The Haversian Canal

Why, the National Board of Medical Examiners answered that question their spring newsletter. The rather drab article is about the flow of questions through the editorial process, but from a student's point of view, the real thing this article reveals is a hint at the general framework the editors use for questions. To explore this, examine the sample question at the bottom of the article and see what the editor does to it. What you see is the editors are *editing*. This may sound like a no-brainer, but it wasn't entirely obvious to me until after I found the article, read it, and asked the question. Editors everywhere, for Conde Nast, the Times of London, and Oxford Press, all baseline their work by seeking specificity (who's in the room, why are they there, what, when, where, how), consistent grammar and syntax (six year old becomes 6-year-old), and consistent presentation (age, sex, chief complaint, info from the intake, physical exam, follow-up tests), and, in the case of MCQs, specific diagnoses. Also,notice how some of the tip-off verbage that may have been au natural in the first draft (trident hand), has become, perhaps more generally correct use of language, but also has lost some of the visceral significance (tridentate appearance of fingers on extension).

The article also links to a prior article, Who Writes Those Questions, reveals another thing worth knowing. Try as they may, the professors just can't keep a hint of condescension out of their communications to students:

Many students and some faculty members at medical schools have the perception that the USMLE Step examinations are designed and constructed by a group of anonymous individuals who have little connection with medical schools or current medical school curricula.

Comments like the following reflect this point of view:

"What a stupid question!"
"We never were taught that!"
"Our curriculum doesn't require us to memorize facts!"
"They must have an army of trolls sitting in a cave writing these questions!!"

In fact, however, designing the Step examinations, developing the examination materials (including the determination of "the correct answer"), and setting the minimum passing scores are responsibilities of examination committees composed of medical educators and clinicians.

The NBME advises their question writers to write mainly what they call hinge questions, that is, the you are given some information, and you have to know the diagnosis in order to then answer the question.

Matthew C Crawford's essay in The New Atlantis, Shop Class as Soulcraft, captures my view on a lot of issues. My dad's an engineer and my mom's a math teacher.

Anyone in the market for a good used machine tool should talk to Noel Dempsey, a dealer in Richmond, Virginia. Noel’s bustling warehouse is full of metal lathes, milling machines, and table saws, and it turns out that most of it is from schools. EBay is awash in such equipment, also from schools. It appears shop class is becoming a thing of the past, as educators prepare students to become “knowledge workers.”

We could hardly navigate the garage at times for all the tools, and we could hardly navigate our rooms at times for all the legos. Lego recently announced plans to lay off 1,200 workers and move production to Mexico. From one perspective, this indicates the upward growth of Mexico, and that's good, but it also concerns me that the people around me, Americans, are losing even more of this:

I never ceased to take pleasure in the moment, at the end of a job, when I would flip the switch. “And there was light.” It was an experience of agency and competence. The effects of my work were visible for all to see, so my competence was real for others as well; it had a social currency. The well-founded pride of the tradesman is far from the gratuitous “self-esteem” that educators would impart to students, as though by magic.

We know the effects of this self-esteem that educators impart are limited, but I know, from my own experience, that the satisfaction of proven agency and competence lasts far longer, almost as long as the effect of winning a race. And so it goes: the easier something is to come by, the less it is valued. An interesting sidenote, is that I have found statistical work to be relatively closer to craftsmanship than pure academic achievement or scholastic accolades. Finding definitive answers to interesting questions through the analysis of data changes the world. Much like craftsmanship, it has social currency. Similarly, leading a group to success in an interesting, significant problem, carries social currency.

In The Mind at Work, Mike Rose provides “cognitive biographies” of several trades, and depicts the learning process in a wood shop class. He writes that “our testaments to physical work are so often focused on the values such work exhibits rather than on the thought it requires. It is a subtle but pervasive omission.... It is as though in our cultural iconography we are given the muscled arm, sleeve rolled tight against biceps, but no thought bright behind the eye, no image that links hand and brain.”

So to, it has seemed to me that teachers are more interested in what the finished student looks like and what influence they perhaps had on the product, and little attention is paid to the vast majority of the work and thought that went into the product, that was mainly the student's effort and thinking. Who has measured what students do to make themselves? How do they make the decisions that lead them to certain methods and tools, and deter them from others? How does the student make himself into a craftsman?

