The TB Lawyer

When I read this a couple days ago, I was incredulous. How many things went wrong? What, if anything, should be done?

Andrew Speaker would be thrown in jail if he had done these actions with AIDS

First, what is TB? Many people in the United States probably know it by name, but have little or no experience with it. TB is the common acronym for tuberculosis, the disease caused by the bacterium Mycobacterium tuberculosis.

For those unfamiliar with microbiology, think of a bacterium (singular for bacteria) as a pill. Some come in ball shapes, others in more elongated brick shapes, just like your medicine. The genus Mycobacteria is a group of bacteria characterized by a brick shape and a thick waxy coat around the bacterium--like a long gel cap.

Mycobacteria are typically the "jungle ulcers" and tropical diseases you think about when you see movies or read history books. They range from Mycobacterium ulcerans, the cause of Buruli ulcer (my personal favorite and target of research for many years), to Mycobacterium leprae, cause of Leprosy, to M. tuberculosis.



M. tuberculosis typically causes a respiratory disease. The bacteria get into the lungs of a person, and your immune system tries to "wall it off" by encasing it because it is hard to kill. When looking at x-rays, you can usually see white spots showing these hard encasings in a person that had infectious TB in the past. Someone with TB will have "chronic, productive cough, low-grade fever, night sweats, easy fatigability, and weight loss" (Medical Microbiology, 4ed, Samuel Baron, ed.). As the disease progresses, the sick person starts coughing up blood.

This month I am at a county hospital in Houston, TX and have seen a couple of tuberculosis patients. Pulmonary TB is highly infectious, and every patient suspected of having TB is put in isolation. Everyone who interacts with the patient must wear protective masks, because TB is spread by coughing.

How bad is this disease? In America there are about 5 cases per 100,000 people (CDC data, 2003). In the rest of the world, it is

the second-largest cause of death from an infectious agent worldwide—killing approximately 1.7 million people in 2003. Despite steady drops in the number of cases in some parts of the world, the number of new cases appears to be growing, with an estimated 8.8 million new cases in 2003. (Disease Control Priorities Project, Tuberculosis, fact sheet)

Approximately 1/3 of the world's population is infected with latent TB, but fortunately only about 10% progress to disease every year.

The short synopsis of Andrew Speaker's journey is thus: he was diagnosed with TB in America, and told not to go anywhere. At that time they didn't know it was the extremely drug-resistant strain he actually has (XDR-TB). He goes against medical advice and flies to Europe for his wedding. Then it is confirmed he has XDR-TB and he goes against medical advice again and against the USA "no fly" policy and flies into Canada and drives into the US. Now he's in isolation in Denver.

You can get a more detailed timeline based on Speaker's view of the events, at abcnews.go.com

In all this ruckus, people have forgotten the most important point--Speaker willingly flaunted medical advice more than once, blatantly snuck into the United States and, most importantly, exposed so many people to this disease.

Mycobacteria are typically the "jungle ulcers" and tropical diseases you think about when you see movies or read history books

He can blame his actions on ignorance, or "he said, she said" stuff, but the truth is he's a bright young man and can't seriously feel the ONLY place he could get treatment is in Denver, CO. He can't seriously believe that when doctors in Europe tell him not to leave, after already being told that in America, that he knows better than them and he should be ok to go to Canada. He can't be a good lawyer when he blatantly flaunts the law he went to school to learn and prosecute and adjudicate.

Let's change the name for a minute. Instead of TB, it's AIDS. Imagine with me. Andrew is diagnosed with AIDS. He is infectious, but doesn't look overly sick. Doctors admonish him to be celibate or practice safe sex. He flaunts their advice and sleeps around without protection and without telling his partners he's sick.

Then he moves to another area, and the doctors there tell him he has a rapidly mutating form of the virus that depletes the immune system far faster than the more prevalent form. They tell him again to be celibate/use protection and that he is required to tell his partners he has AIDS.

Speaker proceeds to again have unprotected sex with many people and not tell them he's infected. Finally, he checks into a hospital.

Andrew Speaker would be thrown in jail if he had done these actions with AIDS. In America it is a crime to knowingly infect or expose someone to HIV. But Speaker had TB, not AIDS. He had a disease that is easier to transmit, infects more people, and kills about as many people. He knowingly put other people at risk many times -- especially when flying to Canada WITHOUT wearing a mask and AGAINST both medical advice and US law.



Many people walk out of hospitals against medical advice every day. Usually they only hurt themselves. TB is a special case. If you do not follow your treatment regimen, you can be locked in isolation until you finish your medication--9 to 12 months. So, a precedent was set by making TB a special disease under the law, and another set by prosecuting special diseases in criminal court (AIDS).

Given what Andrew Speaker did, passengers on that plane have a very good basis for a civil suit, and possibly criminal charges, due to his reckless endangerment of their lives. And that opens up a whole new can of worms...

How News Travels About Periods

What have I done??

Honestly, I never expected this would happen. All I did was write a short comment on a post about the new birth control pill that stops menstruation, and I released a firestorm. If I had known my comment would be picked apart with a microscope, I might have elaborated my position more, clarified some sentences, etc. But now it's generally lost in the conflagration.

One post here, a comment there, causes another post somewhere else, and more comments

This is what happened, and I think it's incredibly interesting as a example of how the blogosphere undulates--if I can use that word--when something is added.

First, Apoorva Mandavilli wrote about the new pill, Lybrel, at Spoonful of Medicine.

This got me thinking about the issue, and I read the articles the post linked to. I thought that was the end of it.

Second, Ann Althouse heard the news and posted a short question on her blog.

Is there some deep psychological/sociological/feminist angle to this story or is it obvious that everyone should obviously want to avoid something that's so inconvenient and annoying and that the only serious question is whether the pill is safe?

Well, maybe it didn't start with me, it started with her assertion that "the only serious question is whether the pill is safe?" (emphasis added). One commenter disagreed with the absolute nature of her question, and replied,

menstruation, like childbirth, is just part of being a woman. If another woman would want to escape it, then sure, she should go for it. But, not being punny, it just wouldn't feel right to sidestep it.

This got Eugene posting on The Volokh Conspiracy. He said,

Again, concerns about long-term health effects are quite sensible. But I don't see any justification for the feeling that it's not "right to sidestep" something that's "part of being a woman." I suppose it could be some esthetic judgment that argument won't much drive; but setting aside esthetics, why on earth should we want to accept natural but painful or unpleasant things?

At this point I jumped in. The Volokh Conspiracy gets so many comments, that I didn't think much about mine--subconsciously figured it would be lost in the proverbial sea, so to speak. I said,

This is an example of how much medicine is an ART and a science. Ultimately, pills treat symptoms and change chemicals that produce a different state of being--but the ideal state of being differs from person to person.

It's been amazing seeing my wife and other women deal with her first pregnancy. Immediately upon announcing to the world she's pregnant, my wife was part of the "in crowd." Every mother--whether she knew my wife well or not--could smile and talk about morning sickness, or finding out the baby's gender, or feeling bloated, etc.

So, it is not aesthetic. Humanity derives meaning from shared experiences, and deleting one of the most universal and central of all female experiences can subtract perceived meaning from people's lives. In that regard it is very important.

As a soon-to-be-doctor, I would never recommend such birth control without bringing up and discussing the social and emotional ramifications in addition to the physiological ones.

Apoorva Mandavilli over at Nature's Spoonful of Medicine posted a little on it about two weeks ago.

The blog post links to Mandavilli's good article on pros and cons in Women's Health. Check it out too.

The other reason I felt this comment wouldn't be noticed, is because I didn't feel I said anything too inflammatory. It turns out I was wrong on two counts.

I figured people were being too literal and misunderstanding my point when a commenter, UVAgirl, wrote,

From the doctor, I get a condescending lecture that I'm missing out on the experience of being a woman if I choose to take this pill.

Then, Eugene Volokh posted a response post, quoting my analogy to pregnancy and saying,

Humanity does derive meaning from some shared experiences — but not all. Shared experience that you bond over: pregnancy. Shared experiences that you don't bond over: hangnails, nearsightedness, tooth decay.

