something about anthropology

As my previous post, a mere 12 hours or so ago, indicated, I don't really do anthropology lately. As much as one is ever "doing" it. Tonight, after a long day at work, I stopped at a nearby tiny sushi place (one of the best I think in SF). I'd done this once before, showing up alone, sitting at the bar, and just eating. Not reading, not looking at my phone, not worrying about work, not planning the future (escape). I used to get to do this all the time. Sitting. Observing. Listening. Thinking. Not rushing. I miss all those things. In doing them, I started remembering what I like about fieldwork, about actively engaging with anthropology. My back was to most of the tables, and so I could only hear conversations among the diners, without seeing expressions or what they were eating.

It reminded me how much I love the observational part of anthropology, how it's a skill and a superpower simultaneously. I like having to pay attention to nuances to read and to absorb the information around me. Having my back to people forced me to do that. It also provided the pleasure of tacit voyeurism. I know I forget in restaurants that the confessional moments with friends can be heard by anyone around me. The assumption that the public space creates anonymity is pretty naïve, but the frequent public cell phone conversations that we all engage in suggests that we all believe it -- or don't care if we forgo privacy and anonymity. I like how much I can read from conversations, little interpersonal dynamics that get lost when it's happening to me, seem so transparent and poignant when I'm listening to or watching others' interactions.

Long overdue

My new(ish) job has eaten up my life. I can't actually remember much about the last six and a half months, which I find disturbing. It seems to be a traumatic-coping mechanism. It's unfortunate, though, that I haven't been writing throughout the experience. Its challenges though probably not worth the "growth" that it's provided are still going to be rich and long-lasting material for understanding healthcare in the U.S.

I am (somewhat bafflingly) working in the pharma/biotech consulting field. I am helping pharma to better market products for metastatic oncology. Except that I don't really believe in their mission nor do I believe in our methods for collecting and analyzing market research. I don't know if I believe in "market research," at least not in its purely market-driven form. It's been frustrating both finding our research methods mechanized and rote and at the same time being highly skeptical of the purpose and goals attached to what we do. Kind of contradictory -- I suppose.

Last summer, I read Atul Gawande's article in The New Yorker, and I cried. It's resonated deeply with me, and I'm posting it here to share. I was reminded of it by this thoughtful post on Arthur Kleinman on Somatosphere, a great collaborative blog on anthropology + science. One of my great frustrations with my work is that we ask doctors whether they would use a product that has a small improvement in survival for patients who are going to die. They are going to die soon. Pharma Company X comes in and asks whether if you could give your patients Product X with these benefits for a few more months, would you do it? Even in our "probes" to explore whether the very unpleasant side effects or the outrageous costs would be prohibitive, the implication always is, well, how could you not offer your patients two, three, 1.5 more months? Not many American doctors would say, 'huh, no. No, I recognize that [as Gawande suggests] a less invasive death is actually better for my patients and their families.'

At the core of the metastatic cancer market is the denial of death. One product I've been working on is with a small biotech company that has a pretty remarkable drug -- an immunotherapy product for a cancer with limited treatment options. The drug costs nearly $100,000. The company's capacity for production is highly limited, even if everyone could pay the exorbitant fee...and yet....aren't we supposed to celebrate and embrace this product for its novel mechanisms and extension of life? Isn't that for what we are all striving?

Underneath all these products and the highly competitive and strategic pharmaceutical marketplace is really the question of whether putting technology in the service of life-extension for any cost is really worth it. Death is everywhere in this work, and no one talks about it.