Language matters

And in my final post of a trifecta today, and to reassure those of you who worry that I buy too much into the Two Cultures phenomenon, I give you a prime example of the intersection of humanities and science.

Take medicine as art and distill it into a coding language. Politics as sausage is sterile by comparison.

Coding taxonomies seem dry until you recognize the magnitude of their influence in our current f**ked up healthcare system. John refers to them as deadweight. I prefer to think of them as red matter. I don't have the patience or aptitude to distill our healthcare dreck into a better future state. Thanks to John, I don't have to.

Albert Crewe obit

From the NYT obit for Albert Crewe, U Chicago Physicist who pushed electron microscopes to show atoms for the first time:

In a public lecture shortly after becoming the director of Argonne, Dr. Crewe bemoaned the growing gulf between scientists and laymen.

“There are too many people behaving like the proverbial ostrich and hoping that science will go away if they bury their heads in the sand,” he said, “and this in spite of the fact that the last few decades have indicated strongly that science will not go away.”

Say hi to Galileo for me Albert. RIP.

That's what I'm talkin about

I can't believe I missed Robbie Aronowitz' NYT mammogram editorial on Thursday!

THE United States Preventive Services Task Force’s recommendation this week that women begin regular breast cancer screening at age 50 rather than 40 is really nothing new. It’s almost identical to the position the group held in the 1990s.

Nor is the controversy that has flared since the announcement something new. It’s the same debate that’s gone on in medicine since 1971, when the very first large-scale, randomized trial of screening mammography found that it saved the lives only of women aged 50 or older. Despite the evidence, doctors continued to screen women in their 40s...

...Even though [the screen at 40] consensus was more asserted than definitively proved by experimental evidence or clinical observation, it soon became dogma...

...You need to screen 1,900 women in their 40s for 10 years in order to prevent one death from breast cancer, and in the process you will have generated more than 1,000 false-positive screens and all the overtreatment they entail. This doesn’t make sense. We could do more research and hold more consensus conferences. I suspect it would confirm the data we already have. But history suggests it would never be enough to convince many people that we are screening too much.

You've heard the rabble and the science. How many times will Galileo be tried before we get it right? Robbie's piece has, sadly, been written before. Different names, same ending.

[disclosure: I'm a proud faculty mate of Robbie's in Penn's Department of Family Medicine and Community Health.]

Has hell frozen over?

I work with many wonderful orthopedists who continue to see patients without regard to payor. That isn't true for most private orthopedics groups in town who continue to refuse medical assistance patients. Still, I wasn't expecting this... – orthopedists asking for my pay to be raised.

I'm gonna have to send them some link love.

Road trips are underappreciated

Thanks for all the b-day wishes. I must say it's been a pretty perfect day. And how often can you say that when you start by waking up in a hotel in Poughkeepsie on a cold rainy October day?

Several months ago my oldest drove across country to return to college. On the old Lincoln Highway (US 30). All the way.

I was jealous, but not wanting to spoil his trip with my company (he had a friend to co-pilot) I instead convinced my wife to take a local road trip vacation with two rules: no interstates, no chains. We committed to only one fixed event in the week and have left the rest to whatever strikes our fancy. So last Sunday we packed a small suitcase with two changes of clothes, headed north via the backroads to Princeton where we walked the Delaware and Raritan Canal towpath with friends older than our marriage. I knew about the Erie Canal, but the Delaware and Raritan? Nice. After a Thai dinner we parted ways with our friends and meandered to Milford, PA and the Hotel Fauchére. Eat your heart out Four Seasons.

Monday we toured Grey Towers, the home of Gifford Pinchot, former PA governor and first head of the US Forestry Service. A gorgeous day and a chance for Elaine to talk to someone about American Chestnut blight, which in her book means fun. For my part the grounds were gorgeous, the house more so, and the stories entertaining.

Later we headed a few minutes north to pay our respects to the site of the Woodstock Festival. As we walked up to the roadside monument someone was playing a Janis Joplin tune. Fitting.

From there we wound our way past innumerable Jewish summer campgrounds, across the Shawangunk Mountains, into the Hudson Valley and across the mid-Hudson bridge to Poughkeepsie. And what's there to say about Poughkeepsie? We didn't have reservations anywhere and so settled for a generic local hotel last renovated in the 80's. Sad as it was however the staff was predominantly young can do New Yorkers who were aggressively good at their jobs. Good thing we checked in before the Yankees lose the series.

Today we toured the Hyde Park home of Franklin Roosevelt and just returned from a fantastic dinner at the Culinary Institute of America. We also found a great spot to stay in Rhinecliff; right on the water, impeccable service and decor, and half-price!

The best part however is that by taking the back roads and taking our time it feels like we've gone to the other side of the world and have been gone for a week, even though it's only been two days.

I don't think I'll drive an interstate highway again.

This American Life is My Life as a doctor this week

TAL is hit or miss, but they've hit close to home (work actually) with their episode Someone Else's Money. The sad part is that the examples of bureaucracy run amok are among the more routine and least outrageous.

What about the time my patient with AIDS was unable to receive his meds because his employer "forgot" to pay the insurer, leaving my patient at the pharmacy counter with a pharmacist saying "you don't have any coverage."? My patient (now dead) missed several weeks of therapy, a pause that is known to breed resistance, contributing to treatment failure and decline. The employer's penalty? Nothing.

I could go on, but I have patients to see.

The value of art

Art is essential.

When the Phillies are down and it's the bottom of the ninth inning the jumbotron doesn't light up with a math theorem, but with the Rocky theme. Myth and metaphor communicate in a flash what science can take years to deliver. Our brains, as predictive rather than computing organisms, make connections more quickly (if sometimes errantly) through art than computers can with logic. And our communities, as social organisms filled with social beings, grow stronger with art, especially shared art.

But don't listen to me, read this speech to incoming students at the Boston Conservatory of Music. (tx to Paul Levy's blog pointing it out.)

A Study in Contrasts

I'm a city boy. Noise and activity. Light and sparkle. But walking across the desert this morning I was struck by its absolute dark and soundless nature. Until, that is, I looked up. I've seen stars before, but this was heaven.

What a beautiful way to start a day of change.