U.S.S. New York

The U.S.S. New York has been docked on the Hudson River for the past several days, having been commissioned on Nov. 7 after arriving from New Orleans.  Today was the last day for public visitation as she leaves the dock tomorrow for duty.  Luckily my exams eased up just enough this morning for me to go explore this historic ship.

The sizable crowd – teens stopping by with their skateboards tucked under their arms, an array of veterans from all branches and all conflicts, tourists who stood in line simply because there was a line and not knowing what the line was for, businessmen who managed to take an afternoon off despite complaining that “corporate America doesn’t celebrate this holiday,” lifelong New Yorkers who gasped when they glimpsed the bow of resurrected WTC steel, middle schoolers on a class assignment for extra credit, and children exclaiming “Look! A soldier!”

Maybe because it was Veterans Day…or this ship herself evoked compassion and memories of togetherness and service…or maybe it was the sense of transparency around this military marvel open to the public…or the prowess exemplified by the behemoth…or the opportunity to climb inside amphibious assault vehicles and hoist bazookas.

Whatever “it” was, it was undeniably a boon to the military’s public image.  I overheard 3 conversations in the hour that I was aboard about enlisting – 2 were teenagers speaking with the Marines scattered throughout the ship (one being told to wait 2 years until he was old enough) and the third was a child asking her father, very much a civilian, if she could be a soldier when she grows up.

I listened with baited breath for the father’s answer, certain that he would caution her against it dismissively.  He took a moment, surveyed the tanks and assault weapons around the deck, pausing to look a Marine in the eye, nodding slightly.  And then he answered.  “Yes, of course.  I would be so proud of you.”

Thank you to all of our men and women in the military on this Veterans Day.  The U.S.S. New York is a functioning reminder of all you do.

Into the Wild Blue Yonder

No, I didn’t join the US Air Force, but I did get to spend a day as a copilot of a Piper Twin Comanche.  We flew from just north of New York City to Houston for the AMA convention. (Oh and btw health care reform…yay.  I guess I should talk about that at some point…)

I had never flown a plane before, nor had I ever really had it on my list of things to do.  It was on a whim (and with blind trust) that I squeezed into that tiny plane for a 9 hour trip last Wednesday.  And strapped myself in, triple-checking that the door was secured.

Of course I brought my camera, but it’s a little difficult to take clear pictures through the windows of a plane as you’re moving at 165 nmph and climbing to 8600 ft.  So I understand why the Air Force One and the Statue of Liberty pictures were pretty terrible.

Minus the takeoff and landing, flying is remarkably simple.  It was completely different from what I had expected.  I felt like it was a video game, with GPS and computers doing the difficult work and all I had to do was nudge the controls back and forth every so often to line up the red line with the blue line on the screen and make sure the wings were level with the horizon.  That’s it.  Of course I played around a bit and maneuvered some deep turns to see how that worked…but stopped after the Washington DC area air traffic controllers warned us that we should stay on course while we were in restricted air space.

Most of the flight we spent on autopilot.  I took a nap, the pilot finished the New York Times crossword.  It’s not so hard to understand how being on a laptop could distract you enough to miss your destination.  But it was a little more difficult to see how the skies could function without the air traffic controllers.  We were in constant contact with them, reporting our existence as we entered one airspace and saying goodbye as we exited, affirming when we had a visual on a plane off to our right and climbing when they gauged we were in another plane’s path.

Being in a small plane, we were buffeted by the upward winds and rain showers as we coasted over Appalachia.  The barriers that come with commercial flights were removed as we had nearly 360-degree views and were essentially part of the sky, with a lot more turbulence.  Commercial flying – being sealed into a tube and shot across the country – had jaded me and I had lost the wonder and amazement of the feat of flying… but this time I found myself imagining if this was what the Wright brothers had felt, if this is why Lindbergh and Earhart dared what they did.

As we flew into the sunset during our approach into Houston, red rays of light washed over us in the cockpit.  I felt a little like Tom Cruise in Top Gun, coming out of the mission successfully.

Linkage analysis

World Series edition.  The Fall Classic.  Because the Yankees rock, and I love baseball.

Yesterday’s winner Cliff Lee was unfazed by NYC traffic and hopped into the subway to get to Yankee Stadium.  He probably took the C train to the D, neither of which get the fancy technology that the Hipster Express does.

ARod, who has finally not choked in the postseason for the Yanks (though he hasn’t been stellar in either game of this series yet), is a philanthropist in my/his old neighborhood of Washington Heights.  Maybe money can solve some other problems en mi barrio?