Of course, surgery is perhaps the highest practical amalgem of study and apprenticeship,

Mike Rose writes that in the practice of surgery, “dichotomies such as concrete versus abstract and technique versus reflection break down in practice. The surgeon’s judgment is simultaneously technical and deliberative, and that mix is the source of its power.” This could be said of any manual skill that is diagnostic, including motorcycle repair. You come up with an imagined train of causes for manifest symptoms and judge their likelihood before tearing anything down. This imagining relies on a stock mental library, not of natural kinds or structures, like that of the surgeon, but rather the functional kinds of an internal combustion engine, their various interpretations by different manufacturers, and their proclivities for failure. You also develop a library of sounds and smells and feels. For example, the backfire of a too-lean fuel mixture is subtly different from an ignition backfire. If the motorcycle is thirty years old, from an obscure maker that went out of business twenty years ago, its proclivities are known mostly through lore. It would probably be impossible to do such work in isolation, without access to a collective historical memory; you have to be embedded in a community of mechanic-antiquarians. These relationships are maintained by telephone, in a network of reciprocal favors that spans the country. My most reliable source, Fred Cousins in Chicago, had such an encyclopedic knowledge of obscure European motorcycles that all I could offer him in exchange was regular shipments of obscure European beer.

And, finally, the guiding light:

So what advice should one give to a young person? By all means, go to college. In fact, approach college in the spirit of craftsmanship, going deep into liberal arts and sciences. In the summers, learn a manual trade. You’re likely to be less damaged, and quite possibly better paid, as an independent tradesman than as a cubicle-dwelling tender of information systems. To heed such advice would require a certain contrarian streak, as it entails rejecting a life course mapped out by others as obligatory and inevitable.

Here are the latest population numbers (see parish links in the right column) for the greater New Orleans area, courtesy of the Louisiana Public Health Institute. Jefferson Parish's population is statistically indistinguishable from pre-Katrina levels, though perhaps down a smidge. Orleans Parish is still down quite a bit, understandably.

Lego Mindstorms NXT is the coolest lego set I've ever seen. Think about it: your budding child engineer can actually use servos and various sensors and the whole thing can walk around! Yeah, it's absurdly expensive, $250, but probably competitve with actually building the thing yourself (yeah, the parts might be cheaper, but you'd have to buy tools, books, etc), and, from a conceptual standpoint, this removes all the bull they'll learn in college and the 12, 13, 14-year old can actually see the product moving around, following commands. The visceral learning value of that at an early age, oh, what I would have given for this...

Zopa is the first borrowing and lending exchange. It is essentially microcredit on an unlimited, web-enabled scope. To give you a sense of the goodness of this thing, Muhammad Yunus and his Grameen Bank just won the Nobel Peace Prize (not the Economics prize, the Peace prize) for developing microcredit. And Zopa is leveraging the web to bring it to the people.

Zopa has 100,000 members in the UK right now, and they're coming to the US soon.

Link via reddit.

Got a Venus's flytrap today. It's sitting in its little pot on the porch right now; I'll plant it in a shady spot tomorrow. It's remarkably small. Turns out there are 595 carnivorous plant species!

Update: it died the next day. Too cold last night, I think.

Go give WWNO some money. I recommend waiting until the 7-8 morning hour or the evening rush hour when they're doing one of the donor-matching periods, but, regardless, you listen. Do your part!

A boss of mine had me make copies of some articles a few years ago for training he was going to hold for some of the other junior officers, the submariners. I wasn't included, but I made copies for myself. Among the articles was this address to the San Diego Rotary Club by Admiral Hyman Rickover, Thoughts on Man's Purpose in Life. The Carnegie Council has posted another version of this lecture, which was delivered in 1982. The Carnegie Council version has some excellent questions and answers, but it's a scanned PDF. The oldest version I am aware of is in the Proceedings of the US Naval Institute, 100 (December 1974): 72.

The users of Aaron Swartz's reddit.com started advocating for a science 'subreddit' a couple of days ago. Aaron launched science.reddit.com yesterday. Luckily I was home today and got to enjoy some of the first finds, like Richard Feynman on the pleasure of finding things out, and Burt Rutan on space flight.

