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September 17, 2009
 

I suspect it has to do with the personality-type that becomes an otolaryngologist. Or perhaps staring into a surgical microscope all day does something to the imagination. We may never know. More than most other medical specialties--oncologists, for example, started using artemisinin (ART) some time ago--otolaryngologists seem to need to be hit over the head before changing their usual and customary approach to treating RRP, noting that their usual and customary approaches typically don't work very well. All too often, I have found, it's like dealing with an armada of aircraft carriers carried along by their own inertia or, on a similar note, a gaggle of dinosaurs. Friendly and intelligent dinosaurs, to be sure, but still.

There are luminous outliers in any profession, of course, and these I wholeheartedly salute. Take, for example, that surgeon at UC Davis who told his patient about ART. He has to know that when the patient told me he had made this referral on his own, it made my day. Or that wonderfully compassionate and astute surgeon in Southern California who has now begun to use ART as well with a handful of his patients. Then there's that intrepid and helpful soul from Chicago, who was the first RRP physician ever to use ART on a number of patients. There are many within the profession whom I would count as friends. These are definitely our kind of people.

In the interests of full disclosure, I should note that I'm a clinical social worker. Goodness knows, my profession also has its problems. As Yeats would say, the worst of us "are full of passionate intensity." That would have to include me, I should think. Or at least that's how it's got to be viewed by some of the more entrenched surgeons within the otolaryngological profession.

The RRP patient and health care professional communities should know that I spent almost ten hours preparing and delivering a report on artemisinin and its effects on HPV/RRP to six RRP Task Force representatives at the American Society of Pediatric Otolaryngology (ASPO) meeting a few months ago. That doesn't even count the work of others who contributed to the presentation. Despite my requests that these ASPO members disseminate it as such, no summary report was ever disseminated to the Task Force as a whole.

My report included numerous surgical photographs from a physician of a child with RRP who was taking ART, a PowerPoint by Dr. Tom Broker who is studying ART in his lab, and even a CT report from a patient who was taking ART with lung cancer that had previously converted from RRP.  The report itself was very well-received, but again, it was delivered to a group of just six doctors.

The need for dissemination of that report apparently got buried in the inertial process even though what was reported included  objective and groundbreaking material. I again asked the group of six to share it with the much-larger RRP Task Force. I asked the chair of the Task Force too to ensure that this would happen.

Nothing else happened--at least, nothing that I was informed about, which you would have thought might have occurred after my initial request(s) and reminders. After waiting even longer, we finally decided to throw in the towel.

That's not the only issue relating to foot-dragging, of course. A year after RRP ISA and the RRPF jointly elevated ART research to the very top of our wish list in terms of research and formally asked the RRP Task Force to do something about it, nothing substantial was done, even in terms of educating the Task Force and finally demystifying ART.

Oh, sure, six people at ASPO heard about ART, but then the report got buried and the "demystification process" that urgently needed to happen with respect to the Task Force as a whole never actually occurred.

With the board's approval, I submitted RRP ISA's resignation to Dr. Craig Derkay, who heads up the Task Force.

This RRP Task Force, you should also know, meets only two hours a year. You heard that right.

Moreover, its members, who are arguably busy and caring people, don't much communicate even by email between meetings. There is no dialogue, virtually no discussion.

It's an ad hoc group that is run in a way that I would characterize as essentially autocratic (never an election of officers, etc.). No one other than RRP ISA has ever dared challenged that deeply entrenched organizational structure.

Instead of removing barriers to communication so that physicians and researcher might better collaborate, these barriers are in fact perhaps wider than ever. Instead of identifying and systematically striving to remove the barriers to such communication, the RRP Task Force seems to have institutionalized them.

Why was that? I wondered. Could it be something that some members like to see on their vitaes and resumes, even if they participate in one meeting every few years? That grandiose name (RRP TAsk Force) seems to confer an enormous amount of prestige and influence when, in fact, it's mostly a fiction. Task Force? Virtually anyone can join it, probably even my dogs.

RRP ISA, as I say, has finally submitted its resignation, having been a member for over six years. We are not doing that in a fit of pique, however. It is necessary to do that in order to openly blog or post as I am doing here, with no conflict of interest. Codependency has its price. As long as we were entagled in a seemingly toxic relationship, very little could be done along these lines.

Why would I use the term "toxic?" We have here what I, as a mental health professional and expert in my own right on such matters, would characterize as a classical picture of co-dependency and enabling. More on this below.

Turns out that RRP ISA's view of the Task Force is not necessarily a minority view. I won't disclose names but several prominent RRP health care professionals/researchers who are not on the Task Force seem to share it. Who knows how many other doctors do, even those who treat RRP?

The RRP Task Force has many excellent people in it, yes, but in my circle, the "Task Force" itself (here I am talking about structural issues, not personalities) couldn't even be called a minor subcommittee. Two hours a year? Doesn't that speak for itself?

Now, sometime last spring, one of the more vociferously-enabling physicians on the Task Force said that my terse observations, which I finally decided to share with the chairperson and the group, were unwelcome and overly "snippy." Not hostile, mind you--which I wasn't--but "snippy," meaning heretical, incisive and direct.

As for my use of the terms "codependent" and "enabling," you may wish to think of a non-medical term called "circling the wagons." The American Medical Association, for example, has honed it to a very fine art-form. Everyone protects each other's back, no one dares speak ill of another physician. I'm not exactly suggesting that the Task Force is a good ol' boys club, but it doesn't seem to excel in reflective or self-critical behavior with respect to its own work process.

Anyway, I found it especially ironic that this surgeon who used the word "snippy" was from Dallas, Texas. I pictured him wearing a cowboy hat when he said that. I told him that he hadn't yet seen the beginnings of "snippy" until he read our advocacy-blog--we are advocates, it must be remembered--which assuredly was coming.

"Most bloggers who are any good are somewhat 'snippy,' are they not?" I genially asked him.

The RRP ISA community has waited almost as long for the blog as we have waited for the Task Force to do something about artemisinin. Please note that at least on our side, the wait is almost over. This post, as it were, serves as an opening shot across the bow.

<surgical snip, surgical snip>

Warm regards,

Michael Green, Executive Director
International RRP ISA Center