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Poster Child (#1)

Posted by Frederick Wasti
Aug 07 2013

On Monday (August 5th), we went in to Dana-Farber for what I've been referring to as a "normal Campath day". However, due to a slight change in protocol, there are actually now ~two~ types of "normal Campath days".

Here in Part C of my clinical trial, I ordinarily have to visit D-F only every other week. For a number of months now (and this will continue for a number of months more), every fourth visit (i.e., once every eight weeks) is a "long Ofatumumab day" (due to blood tests, an exam, and premeds needed before the Ofa infusion, which is several hours long by itself). However, up until now, the other three visits in between involved blood tests, and exam, and a Campath (Alemtuzumab) injection, which makes for a considerably shorter day than any of the "long Ofatumumab days" entails.

However, recently, a modification has been made to some of the "normal Campath days", in that I do not have to have an exam after the blood tests have come back before receiving a Campath injection each time. This spares me (and either my doctor or my nurse practitioner) from having to go through an exam each and every time. This is all good news, and not just because it saves a little bit of time -- it acknowledges that my condition is quite stable as is shown in the graph above and in the graphs further below, and is judged as being not so critical as to need monitoring quite so closely now. (<smile>) (Of course, if my blood test results on any particular "no exam day" seemed to be unusual, the "no exam day" would likely turn into a "with exam day" in short order.)

So, the schedule for a two-month period now looks like this: Calling the "long Ofatumumab day" as Visit 1, I then have a "shorter [without exam] Campath day" for Visit 2, followed by a "longer [with exam] Campath day" for Visit 3, and then a "shorter Campath day" for Day 4. (And then it's back to Visit 1, with a "long Ofatumumab day" starting the next cycle, etc.) This is a small change in protocol, but methinks it's a good one.

Now, as for Fred's latest blood test (non-)news, the story is that everything is still about the same. The latest complete leukocyte graph is above, and below are the rest of the latest graphs, and, if you've been following this blog for any length of time, you should be able to interpret them correctly without any additional help, right? (<smile>)

As you can see, very little change has been taking place in my blood for many moons now, and my artificially induced "healthy but immunocompromised" stability continues... (<smile>)

Now, getting back to Monday (and this past Monday was a "longer Campath day"), I did see both Michele Walsh, my nurse practitioner, and Karen Francoeur, my protocol nurse in the examination room (and, later, Melissa Houston, my infusion nurse). Michele and Karen discussed the new protocol with us, and how they would therefore be seeing me less often, but also how it was a good sign. Michele remarked (once again, and she has said this once before at an earlier exam) that I was now "her " for the trial -- that is, when discussing the trial with patients who were not as far along in the trial as I (and who might be perhaps getting a bit discouraged at times, and the Part B protocol - especially - can be quite daunting), she would (in general terms, of course) mention to them just how well ~I~ was doing in the trial. So, I have become the "Poster Boy for Trial NCT01465334". (<smile>)

Of course, being a "poster boy" is an awesome responsibility (Har!) -- I do have to make sure that I do not "stumble", because I wish to serve only as a good example (mostly because the opposite would definitely indicate bad news). However, and while such an appellation is (maybe just a wee bit) "tongue in cheek", it does represent the recognition that I am indeed doing quite well with my treatment during this particular clinical trial. And, what's not to like about ~that~? Right? The way I figure it, if someone has to be the "poster child" for doing well in treatment, I might as well be the one. Right? (<smile>)

Anyway, I did start to think about the various uses of the terms "poster boy" and "poster girl", and their "parent" term (so to speak) of "poster child". There are actually several meanings of these terms, differing in both denotation and connotation. So, let's take a look at the definitions (and connotations) for "poster child", shall we?

The original, most basic use of "poster child" might be "a child appearing on a poster for a charitable organization" (without specifying the reason for the inclusion). The definition could be expanded to include the reason(s), e.g., "a child who benefited from a charitable organization appearing on a poster for the organization" and/or "a child appearing on a poster for a charitable organization to help solicit funding for the organization". Of course, there usually is a practical reason for including a child on such a poster, so most often the definition could be "a child with a particular illness or other problem whose picture appears on a poster advertising an organization that helps children with that illness or problem". Of course, the sex of the child might result in the "poster child" being referred to as a "poster girl" or as a "poster boy".

The connotation of the original definition(s) of "poster child" is generally considered to be (and is generally intended to be) positive. However, there are those who see the possibility that the use of a "poster child" could be exploitative and perhaps a form of child abuse. Nonetheless, my personal opinion is that, while such exploitation is indeed something for society to watch out for, the intent of using the image of a child as a "poster child" is generally benevolent in nature.

