accomplished this mission.

The purpose of quick reference guides is primarily to inform the reader. The author researched a particular topic in-depth, and now wants to convey what they learned to his or her audience. Often, that means explaining any controversy or current events related to the topic (to draw the reader in). Then, key questions the author expects his or her audience to have are explicitly addressed one at a time.

Quick reference guides are often found in news media. The article itself is a holistic summary of prior investigative reports. Thus, it is typically found in news analysis sections. One article I found was written in Vox, and another was in the New York Times International Business section. Since the article is in-depth and nuanced, it is best suited in a media where readers will be willing to sit down and read a single news item for an extended period of time.

Buisinne, Steve. Newspaper, News, Media, Spectacles, Glasses, Paper. 1/21/2016 via pixabay. CCO Public Domain.

The audience consists of people looking for detailed summaries about particular topics. The report is not quite investigative or original. A reader would not expect to find new tidbits of information that have never before been released. Instead, the article will do the research by going through dozens of articles, manuscripts and journals to give the reader a thorough understanding that would otherwise have required hours or days of research. Thus, the intended audience are people who want knowledge about a particular topic without the work typically involved in developing such knowledge. Typically, the audience is kept broad by making the article accessible to nearly anyone.

The genre is unique in that it is completely informative and supposedly objective and neutral. This is not the type of article that subjects readers to the author's opinions or biases. The genre provides answers to key questions using facts and systematic reviews of previous literature. There is very little persuasion attempted by the author, except to cite evidence as confirmation of the answers to the key questions posed. Thus, there are no appeals to emotion or distractions--the only difference between this genre and a typical literature review is that the article is intended for a broad, uninformed audience.

In short, quick reference guides are summaries for the broad, uninformed general audience. They catch you up to speed on topics you've likely seen in passing but perhaps never took the time to consider in-depth. By the time a reader finishes a quick reference guide, they are likely informed enough to keep up with new developments related to the field.

Reflections:
After reading Sarah's and Marisa's blog posts about video essays, I gained an appreciation for how different video essays are from QRGs. The active visual and auditory stimulation of a video essay can fully engross a viewer in a way that QRGs really can't. However, video essays are so easy to watch and require so much less attention from the reader that you could easily lose your audience if you don't constantly keep them interested. I think video essays might attract an audiences that will more quickly move on if you don't immediately capture and lure them into the video.

My Writing Process

By the time I put pen to paper (or finger to keyboard), I tend to have a game plan in mind. Typically, the focus of my writing has already been pre-determined and the purpose of each paragraph laid out. With this is mind:

1. I would consider myself a heavy planner. The essay is already pictured in my head, and it usually is written in one or two sittings. There's very little additional thought necessary during the actual writing, because most of the thinking happened earlier in the writing process. As with most heavy planners, my first draft tends to be only slightly revised in subsequent drafts. 
2. My writing process includes habits typically found in sequential composers and heavy planners. Like most heavy planners, I can plan out what I will write anywhere and I don't need pen or paper to do it. However, my actual writing is a bit more methodical than a typical heavy planner. This is likely because it takes me more time to organize my ideas into structured sentences. Perhaps writing comes less naturally to me than to other heavy planners.
3. Heavy planning has been a generally successful strategy. This might seem obvious. After all, if it hadn't been working in the past, I likely would have changed it by now. Heavy planning works best when I have few distractions. During such moments, I can think through an essay topic and work through the topic right then and there. However, if I am fairly busy and unable to access a word processor, I often forget the paragraph-by-paragraph breakdown of what I plan to write. In these events when I don't foresee myself writing what I'm thinking about for a while, I will write down a quick outline and then write the actual essay in a manner much more typical of sequential composers.
4. Honestly, I do not plan to change my approach. I've definitely tried other methods. Many times I've had to (or chosen to) procrastinate. The writing process is faster, but the result is sloppier. The rapid, improvised outpouring of a heavy reviser requires a writing skill that I don't quite possess. I'm no Jack Kerouac, and I have never found a hastily written first draft of mine to be worthwhile.

Altmann, Gerd. No title. 1/18/16 via pixabay. Creative Commons CCO License.