The problem with Watson-Crick base pairing

Is that W and C don't base-pair. You know what works? Goldstein-Crick base pairing.

(Why this should be funny but probably isn't to you: In addition to the A, T, G, and C of normal DNA sequences, other letters of the alphabet are used to designate possiblities, e.g. W = weak, which could be either A or T, so named because they make only 2 hydrogen bonds, as compared to the Strong G-C base pairs which are held together by 3 bonds.)

Psychiatry

We get conflicting accounts of medicine in popular media, in undergraduate biology, and in more research oriented basic science lectures. But it's always good to get the single consensus answer. In CPP this comes from the mouths of practicing physicians specializing in the disease being discussed. Their answer has the advantage of having survived contact with reality, and being relatively accepted by a lot of other medical types you might talk to.

Psychiatry is an area where the gap between popular accounts and practice appears to be the widest. Civilians* throw around diagnoses, or sub-diagnoses or outdated diagnoses with great freedom, assigning fairly serious conditions to (say) celebrities they have never met. As described in psychiatry, life is more complicated. Diagnosis consists of large lists of criteria that patients have to fulfil, e.g. in order for you to be depressed, from this list:

Depressed mood
Energy loss
Anhedonia (lack of pleasure)
Death thoughts
Sleep changes
Worthlessness
Appetite
Mentation changes
Psychomotor

You must have depressed mood or anhedonia and five of the others for most of the day every day for two weeks to qualify those weeks as a depressive episode. This sort of formal rigor is much more appealing than saying, "Hey, this guy is sad, let's give 'im some Prozac."

One of the best parts of this section was that in lab, instead of only reading cases, we had actual patients come in to talk to the class so we could see what it was like. And that's where the nice neat system vanishes. Our bipolar patient was being treated for anxiety, our obsessive-compulsive disorder patient had depression. Our schizophrenic patients seemed to have well behaved disorders, but our recovering alcoholic physician had his ADHD misdiagnosed as anxiety, and got addicted to his Xanax. And if depression was such a difficult diagnosis to meet, antidepressants would not be among the top-selling drugs.

They do teach some things that are pretty easy for me to swallow:
Psychodynamic psychotherapy ("And how does that make you feel?") is reserved for those with lots of time and money.
Cognitive behavioral therapy is pushed, especially for certain disorders where medication is not helpful.

It seems to me that the reliance on medication is partially about efficacy and partially about cost. Consider that you can get a month's supply generic prozac or paxil (fluoxetine and paroxetine) for $4 from Wal-Mart, but that a month's supply of cognitive therapy is $400.




* I realize that this is my first use of this potentially derogatory term to describe non-medicos and another step on my long journey to becoming and asshole physician. Further I recognize that this blog began as an attempt to stymie said journey, and has instead served as a record of it.

More Veiled Conceit*

Peruse this wedding announcement:

"Unknown to Ms. Luft, her skirt had somehow become tucked into her pantyhose. When the elevator door opened, she realized there was a problem. 'I only noticed when everyone in the elevator was staring at my backside,'"

Obviously, this woman is very enamored of her sweet, tight buns or she wouldn't have related this tidbit to the whole planet. Or at least she was enamored of her 16 year old buns. Let's see what Wechter has to say about it:

''I was very attracted to Sara when I first met her... She's got a very engaging personality. I thought about her all the way home.''

Sweet, tight, engaging.

Couples write their own wedding announcements, so one can only wonder why the couple chose to write it this way. Do they want us to read between the lines? Do they figure they have a better shot of getting in if they have a bit of salacious summer camp gossip?

Doing an O&P (That's occupations and parents) we find that their jobs are investment/portfolio types, as are their parents, so, they're standard fare for the NYTWCA. They live in New Jersey, he works in Greenwich, and she works in New York. How miserable. Each of them spends at least 3 hours a day in the car or in transit.

