Today’s guest post comes from Greg Skalicky, President, EVERSANA and Faruk Abdullah, President, Professional Services & Chief Business Officer, EVERSANA

Greg and Faruk walk through the marketplace pressures driving Direct-to-Patient commercialization models. They argue that a technology-enabled infrastructure,  combined with clinical and reimbursement support specialists, can improve  patients' access to new therapies, shorten the time to therapy, and enable better overall clinical outcomes.

Click here to learn more about EVERSANA’s Direct-to-Patient care model.

Read on for Greg and Faruk’s insights.
Read more »

Researchers around the world are working at record speed to find the best ways to treat and prevent COVID-19, from investigating the possibility of repurposing existing drugs to searching for novel therapies against the virus.

The Royal Pharmaceutical Society has expressed its sadness at the death of Joy Wingfield, honorary professor of Pharmacy Law and Ethics at the University of Nottingham.

The good folks down at eyeforpharma have asked me to write a few blog posts in the run-up to their Patient Centered Clinical Trials conference in Boston this September. In my second article -Buzzword Innovation: The Patient Centricity “Fad” and the Token Patient - I went over some concerns I have regarding the sudden burst of enthusiasm for patient centricity in the clinical trial world.

Apparently, that hit a nerve – in an email, Ulrich Neumann tells me that “your last post elicited quite a few responses in my inbox (varied, some denouncing it as a fad, others strongly protesting the notion, hailing it as the future).”

In preparing my follow up post, I’ve spoken to a couple people on the leading edge of patient engagement:

• Abbe Steel, CEO of HealthiVibe, which is focused on bringing greater patient input into the earliest stages of trial design through focus groups and patient surveys
• Casey Quinlan, co-founder of Patients for Clinical Research, which aims to be a force in patient education and engagement for clinical trials

In addition to their thoughts, eyeforpharma is keenly interested in hearing from more people. They've even posted a survey – from Ulrich:

To get a better idea of what other folks think of the idea, I am sending out a little ad hoc survey. Only 4 questions (so people hopefully do it). Added benefit: There is a massive 50% one-time discount for completed surveys until Friday connected to it as an incentive).

So, here are two things for you to do:

1. Complete the survey and share your thoughts
2. Come to the conference and tell us all exactly what you think

Look forward to seeing you there.

[Conflict of Interest Disclosure: I am attending the Patient Centered Clinical Trials conference. Having everyone saying the same thing at such conferences conflicts with my ability to find them interesting.]

For people with diabetes, glucose monitors are a valuable tool to monitor their blood sugar. The current generation of these biosensors detect glucose levels with thin, metallic filaments inserted in subcutaneous tissue, the deepest layer of the skin where most body fat is stored.

Medical technology company Biolinq is developing a new type of glucose sensor that doesn’t go deeper than the dermis, the middle layer of skin that sits above the subcutaneous tissue. The company’s “intradermal” biosensors take advantage of metabolic activity in shallower layers of skin, using an array of electrochemical microsensors to measure glucose—and other chemicals in the body—just beneath the skin’s surface.

Biolinq just concluded a pivotal clinical trial earlier this month, according to CEO Rich Yang, and the company plans to submit the device to the U.S. Food and Drug Administration for approval at the end of the year. In April, Biolinq received US $58 million in funding to support the completion of its clinical trials and subsequent submission to the FDA.

Biolinq’s glucose sensor is “the world’s first intradermal sensor that is completely autonomous,” Yang says. While other glucose monitors require a smartphone or other reader to collect and display the data, Biolinq’s includes an LED display to show when the user’s glucose is within a healthy range (indicated by a blue light) or above that range (yellow light). “We’re providing real-time feedback for people who otherwise could not see or feel their symptoms,” Yang says. (In addition to this real-time feedback, the user can also load long-term data onto a smartphone by placing it next to the sensor, like Abbott’s FreeStyle Libre, another glucose monitor.)

More than 2,000 microsensor components are etched onto each 200-millimeter silicon wafer used to manufacture the biosensors.Biolinq

Biolinq’s hope is that its approach could lead to sustainable changes in behavior on the part of the individual using the sensor. The device is intentionally placed on the upper forearm to be in plain sight, so users can receive immediate feedback without manually checking a reader. “If you drink a glass of orange juice or soda, you’ll see this go from blue to yellow,” Yang explains. That could help users better understand how their actions—such as drinking a sugary beverage—change their blood sugar and take steps to reduce that effect.

