Saturday, April 12, 2008

Trauma And Sore Throats

For those keeping track, I'm back in Spokane and in my surgery clerkship. On Saturday, I took call. Whenever a patient comes in to one of Spokane's ERs and needs surgery, they call the doc I'm working with to do it. In addition, today that surgeon was also on trauma call. After we rounded on the practice's patients on the floors, I could have gone home to study or wait for calls. (And the calls would come, a this is the first warm weekend of the year.) Instead of being unproductive at home, I hung out in the ER where the trauma cases would go. It happens to be the same ER I worked in previously as an internal medicine student, so I knew the staff and my way around. From noon to midnight, I managed the following problems:
  • Torus fracture of the radius in a ten year old
  • Sore throat
  • Tooth pain
  • Hypotensive emergency
  • Strep throat vs. mono vs. peritonsilar abscess
  • Bleeding in a 6 week pregnancy
  • Altered mental status
  • Wallpaper induced migrane
  • Alcohol + ATV = Badness
Technically, the only trauma case was the last one. For that, I put in a chest tube to treat a pneumothorax. But that doesn't mean I only did one procedure. I also:
  • Wrapped a soft splint
  • Took throat cultures
  • Placed an IV line
  • Did pelvic and bimanual exams and ultrasound
  • Inserted a nasogastric tube
  • Spoke several times with a social worker
Even though only one actual trauma case came through (so far! I'm on call from home until 7AM), today was great. It's because I was in the emergency room. I'm comfortable enough there that I know where stuff is and can contribute as a team member. And that's what I like about medicine.

Thursday, April 10, 2008

Open Access UpToDate

Yesterday I commented on how members of the University of Washington community were shocked to hear of the subscription cancellation of the UpToDate reference. Read this to get up to speed. The basic story is that UpToDate wanted to charge the UW a fee that amounts to 60% of the Health Sciences Library's budget. To that, the UW said no.

My peer group (medical students) were surprised, appalled, outraged, and saddened by the news.

I say, "eh..." Let me tell you why.

UpToDate is an extremely easy way to learn about the consensus understanding and treatments for a large number of diseases and medical conditions. Maybe it's too easy. For many years, it has been the one stop shop for clinical pearls, research and both general and specific information. The company knows this. Now is the time to cash in. For many students, it's the ONLY place they go for information. For some, it's just the first place. (Every article has extensive reference lists that lead back to the primary data.) What we (myself included) have fallen into is a reliance on an information monopoly. The funny thing is that this is a monopoly of convenience. Part of me thinks that UpToDate is within its rights to charge whatever they want for their well organized service - this is a free market, after all. The rest of me is repulsed by the price this company is charging for what amounts to information that is already in the medical literature.

So Duke, Johns Hopkins and now the University of Washington have said, "No, thanks" to a convenient tool. These aren't poor backwoods places. I have not heard much ideology behind these decisions; today our dean restated the financial motivation for canceling the subscription. Why might a few giants making this choice be good for medical education? Here are three reasons:
  1. Intellectual Laziness. In a response to my article yesterday, one UW professor lamented that third year medical students no longer scoured medical literature, medicine textbooks and other information sources when researching their patients' conditions. I know that as a student, I very much appreciate the ease of using one resource for all of my inquiries. It leaves more time for patient care. BUT, UpToDate articles are authored by one or two people, and believe it or not, medicine is rarely definitive. It could be useful to know different opinions when relevant. There's a good chance that relevant professional societies (take the American Academy of Pediatrics, for example) already publish recommendations, and make them freely available. The problem is that you have to know where all of this information is. The benefit of knowing the location of all this information is that you are actually closer to the basic decisions that affect care. Here is where a web resource portal comes in handy. Health sciences libraries need portals like this one to help care providers find the information they need. UW's HealthLinks page is a good start, but in the post-UpToDate age, will need much improvement.
  2. Conservation of Resources. I am guessing that residency programs, departments, and even medical schools may cough up the money needed for their trainees to access this resource. As I understand it, every single person with UW network access could use UpToDate. Because of the UW's size and far-reaching extent, this could be on the order of 100,000 people. The people that need the kind of rapid access to information that UpToDate offers are students and trainees who are pressed for time in the context of 80 hour work weeks. (and who are used to the convenience of a single information source). If the medical school pays for this smaller number of subscriptions, then the health sciences library can order more subscriptions to basic and applied sciences journals that researchers crave.
  3. Open Access. For me, this is the elephant in the room, and one that I hinted to earlier. My premise here is that this information is not new. It's a repackaging of basic and clinical science that is already out there. I think there is a legitimate mechanism by which UpToDate-styled reviews could be published free. After all, how much do UpToDate's authors get paid? I hope it's a pretty penny given what they are charging universities. In other academic spheres, if academic publishing is a for-profit venture, it's the publishers who profit. The authors get paid in the currency of academia: peer reviewed articles. "Open access" is a system where authors subsidize the costs of making their work available so that any reader can access it. This is an important trend in academia. The ivory tower is being disassembled and reconstructed into a public works project. But wait, if UpToDate doesn't pay their authors much (this is an assumption that I have not verified), why does it cost so much? I think the company would argue that their easy to use platform is worth something, as is the verification of the information as legitimate. In basic, clinical and applied sciences, this is done through the volunteer system of peer review. I am guessing UpToDate pays people to verify the information. Even so, I do not see why this needs to be for-profit. Why not use an open access model for these review articles? Open access works for 3,314 other journals. There are very well established mechanisms for running such systems, including the Public Library of Science family of journals. I would imagine that an UpToDate-styled review could fetch the prestige among clinicians as a Nature paper does for basic sciences. If the academic currency of publishing these clinical review articles could balance their widespread utility, why inject large sums of money into the system?
In the end, I think there are good theoretical reasons for abandoning expensive subscriptions to clinical review literature. The information is already out there. With a little help from librarians, we'll be able to keep providing the quality of care that the UW, Johns Hopkins and Duke are all known for. Who knows! Maybe the system will come out better in the end.

Wednesday, April 09, 2008

UpToDate OutOfDate

Where do most academic medicine providers get their information about the latest understanding of disease and treatment?

A web search engine called UpToDate. This service provides review articles of the medical literature that range from pretty good to excellent.

Imagine the horror medical students, residents and providers across the University of Washington system experienced today when they read this email:
"As a result of extraordinary price increases to provide UpToDate access for our distributed community of UW Health Sciences students, faculty and staff across the Pacific Northwest Region I have had to make the painful decision to cancel this heavily used resource. In spite of extensive negotiations with the publisher over the past two years we simply were unable to negotiate a price that our Health Sciences Libraries budget could afford. The price for UW is much higher than for other institutions, in large part, because we are a regional health sciences center with regular faculty and students across Washington State as well as in other states throughout the WWAMI region. This means that simple onsite access as provided by some Health Sciences Libraries (e.g. walk into the Health Sciences Library physically and access the resource) will not work for many of our students and faculty who would need to get into a car to come here or worse, fly for several hours!"
For more details about the specifics of this situation at the University of Washington, visit the UW UpToDate alert page. As a medical student spending the majority of his third year outside of Seattle, I am particularly aware of the crux of this issue. What I want to know is how they can charge so much money for what is basically a bunch of review articles. Just how much are their writers being paid? Do the authors get paid per hit? I kindof doubt it. The last time I checked, basic science professors don't get paid jack for writing review articles. (Actually, I just (this evening) reviewed the preprint proofs for a review article I was the first author on. Far from being paid, we had to pay the journal because we include color plates...)