Other than the meeting story, this couple is so aggressively boring that they would normally fly under the VC radar, except for the bride's heavily aftershadowed closing line, '''It was Josh, making sure I got home safely from my flight,'' she said. 'That was when we were 16 years old, and we've pretty much stayed together since.'''


pretty much [prit-ee muhch] adv. 1. After dating for two years dating long distance, they agreed to 'see other people at college.' His banana face

doomed him to four years of sucking face at closing time at the Copabanana. (Slogan: Where ugly girls go to cop banana faces.


I just realized that this icon is probably for an establishment where ugly girls go to cop other sorts of bananas, but I think the point is made). His bitterness increased when in a desperate, drunk dialing rage he called her voice mail and got: "Hi, this is Sar, please leave a message after the tone. If you're calling because you saw my name above the urinal at Tongue and Groove (click for awesome music), please send a head and a body shot to luftballoon@emory.edu. I'm totally stoked to hear from you, bye-ee." His sobbing description of a strange sore on his penis drew out her compassion, and she agreed to get back together... after the penicillin kicked in.

2. He demanded that they stay together through college, but then one day that girl in his Management 318 class showed up with her skirt tucked in her pantyhose. She flew in unexpectedly to surprise him, and found the pantyhose draped over his doornob. "Wechter?" He said over the phone, "I hardly knew 'er." Six years, 14 breakups, and numerous heartfelt conversations later, they give up on dating other people and show the whole world their orthodontic work on the NYTWCA.

3. In order to stay together in college, they lived in Rocky Mount, VA (exactly halfway between University City and Atlanta) and commuted 6 hours in either direction, which makes their current 3 hour commute look like crossing the street. Once she got really sleepy and stayed in a rest stop in North Carolina, so they spent the night apart.

Which do you think is most likely?



*Veiled Conceit is the original idea of 'Zach' at Veiled Conceit
With special help from Cara.

A Little Veiled Conceit*

Veiled Conceit: A glimpse into that haven of superficial, pretentious, pseudo-aristocratic vanity: The NY Times' Wedding & Celebration Announcements

Before we begin this week's edition of Veiled Conceit, I'd like to give small public service announcement:

Do not, under any circumstances let your picture look like this:











Seriously. She's either ridiculously smug, or giving every pretentious male in the U.S. a 'come-hither' look. Maybe both. She was in the Peace Corps. I would say that ex-Peace Corps folk are usually highly pretentious about it, but the one's I know are actually quite nice. damn. She used to fight child trafficking in Nepal, but then she started working for Planned Parenthood, and you know what inappropriate trafficking joke goes here. As for the groom, Bob, he's totally oblivious, although his gaze is oddly mesmerizing.

Update: I just noticed the bride is 35. I swear officer. I know she looks 17, but at least she's old enough to know to lie, right?


Let's go to this week's vows couple, fine art photographer Alex Heilner and his bride to be Amy Scott. Let's look at some of his work, eh? I immediately went for the collection called 'microbes.' The best I can say is that the landscape photos are much better.


a colony of Penicillin Resistant E. statebuilding

It seems that Mr. H is known for his alphabetizing ability, and his annual scavenger hunt. He's also known for his list of desired girlfriend qualities, "An abridged version" said the Sunday Stylez Crew, "would include: brainy, creative, humble, funny, confident and energetic enough to go out every night. And one more thing: 'Hot. That was important.'" Translation: Hot. Re-translation: Hot, and willing to always put Queen II in front of Queen on Fire: Live at the Bowl because I comes before O, or U.

Let's look at the man himself...

Objects in mirror are closer than they appear.

Any middle class pig can photograph himself in the bathroom mirror. But, the car mirror! Genius. Every car commercial every written satirized in a single, digital moment! Couldn't we get a better head-shot, you ask? Well, no. He's a small, Beetle-like figure in wedding picture A, and an out of focus cheek in wedding picture B.


He's definitely "small enough to fit in a guitar case"

According to the article, the couple married themselves, as is legal under Colorado law. What sort of pretentious yuppie Napoleon bullshit is this?



Napoleon: Also small enough to fit in a guitar case.




Buyers Remorse

As always, the real story is in the background...