Biolinq’s device consists of an array of microneedles etched onto a silicon wafer using semiconductor manufacturing. (Other glucose sensors’ filaments are inserted with an introducer needle.) Each chip has a small 2-millimeter by 2-millimeter footprint and contains seven independent microneedles, which are coated with membranes through a process similar to electroplating in jewelry making. One challenge the industry has faced is ensuring that microsensors do not break at this small scale. The key engineering insight Biolinq introduced, Yang says, was using semiconductor manufacturing to build the biosensors. Importantly, he says, silicon “is harder than titanium and steel at this scale.”

Miniaturization allows for sensing closer to the surface of the skin, where there is a high level of metabolic activity. That makes the shallow depth ideal for monitoring glucose, as well as other important biomarkers, Yang says. Due to this versatility, combined with the use of a sensor array, the device in development can also monitor lactate, an important indicator of muscle fatigue. With the addition of a third data point, ketones (which are produced when the body burns fat), Biolinq aims to “essentially have a metabolic panel on one chip,” Yang says.

Using an array of sensors also creates redundancy, improving the reliability of the device if one sensor fails or becomes less accurate. Glucose monitors tend to drift over the course of wear, but with multiple sensors, Yang says that drift can be better managed.

One downside to the autonomous display is the drain on battery life, Yang says. The battery life limits the biosensor’s wear time to 5 days in the first-generation device. Biolinq aims to extend that to 10 days of continuous wear in its second generation, which is currently in development, by using a custom chip optimized for low-power consumption rather than off-the-shelf components.

The company has collected nearly 1 million hours of human performance data, along with comparators including commercial glucose monitors and venous blood samples, Yang says. Biolinq aims to gain FDA approval first for use in people with type 2 diabetes not using insulin and later expand to other medical indications.

This article appears in the August 2024 print issue as “Glucose Monitor Takes Page From Chipmaking.”

A thimbleful of soil can contain a universe of microorganisms, up to 10 billion by some estimates. Now a group of researchers in Bath, United Kingdom, are building prototype technologies that harvest electrons exhaled by some micro-species.

The idea is to power up low-yield sensors and switches, and perhaps help farmers digitally optimize crop yields to meet increasing demand and more and more stressful growing conditions. There could be other tasks, too, that might make use of a plant-and-forget, low-yield power source—such as monitoring canals for illegal waste dumping.

The research started small, based out of the University of Bath, with field-testing in a Brazilian primary school classroom and a green pond near it—just before the onset of the pandemic.

“We had no idea what the surroundings would be. We just packed the equipment we needed and went,” says Jakub Dziegielowski, a University of Bath, U.K. chemical engineering Ph.D. student. “And the pond was right by the school—it was definitely polluted, very green, with living creatures in it, and definitely not something I’d feel comfortable drinking from. So it got the job done.”

The experiments they did along with kids from the school and Brazilian researchers that summer of 2019 were aimed at running water purifiers. It did so. However, it also wasn’t very efficient, compared to, say, a solar panel.

So work has moved on in the Bath labs: in the next weeks, Dziegielowski will both turn 29 and graduate with his doctorate. And he, along with two other University of Bath advisors and colleagues recently launched a spinoff company—it’s called Bactery—to perfect a prototype for a network of soil microbial fuel cells for use in agriculture.

A microbial fuel cell is a kind of power plant that converts chemical energy stored in organic molecules into electrical energy, using microbes as a catalyst. It’s more often used to refer to liquid-based systems, Dziegielowski says. Organics from wastewater serve as the energy source, and the liquid stream mixes past the electrodes.

A soil microbial fuel cell, however, has one of its electrodes—the anode, which absorbs electrons—in the dirt. The other electrode, the cathode, is exposed to air. Batteries work because ions move through an electrolyte between electrodes to complete a circuit. In this case, the soil itself acts as the electrolyte—as well as source of the catalytic microbes, and as the source of the fuel.

The Bath, U.K.-based startup Bactery has developed a set up fuel cells powered by microbes in the soil—with, in the prototype pictured here, graphite mats as electrodes. University of Bath

Fields full of Watts

In a primary school in the fishing village of Icapuí on Brazil’s semi-arid northeastern coast, the group made use of basic components: graphite felt mats acting as electrodes, and nylon pegs to maintain spacing and alignment between them. (Bactery is now developing new kinds of casing.)

