Study Biases with Eponyms

Berkson's Bias: selection bias using hospitalized patients as the control.
Berkson's = Bad/sick patient
The history: Berkson was a statistician who recognized that small, selective sampling can cause false correlations.
The problem: "N vs n," statistically.  The data is a poor representative of a greater whole.

Pygmalion effect: Expectations affect the outcome.
Pygmalion = "Pointed": hidden agenda, "a self-fulfilling Prophecy"
The history: Pygmalion is a play in which a professor makes a bet that he can make a poor girl act like a lady. (aka My Fair Lady.)
The problem: unconsciously, researchers and participants conform to predisposed expectations.

Hawthorne effect: a tendency for those studied to affect outcome due to their knowledge of the study
Hawthorne = Heisenberg
The History: Hawthorne Works was a factory that studied the way lighting affected their workers. Productivity got better when the lights were dimmer. It also got better when the lights were brighter. Soon they realized it was because of the novelty of change (and the presence of researchers.)
The problem: observing someone affects the way they act.

Sick of the club facade.

I just received an invitation to the first "Pulmonology Medicine Interest Group" meeting ever! (for my school.)  The signature was questionably left blank as was the agenda.

Frankly, I am getting quite tired of the "Interest Group facade."  I was pretty involved in the Interest groups as an MS-1 -- there certainly seemed to be a lot of them.  Here's the list I compiled from last year:

American Medical Student Association

Business of Medicine

Cardiology Interest Group

Christian Medical and Dental Association

Emergency Medicine Interest Group

Family Medicine Interest Group

Geriatrics Interest Group

Global Health Interest Group 

Indigenous Medical Student Group

Infectious Disease Interest Group

Internal Medicine Interest Group 

LGBT group

Medical Student Mentorship Program

OB/GYN Interest Group 

Pediatrics Interest Group

Philippino Student Medical Association

Psychiatry Interest Group

Student Interest Group in Neurology

Surgery Interest Group 

That's an impressive number of active clubs.  I emphasize ACTIVE based on emails only since I obviously don't go to all of them.  There's been a number of flops.  I recall the development of an Asian-Pacific American Medical Student Association (APAMSA) that sort of disappeared (ironic, considering that the majority of our students fall into this category.)  I attempted to start up an Ethics Club in my first year, but only two other students showed up.  It was then that I realized -- medical students are busy, especially third years.  We've got such a small class size... you're lucky if you can get 5 or 6 people to show up for an interest group meeting.

Now theres the Opthalmology Interest Group and the Rural Health Interest Group to add to the list of club spams.  I signed up to be a part of the RHIG because I am interested in the idea even though my stay in Maui means I won't be able to actually go to any meetings.  I haven't heard of any future meetings though.

Certainly, there are some that are more successful, like the Surgery Interest Group (I showed up to a meeting for some food) and the Emergency Medicine Group (again, food is a big bonus.)  Really, food+drinks (depending on alcoholic content) + sociability (rubbing elbows/nose against something else with doctors in your desired profession) is the only motivation to draw people out of their homes and study carrels to an Interest Group meeting.  It's an academic thing that doesn't give you credit.  Unless you're a club officer, I suppose.  And that's the crux of the whole thing... why I'm calling BS on the whole idea.

There was a time at my med school when there was just one interest group -- family medicine.  Other interest groups came and went, but they stuck around and continue to host Tar Wars as a community service activity.  They were by far the most popular club.

My rant is certainly based on this bias that Subspecialty interest groups contribute little to the interest in these specialties unless they can persist beyond their originators and for more nobler reasons than resume padding.

I can't speak for other students, but I certainly think "wow, another club? really?" when I get emails about the "first meeting" of _____(insert sub-specialty here) interest group.  How many of these people are really going to pursue a career in opthalmology, cardiology or pulmonology?  I feel like they are diluting the Primary Care clubs like Internal Medicine (who can easily host talks on Neurology, Optho, Cards and Pulm), Family Medicine (of which I am a part, though I've gone to ZERO meetings this year), Pediatrics, Psych, etc. UGH.