He and Alex gaze at the same thing far to the right. Is it the open bar? The air conditioner? Or the next item on Alex's scavenger hunt of love? Only time will tell, but statistics say...



Finally, I'm going to try to convince Cara to help me out with a video, which may get updated in below.
Update:


*Veiled Conceit is the original idea of 'Zach' at Veiled Conceit

Top residency choices this week:

1 allergy & immunology 46
2 hematology 44
3 radiology 44
4 aerospace med 43
5 dermatology 43
6 neurosurgery 43
7 neurology 42
8 emergency med 42
9 general surgery 42
10 pediatrics 42

The 3PPS Test

How to do it: Visual examination of the proximal phalanx of the third "ring" finger of the left ("sinister") hand.

Possible findings - documentation:
1. Nil.
2. Ring - describe ring.
3. Ring callus - note.


The upshot is that my frequent failure to perform this simple task has resulted in mockery from my physical diagnosis comrades,

Tofu Cube... OF DEATH!!!

I had a charming case of food poisoning last quarter, which I was able to (thanks to Medical Micro) identify as heat stable staph toxin. I don't want to go into it now, but at the time, I asked my friends who had been at the same restaurant if anyone had the same symptoms, and a friend wrote back that she can't get food poisoning since she doesn't eat any meat.

Contra that, today I noticed a report in the CDC's Morbidity and Mortality Weekly Reports, and they talk about this Chinese couple that got botulism from their fermented tofu.

Anyway, I have extracted below the recipe for TOFU OF DOOM.

The tofu was a commercially packaged product purchased at a retail market. In the home, the tofu was boiled, towel dried, and cut into cubes. The cubes were placed in a bowl, covered with plastic wrap, and stored at room temperature for 10--15 days. The tofu was then transferred to glass jars with chili powder, salt, white cooking wine, vegetable oil, and chicken bouillon to marinate at room temperature for 2--3 more days. Finally, the fermented tofu was stored and eaten at room temperature.


*
Note that I cite MMWR below.

After I dressed this morning...

C: You look like you're going clubbing.
I: Not so much, but I am going to go study clubbing.

The image to the side is of clubbing - bony expansion of the tips of the fingers caused by long-term lack of oxygen, e.g. that caused by smoking or other lung damage.

AIDS drugs cause AIDS I

Yesterday, I was puttering through the hospital when I came across a J, pathologist friend of mine. Whenever I see a pathologist, I always ask to see whatever slide they're working on, which usually results in an interesting story.

J told me about a case from his residency in 1994. A 20 year old man presented to the morgue with multiple Kaposi's Sarcomas in his GI tract. KS is a cancer of an unknown, probably blood vessel cell which is caused by the Kaposi's Sarcoma Herpes Virus (KSHV, HHV8). Prior to 1981, the stereotypical patient with KS was an 85 year old Italian male.

In '94 the stereotypical patient was this patient, a young gay man. Since the cancer was in his digestive tract instead of the skin, he didn't have a chance to get treatment.

Not that there was much treatment.

J kind of breaks off and says, "We don't really see cases like that anymore, not since '96."

Boards question:
A 37 year old male heroin user has noticed multiple 0.5- to 1.2-cm plaque-like, reddish-purple, skin lesions on his face, trunk, and extremeties. Some of the larger lesions appear to be nodular. These lesions have appeared over the past 6 months and have slowly enlarged. The most effective treatment for his condition is:

A. Vincristine, irinotecan, and cisplatin.
B. Valcyclovir, gancyclovir, and foscarnet.
C. Indapamide, metoprolol, and prazosin
D. Zidovudine, lamivudine, and efavirenz.
E. Ticarcillin, clavulanate, and gentimicin.


Tick
Tick
Tick


Correct answer: D. The common thread in all of this is the Human Immunodeficiency Virus, and the cocktail indicated is an ideal treatment. The release of protease inhibitors in 1996 meant that the number of patients with full blown AIDS and AIDS defining illnesses cratered, hence the dearth of KS biopsies.

