A bit of Veiled Conceit* Darria Long- Bryce Gillespie

[Caption: The only time in the last three years that this power couple have been motionless in the same room]
They met in medical school, which is common enough. But how?


"He saw her sing a spoof of 'He Had it Coming,' from 'Chicago.'"** Just so we're clear on what he's implying, she probably looked like this:

[Caption: Her mouth is singing an in joke about some professor. The rest of her is communicating more universally]
He thought she was unattainable since, as a 4th year, she was going to end up working in a hospital far from where he was, and that her having an extra degree would make it difficult for them to relate.

Like the other 4th years, she did vanish, but instead of going to a residency, she showed up two years later with a different extra degree.***

They formally met in an anatomy refresher course, though one hopes that memories of the Cell Block Tango kept Bryce warm in the cold Rochester night. Like all medical students, she had apparently forgotten anatomy immediately after leaving it. There was a cadaver lab that they could go to, but she thought it was 'cold' and 'creepy,' so she wanted backup. Really? A 27 year old with a bachelors and an advanced degree that's already been through anatomy is scared of cadaver lab / doesn't own a sweater? Cynics in the audience will say she was fishing for someone more handsome than Bryce to show up, but other cynics (and me) will say that, like all medical students, she wanted to avoid doing real work in her 4th year, so Darria sent an e-mail out asking if people actually wanted to do this lab thing.

"I always joke that he had me at the shoulder joint dissection." She says. In reality he just kept offering to show her his bones until she fell for it. There's also a cute story about him pumping gas for her because it was too cold for her to do it herself. That's cute, but it misses a key point - that was 4th year medical school He's now a 4th year resident in Boston, and she's a 3rd year resident in New Haven****. What happened in the last 4 years? Why aren't they in the same schools? Did distance keep them together, or apart? In the heat of residency, is it better to be 'dating' someone in another state where they can't trouble your sleep? Who kept the "Cell Block Tango" outfit?

I'm swooning... must be the formaldehyde!

*: In immitation of Zach at the now defunct nytimesweddings.blogspot.com

**: Technically "The Cell Block Tango," but these people don't have to be precise, right?

***: Though not one that tends to socially separate possessors from non-possessors the way the MD does.

****: I'm not trying to conceal that the one is at Harvard and the other at Yale, I'm just trying to reveal distances.

A bit of veiled conceit, 3AM edition

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

Cailin O'Connor and James Weatherall


"Hello! We might be as upset that you are that our picture wasn't online and you were forced to take a picture of your own newspaper, then remember how to use the rotate tool in GIMP.** Or maybe we just like teeth."

The bride! Likes teeth, not T's. Look at her first name more closely and feel the shame of a hundred substitutes while the rest of the class snickers on.

The bridegroom! Getting a PhD in philosophy, ATM machine FAIL! He already has a PhD in physics from here - never heard of it, won't make fun of it, guess he didn't like the program at his undergrad. He's appears to have been an experimentalist. Now, he's pursuing both that doctorate of philosophy in philosophy, and an MFA in creative writing - something terrible happened. The boson is a lie.


Mary Ziegler and John Roberts III


"I knew that I was seeing a very beautiful woman at her frumpiest"

When they first met, she was wearing her 'beater glasses.' I, too, have beater glasses. Coincidentally, they are also my nice glasses.

This would be a perfectly ordinary couple were it not for the couch. Actually, an "uncomfortable," "ugly," "stain-spotted" love seat. Very romantic. She was sick of it, and New York, so she sold it to him so that his female visitors wouldn't have to sit on the bed.

Then she laid beater-glasses-corrected eyesight on him and it was she that ended up back on the couch and back in New York.

As for the couch itself, it makes a cameo on the couple's wedding cake:


It's smaller than I expected. Also, fewer stains. Just let me run the blacklight over it before I hand over the cash.

*This quote and concept are stolen from 'Zach's' original Veiled Conceit

**GIMP - Photoshop for people that haven't got $1000 lying around and think they might be getting a little old to steal everything. Really, when was the last time you used it for anything but crop and autocontrast (don't answer Hippity, Westy, or Milensomthingsomthing).

Primary care - good and good for you!