Johns Hopkins refused to subscribe last year, and now the UW. As of July 1, 2008, UW students, residents and faculty will no longer have access to the most used resource for medical decision-making. In a way it is too bad, because the articles on UpToDate were the best annotated and easiest to read of any online medical resource. Because I am a (small potatoes) employee of WebMD, I've done a little bit of research in to the reference services provided by that company. So far, I haven't been able to use it for comprehensive reference information as seamlessly as UpToDate, but I think that will have to change. And, the WebMD portfolio includes a large amount of other cool information that is more media-friendly than UpToDate. Other services available to providers in the UW system include:

MDConsult (WebMD's healthcare provider page)
Cline-guide
DynaMed
AccessMedicine

If you are logged into your browser with your UW password, these links will send you directly to all of the subscription services.

Despite the inconvenience it will be for me not to have an UpToDate subscription, I am glad that UW just said no to big publishing. This info should be open access, anyway!

Anyone out there have tips for an UpToDate-free world?

As I discover tips, I'll try to post them under the tag, OutOfDate. But that reminds me, I've got a series about presidential health care politics I was going to write, too...

Tuesday, April 08, 2008

Coming Out Of The Closet

"I’m going into emergency medicine."

Head over to The Differential to discover how every medical student must come out - in a way - during the third year of med school.


I don't mean to diminish the stress and anguish involved with the GLBT meaning of the term. I do think it is a valid metaphor. Read the whole article to see what I mean.

One Week Of...

What a whirlwind my last week has been!

I think I know my way around three of Spokane's operating rooms; more importantly, I know where each OR's supply of non-powdered, size 9 sterile gloves is. One important (faculty-endorsed) location is my car's glove compartment - one of the hospitals doesn't have non-powdereds that large!

Boy am I glad I am outside of Seattle for my surgery clerkship! I'm not sure I'd be getting this much exposure to hands-on learning anywhere else... This week, I have:
  • laparoscopically extracted a gall stone from the common bile duct during a gall bladder removal
  • removed one appendix
  • held countless retractors (more on that in a later post)
  • clipped thyroid arteries in a parathyroidectomy
  • learned 3 new knots and 5 new stitches
  • sewn a colon into the skin
  • coined a new term for a certain kind bowel adhesions and was subsequently pimped about said term ("fatty fibrosis" - another story for later)
  • sewn large and small bowel together (using a really fancy stapler)
  • imagined numerous uses for retractors and then seen them used that way...
  • removed pounds of necrotic skin, fat and muscle off one person's shoulders only to have the infection spread to the heart.
  • developed some annoying atopic dermatitis on my hands.
  • eaten much more fiber than usual. Fiber can head off sooooo many bad things.
Did I mention that I am getting very familiar with retractors? I'm sure my fling with surgery will actually be an affair with retractors. Just in time for me to move on to OB/GYN (I hear they have retractors, too!!!), it will be my wife who picks up an affinity for those ubiquitously med student driven tools.

Sunday, April 06, 2008

Meeting Bloggers in Real Life

I just realized tonight that on my list of things to do when visiting certain cities is meeting my favorite bloggers who happen to live in said city. The South Bay, Chicago, Minneapolis, Vancouver, San Diego, Charlottesville, Atlanta...

Is this silly?

Heston's Fingers

I think that we can finally pry that gun from his cold, dead fingers.

Unfortunately, gun control is not so much of an issue in the current political environment. I'll still have to learn how to treat gunshot wounds...

Saturday, April 05, 2008

This One Just Fits

Bikemonkey tagged me with the song chart meme. As retribution, I present this:
I'm not sure if it really satisfies the rules of the meme, but it's what came to mind. I'm tagging Bunnies With Sharp Teeth, Dear Science, Dogs Bark At Night and Lid Upon My Head. If you are dying to figure this one out, take a minute and think about what Sarah said.

An Instance When John McCain Rightly Decides To Distance Himself From George Bush And His Wars


McCain may not be a Warmonger, and he is right to make this statement, but he has miles to go before I would agree with his position on the wars we're fighting. Check out other David Horsey cartoons. (Click on the image above to see a larger version.)

Tuesday, April 01, 2008

No Foolin': NIH to Cater to Young Scientists

Given this notice of a structural overhaul at the NIH, perhaps I should rethink my decision to pass on setting up a basic science lab in favor of the lucrative opportunities available to young scientists. With the champions of scientific humanities bowing to external pressures, I may need to discard my dreams of a career spanning the two cultures...

Friday, March 28, 2008

Social Medicine 101

Head over to The Differential for my latest post there about life as a medical student. I wrapped the frequent moves between clerkships, my own insecurities about interacting with other medical students in non-medical settings and an announcement about which rodents we are currently feeding in Spokane, WA.

Here's a hint on the last one:

Wednesday, March 26, 2008

20,000

Today - March 26, 2008 - at 4:18:48 PM local time, an unsuspecting web surfer entered the Hope for Pandora website. This visitor hails from Melbourne, Australia, uses the Safari browser on Mac OSX, and accessed the internet through an Australian provider called TPG. Evidently, Hope for Pandora is traded on the virtual stock market called Blog$hares. I'm not sure how this works and don't have time to figure it out. This is from the What is BlogShares panel on their site:
BlogShares is a fantasy stock market where weblogs are the companies. Players invest fictional dollars on shares in blogs. Blogs are valued by their incoming links and add value to other blogs by linking to them. Prices can go up or down based on trading and the underlying value of the blog.
I hope my stock is rising. Judging though from the amount of time (not very much!) I've had to make posts recently, I'd bet the value is holding steady or dropping. Some blogs I read have 20,000 readers in one day. It took me ten months.

Friday, March 21, 2008

Looking Over Your Shoulder

As a medical student, everything you say and do is noticed. This is important when you talk about patient information. For some, it's a reminder to not slip up in potentially evaluative settings. Others treat evaluation as an additional motivation to be your very best. A rare number of students don't care. Take for example an experience I had today:

I finished my work on Harborview's wards early today so was able to leave before the sun went down. My wife is on call tonight at the VA hospital. In my quest to be the best husband in town, I paged her to propose a dinner datein between admitting patients. She was happy to let me head over to the International District to pick up some Chinese takeout, and I was thrilled for the opportunity to sit in the hospital lobby eating delicious food with her.

When we first started our clerkships together, no one knew that we were married. Since we were both MD/PhDs, it probably seemed natural that we knew each other and chatted more than with other students. For an example, read this post from November.