This brought to mind a story on badscience.net about South Africa's stand against providing AIDS drugs to AIDS patients. For instance at an international HIV/AIDS conference, the South African booth featured that infamous reverse transcriptase inhibitor, the African Potato. Anyway, part of the South African government's argument is that, as the title of my piece indicates, AIDS drugs cause AIDS.

How can we reconcile J's observations with this claim?

Prior to 1987, there were no AIDS drugs in general circulation. One can only conclude that gay men, injection drug users, and hemophilliacs were secretly stealing AZT and snorting it starting in the mid 1970s. Of course the world's known supply was sitting on some lab shelf in Research Triangle Park. The only reasonable explanation is therefore that the Columbian cartels must have stolen the structure and synthesized a bunch of the stuff, and used it to cut the blow.

Explaining the sudden drop of KS after 1996 is relatively trivial. As it turns out, AZT causes AIDS, but the 3TC and Efavirenz are actually antidotes, so as long as people take them as a cocktail, nothing too horrible happens.

Essential resources:
AIDS reappraisal - Wikipedia (it's almost painful how hard they worked to keep this article neutral)
A little piece of history. Check the date.
Hopefully I'll get to address other aspects of the 'reappraisal' in a later piece.

Among my many flaws:

I: I seem to be missing the gene that makes you want to go to a bar, have one drink, and say, "Hey, let's go to a different bar!

She: SRY?

A problem possibly solved

Yesterday we started anemia, particularly the iron, B12, and folate deficiencies. It reminded me of a patient I saw last year who had a very confusing constellation of symptoms, but which I now realize were all anemia caused by a rash that had appeared on his chest 3 years earlier. The rash contained, presumably, rapidly proliferating skin cells and immune cells, which would suck of the folate and B12, both of which are involved in DNA synthesis. This was compounded by the patient's poor eating habit. Now if I could just figure out what the autoimmune condition was.

Something sort of similar is maybe in this paper.

Problem Solving Skills Dos

We're doing CPP&T this quarter, which is the part of medical school where they actually teach medicine. Each lecture takes the following format: "Here's a disease, here's how you get it, here's how you recognize it, here's how you treat it." Then we have lab twice a day, which is a series of cases where patients have the illness and we have to establish differentials and suggest labs and such.

We're also taking Physical Diagnosis, part of which is to run around the hospital, interviewing patients and doing as much of the physical we have learned, then trying to do diagnosis and present them to an attending physician.

It occurred to me today that medicine is very much like school problem solving - you are presented a patient/problem, you attempt to solve it in a stereotyped way based on practice problems of a similar appearance. You either get it right or wrong, but either way, you quickly move on to the next problem. If you do a good or bad job overall, it will definitely matter, but success on one problem, or even one type of problem is not necessary.

This is unlike other areas of work, which I can't think of right now, where either you can't move on, or all your problems are interrelated in ways that are simply impossible to entangle.

Anyway, that makes medicine comparatively comfortable, as opposed to, say, research, where you may be stuck on a problem for years, never knowing if you have the right answer.

The Second Eval

To: Office of Medical Education
Re: Work load of fall quarter

I would like to clarify my position on the course load for this quarter. I strongly believe that the work load for this quarter is appropriate. Therefore, I would have said "Strongly Disagree," but I'm concerned someone would take that as a request to load more work into the quarter, which I feel would be inappropriate.

Keith Ellison and the Hot Tub

Reviewing this I worry that some people will take it the wrong way, but I worry that throwing more words at it will make it worse. So, please interpret my remarks to be inoffensive to Christians, Muslims, and Jews, and if your worldview is relatively close to mine, we will have achieved communication.

As an aside, I do, in real life, know how to pronounce 'coup.'

Overly extensive coverage at... Wikipedia, where else?