Via science.reddit.com/recommended, and from there to the EdTechDev blog, I learned about these two FREE books from the National Academies Press:

How People Learn: Brain, Mind, Experience, and School: Expanded Edition (2000). By the Commission on Behavioral and Social Sciences and Education. 2000

Improving Undergraduate Instruction in Science, Technology, Engineering, and Mathematics (2003). Richard A. McCray, Robert L. DeHaan, and Julie Anne Schuck, Editors. 2003

Turns out most educational research is pretty hocus-pocus (or worse, one-sided screeds by people who should know better, like this "Yale professor"), but these folks have certainly worked hard to bring together the state of the art. Definitely some good ideas in here that deserve to be fleshed out.

Not Dmitri Shostakovich, not Igor Stravinsky, not Beethoven, not Mozart, not Bach, not Handel, not Tchaikovsky, not Vivaldi. Here's a list of all the lists of classical composers. See if Pandora has any of them. But I can get the New York Philharmonic doing Stars and Stripes Forever?! Stars and Stripes Forever?! Are you kidding me?! That even appeared to be a gateway from a classical search by way of soundtracks. Okay, so I got one interesting follow-up from that, at least a novel follow-up: Danna/Devotchka's We're Gonna Make It. So Pandora's good for expanding the market share of pop, blues, soul, anything on the Billboard charts. It's great for jazz and blues, but it bombed classical in a big way. Why? I can get Kermit Ruffins and the Rebirth Brass Band, but I can't get Vivaldi?! What is it, they're not going to serve anything over five or seven minutes in length?

Update: The Pandora FAQ, way down, mentions that they have 400,000 songs from 20,000 artists from every genre except classical and world.

Blink.

Blink.

What? Is this some sort of marketeering experiment? Who's funding this thing?

The following is taken in whole from the US Department of Defense Standards of Conduct Office Ethics Counselor's Deskbook

POLITICAL ACTIVITIES
I. REFERENCES

A. 2 U.S.C. § 441a
B. 5 U.S.C. §§ 7321-7326
C. 10 U.S.C. §§ 888, 973
D. 18 U.S.C. Chapter 29, Elections and Political Activities; 18 U.S.C. § 1913
E. Political Activities of Federal Employees, 5 C.F.R. Parts 733, 734
F. Standards of Ethical Conduct for Employees of the Executive Branch, 5 C.F.R. Part 2635, Subparts G & H
G. DoD 5500.7-R, Joint Ethics Regulation, Chapters 2, 3, 5 & 6
H. DoD Directive 1344.10, Political Activities by Members of the Armed Forces on Active Duty, June 15, 1990, w/ch 1 (January 7, 1994) & ch 2 (February 17, 2000)
I. DEPSECDEF Memorandum, “Civilian Employees’ Participation in Political Activities,” January 21, 2004
J. Air Force. Air Force Instruction 51-902, Political Activities by Members of the U.S. Air Force, 1 January 1996
K. Army. AR 600-20 Army Command Policy, June 13, 2002, paragraph 5-3 "Political Activities" and Appendices B and C
L. Navy. Section 0514 of Secretary of the Navy Instruction 5720.44A Change 2, Department of the Navy Public Affairs Policy and Regulations, 9 May 2002

II. CONFLICTS OF POLITICAL INTERESTS

A. General Statutory Restrictions

1. Limitations on amount of political contributions. 2 U.S.C. § 441a.
2. No solicitation of fellow Federal employees for campaign contributions. 18 U.S.C. § 602.
3. No contributing to any other Federal employee who is the contributor's employer or employing authority. 18 U.S.C. § 603.
4. No threats or intimidation to secure contributions. 18 U.S.C. §§ 601 & 606.
5. No solicitation or receipt of contributions in any room occupied in discharge of official duties, or in any navy yard, fort, or arsenal. 18 U.S.C. § 607.
6. No paying/receiving of pay to vote or withhold vote. 18 U.S.C. § 597.
7. No promising of benefits which are dependent upon an Act of Congress, as reward for political activity. 18 U.S.C. § 600.
8. No intimidation of voters. 18 U.S.C. § 594.
9. No coercing political activities of Federal employees. 18 U.S.C. § 610.
10. No interference with rights under Uniformed and Overseas Citizens Absentee Voting Act. 18 U.S.C. § 608.
11. No assembling troops at polls. 18 U.S.C. § 592.
12. No election interference by armed forces. 18 U.S.C. § 593.
13. No polling of armed forces. 18 U.S.C. § 596.
14. No use of military authority to influence votes of other military members. 18 U.S.C. § 609.
15. No military officer may campaign for or hold civil office. 10 U.S.C. § 973. (But see NDAA FY 04, P.L. 108-136, which provides for exceptions to holding office for retired regular officers and reserve officers called to active duty for over 270 days).