One of the students from our first rotation together last fall happens to be rotating at the VA with my wife. We don't mind telling people any more, especially since we're more comfortable with both our career choices and our positions in what I've recently taken to calling the medico-educational complex. Anyway, we sat just to the side of the main entrance of Seattle's VA hospital. As I finished my minimally Americanized food, I got a strange feeling like I was being watched. Was it my wife's intern? Our classmate? When I turned around, I was surprised to see, not more than a foot from my face, this exact sight:

This very photo - larger than life - was there smirking at me. His head was about 16 inches across. Just hanging on the wall. Looking over all I was doing. Listening to every word from my mouth.

You never know who's listening to you in the hospital.

Wednesday, March 19, 2008

Autistic Politics

Autism is a real disease. Its prevalence in the United States and other Western nations is increasing. It causes suffering for many parents and children each year. I do not intend in this post to downgrade the significance of autism in society today. I wish to use autism as an example of the wrong way health policy is made in our country.

In reviewing the candidates' health care plans, I noticed that two of them make specific prominent mention of one disease: Autism. McCain says on his website,
As President, John McCain will work to advance federal research into autism, promote early screening, and identify better treatment options, while providing support for children with autism so that they may reach their full potential.
He also has an entire policy platform built on autism which you can read here. I noticed that autism is the only disease he specifically mentions in his health platform. Basically he argues that federal money needs to be spent on learning about and combating autism. Pretty harmless, right? I'll get back to McCain in a minute. Obama has also pledged support of autism research. He says he will:
Support Americans with Autism. More than one million Americans have autism, a complex neurobiological condition that has a range of impacts on thinking, feeling, language, and the ability to relate to others. As diagnostic criteria broaden and awareness increases, more cases of autism have been recognized across the country. Barack Obama believes that we can do more to help autistic Americans and their families understand and live with autism. He has been a strong supporter of more than $1 billion in federal funding for autism research on the root causes and treatments, and he believes that we should increase funding for the Individuals with Disabilities Education Act to truly ensure that no child is left behind.

More than anything, autism remains a profound mystery with a broad spectrum of effects on autistic individuals, their families, loved ones, the community, and education and health care systems. Obama believes that the government and our communities should work together to provide a helping hand to autistic individuals and their families.
I like this statement better. Instead of just spending money on research, he recognizes that the autism epidemic can be attributed to "broadened diagnostic criteria." Rather than to promise cures and treatments, he suggests "we can do more to help autistic Americans and their families understand and live with autism." Oh yeah, he also supports spending a billion dollars on autism research.

I couldn't find Clinton's position in her health policy material, but I bet she supports autism research...

Why is this physician scientist concerned about political leaders' pledges to fund research for a specific disease like autism? The physician in me sees hundreds of other disease that aren't adequately studies that cause pain and suffering to millions of people. The scientist in me imagines thousands of questions about the natural world (answers to which invariably contribute to tomorrow's medicines) that remain unanswered. There is only a limited pool of cash that researchers draw from every year. Why does autism get such a big chunk???

The answer is (drum roll pleas...) patient advocacy groups. Using the most sophisticated research tools available to me (Dr. Google), I found the Autism Society of America, Autism Speaks, Unlocking Autism, the National Autism Association, and many more. Almost all of these sites pledge to support research, make a difference in Washington and provide information about vaccines. And this is where McCain comes back into the picture. At the end of February, McCain's response to a question from a mother of a boy with autism was,
"It’s indisputable that (autism) is on the rise amongst children, the question is what’s causing it. And we go back and forth and there’s strong evidence that indicates that it’s got to do with a preservative in vaccines." He added that there’s "divided scientific opinion" on the matter, with "many on the other side that are credible scientists that are saying that’s not the cause of it."
What's wrong with this? Plenty of other people will tell you what's wrong with this. The upshot is that he is using language of the controversy to lend scientific credibility to an idea that is not scientific. It is therefore ironic that McCain wants to
dedicate federal research on the basis of sound science resulting in greater focus on care and cure of chronic disease.
Sound science. That's a good name for a nerd rock band.


So why is the autism lobby bad for health care policy in America? The first reason is that it puts contingencies on basic science funding. The second is that American health policy is so inept at keeping Americans healthy that we cannot even treat diseases we know how to cure. Your best chance at staying healthy is to be rich. While autism is a disease that affects many social and economic classes, its the rich parents that are driving the emphasis on a national autism program. I believe that disease advocacy groups should focus their resources on identifying worthwhile recipients for research funding. The Feds have much bigger fish to fry if the United States is to develop a health care system that affords access to all Americans.

In the end, autism is an important disease that should have access to national resources. But what I hear is "Vaccines cause autism" (which is not a scientific claim) and "We need more money for scientific research on autism." Autism advocates can't have it both ways.

Do you want to vote for health in 2008? Read my other posts about presidential health policy.

Tuesday, March 18, 2008

Race and Religion in 2008

Barack Obama made a speech this morning about race and religion in America. It cheered me after a rough and tumble day and a half on the wards. On a tip from a friend, I started listening to it in the background while I studied lung cancer. I had to put down the book to consider the elements of our life, culture and nation bigger than the little problems I'm facing today. If you have half an hour, I encourage you to listen. Here's a link to one recording of the speech. Don't worry -it's not a campaign speech until minute 27, and even then, it really doesn't have that feel. His words are part sermon, part lecture, part address to the nation, and yes, part campaign speech.

Sunday, March 16, 2008

A Prized Nest

Old-tyme readers may recall that I enjoy cataloging nature around my apartment. Blog posts and art projects are my primary documentation. One of my favorite little birds is the common bushtit. Not only is the bird's name funny, it is a fun bird to watch. I often see them traveling in groups of 15-30 birds, hopping between bushes and trees in search of insects and berries. As very social birds, they tend to cheep up a storm. Last year, one of my birding friends alerted me to the fact that these birds build amazing nests. I never imagined that North American birds constructed anything other than, well, birdnest shaped nests. Bushtits build socks! Employing nature's wonder-material (spider webs) as the main structural element, these little birds build deep (and toasty) sacks.

After a year of casual searching for a nest, last weekend I spotted one during my required daily ambulation period! (Too much studying turns my brain to sludge, and walking/running around is excellent DVT prophylaxis.) These nests are amazing. Here's a photo of the nest I found; it's silhouetted against a typical Seattle grey sky:

Evidently, bushtit nests are warm enough that the jelly-bean sized eggs need only be incubated 40% of the day. The nests are used for a period of 8 weeks and support two broods each year. If they are disturbed, adults will abandon the nest and build a new one. It takes 3-5 days for a nest to be built. In urban areas, crows like to tear apart the nests and devour the babies; some observers report that the crows do this 'just for fun.' Humans also tend to collect these nests. Sadly, a week after I snapped this photo, the nest was gone. Someone clipped the branch from which it hung. I have since spotted two other bushtit nests in the area. Hopefully, those socks will support a few broods before falling victim to predators.