However, a more recent, secondary usage for the term "poster child" has also emerged. Nowadays the term can be applied more generally, not just to an image of a child in relation to an organization, but more abstractly to the mention of an specific child or adult, or sometimes even to an animal, or occasionally even to an inanimate object, in relation to a group or to a concept. This might be done either to help illustrate the nature of the group or concept being referred to and/or to help illustrate a quality of the subject because of its relationship to the group or concept.

The subject of the more recent usage is most likely to be an adult man or women, and this idiomatic usage is usually intended to be at least somewhat humorous, although the connotation could be either positive or negative, depending on the situation. (Note also that an image of the subject of such usage often does not literally have to appear on any actual poster.) Some specific types of such usage, depending on how the subject relates to the group or concept, can include the following:

The subject could be an example or an archetype, mentioned in order to illustrate the type of person or thing being discussed.

  • The subject could be a personification, mentioned as someone who is a very clear example of a particular quality.
  • The subject could be a model, mentioned as something so good that it should be copied.
  • The subject could be a template, mentioned as something that could be used as a pattern for copying.
  • The subject could be a prototype, mentioned as the first example of something.
  • The subject could be a stereotype, mentioned as someone who might be exactly what many people expect someone of a particular class, nationality, profession, etc., to be like.
  • The subject could be an instance, mentioned as an example of something happening.

It can be seen from the above list that some of these uses naturally tend to be more positive while other uses tend to be more negative.

The Oxford English Dictionary (which purports to be the guardian of British English throughout the world) notes that this second, more recent, idiomatic usage of "poster child" is primarily a North American usage, although I suspect that it may yet spread further throughout the world (and there will be nothing that the OED, the "Poster Child of Language Conservatism", can do about it). [As I will also point out shortly, the original "poster child" concept is also an American invention, too.]

Here are a few generic examples of such modern usage that I found online:

  • "He's a poster child for militant vegetarianism."
  • "She could be a poster child for good sportsmanship."
  • "[It is] the anti-globalization movement's poster child."
  • "She's the poster child for cosmetic surgery."
  • "The poster child of gluten-free grains, quinoa is a wonderful light, fluffy grain."
  • "She went out with a Calvin Klein poster boy."
  • "She's a poster child for free speech."
  • "He is the poster child for excessive chief executive compensation."
  • "The company has been the poster child of denial among those convinced of global warming."
  • "He is the poster child for incompetent government."
  • "She will be Microsoft's poster child for getting teenage girls interested in technology."
  • "Bamboo is the poster child for environmentally friendly accessorizing."
  • "[That] farm is a poster child for environmental friendliness."

Some quotations of such "poster child" usage are:

  • "I realize I will always be the poster child for police brutality, but I can try to use that as a positive force for healing and restraint." - police brutality victim Rodney King
  • "It's a joke to think that anyone is one thing. We're all such complex creatures. But if I'm going to be a poster child for anything, anger's a gorgeous emotion. It gets a bad rap, but it can make great changes happen." - singer Alanis Morissette
  • "I'm a poster child for Luddites. It was a challenge for me to open myself up the tech world." - environmental activist Julia Butterfly Hill
  • "In my early days, I was about 145 pounds. I was really a starving artist, the poster child for starving artists." - actor Creed Bratton
  • "I did not want to become a poster child for yet another disease." - engineer and businessman Andy Grove (prostate cancer survivor and now Parkinson's disease victim)
  • "I am a poster child with no poster." - civil rights advocate Jennifer Storm

The original "poster child" concept was a creation of 20th Century American charitable organizations. A "poster child" was originally (and is still) used to elicit compassion in potential donors. Images of a "poster child" usually appear, not just on posters, but on most of the literature (and now web sites) of organizations. Furthermore, "poster children" would often make public appearances for publicity purposes. In addition, while a "poster child" can serve as what I would call an "external symbol" of an organization (i.e., a symbol representing the organization in the public sphere), a "poster child" can also serve as an "internal symbol" for those involved in an organization, allowing them to focus on the purposes of the organization.

As far as I know, the first use of a "poster child" was made by the National Foundation for Infantile Paralysis (later called the March of Dimes), an organization hoping to educate people about polio, to improve the treatments for polio, and to develop protections against contracting polio (the March of Dimes provided much of the funding for developing first the Salk vaccine and later the Sabin vaccine against polio). The name "March of Dimes" probably originated with a comment by comedian Eddie Cantor that the donation of many dimes from all across the country could become a "march of dimes", which might also, in turn, have referred to the March of Time newsreels of the time.