The series now takes the show to Philly.  It makes leaving the Bronx look easy.  If they return to Yankee Stadium for game 6, fans might be surprised if the overpriced bottles of water just got a little more expensive.

As the batters scout the stats of pitchers Andy Pettite and Cole Hamels for Saturday’s game, those statisticians are probably feeling pretty good about the economy.

I’m hoping for championship number 27 this season…and maybe this dynasty will get to keep the castle (another Red Gym lookalike).

And, oh, did I mention that I can see Yankee Stadium from my window?  I’m calling it my box seat.

Carpet samples

Linkage analysis

I saw my first real patient today.  I mean, I’ve been in the room with patients before, shadowing the physician and taking patient histories.  But this afternoon, I had the amazing privilege of being (somewhat) unsupervised with a patient in the hospital, interviewing her and doing a complete physical exam.  It’s days like these that make me love medical school, make me excited about my future.  And make me want to study.

Though this isn’t the incentive I’m looking for for education.

I would say more, but I don’t want to be expelled.  Though I have one less reason to be expelled now, as I don’t have to get the flu vaccine.

One question we ask that is always entertaining/awkward is about bowel movements.  If you really like going to the bathroom, Charmin is hiring.

Happy Diwali and Sal Mubarak

So says President Obama in a video message that has taken the Desi community by storm, engendering warm feelings amidst genuine surprise that this huge Indian/Hindu holiday was actually recognized by an American president.

Diwali is a time of religiosity and celebration of the new year (lunar calendar), a time spent with family and deliciously fattening foods.  I went home to be with relatives for the weekend and tagged along to the temple on New Year’s Day.  It was such a comical experience that I simply have to share.

It’s been a while since I’ve been to temple, and, just like churches are packed by once-a-year-attendees on Easter and synagogues during the High Holidays, the temple was inundated by thousands of people.  Granted, it was in New Jersey, but I was still astounded by the long line of cars, people parking a mile away and walking in 3-inch heels and saris through the mud, the shuttle bus from off-site parking lots, and the pressured flow of worshippers trying to enter and exit the temple through the same set of double doors.

A new duty for former UW tour guides?

All those fun facts about UW-Madison that I learned while I was a campus tour guide finally came in handy post-graduation.  2 other young alumni and I volunteered last night to run the UW table at a high school career fair in Brooklyn.

Having young alumni represent the school was, from what I could see, a novelty at that fair, with almost all the tables run by paid staff members who may or may not have been alumni of their respective schools.  And the kids were drawn to us – we were closer to their stage in life, we were more energetic, more passionate, and knew better what was relevant to students today.  It was astounding how many students and parents we spoke with who walked up to our table never having heard of UW-Madison and then walked away already planning their applications.

As I flipped through the admissions material (viewbook, website, Parent Program, etc.), I was pleasantly surprised at how much the materials have changed in 2 years.  It’s evident that the admissions office is at least starting to focus on actually recruiting high-achievers and recruiting students in general, selling UW-Madison as a top-notch school and emphasizing the breadth and potentially uniqueness of the Wisconsin Experience.

The kids we met last night were New Yorkers and east coasters, but they by no means fit the definition of Coastie embraced by this odd song.  (Honestly, no coastie I’ve met here fits the Sconnie definition of Coastie.  Sure there is self-selection towards the private dorms on Langdon and State St (almost all of the incoming freshman I met at the sendoff last August were going to live in Towers or Statesider), but the caricature of the Coastie of course isn’t generalizable.)

By far the most frequent question we got from the highschoolers was “How much does it cost?”  Followed often by an “Oh, that’s not so bad.”  Even for out-of-state students, the price tag for UW-Madison is a great value.  And there are some exciting scholarships for talented and/or underrepresented students, like one celebrating the poetry program, funded by the New York Knicks, offering full scholarships to Madison.

Other frequent questions were “Is it fun?,” “How’s the pre-med program?,” “What test scores do I need to get in?,” and so on.  They were all questions that I learned how to answer from my work as a tour guide.  So what about other former campus tour guides in other cities?  Can the Wisconsin Alumni Association partner with the Office of Admissions and whatever they’re calling Visitor and Information Programs nowadays to mobilize this army of passionate trivia troves?  It’s a tiny time commitment (one evening of a couple hours) and potentially high-yield for the university.

Especially for attracting high-achieving out-of-state students who may be able to relate more to someone from their area.  Or for helping underrepresented students make a positive connection to the UW-Madison community.  And of course allowing alumni to connect with future generations of Badgers, sharing our fond memories and encouraging them to come form their own.

