Graham Azon Is Impressive

January 9, 2007

I am so completely impressed with this Stanford medical student.  Please take a look at what he has made (video):

Doctors, nurses, med students, patients, we should be embarrassed.

Welcome 2007. You can email, send instant messages, order airline tickets in seconds, track that airplane as it flies across the globe, manage your calendar, work on documents and spreadsheets in real time with your friends and colleagues, even read newspapers from around the freaking globe. But our computerized medical records (or whatever you want to call them) can’t even print out labs in the right order. This is, in a word, ridonkulous. Hospitals and clinics should demand more. The big medical record makers should provide more. Their interfaces, truly, look like they’re from 1990.

I have spent a little over a year in hospitals, working as an upcoming doctor, and I’ve seen 8 completely different electronic medical records.

Over the year I’ve tried to collect ideas about the best features (and worst) of these different systems, and I’ve put them all together in something I call (for lack of better): the GMR (Grahamazon Medical Record).

Reason to go to Medical School: AIDS in Africa

December 12, 2006

Prevalence rates of AIDS in AfricaI’m in medical school (partly) because I can’t shut my brain off and need to constantly be assuming information.  Boredom is a fate worse than death and this field is the balm.  So aside from reading about Infectious Diseases for my Pathophysiology exam this Thursday, I’m also reading the blogs of Cosmologists, Financial Advisors, Politics, and Economists.  Today, we have synergy.

In Infectious Diseases, I’ve just learned about the rates for sexual exposure to HIV among different groups.

  • Male exposes Female (1/200 – 1/2000)
  • Female exposes Male (1/700 – 1/3000)
  • Male exposes Male (1/10 – 1/1,600)

Do those look low to you?  These rates are not sufficiently high to either cause or sustain an epidemic!  So how the hell are these epidemics sustained in Africa?  The hypothesis provided in my notes:

  • HIV transmission rates are too low to explaoin the epidemic
  • HIV transmission is intermittently amplified by increasing genital tract shedding
  • Amplified transmission is critical to the spread of HIV

So imagine my absolute excitement to find this article by the famous economist, Emily Osler!  Three Things You Don’t Know About AIDS in Africa.

  1. It’s the wrong disease to attack
  2. It won’t disappear until poverty does
  3. There is less of it than we thought, but it’s spreading as fast as ever

I encourage you to read it for yourself.  But we’re not done yet.  If you really want to stretch your mind, you have to surround yourself with mind-stretching ideas.  That’s where TED comes in.  Technology Education Design is an annual conference that brings together remarkable people from around the world into one space to share something valuable: their ideas.  I subscribe to the TEDTalks Podcast and often listen to these 20 minute videos again and again (if you don’t use iTunes, you can listen to them on the web here).  And thanks to this wonderful resource, I’ve learned about Larry Brilliant.  He is a physician and his life story is remarkable including living in India for 10 years studying under a Hindu sage, becoming a diplomat for the United Nations, and in his capacity as an epidemiologist he presiding over the last case of smallpox on the planet.  In his talk (you can listen to it here) he describes the effort it took to hunt down the disease, door to door, over and over, for years.  He’s amazing, and it will take people like him to actually take what we are learning about the spread of AIDS in Africa and actually turn that information into eradication.

And I wouldn’t have put any of this together if I had decided to study something else.

Recommended Links 01

December 11, 2006

Thanks to the brilliant folks that invented aggregators, I have the ability to subscripe to over 60 blogs and have their new posts sent straight to me without having to check their site each day. If you haven’t picked one up yourself, I highly recommend them. They are so choice. My favorite is Google Reader though I hear that RSSOwl is also good and would suffice.

So I read a lot and a good portion of it is worth sharing. If you’d like to see everything that I think is worth sharing, click here. While I can’t contribute just now (test tomorrow morning and on Thursday, followed by celebration for finishing up the first two years of medical school) I thought I’d offer a few links to keep you busy.

Aggravated DocSurg writes,

“I belong to this quirky group of docs that gets together once a month — we have a few adult beverages and a nice dinner, and then each evening two of us give a talk.”