Sorry.  I had to get that out of my system.

About Me

I am a Gemini. Now that I've said that, I will do my best to backtrack and say that I do not put any faith into horoscopes (beyond simple self-selecting positive characteristics. In my case, I'm two-sided.)

I see-saw in my extrovert-introvert nature. I love being with people; they energize me. I'm also perfectly content going home and studying by myself day after day. Perhaps the realm of the inner-reflective self and the outwardly-social me are not mutually exclusive.

I used to be sarcastic, but now I've become too sensitive to speak with such caustic irony. I doubt I have the heart to use the barbed wit that I once wielded.

I sing like a mockingbird. I do well copying the songs with others, but I cannot hold my own in a solo.

I love biology. In it, we define ourselves and the living world around us. I think that nature has so many secrets to share with us if we just listen... but so many people get caught up with the insignificant factors in their lives that they get pulled right out of living.

My biggest fear is complacency. I do not want to become a part of the Combine.
My next biggest fear is failure. I hate it when I try hard to do something and I fail.
These two fears have driven me to "exceed" in a way very similar to ambition.

If you haven't caught on already, I'm analytical to the core.

Ectopic haiku

Tubal pregnancy:
Entangled adnexa hold

A uterine gift.

Photo by euthman, Ed Uthman, MD

(FYI, most ectopic pregnancies do not look this developed -- the two I saw yesterday were ~4-6 wk gestational age; this one is 9 weeks.)

Adverse Drug Reactions should be "tagged" in clouds

Adverse drug reactions (ADRs) are quite common in the elderly, given their longer lists of illnesses and medicationsl in combination with failing kidneys and livers. ADRs are the 4th leading cause of death ahead of pulmonary disease, diabetes, AIDS, pneumonia, accidents and automobile deaths!

Yet a significant portion of reported "side effects" are confounded by other factors -- patients taking medications are sick and they can worsen in certain ways regardless of medications taken.

The U.S. errs on the safe side and reports all known and reported side-effects on the information packet that comes with drugs. These are intimidating and long lists. How are patients and future clinicians (such as myself) supposed to know which are the important side effects to watch out for among the long list of "CYA (cover your anus) reporting/disclosure"?

I propose that all adverse drug reactions and allergies should be in a "tag cloud," the way webpages are tagged with various categories. The most common reactions will grow in font size relative to their frequency. The most cited reactions in journal articles, relative to their danger AND frequency will also grow in size.

This will be a great way to visually assess the important reactions related to a particular drug! Maybe someday, drug interactions will be seen by associating two tag clouds together and noting the strengthened connections.

References:
Center for Drug Evaluation and Research -- Preventable Adverse Drug Reactions: A Focus on Drug Interactions
Nebeker JR Clarifying adverse drug events: a clinician's guide to terminology, documentation, and reporting. Ann Intern Med. 2004 May 18;140(10):795-801.
How to report adverse experiences to the FDA

Hernias RIP a hole

What are the borders of the Hasselbach triangle?
How can you remember the difference between an indirect (50% of all hernias) and a direct (25%) inguinal hernia?

think: Direct inguinal hernias RIP a hole Directly through the abdominal wall.
Rectus abdominus
Inferior epigastric vessels
Poupart's ligament (also called the inguinal ligament)

References:
Surgical Recall

"Overrated Career: Physician 2009."

http://www.usnews.com/articles/business/best-careers/2008/12/11/overrated-career-physician-2009.html

The Appeal: You get to help keep people healthy and cure them when they're sick. Prestige is high, and so is the pay.

The Reality: Fewer and fewer patients see their physicians as godlike, especially those who go online for medical information. Doctors are spending less time than ever with patients and more on paperwork. Insurers keep hacking away at physician costs. And it seems increasingly more likely that physician pay will decline as part of healthcare reform. Also, their workload will more likely increase as the existing cadre of physicians may be required to care for the 47 million currently uninsured people in the United States.
...