Abraham Verghese thinks there aren't enough primary care doctors. Perhaps he's right.

Primary care doctors - internists, pediatricians, and family practice docs - are patients' first point of contact. There are two ways to think about primary care. I would argue that because primary care doctors need to be able to distinguish between tension headaches and brain cancer (for instance) that primary care physicians should be The Best doctors, while people working in a specialty need less diagnostic expertise due to the smaller disease spectrum they see. Curmudgeons, like V, would argue that because you have virtually no way to distinguish between tension headaches and brain cancer without an MRI (or similar) that primary care should be done by flowchart wielding nurse practitioners.*

Verghese wants more primary care physicians because:

Real patients want someone whose examining skills, when combined with common sense and sound judgment, can spare us the costly, blind, shotgun, ‘tick-all-the-boxes” kind of testing and imaging that has come to be the American brand of medicine. We want a doctor who orders tests judiciously, who calls in specialists sparingly, and who rides herd on them and weighs and translates what they say. What we want, in other words, is a primary-care physician.

Now, I agree with this entirely.** However, if V were to read this, he would point out patients, with the exception of Abraham Verghese (note the they -> we switch mid-paragraph), do not know and are not particularly interested in the formal status of the person caring for them. An M.D. does not increase, and likely decreases compassion. Becoming a primary care physician does not make one conscientious, similarly specialization does not remove that characteristic.

Since I agree with Verghese entirely, though, let's look at why there aren't enough primary care physicians. Verghese lists several reasons, summarized as: Primary care doesn't pay enough relative to the degree of training and the debt level most M.D.s graduate with.*** That's it. Secondarily to this, because primary care physicians are paid on a per-patient basis, they have to work long hours and don't get to spend much time with patients, so the work-style isn't much fun.

The above paragraph carries three completely plausible suggestions in it. Verghese clips one of them and misses the others completely. Instead he suggests an Peace Corps style program in which recent med school grads would be forced**** to work for a year doing primary care in an underserved area, in exchange for lowered student debt. Students exposed to the joys of primary care would abandon their future plans and switch to primary care in droves.

Students are already exposed to the joys of primary care, in the form of (at Dupont) 12 weeks of medicine (1/3 outpatient), 6 weeks of pediatrics (1/2 outpatient), and 4 weeks of family practice (all outpatient). One might argue for adding more to the curriculum, but if a student is offered primary care in at least 3 different flavors and likes none of them, what are the chances that a fourth will change their mind? Treating the students like grunts to be worn down in the toughest areas is also likely to leave a sour taste in the mouth.

Verghese does hit one nail on the head - debt forgiveness. Unfortunately, his program is begging to be ripped off. What's that you say, it will help me get a dermatology residency, and it will decrease my debt? A more straightforward plan would be to pay off the debt of students that go into primary care and practice in it for at least 5 years after their residency is over.

Consider the two other problems Verghese identifies - excessive training times, and reimbursement. Adding a year to training will only exacerbate the problem. Conversely, switching to a more nurse practitioner-based system (i.e. fewer years of training) could increase the number of primary care providers without provoking bitterness. Finally, why not suggest a tweak in the reimbursement system?

Funny conclusion goes here.

*:

Is the headache new or old?
New -> Consider headache characteristics
Thunderclap headache -> Head CT / LP
Signs of infection -> Consider meningitis
Headache with neurologic signs -> Neuroimaging
Morning headache -> Consider broad differential (including brain cancer)
Else -> New onset primary headache (give up)

Stern SDC, Cifu AS, Altkorn D.

**: See answer #9 here, except replace "NBME" with "Abraham Verghese"

***: Note that the difficulty of acquiring a residency 'slot' in a given specialty directly proportional to the future compensation of that residency. Surprise, M.D.'s are human!

****: He says it is voluntary, but says that competitive specialties (particularly dermatology) would use it as a criterion for entering physicians. Let me translate that into med studentese: Unless you want to end up as a [least favorite specialty] practicing in [a state you hate], you WILL do this program.

Roger Cohen meet Stanley Kubrick

So there's an Op-ed where some guy went to Iran and discovered:
Iran's inner America

I'll hold my tongue, except for one quote from Full Metal Jacket

We are here to help the Vietnamese,

because inside every

gook there is an

American trying to get out.