The original "poster child" poster

Since children so often were the victims of polio, it seemed (I assume) quite natural to use children as "poster children" for the organization and its work. The March of Dimes credits Donald Anderson, of Portland, Oregon, as being the first March of Dimes "poster child" in 1946, but there have been a number of other children used as March of Dimes "poster children" since then.

March of Dimes canisters (including an "iron lung canister") for collecting donations

"Iron lungs" were a necessary (and very expensive) tool used to keep many polio victims alive

President Franklin D. Roosevelt, himself a victim of polio from a young age, helped found the National Foundation for Infantile Paralysis (and, in a sense, ended up also becoming a "poster boy" for the March of Dimes).

Before the National Foundation for Infantile Paralysis was founded, FDR organized a President's Ball on several of his birthdays to raise funds for fighting polio

A matchbook in support of FDR's Send a Dime to the President program

FDR meeting with Basil O'Connor, the President of the National Foundation for Infantile Paralysis

So, when FDR died in 1945, and public sentiment desired that his likeness appear on a US coin, an act of Congress in that year specified the dime for that coin, and the "Roosevelt Dime" was finally released on what would have been FDR's 46th birthday in January of 1946.

Roosevelt Dime

[I think it is interesting that the dime in use from 1916 to 1945 was generally referred to as the "Mercury dime", since it seemed to show a winged head of the god Mercury - however, the image on the so-called "Mercury dime" was actually that of the goddess Liberty, with wings on her head intended to symbolize freedom of thought. But I digress...]

So-called "Mercury" Dime

By mid-20th Century, other organizations, such as the Muscular Dystrophy Association, the Easter Seal Society, and the United Cerebral Palsy Association, following in the footsteps of the March of Dimes, also started using "poster children". And the rest, "as they say", is history...

The March of Dimes provided major funding for the development of the Salk vaccine (1955) and the Sabin vaccine (1962)

On the Times cover showing Jonas Salk, "poster children" can be seen at the top, surrounding the magazine title -- this was entirely appropriate because "poster children" had helped greatly in the battle against polio

The fight against polio has been commemorated in postage stamps -- above are stamps from 2006 honoring the developers of the Salk and Sabin vaccines

An earlier (1957) stamp honored all who contributed in the battle against polio

And a 1999 stamp celebrated the tremendous gains against polio due to the use of vaccines

A first day cover from 2006 combined all of the above stamps together

Of course, the fight against polio was not just an American struggle (even if "poster children" were predominantly American), and there have been commemorative stamps issued by many countries...

...including Canada...

and France

In a sense, though, and in the more recent, secondary usage of the term "poster child", historically there have been "poster children" in literature going back thousands of years. Certainly many of the characters (human and otherwise) in ancient texts represent examples of good or evil, brave or cowardly, etc. However, when thinking about metaphorical "poster children", the first literary "poster child" that came to my mind was Tiny Tim, the crippled young boy in the Charles Dickens classic novella from 1843, A Christmas Carol. Tiny Tim provided readers with probably the most well known symbol from the 1800s of the sad life (and potential early death) of a debilitated child from an impoverished family in all of English literature.

While Tiny Tim was not a major character in A Christmas Carol, he nonetheless was an important one. Although we are never told exactly what is the cause of his condition, his infirmity is an important attribute in the story: "[A]nd in came little Bob, the father, [with] Tiny Tim upon his shoulder. Alas for Tiny Tim, he bore a little crutch, and had his limbs supported by an iron frame!" Perhaps more important than his present condition for the purposes of the story is that he is likely to get considerably worse:

When the Ghost of Christmas Present paid a visit to Scrooge, old Ebenezer was shown how weak Tim really was, and he learns that Tim would likely die without treatment - treatment that the Cratchit family could not afford since Scrooge paid Tim's father Tom, an employee in Scrooge's business, so very little. Tim's death was foretold by the Ghost of Christmas Present:

"Spirit," said Scrooge, with an interest he had never felt before, "tell me if Tiny Tim will live."

"I see a vacant seat," replied the Ghost, "in the poor chimney-corner, and a crutch without an owner, carefully preserved. If these shadows remain unaltered by the Future, the child will die."

When Scrooge was later visited by the Ghost of Christmas Yet to Come, he did not see Tim any more - all that was left was a grieving family. Because of this preventable tragedy (and other such bleak glimpses into his woeful future), Scrooge finally "saw the light" and vowed to change his ways, so that, in the end, Tiny Tim did not die after all, and it seemed as if Scrooge more or less adopted the Cratchits - and Tim in particular - as if his kin, for which he (finally) felt responsible (as we all should).