By setting up the cells in a parallel matrix, the Icapuí setup could generate 38 milliwatts per square meter. In work since, the Bath group’s been able to reach 200 milliwatts per square meter.

Electroactive bacteria—also called exoelectrogens or electricigens—take in soluble iron or acids or sugar and exhale electrons. There are dozens of species of microbes that can do this, including bacteria belonging to genera such as Geobacter and Shewanella. There are many others.

But 200 milliwatts per square meter is not a lot of juice: enough to charge a mobile phone, maybe, or keep an LED nightlight going—or, perhaps, serve as a power source for sensors or irrigation switches. “As in so many things, it comes down to the economics,” says Bruce Logan, an environmental engineer at Penn State who wrote a 2007 book, Microbial Fuel Cells.

A decade ago Palo Alto engineers launched the MudWatt, a self-contained kit that could light a small LED. It’s mostly marketed as a school science project. But even now, some 760 million people do not have reliable access to electricity. “In remote areas, soil microbial fuel cells with higher conversion and power management efficiencies would fare better than batteries,” says Sheela Berchmans, a retired chief scientist of the Central Electrochemical Research Institute in Tamil Nadu, India.

Korneel Rabaey, professor in the department of biotechnology at the University of Ghent, in Belgium, says electrochemical micro-power sources—a category that now includes the Bactery battery—is gaining buzz in resource recovery, for uses such as extracting pollutants from wastewater, with electricity as a byproduct. “You can think of many applications that don’t require a lot of power,” he says, “But where sensors are important.”

The teachings of Mahatma Gandhi were arguably India’s greatest contribution to the 20th century. Raghunath Anant Mashelkar has borrowed some of that wisdom to devise a frugal new form of innovation he calls “Gandhian engineering.” Coming from humble beginnings, Mashelkar is driven to ensure that the benefits of science and technology are shared more equally. He sums up his philosophy with the epigram “more from less for more.” This engineer has led India’s preeminent R&D organization, the Council of Scientific and Industrial Research, and he has advised successive governments.

What was the inspiration for Gandhian engineering?

Raghunath Anant Mashelkar: There are two quotes of Gandhi’s that were influential. The first was, “The world has enough for everyone’s need, but not enough for everyone’s greed.” He was saying that when resources are exhaustible, you should get more from less. He also said the benefits of science must reach all, even the poor. If you put them together, it becomes “more from less for more.”

My own life experience inspired me, too. I was born to a very poor family, and my father died when I was six. My mother was illiterate and brought me to Mumbai in search of a job. Two meals a day was a challenge, and I walked barefoot until I was 12 and studied under streetlights. So it also came from my personal experience of suffering because of a lack of resources.

How does Gandhian engineering differ from existing models of innovation?

Mashelkar: Conventional engineering is market or curiosity driven, but Gandhian engineering is application and impact driven. We look at the end user and what we want to achieve for the betterment of humanity.

Most engineering is about getting more from more. Take an iPhone: They keep creating better models and charging higher prices. For the poor it is less from less: Conventional engineering looks at removing features as the only way to reduce costs.

In Gandhian engineering, the idea is not to create affordable [second-rate] products, but to make high technology work for the poor. So we reinvent the product from the ground up. While the standard approach aims for premium price and high margins, Gandhian engineering will always look at affordable price, but high volumes.

The Jaipur foot is a light, durable, and affordable prosthetic.Gurinder Osan/AP

What is your favorite example of Gandhian engineering?

Mashelkar: My favorite is the Jaipur foot. Normally, a sophisticated prosthetic foot costs a few thousand dollars, but the Jaipur foot does it for [US] $20. And it’s very good technology; there is a video of a person wearing a Jaipur foot climbing a tree, and you can see the flexibility is like a normal foot. Then he runs one kilometer in 4 minutes, 30 seconds.

What is required for Gandhian engineering to become more widespread?

Mashelkar: In our young people, we see innovation and we see passion, but compassion is the key. We also need more soft funding [grants or zero-interest loans], because venture capital companies often turn out to be “vulture capital” in a way, because they want immediate returns.

We need a shift in the mindset of businesses—they can make money not just from premium products for those at the top of the pyramid, but also products with affordable excellence designed for large numbers of people.

This article appears in the November 2024 print issue as “The Gandhi Inspired Inventor.”