An Alternative: Physician Assistant

Heh. Funny how being a PA is more desirable in this economy than being a physician. Don't get me wrong, physician extenders like PAs are an important part of our health care system in providing routine services to patients -- but why would it be more attractive to get two years less school training and skip residency altogether only to become essentially a resident for the rest of your career? I understand that there are more opportunities to enter practice as a PA than an MD. Slots for med schools are slim to none. More and more PA schools are opening up to meet the growing demand.

The thought that makes me most uncomfortable with this trend is not that PAs are taking on more and more work that MDs used to do. It is that the PUBLIC often does not know the difference. After all, PAs and MDs both wear white coats, sit down and talk with you after the nurse sees you and takes your blood pressure. I think that there needs to be more of a distinction so patients don't feel cheated (and I've had a few complain to me) when they realize that they've been going to the doctor's office only to learn that the person they are seeing is a PA under wraps.

"Evidence-Based" Pre-Meds!

Premed survival: understanding the culling process in premedical undergraduate education. Lovecchio K, Dundes L. Acad Med. 2002 Jul;77(7):719-24.

n=97, 100% response rate
44 decided to pursue another career

Premed students were attracted to the field by the intellectual stimulation and the power to help others, yet most were also very concerned about being in debt, dealing with patients who might die, and the compatibility of medicine with having a family.

Women students were more concerned than the men about having only limited time to become acquainted with patients on a social level.

The decision of students to forgo a career as a physician was shaped by apprehensions regarding the years of work required in residency, the need to be on call, unacceptably low grades, and the realization that other attractive career options are available. Of those who said low grades were a deciding factor, most (78%) named organic chemistry as the single course that had affected their plans.

When I was in undergrad, it was almost a "bragging" right to say that you finished o-chem. Of course, for the chemistry majors I bet it was met with silent indulgence as they moved on to physical-chemistry, meta-physical chemistry, spiritual chemistry (or whatever the progression is.)

It's interesting how o-chem IS the filter for all pre-meds. The phenomena can be observed within the class itself -- starting the year with a room full of students and in the course of a week, a month and after the first quiz -- seeing the class cut down by a third, a half, and then 2/3s of its original size.

The irony is that once you get to med school... you don't need to know any o-chem at all. Sure, it's nice to know what NMR is for certain tests in neurosurgery to detect brain tumors (Hunter's angle and such.) It might come in handy when trying to recall the name of some obscure biological molecule based on what it looks like (like p-aminobenzoic acid) . The reality is that MANY of the facts of life in undergrad do not apply in med school. Perhaps that's not such a bad thing after all.

How long does it take before I feel a lump?

Here's some of the questions that might come up in the clinic relating to breast cancer detection.

Why do I have to get so many uncomfortable mammograms?

How long does it take for breast cancer to develop before I feel a lump?

Robbins Pathologic Basis of Disease elegantly answers:

"One can begin the consideration of tumor cell kinetics by asking the question: How long does it take to produce a clinically overt tumor mass? It can be readily calculated that the original transformed [cancer] cell (~10micrometers in diameter) must undergo 30 population doublings to produce 10^9 [one billion] cells (weighing ~1gm) which is the smallest clinically detectable mass.

In contrast, only 10 further doubling cycles are required to produce a tumor containing 10^12 [one trillion] cells (weighing ~1kg), which is usually the maximal size compatible with life."

Sadly, the corrollary to this is that by the time a solid lump is felt in your breast, the cancer has already been doubling for 30 generations BEFORE IT EVEN BECOMES A CENTIMETER IN SIZE, giving it plenty of time to evolve plenty of ways to evade your immune system, develop resistances to drug treatments, etc.  That's why surgery, radiation and chemotherapy are often done in tandem to reduce the risk of spreading.