B. Political Activity of Military Members (DoD Directive 1344.10 (reprinted in JER 6-300)).
1. Spirit and intent of Directive prohibits activity that may be viewed as directly or indirectly associating DoD with partisan politics.
2. Does not preclude personal participation in local nonpartisan political activities, so long as:
a. not in uniform;
b. no use of Government property or resources;
c. no interference with duty;
d. no implied Government position or involvement.
3. Permitted political activities include:
a. Register, vote and express personal opinions;
b. Encourage other military members to exercise voting rights;
c. Join a political club, and attend political meetings and rallies as a spectator when not in uniform;
d. Make monetary contributions to a political organization;
e. Sign petitions for specific legislative action or place candidate's name on the ballot;
f. Write letters to the editor expressing personal views;
g. Bumper stickers on private vehicles.
4. Prohibited political activities. A military member may not:
a. Use official authority to influence/interfere;
b. Be a candidate for civil office,
c. Participate in partisan political campaigns, speeches, articles, TV/radio discussions;
d. Serve in official capacity/sponsor a partisan political club;
e. Conduct political opinion survey;
f. Use contemptuous words (10 U.S.C. § 888);
g. March or ride in partisan parades;
h. Participate in organized effort to transport voters to polls;
i. Promote political dinners or fundraising events;
j. Attend partisan events as official representative of Armed Forces;
k. Display large signs/banners/posters on private vehicles.

C. Political Activity of Civilian Employees (5 C.F.R. Part 734; JER 6-200; DEPSECDEF memorandum, “Civilian Employees’ Participation in Political Activities,” January 21, 2004 (on the DoD SOCO website))
1. Participation in non-partisan activities. May:
a. Express opinion on political subjects;
b. Be politically active in non-partisan questions;
c. Participate in non-partisan civic, community, social, labor, or professional organizations;
d. Participate fully in public affairs where no compromise of efficiency or integrity of the employee or agency.
2. Participation in political organizations. May:
a. Serve as officer of political party or group;
b. Attend/participate in nominating caucuses;
c. Organize a political organization or group;
d. Participate in political conventions, rallies, or other gatherings.
3. Participation in political campaigns. May:
a. Display pictures, signs, stickers, buttons, etc.;
b. Initiate/circulate nominating petitions;
c. Canvass votes;
d. Endorse or oppose partisan candidates in political advertisements;
e. Address a convention, caucus, or rally;
f. Take active part in managing political campaigns;
g. Be a candidate in nonpartisan election;
h. Attend political fundraiser.
4. Participation in Elections: May:
a. Serve at polling places;
b. Serve as election judge or clerk;
c. Drive voters to polling places for partisan candidate, group, party.
5. May not:
a. Be a candidate for election to partisan political office. Exception: in certain, specifically designated locales (5 C.F.R. Part 733), may run as an independent for partisan political municipal office.
b. Use official authority to interfere/influence;
c. Use official authority or title to fundraise;
d. Personally solicit political contributions from the general public (e.g., in a fundraising speech);
e. Participate in political activity while on duty, while in a Federal workplace, while wearing insignias identifying employing agency, or while in or using Government resources.
6. Separate rules exist for career members of the SES and employees of NSA and DIA. 5 C.F.R. 734, Subpart D; JER § 6-202.
7. Under long standing DoD policy, political appointees and non-career SES officials may not participate in any activity that could be interpreted as associating DoD with partisan political activities. DEPSECDEF Memorandum “Civilian Employees’ Participation in Political Activities,” January 21, 2004 (on the DoD SOCO website).

D. Role of U.S. Office of Special Counsel (OSC)
1. OSC's Hatch Act Unit provides advisory opinions on political activity of civilian Federal employees. They do not provide advice on DoD’s rules concerning military members.
2. Advisory Opinions online - http://www.osc.gov/hatchact.htm.