What's in _The Atlantic_'s library?

Red Arrow - Harrison's Internal Medicine, 14th Edition. Next to it, Physician's Desk Reference. Should come in handy if healthcare ever comes up.

Image: The Table.

B-b-b-b-b-b-b-billion

People need to stop talking about the stimulus as being this many Bbbbbbbbillion or that many bbbbbbbbillion dollars. To the government, a billion dollars is like 100 dollars to you or me. In order to get anything done, a billion is the right amount of money to spend. I understand you all went to diction school and have to ENunCiAte so people don't get confused about billion versus million, but there's a difference between, "Obama plans to add 3 Billion to the NIH budget" and "Obama plans to add... B-b-b-b-billion dollars..."

Bruce Ivins is still getting published

In the Journal of Infectious Disease.
But also in the NY Times.
Basically, the evidence against Ivins is that he was a mentally troubled guy that drank too much. Also, he had the technology and expertise available to produce the anthrax spores sent out. Also, he really creeped out one woman when she was in grad school. Seriously.
Nancy Haigwood knew Bruce Ivins when she was in grad school and decided he was creepy. Then her house was vandalized, and a letter was written to the local newspaper in her name defending a campus sorority. She decided that Ivins had done both those things. There's no evidence, as it was 30 years ago, but because she was creeped out by Ivins, she assumed that he did these things. Later, in e-mail conversations, Ivins mentioned things to Haigwood about her children that she hadn't told him. This is rendered as evidence of stalking, but it seems to me like evidence of gossip.**
Flash forward to after the anthrax attacks. She receives an e-mail from Ivins with a picture of him in an anthrax lab working without gloves. She decides that this demonstrates an unnerving hubris - a very odd conclusion to make from a single photograph.*

o.k. o.k. some of the defenses that I've thrown up of Ivins in the past - that he may not have known how to make dried spores, that he was just a bit eccentric. Obviously, Ivins was in an excellent position to make the anthrax, and he was in some way mentally outside the normal range. You might argue that alcoholism and psychiatric hospitalization, even voluntary, should disqualify someone from working with anthrax. That seems a bit harsh.

But the evidence actually linking Ivins to the anthrax attacks is nonexistant. He worked late prior to the attacks, but on what? The FBI must have asked him, but I don't have his answer. They couldn't match him to the envelopes, the stamps, or the post office in New Jersey. The fact that he takes long drives does not, in fact, mean that he was in Princeton lo that mailing morning.

Remember Steven Hatfill. The FBI's positioning of him as Mr. Anthrax was very convincing for a while.*** As the NYT says, "Dr. Hatfill, too, was eccentric. He, too, had begun drinking heavily as he came under scrutiny. He, too, had grown depressed and erratic under the FBI's relentless gaze. What if Dr. Hatfill had committed suicide in 2002, as friends feared he might? Would the investigators have released their evidence and announced that the perpetrator was dead?"


The reporter is too polite to provide an answer. I'm too worried about a future FBI investigation into me to be honest.**** But you aren't. And you know the same answer applies to Bruce Ivins.



*: There is definitely bacteria growing on some of the plates, and they are definitely blood agar or similar, invalidating any suggestion that he was just looking at media or working with a non-anthrax bug (like E. coli). On the other hand, the initial investigation of anthrax was done by Robert Koch working in an upstairs bedroom of his house with zero protective gear - caution and a lifetime of working with the bug might be protection enough.

**: BTW, if I can find your home address or details about your kids with a single search on Google or Facebook, it's not stalking. It's hardly even research.