If you're in Seattle and want to know where the other nests that I've spotted are, I'll tell you if you promise not to disturb them!

For more info about bushtits or any other bird in Washington State, visit the BirdWeb site. It's an excellent resource for pictures, habitat, songs, distribution and behavior. (That's where I got the nice little bird picture above.)

Pay It Forward

How do you remember your grandparents?

Trombones, the importance of hard work, singing, a warm smile, morning walks, unconditional love. This is how I remember my grandfather. Evidently, Amos Buchwalter touched more than his grandchildren. This story in the Oregonian about a United Way executive is a testament to the value of having a large heart.

Grace follows him in life and in death.

Saturday, March 15, 2008

Debating Health Care

My piece about the remaining presidential candidates' positions on health care is up over at The Differential. Since I refrained from offering any of my opinions over there, I'm using this space to point out more opinionated perspectives that wouldn't be appropriate for a non-partisan site. The one liner for me about the three remaining candidates plans is:

Each of the plans has good ideas built in, but the Democrats' proposals far better at addressing the critical challenged faced by our health care system today.

By the way, I think one plan is the best, I voted for a different person than who I think has the best plan and see many good ideas in the third person's plan. Stick with me, and you'll learn which names go where. Unfortunately, I cannot devote enough time right now (exhibit A: the 80 hour work week) to post all of the information about the plans, so I'll periodically post follow-ups and link them here. The first post (maybe you've read it) is my primer on the health care platforms over at The Differential. When I write a new article, I'll link it from the list below, or you can click on the Vote for Health link on my Readers' Favorites sidebar.
  1. Vote for Health in 2008
  2. Autism
  3. Walk-In Clinics
  4. Electronic Medical Records
  5. "Socialized Medicine"
  6. Paying For It
  7. "Increasing Quality"
  8. Generic Drugs
That's a fair start. Now you know what to expect. I hope you come back to visit early and often. When you do, be sure to chime in when I'm off my rocker or when I'm right on.

Oh yeah: my biases are: Clinton's plan is the best, I voted for Obama, and McCain has good ideas that the other two should pick up on.

Thursday, March 13, 2008

What is Trolling?

This post is for only the hardest of the hardcore blog readers.

Because I have a different view about some topics people write on various science blogs out there, I have been occasionally labeled as a Troll. Usually it's for when I speak up in the comments sections of others' posts for some middle of the road perspective about the science/religion conflict or (more rarely) if I say something good about a Republican. I welcome critical conversation on my blog, and sometimes wish I got more trolls. (I've had two that have corrected me and one that was merely annoying.) Mostly, I get spam. That's why you have to wait for my approval for your comment to show up.

You should know about a blogger out there who goes by the name of PhysioProf. His posts (now featured on the ScienceBorg) are frequented by words I care not for, but his ideas and points I almost always appreciate. PP has gotten into a little tiff with another ScienceBlogger named Greg Laden about a post Laden wrote about the recent retraction of a research article by Linda Buck. (She's a Nobel Prize winner who happens to be the mentor of a good friend of mine in the UW MD/PhD program.)

At the end of his long dissection of Laden's imprecise statements, PP makes a nice observation about blog trolling:
Is it "trolling" to use the Socratic method to lead people to novel understanding? Is it trolling to force people outside their comfort zone in particular domains, as a means for encouraging personal growth? Is it trolling to vigorously advocate for and defend positions using coherent arguments based in fact and logic? Is it trolling to identify bu#$&it as such? Being comfortable all the time is no way to grow, to expand one's capacities, one's scope of knowledge and expertise.
Right on!

Elsewhere in his article, PP discusses the Nobel Prize, blogging ethics, the biomedical research complex and more. I started to read it with the intent to tire my eyes before a post-call mid-afternoon nap, but seem to have fired myself up, instead. Maybe curling up with a medical text under a blanket before the fireplace will do the trick. Maybe I should nix the textbook part...

Monday, March 10, 2008

One Book, PRN

In medical abbreviations, PRN stands for "pro re nata" or "when necessary." In my article for The Differential this week, I review the practice of giving one book to each kid at every well-child check between the ages of 6 months to 5 years. I learned about this strategy to increase literacy and the love of literature at Seattle's own Odessa Brown Children's Clinic when I rotated there last October for my pediatrics clerkship. Go on over to my article to read more.


Then come back here and pick out your own title from the book pharmacy.

The one about Ceasar Chavez is good. So is Goodnight Moon.

Sunday, March 09, 2008

Saturday, March 08, 2008

Springing Forward

One of my current heroes is often touted as the originator of daylight savings. These days, the government says it saves money on electricity. Skeptics argue that the effect is paradoxical and the real reason savings time was instigated was to get people to shop at stores more in the evenings. At 48 degrees north, summer daylight is long at baseline. The sun is early to rise and late to bed. But for a nice take on DST, read this.

To be sure, daylight savings doesn't mean much for me. For example, last night when I looked at the ER wall clock while admitting a patient, I had to pause: "Is it 9:30 AM or PM?"

Thursday, March 06, 2008

Blogging As An Inpatient

If I don't take care of myself by sleeping and eating properly this next month, I'll have to admit myself to a hospital, rather than work at one. So I must curtail my posts for only a small while in favor of crafting a better hospital note or reading up on a medical condition afflicting a patient. I have a few posts in the queue over at The Differential for the next few weeks, and I am sure I won't be able to steer completely clear of Hope, but I have to go for now.

I'll be sure to treat you to some reflections from my current stint at Seattle's county hospital. These stories need more time for crafting - time that I do not have right now. It's also, in my opinion, inappropriate to write real-time about patients who cannot consent to be the subject of an article here or elsewhere. Time and distance are good cofactors for anonymity. I could write about the practice and education systems of medicine, but fear that my accounts would emerge more cynical that I mean.

I hope my regular readers will keep me in their site feeders. I'll be back.

Tuesday, March 04, 2008

Decision Tuesday

Another Tuesday, another decision. Pundits say that by tonight, we could have nominees in both parties. If my political decision making device is accurate, however, I wouldn't be so sure. Past readers will recall the back story of this science/art experiment/installation. Basically, I've employed red, white and blue berries collected from various Western states to predict the outcomes of the presidential primaries. At various major elections, I present a snapshot of the electorate and offer a critical review of the candidates' positions. Since setting this up back in January, I have not uncapped the tubes. You can track the changes on this collection of posts. But for contrast's sake, just take a look at what politics does to the voters in just 3 short months:


This compares to January 8:

The entire collection of specimens has dulled, even accounting for the differences in lighting. (The artist apologizes for having a day job.) This clearly represents the dulling effect that the increasing rancor has on common citizens. Another striking finding is the bold assault of the red berries with mold. Earlier observations identified some of the mold as being blue, suggesting the possibility of formerly red voters crossing over. (If no one has coined the term, "Obama Republicans," let me take this opportunity to do so.) Today, however, the white snowberries show intense degradation. In fact, it appears as though small gremlins have spun cocoons in that sample. Snow. Fresh. Pure. These all could be represented by this specimen. These all are no longer present in the race. Biting attacks, political dirt and stale refrains now dominate. It is still unclear which berry correlates to which candidate. Perhaps the dear reader can offer a suitable explanation.