Manu Prakash spoke with IEEE Spectrum shortly after returning to Stanford University from a month aboard a research vessel off the coast of California, where he was testing tools to monitor oceanic carbon sequestration. The associate professor conducts fieldwork around the world to better understand the problems he’s working on, as well as the communities that will be using his inventions.

Prakash develops imaging instruments and diagnostic tools, often for use in global health and environmental sciences. His devices typically cost radically less than conventional equipment—he aims for reductions of two or more orders of magnitude. Whether he’s working on pocketable microscopes, mosquito or plankton monitors, or an autonomous malaria diagnostic platform, Prakash always includes cost and access as key aspects of his engineering. He calls this philosophy “frugal science.”

Why should we think about science frugally?

Manu Prakash: To me, when we are trying to ask and solve problems and puzzles, it becomes important: In whose hands are we putting these solutions? A frugal approach to solving the problem is the difference between 1 percent of the population or billions of people having access to that solution.

Lack of access creates these kinds of barriers in people’s minds, where they think they can or cannot approach a kind of problem. It’s important that we as scientists or just citizens of this world create an environment that feels that anybody has a chance to make important inventions and discoveries if they put their heart to it. The entrance to all that is dependent on tools, but those tools are just inaccessible.

How did you first encounter the idea of “frugal science”?

Prakash: I grew up in India and lived with very little access to things. And I got my Ph.D. at MIT. I was thinking about this stark difference in worlds that I had seen and lived in, so when I started my lab, it was almost a commitment to [asking]: What does it mean when we make access one of the critical dimensions of exploration? So, I think a lot of the work I do is primarily driven by curiosity, but access brings another layer of intellectual curiosity.

How do you identify a problem that might benefit from frugal science?

Prakash: Frankly, it’s hard to find a problem that would not benefit from access. The question to ask is “Where are the neglected problems that we as a society have failed to tackle?” We do a lot of work in diagnostics. A lot [of our solutions] beat the conventional methods that are neither cost effective nor any good. It’s not about cutting corners; it’s about deeply understanding the problem—better solutions at a fraction of the cost. It does require invention. For that order of magnitude change, you really have to start fresh.

Where does your involvement with an invention end?

Prakash: Inventions are part of our soul. Your involvement never ends. I just designed the 415th version of Foldscope [a low-cost “origami” microscope]. People only know it as version 3. We created Foldscope a long time ago; then I realized that nobody was going to provide access to it. So we went back and invented the manufacturing process for Foldscope to scale it. We made the first 100,000 Foldscopes in the lab, which led to millions of Foldscopes being deployed.

So it’s continuous. If people are scared of this, they should never invent anything [laughs], because once you invent something, it’s a lifelong project. You don’t put it aside; the project doesn’t put you aside. You can try to, but that’s not really possible if your heart is in it. You always see problems. Nothing is ever perfect. That can be ever consuming. It’s hard. I don’t want to minimize this process in any way or form.

Value-based care contracting is especially difficult for behavioral health providers, Taft Parsons III, chief psychiatric officer at CVS Health/Aetna, pointed out during a conference this week.

The post CVS Health Exec: Payers Need to Stop Making Behavioral Health Providers Jump Through Hoops In Order to Participate in Value-Based Care appeared first on MedCity News.

Building trust while simultaneously building products, selling, recruiting, and fundraising can feel impossible. But it’s required whether you have the time or not, and it doesn’t stop no matter how big you grow.

The post The Trust-Building Playbook: 5 Tips Every Digital Health Marketer Needs to Know appeared first on MedCity News.

In vitro diagnostics (IVDs) play an indispensable role in modern medicine. Health care providers routinely rely on these tests—which analyze samples such as blood or saliva—to help diagnose conditions and guide potentially life-altering treatment decisions. In 2017, for example, clinicians ordered blood tests during about 45% of emergency room visits in the United States, according to the Centers...

The Public Service has expressed its commitment to implementing flexible work arrangements (FWAs) for its employees, taking into account the workforce's changing needs. In a written answer to a Parliamentary question posed by Choa Chu Kang GRC MP Zhulkarnain Abdul Rahim on Monday (Nov 11), Minister-in-charge of the Public Service Chan Chun Sing said the Government recognises the growing need for FWAs, given Singapore's demographic changes and its ever-changing demands on Singaporeans. Zhulkarnain had asked whether the Civil Service will continue to support flexible working arrangements despite some companies in the private sector requiring employees to work from the office five days a week. Grab Singapore, for example, said it will enforce its five-day return-to-office mandate starting Dec 2, reported CNA. Referencing the Tripartite Guidelines on FWA Requests (TG-FWAR), which will be enforced starting Dec 1, Chan stressed the importance of such arrangements in supporting working caregivers, encouraging workforce re-entry, sustaining labour force participation, and attracting and retaining talent.

