Archive for August, 2008

Runnin’ against the wind

Posted on August 30, 2008. Filed under: Miscellaneous |

Evacuating in the face of Gustav, said to be heading for my Lafayette street.

UPDATE SEP/1/08: Eye about to pass over. Bye-bye electricity.

UPDATE SEP/2/08: Back home. Amazingly, no significant damage (for my family/possessions). Sadly, four deaths in town.

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“How ya like me now?” he asked stiffly …

Posted on August 26, 2008. Filed under: Medical marketing, Sexual issues |

Since the “little blue pill”, the question that seems to be on everyone’s lips is, “What about these phosphodiesterase-5 inhibitors?” Right? Here’s someone inquiring, even as we speak. PDE-5’s inactivate one of the chemicals that makes erections go away (yeah, I know it seems that the verb should be “make” instead of “makes”, but that’s because the subject “one” is hidden by the prepositional clause “of the chemicals”; trust me: I went to school on an English scholarship). Male sexual arousal produces a chemical to initiate erection, and unless opposed, erection is maintained. Eventually, the almost non-flowing blood in the erect penis would clot (priapism), and without rapid treatment, probably no other erections would ever occur. Clearly, animals whose penises worked in this fashion were eliminated by natural selection. In those of us who have evolved long enough to be reading this blog, male arousal produces, along with the “get it up” chemical, a “get it down” chemical. When arousal is adequate, the former exceeds the latter. Eventually, e.g., after ejaculation, or when boredom replaces curiosity, or when the kid says, “What are you doing to Mommy?”, or when the prolonged friction has produced near-toxic levels of latex vapor emanating from the girlfriend’s woo-woo, or the Super Bowl is starting, the production of the “up” chemical slows, and the “down” chemical takes over. In the case of ejaculation, epinephrine production hastens the decline. If you want to know the exact technical aspects, check this summary.

But that’s not what I’m here to talk about. I want to explore the marketing of these miracle pills (more…)

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How old is too old to … well, you know …

Posted on August 23, 2008. Filed under: Sexual issues |

How old is an old person? I’m not sure (although Ohio State University seems to have a strong opinion). It’s got some range to it, certainly. For instance, at the upper end, “old” is at least somewhat younger than “dead”, yet at the lower end, “dead” might be younger than “old”. What to do? Well, if you really want to generate some strong opinions, modify the question and ask, “When is a man too old for sex?” Here are categories of people with whom I’ve discussed the subject, and who have widely varied opinions (guess what they are):**

  1. the man himself
  2. the man himself, if he is a Cajun musician
  3. the man’s wife, if she’s never had orgasms
  4. the man’s wife, if she’s always had orgasms
  5. the man’s fiancee, if he’s wealthy and she’s younger, with a boyfriend
  6. the man’s fiancee if he’s a pauper, their age is similar, and they’re in love
  7. the daughters of a widower whose marriage lasted 40 years
  8. the sons of a widower whose marriage lasted 40 years
  9. a feminist of any age, once she discovers the feds will pay to make it possible for every man on Medicare, but won’t pay for her mother’s eyeglasses
  10. fanatically religious men
  11. fanatically religious wives
  12. some others I’ll probably think of as this goes along

** Hint: all the opinions given by the men are the same; the ones given by the women vary (more…)

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Posted on August 23, 2008. Filed under: Layman's AI, Self-deception |

A couple of years ago, I saw a reference to a new book in New Scientist magazine: The Singularity Is Near, by Ray Kurzweil. My leisure reading interests had turned to physics, evolutionary biology, and the quest for the Theory of Everything in recent years (I know that doesn’t sound like “leisure”, but one man’s trash is a sow’s ear, as the saying goes), and Kurzweil’s tome seemed to be about a curiously related issue. I bought the book, and read it. I haven’t been the same since.

Kurzweil discusses the almost certain (in his mind) upcoming emergence of the technological Singularity: the development of smarter-than-human intelligence. Among my friends, and apparently people in general, this is a topic that, once broached, causes severe polarization. I admit, it’s not sweeping the country with polarization; most people have never heard of the concept, except in movies and sci-fi books. But once they become aware that serious scientists with ninja-brainpower are working on it, most reactions that I have seen fall into one of two categories: 

  1. reject it out-of-hand, or
  2. think about it carefully, and then reject it. (more…)
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Here’s your summons, doctor. Wanna play tennis?

Posted on August 22, 2008. Filed under: Everything you wanted to know about doctors, Medico-legal issues |

In this recent post, I mentioned in concluding that I would give an opinion about a cause for the lack of aggregate marginal value of American medicine, as documented by economist Robin Hanson. I began reading Overcoming Bias a little while back, and, being a doctor, my curiosity was tweaked by a series of articles like this one about the lack of efficacy of American medicine. As I mentioned in a previous post, I found the arguments of math-ninja/economist Robin Hanson persuasive. He goes overboard, as you can judge for yourself, by suggesting that modern medicine is a conspiracy to defraud. (more…)

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Ray, where are you, now that we need you?