Look there's a moose

My friend Sancho began working at Garmin recently and is justifiably proud of their winter ad campaigns. Observe:

"The moose"


Sancho prefers the moose, but I find it's scare tactic ways a little troubling. More realistic of what I would use a NuVi for would be:

"The unibrow"

Why Rumsfeld stuck around so long

On the top, Leo Thomas McGarry, the wise chief of staff cum vice presidential candidate on the West Wing
On the bottom, Donald H. Rumsfeld, the secretary of defense cum ex secretary of defense on CNN.

Scary it took me so long to figure this out.

Matchmaker matchmaker: A little veiled conceit

Recently, my mother asked whether people actually meet on JDate. Well mom, if the December 3rd vows couple is to be believed, not only JDate, but also SawYouAtSinai.com and JRetroMatch.com are smoking. Yes, mom, I'm sure they're full of nice Jewish girls.

But what's with Jews and constantly fulfilling stereotypes (and using that classic Seinfeld construction?)?

The bride, Rebecca Benjamin (oy!) is a matchmaker from Chappaqua, home of those other famous Jews, the Clintons. Alas, she is doomed never to fall in love, until she does. Maybe it's because she's so bossy, what with her always having to get the appetizer that she wants and getting a seat next to the groom at a singles event. She's quite picky though, "surmis[ing] from his height and appearance that he was potentially the one for her." From the pictures it looks like those qualifications were, "taller than me" and "cheeks you can grab while calling someone a little punim."

Not that his judgement of hotness is that great either. When visiting a friend, he saw a picture of that friend, former Vice President Dan Quayle, and Ms. Benjamin - focussed on her! Maybe it was recent and Danny boy has lost his hotness... sigh. Oh Dan.

I'm sure her heart jumped when she found out he worked at the law firm of Goldstein (no relation), Goldstein (no relation), Rikon, and Gottlieb, but must have descended a bit when she discovered he was only an associate. This means one of two equally troubling things: Either there are a lot more Rikons running around than I thought, or the groom is working for his father at the age of 30.

Finally they danced and formed an "instant relationship." They were "inseperable" But three weeks later the little Punim went on another singles cruise.

Why did he go?

"I booked in advance, and it was non-refundable..."

It was non-refundable.

IT WAS NOT REFUNDABLE!!!

Way to make the race look bad, buddy. *

The rest of the piece continues in its typical sappy fashion with additional bits of sterotypical Jewishness, but nothing can match the enormity of this confession, so I think I'll leave you with that.

As always, I must give credit to the originator of this concept, "Zach" of Veiled Conceit.

* Among the commandments that Jews are required to follow is to not commit Hillul ha-Shem, which is shaming the name of God. Indeed, there is a commandment against bad PR. Of course there's also a commandment against shaving with a razor, but being the modern Jew that I am, I continue to see the historial reason for the former commandment while gleefully violating that latter.

Continuity

So, linking in the pictures and the videos means that there will be some continuity errors with what was previously published, id est, I lied. But you were expecting that, right?

The new idea is to provide a mix of multimedia content that is unashamedly comprised to incomplete thoughts, why? because I don't have time to complete them.

That is all.

Video Archive

My video channel is:
http://www.youtube.com/profile?user=lostea

It's, video-ish and what I've been doing.

Circular Reform II

The meat.
The Poobah feeds us what he thinks good curricular reform looks like. We need to get away from spoon-feeding lecture material and move toward problem based learning. We neeed to encourage life-long learning. We need to promote horizontal and vertical integration, i.e. I need to talk to more 4th years. We need to get away from the 2+2 formula of medical education where there are two years of preclinical class-work and two years of clinical apprenticeship in the hospital. We should replace it with a 2x2 formula that promotes more integration between the preclinical and clinical worlds. I wonder if he's aware that, on a stricly mathematical level, 2x2 = 2+2? Obviously, this is deeper than math. Of course, I have no idea how 2x2 might work, and Poobah gives no pointers.

Poobah also encourages our initiative to promote good teaching and our huge push for professionalism. Little does he know that our professionalism teaching actually includes (see Hubris). Finally, he says that we shouldn't be seduced by false outcomes, things like standardized exam (board) scores, student satisfaction, and residency results (the Match). After all, we're amazing students, so we should do well on the boards regardless.