...But let's hear from some people who actually menstruate, and have been pregnant. When you menstruate, do you feel that you're part of the "in crowd"? If you chose to stop -- not because of menopause, which is a marker of age and of lost fertility, but voluntarily and reversibly -- would you feel "out"? Do you smile and talk to your friends about the cramps, the mood swings, and the like? Do you feel you derive meaning from the fact that you share menstruation as an experience with other women? Would you feel meaning subtracted if you stopped menstruating, because menstruation is so "central" a "female experience[]"? Do you find menstruation to be similar to pregnancy in any emotionally positive way?

Eugene posted a comment later where he defended his second post by saying,

When someone says "menstruation and pregnancy are analogous, and pregnancy is A, B, and C," it seems sensible to explore the analogy by asking whether menstruation is A, B, and C, too.

Is it that people didn't connect that my questions were just quotes from Triet's comment, aimed at showing that Triet's analogy was unsound?

Well, obviously no analogy is perfect. And yes, you can sit and look at why the analogy might not work, but that's only half the issue--you should also look at why the analogy might work too. Some of the comments on the first post had basically agreed with me, but things changed. Taking just this quote, people became very polarized about whether or not you can derive meaning from a period. Now I sit here and wonder if the rapidity and severity of the response doesn't prove my point.

Có tật giật mình.

But that's not the end. Ann Bartow from Feminist Law Professors remarked on her blog that he needed to be educated. Someone defended him at Is That Legal? by saying,

Some guy said something kinda stupid, and Volokh replied: "Oh, really? Lets ask actual women about menstruation. So, women, how about it? Is it a life affirming shared cultural experience?"

That's an entirely reasonable response.

So now, I've said "stupid" things, according to someone I'll never know. But that's not all people said. In the comment section to the second post, many women agreed with me, like the first one that said

Is it a bonding experience? Sure; it can be. Especially if you live with the women in question, because then you all get cramps together.

and of course other's disagreed

A bonding experience? Puhleeze. Look men, would you want to spend five or six days every month with blood leaking from your body, sometimes coming on with little warning, and potentially putting a very embarrassing stain on your business suit?

All I did was write a short comment ...but now it's ... lost in the conflagration

Unfortunately, as often happens in comment threads (see Xanghe's post on Breeder's of Hate), the discourse tends towards the extremes instead of answering the question in a logical and amicable way. I noticed that people had now totally missed the point of Lybrel--to offer a way for women to take birth control without monthly periods, but that it still comes with it's own issues (one of which is random bleeding). Everyone is pontificating on how many periods are normal, etc. Another commenter, Falafalafocus, summed it up greatly, saying,

I must say, this topic is like an incredibly large automobile collision. I can do nothing to help it along and there are parts that make me want to run and hide, but I find myself strangly [sic] fascinated by the discussion nonetheless.

Since it was my comment that caused the "automobile collision," I felt obligated to respond and clarify. On the subject of bonding, I said,

I believe it does derive meaning from all shared experiences, good or bad. Some may play a larger and more central role in a person's life, and the composite of experiences that people share changes from relationship to relationship, but we bond over the bad and the good, the trivial and the important.

Haven't we all complained off the cuff about stubbing our toe or having a hang-nail and someone else said "yeah, that sucks." Such a small and arguably insignificant thing has demonstrated another level of understanding between the two people involved.

And shared bonds that we may not want to endure still provide meaning to our lives. When my lung collapsed spontaneously as a high school student, I was introduced serendipitously to a girl in Minnesota who had the same thing. We became pen-pals and friends, bonding on many levels including the pain we suffered dealing with a collapsed lung. In addition to the bonding, I also gained a little more "meaning" to my life by realizing that I would be dead if not for some modern machines.

And on my last sentence which caused such consternation, I said,

This is not because women should be persuaded out of this pill--no, not at all!--but that all women should be advised of the physiological changes and risks taking the pill entails, as well as the lifestyle changes (including possible absence of monthly menstruation), so that they can decide with their doctor if taking the pill is in their best interest for their health, lifestyle, and vision of who they are.

Another commenter, JM Hanes, totally misunderstood how humanity might derive meaning from common experiences and yet people can derive individually different meanings from experiences. Well, I'm going to use another analogy--which we all know are never perfect--that I think can illustrate the premise.

When you learn about bacteria, there are many kinds. One for example, is Escherichia coli. E. coli is familiar to us because we get sick from it, typically if we eat an undercooked hamburger. But not all E. coli's are the same. In fact, there are broad categories of E. coli--ones that cause watery diarrhea, ones that cause bloody diarrhea, etc. And when you look even closer at one type (say, Enterohemorrhagic E. Coli, or EHEC, that causes bloody diarrhea) you will see numerous variations in its genetic code that gives attributes, such as increased susceptibility or protection from antibiotics.

So also is humanity. We may gain meaning from shared experiences, but yet have differences. On a microscopic scale we may seem incredibly different from each other, espeically if just one issue, like menstruation, is looked at. But when we step back and look at the aggregate of our experiences, we start to have more and more in common.

JM Hanes also said this about my last assertion to talk with the patient about all the consequences of a pill:

I'll chalk up the unwitting condescension here to youth, and suggest that you pay your future patients the courtesy of keeping your ruminations on the subtractive nature and social raminfications of the decision at issue to yourself! There is simply no way you can inject questions about the symbolic, psychological, and social affects of womanliness without adding gratuitous, if not specious, judgmental freight to a decision which, per this discussion, women are perfectly capable of sorting out as they, themselves, see fit.

to which I responded,

And I'm sorry you groaned over my last comment, but you must have missed the point. How could I bring up any birth control pill without discussing the social and emotional ramifications with a patient? I have been taught repeatedly to do that in medical school and I believe it is a correct principle. If a woman came in wanting birth control, I am going to talk to her about ramifications such as:

1. Social -- do you know this birth control causes random spotting and bleeding? If your job or lifestyle puts you in situations where this might be inconvenient, then I might recommend a different pill.
2. Emotional -- do you feel a period is a part of being a woman you don't want to give up? If yes, then obviously I'm going to suggest a typical estrogen+progesterone pill. If no, then the new one might be right for her.
3. Physiological -- as with all progesterone+estrogen pills, this one carries with it an increased risk of blood clots, heart attacks and strokes. Typically estrogen+progesterone pills do not carry the increased risk of cancer that progesterone only pills carry.

Such a discourse in no way dictates condescendingly to a woman what pill she should take, but gives her the full knowledge so she can make an informed decision about what is best for her life.

Oh, but that's not the end. For the furvor caused not only my first post on menstruation, and this second post, but a third post on The Volokh Conspiracy, those posts on Feminist Law Professors and Is That Legal?, and a post on Conglomerate by Christine Hurt. It is refreshing for a couple reasons.

1. It is a real thoughtful response to his second post's questions, which the other commenters didn't do, and
2. It agrees with me, which is very nice since my first comment got picked apart.

She says, in part,

1. Yes, pregnancy and childbirth make women part of a very large club whose members have something very important in common. Consider it like sports for men, or Dungeons and Dragons. Female culture doesn't have a common theme that most girls' youth revolves around that joins generations of women together other than fertility and childbirth. I remember finally having something in common with my grandma when I got pregnant. Menstruation is similar. When girls begin to menstruate, they do join sort of a club, but it's much more underground. Once girls begin to menstruate at school, their other friends want to also. No one wants to be left out of this growing up thing, obviously.

2. Menstruation might be more of a bonding thing in this country if the culture were different. In the U.S., our culture is one of sanitizing and deodorizing must bodily functions. We shave a lot, bathe a lot, shampoo a lot, powder and perfume a lot, etc. Menstruation runs against that. So to some extent, especially among young girls, menstruation is embarrassing. The onset of menses also comes when girls are the most self-conscious they will ever be, adding to the secrecy and embarrassment. I'm not sure it has to be that way, though.

It is a great post, so please click on the link and read the whole thing.

Ultimately, I take you through this journey partly because I'm very interested in how YOU feel about the new pill and menstruation, but more because I'm fascinated by how discussion travels in waves around the blogosphere. One post here, a comment there, causes another post somewhere else, and more comments. Eventually people like me are reading blogs I would never have before (like Feminist Law Professors or Conglomerate) and different types of people are mingling. I'm sure some sociologists far smarter than I will or have already dissected this phenomenon and shed some light on it.