E. Use of DoD Resources During Campaign Years
1. SECDEF 0312052112Z, Department of Defense (DoD) Public Affairs Policy Guidance Concerning Political Campaigns and Elections.
2. Command newspapers - no campaign news or partisan discussions, cartoons, editorials, or commentaries.
3. No use of installations and/or facilities by any candidate for any activity that can be considered political in nature.
4. Offbase political events - no support, except joint color guards at national events.
5. Speeches, articles, and public comments of military personnel in capacity as service representatives must not contain political material.
6. POC for policy questions -- OASD(PA), (703) 695-6294/DSN 225-6294.
7. Note that FY02 NDAA, Section 1607, amends Section 2670 of title 10, United States Code, to prevent the Secretary of Defense or a Secretary of a military department from prohibiting use of a military facility for an official polling place for local, State, or Federal elections if that facility was designated as a polling place as of 31 Dec 2000 or had been used as a polling place since 1 Jan 1996. There is an exception for the Secretary concerned to waive the provision if he determines that local security conditions require prohibition of the designation or use of that facility as an official polling place for any election.

F. Lobbying
1. "Anti-Lobbying Act", 18 U.S.C. § 1913.
2. Prohibits grass roots lobbying efforts.
3. Does not prohibit agency officials expressing views regarding merits or deficiencies of legislation.
4. Recurring appropriation provisions - e.g., DoD Appropriations Act for Fiscal Year 2004, P.L. 108-87, §§ 8001, 8012.
a. No use of appropriated funds for "publicity or propaganda purposes not authorized by the Congress."
b. No use of appropriated funds to "influence congressional action on any legislation or appropriation matters pending before the Congress."
III. CONCLUSION [sic. Ed: I have no idea why they put this in there but left it blank]

Some Aussies are all up in arms about some purported ban on Vegemite into the US, citing the folate content. If you can get over the taste, it can be quite tasty.

So I asked my friends at the FDA, one of whom responded

I didn't find "Vegemite" on the FDA website either. I also searched the Federal Register and did not find "vegemite". If there was a ruling it would be been printed in the Federal register.

Of course, there's still the possibility of a general ban on things other than bread that contain folate, so I searched the Federal Register for 'folate' and got this is all that came up (IOM: Institute of Medicine).

Pregnant, lactating, and non-breastfeeding postpartum women: Priority nutrients identified as lacking are calcium, iron, magnesium, vitamin E, potassium, and fiber. Nutrients with moderate, but still high, levels of inadequacy are vitamins A, C, and B6, and folate. Nutrients with lower levels of inadequacy are iron, zinc, thiamin, niacin, and protein. Sodium intakes and saturated fat intakes as a percentage of food energy intakes are excessive in the diets of pregnant, lactating, and non-breastfeeding postpartum women.

B. Nutrition-Related Health Priorities

In addition to analyses of nutrient adequacy, the IOM reviewed epidemiological evidence on body weight status, micronutrients of special concern during reproduction and early childhood, food allergies, and selected environmental risks to the health of women, infants, and children. Several concerns were identified by the IOM for all WIC subgroups--obesity, poor iron status, and contamination of food with dioxin and methylmercury. The IOM also determined that low folate intake is a concern for all women during their reproductive years because of its importance in preventing neural tube defects; insufficient calcium intake for pregnant and breastfeeding women may be associated with potential lead toxicity for the fetus and infant; low intake of vitamin D is a potential concern for women of reproductive age because of its importance in bone health; and inadequate zinc intake is a concern for breastfed infants 6 through 11 months of age because human milk does not provide recommended amounts of zinc for older infants. ——Federal Register, Vol 71 No 151, 7 August 2006)

Ah, scrolling through comments in the article above, turns out there are two reasons to not let Vegemite in, though it appears to be administrivia on the part of Kraft, not the government:

Reason: NEEDS FCE Section: 402(a)(4), 801(a)(3); ADULTERATION Charge: It appears the manufacturer is not registered as a low acid canned food or acidified food manufacturer pursuant to 21 CFR 108.25(c)(1) or 108.35(c)(1).

and

Reason: NO PROCESS Section: 402(a)(4), 801(a)(3); ADULTERATION Charge: It appears that the manufacturer has not filed information on its scheduled process as required by 21 CFR 108.25(c)(2) or 108.35(c)(2).

At first I was fairly sure this Northern Iowan article was plagarizing from the Dallas Morning News because I'm the guy that was interviewed, and here's my blog's record copy of the story by Holly Hacker from the Dallas Morning News.

