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Roll Wave! Isaiah Washington, aka Preston Burke, will be wearing a Tulane t-shirt in an upcoming episode of Grey's Anatomy! Sweet. I don't even watch the show, but I might now. Sunday at 10, 9 central.
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Ed: Thanks to Molly for correcting me: Burke was established as a Tulane undergrad in the first episode, and no affiliation with Tulane's School of Medicine has been made on the show.
Med Gadget is hosting the 2005 Medical Weblog Awards; he's currently accepting nominees.
One of the second-year students, a prior Army tanker, has been sending me harassing e-mail all week. Brian: read and weep, read and weep.
A short comparison: the AAMC's stance on international medical graduates, versus the writings of a couple of international medical students, Enrico, the Mexico Medical Student and the Carribean Medical Student. My wife swears the best allergist she ever went to was trained in Mexico.
Susan Sontag's son, David Rieff, recently wrote an article in the New York Times Magazine that included this picture.
There are a number of interesting things to see here: a library full of books, book boxes, presumably full of books, fountain pen ink, a letter holder, gobs of post-its, which mainly contain phone numbers, and a computer. This is all about intense information. One gets the sense the computer was a productive tool, synthesizing information gleaned from all the other sources (books and personal conversations) and she prized the ability to get thoughts directly out of her mind when pen-and-ink writing was required because fountain pens, without a ball and with thin ink, create a very intimate and permanent connection between the author's eye-brain-hand system and the recording media. I particularly like the ladder, which indicates books where most people would have stopped. I can't comment on Sontag's work, as I haven't read it, but I like her desk.
Here's a pet peeve of mine: introductions used as a platform for the host to push their own issue. Well, isn't that what the speaker is doing? Why else were they invited to speak?
The best introductions I ever heard were by General John Allen, who could made his best effort to make everyone he introduced sound like a national hero.
Flickr's next DILO day is 21 December 2005, so get your cameras out!
We're in our stress lecture of our 'how to be a doctor' lecture. Adding up the applicable line items on the Social Readjustment Scale, the lecturer estimated all of us have a minimum of 280 points, where less than 149 is low, 150 to 200 is mild, 200 to 300 is moderate, and over 300 is high. Personally, I don't feel highly stressed out, maybe because I don't get very excited to begin with, but I really think it's a matter of context. Compared to being underway on a Navy ship, with my wife and kids alone in a strange city, it's just not that bad, but, according to the scale I'm over 350.
Cutting 180 faculty positions; fundamentally fewer hospitals and patients. Ouch... "Somebody has to make the move first"... I wonder if that means LSU hasn't decided to go back yet. Maybe they'll stay in Baton Rouge????
MEDICAL SCHOOL TO RE-FOCUS ON RESEARCH, EDUCATION
December 9, 2005In a move to respond to a healthcare environment changed by Hurricane Katrina, Tulane University is restructuring both the focus and scope of its medical school. The Tulane Board of Administrators has announced that the Tulane School of Medicine will eliminate 180 faculty positions, downsize its clinical operations and re-focus its research areas.
“The fundamental fact is we don’t have as many hospitals and patients in the city of New Orleans,” said Martin D. Payson, who sat on the board’s medical subcommittee. “You have a large medical teaching operation that has to be brought back to the size of the constituency.”
Linda Wilson, chair of the board’s health sciences committee, said that in terms of research, the medical school will emphasize areas of strength: gene therapy, organ transplantation, cancer, infectious disease and cardiovascular diseases. “These are areas that are important to our population and where we are first class,” she said.
Payson and Wilson said that Tulane will recruit volunteer community physicians to supplement full–time clinical work and will reach out to other institutions to form partnerships to aid in developing residencies and clinical operations. “Tulane is saying that somebody has to make the first move, so we are making it with partnerships to the extent that they are ready to step up to the plate,” said Payson. Wilson added that HCA, Tulane’s partner in Tulane University Hospital and Clinic, was consulted in developing the current plan.
The medical school, which has been functioning at Baylor College of Medicine since the hurricane, is expected to return to its location in downtown New Orleans for the fall 2006 semester.
The hard knocks keep coming to the medical school. In my last entry I quoted the University's article on the decision to cut 180 faculty. The dean names one of the consultants below.
December 9, 2005
The University has been proactive in developing a plan in response to Hurricane Katrina. A consultant firm with an international reputation was hired to work with the Health Sciences Center Leadership to develop a vision and plan for the future. This team was headed by Dr. David Chin, a Harvard M.D. and a Stanford MBA. In addition, several Presidents of Universities who oversee world renowned medical centers acted as consultants.President Cowen has announced publicly that he wants our School to be in the upper echelons of Medical Schools. To achieve this goal we have had to define what is mission critical for our School so that we can develop a firm base on which to grow and expand in the future. A clear indication of the President’s commitment to this goal is the fact that the University is guaranteeing the total salary of mission critical faculty through June 30, 2007. This represents almost two years of post-Katrina support which will ensure the quality of our faculty and our educational programs. This will also ensure our educational mission continues to be central to everything we do. The educational experience for our students and residents this year has been of the highest quality thanks to the dedication of the Tulane faculty and the generosity of the South Texas Alliance. We are all committed to continuing to provide the highest quality education when our students and residents return to New Orleans for the next academic year.
Ian L. Taylor, M.D.
Associate Senior Vice President for the Health Sciences
Dean, Tulane University School of Medicine
More on Dr Chin here, a report on a project he did for the VA, an article about the project. He is on the advisory board for Harvard Med's Health Care Policy department. He works for PriceWaterhouseCoopers. Here he is on a video from PriceWaterhouseCoopers.