The good news is that mammography can spot smaller lumps, before they can be felt by physical exam.  The bad news is that mammography is an imprecise image of the processes going on in the breast which leads to the occasional false-positive (getting an unnecessary biopsy) or false-negative (lump is not very suspicious and the diagnosis of breast cancer is missed.)

US is the future of imaging

Should a hand-carried ultrasound machine become standard equipment for every internist?

I say YES!
I'm very excited by ultrasound.  It's used by dolphins, bats, the navy and OB/GYNs. It is harmless, non-invasive, fast, and it is easily performed at the bedside or in the clinic. It can diagnose a lot of fetal conditions, heart, vascular, joint and GI problems. A doppler can detect pulses and heartbeats that a stethoscope cannot. I want to be well-trained in the use of the US before I start my own practice... I foresee an explosion in its potential uses in the near future.

The only downside is that it is "operator-dependent." What does that mean?  You need to be well-trained and KNOW what the heck you're looking for, how to find it and how to interpret the image you're seeing.

Here's how I read an ultrasound, using some super basic tips I picked up from observing some US exams.

You need to be in a position to simultaneously watch the screen AND the hand of the operator. A lot of people make the mistake of looking at the image on the screen itself and they get totally confused by what they see. A slice of a face may briefly pop into view only to be replaced by a round circle with the dark devil horns in the middle. The observant one would notice that the US operator merely rotated his hand to "slice through" the face to visualize the cross-section of the fetal brain and ventricles.

Imagine the transducer (the probe) as the handle of a spatula and the image on the screen as the face of the spatula underneath.

This simple visualization exercise combined with the subtle spinning, pressing, sliding and tilting of the transducer will help you figure out what's going on.

Want to learn more about the ultrasound machine? Visit: HowStuffWorks "How Ultrasound Works"
Spatula image courtesy of beer_squirrel

Obama's Inauguration

A Chant for Obama from Hawaii by Manu Ikaika, leader of Halau Ho'omau I ka Wai Ola O Hawai'i in Alexandria, Va.

E nana i ke ali'i, he kanaka ikaika
He keiki o ka 'aina kupono la e
He pua o Hawai'i, i kuhia i alaka'i
Nana e ho'oulu i ka pono, aloha e
'Ike 'ia ma ka lani la ka hikina 'ana mai
Ka 'imi 'ana i ka pono me ke aloha
Paulele 'ia ihola ka hulina
'Oiai mau ke ea o ka 'aina i ka pono
Ha'ina 'ia mai ana ka puana
Hiki mai ke alaka'i e ho'oulu hou
Uluhia maila
ke ola o ka 'aina
Aloha no, e
He inoa no Barack Obama

THE LEADER OF INSPIRATION COMES
TRANSLATION:
Look at our leader, a strong person is he
A child from the land of righteousness
A child of Hawai'i destined to lead
Who will make goodness flourish, with aloha
Signs in the heavens tell of the coming of a new chief
Working for righteousness with love
Belief in change is instilled in the heart
For the life of the land is perpetuated in righteousness
Let the story be known in the telling
The leader to renew inspiration has come
The living essence
of the land flourishes
We offer loving regard, indeed
A name song for Barack Obama

Politicians in Hawaii call him "our Native son" on the news, but everyone here calls him "local boy." The word "local" has a strong connotation here of belonging, of family. So we're proud that someone from the islands will step up to the podium and become one of the most powerful figures in the world. He's already gained so much respect and admiration for his achievements on his way to the top.

I remain hopeful for change (his buzzwords have been ingrained into my skull.) He acts with a purposeful sense of deliberation and calm that gives him an aura of leadership our country has been lacking for a long time. May he be up to the task of bringing us all together as one ohana.

[edit] Messed up on the link to the Obama chant. It has been corrected.

A Shock for the ED Doc

Hawaii doctor didn't realize beating victim was her father

When Dr. D treated a savagely beaten man Tuesday at The Queen's Medical Center, she did not recognize the victim as her father.