‘India does not want to play into the hands of terrorists by shunning dialogue.'

Even with support from the government, serious threats against Bhutto will persist.

Feb 29, 2024

Former U.S. Ambassador to Israel Ed Djerejian says Israeli Prime Minister Yitzak Rabin once told him, “There is no military solution to this conflict, only a political one.” Rabin was assassinated a few years later, and today bullets are flying, bombs are falling, and 1,200 Israelis are dead after the Hamas terrorist attacks of October 7 and nearly 30,000 Gazans have been killed in the Israeli response. Yet Djerejain still believes that a breakthrough is possible even in the current moment, as horrible as it is. Djerejian, a senior fellow at Harvard Kennedy School’s Belfer Center for Science and International Relations, says the crisis has shaken the regional status quo to the point where—if the United States pursues diplomacy that includes principled pragmatism, coalition-building, and good old-fashioned backbone—a breakthrough may finally be possible. But in a recent paper he argues that any breakthrough will have to be built around a two-state solution, which he says is the only path to peace and stability not only in Israel and Palestine, but the wider Middle East. Djerejian’s career as a diplomat spanned eight U.S. presidential administrations beginning with John F. Kennedy’s, and he also served as U.S. Ambassador to Syria and Assistant Secretary of State for Near Eastern Affairs.  

Jan 8, 2024

Sensors, actuators, and IoT devices will enable AI to interact with the physical plane on a massive scale. The question is, how does one build trust in its actions?

Husband and father of three young children, Travis Roberts, was diagnosed with inoperable cancer. This is his story.

John Peden - #NMClientStory

This #AutismAwarenessMonth we encourage families with special needs to take steps now to plan for their loved ones� futures. Our Director of Advanced Planning, Ruthann Driscoll, discusses the importance of planning to secure long-term security and quality of life for your family. Learn more: http://u.nm.com/1AQBAsN

Rowenta Brand Ambassador Dr. Noreen Khan-Mayberry discusses how allergens affect our health, and the importance of removing them from our homes.

Viva� and Monica Potter Unleash Clean Event Video

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Trust is critical, especially for a person with autism and their family. Meet the Vollmert family and get a sense of how they approach daily life and planning for a financially secure future with their autistic son, Scott. Learn more: http://u.nm.com/1AQBAsN

Video: Invention of the Starr-Edwards valve

A Technology Development Story: meet the SYNERGY� Stent System engineers

Gillette Children's Specialty Healthcare is launching Emojability. Learn more about this one-of-a-kind emoji keyboard app for Android and Apple.

I took a break from my craft series for a couple months. And then I handed in the first draft of a new book this week! Which means that this weekend I can finally turn my attention to writing about craft in The Housekeeper and the Professor, by Yoko Ogawa.

Yoko Ogawa's slender, stunning book, translated from the Japanese by Stephen Snyder, is a challenging one to use as a writing lesson, because while I can describe a hundred smart and wonderful things about it, that doesn’t mean I know how to translate its beauty into advice to other writers. It’s not helpful for me to say, “See how perfect this is? Now go do that." 

And it is that kind of book, the kind that pulls you into a narrative dream and holds you there so gently, with such soft hands, that it's hard to figure out how you got where you are. When did it happen, and how?

For me, it had already happened by the time I'd gotten to the end of page 3. And I think that the "how" has something to do with a sense of spaciousness.

What do I mean by a sense of spaciousness? Well, it's pretty hard to nail it down exactly, but I've been considering this a lot, and I think it has to do with a combination of things. One is unflowery, unfussy prose. Another is revelation of character through brief, searing lines of plot or observation. (You know those beautiful moments in books when a single sentence seems to capture the essence of a character, and just like that, you feel like you can see into their soul?) Another is a gentle, no-rush kind of pacing. Another has to do with themes that lend themselves to spaciousness. And another is the way Ogawa hooks this story into two real-world entities that have power, meaning, and spaciousness outside any book: mathematics and baseball.  