***I particularly like that the 'damning evidence' brought over to this article was that Hatfill bragged about having a "working knowledge" of biowarfare pathogens. Imagine, someone actually bragging on their resume. That's amazing. Also, if I can have working knowledge of Drosophila genetics and vector construction, why can't someone else have working knowledge of biowarfare pathogens {presumably he enumerated them, NY Times said biowarfare pathogens}

****: Dressed up in a fly costume. Drank tea from a mason jar (repeatedly!). Liked Iowa. Secretly devout. A momma's boy. History of binge drinking. Once messaged a woman on facebook mere hours after meeting her at a party and knowing only her first name and major. Worked late hours. Worked odd hours. Occasionally handled hazardous materials without gloves. Struck some people as weird. Laughed at odd times in medical school classes. Once came to medical school class with a mowhawk hair cut. Longstanding interest in synthesis of methamphetamine from commercially available products. Previous interest in synthesis of chemical warfare agents from commercially available products. Interest in home microbiology. Interest in home distillation. Reputation for attempting techniques merely to see if they work. Occasionally angry. Hubristic. Questions medical hierarchy. Questions findings of the FBI...

-EDIT-
Also, 'working knowledge' of multiple (2) human pathogens (E. coli and a 5 week stint of Hepititis C work).

Sent to Andrew Sullivan

Glenn Greenwald asks:

Is there any other significant issue in American political life, besides Israel, where (a) citizens split almost evenly in their views, yet (b) the leaders of both parties adopt identical lockstep positions which leave half of the citizenry with no real voice? More notably still, is there any other position, besides Israel, where (a) a party's voters overwhelmingly embrace one position (Israel should not have attacked Gaza) but (b) that party's leadership unanimously embraces the exact opposite position (Israel was absolutely right to attack Gaza and the U.S. must support Israel unequivocally)? Does that happen with any other issue?

The answer: Immigration. The Republicans. 2005. oh crap.

via Andrewsullivan

Lay off Barack Obama's Birth Certificate

In re:

I’m sure the comments section will fill with various conspiracy theories over Indonesian school records, Kenyan births, and so on. None of it — absolutely none — has any real, solid evidence showing that Obama was born anywhere else than Hawaii apart from sheer speculation and hearsay, and even less evidence that Obama’s stepfather renounced Obama’s birthright citizenship, which he didn’t have the power to do anyway. It’s a conspiracy theory spun by conspiracy theorists (Philip Berg is a 9/11 truther) who use their normal thresholds of evidence for this meme.

Ed Morrisey via Andrew Sullivan

There are two ways to be a native born American citizen.
1. Be born within the United States (14th Amendment, *1)
2. Have a parents that was a U.S. dwelling U.S. citizens (U.S.C. Title 8 thingy 1402-g *2)

1. Barack Obama was born in Hawaii, therefore he is a native born citizen.
2. Barack Obama's mother was a U.S. citizen, therefore he is a native born citizen.

Hardly anyone belives #1, but even if they did, they still run up against #2.



*1: All persons born or naturalized in the United States, and subject to the jurisdiction thereof, are citizens of the United States and of the State wherein they reside

*2: The following shall be nationals and citizens of the United States at birth:
...
(g) a person born outside the geographical limits of the United States and its outlying possessions of parents one of whom is an alien, and the other a citizen of the United States who, prior to the birth of such person, was physically present in the United States or its outlying possessions for a period or periods totaling not less than five years, at least two of which were after attaining the age of fourteen years: Provided, That any periods of honorable service in the Armed Forces of the United States, or periods of employment with the United States Government or with an international organization as that term is defined in section 288 of title 22 by such citizen parent, or any periods during which such citizen parent is physically present abroad as the dependent unmarried son or daughter and a member of the household of a person
(A) honorably serving with the Armed Forces of the United States, or
(B) employed by the United States Government or an international organization as defined in section 288 of title 22, may be included in order to satisfy the physical-presence requirement of this paragraph. This proviso shall be applicable to persons born on or after December 24, 1952, to the same extent as if it had become effective in its present form on that date; and

Failout

Submitted to UrbanDictionary

Failout
1. When you try to bail someone out, and fail.

2. A level of failure more severe than an epic fail.

use 1. After David got picked up for public drunkenness, I tried to get him out of jail, but didn't have enough money, that was a real failout.

use 2. Henry Paulson - failout.

The Notch, updated

2008 Primary results
Democratic Primary: (10 voters)

* Barack Obama - 7
* John Edwards - 2
* Bill Richardson - 1

Republican Primary: (7 voters)

* John McCain - 4
* Mitt Romney - 2
* Rudy Giuliani - 1

Therefore, Obama got all the independents and 1 of the Republicans to switch to him. DN went 19-7 for Bush over Kerry. Obviously Obama will win the national popular vote 70-30.