Dr D didn't learn the truth until "later that evening when my brother called me," she said at a news conference yesterday.

"It was a shock to me," Dr D said as tears tracked down her face.

My dad brought this piece of news to my attention last night. *sigh* I cannot even imagine the shock and horror that she must have felt, realizing that the brutalized victim she triaged and treated was in fact her father.

"Has this ever happened to you?" My dad asked. "Well, it's only a matter of time..." Hrm. I hope I am never put in this situation. A chill will certainly run down my spine whenever I'm in the ER though and a person rolls in beaten beyond recognition. It will remind me though, that the best treatment for a patient is to care for them as if they were a member of your family.

The irony is that knowing you're treating a family member suddenly changes everything and you risk losing objectivity. This conflict of interest can manifest itself as a desire to "do everything" and feel the need to be supremely heroic which may in fact extend their suffering. So I think, the solution is to treat all patients as family but refuse to treat family. Sad but necessary to provide quality care based on experience and judgment rather than emotion and stubbornness.

Chinese Dairy Buys off Parents and Texts "Sorry"

This is outrageous.

Milk Scandal in China Yields Cash for Parents

The parents of a baby who died last May from drinking tainted milk formula have accepted a cash payment from the dairy company at the center of a nationwide scandal, a lawyer representing the parents said Friday.

The parents, Yi Yongsheng and Jiao Hongfang, are the first to receive compensation for the death of a child from tainted milk. They have accepted more than $29,200 from Sanlu Group, the manufacturer of the baby formula that their 6-month-old son was drinking before he died, said the lawyer, Dong Junming.

China dairies offer text apology

Chinese dairy companies involved in the tainted milk scandal have apologised in a New Year text message sent to millions of mobile phone subscribers.

"We sincerely apologise...and we beg your forgiveness," read the note from 22 dairy firms, led by the now-bankrupt Sanlu, China's state news agency said.

At least six babies died and 290,000 became ill from melamine contamination in milk products made by the companies.

I can't believe it... with ethical violations, gross negligence and intent to harm for a measly profit of selling milk as "more nutritious" due to the addition of a renal toxin ... the best that they can do is give them 29K for dead kids and TEXT "I'm sorry?!?!"

That's just cold. The Chinese government has even gone as far as intervening to prevent demonstrations (and avoid riots... afraid that they will speak out against the government too?) So I guess they think it's ok that the Chinese corporations can get away with murder while the parents of victims are being treated like criminals.

[edit] Melamine and the Global Implications of Food Contamination article in NEJM.

whoa!

to those of you who might have subscribed to my feed and have noticed the sudden influx of posts... from a blogger you thought was dead and gone... hello!

I'm going to do the awful thing of meta-blogging, a self-serving, useless and noisy post that amounts to nothing in the greater blogosphere. However, talking about relevant and poignant posts will be precisely my goal for this meta-blog entry.

First up on the point of news, I've moved to Maui for 5 months where I will be finishing up my third year of medical school. I completed 6 months of inpatient rotations on Oahu in Queens, Kapiolani and Kuakini hospital. As a member of the third-year longitudinal program, I have the distinct pleasure of getting to live on a neighbor island, get to know a community and precept in several clinics.

Second up on the point of news, my girlfriend broke up with me three weeks ago. It was difficult to spend time with her in the initial part of the third year and we both recognized how much harder things would get. Our paths converged for a wonderful 3 months and then a subsequent sometimes frustrating/content/puzzling 3 months... but now our paths have diverged. I'm trying to have the insight and wisdom not to dwell on it too much while taking the best of it, learning and moving on.

Both of these bits of news mean that I am now going to resume my devotions to blogging. I have kept up reading other blogs, but when it came to the creation of my own material, often the only things I found worthwhile preserving out in cyberspace were a list of mnemonics I found helpful on my journey to the MD.