Posted on August 22, 2008. Filed under: Good ol' days |

Today, I learned of the death of my public high school’s “Dean of Boys”, Ray Stasco.  It marks the passing of an era in America, in several ways. Members of “Generation Y” might not be able to conceive of the role Stasco played when I was in school. Our innovative principal was a former football coach, Billy Parker. Mr. Parker had such a successful record with motivational techniques that the county school board allowed him great leeway in his management of our school, which had been in existence only two years at the time of my matriculation. There was no public-school racial integration in those days, so racial conflict was not an issue on campus. Guns also were not a problem. What there was, however, was an entity called “juvenile delinquent”, JD for short. Our school had more of these ne’er-do-wells than any other, at a time when students were assigned to the school in their own neighborhood. They had no desire to be in school in the first place; since the state allowed students to drop out voluntarily after completing the eighth grade, or reaching the age of sixteen, none of them expected to be there. So, why were they there? Almost without exception, it was a condition of their probation arrangement. (more…)

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We don’t wanna hear it

Posted on August 21, 2008. Filed under: Everything you wanted to know about doctors, Self-deception |

I have an investment partner whose gainful employment, unlike mine, cannot be succinctly described. Truly he is an entrepreneur. He uses his superior intelligence and education to take an entity’s high-potential, low-performance business, reorganize it, and sell it for enormous profit. He manages the affairs of people who have marketable talent, but no financial skills (popular bands). He buys onto the boards of tech companies that have wonderful products and no knowledge of how to sell them. He buys small oil and gas companies whose owners have no idea of the actual worth of their companies (plus or minus), and resells them. He wears a lot of hats. He is a gazillionaire.

I met him because he realizes that doctors have very marketable skills, which are always in demand, but virtually no business expertise (because of the channeled educational curriculum they followed), and who are so arrogant about their abilities to handle anything, in any field, that they will run into bankruptcy most of their personally-managed investments outside their own practice  post haste. Our acquaintance occurred when a number of my colleagues (doctors) decided to start a private, for-profit cardiovascular hospital. This businessman could never be productive, in the sense of directly generating income (he has no license to practice medicine), but his non-productive (again, business definition) efforts are the only reason we are viable. The resistance of the other doctors (never me) to his involvement in our our project is part of a future post. Suffice it say, it never occurred to me in college simply to obtain my diploma, and then use my intellectual ability to make a living by thinking better than the competition. In fact, my first senior surgical partner told me, “Just do the work. The money will take care of itself.”

Recently, the businessman and I were having a conversation about my current status: professionally disabled. I sustained an injury about three years ago that prevents me from continuing as a surgeon. I was relating this sad story, along with details of a nearly concomitant divorce for which I was not liable in any moral way, yet lost my shirt, and the necessity to sell my house in a down real-estate market for the division of the equity. I wasn’t looking for sympathy (I probably was), but the effect on him was immediate and total. He said, “I admire you for what you went through to get your credentials, and for your skills. It’s too bad the way things have turned out. But don’t ever tell that story to anyone again. The average man does not want to hear about the rough life of a surgeon. You’re living far better than 99% of the people, and the business world will reject you if you make that story your mantra.” This is the first time I’ve mentioned it since.

In recent times, chasing a better understanding of the quest for the technological Singularity, I began reading (and unwisely commenting) on the posts at Overcoming Bias. This has brought about several realizations, unfortunately all later in life:

  • Most branches of true science rely heavily on math as the language. Some mathematical concepts literally cannot be put into words, yet another mathematician knows exactly what they say.
  • Medicine is not a true science; doctors are not mathematicians.
  • Scientists base all their conclusions on falsifiable evidence; doctors, for the most part, are not even familiar with the methods for evaluating evidence in their own fieldsSee this, for example. I didn’t come close to the correct reasoning.
  • Anecdotal experience, to a scientist, is no different from lies; anecdotal “experience” plays a major role in the decisions doctors make about patient management.
  • Doctors have an incredibly positive influence on the health of some individuals, at some particular times, but for the most part they are unaware of, or unwilling to accept the statistical evidence for, their ineffectiveness regarding the health of the American populace as a whole. See the evidence here and here, for instance. I have been in medicine for 38 years, and I was unfamiliar with these statistics. As Eliezer Yudkowsky chided one doubtful responder about this information: “I don’t think you understand what statistics mean. They are not a sort of weak extra argument that you weigh in addition to your much more reliable personal experience; statistics are a stronger, more reliable way of looking at the world that summarizes far more evidence than your personal experience, even though it just looks like a little number on paper while all that other experience weighs so heavy in your mind.” Elegant, and a statement that I guarantee most of my colleagues would reject.