Then I noticed this the original link in the Dallas Morning News was in a directory called /sharedcontent. So, I guess newspapers sell their content to other outlets who can then wrap *their* advertizing around the work as well? The MBAs are clearly hard work finding out how little actual journalism can actually be done to produce the maximum profit. So, all those newspapers you think are out there? After you discount AP and Knight-Ridder, and this /sharedcontent stuff, how many active journalists do we actually have in this country?

It's not new to consider getting aspirin directly from the bark of the white willow (salix alba), though the dosing is not exactly precise. This article seems especially intriguing:

OBJECTIVE: To evaluate the pharmacokinetics of salicin and its major metabolites in humans after oral administration of a chemically standardised willow bark extract. METHODS: Willow bark extract corresponding to 240 mg salicin (1,360 mg, 838 micromol) was ingested by ten healthy volunteers in two equal doses at times 0 h and 3 h. Over a period of 24 h, urine and serum levels of salicylic acid and its metabolites, i.e. gentisic acid and salicyluric acid, were determined using reverse-phase high-performance liquid chromatography. Renal excretion rate, elimination half-life and total bioavailability of salicylates were calculated. RESULTS: Salicylic acid was the major metabolite of salicin detected in the serum (86% of total salicylates), besides salicyluric acid (10%) and gentisic acid (4%). Peak levels were reached within less than 2 h after oral administration. Renal elimination occurred predominantly in the form of salicyluric acid. Peak serum levels of salicylic acid were on average 1.2 mg/l, and the observed area under the serum concentration time curve (AUC) of salicylic acid was equivalent to that expected from an intake of 87 mg acetylsalicylic acid. CONCLUSION: Willow bark extract in the current therapeutic dose leads to much lower serum salicylate levels than observed after analgesic doses of synthetic salicylates. The formation of salicylic acid alone is therefore unlikely to explain analgesic or anti-rheumatic effects of willow bark.——Schmid B, Kotter I, Heide L. Pharmacokinetics of salicin after oral administration of a standardised willow bark extract. Eur J Clin Pharmacol. 2001 Aug;57(5):387-91.

But I what I really wonder is if the chewing action might relieve people's desire to snack, thereby lowering the rate of obesity?

I had the opportunity to meet a couple of the AMA trustees today, Dr Ardis Hoven (pdf bio) and Dr Robert Wah (pdf bio). They're on a roadshow, talking to students at various schools, and, I gather, some other audiences as well.

Here are the questions I asked and their responses, as best I can remember them:

1) Responding to Dr Hoven's opening question (What do you, the students, think is the number one question in medicine?), I said information control. Dr Wah responded. He was the chief Health Information Systems officer in the Department of Defense before retiring recently. The military has had a world-wide integrated database for years, but he doesn't believe that other populations really need such a requirement (ed. what about the mobility of the US population: moving on average every seven years?). He questioned the wisdom of keeping the old model of physicians being the custodians of patient data. Instead, he invisioned perhaps custodians should exist on the free market and physicians would the rent data from the custodian for the patient's benefit. (ed: of course, the cost would ultimately be passed on to the patient). Alternatively, perhaps the growing non-system of disparate (ed: and dysfunctional) electronic medical record systems at every hospital and doctor's office will become the norm.

2) Given that drug companies purchase portions of the AMA Physician Master File and also purchase physician prescribing information from pharmacies, and correlate the two data sources to tailor marketing to individual physicians, had the AMA considered acting on behalf of its members to get the same prescribing data from pharmacies (big pharmacies, like Walgreens, and CVS) and provide their members, even on a fee-for-service basis, with their own prescribing data, with perhaps intraspecialty and local trend comparisons? Dr Wah fielded this also, indicating that this sort of data warehousing was not one of the AMA's core competencies, and it would probably be on the table for discussion, but would probably be farmed out to a third party, perhaps a pharmacy managment firm.

3) Someone else asked a question I've been dying to find the answer to: how many physicians belong to the AMA? Dr Hoven indicated about 250,000 were members and she went on for a couple of minutes stumping for people to sign up. I seem to recall a recent article indicating there are about 891,000 physicians in the US.

