Saturday, December 22, 2012

My New Year's Resolution

My writing on this blog sucks.

It's obtuse. Constipated. Convoluted.

In the New Year, I resolve to put into writing that which I mean to say instead of filler words or phrases awkwardly assembled into incoherent arguments.

I will say what I mean.

That is all.

Monday, December 17, 2012

"The Signal and the Noise"

Nate Silver's first work of non-fiction reads more like an enthusiastic extended commentary within a science or economic journal, especially when compared with works by contemporaries like Malcolm Gladwell. This is no accident: Silver is a statistician, a numbers and predictions wonk. He's not into (nor, to my knowledge, extensively trained in) descriptive writing, and the brief interludes his accounts of discussions with scientists, politicians, and experts in various fields, his prose becomes awkward. But then he starts talking numbers. And the chapter sails on. Flush with new approaches to data analysis in a complicated world.

All that said, the analysis is stellar, and in the spirit of Freakonomics, S&N encourages us to approach real-world problems with a few great ideas:
1. A Bayesian approach is reasonable, especially when dealing with the probability of an event happening, and in which prior information ("Bayesian priors") is available.
2. "Noise" comes in several forms: data points that neither reflect trends nor are truly significant (especially true of rare events); noise is in the news all the time (storms, accidents, global warming, political polls, commonly held beliefs that are statistically un-proven and may in fact be completely wrong); trends in sports; misperceptions about money, the stock market, economies in general.
3. "Signal" is more of a pseudonym for well-collected and well-organized data that are neither 1) over-fit or 2) meaningless because of the uncertainty in of the prediction (in time or space); "Signal" also takes into account known knowns, known unknowns, and tries, as best it can, to leave wiggle room for the dreaded unknown unknowns.

Anyway, it's a good book. Give it a read!

Unimaginable

Gun violence continues to ravage the U.S.A.

I was particularly moved by this piece, penned by a pediatric ED physician. How a person, particularly a young and innocent child, dies from a gunshot wound, is important to remember in the midst of all the chatter about a New Conversation and a renewed interest in gun regulations.

Spoiler alert: it's gory and nauseating.

Saturday, December 01, 2012

Tuesday, July 31, 2012

Cooper the body snatcher

Turns out the guy behind "Cooper's ligaments" in the breasts was pretty revolutionary. He seemed to get it, was far ahead of his time, and clearly was part of some crazy goings on in medicine in the 19th century.

Thursday, June 28, 2012

Health Care

A couple thoughts:
1. The problem with health care reform advocates in this country is they fail to do what the pharmaceutical industry does so well: convince people first they have a problem -- ever seen those commercials telling people about a disease, such as, "Do your legs ever become numb? You may have peripheral vascular disease. Talk to your doctor," and the commercial ends without advertising a drug. It just states a horrible problem. Then, months later, after those adds have shown on several occasions, the next wave begins, in which the solution ("Plavix, an anti-thrombotic for vasculopaths.") is presented.
2. People don't get it: the government has been picking up the tab, in numerous difficult-to-define ways, for health care. Reform is just about trying to lower the bar bill. Get people to drink cheap beer instead of the top shelf stuff. No fancy soft-shelled crab. It's going to be happy hour pub grub, budweiser, some chips and salsa, and a pie for dessert. Still pretty good. Gets the job done. And doesn't bankrupt the country...we'll get there, and if I get paid less for it, that's OK.

Monday, June 11, 2012

why to not be obsessed with jobs

http://www.nejm.org/doi/full/10.1056/NEJMp1204891?query=featured_home

a very sensible and economical argument behind the misguided obsession with healthcare "jobs."

The graph says it all

Hospital costs soaring, mortality rates in-hospital holding steady. http://www.nejm.org/doi/full/10.1056/NEJMp1202628

fish oil fail

http://www.nejm.org/doi/full/10.1056/NEJMoa1203859?query=featured_home

guess the fish oil craze isn't all that it was billed to be...

One of those days

Today:
1. When I arrived this morning, I learned a favorite patient of mine died last night, somewhat unexpectedly.
2. I had to help break devastating news to a patient.
3. Clinic was a downer, with more sad stories...

And yet, I still love what I'm doing.

Friday, June 08, 2012

What's the question?

Knowing the question is the key to calling a consult.

Saturday, May 19, 2012

Two months of medicine wards

Today's one of 8 days off over the next two months. But then third year ends. So the finish line begins to appear. Been great fun so far. It's the little things...

