Thursday, February 28, 2008

Booze and Cigs- a Public Health Prevention Scheme


Having this handy bottle opener around would help you monitor your alcohol consumption, eg, I can think of some patients I see every day who could use one of these as a gift to accompany their discharge papers from the ED. Or perhaps ambulances could stock them and hand them out as a public health initiative- sort of like the NYC Condom idea- thanks for riding with us. Maybe one end could have a cigarette lighter which would monitor your smoking too, and another little application would be a breathalyzer. Yes, another great idea for halfbakery.

Tuesday, February 26, 2008

Jarvik and Pfizer

Apparently Pfizer has done something worse than overcharge(Gouge? Extort?) 80 year old ladies for off label use of viagra to treat their pulmonary hypertension. (Viagra costs about 10 dollars for 100 mg, whereas Revatio, which is the same thing (sildenafil), is marketed at 10 dollars for a 20 mg pill which is usually taken three times daily. Change the name, triple the cost, the old bait and switch...)

Pfizer, according to our duly elected representatives in the US Congress ( John Dingell and Bart Stupak), has gotten the inventor of the artificial heart, Dr. Robert Jarvik, who has degrees in both Engineering and Medicine, to speak for lipitor in between rowing sessions. This is supposedly misleading because he allegedly is not licensed to actually practice medicine, therefore his advice on an effective lipid lowering agent should not be trusted. hmmmm. This logic is somewhat tenable (more tenable is the idea that he is decidedly not an expert on lipid physiology), however the irony of what appears to be at face value an honest fairly conservative advertising campaign blowing up in Pfizer's face is more palpable than an atherosclerotic thrombus in the LAD.

in training review

My peripheral brain for tomorrow's intraining exam, as modeled in House of God by the Ice Queen. However, the mnemonic for gravity and parity is conspicuous by its absence as pointed out by Dr. S, A G3P40089344 woman walks into the ED, huh? Read it if you dare...

Sunday, February 24, 2008

good reads vs librarything

I recently learned about goodreads.com, which compared to library thing is more slick, more social, and has neat features like author's lists, and the ability to sort into different types of "shelves",such as a "to buy", "to read", "to leave on a bench for bookcrossing"...


One problem on library thing is the lack of discrimination between books I have and books I wish to have... However, the geek in me likes librarythings taggability (is this a word?), and it's data-driven method- one can create "clouds", which suggest new avenues to go on from previously read books, as well as generate statistics such as "median/mean library obscurity", as well as generate a gallery of pictures of the authors in your library


While migrating my library to GoodReads, I stumbled on a prescient link from my 2005 blog to the NY Times best 100 books of 2005, which I had come across in December 2005 while doing a winter elective at the Mayo Clinic, elicited most likely by my friend Kat in Minnesota. As I looked over the titles picked as excellent in 2005 by the NY Times, I noticed one, Cormac McCarthy's, has since been made into an Oscar Winning movie- "No country for old men", (a nice addition to the 2007 Pulitzer Prize for "The Road" from this secretive author, and another is Friedman's "The World is Flat", "Glass Castle", "Freakonomics", Marquez's "Memories of My Melancholy Whores" were all in there.


In retrospect, I should have picked up Ian McEwan's "Saturday", a book about a day off in the life of a neurosurgeon...

Fast forward to this year's list, 2007 , and I noticed these ones which look good- "Matrimony" by Joshua Henkin, "Septembers of Shiraz" by Dalia Sofer, "Then we came to the end" by Joshua Ferris, and "How Doctors Think" by Jerome Groopman...


My only question now is where Oprah gets her list?

Sunday, February 03, 2008

Class Divide in Brooklyn


Today, Superbowl Sunday, I had off, and I took the morning to venture out to Coney Island which is at the end of my subway line. I found a surreal place, this picture with the seagull sums it up: some sea life, an aquarium, urban decay, the Verrazano Narrows bridge in the background, and some really ugly public housing.


As I ventured farther down the beach, I came to a fence that extended half way down the beach to a jetty, with a sign that said something to the effect of "this area is closely monitored by surveillance. Violators will be prosecuted". Violators of what exactly? The sign didn't expressly say that you could not walk down past the fence... I would have thought that if that was the case they would have put the fence into the water, or said, no trespassing, keep out, private property... instead it said, this area is being surveiled. This is apparently private beach, although it is unclear where the private property ends, clearly they don't own the water. There is some talk of building public jetties here to protect the private sand, without providing public access. I decided to do my own surveiling and take a picture, and it appears the moss is greener on the left, which is the private side, nicely juxtaposed against the fugly public housing on the right.

As you get up closer you realize the development on the left is Sea Gate, a private gated community, and the developments on the right consist of classy buildings such as "Mermaid Manor"
I was really only trying to get around Sea Gate to take a picture of the bridge, but the guards of Sea Gate and the scary environs of Coney Island deterred me from heading any further into the heart of this island. This was the best I managed to do
Now, I guess the mermaids that live on Coney Island year round are not the ones that participate in the annual mermaid festival, perhaps the mermaids of Mermaid Manor frequent this establishment?

On my way back from trying to get around the lovely development of Sea Gate to take an unobstructed picture of the bridge, I ran into some more citizens of Coney Island. First were the retirees and Russians of Brighton Beach getting their afternoon winter sun.
As I walked around, it began to dawn on me why the Russians love Coney Island. It's just like home! It's cold, with ugly public housing, which reminds them of the communist housing in Russia, and it has decayed burned out buildings reminding them of the fall of the Communists, and it has a large esplanade for them to parade around, sans high boot kicking, with their orange lipstick and heavy furs. It is perfect for the Russians.

As for me, they can have it. I wonder why Coney Island gets the bad rap. It has the same sand that Fire Island and the Hamptons have, same Atlantic Ocean, maybe it is the reach of government projects that spoiled it. I did see evidence that at least some happy people do enjoy the beach, the Polar Bear club came down with their American Flag in preparation for a cold midwinter swim. Seeing the American flag, it got me to thinking about the place as representative of what US government is good at and what US government is bad at, in fact, any sort of government.

Government is good at making fixed assets which require little maintenance, for example the boardwalk, the tennis courts, the public housing. These are victories for Coney Island. Lots of poor people have these resources. However, what government tends not to be very good at is high demand services like healthcare, education, or trash collection, or policing, or other services which require responsiveness from consumers/users to improve them or provide adequate service. There are too many levels of power/bureacracy/politics between the provider of the service and the user.

This became clear to me as I was walking back to get on the subway. I saw a sanitation enforcement officer parked in a Prius, as I was about to marvel at how efficient the NYC sanitation department is, I noticed the officer threw a cigarette butt out the window onto the street, still smoking. I had my camera with me, so I took a picture of the officer's car with the butt on the street, and as I started snapping pictures, she took off.
I did catch up with her a block or two up the street, as she was policing some businesses who had left their trash in bags out on the street. I asked her if she had thrown the cigarette butt out onto the street. She denied it.

On my way back on the subway, I stopped into another little suburb in Brooklyn, a development of houses which was meant to cater to wealthier folks. The subdivision has street names that are based on English place names... In any case, the subdivision is now surrounded entirely by projects and public housing. It is a bit odd to see these huge houses right next to public housing developments, and kind of makes you wonder if it contributes to class/ethnic tensions?But perhaps, like the parading Russian retirees, the midwinter swimmers, and the smoking sanitation worker, it's just life in Brooklyn.