I for one can’t wait to volunteer at another career fair.  On, Wisconsin!

High Bridge water tower

Every day I look out of my window and see this neo-Gothic granite tower, but it was a friend’s question of “What’s that?” and my lack of an answer that prompted me to take a walk.  Well, not exactly prompted, as it has been a couple months since I was first intrigued by the stalwart tower’s mystery…but I wanted to wait until the tower’s doors were thrown open for the Open House New York program.

The High Bridge water tower, on the National Register of Historic Places, was an integral part of the old Croton aqueduct that brought clean water into Manhattan and rid New York City of massive cholera epidemics (civil engineering designed for the public’s health…brilliant!).

The vertigo-inducing climb rewarded me with panoramic views of my little corner of Manhattan, serene images and plentiful greenery that provided an escape from the city.  (And a view back to my place…)

The High Bridge (not the Brooklyn Bridge, as I had previously thought) is NYC’s oldest bridge between boroughs, connecting Manhattan and the Bronx.  According to the Urban Park Ranger I spoke with, it used to be a promenade when it was a functioning aqueduct, attractive to the well-to-do because of the beauty of the Harlem river and the views of the city growing in the distance.

The water tower itself was restored just a few years ago after a fire devastated the roof, and the High Bridge will finish renovations in the next couple years, providing a purely pedestrian and bicycle path between Washington Heights and the Bronx.  So we can party like it’s 1899.

Overheard in New York…

Passerby 1:  “Tibet?  What country is that in?”

Passerby 2, confidently:  “Mongolia.”

Tibetan culture parade, shoved to the side of the street by capitalism.  Yes, this is a metaphor.

The name says it all: Portugal. The Man

Yes, yes, that must be why they chose such a pretentiously indie name — Portugal. The Man is, in fact, The Man! The Alaskan fourpiece’s show at the Majestic Theatre Thursday night was insistent, pulling you into each and every quirky yet still-rocking guitar riff, folksy moment, keyboard drone, or churning jam. And when the drums revved up and led the band into a full-on, rib-rattling charge, when the bass player leaned back so far his head seemed to knock time on his high-top heels, why, then it was pure rock euphoria!

But this euphoria was over too quickly, about an hour and 15 minutes to be exact, encore included. It wasn’t for lack of love from the audience, who immediately ushered the band out for two more songs and would have gladly had them back for more.

Is the Majestic capping its headliners at 75 minutes!? This is, after all, the second unusually short set in two weeks, an unlucky trend that began with Trail of Dead at the Majestic on Sept. 26.

Call me old-school, but I expect at least an hour-and-a-half of music when I pay for a show, unless it’s some underfed white kids playing hardcore at Usain Bolt hundred-meter pace. What is the meaning of a 75-minute show in a day and age when feature films often run twice that long?

According to my roommate, who saw Portugal again in Milwaukee last night, their set stayed about the same, so this length may just be consistent for this tour.

Nonetheless, Portugal rocked the staid masses Thursday night. My only advice would be to singer/guitarist Jason Baldwin Gourley, who needs to step up and become the stage-swaggering frontman his soulful, fluttering voice demands. His sideways hunching at the mic and back-to-the-audience jamming was only endearing for a song or two; then it seemed to raise the awkward question of social anxiety. Look at Jim Morrison — he didn’t get big until he turned to face his audience. Of course, then he took it a bit too far with the indecent exposure bit, but in rock ‘n’ roll, you have to forget “less is more” — more is more.

Linkage analysis

State the obvious version.

- People will buy cheap food, even if it is unhealthy.

- UW research is influential.

- Clouds are pretty.

- You can contribute to crowd-sourcing.

- Badger fans are boisterous.  (Even at the alumni bar here in NYC)

- It’s all too easy to ignore the homeless man on the bench.

- Medical billing is convoluted.

- Immunology is intricate.

Linkage analysis

Fun fact.  You know all those seemingly random generic drug names (basiliximab, desloratidine, etc.)?  There really is a method behind the madness, and the names give you an idea of what the drug can be used for and how it works.  …Ok, that wasn’t really a *fun* fact for most of you, but, for me, realizing some of the patterns was one of those moments where the haze clears and suddenly it’s sunny outside.  Which makes it a tiny bit easier to learn hundreds of drugs for this pharmacology exam…

And just as you need to clean out your medicine cabinet from time to time, it’s time to toss out some old links:

- The NIH is betting on the underdogs, awarding grants to upstart researchers without a long history of publication and also those with ideas that have the potential to be transformative innovation.  Of course the “seasoned investigators” are angry.