I recently divulged my true name onto the site of this blog. Frankly, this idea terrified me. I had a lot of great lessons to share and stories to tell from my hospital experiences, but I didn't want to have a repeat of an experience like this; where my pseudonymity betrayed me. Hopefully the passage of time has colored these experiences and I can share some of the details without violating anyone's right to privacy or bad-mouthing any particular resident or attending. I will be scheduling many of my posts which should help with the release times (and in case any of my patients check out my blog, they would be hard pressed to recognize themselves or anyone they know in my stories.

What Kind of Person are You?

In my Senior year of college, I performed a monologue at the end of the semester. I read through a few and I really liked the two I found, back to back, in the play entitled A Thousand Clowns. It's about a funny writer who quit his job working for a syndicated children's show. Because he lacks financial security in his life, he might lose custody of his very bright, very mature nephew. His brother tries to convince him to get back into working for the show... and they both reveal their character secrets. It's a very powerful moment on the stage.


MURRAY: Oh, Arnie, you don’t understand anymore. You got that wide stare that people stick in their eyes so nobody’ll know their head’s asleep. You got to be a shuffler, a moaner. You want me to come sit and eat fruit with you and watch the clock run out. You start to drag and stumble with the rotten weight of all the people who should have been told off, all the things you should have said, all the specifications that aren’t yours. The only thing you got left to reject is your food in a restaurant if they do it wrong and you can send it back and make a big fuss with the waiter…

Arnold, five months ago I forgot what day it was. I’m on the subway on my way to work and I didn’t know what day it was and it scared the hell out of me…

I was sitting in the express looking out the window same as every morning watching the local stops go by in the dark with an empty head and my arms folded, not feeling great and not feeling rotten, just not feeling, and for a minute I couldn’t remember, I didn’t know, unless I really concentrated, whether it was a Tuesday or a Thursday… or a … for a minute it could have been any day, Arnie… sitting in the train going through any day… in the dark through any year… Arnie, it scared the hell out of me.

You got to know what day it is. You got to know what’s the name of the game and what the rules are with nobody else telling you. You have to own your days and name them, each one of the them, every one of them, or else the years go right by and none of them belong to you.

And that just ain’t for the weekends, kiddo… here it is, the day after Irving R. Feldman’s birthday, for God’s sake… And I never even congratulated him…

ARNOLD: MURRAY!

MURRAY: What’s so funny?

ARNOLD: Wow, I scare myself. You hear that voice? Look at that, I got you to stop, I got your complete, full attention, the floor is mine now… and I can’t thing of a God-damned thing to say…

I have long been aware, Murray… I have long been aware that you don’t respect me much… I suppose there are a lot of brothers you don’t get along… But in reference… to us, considering the factors… Sounds like a contract, doesn’t it? Unfortunately for you Murray, you want to be a hero. Maybe if a fella falls into a lake, you can jump in and save him; there’s still that kind of stuff. But who gets opportunities like that in midtown Manhattan, with all that traffic. I am willing to deal with the available world and I do not choose to shake it up but to live with it. There’s the people who spill things, and the people who get spilled on; I do not choose to notice the stains, Murray.

I have a wife and I have children, and business, like they say, is business. I am not an exceptional man, so it is possible for me to stay with things the way they are. I’m lucky. I’m gifted. I have a talent for surrender. I’m at peace. But you are cursed; and I like you so it makes me sad, you don’t have the gift; and I see the torture of it. All I can do is worry for you. But I will not worry for myself; you cannot convince me that I am one of the Bad Guys. I get up, I go, I lie a little, I peddle a little, I watch the rules, I talk the talk. We fellas have those offices high up there so we can catch the wind and go with it, however it blows. But, and I will not apologize for it, I take pride; I am the best possible Arnold Burns.

Speculations on Life (2)

Energy is infinite. It hops in and out of "existence" constantly, summoned forth in exactly equal amounts of counter-energy, thus giving us the illusion of stability when really, every point is boiling over with this completely balanced, but supremely connective notion. My grasp of the physical world as we know it, is that we are a series of values and positions, most likely composed of vibrating strings of energy/mass... but the closer we examine things, the more they break apart.