[+/-] read/hide the rest of this post

A Woman's Life Without Periods?

A new contraceptive pill cleared by the FDA that drops the monthly menstruation some common in women's lives has garnered a lot of publicity and talk from a variety of corners.

Ultimately, any decision on birth control should not be made on the fly

I first heard of the pill from a new blog I'm following: Nature's Spoonful of Medicine.

At the time, I thought it a curious concept, but nothing too serious. After all, the pill women take now in effect does away with true menstruation anyway, since there is no ovulation. As Spoonful says,

This fake period was designed into the pill when it was first introduced in 1960 so as not to freak women out too much.

Later, Eugene Volokh posted his take on it at his blog, The Volokh Conspiracy. He felt it was

perfectly sensible to be concerned about the pill's safety, ... But [he didn't] see any justification for the feeling that it's not "right to sidestep" something that's "part of being a woman."

It was the second assertion where I disagreed with him. I left a comment, and that was that.

Today I noticed that he posted about it again, but this time QUOTED ME. I must say, I was quite flattered, even if he agreed with me in part. I respect his opinions and intelligence greatly (part of why I read his blog). So I have commented again.

I feel that this discussion lends itself easily to tangents that confuse and distract. From a medical standpoint we must not forget that no contraceptive pill is perfect. Pills come in two general classes: estrogen + progesterone pills and progesterone-only pills.

The standard menstrual cycle is roughly 28 days. The follicular phase lasts 12-14 days, ovulation is 1 day, and the luteal phase is 12-14 days. Normally, a woman's anterior pituitary in your brain secretes two hormones, FSH and LH, into her bloodstream. The amount of these hormones in the blood cycles throughout the day. At ovulation, a surge in Estradiol (an estrogen) sparks a surge in FSH and LH and a release of an egg from the ovary. Progesterone functions to maintain pregnancy by decreasing fluid secretion and motility of the uterus. Without fertilization, progesterone levels drop, and the body sloughs off the bloody lining of the uterus with the unfertilized egg during menses.

Estrogen + progesterone pills block ovulation by "tricking" the woman's body into believing it doesn't need to secrete an egg. Then, a placebo week drops progesterone levels and the woman's uterus sheds the blood-filled lining.

They have two types: monophasic and multiphasic. Monophasic pills have a fixed dose of hormones that the woman receives daily. Multiphasic pills have varying dosage of hormones throughout the month and lower total steroid levels.

Today I noticed that he posted about it again, but this time QUOTED ME

Progesterone only pills have an increased risk of endometrial breakthrough (i.e. cancer), but are a good option for nursing mothers because estrogen messes with lactation. They also have a higher failure rate because technically progesterone doesn't prevent ovulation, it just makes it near impossible to be fertilized and implanted in the uterus.

Lybrel, the new pill that eliminates periods, is an estrogen + progesterone pill, and therefore blocks ovulation. However, it's not the magical bullet people think it is. The FDA says,

Women who use Lybrel would not have a scheduled menstrual period, but will most likely have unplanned, breakthrough, unscheduled bleeding or spotting.

...The risks of using Lybrel are similar to the risks of other conventional oral contraceptives and include an increased risk of blood clots, heart attacks, and strokes.

Seasonale, a pill that came out in 2003 and limits menstruation to four times a year also has spotting.

"It was really inconvenient, which kind of defeats the purpose," grumbles Pierrette Lo, 27, of Houston, who tried Seasonale last year but gave up after a few months.

For those women who don't have horrible cramping during their periods, they might be better off with the regular pills, because at least then a woman knows when she will bleed. Lybrel's real benefit comes not in giving every woman who doesn't want a period an out, but in helping those women who really have bad cramps and other symptoms. Those women can opt to give up the five days of torture for unscheduled bleeding and spotting.

Ultimately, any decision on birth control should not be made on the fly. All options should be discussed with a doctor, so a woman can best decide what type of pill will do the job effectively without causing undue physiological changes/problems. She will also be able to decide if the lifestyle changes that taking the pill entails is truly what she wants. For a patient's emotional well-being should be just as important to the modern physician as her physical well-being.

[+/-] read/hide the rest of this post

Snapshot of Bus 87

Yesterday morning I hopped on the 87 bus and headed up to the medical center. Route 87 is the main conduit for students and workers to the two medical schools in the medical center--Baylor and UT-Houston. In addition to the 87, routes 297 and 298 carry professionals to the medical center from the 'burbs, and the light rail carries professionals and students from the southwest. But nothing says student bus like the 87.

I got on about 9:00am and the bus was packed--standing room only--as usual. So I, being the bored, odd person I am, counted everyone who got off the bus. I can do this because UT-Houston is the "last" stop--it's the last place people need to go in the morning, so I'm always the last person off the bus. Then the 87 starts the return part of it's loop.

Now, the 87 is an incredibly interesting loop, because it runs from Sunnyside through the southside of the medical center and ends at the medical center proper. Then it backtracks. Sunnyside is predominantly African-American and very poor. South medical center is racially heterogeneous and predominantly students or middle class professionals who work at the medical center. Hence it has two incredibly different population bases that it services. Also interestingly, they don't overlap. Those who use the bus in Sunnyside rarely go to the medical center, and those who live south of the medical center rarely travel to Sunnyside.

My impromptu count represents a snapshot of the populace that lives south of the medical center--not Sunnyside. The results?

Total people: 45
Caucasian: 5
African-American: 7
Indian: 12
Chinese: 21

Thoughts?

Finals

I've reached the other side...

At 3:00pm Friday I walked out of the NBME Microbiology test, heaved a sigh of relief, and laughed. For the first time in a month, I did not have a test to study for. For the first time in nine months, I did not have anything school-related to do.

I was free.

Oh, how beautiful is freedom. Our founding fathers got it right. How could they have foresaw the exquisite joy of having no pressing responsibilities weighing down on your shoulders as you watch tv in the evening? They were men of genius.

The exam schedule was rough--nine exams spaced over two and a half weeks. Studying for the exams starts about a week and a half before the first exam, so in reality a full month is spent on these things. I study and go to class from 8 am until 2 am for a week and a half, then have three exams in a row--Wednesday, Thursday, Friday--just to finish the fourth block. Two weeks, six exams, and no sleep later, I'm done.

Thank you to everyone who's helped me--or laughed at me--especially my wife, who lived without a husband for a month. It's no fun going to bed before your spouse, so you only see him for ten minutes as you drive him to school each morning, but that's what she did for four straight weeks.

Now it's on to summer--the last "summer" of my life. I start a preceptorship at Ben Taub hospital on Tuesday and hopefully I'll do research to keep me busy once the preceptorship is finished.

But for now, it's nice to watch tv....

The Month from ...

This is a disclaimer. I will be blogging only SPARSELY -- and by that I mean only if something really tugs at me -- because starting tomorrow (May 2) and running through May 18 (three weeks) I have exams.

Yes, you read that right. Three weeks of exams.

This week are my Block IV exams, and the next two weeks are finals. Do I think it's stupid to have three whole weeks of exams like this? Yes, yes I do. But it could be worse (such as dropping on the class the day before the exam the news that the exam is cumulative over the semester and not just over this block's materials...like my Physiology prof did today).

So, pray for me, that I will make it out alive, with my sanity, and passing.

As I used to tell "dying" missionaries back in California, "I'll see you on the other side."

Medical School Lecturers

Liveblogging from neurology class...

Today we're learning about language and higher cortical executive processes. Overall, one of the more interesting things to learn about in neurology. So why is it so boring? And why are there only 23 people, out of a student class over 240, here?

Medicine is an interesting profession, because it constantly stives for the new -- new medicine, new procedure, new discovery -- while stubbornly and stupidly holding on to the old. This includes surgeons working billions of hours, and didactic learning.

they grasp didactic learning like a cadaver's hand in rigor mortis grasps a broken tool

At my school, we see this poignantly. Embracing modern technology, my school has wi-fi in every classroom and videotapes every lecture. This allows students to review the lectures from home, at faster speeds if preferable, or not go to class at all. On the other hand, my medical school stubbornly holds to lecturers in stand alone courses (biochemistry, neurology, etc.) instead of embracing a new, organ systems-based teaching model and moving away from didactic learning.