- And if you can’t get published, do you just skirt peer review and go to the media?  Under what immediacy?  The media isn’t really qualified to judge scientific research as quality or not…they’ll report whatever they’re fed.  And the public will consume it blindly.

- The annual UW Foundation report shows pretty much what you would expect in a recession.  Though the website itself is beautiful.

- All those excessive medical tests that are being lambasted during this health system reform debate?  An MD examines why doctors order these tests.  And a commenter points out that he probably missed the most important one.  Because time is of the essence, and you can’t get paid for what you can’t quantify.

Trail of Dead in Madison

… And You Will Know Us By the Trail of Dead played the Madison’s less-than-majestic Majestic Theatre* last night, tickling (and then punching out) the eardrums  of both stout business types in suit coats and waifish hipsters in skinny jeans, swaying like dandelions in the breeze. For those who, like I once did, write off Trail of Dead as some boring death-metal band (it doesn’t help that their MySpace account lists this as their genre), the time is ripe to explore their music, which has truly already matured to near perfection. The band’s name must go down as one of the great travesties of modern music for having earned immediate dismissal of what amounts to an indie-rock band with punkish roots and an art-rock future.

At the outset of the concert, it seemed krautrock-revivalists (think Kraftwerk meets Wolfmother) Secret Machines would steal the show. From the first massive kick-crash combo, minds were instantly numbed by the satanic pleasure being perpetrated on the stage in front of us. The band seemed to have to descended from some dark corner of an unknown galaxy (the unblinking wall of floodlights behind the group was surely — my God, could it really be!? — the outside of their spaceship), a place where Black Sabbath had muzzled its singer for good and given free reign to its hard-rock rave-up tendencies.

What went wrong? Their set went too long. At the first faux-climactic ending, my neighbor and I stupidly turned to each other to congratulate ourselves on the mutual testosterone high of good old-fashioned demonic rock ‘n’ roll, only to find our left ears had been permanently dulled for the evening by drummer Josh Garza’s (the man truly does hit like Bonham!) far-too-liberal crash cymbal use.  By the fifth faux climax, we were outside for a smoke.

I was feeling positively wrung out after Secret Machines’ one-and-a-half hour set, and even more so by the time Trail of Dead hit the stage at 11:30, two-and-a-half hours after showtime. I’m still not sure where to place the blame; Secret Machines may have been simply hotdogging it up, or they might have been covering for the late-arriving Trail of Dead. Although the whirring squall of guitars and drums (many songs feature two drummers) were boosted by live amplification, singer Conrad Keely’s reedy voice cut through the wall to carry the melody in harmony with the band’s always-tasty keyboard lines. New songs like “Isis Unveiled” and “Bells of Creation,” no doubt subconsciously crafted by an experienced band to sound just as good in live performance, were the gems of the set.

Otherwise, Trail of Dead focused on older punkish material that doesn’t highlight its gift for melody. Notably and lamentably absent was material from their kick-ass album So Divided. The band seemed to be holding back, keeping their set disappointingly short. So while I’d tell the band to, “Start a little earlier, for chrissakes!,” I’d also tell you music fans out there to pick up their last two albums, So Divided and Century of Self, in that order.

*****

To be fair, I should note that the Majestic is doing well going into the third year of new ownership after its makeover in the fall of 2007, which was prompted by a police crackdown following two shootings and a stabbing.  Although a small venue, the multilevel mixed table-seating and standing in the concert hall provide much more flexibility than the Barrymore’s immense bank of cinema seating, for example.  And the place has a huge number of national acts coming through, despite its size; I’m seeing Portugal. The Man there next week.  Much better to have these acts on the isthmus rather than out in Atwood … But the place still feels a little too so-fresh-and-so-clean for a concert venue.

Individual results may vary

That phrase often appears in the fine print on TV commercials for prescription drugs or in magazine advertisements for over-the-counter drugs.  And there’s a really good reason why, as I’ve been learning this year in my pharmacology course.

You’ve seen the warning labels on drugs:  “Do not take with alcohol.”  “Take with meals.”  “Do not take with food.”  “Tell your doctor if you are taking any other medications.”  “People taking X should not take Y.”

Every drug you take (including food) affects or is affected by your body’s metabolism in some way.  A drug’s course through your body follows the sequence of absorption, distribution (to tissues, throughout the blood, etc.), biotransformation (rendering it useful or useless), and elimination (excretion).   After all this occurs, the drug dosage you’re prescribed isn’t always the one your body feels.  It’s an interlinked system, and introducing a change into it will set off a physiological cascade, with opportunities for variation at all levels, particularly because of genetics and slight polymorphisms in the genes encoding the enzymes that metabolize the drugs.