But what of my predictions? Or shall I say, what of the experiment's predictions. It is obvious to this observer that neither set of blue berries shows a dominating difference of decay. At the end of the night, neither will have sufficient reserve to claim victory. On the red side, however, both samples are bathed in mold. My guess is that a more intensive analysis than observation will be needed to correlate the presentation at hand with the apparent victory about to be handed to John McCain. And by 'more intensive analysis,' I am thinking 'taste.'

Monday, March 03, 2008

The 'View

On my way to Harborview Medical Center...

Friday, February 29, 2008

No Place Like Home


Spokane has been nice. It's a good place for students to learn medicine. I've learned a lot, and could probably take the final right now and pass. So, thank you Spokane.

There is, however, something about Seattle that whispers to me: "home."

We head there tomorrow. For 4 weeks. It's been 14 weeks since I've lived in the Emerald City; I have some catching up to do. The truth is that I'll see a lot more of Harborview Medical Center than of my 'real' home. But that doesn't matter to me now. My next post will be from the comfy chair in front of the fireplace.

Wednesday, February 27, 2008

Jackhammers

Fortunately, there was someone on the other side of the brick wall trying to get out, or trying to help me through. I'll probably never know.

It's amazing to me how just a small connection formed with other people can help overcome stress, anxiety and malcontent. Medicine is too full of emotional brick walls for us to get by on our own. Sometimes just the presence of another heartbeat - or in my case, an ECG crew - is all you need to break through.

Tuesday, February 26, 2008

Hit the Wall


These days, there's a new one around every corner. Just when you get the hang of something, bam, there's another one to climb. Studying, scheduling classes, seeing patients, sleeping. There's always a new challenge. If you have any tips on that last one, I am accepting suggestions.

Neal Lane on ScienceDebate 2008

Both the Washington Post's and the NYTimes' Live Blogs have noted tonight's debate to be the last of the primary season. Clearly, they are forgetting about ScienceDebate 2008. Or else they think the primaries will be locked up by April 18, 2008.

In November 2006 I had the pleasure of hosting Neal Lane for a visit to the University of Washington. The UW's Forum on Science Ethics and Policy invited the former NSF Director and Bill Clinton's science advisor to speak about the future of science in America. He and a large number of science superstars have come out in support of ScienceDebate 2008. Here is a video of him making a case for it.




Find your favorite science star at this page.

Grand Rounds!

Bertalan Meskó of ScienceRoll has compiled a wide assortment of posts for this week's edition of Grand Rounds. If you need your med blogging fix, grab some coffee and head over there...

Monday, February 25, 2008

SPUWing Science and Policy

Hey Seattleites! The Science Policy at the UW social group is meeting this week in the back room of the College Inn Pub. It's an informal meeting where you can chat about, discuss or argue science and politics. Students, faculty, staff and members of the local community are all welcome. If I weren't in Snow-can, WA, I'd be there. Get more info at www.fosep.org.


Wednesday, February 27 5:30 to 7:30

Sunday, February 24, 2008

Ben Stein: Tasteless

Have you heard of Ben Stein's latest farce? It's a movie called EXPELLED: No Intelligence Allowed, and is billed as a response to the 'suppression' that Intelligent Design has experienced. Well, the film was supposed to open on February 12 - Darwin's Birthday. I was looking forward to viewing and reviewing it while I was on my outpatient medicine rotation (more time to myself = more blogging... Hi Dr. Novan!) but now they've up and changed the opening date to April 18. I'll be on surgery then!

Leave it to the movie's proponents to point out that this moves the opening from Darwin's birthday to the day he died (April 19). And some of them revel in this decision!

Bad form, guys. Tasteless.

Blogrolling

I updated my blogroll this evening because I was tired of reading about neurology.

White Coat Underground's slogan is "Musings on the intersection of science, medicine, and culture." That is strikingly similar to my own "Where science, medicine and society collide - and something good comes of the mess..." The author is anonymous, so you don't have to put up with any stories like the personal vignettes I tell.

DrugMonkey is no stranger to this blog, but I only now have updated his ScienceBlogs link in my blogroll.

The Inverse Square Blog is authored by a science writing professor at MIT. Reading it makes me feel like I'm sitting on a steam vent in the park on a cold winter's day. His slogan is "science and the public square." (It's just the vent keeping my science writing urges warm.)

I also put the Science Blogging Ethics Wiki in my linklist. Check it out and contribute if you have any bright ideas on that front!

A Democratic Jesus

It's been a while since I've posted anything in overt reference to religion on this page. A piece in the Washington Post today got me fired up, though. I'd encourage all the liberals (religious, skeptic and/or atheist) out there to read this nice article by Amy Sullivan.

She uses some great examples of people from different backgrounds and intentworking together toward a common goal and wraps up with the following account:

Walking through Dulles Airport not long after losing the 2004 election, John Kerry was stopped by a supporter. The man shook Kerry's hand and told the senator that he was an evangelical. "I voted for you," he said, "and so did a lot of evangelicals. But you could have gotten more of us if you'd tried." Kerry was floored. Evangelical Democrats?

No wonder Kerry fared worse among evangelicals than any other Democratic nominee in modern history, losing the votes of nearly four out of five. To engage a constituency, a campaign needs to at least know it exists.

Even so, the Democratic nominee this fall will have advantages Kerry never did. Sen. Hillary Rodham Clinton is a lifelong Methodist with years of experience teaching Sunday school in Arkansas who's married to the party's most prominent evangelical Democrat. Obama, a committed Christian, is more thoughtful and relaxed talking about religion than any other Democratic politician. Most important, they'll have the support of a party that is slowly starting to see that there are many faces of the faithful.

There is a reason to make friends on the other side of the aisle. We may not all agree on everything, but a lot of us agree that something needs to change. Let's find that small voice of hope and use it to tie us together in common cause.

Just Ignore Him

Sheesh. Not again! In announcing his bid this time, Ralph Nader almost endorsed Barack Obama.
He called Mr. Obama a “person of substance” and the “first liberal evangelist in a long time.”
Let's hope the trend of his support by the electorate follows from his past two bids:

2.7% in 2000
0.3% in 2004
0.04% in 2008

Drug Reps 'R Us

Now five months in to my third year medicine clerkship, I'm pleasantly surprised about how little interaction with pharmaceutical company representatives I've had. As I get deeper into it, I am realizing just how tenuous the dynamic between pharmaceutical innovation and controlling costs in health care.

I am pleased to report that I still feel uncomfortable in the setting of drug company schwag or it's provider. Sometimes I feel the same squeamishness I've felt witnessing (illegal) drug transfers. Is it a coincidence? In doctors' offices: Who's the pusher? Who's the dealer? And what does that make the patients? Are they stuck in a crossfire?

Here are a few personal vignettes about my encounters with (legal) drug dealers.