Of course, I’m not yet aware of what, if at all, studies have to say about the marginal value of professions other than medicine. I suspect another post will follow addressing that. But for now, I’m reminded of the original United Negro College Fund ads that asserted, “A mind is a terrible thing to waste.” American physicians are smart; the selection system almost guarantees it. But, we’re not the smartest of the professions, and much of our smartness is wasted by our undisciplined thinking.

I think I know one very good reason for this, and I’ll discuss it soon.

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Not tonight, dear; I have a headache.

Posted on August 17, 2008. Filed under: Sexual issues |

In a post on the Future of Humanity Institute’s “Overcoming Bias” blog, Dr. Robin Hanson discussed the “inexplicable shortage of sex” and the neglect of sex as a research topic. He asks the question: since sex is the greatest gift, what can we do to inspire more precious gift-giving? The question addressed is “why we have too little sex”. An implied question is “why have men evolved to desire sex more than women?” (more…)

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How do you like this education, doctor?

Posted on August 16, 2008. Filed under: Everything you wanted to know about doctors, medical ethics, Medical marketing, Self-deception |

Chances are, if your doctor seems quite successful, he is a drug rep. He may not even know it. He surely won’t admit it, especially not to himself. It probably started out as a part of his continuing education.

I wrote: In my next post, I’ll talk about the real leaders in doctor “education”; they weren’t included in this one because it’s not official CME. I’ll also throw in some first-hand, saw-it-with-my-own-eyes anecdotes. Here it is; I know you’ve been waiting with bait on your breath.

You’re sitting in your doctor’s waiting room. You have the first appointment of the afternoon, yet there are five others waiting as well. They are all relatively young women in very nice outfits. They’ve got some cleavage working, and they’re shod in FMP’s, the good kind, maybe Jimmy Choo’s. They don’t seem to be ill. They’re pharmaceutical reps. (NOTE: if your doctor is a woman, these people will instead be athletic-looking youngish men, or perhaps an occasional older, plainer chick, no cleavage. Nothing suggesting competition). They are waiting to help your doctor with his continuing medical education. In fact, statistically, they are the major source of your doctor’s new knowledge about medicines. You will be ushered to an examining room and told, “The doctor will be with you shortly.” One or two of them will see him in his private office before he comes to see you. And so the day will go. (more…)

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Why your doctor thinks what he/she thinks

Posted on August 16, 2008. Filed under: Everything you wanted to know about doctors, medical ethics |

 

When it comes to the source of your doctor’s upgraded medical knowledge, follow the money. I thought that phrase was from Jerry Maguire but apparently it’s not. Whether from the mouth of a sports agent, an investigative journalist, a movie script writer, or just someone who knows what he’s talking about, when it comes to your doctor, chances are it’s right on. Once your doctor finishes his training, he is on his own for further education (the editorial “he”; I’m not going to say “he/she” every time, regardless of PC, and regardless that we will soon have more female doctors than male; that’s another post). All US state medical boards now require doctors to show evidence of Continuing Medical Education (CME) in order to retain their licenses to practice. Talking over a problem in the doctor’s lounge, or calling the old professor to see what’s new, does not qualify as CME. Neither does reading the new edition of a comprehensive textbook (which, by the way, is already years out of date by the time it’s published). So how is CME accomplished? Commonly, there are four ways: (more…)

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Doctor, are you FDA-approved?

Posted on August 16, 2008. Filed under: Everything you wanted to know about doctors, medical ethics |

For the most part, the “practice” of medicine does not work like a science. I wrote that comment recently on the Overcoming Bias blog. Prior to 1910, when the Flexner Report was released, there were no general guidelines for teaching American doctors. As a result of Flexner’s recommendations, over half of the American medical schools had been closed by 1935, leaving a total of 66. Since then, with the growth in population, the number has climbed to 129, with each of these following the same rigorous standards. There are no “bad” American medical schools (unless they all are bad). All American doctors are trained in a evidence-based curriculum. All “board-certified” doctors must give at least the minimum number of  correct answers on the Board examination, and demonstrate the ability to avoid being fired for the duration of their specialty training, such that the Professor is somewhat obligated to give a recommendation, since the candidate was allowed to complete the program. 

So why isn’t the practice of medicine a “science”? (more…)

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    About

    The director of the Sexual Medicine Center leaves penile implants behind, and launches a quest for knowledge about Artificial Intelligence, extended life, and the issues inside the health-care industry.

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