You didn't think this was going to be simple, did you? :o) The Housekeeper and the Professor is a book that seems spare and uncomplicated as you read it, but I think it's deceptively so. There's a lot packed into its 180 pages. The reader who feels suspended in a narrative dream is actually perched on top of a lot of strong, invisible foundations. Today I'll try to look at those foundations a little closer.

I'm not going to harp on the unflowery, unfussy prose, because I think you'll see that for yourself when I share examples from the text. Instead I'll talk first about the revelation of character, then get into pacing and themes, then say a little about the allusions to mathematics and baseball.

All page references are to the 2009 English-language paperback edition published by Picador.

First, a brief overview, with no spoilers: A housekeeper is assigned to work in the house of a professor of mathematics who lives in a small city on the Inland Sea. The professor, who's sixty-four, sustained a brain injury in an automobile accident seventeen years ago and lost his ability to form new memories. "He can remember a theorem he developed thirty years ago, but he has no idea what he ate for dinner last night" (5). He can only remember new things for eighty minutes. 

As a consequence, every morning, when the housekeeper arrives at the home of the professor, she's a stranger to him, as is her son who often accompanies her. And every day is predictable in some ways, yet thoroughly unpredictable in others. 

Told from the perspective of the housekeeper, the book is about the inner lives and growing relationships of four people, all of whose real names are not used: the housekeeper; her son; the Professor; and the professor's sister-in-law, who lives in the main house across from the professor's cottage. The book contains small, quiet, satisfying revelations. You learn more information about all of the characters over time. But the journey is as satisfying as the destination. This is one of those books where I wasn't reading to find out what happens; I was reading for the pleasure of spending time with the book.

Now, let's talk about character.

In the hands of a clunky writer, a character's inability to form new memories would be a gimmick. There are no gimmicks here. Almost from the first line, these are people you believe in, with thoughts and dilemmas that suspend you in a state of wanting, along with these characters, to understand what it means to be human. 

Here's how the book opens:

We called him the Professor. And he called my son Root, because, he said, the flat top of his head reminded him of the square root sign.

"There's a fine brain in there," the Professor said, mussing my son's hair. Root, who wore a cap to avoid being teased by his friends, gave a wary shrug. "With this one little sign we can come to know an infinite range of numbers, even those we can't see." He traced the symbol in the thick layer of dust on his desk.

This opening is the first of many times when the Professor embarks on an explanation of a mathematical concept. You, the reader, might immediately groan, thinking, Oh no, he's going to lecture, he's going to mansplain math… But only two pages later, on page 3, our narrator, the housekeeper, addresses that concern with this description:

But the professor didn't always insist on being the teacher. He had enormous respect for matters about which he had no knowledge, and he was as humble in such cases as the square root of negative one itself. Whenever he needed my help, he would interrupt me in the most polite way. Even the simplest request—that I help him set the timer on the toaster, for example—always began with "I'm terribly sorry to bother you, but…" Once I'd set the dial, he would sit peering in as the toast browned. He was as fascinated by the toast as he was by the mathematical proofs we did together, as if the truth of the toaster were no different from that of the Pythagorean theorem.

It's this description of the Professor peering in as the toast browns, caring about it as much as he cares about everything else, that captured my heart on page 3. With that tiny act, Ogawa shows us something essential about the Professor's character. And Ogawa repeats this method of revealing character over and over again, sharing small, isolated moments of searing revelation.

Here's another example of a small moment, one where we learn the Professor's particular, yet socially clueless, sympathy toward children:

Just then, there was a cry from the sandbox. A little girl stood sobbing, a toy shovel clutched in her hand. Instantly, the Professor was at her side, bending over to comfort her. He tenderly brushed the sand from her dress.

Suddenly, the child's mother appeared and pushed the Professor away, picking the girl up and practically running off with her. The Professor was left standing in the sandbox. I watched him from behind, unsure how to help. The cherry blossoms fluttered down, mingling with the numbers in the dirt. (46-47)

I'm not sure the professor understands what's just happened in that moment, but we do. And we can see him and feel for him (at the same time as we might feel frustrated with him).

Here's one more, shorter example: "I wondered how many times I had said those words since I'd come to work at the Professor's house. 'Don't worry. It's fine.' At the barber, outside the X-ray room at the clinic, on the bus home from the ballgame. Sometimes as I was rubbing his back, at other times stroking his hand. But I wondered whether I had ever been able to comfort him. His real pain was somewhere else, and I sensed that I was always missing the spot" (169-170).