Before my clerkships, I often attended the University of Washington's Chairman's Rounds each Tuesday. That food was provided by a rotating ensemble of drug company reps. They asked for attendees to sign in, and would actively seek eye contact of the audience as we filed in. If I were dressed less formally (PhD casual), I would occasionally be interrogated about which department I was with. (My answer was always pathology.) Most times, I clipped on my medical school ID badge kept my eyes focused on the food or floor and walked past them without noting the company or drug. After all, I was there to keep up my clinical mind. I did take the food, however. Some other students and residents (but never faculty) brought or bought their own lunches...

My first rotation at Seattle's Children's Hospital was pharm-free. The free food at the daily noon conference was provided by the residency program rather than drug companies. Monday's World Wraps and Wednesday's fish burritos were my favorites. Then as an outpatient in the pediatrics clinic, I discovered that the patientmedicine samples were provided by Children's Hospital, not by drug reps. In fact, some of the residents placed the absence of "pharm food" as a positive attribute for that program.

The next stop on my magical medical mystery tour was a family practice office in Anacortes, WA. They had kicked the drug reps out years before in favor of samples provided by Group Health. The idea being that enough of the practice's patients are insured by Group Health that it will pay off to get docs in the practice of handing out and prescribing the generic meds on GH's formulary that it will benefit the insurer even if the docs give the samples to non-Group Health patients.

For the last 7 weeks, I've been in Spokane, WA for my medicine clerkship. The only evidence of pharmaceuticals at the hospital where I worked were in the ubiquitous pens and post-it notes on the floor. Not until my outpatient experience have I had direct contact with drug reps. In the endocrinology (diabetes, thyroid and hormone problems) and dermatology (rashes and acne) clinics, I've encountered piles of free handouts, cabinets full of samples, company provided patient handouts, occasional lunches and the well-dressed woman with a clipboard. "Who is this attractive lurking specter?" I wondered the first time in the endocrine clinic? She was just waiting patiently for the doc to sign a clipboard acknowledging receipt of the samples. She got in one sentence before my preceptor informed her that she had more patients to see.

I am being gradually exposed to the tight grip of pharmaceutical companies on medical practice. Fortunately, I am also experiencing some of the push-back that entities as different as private practice and world-class health care institutions are giving. Whether its the cold shoulder given by docs as they sign the receipt or the broad resistance of entire hospitals, there is certainly a tension that was not there 10 years ago. The consequences of doctors giving free samples of brand-name drugs is not always obvious to patients or doctors. But I'd like to think that the next generation of physicians is ready to approach health care in a less expensive, more sustainable manner.

We shall see.

Thursday, February 21, 2008

Fair

Fair is a principle I have been concerned about as a kid. It's probably why I'm interested in ethics, social justice and even medicine. It's also what got me to reading George Will's recent opinion piece in the Washington Post. I appreciate the last paragraph:
The president who came to office with the most glittering array of experiences had served 10 years in the House of Representatives, then became minister to Russia, then served 10 years in the Senate, then four years as secretary of state (during a war that enlarged the nation by 33 percent), then was minister to Britain. Then, in 1856, James Buchanan was elected president and in just one term secured a strong claim to being ranked as America's worst president. Abraham Lincoln, the inexperienced former one-term congressman, had an easy act to follow.
And I was just rewarming to Hillary Clinton...

Wednesday, February 20, 2008

LOL Zygotes


I'z got 2 faces
I zgot 2 faces
1 zygot, 2 faces
1 zygote, 2 faces

And no, I didn't do any Photoshopping on this one. Read all about it!

Mooned!

The moon passed through the lower aspect of Earth's shadow (also called the umbra) this evening resulting in a total lunar eclipse. My previous attempts at photographing the eclipse failed for three reasons.
  1. No good camera
  2. No good telescope
  3. No tripod
Thanks to Spokane's cloudless sky, look what I can do now!

Actually, I didn't need any of the above to get this image. Instead, I found a nice picture with the help of Mr. Google, then I rotated it in Photoshop to get to just the right angle, then voila! A striking representation of what I saw in the Spokane sky tonight. Well, except that the craters and plains on the moon's surface are in the wrong location...

Update! My former labmate from PhD land was interviewed on Seattle's King5 news about the eclipse. Watch the news segment here, and read about the Green Lake experience on her blog.

Tuesday, February 19, 2008

Passing (on) Gas

Are you as alarmed as I am about the cost of oil reaching $100 a barrel? Chances are good that you're just worried about 87 octane costing $3.00 a gallon. What are we going to do about it? I've been carpooling. But that's a pretty short term fix. Jonathan Golob (known to some as Seattle's only scientist) has put together a nice little call to arms over at his blog. In a rally the troops approach, he's thinking about environmentally friendly potential of oil shale and coal as dominant American energy sources. It's easier for me to get behind other (closer to implementation) innovations like residential solar, wind, and even geothermal production than by ravaging the land for its energy. But that doesn't mean you shouldn't surf on over to DearScience to read what he has to say. And after you're done there, go over to the World's Fair for an excellent essay linking $100 oil with Cuba.

Monday, February 18, 2008

Total Eclipse of the Heart

I mean moon. Total eclipse of the moon. And for West Coasters, it's at a reasonable time! 7:30 PM! Here's NASA's diagram explaining when to look on Wednesday night:


If you live in a different time zone, go to this page. 'Supposed to rain or snow in Spokane, so I'm not going to get my hopes up for seeing it this time. At least I witnessed the full lunar last August in Seattle.

High School Science Bloggers

I recently stumbled upon the efforts of a high school biology teacher to increase her students' fluency in online learning and discussion. I think it is smart to introduce them to the science blogging community, and what could be the future of science communication. Elissa Hoffman at Appleton East High School is moderating a blog called Endless Forms Most Beautiful, and she is looking for guest bloggers. Here is my unauthorized want ad placed on Hope for Pandora on her behalf:

Seeking scientists who can capture the attention and imagination of AP Biology students in east-central Wisconsin. Duties include posting one or more 500-1000 word entries to a weblog and participating in the online comments section. Candidates need not be local. Compensation in the form of warm fuzzies.

Sound interesting? Read this informational page. Cruise around the other entries and responses, too. But avoid this post.

Sunday, February 17, 2008

How Much Longer?

Medical school is full of firsts. Last Friday afternoon included several. Femoral ABGs, chest compressions, calling time of death. There is too much to unpack in one post - I've yet to parse through the entirety of my thoughts. My first attempt at relaying the complexity of experiencing another human's death is up over at The Differential.

Look for more here soon.

Flicker

My wife and I installed a homemade bird feeder fashioned from a gallon milk jug on our back fence. So far, the only critters who frequent it are a pair of squirrels. We've seen a bevy of quail in the park on the other side of the fence, and a few stragglers have investigated the seed strewn in the snow by the messy rodents. But to my knowledge, no birds have actually visited the feeder proper. You can imagine my delight when I saw a flicker sitting above the feeder trying to decide if it was safe to jump down to munch on the delicious seed. It's fair to say that:

The flicker was on the fence about the bird feeder.