Friday, May 04, 2012

What I Did Today

Talked down a coke-head who had been up for four days, psychotic and possibly delirious tweaked out of his mind, until the anti-psychotic/sedative cocktail could kick in. Psychiatry, it's been fun so far.

Chronic Traumatic Encephalopathy

CTE is back in the news. This time, everyone's suspicious the most recent NFL casualty to suicide was linked to chronic head trauma. CTE researchers will let us know soon.

Grad School in GIFs

The life of a graduate student, explained through witty gifs. It's lulz all around.

Wednesday, April 25, 2012

I think people might get the wrong idea

Look, I'm definitely astounded and happy to hear about this story, but this is the kind of story which might make folks too overly-optimistic if and when something like this happens to a loved one.

But most of the time, people don't make it in this guy's situation. Yes, anything can happen, but being realistic is as important as having hope and loving your loved ones.

Anyway, something to think about.

Wednesday, February 01, 2012

Paula Deen has metabolic syndrome

Paula Deen has been diagnosed with an illness that gives her the risk of heart attack equivalent to an individual who has already suffered a heart attack. In other words, she has type 2 diabetes.

This is the woman who has become renowned for her high-calorie and fat foods.

Now she's a compensated spokesperson for Norvo-Nordodisk.

OK guys. But remember, type 2 diabetes is a real, serious disease. And Paula Deen will only get better if she actually does dieting and exercising the right way. But I'm skeptical.

Thursday, January 26, 2012

Eugenics

Yep, states used to have "Eugenics" boards. The consequences live on.

Thursday, January 19, 2012

A vigorous argument against sexual "performance enhancing" drug use in youth

Here's an interesting quotation from a 2004 NEJM piece by Morgentaler on the treatment of erectile dysfunction.



"...the effects of the recreational use of PDE 5 inhibitors have not been well studied. My major concern is the psychological impact of taking these medications for younger men who are not yet in a stable relationship. I have seen cases where men who lack for nothing except confidence secretly take sildenafil every time they go on a date, in the hope that it will help them please their partner. However, this can create obstacles for a solid intimate relationship. Apart from issues of authenticity, trust, and honesty, it seems to me that the key psychological cost of using sildenafil recreationally is that, by relying on a pharmacologic enhancement to his sexuality, a man loses an opportunity to achieve what we all look for in relationships—namely, to be loved and accepted for whom we really are."


That's some sincerity right there...now, whether you agree with the degree of passion in that statement.

(h/t UCLA IM Residency program IMS morning conference, 1/19/2012).

Sunday, January 08, 2012

News Flash

Wow, the NFL is violent.

Saturday, January 07, 2012

Charges filed

The unspeakable, tragic death of Sheri Sangji, hit especially close to home to the bloggers on this site: the accident (which left Sangji burned over half of her body) occurred in an Organic Chemistry laboratory at UCLA. And Sheri was an alumna of the Pomona College Chemistry Department, of which Anthony and I were also graduates.

At this time, I do not wish to re-hash the details of her accident, aftermath, death; nor the policies and procedures enacted at UCLA as a result. But in the last two days, some newsworthy developments have taken place. Criminal charges have been filed against both UCLA and the principal investigator of the laboratory in which Sangji worked. This is unprecedented indeed; and Sheri's death was unimaginably tragic for those closest to her. I don't know what else to say.

Friday, January 06, 2012

Economics

I just finished reading Economics in One Lesson, a veritable manifesto of libertarian economics by "Austrian" Henry Hazlitt.

I strongly recommend everyone gain some basic understanding of economics, and although this book was pretty slanted toward "free market," "no government," and all the other tenants of libertarianism, it was thought-provoking. And It forced me to wrestle with assumptions I've had about various government programs over the years.

The point is not to read (and understand) basic economic texts with the hope of becoming indoctrinated. That's easy. The point is to just learn and understand some basic stuff that a large chunk of the population have never considered, save for taking basic econ in high school. And I'm not claiming this based on elitism, just based on how many conversations I've had with people where economics are fundamentally misunderstood.

Tuesday, January 03, 2012

New Year Readings

Oh hey, Happy New Year! Here are some excellent pieces on the current state of health care. First something optimistic:

Atul Gawande exposes a program in New Jersey which aggressively targets the sickest of the sickest patients, with early promising results for bending the health care cost curve. Obviously, it paints a rosy picture (usually the case w/ AG's work) but still it provides some good stuff to consider.

In another recent piece by the NYT, the disturbingly prevalent problem of patients staying in hospitals due to placement issues (lack of insurance, housing, or transitional care). I saw this all the time during the first six months of third year.

Lots to do. Lots to do.