Maybe when I use the word "spacious" to describe this kind of characterization, what I mean is that nothing is crowded, every detail is illuminated and clear, and allowed to be the star of the scene it's in. Every description is given the space it's needed. As a result, the characterizations seem clean and spare, but not because the characters are simple people with simple lives. They are complex people with difficult, tragic, sometimes frightening lives. But we can see them clearly, because Ogawa draws them with precise lines on a spacious page. 

I almost want to say that it's like each character is standing alone, visible to us in a bright, uncrowded room, but that makes the characters and the book sound sterile, which is completely wrong. In fact, they live in rooms full of things, especially books, papers, baseball cards, and food. And their lives, thoughts, and feelings are deeply entangled. But reading this book, the reader does not feel entangled. The reader has room.

This is partly because Ogawa gives every moment in this story the same weight as any other part of the story. The moment with the browning toast, for example, is just as important as other longer, more emotionally fraught scenes in the book. And this gets us into pacing. 

This book is composed of a lot of different kinds of passages. Tiny plot moments, like the Professor watching the toast brown. Longer scenes, like one where Root gets injured and the Professor and the housekeeper rush him to the hospital; one where they all go to a baseball game together; one where they have a party. Passages where the housekeeper is musing about the life of the Professor; passages where she's doing a little snooping in the Professor's house, hoping to learn about his past. Occasional passages where the housekeeper is telling us something about her own past. Also, lots and lots of passages about math.

Pacing isn't something I can demonstrate using short examples, because it depends upon how all the parts of the text sit in relation to each other. But I can try to explain what Ogawa does, and what it's like to read: She simply and straightforwardly lets every passage take as much time and space as it needs. It's okay if a math explanation fills up several pages. It's okay if some of the most beautiful and revealing character moments for the Professor — like his ability, every afternoon, to see the evening star before anyone else can (page 79) — take less than a page. There's a way in which the weight of any one part of this book has nothing to do with its length. All the different needs of the text are balanced in their significance. 

How does a short description manage to carry as much weight as a many-paged scene? I think it's partly because of what this book is telling us — its themes. Browning toast is, in fact, as important as the Pythagorean theorem. The housekeeper tells us so. A child is as important as a mathematician. A moment when a man with a brain injury is sad and confused is as important as the most fundamental mathematical discovery. Everything is connected, everything matters, and everything gets to take up space.

One thing I took away from the pacing of this book is that I want to try to worry less about the moments when my text feels uneven. I'll always listen to feedback from my readers when it comes to my pacing — but ultimately, there are other aspects of a text, particularly its style, mood, and themes, that can bind seemingly disparate parts of a book together. Maybe that's something I can talk about more sometime using one of my own books. It comes down to a book being a web, and that's a really complicated thing to try to talk about!

Here's another interesting thing Ogawa does with pacing: While it becomes pretty easy, pretty quickly, for the reader to know who the Professor is, this makes a fascinating contrast with the other characters in the book, who come into focus much more slowly. Especially the housekeeper herself, who's the narrator, but who's always talking about everyone else, hiding herself in the background (much like a housekeeper). Honestly, it took me a while to even notice the housekeeper as a character. And then I began to care about her experience deeply.

A lot of our revelations about the housekeeper's character relate to math. With a quiet, patient kind of wonder, the housekeeper absorbs every math lesson the Professor gives, and we see what that's like for her. We watch it touch her daily life—and reshape her entire outlook. 

"There was something profound in his love for math," the housekeeper says. "And it helped that he forgot what he'd taught me before, so I was free to repeat the same question until I understood. Things that most people would get the first time around might take me five, or even ten times, but I could go on asking the Professor to explain until I finally got it" (23).

Just as the Professor explains math to the housekeeper, Ogawa explains it to the reader, and explains it well; we understand it because we're sharing the housekeeper's growing understanding of it. Consequently, we can understand the way it's changing the housekeeper. One day, while cleaning the kitchen, she finds a serial number engraved on the back of the refrigerator door: 2311. Unable to help herself, she pulls out a notepad and gets to work trying to figure out whether this is a prime number. "Once I'd proved that 2,311 was prime, I put the notepad back in my pocket and went back to my cleaning, though now with a new affection for this refrigerator, which had a prime serial number. It suddenly seemed so noble, divisible by only one and itself" (113).