4) How does the AMA's insurance reform plan compare to the recently passed Massachussetts plan? Dr Hoven said the AMA plan has 3 pillars (ed. don't they all?): health insurance portability, tax credits (she thought vouchers might be a better word), and insurance market reform. The AMA differed with Massachussetts in the second two. With respect to the vouchers, instead Massechussetts used an employer mandate. Interestingly, Dr Wah seemed to come out in favor of the employer mandate, citing that had, since the 1940s, been a component of the US system (ed. See Paul Starr's The Social Transformation of American Medicine). I also question these vouchers, because they really are tax credits, which means they really a form of investment, so where's the government going to get that money? I think keeping the employers in the loop of responsibility makes a lot of sense. As for insurance market reform, the AMA's plan called for starting subsidies for people making less than 500% of the poverty line, which would cover 11% of the existing uninsured; Massechussetts set the bar at 300% of the poverty line, which covers roughly 90% of those currently without insurance (Steinbrook, NEJM 354:2095-2098). These differences, 500% vs 300% and tax credits vs employer-mandate, make the AMA plan essentially a clone of the Republican plan, or is the Republican plan a clone of the AMA plan (some comparative stats here)?

There are a number of coincidental shifts in the faculty involved in the first-year curriculum, and I have been invited to participate in a committee that will be looking at some changes. I have a number of opinions on different issues, so I really want to hear what you have to say.

So, for anyone reading this, what have you liked and disliked about school in general?

If you're a medical student or doctor, what would did you like and dislike about your first year of medical school?

You heard it here first. From the Web 2.0 Validator:

The score for http://nielsolson.us/ is 8 out of 52

• Uses inline AJAX ?  No
• Is in public beta?  No
• Uses python?  No
• Is Shadows-aware ?  No
• Uses the prefix "meta" or "micro"?  No
• Mentions startup ?  No
• Rocks out to the dance noise of Chinese Forehead ?  No
• Uses tags ?  No
• Mentions Less is More ?  No
• Appears to be non-empty ?  No
• Refers to mash-ups ?  No
• Uses Google Maps API?  No
• Uses Cascading Style Sheets?  Yes!
• Has a Blogline blogroll ?  No
• Appears to be web 3.0 ?  Yes!
• Has favicon ?  No
• Attempts to be XHTML Strict ?  No
• Mentions Dave Legg ?  No
• Mentions an "architecture of participation"?  No
• Appears to use AJAX ?  No
• Refers to the Web 2.0 Validator's ruleset ?  No
• Makes reference to Technorati ?  No
• Appears to be built using Ruby on Rails ?  No
• Refers to Flickr ?  Yes!
• Mentions Chinese Forehead ?  No
• Refers to VCs ?  No
• Mentions Nitro ?  No
• Mentions The Long Tail ?  No
• Possibly contains bytes ?  Yes!
• Mentions Cool Words ?  No
• Links Slashdot and Digg ?  No
• Mentions Ruby?  No
• Has prototype.js ?  No
• Creative Commons license ?  Yes!
• Mentions Ruby ?  No
• Appears to use MonoRail ?  No
• Refers to podcasting ?  No
• Uses microformats ?  No
• Actually mentions Web 2.0 ?  No
• Mentions RDF and the Semantic Web?  No
• Refers to Rocketboom ?  No
• Refers to web2.0validator ?  No
• Refers to del.icio.us ?  Yes!
• Use Catalyst ?  No
• Uses Semantic Markup?  Yes!
• References isometric.sixsided.org?  No
• Appears to over-punctuate ?  Yes!
• References Firefox?  No
• Validates as XHTML 1.1 ?  No
• Mentions 30 Second Rule and Web 2.0 ?  No
• Appears to have Adsense ?  No
• Uses the "blink" tag?  No

Well, a quick Google search (so Web 1.0) shows people are looking for better mobile computing, more use of scalable vector graphics, the overthrow of the Microsoft OS with open source operating systems (any of the various Linux distributions, like SUSE, Debian, Ubuntu, etc) or browser-based operating systems, more semantic design (using ontological languages . . . good luck with that :p). AJAX is pretty much the definition of Web 2.0. If 2.0 was javascript doing work on the client side, then maybe 3.0 will be Flash doing work on the client side, but, as the AJAX folks will tell you, wireframing a GUI-independent design can be painful. Flash seems even more challenged, though you would get obvious design gains among compliant clients. This will be great for the video freaks, the people who want to watch ESPN on their shirt cuff, and "desktop links" (purposeful browsers like Google Earth), but me, I mainly want text, maybe some particularly illuminating illustrations and graphs. Ideas. I thought that was what the Internet was about. So Web 0.0.