Having taught ESL in California and Vietnam, and worked as a Teaching Assistant and tutor in college, I've taught my share of good classes and boring ones. Didactic learning, we all know, is horrible for teaching and retaining material. Having a lecturer stand and speak in monotone about brain hemispheres to many students does very little to help them learn.

While researching ESL teaching methods and curricula when starting an ESL school in SoCal (at which Xanghe helped), I listened to many audio seminars and read books advocating the benefits of including the student in the learning process. Having students repeat things, connect thoughts, work in groups, perform, and create projects, in addition to using audio, visual, and tactile stimuli together in unconventional ways (songs and poems, demonstrations, props to pass around class) always result in better student scores, and greater retention (not to mention my own opinion of a happier student body).

Nevertheless, my school is stuck in didactic learning. Slowly medical schools around the country are integrating classes into a systems-based structure, but they grasp didactic learning like a cadaver's hand in rigor mortis grasps a broken tool. Systems-based (organ-based) learning melds the biochemistry, histology, pathology, etc. together in one class as the student learns about one organ system. This makes sense, since a bacterial infection of the liver will influence all of those things--in the liver or circulatory system--and not, in normal cases, your big toe.

In addition, some professors are gifted at teaching and others aren't. It makes no sense to get the most knowledgeable person on the limbus system teaching it if he or she is dry as the Sahara desert, monotone, speaks incredibly slowly, and repeats his/herself. It is logical to take the second or third most knowledgeable person, who is a much better teacher, because the depth of material we need is not great (we're doctors not PhDs) and overall learning and retention will be much better. Any questions too deep for the lecturer can always be forwarded to the expert anyway.

Medicine is an interesting profession, because it constantly stives for the new ... while stubbornly and stupidly holding on to the old

So if you're thinking about medical school, study hard what schools teach what ways, and if possible, sit in on classes. I feel I have regressed back to the stone ages in learning material coming from Brigham Young University to my current school. At BYU, I was mostly in small group classes, with professors that encouraged alternative learning methods. Some of this was my astute choice of teachers and classes that fostered that, and some of it was BYU's emphasis on teaching. Not every class was that way, but the percentage was far higher than the 0% of my current institution. And although my grades aren't horrible, they have definitely decreased.

Medicine is a fun and exciting field, and the prospect of helping people each day drew me to it. I encourage any who want to help people, and be compassionate, to go for it. But beware the lecturer...the almost extinct beast whose last bastion of strength is the medical school. He may bore you to death.

The Heart Beats

Today, amid all the sadness we've heard, I think I'll blog about a little bit of happiness.

Today my wife and I saw the OB/GYN and heard the future blogger's heart beating for the first time. The nurse stuck the gel on my wife's belly button, and moved around her "magic wand," and wow! Thump thump, thump thump, thump thump.

The heart was beating steadily and healthily at 165 beats per minute. FYI, that is normal. Adult hearts beat about 70 bpm, but fetal hearts and newborn hearts beat much faster.

Some of my favorite quotes of the appointment:

Me: Did you just go to the bathroom?
Wife: Yes.
Me: Why?
Wife: I had to pee.
Me: Why do you go to the bathroom every time you come?
Wife: I dunno. They tell me to pee and I pee.

*****

Wife: There's life growing inside me!

A Tale of Two Peoples

"IT WAS the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity, it was the season of Light, it was the season of Darkness, it was the spring of hope, it was the winter of despair, we had everything before us, we had nothing before us, we were all going direct to Heaven, we were all going direct the other way ..." Charles Dickens, Tale of Two Cities, pg.1

Two weeks ago a Thai court overturned an extradition ruling for Ly Tong and made him a free man. For many people, they may say, "So what?" and they'd be right. Ly Tong is whom??

I would bet that most people in Vietnam don't know who he is. I would also bet that most older Vietnamese in America do know who he is. You see, Lý Tống has made a life trying to get the Vietnamese to rise up and throw off communism.

This message reverberates through Vietnamese-American communities. Most of the adults -- the older generation -- came to America as refugees after 1975. When they talk about Vietnam today, there is still sadness, a tinge of bitterness and invective, when refering to the current government. Over ten states and numerous communities in America have recognized the "Vietnamese Freedom and Heritage Flag" as the official flag of Vietnamese-Americans.

Also,organizations use it in their logos.

So you can see, that the war, democracy, and the hurt from years of fighting and exile from your homeland is still very much ingrained in the lives of Vietnamese-Americans today. I remember visiting a house of a man who had a big picture of Lý Tống on his wall and the words "FREEDOM FIGHTER" printed above it -- and I didn't think anything of it.



But this is a "Tale of Two Cities" so to speak. Before my first trip to Vietnam, I'd never been out of America except to the border towns across the Rio Grande in Mexico, and they don't really count. My only Vietnamese experience was with Vietnamese-Americans, so I naturally based my expectations on that prior experience. In other words, I half expected Vietnam to be a poor country where everyone lived in fear of the government, rushing to and fro quickly, speaking in hushed tones, and hiding as the police rode by.

In Ho Chi Minh City, I saw a different Vietnam--a Vietnam where people really came and went as they pleased. It was markedly more open than in the North, and NOTHING like what my naive brain had envisioned before I left America. The Vietnamese in Vietnam don't know or care about Lý Tống because they are satiated with what they have. Those in the North fought for the communists. They will not go against it. Those in the South are too happy not worrying about bombs, or standing in long lines for handouts, being in "reeducation camps," or buying things on the black market.

Economic prosperity has quieted the masses. People are happy because of the foreign investment, the jobs, the opportunity, and the paychecks. Ultimately, the human mind has a very short attention span, and in a world of "what have you done for me lately," the communist government has done quite a lot.



My wife still bristles at seeing that yellow and red flag flying. It isn't her flag. Her flag is the red field with the single yellow star. To her, that is not communism, that is Vietnam--her country, the country she loves. Her feelings mirror most of the other young adults and youth in Vietnam today. They are happy for the progress Vietnam's made, excited about the future. Some are level headed and wish for better, but the majority are quieted by the relative opulence that Vietnam now enjoys.

And so it is truly a tale of two cities--two peoples. The Vietnamese look at the Việt kiều as another nationality, because in a sense they are. Although they call themselves "Vietnamese" in America, they are at most Vietnamese-American. Their culture has become wholly different. Their history is different (after 1975). Even their language is different (speaking half Vietnamese, half English or "Viet-glish" and using Vietnamese vocabulary circa 1975).

And in Vietnam you have a new young population that doesn't remember war and food shortages, and who's youthful optimism is buttressed by economic progress and growth of a new middle class. They are learning English as a second language, working for foreign companies, and worried more about the new CD by Mỹ Tâm than the latest actions of Lý Tống. In many of their minds, it truly is "the best of times ..."

New Edition to the TBE Family

As I mentioned in my last post, Vicissitude, life is a series of ups and downs, circling constantly back around on itself. It really is a series of stages of awareness--to self, others, God.

Along the way, we enter into the vicissitudes of humanity, contributing consciously and without effort, to the upswing in the wave and the downswing. It is a matter of debate whether or not the wave circles back on itself--whether "history repeats itself." It is a greater debate whether we, as individuals, can affect the outcome of humanity on a macroscopic scale. I believe it does repeat itself, and I believe we can change that.

So, back in January I learned that I was joining humanity as it repeated itself. My wife came yelled at me from the bathroom while I was studying.

Anh! Come see this!

This is what I saw:

"Am I pregnant?" she asked.

"Well, when are you supposed to have your period?" I replied.

"This week," she answered. "I haven't started yet."

"Well then you better wait. The second line is faint. Maybe, maybe not."

My lovely wife did not heed my advice, quite usual in our family, and used another test the next day.


Again, I told her to wait.

"Em, usually the female body does not make that hormone unless you are pregnant, however, I don't know how sensitive the tests are or your specific hormonal makeup, so just wait a week and do it again. It won't change anything." I cautioned.

Obviously, that did nothing to calm her curiosity--I mean who wouldn't want to know right away if there's a life growing inside them?--but this time she waited (it also helped that she had no more test sticks). On the other hand, I knew pretty well that those tests are 99.99% accurate, and a healthy non-pregnant body should have NO hCG hormone. In all likelihood she was pregnant. That 0.01% wrong is usally a false NEGATIVE, not false positive.