I've heard talk of people suing for damages that were caused in the immediate aftermath of the storm. Payroll cuts are THE sure sign that an organization is having a tough time. In light of payroll cuts, I don't think anyone with a vested interest in the school would be looking out for their own interests by trying to milk money from the school, whether to punish the school or because they need money. To the punishment argument: that's just not going accomplish a systemic effect without punitive damages, and, given the weakness of the case to begin with, I don't think punitive damages are reasonable goal. To the argument that a student needs the money: in the long run, and this may seem cold-hearted but read on, those scant posessions in a dorm are non-issue. Reading on, think about the conversations my wife and I must have had with a mortgage and a house full of possessions accumulated over ten years, toys for kids, etc. Thankfully we didn't get hit. Meanwhile we're paying a mortgage in a house we're not living in. Anything that fit in a dorm room is a rounding error in the life of a future physician. Get over it, the school is more important. Come meditate on the pull-out couch I'm sleeping on for nine months.
Also, by comparison, LSU Health Science Center laid off 430 without pay or benefits.
This post isn't in favor of the dean, the university's consultants, the faculty, the students or anyone else. I do believe the organization should be everyone's long term concern because it seems to be on shaky ground and we all signed on. Ship, shipmate, self.
Actually, Dr Charles had it up on Tuesday and I'm a social derelict for not posting it until now.
As for me, test next week, so, if you see me, tell me to go study.
Professor Philip Greenspun of MIT has accepted my proposal to build an online learning community for the Tulane School of Medicine, at least he's going to let his students consider it. Now I need to come up with what exactly it is a I want. I sketched the web pages as I think they should look. I would be very greatful for your comments by email or posted directly on the sketches.
I finally cracked the code on comments! If you have a TypeKey identity you can now post comments!
Brian Chase is the man that wrote in Wikipedia that John Seigenthaler Sr., a former editor of The Tennessean in Nashville, had been involved in the assasination of Robert Kennedy. It was a prank that caught national headlines when Mr Seigenthaler came across the misinformation, couldn't track down the culprit, and then wrote about it in USA Today. Daniel Brandt, a critic of Wikipedia, started digging for the Wikipedia source, which led him to Rush Delivery. There was some tension in the office after Mr Brandt called inquiring. The effect of that call was sufficient for Mr Chase to hand deliver a letter of apology to Mr Seigenthaler and the two have talked. Mr Chase resigned from Rush Delivery because he felt so bad. Even Mr Seigenthaler has urged Rush Delivery to rehire Mr Chase.
So far no word from Rush Delivery on rehiring Mr Chase.
If ever there was an opportunity to demonstrate that reconciliation is the right thing to do, Rush Delivery has the chance to do so by rehiring Mr Chase. Give them a call.
I called and talked to Ken, who was pleasent, succinct, and thanked me for my input. If somebody finds out a decision has been made, please comment.
Commenter John Graham makes a good point about Rush exercising restraint in not firing Chase. Rush exercised restraint in not firing Chase. Good point. I agree. Their restraint was not necessary, though it was certainly more than sufficient. The point is Rush has an oppurtunity to establish a reputation of benevolent leadership in the community. This isn't about Chase. This is about Rush Delivery and the Nashville community.
Dmitriy at healthvoices advised me that Dr Hsien-Hsien Lei recently wrote about the ethics of medical bloggers in which she proposed we should (among other things?) answer these ten questions from The National Center for Complementary and Alternative Medicine. I took a very good class at the University of Maryland from Carol Pontzer, an immunologist at NCCAM, and I have to say I think the scientists there are pretty ready to blow the whistle on pseudoscience. We spent a fair part of that class learning to assess the quality of evidence presented in journals. She was passionate about it. So, I'll be happy to answer these questions.
1. Who runs this site? Me
2. Who pays for the site? Me
3. What is the purpose of the site? Genuflection and interaction with everyone else.
4. Where does the information come from? Me and sources I assess to be legitimate.
5. What is the basis of the information? My experiences, my studies, my research, my opinions.
6. How is the information selected? With the trained judgement of a Navy lieutenant, married father of two with a mortgage, and a medical student.
7. How current is the information? I lag the extreme recency bias of the internet.
8. How does the site choose links to other sites? With the same judgement exercised for question 6 above.
9. What information about you does the site collect, and why? My hosting company has lots of site traffic monitoring set up. My main interest is seeing what use I am to the world through the statistics. I've never used the information to chase someone down, though I suppose I could. The only reason I can imagine for doing that would be to make contact with an interesting person.
10. How does the site manage interactions with visitors? I've just recently figured out the commenting module in Movable Type. I now know that before this I was too liberal with trackbacks and too conservative with comments. Anyone can now comment, though I will screen unregistered commentors, and I allow no trackbacks, sorry.
This came as a surprise to me, and I think many of our classmates. Good luck Dr Taylor, and godspeed.
Dear Students of the School of Medicine,
I am writing to inform you that Dr. Ian Taylor has resigned his position as dean of the School of Medicine, effective immediately. I have asked Dr. Paul Whelton, senior vice president for health sciences, to also assume the role of dean for the foreseeable future.
Hurricane Katrina has clearly taken a toll on all of us, and I know that is especially true for all of you. With the announcement of our Renewal Plan on Thursday we have a clear pathway to a bright future for both the School of Medicine and the university, including reopening our educational programs at the medical school here in New Orleans on July 1, 2006.
On behalf of the entire Tulane University community, I want to thank Dr. Taylor for his four-plus years of service as dean. During that time period, he made many contributions to the school and university, including continued LCME accreditation, expansion of the faculty, and greater emphasis on research and the clinical enterprise. We are appreciative of his efforts.
I hope you will all join me in supporting Dr. Whelton and his senior team during this transition. Ever since Hurricane Katrina they have done a marvelous job of addressing and resolving every critical issue they have faced in a very difficult and complex environment. I am confident that same focus and determination will guide them in the future. I stand shoulder to shoulder with them to ensure the future success and vitality of the School of Medicine. We all look forward to welcoming you back in July.