Photo lifted from the NaturalVisions Birding Website.

Saturday, February 16, 2008

Lincoln Park, Spokane

I am very fortunate during my stay in Spokane, Washington to be living in an apartment that backs up against a nice little patch of nature called Lincoln Park. In the snow, my wife and I can snowshoe out the back door and hike over to our own private sledding hills. Now that the temperature has risen, much of what we thought to be permafrost is thawing. Our afternoon reward for studying was strewn with slick rocks, muddy runoffs, iced puddles, and to say the least, uncertain footing. This brought to mind a conundrum:

When is a walk in the park no longer a walk in the park?


Six-Word Memoir

The World's Fair and in an echo, Adventures in Ethics and Science have issued a challenge:
If you had to write your memoirs in 6 words, what would they be?
This was based on a book called: Not Quite What I Was Planning: Six Word Memoirs by Writers Famous and Obscure, edited by Smith Magazine. Since I've been struggling to get my oral case presentations down to a concise 3 minute overview, this is a pertinent exercise for me. I started out with a list, but it sounded too much like a personal ad. I challenged myself too a sentence. My working six-word autobiography is:

Pieces converge for love and health.

What is your 6-word memoir?

Thursday, February 14, 2008

Takotsubo Cardiomyopathy

For all of you out there with Takotsubo cardiomyopathy, or something like it, try not to let today's consumeristic holiday bring you down. And for those of you with something to celebrate today, I would recommend tucking some of those tokens of love away for when your sweetie is least expecting it. Like on Flag Day or something.

But lest you think me a total scrooge, I did purchase a couple of doses of phenylethylamine for my true love.

Tuesday, February 12, 2008

Looking Good After All These Years

Chuck D turns 199 today.


Hero to some. Pariah to others.
Misunderstood most of the time.

We're still talking about you and your ideas, Chuck.
I hope you don't mind.

Monday, February 11, 2008

Reinventing the ER

Since emergency medicine is near the top of my list of medical specialty choices, I often think about how the emergency room functions in the treatment of emergencies and, well, not-so-emergencies.

One way that hospitals are starting to address the challenge of caring for such diverse patients as car crash victims, IV drug users and uninsured folks with chronic disease is to stratify the care given after you walk through the door (or metal detector). For example, San Francisco General Hospital's free wound care clinic for IV drug users saves a lot of money by providing care there rather than in the expensive ER. By moving less urgent cases into a special care track, hospitals can save money and provide more appropriate care.

An article in today's NYTimes spins it a different way:
An increasing number are taking steps to bring civility and even hospitality to the emergency room, in part because, for all their turmoil, they remain vital points of entry for paying patients whose eventual admission accounts for needed revenue.
So not only is the ER a place to provide health care, it is the point of entry for revenue producing units - I mean patients. So we better make them happy or they will take their care (and reimbursements) elsewhere! Unfortunately the article focuses on remodeling costs and a laundry list of NY City ER's that are under construction.

There is great potential for improving the frontline care for uninsured and underinsured ER users. Sure, customer service reps are nice, but I am guessing that patients really just need problem-focused care. (Score one for family medicine!) If I go into emergency medicine, I want to be part of creative solutions to sorting what is a mixing pot of symptoms, diseases and emergency that keeps medicine affordable, but send patients home less likely to return.

Science Debate 2008

Science is important. It will be more important in April because of:
You don't know how catchy that sounds until you speak it aloud. Say it with me, "Science Debate 2008." Now with syncopation. Now in a group with your friends. There we go - that should be enough to convince you. If not, continue reading.

A couple of units of time ago (I'd put my money on months), I signed up to support Science Debate 2008. I have to be honest, though: I wasn't entirely sure what I was supporting. In principle, the idea is easy: collect the remaining standing presidential candidates to answer questions about science, health and the environment. Among my many questions about this concept were: Would candidates for president actually all come together to debate science? How would you involve Democrats and Republicans before the nominations were set? Would people care?

I underestimated the mobilizing power of Chris Mooney and Sheril Kirshenbaum of The Intersection. They have collected a wide range of Nobel Laureates, university presidents, politicians, science bloggers and regular Joes to endorse the idea. And now with the help of the AAAS, the National Academies and other major institutions of science, a date has been selected and the four remaining candidates have been invited Philadelphia's Franklin Institute to talk about science.

How appropriate! In the tradition of Franklin's Junto, these four leaders will come together to debate questions of morals, politics, and natural philosophy. Yes, I too can dream.

Is your name among the list of supporters? It isn't? Head to this site to sign up. Don't think it matters? You're wrong! There are currently 13,000 signed on to this idea. The networks and media folks need to see an interest among the people to make coverage effective. That's you! They're current goal is 20,000. If you want to do more, contact the campaigns or write letters to your newspaper. If you wish to consider this more carefully, head over to Nature magazine's story about Science Debate 2008. They remain skeptical of the idea, but I believe their criticisms are mostly hollow.

This debate could have an impact on Pennsylvania's primary or could be one of the first formal interactions between the presumed nominees from each party. Either way, I think Ben Franklin would be proud.

Sunday, February 10, 2008

RADAR

Sorry I've dropped off the radar the last few days. I had a last minute trip back to Seattle to take care of about a hundred things - all of which needed taken care of and some of which couldn't wait until March. I'll fly back to Spokane tomorrow morning. Meanwhile, I'm hanging with the undergrads at the UW's Odegaard Library while I finish up a response to reviewers.

The reason I decided to make a post is an observation from Saturday's caucuses. About 160 folks from my precinct showed up. 5 delegates went to Obama & 3 to Clinton. The strange thing about the speeches people gave was that several individuals decided to vote for Clinton because the media had wronged the Clinton family, made fun of Chelsea, or otherwise unfairly represented Hillary. Few people actually detailed the candidates' positions. The most interesting speech was by a man my age who had lived in Obama's state legislative district in Chicago before moving to Seattle.

I've procrastinated enough. Back to the grind.

This post was brought to you by the Doctor.

Wednesday, February 06, 2008

And Speaking of Artificial Hearts...

Those Lipitor (atorvistatin) ads featuring Robert Jarvik make me puke. (Only recently could I fully appreciate the connection with Pfizer's commercials and emesis.) Of all the drug company commercials, this is the most non-sequitur. The basic premise is:
  • I'm a doctor.
  • I invented an artificial heart.
  • I take Lipitor.
  • I feel great.
  • You should take Lipitor.
  • You'll feel great.
  • You'll be a doctor.
  • You'll invent an artificial heart.
Why did this bother me? Maybe it's because I know Jarvik never has seen patients, he's no cardiologist, and he hasn't done much since crafting together a mechanical artificial heart that was only implanted in a small number of patients because it turned out to cause lots of strokes. Maybe I am jealous of his success. Maybe I just really despise drug company commercials. Maybe it's because simvastatin (the generic form of Zocor) is way cheaper and has the same effect as Lipitor. Maybe it's because Jarvik looks like Randall from Monsters, Inc.