A week later, she grabbed another box of sticks and tested herself again. The results confirmed my suspicions.


Needless to say, we were very excited. My wife immediately started dreaming up ways to paint my study room into a nursery, and looking at maternity clothes. I just stared at the wall wondering how I'm gonna do school and be a dad. She didn't want to tell anyone until we saw the ultrasound, but after about one week she broke down and told my mother.

Then, the second week of March, we went to the doctor and saw the little blogger for the first time. Here is the new edition to The Bleeding Ear:



The doc forcasts his/her first blog to be about October 22, 2007. We find out the gender in June-ish. (You can see at the bottom of the ultrasound, the new blogger is currently 1.69cm long, at the 8 week mark, and the computer's due date)

And so, I am now filling the role my parents went through some 28 years ago. My life is definitely on the upslope of the wave. Ah, the vicissitudes of life!

Vicissitude

I was walking with my companion, Thuan, when he stopped suddenly. I turned, a couple steps ahead of him due to my slow reflexes, and noticed him reading a poster. Here in Little Saigon, glossy posters covered with famous Vietnamese faces and advertising everything from plays to Paris by Night were commonplace--more than commonplace. On this particular wall the poster melded into a sea of posters, all taped up with clear packing tape, one right next to--and sometimes on top of--the other.

(example of the posters I'm talking about)

For the most part, we ignored the ubiquitous posters, but this time was different. Thuan had found a word he didn't know. We searched are pockets for our faithful "girlfriend Kimmy" (electronic dictionary). "Những nỗi thăng trầm của cuộc đời" or "The vicissitudes of life."

Vicissitudes...I have never forgot that little moment, and it is just those times that make language live. At that moment on Bolsa Ave. "vicissitude" gained a second meaning outside of the dictionary--that memory.

The other day, while reading a post on Virtual Doug, I realized one more time how life moves in circles. However, after finishing Block III exams, I realize it's more complicated than that. It's like photons--at once both a particle and a wave.

Everyone in life deals with vicissitudes while at the same time circling back to where we were before. It's like a wavy circle, if you can picture it. For me, a medical student's life runs in four-week waves. The first week (this week) is very low key, because you're exhausted from the exams you just finished. You sleep 8-10 hours a day, and your schedule is malleable. The second week starts the dip. You start to focus, and play catch-up on what you missed during week 1, because studying is immensely difficult. Week three is near the bottom of the wave. By this time you're in your last week of studying, so every minute is spent looking at a notecard or memorizing some random fact that could be on the test. Sleep has now dropped to four hours a night or less. Time spent with the wife is even less than that. You have a blood caffeine content of probably 0.05%, and you've got sharp headaches from the tension built in your shoulders from reading constantly.

Week four is actually on the upside of the next wave. You see, taking the exams is horrible, but it's mitigated by the fact that you're now knocking them off one-by-one. No more juggling time to study for every exam--just spend all day on the next one up. Then it's over with and out of mind. Once Friday evening hits, you're back to the top of the next wave, and coincidentally, you've made a circle back to the beginning of the cycle.

Take a deep breath! You've gotta do it again...

Google's Free Broadband

Is it real?? I dunno. At first I thought, "cool!" but then I noticed it was after midnight, and that made it ... April Fool's Day.


So what is it? Well, Google has announced free broadband internet. You sign up and they will send the stuff out to you. Sound too good to be true? Well, maybe not. It's been talked about for a while that Google is doing internet. Something about free wi-fi in San Francisco. They actually actualized (is that grammatically legal?) the plans by providing free wi-fi to everyone in Mountain View, CA at the end of August, last year.

So, giving out free internet isn't too much of a stretch...

...which also makes it the perfect April Fool's Day joke.

If they had stopped there, they would have had me. But they didn't. I clicked on the install link at http://www.google.com/tisp/install.html. That took me to a page showing me how to install the internet -- THROUGH MY TOILET.



Awesome. Instead of crappy internet, I can get my internet crappy.

Sorry .... it's late and I've been studying hard.

So, in case you think we might actually get super fast internet for free, it's all a joke. You're stuck with the junk we have from our cable companies or DSL providers or AT&T, who all want to charge us an arm and a leg for slower connections than the Japanese and Koreans have, and have the audacity to want to start making the internet a tiered system by preferentially charging websites for faster access by surfers.

Unless you live in Mountain View, that is.

Define Anti-Semite

How is this anti-Semetic:

"They got a lot of power in this world, you know what I mean? Which I think is great," Richardson told The Times Union on Tuesday. "I don't think there's nothing wrong with it. If you look in most professional sports, they're run by Jewish people. If you look at a lot of most successful corporations and stuff, more businesses, they're run by Jewish. It's not a knock, but they are some crafty people."

That's what Michael Ray Richardson, ex-NBA player and current CBA coach of the Albany Patroons, said to a newspaper. The result? The CBA suspended him.

Now the beauty of MSM is that they never give you all the facts--no links to the original interview, etc., so we can never know how in- or out-of-context that quote is, but looking at it on face value, it seems pretty inocuous. Is "crafty" the word they're mad about? I've always taken it as a compliment to be crafty, but it could possibly be taken the other way.

Otherwise, I don't see how his comments are anti-Semitic. If he replaced "Jewish" with "White" or even "American" in his statement, would he have been fined?

I'm all for discouraging racial slurs -- I've grown up in the South and I've seen/heard them many a time. This one just seems a little overboard given the info at hand.

"Fixing" the NCAA March Madness Tournament

Every year during March Madness, amid the amazing games, comes the reason we say
"madness" in 'March Madness." Someone wants to change the system.

Can't people just leave well enough alone?

I think people are barking up the wrong tree. The tournament is fine as it is. Each team has 30-odd games to prove themselves, and a conference tournament. Eventually, there are 31 conference champions and 34 at large births. You have a committee of very well versed people that sit down, look at the whole body of work, and pick those 34 at large teams. Sure, sometimes they must split hairs, and occasionally they're going to make a mistake, but most of the time they're going to be pretty accurate. For those 2-3 teams on the cusp that get left out in a given year, here's my advice: Play better next year. Another win here, a harder scheduled opponent there and things would be different. Ultimately the onus falls on your shoulders to execute, and you didn't. Unless you go 30-0 and get left out, you have SOME blemish that is very real, and potentially very worthy of causing people to think you aren't among the best 34 non-conference champions in America.

Can't people just leave well enough alone

Those who want to change things (uhhhumm Jim Boeheim), typically point to those last cut teams as proof that things need to be expanded. Well, Syracuse, I might be inclined to agree that you're stronger than Alabama, but it was close. All you had to do was beat Notre Dame in your final game and you wouldn't have had that issue. Or maybe not let go of Villanova, when you lost 75-78. Or what was the loss to little ole' St. John's (60-64)?

When I was a freshman in high school I had my heart set on playing on my high school's basketball team. I played basketball daily--loved it. Tryouts came around. I did the sprints. I shot the free throws. I ran the drills. Names were called and cut boys headed to the locker room. That was day one. I came back for day two, and day three.

At the end of day three coach gathered all of us sweaty freshman around him. He had varsity full and put one of us on JV. That left 15 boys for 12 spots on the freshman team (yes, I was at a big high school that had three teams). One by one, twelve boys had their names called, until I and two others were left--cut.

It hurt--sure it hurt--because those boys playing ball were the ones I played with every day after school at the park. It hurt because I felt he picked players he was more familiar with--those who played AAU. It hurt because I felt I was good enough to be out there with them, but I wasn't. However, I came to realize that I had nobody to blame but myself. Of course a coach is going to pick a known quantity over an unknown quantity (that's the same reason a medical school residency program will pick a medical student with lower grades from in house over a graduating student from another medical school). Moreover, if I wanted him to know I was a good basketball player, I could have run a little harder, shot a little better, practiced a little more at nights. If I had truly stood out, I wouldn't have had to worry about having experience with me, or sweating out the cuts. But I didn't take care of my end of the deal.

So, Syracuse, do what my old girlfriend used to tell me:

Cry me a river, build a bridge, and get over it.

I mean, you wouldn't want a computer doing the picking would you (a la NCAA football)?