President Cowen
This is from Dr Whelton:
Dear Colleagues,
By now you may have heard the news that Ian Taylor has decided to step down as dean of the School of Medicine. I want to take this opportunity to thank Ian for his many contributions to the school over the past four years. During his tenure as dean, the school experienced one of its most vibrant periods of growth; the school's educational programs were further strengthened; the track record for conduct of competitive research was greatly enhanced; and the capacity to offer high quality clinical services was substantially expanded. In addition, Ian provided the leadership for a new strategic plan and appointed many of the school's senior leadership team. He leaves a rich legacy of successful accomplishments. On a personal basis, I am grateful to Ian for his contributions as a valued member of the Health Sciences Center senior leadership team and for his friendship and support.
President Cowen has asked me to step in as dean and I have agreed to do so for the foreseeable future. Needless to say, the current circumstances require that we all focus on a common goal of recovery and renewal. Recognizing the challenges that confront us in the aftermath of Hurricane Katrina, I feel confident that the School of Medicine can thrive in the future. I will do everything possible to facilitate this and to encourage the continuation of excellence in each of the school's three mission areas. The Tulane University School of Medicine is a historic academic institution with a bright future. I look forward to working with each of you and to receiving your advice and support in the coming weeks and months.
Paul
Paul K. Whelton, M.D., M.Sc.
Professor of Epidemiology and Medicine
Senior Vice President for Health Sciences
Tulane University Health Sciences Center
1440 Canal Street, Suite 2400, TW-5
New Orleans, LA 70112-2709
The second-year class president, Scott Simpson, sent another e-mail "message from Dr Kahn". Dr Kahn is the dean for student affairs.
Students:
In regards to the recent developments, Dr. Kahn has asked me to inform you that the administration will address the students on Thursday 12/15/05. This will be an informative session with a question and answer portion. More specific details will be available soon.
While many details are forthcoming, there is indication that there will be no additional layoffs in the near future, hence Dean Taylor's statement "the University is guaranteeing the total salary of mission critical faculty through June 30, 2007" reference in his recent email. It is my understanding that this decision to leave was Dean Taylor’s choice and was not forced upon him.
Dr. Kahn is currently at a Hematology conference and will be back in Houston on Weds. Dr. Krane is in New Orleans and will be back in Houston for the meeting.
These have been exceedingly trying times for all of us. Please stay strong.
Scott Simpson
Class of 2008 President
This is a series of postings I made on Flickr. The discussions always seemed to collapse into adolescent drivel, but I hosted my posts as static content and they actually get some good Google searches, so I'm reposting them here to solicit your comments and further the conversation. Thanks for reading.
I believe the Supreme Court's ruling in Crawford v. Washington was that recordings, such as written letters, tapes, and photographs, may not stand on their own as evidence. This is based on the Sixth Amendment, which states the accused has the right "to be confronted with all witnesses". Insofar as the photographer is the actual witness a photograph is admissable only if the photographer is willing to take the stand or is subpoenaed. In the case that was heard I believe the particular argument was that the defense can't cross-examine an audio tape.
The Crawford v. Washington opinion is an interesting read in and of itself, particularly the discussion of Sir Walter Raleigh's conviction based in part on the reading of a letter written by a witness who did not appear before that court. This quote is also interesting, coming from the conservative Judge Scalia "The Framers, however, would not have been content to indulge... They knew that judges, like other government officers, could not always be trusted to safeguard the rights of the people".
This is a series of postings I made on Flickr. The discussions always seemed to collapse into adolescent drivel, but I hosted my posts as static content and they actually get some good Google searches, so I'm reposting them here to solicit your comments and further the conversation. Thanks for reading.
Here is the Supreme Court of Canada's decision in Aubry v. Edition Vice-Versa inc. to which brevity refers. There was no question but that the photographer infringed on Ms. Aubry's privacy. As Barrybar touched on above, the fine lines the photographer walked were 1) whether or not publication caused damage, and 2) whether or not publication served the public interest. Uidzero's argument conflicts with the court's final basis which was the fact that the artistic expression rendered the subject identifiable is what made the photographer liable a priori. That is, the court felt the photographer should have known he was assuming responsibility before ever taking the picture because theory and a reasonable knowledge of social context alone should have led him to the conclusion that the photograph violated privacy and publication lacked adequate public value. That seems like a shaky argument. The majority opinion relies heavily on context (i.e., would the decision have been different If the claimed damages had been less? If the public value had been greater? To take it a step further, if the subject wasn't a female minor?). Tough decisions make bad precedent.
However, stripped of context, one would have to read the court's decision to mean that a hyperrealist painter with a photographic memory would in fact be liable (not guilty, but liable) if he did in fact paint the image of the face of a passer-by. This would come back to the privacy argument: yes, such a painter would be violating the subject's privacy. Why do we find the hypothetical painter test rediculuous compared to the hypothetical photographer test? Because we know, and there's evidence against, anyone, ever, having been such a good painter as to be able to render someone identifiable without a photograph or the subject's cooperation (i.e, sitting for a portrait). The reason Uidzero's painter evokes our sense of rediculuousness has nothing to do with whether or not privacy is violated, but only to do with our knowledge of the painting and photographic arts.
So, for the Canucks, and anyone else who finds themselves in Canada, assume that you are violating privacy by doing street photography, as Genista explains above. If you proceed without securing permission, you are on your own to evaluate the court's two contextual questions: 1) whether or not damage will be caused by publication, and 2) whether or not publication adequately serves the public interest to offset any damages.
I'm very interested in this as I plan to be doing some street photography later this month in the French Quarter.
This is a series of postings I made on Flickr. The discussions always seemed to collapse into adolescent drivel, but I hosted my posts as static content and they actually get some good Google searches, so I'm reposting them here to solicit your comments and further the conversation. Thanks for reading.
