“Count something.” -Atul Gawande
In a previous post, I criticized the emphasis of HIV research, citing the enormous amount of money spent testing novel interventions that are unlikely to change the course of the epidemic. In this post, I think it is requisite that I take the other position. To be clear, I am not writing this repentant post in order to be “fair”. (My Irish mother took care to inform me that life is not fair.) This post is also not for the sake of making my own argument stronger. Rather, I feel a burden because my own research project is not directly saving lives. More importantly, on principle, every effort to make observations about our world is intrinsically valuable. All of science hinges on that idea.
Taking solace therein, I will confess that my sole job is to count things. Babies, to be exact. To be more exact, I count the neurological development of infants. When the study is over, I will have assessed 200 infants in an attempt to quantify the effect of in utero HIV exposure on their development.
Today I counted the mental abilities of four babies. With each of them, I spent about 45 minutes handing them toys and puzzles and recording their responses. I make them all ring a bell, then stack blocks, and then, for a grand finale of mental achievement, I have them put the square peg in the square hole and the round peg in the round hole. Altogether, I spent a grand total of three hours playing with babies.
That is correct, I spent most of my workday playing with babies. I will do the same tomorrow, and again the next day, until the requisite 200 babies have been played with and assessed. Then, I get to publish a scientific paper all about playing with babies. I get to list “Baby Playing” on my curriculum vitae. (If all you had listed on your CV were Founder and CEO of Facebook, or some other inanity, I would understand your jealousy.) When some residency director asks me what I did on my research fellowship, I get to grin and say, “Sir, I played with babies for an entire year.” What did you do on your research fellowship?
What is more, I am actually getting paid for playing with the babies. Why is someone paying me to pad my resume with toddler time? Setting jest aside momentarily, our research group is testing a theory regarding HIV-exposed, but uninfected infants. I wrote a recent post in order to introduce briefly the idea of HEU populations. These kids are my babies. Our hypothesis is that being born to an HIV-positive woman will delay neurological development by a measurable amount, even though the affected baby is HIV negative. In order to put that theory to the test, we are using a scale that was developed about 50 years ago by psychologist Nancy Bayley. The scale consists of a series of games and toys and puzzles that the infants have to solve. The bell I mentioned above is a good example. Does a child ring the bell, explore it, or simply put it in her mouth? Is a child at a level mentally where she can put the circle piece in the circle hole? Do social cues and phrases make sense to a child? (Click here to watch an example of the test.)
So, now I ought to humble myself (surely a rare occurrence). The CAPRISA researchers I criticized are identifying new ways to curb the HIV epidemic. If their product does not work well, they will likely come up with something else. I, however, am playing with babies and calling it research. Notwithstanding our research question is new and unanswered, I am merely counting things, observing the effects of natural phenomena. I may as well take a nap under a tree and wait for an apple to fall on my head. Or rather, I should take a long, bird watching walk on a deserted, South American beach. Such is the difficult life of a researcher.