Now that I've just pontificated about why things shouldn't be changed, I'm gonna give you my thoughts on how to change them (sounds dumb, huh?). The two main issues I see with the current tournament format are:

1. Some good teams get left out because the tournament doesn't include more teams. These "cut" teams want an expanded tournament.



2. Smaller conference champions get embarassed having to play the "play-in game" between seeds 64 and 65. The don't want to be in such a game since they took care of business and won their conference.

My solution is so easy, that should the powers that be actually do the stupid thing and tweak the tournament, they'll never institute it. I propose that:

• All conference regular season champions be issued automatic invites to the dance. They proved they were the best team from their conference over 16 games.


• All conferences should hold a conference tournament and the winner, if not the same as the regular season champion, should be invited to the tournament. Each regular season champ still plays in the tourney because they want a good seeding by the committee. In most smaller conferences, the regular season champ and tourney champ are often the same team, and the benefit for a regular season champ of winning the conference (seeding) will outweigh tanking to guarantee the conference two bids, so those "one-bid" conferences will--in all probability--stay so. In stronger conferences, the regular season champion is less assured of winning, and it effectively gives the conference a second automatic bid--up for grabs for the teams like Syracuse.


• All remaining at-large teams, from 34 to 3 (if no regular season champ won their tourney), would be selected by the committee and seeded as usual. This is not far different from now, because most sportswriters admit that there really are only 5 or 6 bubble spots truly available after the conference tourneys are over.


• Make the "play-in" game between the two lowest seeded at-large teams. This allows for a potentially more enjoyable game, because the at large teams could be playing for a 14 or 13 seed, and rewards those teams who won conferences/tourneys to bypass the indignity of being forced to play another game.

Cry me a river, build a bridge, and get over it

These suggestions will effectively turn the conference tournaments into the extension of the NCAA tournament that people wish for. With potentially two automatic bids up for grabs in each conference, you have double the reason to perform during the season or go for broke in the conference tourney, and half the reason to gripe. Also, the change in the play-in game can happen regardless of the other changes and still bring the benefit outlined.


[+/-] read/hide the rest of this post

The First Yahoo 360 Blog Highlight: Susan

While in Vietnam I met many people who touched my life forever. Many of my students taught me almost as much (or more) as I taught them. For good reason, this girl's blog is my first blog to highlight. She is one of the students I grew closest to, possibly because we have such similar dreams.

And, she's only 15. Man, I wish I was so forward thinking when I was 15.

Her post on February 25 highlights the direction I desire Vietnamese blogging to go. It's title: "Top 10. Good or Bad." In it she points out some very salient things. The blog is in Vietnamese, and I won't attempt to translate it, but I will paraphrase some things. She says

Viet Nam dung thu nhi the gioi ve san xuat lua gao. Dieu nay di nhien la tot, no chung to rang nuoc ta co nen nong nghiep vung chac.

...Viet Nam dung trong 10 nuoc tren the gioi ve viec an hoi lo nhieu nhat. Good or bad?"

She, like many of the youth in Vietnam, goes on to express displeasure in the bribery and corruption rampant in Vietnam because they have such pride and patriotism. Her blog is well written, and in her short time blogging, has covered a variety of topics personal to her.

My hope is that people -- especially China -- will stand up and take notice. These youth like Susan are proving that you don't have to keep your people in the dark. Vietnam has taken the lead in Southeast Asia by being open about corruption within and without the government, and trying to clean it up. It's also let people discuss it. The result is the realization that Vietnam has succeeded where China has failed. The Vietnamese youth can be incredibly patriotic and loyal to Vietnam, while expressing displeasure about something specific in the system. They are not mutually exclusive.

Her most recent post is called "Cay Tao." It's a Vietnamese translation of the parable of the child and the apple tree. I don't remember who first wrote it. You know the one--child eats apples, young man sells apples, adult cuts down tree, elderly man sits on stump--to teach us about serving. It's interesting to see her Vietnamese take on it's meaning.

Cay tao ay chinh la hien than cua cha me chung ta. ...

So, check out Susan's blog.

BYU Woes and Shady Refs

I'm gonna start the conspiracy theories now -- the NCAA puts a little extra $$$ in the pockets of the refs if they can stack the cards in Xavier's favor. Because, hey, a Xavier-Ohio St. matchup (old romp of Matta vs. new) will bring more ratings than BYU v. Ohio St.

What really happened?? A superior BYU team got handcuffed by refs that put them in the bonus with over 14 minutes to go. Xavier didn't hit the bonus until 7 minutes. Yes, a full seven minutes of free points. Xavier ended 23-29 from the line while BYU was 10-13 from the line. 13 free points? BYU lost by 2? Hmmm, sounds like an 11 point swing to me.

Whatever the nefarious reason really was, it was clear that the refs were calling the game tight at one end and loose at the other. They called it clean--no phantom fouls--but ticky-tack. On the other hand, Xavier was doing the same thing at their defensive end and getting away with it.

I hate that.

Well, good luck Xavier. I hope Ohio St kills you by 50. Long live Texas A&M and Georgetown, Kansas and Florida. That's the final four.

The New Generation of Viet Bloggers: Yahoo 360

Since the inception of the Bleeding Ear, we have joined with others in looking for Vietnamese blogs. Previously, I listed a couple blogs I found off of Noodlepie, and some reasons why I wished blogging among the Vietnamese would blossom.

How Yahoo became the exclusive purveyor of chatting in Vietnam, I don't know

My first foray into the "Vietblogosphere" found a wide variety of expat blogs but only a few blogs written by Viets.

Yet over the last year, things have started to change. I'm not sure how noticeable this is from America, but I have seen it personally. You see, Yahoo and Google get a lot of flak for bowing to communists and censoring search results--as well they should. But Vietnam is showing China that things can be done differently. The internet is slowly opening--not closing--in Vietnam, and the presence of Yahoo and Google, if neutered, has had profound blessings.

What blessings?? Well, Vietnamese youth waste hours a day chatting on Yahoo messenger. My first day as an English teacher in Vietnam was a lesson in the power of Yahoo. It was in Go Vap district, in Ho Chi Minh City, with VATC--Vietnamese American Training College. I arrived to the skinny, three-story concrete building as the sun was setting, and walked inside the front doors, found the manager, and received my lesson materials. After a quick planning session, I was escorted to my first class--PET3. PET classes are pre-teenage classes. My class was full of 25 boys and girls all about 12-14 years old, with moderate English skill.

These pages mix the allure of Myspace with the chatting of Yahoo Messenger

My teaching was nothing memorable that first day, with most of it spent answering personal questions from the students. But every class has a ten minute break, and when the bell rang, my class emptied so fast, I almost believed the previous 45 minutes had been a dream.

Eager to find out where my students were running to, I walked downstairs. I passed one or two talking on the staircase. Then I reached the first floor and found the computer room. Every VATC has a room for students' use that contains about 10 computers. This room was packed--standing room only--with about three students per computer. Every student was doing two things--playing flash games and chatting on Yahoo.

How Yahoo became the exclusive purveyor of chatting in Vietnam, I don't know. But unlike America, where everyone is broken into AIM, Yahoo, GoogleTalk, and MSN circles, there is only one large circle in Vietnam--Yahoo. Children and teenagers squeeze every minute they can chatting with friends--10 minutes here, 20 minutes there, an hour before school here, an hour at night before bed there. Internet cafes are chalk full of them at almost all hours of the day, and it has become a nearly unregulated way of mass communication and relationship building.

At that moment, seeing all those students chatting, I wondered if they would ever jump to blogging. They were so close--talking to friends about school, what to do the next day, the game they're playing--all over the internet. I shouldn't have wondered.

Thanks again to Yahoo comes the next generation of Vietnamese youth. Yahoo 360 has finally taken off. I have seen most of my chatting students set up personal Yahoo 360 pages within the last year. These pages mix the allure of Myspace with the chatting of Yahoo Messenger. You have a home page where you see new blog posts or messages from friends in your network, a blog page, and picture albums like Myspace.

My Yahoo 360 page

All of this thinking about Vietnamese blogging and Yahoo 360 happened when I read a student's post that came nearest to an American blog post that I have ever seen. Over the next couple weeks I hope to highlight her and some of my other students' pages because they are the next generation--no, the first true generation--of Vietnamese bloggers. As they get used to writing their feelings online, I think it will be wonderful to follow their maturity, and see how their discussions of weather and music turn to school and love and even politics.