The Sensitive Photographs thread has some more on this. Here are my readings of a recent US Supreme Court ruling and a Canadian Supreme Court ruling. They include links to the actual court opinions. Does anyone have other references? US Code, etc? Here's the US Government Printing Office's site, GPO Access. One thing on the site that really ought to be on the front page is is the Constitution. You can browse down to the First Amendment. The First Amendment page includes very intense discussion including citations to relevant court opinions.
The Photographer's Right is an excellent field guide, but nothing replaces the confidence of having first-hand knowledge of legislative, executive, and judicial law. With the hope that we can develop that first-hand knowledge through conversations on Flickr, here's a quick overview of US legislative, executive, and judicial law.
The Congress passes Public and Private Laws. Many of these are Good-job-to-Benny-for-twenty-five-years-of-public-service laws, but the serious ones, the ones that get reported in the news, like the Patriot Act (Public Law 107-056), are changes to the US Code. These laws are literally telling the Government Printing Office which words and what punctuation to add and delete from the US Code. The first part of the Patriot Act is fluff, but scroll down to Section 106 and you'll see what I mean.
SEC. 106. PRESIDENTIAL AUTHORITY.
Section 203 of the International Emergency Powers Act (50 U.S.C. 1702) is amended--
(1) in subsection (a)(1)--
(A) at the end of subparagraph (A) (flush to that subparagraph), by striking ``; and'' and inserting a comma and the following: ``by any person, or with respect to any property, subject to the jurisdiction of the United States;'';
(B) in subparagraph (B)--
(i) by inserting ``, block during the pendency of an investigation''after ``investigate''; and
(ii) by striking ``interest;'' and inserting ``interest by any person, or with respect to any property, subject to the jurisdiction of the United States; and'';
This is why you hear Congressmen says no one has read the Patriot Act. Reading these changes to the US Code doesn't make any sense unless you've got the current code open next to the Act and you are prepared to go through it with a pen and make the changes. That's what the Government Printing Office does. Notice the snippet above is amending 50USC1702. Here's the bit of Section 1702 of Title 50 of the US Code to be amended by the above snippet of the Patriot Act
(A) investigate, regulate, or prohibit--
(i) any transactions in foreign exchange,
(ii) transfers of credit or payments between, by, through, or to any banking institution, to the extent that such transfers or payments involve any interest of any foreign country or a national thereof,
(iii) the importing or exporting of currency or securities;
and
(B) investigate, regulate, direct and compel, nullify, void, prevent or prohibit, any acquisition, holding, withholding, use, transfer, withdrawal, transportation, importation or exportation of, or dealing in, or exercising any right, power, or privilege with respect to, or transactions involving, any property in which any foreign country or a national thereof has any interest;
Notice the changes haven't been made yet. it's only every six years that the GPO has to provide a certified up-to-date copy of the US Code to Congress. We're currently one the 2000 edition. Everything should be in by January 2006.
As the Congress issues laws, and some of those laws change the US Code, the President issues Executive Orders and some of those orders change the Code of Federal Regulations (CFR). A well-known example is President Clinton's ban on smoking in federal buildings, Executive Order 13058. Browsing the CFR can be tricky. If you don't have an exact citation to search for, then you need to know the year and title to browse. For example, the smoking ban was issued in 1997 and affects Title 3. Since it was issued in 1997 it is in the 1 Jan, 1998 update. If you only know the subject matter, you're usually better off Googling until you find some random webpage that states the CFR citation or the Executive Order citation. Organizations with a vested interest in the subject at hand often post not only the citation, but the entire text. IF they do, I recommend you still get the copy from GPO Access, because who knows where somebody made a critical typo.
The US Supreme Court issues opinions which can trump the US Code and the CFR. They haven't finished putting the 2004 opinions up yet, but here are the 2003 Term Opinions. They can also change their rules, which effect how lawyers and judges behave, and what constitutes evidence. When reporters say a case was overturned on a technicality, they are often referring to rules violations.
The states and most post-American-Revolution democracies follow a similar pattern. Would representatives of the 50 states and the internationalists among us please provide links to your legal sites and any other cases you've heard about in the news so we can find out what law actually applies to us? - Photo taking and the Law...
[A]dmittedly I'm American so that's what I know best. I believe Her Majesty's Stationery Office is where you want to start. From my discussions with Britons, European legal systems are very involved compared to the US, which hasn't been around as long, so things usually boil down to, what's the phrase? Principle and precedent?
Two ways to take good family pictures inside a home with white walls and windows:
1)Euclid's Method (geometry students unite!) Stand next to a window with a thin white shade drawn. Imagine an acute isoceles triangle. The window is one long leg; the camera, at one end of the window, is the acute angle. Your family is at the other end of the window. So, the line from the camera to the person in your family closest to the window is the other long leg of the triangle. The line from that person to the edge of the window is the short leg of the isoceles triangle. The remaining members are on the arc of a circle who's center is the camera and is tangent to the short leg of the triangle, arcing away from the window. This only works for single portraits, two adults and a family with one or two kids. Take as many pictures as you can before the victims (I mean, family members) start to drift away.
2) Expensive. It's easier to get good results with this and it works at night, but it's tough to get dramatically brilliant results. Euclid gets you brilliant results even with cheap cameras. Anyway. Get a digital SLR and a flash that pivots both up and sideways. And a lens that provides you a 50mm to 80 mm focal length (as measured for 35 mm bodies. DPReview.com provides conversion factors for various digital camera bodies with sensors that aren't faithful to 35mm dimensions). Point the flash straight up for groups, up and to sideways toward the nearest wall for singles (this gives a nice sidelight).
Excellently said by the president of the Owl Club, the group that does most of what student governments do at other schools.