He talks about the need for humanism and the goodness of having a standardized patient interview as part of the 2nd step of the boards. He talks about the possibility of changing pre-medical requirements to start out with better trained students, or other larger reforms. In response to questions, he complained about the loss of low-income students who don't understand that they'll be able to pay their way out of the enormouse debt burden that medical school entails, and speculates unproductively about how medical schools can decrease their costs.

Ahem.

1. There's no data. I complained about this on the way out, and another student said, "There is data, he just didn't show it to us. If he had, it would have taken six hours." Maybe, but without the data, the hour speech is a waste of time. As Poobah said, one of the major obstacles to curriculum reform is student opposition.

2. I have very little to say to a fourth year, thank you very much. I mean, we can talk, but when we do I don't learn things that I need to know. Unlike undergraduate, there's not stuff that you need to start right now or you'll be screwed, because all that stuff is built into the curriculum.

3. 2+2 is not on the table. Sure, the inspiration for this system (The Flexner Report) is almost 100, but that doesn't automatically make it wrong. More significantly, the dean's office told the MSTPs that this is unlikely to change. Since we do 2+4+2, a major disruption of the 2+2 system will affect us deeply. This isn't to say that they would never do anything to inconvenience us, but they gave no details on what the reform would be, other than to say 2+2 was unlikely to change, which makes me feel more confident that it will be protected.

4. The reason DMS couldn't tell us what the reforms would be is that they pitched them as being student originated and student driven, so I resent the possible implication of this meeting that reform will be centrally designed and executed.

5. Problem based learning is not a panacea. For the non-medical types, PBL is a system where, rather than sitting in lecture, students are put in small groups and assigned problems to deal with. In medicine, these normally take the form of cases. The varied parts of the case serve as teachable moments, e.g. we have a patient with poor circulation and use it as an excuse to talk about hemoglobin. At the same time, we can talk about the physiology of circulation, how to interview this patient, what parts of the history are significant, how to deal with this patient's access to care etc. etc.

This sounds great, right? Kind of. This environment isn't the best environment for everyone. Some people love lecture (I go back and forth). If you don't learn from lecture, you just don't show up. If you don't learn from small group, they still take attendance, so you get to suffer through however many hours of groupthink, then go home and try to learn it your way. Regardless, some things are just better lectured. The tie-ins can be somewhat contrived. Each small group has to be led by someone, who will either be a professor (expensive) or a TA (useless). There's also no way to standardize what a small group will cover. Do you want to be treated by someone whose group shortchanged the hemoglobin, or the history taking? What happens when they have a patient that isn't a case? There are thousands of pathogens and drugs that 2nd years have to know cold - how is that case-able? Switching to case-based learning would also require Dupont to build us a huge new expensive building to accomodate the numerous small groups, making the transition that much more expensive.

Every generation has its own educational fads. Whole language. Integrated Math. International Baccalaureate. Self Esteem (ugggh). How do we know that PBL is a real advance and not a random gyration or cul-de-sac of edu-bureaucra-somethingorother?

6. My last question is not solely rhetorical. How do assess whether a pedagogy works? It's not trivial. One way is to look at internal grades. Early in Harvard's New Pathway program, for instance, rather than teaching students the names, origins, insertions, and actions of the muscles, they just taught them that muscles have names, origins, insertions, and actions. These students were quite noticeable in their 3rd and 4th years as they were the ones that had no f'ing idea what they were doing. We don't really have internal grades, so this won't work too well.

Since medical school involves a lot of material, one simple and obvious way to test multiple pedagogies is a standardised test, like the US Medical Lisencing Exam, and see whether a pedagogy improves scores. But Poobah said that board scores don't matter because we're such stellar students that we'd do well anyway. No. Look at Baylor. They teach to the boards to an outrageous degree, and their board scores are significantly higher than say, ours, since we basically ignore said boards. Thus, pedagogy can have an impact on board scores. Second, it's ridiculous for a person that is (somewhat) involved in running the USMLE to say that it doesn't measure anything. Emphasize touchy-feely all you like, but there is a body of knowledge that doctors MUST posses. The degree to which a school imparts that information is relevant, even if it is not the whole story.