Later, she reflects on the relationship between math and meaning: "In my imagination, I saw the creator of the universe sitting in some distant corner of the sky, weaving a pattern of delicate lace so fine that even the faintest light would shine through it. The lace stretches out infinitely in every direction, billowing gently in the cosmic breeze. You want desperately to touch it, hold it up to the light, rub it against your cheek. And all we ask is to be able to re-create the pattern, weave it again with numbers, somehow, in our own language; to make even the tiniest fragment our own, to bring it back to earth" (124).

(It's worth mentioning that this book's sense of spaciousness is also aided by descriptions of actually spacious things. It's hard to imagine something more spacious than infinite lace!)

Slowly, we watch the housekeeper's relationship with the Professor—and with math—change her entire concept of herself. Here, the Professor has just watched her cook dinner with utter fascination and respect: "I looked at the food I had just finished preparing and then at my hands. Sautéed pork garnished with lemon, a salad, and a soft, yellow omelet. I studied the dishes, one by one. They were all perfectly ordinary, but they looked delicious—satisfying food at the end of a long day. I looked at my palms again, filled suddenly with an absurd sense of satisfaction, as though I had just solved Fermat's Last Theorem" (135).

Honestly, the mathematics in The Housekeeper and the Professor is one reason it's tricky to use this book as a craft lesson. It's clear Ogawa has enormous mathematical expertise, which breathes life and meaning into this story — but not many writers are going to have that expertise at their disposal, and not all stories can be about math. I also wonder what it's like to read this book if you're indifferent to math, or even hate it? Baseball, which is extremely math-based, plays another huge part in this book — I wonder how the book reads to people untouched by both math and baseball? I happen to adore both; I lap up baseball movies and math plays like Arcadia or Proof with the purest joy; so it's impossible for me to imagine reading this book from the perspective of a baseball-hater or a math-hater. It's hard to imagine that reader having the same experience I'm having.

Nonetheless, the point remains that Ogawa is harnessing the essence of other disciplines, math and baseball, and using them to expand her story — and it works for a lot of readers. It creates a kind of magic similar to Victor LaValle's use of fairytales in The Changeling. Things that we understand in a different context, like math or fairytales, can expand the meaning of realities that otherwise don't make sense, or hurt too much. Like a person who's lost a part of their brain that they need in order to make new, sustained relationships. Or a housekeeper who's been alone, unsupported, and unappreciated for most of her life.

And here again, Ogawa makes spacious choices. Is anything more spacious than math? Math defines space, and the infinity of space. And one of the complaints most often brandished at baseball is that there's way too much empty space in the game :o). Math and baseball serve as themes helping to create the book's spaciousness.

So. I'm not convinced that this post is the most useful entry in my craft series, especially for any of you looking for nitty-gritty writing advice. But I do hope you'll read Ogawa's The Housekeeper and the Professor, and maybe my thoughts will combine with your own to help you come to some conclusions. I'll end this post with a spacious image:

"As we reached the top of the stairs that led to the seats above third base, all three of us let out a cry. The diamond in all its grandeur was laid out before us — the soft, dark earth of the infield, the spotless bases, the straight white lines, and the manicured grass. The evening sky seemed so close you could touch it, and at that moment, as if they had been awaiting our arrival, the lights came on. The stadium looked like a spaceship descended from the heavens" (88).

Happy writing!

 

Reading like a writer.

Here are a few organizations that need our support right now: 

Fund Texas Choice. A nonprofit organization funding abortion travel for people in Texas. 

Frontera Fund. Making abortion accessible for people in the Rio Grande Valley. 

Clinic Access Support Network. Providing transportation, lodging, emotional support, and more to those seeking abortion care in Houston, TX. 

Bridge Collective. A full spectrum doula collective, nonprofit organization based in Austin, TX. 

The Afiya Center. An advocacy organization based in Dallas, TX, dedicated to transforming the lives of Black womxn and girls through reproductive justice. 

Texas Equal Access Fund. Providing financial and emotional support to people seeking abortion care in the north, east, and panhandle regions of Texas. 

Lilith Fund. Financial assistance, emotional support, and building community spaces for people who need abortions in Texas — unapologetically, with compassion and conviction. 

West Fund. Working to make abortions accessible and affordable to people in West Texas. 

Thank you to the folks at @FundTexasChoice who helped me compile this list.

 

 

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