All-I am assuming that many of you are as crestfallen as I am with the recent news of Dr Taylor's resignation and the mass layoffs of our faculty. Clearly we are all hungry for information as to the future of our school and the committment of Tulane University to the School of Medicine.
I had the opportunity to sit down and talk with Dr Taylor today about these recent unfortunate events. I think it is important for all of us to know that his first question for me was in regards to the status of the student body- "How are they holding up?"
This is the man that led a group of administrators, faculty and students to Houston and succeeded in reconstituting the medical school in a matter of weeks- in talking with him, he is now clearly saddened to see his medical school face yet another challenge. I think it is important for everyone to know that he has not "jumped ship" and abandoned us, and I hope most of you will be able to see his resignation in the context of the current situation.
I think it is also important for all of us to realize that everyone at the medical school is in the same boat- students, faculty & staff. We are all upset, concerned with the future of the school, and wanting answers to our questions.
I strongly encourage you all to attend the informational meeting to be held on Thursday (I do not know the time or place), and be prepared to ask the tough questions that are in all of our heads. Drs Taylor and Whelton will be present, as well as Kahn and Krane. We all have exams that we are worried about, but we are at a crossroads and need to speak up for the best interests of our school.
We as the student body should be organized and show up to have our questions answered and make it clear to the University that we are unsatisfied with the decisions that have been made. Your class may be interested in getting together beforehand and organizing your questions so that you can have a unified voice and have your various issues addressed. I suggest you contact your class officers if you are interested in doing so- the T3's have already initiated this process.
I would not expect to be given any miracle answers to our questions on Thursday. However I am expecting that you all will rise to the occasion and ask enough good questions that the University will have to respond.I will not pretend to be unwaivering in my optimism, but I think it is important that we stand up together to speak out for the future of our school, faculty and administration.
Justin Lafreniere
President, Owl Club
Oh hell, now a student's inciting a revolution. Great. There goes my tuesday evening. The Superintendent of the Naval Academy resigned while I was there, and the Commandant resigned before I got there. Another's promotion to the admiralty was held up over the 1993 cheating scandal. I wonder if they know this isn't the first time a leader has resigned?
Students of the Tulane Community,
The past four months have been very trying times for all of us. However, the full brunt of Katrina has not been felt by the medical school until the past week. After a unprecedented reorganization by the administration and faculty, we were the only Tulane school to continue regularly scheduled courses, only slightly interrupted, during the last semester. While the rest of the university has maintained a retention rate in the 85% range, we were able to retain 97% of our students.
What may ask is the reward to us for maintaining our faith in Tulane School of Medicine? Only the removal of 30% of our faculty who have worked so hard over the past four months to ensure the educational standards we are used to.
It is about time we get together and tell not only Scott Cowen, but the entire Tulane community that we are no longer okay with them compromising our education. We need to get together before Wednesday’s “meet and greet” to draft a letter that we’re not willing to have decisions be made without student representation. I urge you to meet with me and other leaders of the Medical School tomorrow afternoon at 5 pm. We have yet to acquire a room for this meeting, but you will receive an email tomorrow clarifying location. I understand that this is exam season, but due to the timing of the recent faculty changes, it is imperative that we come out with a statement immediately. If you are unable to meet then, however, you would like your name attached to any letter we compose, that can be accommodated, as you will receive a copy of our letter tomorrow.I thank you for your time, and for your belief that Tulane medical school can once again become the beacon of education that it once was.
I've got a better idea, why don't we all get together and figure out what we can do to make it better. Ship, shipmate, self.
Google for haversian canal. It's not right. It's just not right.
Professor Lowe at In the Pipeline is hosting vol 2, no 12. Check it out!
Death of an American City - New York Times
This is the sense of things from New York. Add that to the current state of the medical school. My wife has word from a private clinic where she interviewed antedeluvian that there are more therapists in New Orleans than jobs, so we are not optimistic about relocating the family even when I go back with the school this summer. We live in interesting timees.
I woke up late this morning and hurried out of the house so I could set up the recording equipment for lecture before it started. I ride my bicycle to school. While still in the driveway I realized I'd forgotten my helmet. Screw it. I'm late. Gotta go.
I took all the short-cuts. Little things that save time but I normally avoid because they're riskier. I was riding fast and it was wet when I came off the bayou trail onto the busy McGovern Avenue, just in front of the Texas Medical Center. That's where I slid out and got hit by the truck. My wife is typing this by my bed at Ben Taub General Hospital. They think the truck's bumper is what fractured my skull, which ruptured the middle meningeal artery, which caused an epidural hematoma, which is why I can only mumble.
Not really. But that's what I was thinking as I rode to school. Wear a helmet.
Dr Taylor resigned under pressure within himself. In his words "I had a conflict between my cerebral hemispheres and my heart. My heart won."
- fired clinicians he hired when he came in. Hired to grow.
Dr Paul Whelton: - 2500 beds to about 100. 40% clinic use, 25% inpatient use. 11 hospitals to 2. If we can't continue to be a school of excellence, we don't want to be there. Maintain ourselves as a "top ten" school. Trying to be in top fifty in research. Committed to pay faculty through June 2007. Committed to maintain direction Dr Taylor. We will be ready to return to New Orleans. Expect to have TUHC fully open by April. Working with VA to contract space and beds. They also have (VA) significant capacity to build.
Working to bring Charity with back. Leasing space in Elmwood to restart charity trauma unit.
University hospital also expected to come back, maybe above the first floor.
Dr Taylor is committed to continuing to help us. Advocacy?
Charity resident pay is a big if.
Question: we want a list of faculty. That is simply not possible. These people have careers that are not to be advertized.
We may be replacing the faculty that have left(?!)
You're asking us to commit to the institution. We came here because of the family. We have a sense that some members of the family have been kicked off the boat. We want to know what the core values are.
Clinical faculty were cut across the board.