It's an exciting time to be growing up in Vietnam. Yahoo 360 just adds another dimension to that statement.

[+/-] read/hide the rest of this post

AMPAC Regional Campaign Workshop

I just returned from attending a political campaign workshop in Austin, Texas. What an interesting experience. Truth be told, I wasn't expecting to go. Another student from UT-Houston's TMA/AMA chapter was assigned to go and bailed at the last minute, so I took his place. So many stories from two days!

Wow, I feel all warm and fuzzy about our democracy ... Goodbye warm-fuzzies

Many of you who know me, have heard me ruminate about possibly running for office someday. Unfortunately, I'm an idealist and a family man. I know in my heart of hearts that politics is dirty, but I want to "help the world." I also want to provide for my family, and often politics doesn't allow that. This workshop allowed me to see more in-depth the makings of a campaign, the strategy behind one, and weigh whether or not I really want to do that in the future.

AMPAC is the American Medical Association Political Action Committee, basically the political wing of the American Medical Association. American laws are all screwed up, and election laws are no different. As I learned on Monday, American politics are supposed to be pure, unadulterated, bereft of corporate or other special interests. To such end, laws prohibit corporations, unions, or professional organizations (like the TMA and AMA) from making direct contributions to a candidate or campaign.

Wow, I feel all warm and fuzzy about our democracy.

BUT, they allow any of the above entities to sponsor political action committees (PACs)made up of employees, run by employees, and --obviously-- espousing the ideals of the "parent" organization.

Goodbye warm-fuzzies.

Actually, the pragmatist in me doesn't see any real problem with this. It allows people interested in the survival of HMOs to tell their point of view and those who want them gone to share theirs. Ultimately, the people vote (via candidates and party platforms) for whose ideas they support more.

So, the AMPAC (and TEXPAC...Texas Political Action Committee) is made of members of the AMA (and TMA, respectively) who feel strong enough about their feelings to make monetary and time donations to the candidates and parties that they feel will support and protect the profession of medicine.

the average age of a person who responds to mailers is 67

AMPAC sponsored this workshop, and brought in two political campaign strategists to teach us about fundraising, advertising, employees/volunteers needed, strategy, etc. Heck, who better to protect medicine than a DOCTOR in office, right?

The AMA (and AMPAC) is a nonpartisan organization, so they brought in one Republican campaign strategist--Carlyle Gregory (without the mustache)--and one Democratic strategist--Gary Nordlinger. Both were very good. Some things I learned from their presentations:

1. 80% of voters have their mind made up regardless of what you do to persuade them. They're either Democrat or Republican, or care about some issue so much that their minds are made up in the beginning. 5-8% are "hyperinformative" voters, because they weigh everything up until the last minute and make up their minds on who to vote for while on the way to the polls (yours truly). The remaining 12-15% of voters are considered "low information" voters. These people are those who pay little attention to a campaign until the last two weeks. Then, they see a couple adds, gain little information, and make a decision on who to vote for. They are typically able to change their minds many times up until about 5 days before the election.

It's these "low info" voters that most TV ads are targeted to, so if you wonder why sometimes TV ads have so little substance, now you know. (This was from Gary Nordlinger)

2. Evidently direct mailers are the most statistically researched of all advertising techniques. Everyone knows that when you send out a mailer asking for donations, you will receive 50% of your money in the first 5 days. It's like gospel. Also, the average age of a person who responds to mailers is 67. The stats experts have also shown that the longer the letter (contrary to logic), the more likely someone is of reading it and responding. (This was from Carlyle Gregory)

I suppose this is because as you get older, you get less and less mail, so any seemingly personal but really impersonal letter one receives from a candidate will allow he or she to delude herself with the joy of receiving correspondence.

All in all there was too much information to put down here and not bore everyone to death. Yesterday we lobbied at the capital, and then came home--but that is another post.

Engine Troubles ... Blogger Style

Now that I have a little free time, I'm trying to bring this blog into the 21st century. Or how should I say, bring this blog into the year 2007.

Blogger has gone and revamped everything, and while this is old news for most everybody, it's new to me because I've had my head stuck in a book for the last billion years (it feels like).

Now, I love my layout. TBE version 2.0. I worked long and hard with my meager HTML skills to put that together...and I mean meager skills. But I feel the need to be on the new platform--give in to the man, so to speak. I have some great additions to my blog, things under the hood, like my categories and such, that require user scripts through greasemonkey on firefox for optimal use.

I love greasemonkey, and everything about it, but there is one problem: my new life at medical school has me using many different computers throughout the day. Most are not my own (school labs and such), meaning they do not run greasemonkey, or often firefox at all. That leaves me a list of things to fix when I get home--provided I post at school--or not do at all.

A switch to the new blogger would smooth some of the multiple computer issues, but i fear I don't have the talent or time to transfer my design to the new system.

Grrrr...engine troubles again. Can anyone point me in the direction of a really good tutorial or to that explains the new layout system, writing for it, or transfering designs to it (not counting actual blogger pages, seeing as how I've read all them)? I could really use pics. Blogger gives code and some explanations, but i like to see pics to tie with the code.

Welcome Xanghe

There's a new blog in the Bleeding Ear -o- sphere.





It's Xanghe, a blog about all things xang and he. Actually, his tagline says

God gave me a mind to think and a heart to feel, but sometimes I get confused about when I should be thinkin and when I should be feelin. That's when I just talk.

It's written by a good friend of mine, and deals with Vietnamese issues. I'm glad he finally joined the blogosphere, because I think his perspective will be a good addition to the collective we have going.

Here's to many posts and much success, Xanghe!

Texas 1st to Require HPV Vaccine

Friday I was greeted by some good news after finishing my practice physical exam. Texas is requiring all girls entering sixth grade to be immunized for HPV.

HPV stands for Human Papilloma Virus--a sexually transmitted virus that causes genital warts. This disease is especially interesting because it doesn't ALWAYS cause disease.

While at BYU, I collaborated with Dr. Meyers of Penn St. Medical School who is very well known in HPV research. His research focused on elucidating the lifecycle of the virus. He was interviewed by WPSU (Penn State Public Broadcasting) about the vaccine and disease.

One of the problems with studying HPV is that it's lifecycle has different stages in different tissues. That made studying it in vitro almost impossible until Dr. Meyers perfected a method of creating an organotypic skin culture--pseudoskin--to study it. The other big problem is that HPV has numerous different strains. Each strain behaves similarly, but not identical, to others. While many cause genital warts, the nature of the virus may lead it to latent infections, and some strains lend themselves to that more than others. This means it can be transmitted very easily because many people--especially men--may not know they have it because they won't have any symptoms.

HPV has an interesting secondary disease. According to Dr. Meyers,

"Certain types of the virus that infect the cervix or anal-genital region can cause cancer."

In fact, about 90% of all cervical cancers have HPV as a cause. According to Dr. George Ort, on the same radio show, cervical cancer causes about 25% of cancers in women worldwide. Hence a vaccine that could prevent 90% of those cancers would be incredibly important.

The vaccine, Gladasil by Merckx, doesn't quite get 90%, but it is very good. Dr. Meyers said,

"there are over 15 human pap virus types that cause cancer, and the vaccine is directed against the two major types that cause cancer--and about 70% of cancer are caused by these two types--so its effective for 70% on that basis."

However, although this vaccine looks so good, it has caused a lot of controversy.

In Texas, a very conservative and strongly religious state, many people and groups argue (like when arguing birth control in schools) that requiring this vaccine will give a green light in girls' minds to have more sex. Others are not properly educated on the vaccine because it is so new. My mother worried about the vaccine on Friday. She remarked that she had raised my sister right, and didn't worry about her being at risk for getting HPV, so why spend the money? Why have the chance to get the virus?

It is imperative that pap smear education go hand in hand with HPV vaccine distribution

Well, giving the vaccine to 9 year old girls, or girls entering 6th grade, will not give them the greenlight to have more sex anymore than preaching safe sex in schools will. Surveys are showing sexuality rates declining among high school students, giving fodder for the view that possibly sexuality has more to do with culture and less to do with the availability for sexual education in schools. Moreover, students are required to get many shots before school anyway, and few know what the shots are for. Adding one more shot to the barrage placed before them will be accepted as a fact of life, with little care into what disease it will prevent and therefore minimally impact behavior.