He then gives us his story about Rudolf Erich Raspe. I have read this article three times over and still want to read it again. I can’t imagine the thunderous applause that greeted him when he finished. If you’re like me and want to know more after reading it for the fourth time, bone up on “The Surprising Adventures of Baron Munchausen.”

Steve Mirsky writes Antigravity for Scientific American and he always Read the rest of this entry »

No Right to Health Care

December 9, 2006

I’ve been thinking a lot about health care and the mess I’m about to inherit in the next couple of years as I earn my MD and enter Residency training.  As a student of medical blogs, it’s hard to be keep my head in the sand about such things as they clearly occupy a good deal of the discussions.  So right now I’m addressing the perceived “right to health care.”

I’m against it and here is why.

When we think of our rights, we often think about the Bill of Rights and the Amendments.  The right to bear arms, the protection from unreasonable search, the right to peaceful assembly and the right of free speech.  The common thread in these rights is that they

  • cost nothing to maintain or respect
  • requires other persons to refrain from violating it in order to fulfill it

These are referred to as Negative rights.  If you leave me alone and I leave you alone, we have maintained these rights and violated nothing.  Now if you look at the proposed Right to Health Care, you will notice that this fails both of these standards.  It instead

  • costs a great deal
  • requires other persons to perform a service in order to fulfill it

These are referred to as Positive rights.  Under this right, if I fail to provide you the service of Health Care, I am violating your right to my service.  And now we reach the crux of my argument:

I do not recognize your right to my service.  I instead take this time to remind you of Section 1 of the Thirteenth Amendment which states:

Neither slavery nor involuntary servitude, except as a punishment for crime whereof the party shall have been duly convicted, shall exist within the United States, or any place subject to their jurisdiction.

Dramatic, no?  The Thirteenth Amendment is a perfect example of a negative right and I find it defensible as such.   If you’d like a more contemporary quote, you need go no further than Ayn Rand:

“I swear by my life, and my love of it, that I will never live for the sake of another man, nor ask another man to live for mine.”

I think that the goal of providing Universal Health Care ffor the United States is an admirable one, but I object to the justification used and the way people want to implement it.  But that’s for another post.  In the meantime, if a proponent of Universal Health Care cannot successfully address my simple argument above, then that person needs to seriously reevaluate their support of the idea and their attacks against physicians (both present and future) that object to it.

Though I am training to provide a service, that does not make me your servant.

Wikipedia has a great entry on Positive and Negative rights.

A Monty Python Grand Rounds 3.08

November 14, 2006

historian smallHello there! I am A Very Famous Historian and I welcome you to the Grand Rounds. From a field of over 60 submissions, 26 authors have been chosen to seek the Grail. It will be a dangerous journey full of peril and death may await with nasty big pointy teeth. We shall see if anyone makes it out of these woods….alive. Feel free to traipse past all quotes.

Burn HerA point of disclosure: Kim has written a provocative piece about how a famous historian should edit Grand Rounds for quality and content and it has informed my every decision. I have decided to change the title to Two Bloggers, Two Voices, One Opinion. On second thought — she’s a witch and we should burn her! [everything in italics will have sound in a separate window] Read the rest of this entry »

Millions for Millions

October 23, 2006

This is a wonderful idea and a well written piece from The New Yorker. Full article.

Yunus, a silver-haired man of sixty-six with a round, luminous countenance, is a highly gifted interlocutor between the extremely poor in the developing world and the West, and for years he had been seen as a candidate for the Nobel Peace Prize. (This December, he will go to Oslo to receive it.) During the famine of 1974 in Bangladesh, when the dying lined the doorsteps of the better-off in Dhaka, Yunus, an economics professor at Chittagong University, found the theories he was teaching maddeningly irrelevant; so he went into a neighboring village and began talking to the poor. He experimented with ways of helping them—initially, he lent twenty-seven dollars to a group of forty-two villagers—and before long he became convinced that he had a remedy for their condition: providing very small individual loans to the impoverished to start activities ranging from making bamboo stools to buying a dairy cow. In 1976, after local banks refused his entreaties to make the loans, he resolved to do it himself, and he founded the Grameen Bank.