From Dr Krane: there are real challenges to the nature of the education. We have kept small group sessions. We're going to pair 1st and 2nd years with 3rds and fourths to interview. We have gotten Houston physicians to start serving as preceptors.
From Dr Kahn: with regard to counseling and tutors. I'm here for you guys. We've got student tutors. Working on a website for local resources. AAMC site allows you to do career counseling.
Dr Whelton said that, contrary to the news reports, we actually separated about 140 faculty.
Orleans parish population went from 600,000 to 60,000 to 100,000, projected to go up to 250,000. 1.3 million antedeluvian. 1 million now, but many in St Tammeny and Jefferson parishes.
It is illegal for us to prevent people from transferring. We are not preventing people from transferring. I certainly do urge people to stay here because I believe it's important to keep the school together. When called by other deans about transfers, when they ask about you as a student.
Test — tomorrow. Must —— study —
Head Nurse recently posted her responses to the ten NCCAM site ethics questions about her site. She went on to say that, for purposes of confidentiality, she felt obliged to conceal her identity in order to protect the identity of patients she writes about. I'm completely up front about who I am.
Since Google can identify its users, since IP addresses can be traced, and whois queries can be made, and all sorts of creative cross checking is possible on Google, community sites, and the good old phone book, it seems to me that perfect anonymity on the Web is an unsafe assumption for any blog author. It is essentially self-censorship. The internet perceives censorship as damage and routes around it. So I assume that everything I write can be traced back to me and therefore I modify my content from there. This is sufficient for any number of journals that publish weekly case studies and images in medicine. Those authors are all to happy to have their names associated with those articles. I think I should be proud of what I write, and I think it is incumbent on me to ensure the patient's identity and not start with the false assumption that I myself am anonymous.
White House to Double Spending on New Orleans Flood Protection - New York Times
$1.5 billion is a step in the right direction, but more will be needed. That magic 'Category 5' issue is going to have to be addressed.
This was the single biggest issue behind the dean having to fire 140 faculty. They were primarily clinical faculty, because there just aren't enough people. There aren't enough people because there have been no assurances regarding the levees. Is it enough? I've heard as much as $32 billion. That's 21 times more. I think the numbers are going to have resolve somewhere in the middle. I just hope they don't give the money to the state.
There's a block party to night to celebrate the end of gross anatomy and the first semester in general. Hope everyone has a good time. Make it safe. I'm on my way to College Station for the break. Going to San Antonio tomorrow for a day trip with the fam.
Dmitriy recently commented (Credibility Spat: Blogs vs. Peer-Reviewed Pubs) on George D. Lundberg's opinion of mass media's opinion of blogging. Dr Lundberg is the general editor of Medscape General Medicine. He starts by using a lot of loaded phrases (possibly designed to encourage blogging about it?), but I think Lundberg's central point, that blogs represent nothing more than the opinions of the bloggers who write them, is correct. However, the whole piece misses the larger issues: the real blogging community and the role of blogging in society.
Blogs are not peer-reviewed journals of the scientific community. Like any uncontrolled form of communication, blogs are a superb source of vast amounts of poor information. I didn't say bad information, just poor information. Looking down from thirty thousand feet, the blogs don't have much information. On average. Within the 70 million or so blogs, I'm fairly sure there are fewer bloggers than blogs. There are relatively few multi-author blogs, while there are many authors with multiple blogs. Among these authors, there are some who write poorly, inconsistently, and are factually wrong. Some write well, consistently, and are factually accurate. And there's everything in between.
Writing improves over time. We know that. The brain gets better at what it does repititiously. Einstein, Richard Feynman, Leonardo Da Vinci, Walt Whitman, Herman Melville. They weren't just good, they did a lot of what they did (ever read Moby Dick?). So, after allowing for a certain degree of talent, intelligence, whatever, writing consistently leads to writing consistently well, or at least better.
The third criteria one wants from a blogger is good fact-checking. Problem-solvers are less prone to factual error. Such things as solutions to real problems require facts. So the ability to appraise evidence is at a premium in problem-solving. There are classes dedicated to it. There are professors that spend their careers teaching the fine art of analyzing evidence. The fear of public embarrasment, more positively the pride of reputation, is an independent motivator for fact-checking.
Out of those 70 million blogs, a large number of those appear and disappear very frequently. Genuflecting on virtually any graph of internet traffic, with the high, sharp spike at 0 and a long right tail, it's easy enough to understand that most people don't stick with one thing on the internet for very long. So the longer from inception, the less likely it is that a blog is still posting new content. The only question is how many. My guess is that fewer than 1 million see the first six months. Why do I say that? Right now I'm ranked 15907 in the TTLB ecosystem, and 146,340 in Technorati. I've been blogging for six months, one week, and two days.
So how much more reliable are journals than blogs? The work of John Ionnidis is helpful here. His recent article in PLoS, Why Most Published Research Findings Are False, is representative. That article in particular indicates that any single work in a collected body of works (all journals, all textbooks, all blogs) has a certain probability of being wrong, and that, for traditional journals, this probability is high in an absolute sense. Picking up a random journal article, the odds of a correct conclusion are slim.
This, however, has to do with the medium's highly specific hypotheses. Textbooks, on the other hand, are amazingly reliable for general reasoning, though the more specific the clinician attempts to get, the closer to journal articles one has to go. It may be that the clincian would actually be able to get even more specific about a particular patient, and occasionally about a particular issue, through blogs than through journal articles, much as the textbooks are amazingly accurate at 30,000 feet, yet desperately myopic when compared the the truth at ground level. By honing in on the recorded thoughts and actions of one individual, the clinician may gain considerable insight into clinically important things, like the person's values, models of disease, and decision-making processes.
On a different tack, an expert blogger might post some exceptionally specific and useful information about their particular research interests in a blog. Unlike the medical column of the typical newspaper, where it is extremely difficult to assess the background, decision-making, and values of the once-weekly 500 word columnist, a blog reader has instant access to the blogger's archives and can rapidly assess their reliability and degree of expertise.