MBA programs are ranked by how much money their graduates make after 3 years. The analogous system for medical schools would see where people go for their residency. This seems more reasonable than board scores - the application process involves interviews, recommendation letters and descriptions of our performance in clinical clerkships. If I've learned nothing, continued my unprofessionality, and turned into a peronality-free robot, they'll notice. There are problems with this, obviously. It's less quantifiable than boards, unless you want to assign points based on how prestigious the specialty and location of the residency are, which would itself be arbitrary. Since residency is a matter of matching, in which students rank their preferences, you could see what percentage of students get their first choice, but what if I rank a place first because I know they're the only place that will take me? Finally, part of the reason I'll get into a specific residency is because I went to Dupont. The system is sticky - difficult to change. Still, looking at the change in our performance, relative to ourselves, provides some quick feedback.

One could argue that the true definition for success lies in the future, some 10 years hence, when they see what kind of doctors we are. This is horribly non-quantifiable. How are they going to assess our competence then if they admit it's impossible to measure competence now? Is it going to be outcomes, in that our school is better if we place more professors? That ignores the fact that most people don't want to be professors. Should we do take-home pay? How uncivilized. It does however, have the advantage of being a realistic assessment of your value to society.

Once you eliminate ways to compare programs, the relative value of programs is dependent entirely upon reputation. For instance, we have a reputation as a "Top 10 medical school," when, in fact, we're not. Not even close. But the strength of the Dupont brand is such that we seem that way. Or something. The whole 'not top 10' is based on US News's rankings (http://www.usnews.com/usnews/edu/grad/rankings/med/brief/mdrrank_brief.php) which, in the absence of better data, will be the way med schools are ranked (which should be incentive for developing alternate rankings). Let's look at the rankings and methodologies (http://www.usnews.com/usnews/edu/grad/rankings/about/06med_meth_brief.php): Reputation. Reputation. (This counts for 40% of the score, btw). NIH grants total, and per researcher. How this affects the quality of my MD-only colleagues education, I couldn't say. Note that the total is more heavily weighted than the per-researcher, thus encouraging schools to add mediocre scientists.

The next part is hillarious. Acceptance rate - what this has to do with quality, again, is unclear. Plus it encourages schools to drum up applications. Also, is this based on primary applications, or secondaries? A primary application costs $30 and all you have to do is check another box on the common app. To do a secondary, you actually want to go to the school. MCAT - yes, let's replace using board scores for a test that wonders whether you remember your cyclohexane chair conformations (http://www.cem.msu.edu/~reusch/VirtualText/sterism2.htm) from OChem. Undergraduate GPA - . Enourages schools to accept people that avoided PChem and/or classes that they thought would prove difficult - these are precisely the sort you want for your physician, no?

Faculty/student ratio is interesting. Note that's faculty members per student. We're not in undergrad anymore, dorothy. And while I would appreciate getting picked apart by 9.5 professors if I went to Harvard, I'm not sure I would notice if it was only the 4.5 that would be after me at Hopkins. Again, this encourages schools to hire more crappier professors, or relabel reserach assistants and other non-helpful people as 'teaching faculty.' Next to these metrics, board scores and %1st pick for residency seem downright brillant.


Satisfaction
The third criterion rejected by Poobah is student satisfaction. I've heard the argument before: I have no basis for comparison. I don't know whether my level of knowledge is actually good or competitive, only how it measures in the eyes of the very people I'm rating. Just because I had a good time in class doesn't mean I got anything out of it. But, as Poobah says, we're good students. We went to top schools. We take out knowledge and try to think about problems. We have a basis for comparison - it's called undergraduate. I've been taught physiology before, and I know when they're doing a bad job. We're here to learn, and we can tell the difference between when the professor is imparting useful information, imparting details about their research, and goofing off, and we rate them appropriately.