Secondly, people can raise their chlidren "right," in the sense that those children might not be sexually active during their teenage years or before marriage, but that never decreases the probability for rape or abuse. Unfortunately, raising your child right doesn't mean others raised their children correctly, and nobody wants their daughter to develop cervical cancer after being raped.

Thirdly, the vaccine is not the virus. Dr. Meyers described it as,

well this is a very simple little virus, and with all viruses theres a nucleic acid--either dna or rna inside. And what they did was they made empty viruses, so there's no dna inside these particle, so there just empty little particles, and when they inject that into a woman, the woman's immune sys sees them as a virus even though their empty, and so it mounts a response and creates protection against infection by that virus."

So if a person gets the vaccine, there is NO CHANCE she could get infected by the virus.

One problem with the vaccine is that it only protects 60-70% of cervical cancers, so some health professionals fear that vaccinated women will stop getting regular pap smears (that test for cervical cancer). It is imperative that pap smear education go hand in hand with HPV vaccine distribution.

The shocking thing is that Texas is the first state to require students to get the vaccine. Governor Rick Perry did an end-around republican state legislators and the inevitable fight it would have received in this conservative state, and passed it by executive order. According to the Los Angeles Times, Perry side-stepped part of the backlash by saying that parents who don't want the vaccine for their children because of reasons of conscience can opt out of it. However, human nature is such that most parents won't object, because it's just one more shot.

Having just returned from the Texas Medical Association Winter Conference, I can say that this was the news of the meeting. Over the two days I was in Austin, both doctors and medical students were discussing this, and I heard 100% happiness that Gov. Perry took this step. Although controversial among social conservatives, he has the backing of the medical community, and that might be most important of all.

School-Girl Fight

Another article on CNN describes girls fighting at school, and some idiot stabbed and KILLED another student in Boston the other day. All that got me thinking about how Youtube.com always gets fingered for having fight videos.

How many? Lots. Tons. That kinda surprised me, but i guess it shouldn't. However, in comparison with these fights we've just heard about, hear's a video of a girl fight in Vietnam--similar to one's I've seen, and much better, in my opinion.

(Plus I get to try out Youtube's blog posting stuff and see if it's worth it).

The Wonders of MRIs

My professor started off our second neurology lecture today by saying:

"Today we just heard a description of CT, and MRI, and PET, and how they are useful. A couple years ago, a senator and a president ran against each other for office in this country. After the election was over, both were incredibly tired and got routine physicals from their GPs. The muscle fatigue was serious, so both got MRIs. After the results came back, the senator and president asked what they were.

'Well, you can see both the left brain and the right brain in these scans,' replied the doctor. 'We know that the Left has got nothing right, and the Right has nothing left!'"

Well, I thought it was funny.

The cold of Utah...The Universal Problem of New Labbies

Ouch, is it cold. I cannot even ride my bike outside. Well, who in their right mind would want to ride in Lycra in a single digit wind chill? Not I.

But I cannot explain why people who sign up to be part of a science lab do not commit more time to the lab when the weather is horrible outside? Shouldn't they enjoy the heat of an autoclave or a hot water bath? I say nay. They (the labbies) do not take the time to hibernate in the lab. Maybe they are in the library or cuddling up with a good read such as a biochemistry textook or a book on evolutionary biology. I think my thoughts deceive me. The labbies are not looking up journal articles. They are not studying. They are wandering through the mists of darkness of not understanding that they are not alone in the process of research! Each labbie may "own" a project, but they do not understand that the only way to come to a knowledge of the truth of research is by performing it. It is time for them to step into the unknown, the darkness of the lab and turn on the light to see that the pathway is lighted that much more after they make the initial step.

Till next time.

Old Man Winter...

The last two days have been amazing. The cold front sweeping through the nation finally hit Houston, and we've had winter for the first time. When living in Utah I wasn't a huge fan of the snow and cold, but it was beautiful and did give variation to the year. It was such a pain to drive in though.

I was beginning to be afraid that we might get three seasons here but not four

Now I'm in Houston and December was warm--50s and 60s warm. I was beginning to be afraid that we might get three seasons here but not four. However, it's finally into the 30s, and although it's not likely to stay there for long, it'll be in the 40s for the next week or so. At the very least, I'll get two weeks of winter.

It's funny to see everyone react to the cold. People have no experience driving--living--in cold weather. It hit 31, 32 degrees, with a little ice on the roads, and about two-thirds of the school districts closed. The other one-third opened late. I drove my wife to work and there was no ice on the roads at all except for a little patch on an entry ramp to the 59 freeway. I hit it, skidded a little, and kept going--nothing major at all--but it had caught someone inexperienced because there was a wheel laying in the middle of the ramp--not a tire, but the metal wheel of a car.

It's too bad I have exams next week, or I might be able to spend some time outside in the refreshing cold air. As it is, I have to make due with breathing it in while waiting for the bus, and trying to warm my feet on my cold, cold hardwood floor.

A Crazy Day

Monday was a crazy day. I looked up trying to find a full moon--since full moons often are harbringers of disaster--but to no avail.

I was at the bus stop when my wife called me. The car was smoking. Quick change of plans. I hopped another bus and eventually reached my poor wife, sitting in our car, late for work, and found the radiator busted. The metal "T" that connects the radiator to the hose was snapped clean off. Old radiators suck. After getting my wife on another bus and off to work, I grabbed a tow truck, took it to a shop, and went to school.

I want to highlight how awesome the public transportation in Houston is. People think that Houston is so large a city, that you MUST have a car. Well, I have been able to go anywhere with minimal planning because the routes are so well done.

Now, at the end of the day I picked up my car. $500. Sucks. But that's not the big deal. Well, it is big, but not the deal. On my way home, I'm stopped at a light, and I see a college-age girl jogging in place as the light turns from yellow to red. I thought to myself, "Gee, she looks like she wants to run."

Then, right as the light turns green (for the cross traffic), she takes off. Now, it's not a large street. The car in the turn lane almost goes, but sees her and stops just short of hitting her. The car in the fast lane sees her and stops. The car in the slow lane goes before she gets there, causing the car behind it to go and never see her, until it hits her and she flips over the car hitting the ground.

All i could think of was "ooooo..." Evidently she was trying to reach her father/older man waiting for her on the other side. She got up and was crying on his shoulder as the man who hit her got out to see what had happened and how bad she was hurt. A couple people pulled over to help also.

How dumb are you to cross a full street at a green light? I just feel bad for her.

But that's not the end--I get home and there's an ambulance outside my building. Some old lady was in the back. Dunno why. I talk to two guys waiting for it to leave so they could get to there car, and find out one of the two had his $400 bike stolen a couple hours previous.

At least after that all i did was study.

What a crazy day.

First Semester in Review

It's been two months since I've written a post on TBE. I must say, it's been a loooonnnngggg two months. Not a week--no--not a day has gone by that I haven't thought about posting. Countless reasons to post have came and went, but one reason not to post trumped them all: school.

I never imagined medical school would be this hard. My sentiments have been echoed countless times by most of my classmates. Every one of us did well at our undergraduate institution. Some did remarkably well. We all expected to come into medical school and do what we always did--studying and what not--and get the grades.

The first semester was divided into three blocks. Each block was about six weeks long. Block exams then lasted one week. At the end of the semester we had Thanksgiving, then third block exams, and then finals. All in all, I was studying exams for the first two and a half weeks of December.

After finals, I spent the next week before Christmas playing tour guide, translator, and shopper. My father-in-law came in town and spent Christmas with us. It was great, but busy. While my wife worked, I got to drive all over Houston, pointing out interesting sites, translating things into Vietnamese, and trying to find Christmas gifts.

After Christmas, we all (wife, father-in-law, myself) went to San Jose, CA for a wedding. I love California. Now, I'd never want to live in San Francisco, but I was impressed. It was my first time going there, and it was fun, interesting, delicious (the food), and expensive. I'll talk more about that later.

But now I'm back. It's a new year, a new semester, new classes, new experiences, a new blogger (if you have a blogger blog you understand), and new posts. Here's to a great 2006 and a better 2007.