A third value of blogs is penetration. Blogs are easier to read than journals so more people read them. At least, I'm willing to bet less than 30% of America's population read a scientific journal article in the first three months of 2005. However, blog readers may value the bloggers that do read the literature. Personally, I got my subscription ot the New England Journal of Medicine in April 2003 and I currently have subscriptions to the New England journal, Nature, JAMA, and The Medical Letter (a newsletter on medications supported only by subscriber dues, no advertising). As a student, a student, I'm paying over $250 a year for those four subscriptions, and the librarians assure me that I'm getting off cheap. Just like internet usage, most doctors get their information from similar sources. Most medbloggers, I'll bet, have a lot of similar subscriptions. And those subscriptions are expensive.
Note that I didn't make originality a value among blogs. While the fiction of medbloggers is particularly good, IMHO, I should hope there's not to much original research coming out in the blogs. Similarly to political blogs that ultimately rely on foot-leather journalists, medical blogs rely on scientists in the clinic and in the lab for at least some of their content.
I predict that if there are 300 medical blogs, 60 have been published for more than six months and 50 of those authors have subscriptions to at least either the New England Journal or JAMA. Maybe somebody could check my prediction on medlogs.com, technorati, or some other aggregator. More generally, I think bloggers and medical journals have similar philosophical goal of distributing knowledge. In the war against myth and pseudoscience, bloggers are more valuable not as original sources but as more diffuse translational resources for the general public. For the general public, blogs are more useful than journals because they are linguistically and economically more accessable.
This is an interesting idea outside Texas A&M's bookstore. The placard looks like it's been in use for some time. The cameraphone picture is poor, so I'll explain, but its purpose is self-evident to the average passer-by.
If you have room in your car, you can jot your information down your information on a scrap of paper and drop it in the bin associated with your region of Texas or the country. Riders can do the same. If a match already exists, then the second person can simply take up the other person's information, thus the bins are self-clearing. If several scraps of paper, for, say, rides to region 1, are still in the bin, then it's fairly obvious that another request for a ride to that region may be wishful thinking.
Do other colleges do this and I've just lived a sheltered life? It seems to effective to have not caught on elsewhere.
When you send something through the US Mail, don't write your phone number or anything else with five digits under your address. Turns out the scanners read your address from bottom to top and assume the numbers in the bottom right is the zip code. Best case scenario, the machine can't match the numbers with a real zip code, rejects your package and a person has to manually figure out where it's supposed to go, and the cost of mailing a package is still higher. If those numbers align with a legitimate zip code, your mail will be misrouted. To Grand Central Station if the last five digits of your phone number are 1-0017.
Dispute Over Historic Hospital for the Poor Pits Doctors Against the State - New York Times
The premise of the article is that untrustworthy state officials are money-grubbing for a new Charity hospital for New Orleans. The doctors who have worked in Charity are countering by saying the building is fine and, aside from major mechanical repairs, should remain the cornerstone of New Orleans' indigent care. Particularly, I was interested to read the doctors feel this is not the time to take down available beds in Orleans parish. Based on the numbers from our new dean, this is a great time to take some beds offline in New Orleans. The dean's numbers, by the way, jive with what my wife has learned about the area as she looks to regain an occupational therapy job in the city. The claim that the city's poor have been trying to reestablish themselves, and thus need Charity's free healthcare, is at odds with my general impression thus far that the people who have reoccupied so far are principly professionals who have the money to finance their return.
Should the state be begging for money? Yes. Should they be rallying around the idea of tearing down the old Charity? I think not. However, Charity does need to be completely gutted and rebuilt if it is to remain the center of healthcare in New Orleans and Louisiana. The generators need to be safe from floodwater, provisions need to be thought out, a helipad should be added (a trauma center without a helipad!?), and, if you've ever been in Charity, you know it was in need of some serious renovation.
Now there's somebody I want to study under.
If somebody could tie Berardinelli's movie reviews to a local listings service like moviefone, that would be really nice. Personally, I stick with Berardinelli's reviews and have found them very close to my tastes. If you prefer the modern excess of choice, check out the Online Film Critics Society. Still not tied to local listings.
This is either going to cost a LOT of money, or cleanliness is going to go downhill fast.
I don't know, but medical school without patients. Hmmm.... Probably evidence of my own short-sighted, selfish desire for some immediately gratifying reminder of why I'm doing this, but I went on rounds today at the rehab where my wife works, and man! That was helpful. I gotta do more of that.
Yeah, there's were sad stories, like the 27 year-old mother who didn't go to the dentist when her tooth hurt, got an abcess, the bacteria got in her blood, parked themselves in her heart, grew, and a chunk of the new colony broke off and took a quick trip to her brain, where it lodged in her middle cerebral artery, cut off the oxygen to that part of her brain, and now she can't move half her body. So now she's had a stroke, open heart surgery, and a titanium butterfly valve in place of of the custom, home-grown, miracle of nature she was born with. The new one, it clicks. And she got that root canal she needed. And blood thinners for the rest of her almost certainly shorter life.
And sad, yet satisfying stories, like the five discharges, one of whom, by surviving her injuries, finally lived to see her abusive husband in jail.
But the whole thing reminded me distinctly of the difference between shore duty and sea duty. Officers on shore duty ride desks and have no sailors or very few sailors working for them. Hours are good, but everybody is a little uptight. In the fleet, hours are horrible. Really. Medical hours just aren't that bad by comparison. That's a whole 'nother post. But at the same time, at sea, something is right. Palpably, leading-sailors-is-what-I'm-supposed-to-be-doing right. Some feel it more strongly than others. Admiral Leidig showed me that once when he was a captain: "Niels, I gotta get promoted to admiral so I can go back to sea." Uh, okay, boss. But that's it. Same thing for me at the rehab today: I gotta get this degree so I can be here with these people, doing these things. I gotta go learn how to do a neurologic exam. Right now.