So, in a sense, Tiny Tim represents a perfect example of a "poster child" (which is to say he is a "poster child" for all "poster children") - not only does he stand for all the poor, neglected, handicapped children of history, he also presents us with a lesson in the importance of making (or of not making) a proper moral decision. Scrooge was given the choice of doing nothing to help, or of doing something to help, and, because he chose the latter - that is, because he learned to have compassion - Tiny Tim lived.

If I may exercise a bit of additional literary license here, I would suggest that Tiny Tim was likely intended to serve as a "poster child" by Dickens (even though the term did not exist yet). In 1842, one year before writing A Christmas Carol, Dickens visited mines in England where young children worked incredibly long hours under entirely abominable conditions. While attending a fundraising meeting in Manchester for a charity for poor children soon after, he apparently decided that, instead of writing a political essay about the criminal mistreatment of children during the Industrial Revolution in Victorian England (which had been his original intent), he would write a short work of fiction that might illustrate the effects of poverty and gross income inequality more effectively. As Dickens put it in writing to one of the commissioners of the group sponsoring the meeting about the reason for his change in plans, by writing a work of fiction, "[you] will certainly feel that a sledge hammer has come down with twenty times the force I could exert" by writing a mere political pamphlet.

Charles Dickens in 1842

Furthermore (and I may ~really~ be going out on a limb with this one), Tiny Tim himself even viewed himself at one point as being a "poster child" of sorts: When Tim's father Tom brought him home after the two of them attended the Christmas Day service at the local church:

"And how did little Tim behave?" asked Mrs. Cratchit [...]

"As good as gold," said Bob, "and better. [...] He told me, coming home, that he hoped the people saw him in the church, because he was a cripple, and it might be pleasant to them to remember upon Christmas Day, who made lame beggars walk, and blind men see."

Now, the first problem with Tim's statement above is that small children generally do not speak (or think) in such a manner. However, this is after all a fictional tale (involving multiple ghosts, and time travel as well), so we should allow Dickens a bit of leeway here. However, it does seem to me to be illogically backward for Tim to think that he, as a cripple (who maybe didn't know he soon could die, but who at least probably felt himself getting worse over time), might remind people of Jesus, "who made lame beggars walk, and blind men see".

Nonetheless, Tim thusly offered himself up as a "poster child" in church, to somehow remind people of what Jesus was biblically ~capable~ of doing. The fact that Tim had not been cured by God may not have been much of a problem to many Victorian era churchgoers -- the influence of Calvinism in much of Victorian Christianity at that time resulted in an unfortunate emphasis on predestination, where the favored would be saved and the rest would be damned (and, by extension, those with a good lot in life must be among those favored by God, and those without earthly comfort were not so favored). However, despite the precepts of Calvinism, Tiny Tim suggested to his father that he could well serve as a lesson to others -- it could be said that this - in a small way - would not be totally unlike the example set by Jesus on the cross, who offered himself as a lesson to others, even as he was taunted for not saving himself - "If you are the Son of God, come down from the cross".

The line in A Christmas Carol that Tim is most known for was spoken during the Cratchit's meager Christmas Dinner, as witnessed by Scrooge and the Ghost of Christmas Present, when, after his father said "God bless us" before their dinner, Tim said "God bless us, every one". That Dickens-the-author felt that ~everyone~ should be blessed is driven home by Dickens-the-narrator, who also ended the book with these words: "And so, as Tiny Tim observed, God bless Us, Every One!" I will point out that "God bless us ~every~ one" does ~not~ seem to be a Calvinist sentiment, and the fact that Tiny Tim's earthly fate was not predestined, but could be changed by the "good works" of a sinner such as Scrooge, does ~not~ seem to be a Calvinist sentiment either. But I digress...

George C. Scott, my favorite film Scrooge

[A complete online edition of A Christmas Carol, surely one of the most important short works of fiction in the English language, is available at http://www.ibiblio.org/ebooks/Dickens/Carol/Dickens_Carol.htm - its 92 short pages of the novella are reproduced in one long page for easy reading by anyone interested.]

Hmmm... Finally, you might remember when I mentioned in a previous blog entry how we saw my nurse practitioner Michele Walsh "riding the bus". Well, today's particular blog entry included, near its beginning, how Michele had said ~I~ was the "Poster Boy for the Trial". Well, now that I think of it, I guess Michele's image on the side of a bus made ~her~ the "Poster Girl of the Simmons Nursing Program". (<smile>)

Categories: General, Leukemia