I like to think that life is the same way. However, life is a force that is by nature, unbalanced. It is wild, wrestling with energy of all sorts, taming it and finally locking it down into painful staticity. It moves with direction and it has but a single intent. Stay alive. PERSIST in this roil of chaos. Other goals crop up later, should this one fail (and it always does.) Make a legacy. Make an impact. Change the world, whatever that might be.

Life's attempts to build a world are ultimately futile. Everything that is harnessed, altered or "created" is someday broken, destroyed and lost, from the kindergarten ash tray art project to the glucose molecules you've stolen away from some other poor struggling organism, as devoted to life as you or I. I feel no guilt eating the flesh of another creature or chomping the vegetable matter of one of my really distant plantcestors. My moral pain or their physical pain -- it's a choice I make everytime I sit down to eat.

Life is a terrible competition. We fight daily in ways that we aren't even aware of. I kill myselves everyday just to stay alive. If I didn't, I would be so selfish that all sorts of cancers would take over my body and totally cripple me. WE aren't what we think we are. There is no I, only a collective ME/WE. Every cell in my body struggles to live as much as the next, but some make sacrifices. They all devote themselves to tasks assigned to them following day one when the Originator-zygote was formed from the union of dad-sperm and mom-egg.

Speculations on Life

Let's start at the beginning.

In the Book of Genesis, Adam was formed out of the dust of the earth (hence his name, which means "red earth"), and God breathed into his nostrils the breath of life. In the Korah, God created man out of clay and told him to "Be!" and he was. (wikipedia told me so.)

In my opinion, these symbolic texts are closely linked with the current views on the more scientifically derived speculations on the origin of life. The panspermia/exogenesis theory proposes that life drifted down from the stars on the dust of comets. These lumps of ice and rock are known to have biological precursor molecules. The silicate theory claims that the slow accumulation of the right rudimentary particles on the surface of clay gave rise to life. Of course, there are problems with these theories.

Despite Biology's current insistence that there is no such thing as "spontaneous generation," which was a belief carried into Medieval times that things like flies were created from dead meat... the question of First Life begs the question. How did life derive from non-life?

Does it have to? How do we define life? Here are a few biological requirements:
1) metabolism -- processing of chemicals for sustenance
2) growth -- gaining complexity/maturity
3) reproduction -- generation of offspring
4) response to environment -- reacting appropriately to situations
5) made of cells

However, this is not all encompassing. It still has embarrassing holes. If it could exist, what would we consider artificial life? What about digital, artificial, manufactured intelligence? Why do we sometimes confuse dead things, or inanimate objects with live ones? What about viruses? They fulfill the first four pre-requisites, but it is not a cell. Perhaps our scientific definition works for our world, but it needs revising to match the more basic, simpler world when life as we know it did not exist.

A few years ago, a friend asked me to fill in the blank for "Life is ___." It took me a while to come up with a thoughtful definition that I liked, but I decided on "Life is directed, anti-entropic force."

I still find it to be the most relevant and striking definition I've ever come up with... reminiscent of Buckminster Fuller's definition of the universe:

"Universe is the aggregate of all humanity's consciously apprehended and communicated nonsimultaneous and only partially overlapping experiences."

`` `Aggregate' means sum-totally but nonunitarily conceptual as of any one moment. `Consciousness' means an awareness of the otherness. `Apprehension' means information furnished by those wave frequencies tunable within man's limited sensorial spectrum. `Communicated' means informing self or others. `Nonsimultaneous' means not occurring at the same time. `Overlapping' is used because every event has a duration, and their initiatings and teminatings are most often of different duration. Neither the set of all `experiences' nor the set of all the words used to describe them are instantly reviewable nor are they of the same length. Experiences are either involuntary (subjective) or voluntary (objective), and all experiences, both physical and metaphysical, are finite because each begins and ends.''