Note that Hillary got 0 votes in the primary, so DN may not be all that representative... small n, damn!

Edit: Silver!

Dixville Notch

The New Hampshire township where the polls open at 12:01 November 4.

General Election: (21 voters)

* Barack Obama - 15
* John McCain - 6

This is the first time Dixville Notch chose a Democrat since 1968.

Meh meh meh meh.

Latest outrage

The Economist has set up a mock electoral college where people from around the world can 'vote' to determine who America's next president should be. Of course, Barack Obama is winning. It's practically an indictment of him! After all, what kind of elitist Francophile, wine snob, Democrat would think we should show, "a decent Respect to the Opinions of Mankind?"

Meta voting for the nigger

From 538:

Last week, Julie Hensley made one of her thousands of phone calls on behalf of Barack Obama. A woman answered. As Hensley ran through her short script, the husband impatiently broke in.

"Ma'am, we're voting for the n***er." And hung up.

Hensley wasn't having it. "I went and made a couple other calls but chafed over this absurdity," she told us, "so I called them back, as I still had a couple questions for the wife." This time the man answered, asked pointedly who she was, and when she replied he hung up again.

If I were a journalist, I would put this in the 'too good to check' category. I'm not, so I went looking for evidence. Surely in 2008, some Western PA canvasser with a cell phone camera caught the evidence and posted it... right? So, I check on the YouTube and got the image above. I guess YouTube is worried about the racism, but should I be forced to guess which letters of nigger to star out? Also, what does it say about latent racism in the U.S. that YouTube seems to have replaced "nigger" with "devil?"

Fruitfly v. Palin

D.M. and Olbermann both reference Sarah Palin's attack on frivolous fruit fly research.

There's been a major pushback. I note this is the third time biology research grants have come up in the campaign. First McCain attacked earmarks for studying those undeserving grizzly bears. Then, Democrats shot back with Palin's earmarks to study harbor seals.

One of the many P.R. problems of science is that virtually all research topics can be made to sound silly - who cares about glowing jellyfish, and who wrote that grant for counting the number of cells in a worm, anyway?

Perhaps the real reason Palin hates the fruit fly isn't about wasting money, it's about the culture wars. The fruit fly looms in this arena, even to a greater extent than it is loomed over in everyday life. Think you can pray away the gay? Meet fruitless. Some mutations make male flies try to mate with other males, others remove gender preference, or create flies with no interest in mating.

There isn't a gene in mammals that seems directly related to fruitless (a homolog, in the parlance). However, such genes do exist for other diseases, for instance myc, a determinant of cell growth, and thus cancer. Our ability to productively apply research from Drosophila myc to our understanding of human cancer blows a huge practical hole in Genesis Creationism, or the 'Orchard Model' of several special creations. If everything was created separately, why are they so similar? And if they were intelligently made similar enough to be studied, why not make them identical?

If you just want to ignite the culture wars, any attack on science will do, but an attack on the fruit fly covers so many more bases.

Why I don't care about Sarah Palin's clothes

A few months ago, I was trying to mock John McCain's $520 loafers, and a friend pointed out that as a politician, he can probably write off his suits as a business expense, which means we get to pay for them (sort of).

If the RNC wants to spend that money on Sarah Palin, more power to them, it's money they can't spend on ads or turnout. As a non-RNC donor, I don't care. If I were an RNC donor, I would think I got my money's worth. Other than isolated comments about one Tarkin-esque outfit, Palin's atire has never been a source of embarrasment, which compares quite favorably to Hillary Clinton's Sisterhood of the Travelling Pantsuits.

Ballot folding: Official reply

Dear p.e.
Thank you for your questions...and no these are not dumb questions although my answer may seem a bit...never mind. We prefer as you stated that the ballot be folded as received. We would like them in the order received, i.e.., page with President first but any order you send (folded any way that allows you to put them back in the envelope) will suffice. We request they are in order to make our lives easier at tabulation where they must be in the correct order and sequence to tabulate properly. We have a team of assistant that will review all ballots prior to scanning to insure proper order and tabulation with minimal interruptions and thereby deflect any problems to sort. We are pleased at the interest in this year's election and I am grateful for your query. If you have other questions, please contact me personally. Thanks again for your questions.