I suppose this is all very quaint to anybody who actually works in healthcare for a living, but hey, I'm just a first-year medical student.
He turned around fast, and he saw a small Who!
Little Cindy-Lou Who, who was not more than two.
The Grinch had been caught by this tiny Who daughter,
Who'd got out of bed for a cup of cold water.
A friend recently asked me why he couldn't just buy a floodlight from Home Depot to use for photographic lighting. Here's my response:
The floodlight from Home Depot doesn't work because it glows at a different temperature. "White" light is not a very good description of light in photography. I'm sure you've noticed things look warmer at sunset and colder, or at least 'white hot', at noon. The red line in this graph indicates, roughly, the intensity of different colors of sunlight that actually make it across space, through the atmosphere, and land on us during daylight hours (the numbers on the bottom: red is 750, green is 500, blue is 250, ultraviolet is everything really close to zero and infrared is in that long right-side tail. Why does the sun produce 'warm' light during sunset? Because short wavelength light, like blue light, scatters more easily when it bounces off particles in the atmosphere, than long light, like red light. This graph compares the spectra of noon and sunset. You can tell, however, that if we ignore the spikes in that first red line, there's one smooth curve, like this, and that curve is defined by the temperature of the sun, which is commonly measured in units of Kelvin (like Celsius but 0 K is absolute zero: 0 K = -273.15 C; 273.15 K = 0 C = 32 F; 373.15 K = 100 C = 212 F). Flash bulbs are designed to emit light of almost the exact same temperature (6000 K) as the light from the sun (5770 K). Flood lamps, household bulbs, stadium lighting, they all use different gases, different heating elements, yada, yada, yada, that cause them to emit light, but the light is of different temperatures, so that imaginary smooth curve is shorter, or taller, has a longer taper, the peak is moved to the left or right, yada, yada. Basically, things that get really hot glow. It's blackbody radiation, which Wiem's law and Stephen's law describe, and quantum mechanics governs. They all get that sharp spike near zero and taper gradually. Really hot ones spike blue and taper quickly, realitively cold sources spike red, or even infrared, and taper gradually. Here's an article on the theory, as applied to vehicle lighting, and here's a nice superb summary article of many different sources.
What's really important in understanding photographic lighting is understanding that hot sources, like flash-bulbs and the sun, the spike is sharper and closer to zero, which means more blue light. Hot source means blue light, which looks 'cold'. A relatively cold source, like a halogen flood lamp, has more red, so it looks warmer. Most "light bulbs" use tungsten filaments. Here's the tungsten spectrum, note it spikes in the infrared! It's so cold (3200 K), most of it's energy is lost as heat!. Review the sunlight spectra, where do they spike? About 500 nm, which is green. The spectra I have described represent virtually every spectrum you'll actually use, except florescent, and I'd just advise avoiding that like the plague because it's so highly variable and cruddy (greenish, you know?). It's a screwed up technology that uses radio waves to excite vaporized mercury. Not cool. The one good thing about florescent light is that it is usually very dim so you can blow it out with a flash, even a flash bounced of a ceiling or wall.
If that's entirely murky, read this a couple of times, and read the other articles. If it's still murky, go take some pictures under different lighting situations, read again, and then, if it's still murky, talk to some people, call me, whatever. If it's still murky, repeat the above steps in random order and times throughout your life until you get it or die. ; )
So, quick summary of the important light sources:
Other light sources you may come across:
Is up at The Health Care Blog. Thanks to Matthew Holt for hosting.
Dan died on 22 November. I found out when I reviewed my site's statistics and noticed a spike of in-bound clicks from internet searches for his name.
Dan was one of the first midshipmen I recall learning about during my recent shore tour on staff at the Naval Academy. That tour started in January 2003 and I knew him by name by March. He had cancer even then. Congress says the Naval Academy program is four years. Due to the cancer, Dan wasn't going to graduate with his class in 2003, so the Superintendent and the Dean and the Commandant and the rest of the Academic Board had to review his case and decide what to do. I was the doorman. In reality there was more to the job than that, but when the Academic Board was actually in session, when the heavies were sitting at the big table in the dark room with a scared, I'm-about-to-get-kicked-out-for-whatever-I-did-or-didn't-do midshipman sitting on the other side, all I did was open the door and close the door. They kept Dan.
They kept him at the next five board meetings. He graduated, two years late, probably the only midshipman to graduate in six years. Once he had been in remission for almost a year when he got in trouble and had to go before the board. We literally notified him the afternoon before he had to appear, his doctor at NIH called him that evening to confirm that the cancer had metastasized, and he came before the board the next day.
The votes weren't perfunctory. Every time the situation was different, and I think it ended up being good for all involved to leave each session with that affirmation of support.
For some reason Dan had to come to my office one day after class, I told him about my plans for medical school and he ended up staying for two-and-a-half hours. Reflecting on his own experiences as a patient, he had written up some advice for those few of his classmates who would go on to be military physicians, and I asked for a copy of it, which he provided me. He also said I could post it on my site. If you google for him, it is now the top search return for him.
So does that mean anything? Is it just a statistical fluke? The two ships that passed in the night and bumped just enough to trade paint? Future military doctors won't find the essay, only people looking for Dan. Will it become a top search for pre-med midshipmen looking for advice? Do they look for advice? Who's searching for him?
When the Air Hits Your Brain, Tales of Neurosurgery, by Dr Frank Vertosick. Gearing myself up for Neuroscience this semester.
This page contains all entries posted to The Haversian Canal in December 2005. They are listed from oldest to newest.
November 2005 is the previous archive.
January 2006 is the next archive.
Many more can be found on the main index page or by looking through the archives.