Some might find this overly technical... but in my mind, its pure philosophical poetry.

Family History Health Profile

I had to write an essay about "Illness and Coping" for family medicine. It was not very good, otherwise I'd share some of that information here with you. However, one good thing did emerge from my reflection and subsequent discussions with my parents and grandparents... I learned more about my personal family history health profile.

My family is remarkably healthy and long-lived. My Baban (grandmother) and great-Baban on my mother's side both had dementia and lived to their 80s-90s in spite of it, much to the concern of my mom. (I assure her that mental fitness decreases the risk of developing Alzheimer's.) Other than that, my family has not had to go through any ordeals with cancer, mental illness, diabetes, heart attacks or anything like that.
----

Perhaps the talk about family history came up with a physician when discussing risk factors for cancer or heart disease in a visit you've had. Sometimes MDs will even take the time to do an in-depth family tree, tracing back lineages using as much detail as possible to explore genetic, and acquired multifactorial diseases, with an exhaustive list of things including, but not limited to:

* Cancer
* Heart disease
* Diabetes
* Asthma
* Arthritis
* Mental illness
* High blood pressure
* High cholesterol
* Stroke
* Kidney disease
* Alcoholism or other substance abuse
* Birth defects
* Vision loss
* Hearing loss
* Learning disabilities
* Mental retardation
* Miscarriages or stillbirths

(via Mayo Clinic's Medical History page)

Hear more clinical information with this mp3 about Family Health Portrait
or visit MedlinePlus.gov for more information about Family History, including a handout to print out and use when talking with your family.

[update]
Surgeon General's tool for creating a Family Health Portrait.
It's a little slow to load, but its thorough (and you can email it to family members to fill in the blanks!)

(via AP, hat tip to sandybeach)

Creativitity galore in Crayon Physics

Crayon Physics Deluxe from Petri Purho on Vimeo.

I loved playing the demo version of this game and now the deluxe version is available! :) Check it out... here's a Crayon Physics review that Petri Purho, designer, really liked:

Now, my live-in boytoy Zach is an artist. He keeps plenty of scribbleware around the apartment - including crayons. Truth be told, he loves crayons. And he loved Crayon Physics Deluxe. In no time he was sketching - wait, do you sketch with crayons? - no, he was doodling fantastic monstrosities and elaborate Rube Goldberg devices. The virtual reality of it had him hooked. I’ve long been suspicious of cuteplay, where a precise blend of childishness and verisimilitude charm the player beyond argument. The outside world thinks games are an apocalypse of blood and bare breasts, and yet grown gamers want nothing more than teddy bears, baby schema, and the same damn Mario system after system after system.

The lesson here is that kids understand what crayons are all about. I foresee an entirely new gaming industry that will be based off of this idea.

Think about this if you will: kids love to grab a crayon and just go wild on a piece of paper. Purho has created a game that is interactive and teaches kids about physics and problem solving along the way! I'd love to give this to a lil one and see what sort of magic happens...

xkcd's Guide to Converting to Metric

I would add to this:
37 degrees C: Body temperature(98.6 Fahrenheit)
38.5 degrees C: Fever (101.5 degrees Fahrenheit)
40 degrees C: The temperature of Kahlan* in Legend of the Seeker. Seriously, she's smoking hot!


*Much better than Summer Glau in my opinion.

Cervical Cancer Screening: Test Yourself!

I put together the following presentation for my classmates.  Actually, its for myself -- to be quite frank, cervical cancer screening was one of the most intimidating topics for me in OB/GYN.  There's a lot of different numbers, ages, procedures and acronyms.  It's extremely common -- my outpatient friends have scheduled "colpo clinics."  I haven't had anything like that yet.  I'm hoping that this presentation will help to prepare me.

Cervical Cancer Screening

View SlideShare presentation or Upload your own. (tags: ob/gyn)