Okay, maybe not that last one.

It turns out that some other people think the Jarvik Lipitor relationship is fishy. There's a big splash in the NYTimes today about how Jarvik misrepresents his physical activity level in the commercial where he is rowing in a scull across Washington State's Lake Crescent.

Someone did dome pretty good digging on this one.

Artificial Poetry

I know. You're itching to read some poetry inspired by my time as a clinical technician for the artificial heart program at the University of Pittsburgh.

Check it out over at The Differential. Then tell me what you think. Really. I have thick skin.

Voting in Washington State

Washington voters: You're up!

My last post about how to vote in Washington State was convoluted and heavy on personal commentary. Here is a simple explanation, with appropriate links.

Are you a Republican? If so, half of the delegates will be determined by a primary election, and half will be decided in the caucus this Saturday. Go to the state party webpage. That site will connect you with each county's party, but you will need to figure out your precinct in advance. If you are in King County, use this tool.

Are you a Democrat? All of the elected delegates are decided this Saturday at the caucus. You might as well tear up your absentee ballot. Democrats in Washington have never used a primary to decide a presidential candidate; hey probably never will. To find your caucus location, go to the state party caucus finder. You only need a name and a zip code, and that server will tell you where to go for the caucus and will remind you of your precinct number.

What's my precinct number? Good question. If you know your precinct number when you get to the caucus, it will save you from waiting in a long line. Most counties have web lookup tools like this one for Martin Luther King County.

Haven't registered to vote? It's too late for you to vote in the primary/caucus, but it's never to early to register for the vote that counts the most. In the state of Washington, you can register online.

Want to know your voting history and information about where to vote? Go to the Washington Voter's Vault. There you can be reminded of which elections you have participated in back to 2004. Which is pretty cool.

Want to Reed more about the primary and caucus system in Washington state? Check out this useful FAQ sheet prepared by the Secretary of State.

Were you thinking of trying to spoil the other party's election by crossing over between the caucus and the primary? Think again! From the FAQ sheet:
Voters can participate in both the party caucuses and the Presidential Primary as long as they participate on behalf of the same party.

Both major parties plan to hold their caucuses on Saturday, February 9, 2008, ten days before the primary. The parties will invite voters to participate in the caucuses and will require participants to sign an oath declaring their party affiliation.

Voters participating in the Presidential Primary will be asked to sign an oath submitted by the political parties indicating that the voter has not participated in the other party’s caucus process. Each party will receive a list of voters who chose to affiliate with that party in the primary.
Is there anything else you need to know? Well, you should probably have a good idea of who to vote for pretty soon. If you haven't made up your mind, Clinton (Pier 30 warehouse Thursday), Obama (Key Arena Friday) and McCain (Before the 2/19 primary) will all be visiting the state in the coming days. Michelle Obama will visit Spokane and Janet Huckabee will be in the state for two nights. Ron Paul may also be making another stop. (He's been in WA quite a bit already.) Look for them! This Seattle P-I article has the most current details so far.

This post may not have been any shorter than my last one. Hopefully it is more informative.

Tuesday, February 05, 2008

24 States Later

Five hours after I decided to live blog Super Tuesday, I am much more comfortable in my decision to support Barack Obama this Saturday at Washington State's caucus. As I alluded to earlier, I could have gotten behind any of the three leading candidates on the blue side. While I was waiting for returns to come back, I considered in detail some differences between the Obama and Clinton health care plans, and I side with the senator from Illinois. Clinton is better prepared to keep the US on the scientific cutting edge. I bet in the end, the two will end up with really similar policy...

It is strange for me, but a lot of my decision here originates in my gut. I like Obama's approach better. I'd rather have a chat with him than Hillary (though both are in my current top ten!)

Am I glad I did this live blogging thing? Yes. I prefer knowing that I spent 5 hours watching politics than a football game. I did miss out on some quality time for studying topics like HIV disease, and I could have been touching up some comments for reviewers on that paper. But I made this choice. And I don't regret it. It will, however be a while before I live blog. And next time, perhaps I'll just re-edit the same post so that I don't back up my (5) loyal readers' site feeders!

And if for some reason, you missed it live and want to experience my unique perspectives on each state as various major media outlets called them, click here and scroll to the bottom of the page to read my reviews as the polls closed.

Nuevo Mexico

This is the last state for me in my little live blogging adventure. While 30% of the precincts have Clinton winning 51% of the vote, the exit polls break pretty hard for Obama. So, without any press agency calls, I'll dispense with that part of my entry and skip straight to the nostalgia. For that, I have one word: Philmont.

California

Hillary Clinton has scored big in California. I bet Alameda County (Oakland) pulls Obama closer, but without San Francisco, LA and San Diego (Obama has done the best in cities), there is no way that he could win. It also looks like 10 % of voters sent in their absentee ballot indicating John Edwards as their choice... Sheesh. That's why you want to wait in the primary season. Anyway, the way the delegates are split up kindof favors the loser versus the popular vote in each district. If a district has 4 delegates, for example, the winner would have to get more than 68% of the popular vote to get 3 of those 4. Otherwise, the two delegate split them 2/2. Methinks it will take weeks for this to get figured out.


Cali has lots of memories now that my folks moved there. Favorite science memories include trips to the Monterrey Bay Aquarium and my very first scientific conference: the American Society for Artificial Internal Organs in San Diego circa 1999.

Red Earth

Obama and Romney in the West. It's a broken record. They've got Colorado. What of my exposure to science there? As a kid, I was fascinated by the cog wheel tram that ascends Pike's Peak. But not fascinated enough for me to track down a picture for this post.

Alaska

As the results come in by dog sled from Alaska, it seems as though Obama has picked up another giant Western state. Now that I am clearly rooting for Obama, I guess I can dispense with the attempts as objectivity. If only he could do better in that giant western state called California!

Coolest part about AK for me involve watching the marine mammals from the deck of the Alaska Marine Highway System ferry on a poor man's cruise between Juneau, AK and Bellingham, WA. If you stay tuned, you'll start hearing tales from a Fairbanks delivery room come this May.

Fun In The tucSon

My favorite memory in Arizona is visiting my great aunt and uncle in Tuscon for Thanksgiving about 5 years ago. I also met up with a good friend from high school who was studying galactic gravitational lensing for an astronomy PhD at the University of Arizona. Sure the Grand Canyon is cool, but I had a better time with friends & family.

Oh yeah. Arizona. Clinton won. McCain won.

Utah

Guess who won Utah for the Republicans? Mitt!

It hardly matters that Obama is projected to win here, what with 6% of the electorate registered as Democrats... At this point, it looks like Clinton has been successful in the states that matter most. At 9:00 PM tonight, I can safely say that my vote in Washington will matter (should I be able to get back over the passes this weekend.)

I can hit the visit and the science in one swoop: I presented my research at a Keystone Symposium on tissue engineering and developmental biology at the Snowbird ski resort last March.