Enter the field of pharmacogenetics, which deals with how individuals or populations will metabolize a drug differently and thus feel different effects of that drug.  A frontier in medicine is to predict individual responses to pharmaceuticals.

Take warfarin, for example.  It’s one of the trickiest drugs to prescribe and to monitor, with the initial dosing having to be fine-tuned every couple days, because this anti-coagulant confers serious risks of bleeding or clotting if the dosage isn’t correct.  Research shows that variation in 2 genes influence warfarin metabolism and thus its efficacy, and knowing a patient’s genetic profile for those 2 genes would help a physician determine a more ideal dose.  Except Medicare says it’s not (yet) cost-effective to do this genetic testing, so they’re not going to pay for it for their patients.  Even though the FDA recommends it.  Hmm.

Pharmacogenetics can also be used for nefarious purposes.  A deletion of one gene that metabolizes tobacco is seen particularly in Asians.  The lack of this gene can inhibit smokers from quitting, while also slightly reducing susceptibility to lung cancer and emphysema.  So you can keep these smokers alive and addicted, a cash cow for tobacco companies.  It’s not too radical an assumption to believe that tobacco companies have taken advantage of this in developing markets like China and southeast Asia.

These two examples are for particular individuals and populations.  Some implications of drug metabolism affect everyone, simply because of the structures of the enzymes and the drugs.  This has serious implications for people who take over-the-counter drugs like simple ibuprofen (which could modify the effects of the breast cancer drug tamoxifen, etc.).  Herbal supplements (St. John’s wort can inhibit HIV antiretroviral therapy) or even food like grapefruit juice (which reduces the efficacy of cholesterol-lowering statins)…everything interacts with everything else.  Self-medication is potentially dangerous.  This realization was a little shocking to me, as I’ve always thought that OTC drugs were pretty harmless.  But no.  You really do need to tell your doctor about them, especially if you’re on other medication.

And this is one more reason why we need a more integrated health history system and improved continuity of care through electronic medical records.  Because we can’t rely on Grandma to remember every single drug she’s on.  And if she doesn’t report that she was put on Valium by her psychiatrist (she doesn’t even tell you she sees a psychiatrist!) for her depression and you as her primary doctor prescribe her Prilosec for her acid reflux, she might end up in a coma from what is effectively an overdose of Valium.  Where does the liability lie in that case?

I could go on and on here (I’m really excited about my coursework, in case you couldn’t tell).  But the bottom line is, Talk with your doctor.  We’re learning this stuff for a reason.

Broadband, across the land

Money is in the air … $750 billion in stimulus bill funds for broadband development, and Wisconsin wants to get a piece, too. The first chunk up on the block is $350 million for broadband mapping, which will supposedly give states a better idea of where broadband access needs to be improved (although the federal money will all be doled out long before these mapping projects are completed).

The Wisconsin Public Service Commission has been conducting a survey since last March asking residents if they have broadband, and two suits from the regulating agency presented their findings at a joint legislative hearing at the Capitol Wednesday.

It’s actually pretty impressive that the PSC was on this so fast, and survey architect Gary Evenson is far from clueless about the issue. Ever eager, the PSC has even signed a contract with a consortium called LinkAMERICA to do the mapping, pending federal funding approval next week.

But when I asked Evenson about whether the telecoms would give LinkAMERICA the full extent of what they know, he could only reply “Time will tell.” He believes that the presence of a third-party (i.e. LinkAMERICA) and non-disclosure agreements (which may pose a problem when it comes time to publish all this mapping info on a web site, like the PSC has said it wants to do) will encourage the telecoms to be truthful.

When will we realize that big money is never truthful, if it doesn’t have to be? It’s much better, from the telecoms’ viewpoint, to blur the picture: They’ll claim to provide service based on proximity to Internet service infrastructure, even if there’s no actual access for the homes in question, they’ll label grandma-in-a-walker Internet speeds as “broadband” service, they’ll simply shut up so as not to let competitors (we have many small-time telephone and Internet providers in Wisconsin, and Verizon has chronically under-invested here and left itself vulnerable) know where to counterattack.

Just look at what Connected Nation, which has been contracted to do broadband mapping in many states, including Minnesota, did in North Carolina; they created a map with telecom dollars that showed 92 percent of the population had broadband access. Really?! LinkAMERICA is not quite as in bed with the telecoms, but that’s no guarantee it won’t also get taken for all its worth ($3 million, if the PSC gets its funding).