Small Town Values and Real America

One reads about the idea of "Real America" - small town, rural. This is explicitly Republican leaning. Because it is also implicitly not black, it has been interpreted as racist. But, this kind of appeal is not solely directed against blacks, but also against Catholics - Irish(1)/Italians, recent immigrants, Jews, asians, Hispanics... A little something to convince your touchy, fence-sitting Irish friends.


Arguing for small town values seems like a loser - just over 20% of the population lives there. Insofar as arguing for small town values is a dig at city- and suburb-slickers, it seems likely to piss off big parts of the electorate.

It doesn't seem that most people take my zero sum urban/rural view. Perhaps urbanites just see it as part of the dumb pander that politicians have to do, a source of cynicism, but not outrage. Since every state has both urban and rural areas, urban voters will have been conditioned by a lifetime of watching big city politicians pitchforking hay.

The 20% also misses a large group. One aspect of modern small towns is that the young are constantly moving away. There will always be a cohort, then, which can be guilted into voting for the party identified with the values of the parents they 'abandoned.'

So, no negatives, diffuse positives, pander me up!

1. I think there was one Irish kid in my high school class

The youth vote

From an interview by Ken Silverstein of Tom Edmonds in Harper's

The other big thing is the youth vote. There’s been a lot of hype about it, but it’s not going to materialize on Election Day. Roughly 33 million people voted in the 2004 primaries, and 58 million people voted in this year’s primaries. The youth vote was up, but not nearly as much as voting by middle-aged people and old fogies. The polls are capturing the enthusiasm for Obama, but college students are not going to turn out.

There are two possible arguments that this piece is actually making:
A. A technical argument, about whether polls are properly projecting turnout. Note that all polls weight their numbers for turnout based on their model. The appropriate thing to do, then, would be to weight polls based on their previous ability to do this and average them. See here.

B. A pre-game Mad Libs style of prognostication along the lines of:
If (local sports team) can (active verb) (vague accomplishment), (conjunction) (preventing / avoiding / derailing / keeping ) (opposing team) from (another vague accomplishment) they will (statement of probability) (synonym for win).

e.g. "If the Panthers can effectively deploy Riggins, while shutting down Arnette Mead's running game, Coach Taylor's gettin' some free ribblets at the Applebee's on Saturday- if you know what I mean"

Often self satirizing as in: "If the Tigers can get at least 14 points, while holding the Browns below 14 points, they very well may win this ballgame."

The self satirization makes a point - of necessity, the only prognostication that is always true is also trivial - If Barack Obama can ammass majorities in states, the District of Columbia, or the congressional districts of Maine or Nebraska sufficient to give him a majority in the electoral college, or if neither he, nor anyone else can reach a majority, and he receives a majority of votes on a state-delegation bases in the House of Representatives, he will almost certainly be the next president of the United States.1

Consider a statement such as "If Barack Obama cannot connect with white, working class males, he cannot win this election." It is meaningless. First: white, working class males are not modems. They cannot be connected with. Second: Every white, working class male could vote against Barack Obama and he could still win, since wwcm's do not make up a majority of voters in states, the District of Columbia, or the congressional districts of... Third, if Barack Obama wins 35% of the wwcm vote and becomes the next president, he will have connected sufficiently. If Barack Obama wins 35% of the wwcm vote and does not become president, he will have connected insufficiently, even if he has received the same number of votes. The wwcm vote is not only part of a larger system, it is interconnected with, say, the wwcw vote, or the bwcch vote.2,3

The short of what I'm saying is that Barack Obama won the nomination of his party primarily due to votes from the young, the middle aged and old fogies. If he continues to do well in these age groups, he could be getting a very good night's sleep this November 4th.



1. And that statement still requires caveats!
2. black working class cracker hatin' vote
3. This is a variant of Matt Yglesias's 'these people's votes don't count' argument.

Ballot update

I called the Obama office in Boulder, and they said just fold it up so it fits and send it in.