New format

On the advice of a friend, I just ported my blog over to Wordpress. It's much more customizable; the themes are prettier; and I just plain like it.

I'll keep this site up, but why not mosey on over and see what I've been up to lately.

[Update: You'll be automatically redirected. Just FYI. This message will self-destruct in 6 seconds.]

This is just to say...

...that Montana is awesome.

I spent 10 days hiking around Glacier National Park, Yellowstone, and the Grand Tetons.

Highlights included:
-Climbing to the very top of a snow-laden trail. (Snow! In August!)
-Elk grazing on the front lawn of our hotel.
-Being chased by an enraged mother bison. Those things can move.
-Old Faithful. The lady behind me asked a ranger if the 'stremely accurate timing was "controlled by someone."
-Huckleberry ice cream, which has replaced Canadian Maple Walnut as my Flavor of the Month.
-"Caulk your wagons and float" down the Snake River. Ah, the postmodern pastiche of comparing a real-life experience to a twenty-year-old computer game.
-Generating all the Vitamin D I'll need to tide me over for another year of living in the library. (Almost literally! The second-year classroom is on the fourth floor of said library, and my room is across the street. Hey, at least the commute is non-existent.)

Last day of work

Tick-tock, tick-tock.

It's a slow day here. Kind of sad to think it's my last one. Although I'm glad my only major project for this week, a presentation on vaccines for substance abuse, went off without a hitch. I am nervous about public speaking, but when one of the other interns tried to steal my thunder with a question that turned into a soliloquy on political ideology, I stole it right back, got everyone back on track, and finished with a bang. (Thunderclap? This analogy is dead.)

Putting together the presentation was pretty cool, though. Basically, antibodies "soak up" the cocaine/nicotine/meth and keep it from crossing the blood-brain barrier. Result: no high. It was all fMRIs and mouse studies and made me realize how absolutely awesome neuro is. It was probably the best class of first year. Even if I did fall asleep during the last exam.

But the absolute coolest part about putting together this presentation was doing the handout, for which I had to haul out the scissors for some old-school cutting and pasting. (Well, taping, but you know what I mean.) I've never done real life cut-and-paste before. You have to think about orientation and spacing! You can't just resize images! It was ... surreal.

So much drama on C-SPAN!

On a bill to give the FDA regulatory authority over tobacco, especially to ban flavored cigarettes (kids' favorites).

Rep. Boehner (R-OH): This is a boneheaded piece of legislation. *handwaving and rant about big government*
Rep. Dingell (D-MI): I yield myself 15 seconds of time to respond to my beloved friend. Mr. Boehner, tobacco kills. And you will be the next to die.
Entire AAP Office: Whoaaaaaa!

(I wish I were making this up.)

Textbook time!

Late last week, one of my class reps sent out a survey from the class of 2010 (well, a third of the class of 2010) about second-year textbooks. Exciting! I definitely bought way too many books for first year, though, so I'm trying to hold off this time. The top-rated books for pathophysiology are subject-specific (Lilly's Pathophysiology of Heart Disease, Despommier's Parasitic Diseases), but I'm debating about supplementing with a general pathology book. Robbins, perhaps? Or BRS?)

Truly, though, I'm nerd enough to be looking forward to the start of second year. I went ice skating this weekend with some high school friends, one of whom is now a pharm tech. He was lecturing pharm to everyone who would listen -- basically, me. So exciting to think that in a year, I'll know everything he was talking about! :)

I mean, second year will probably be scary. More volume, more detail. That pesky little board exam in June. Building on previously learned material. Which I have pretty much completely forgotten. (Bones of the wrist? What? I only vaguely remember our rotund little professor with the sweat issues, standing in front of a slide of a giant hand and telling us a dirty mnemonic about Tillie's pants.) But also really cool! I mean, parasites! What could possibly be more interesting than that!

I've spent most of the last few weeks at work on the phone, trying to scheduling meetings on Capitol Hill but mostly getting transferred from voicemail to voicemail. An awful lot of Congressional staffers are away from their desks, all the time. I have this vision of them wandering the Halls of Power, like zombies in a a 1950s scifi flick, searching for the Mother Ship.

Big news today: the leaked HHS proposal that seeks to redefine "abortion" to include contraception. (Ummm... Griswold v. Connecticut, anyone?) The so-called "conscience" clauses grant financial (and possibly legal) immunity to those who deny services based on religious beliefs. What I can't seem to find is the HHS definition of contraception. Is this just Plan B, which prevents implantation of a fertilized embryo? Or shall we include barrier contraception, which prevents fertilization? What about hormonal contraception, which prevents ovulation itself? (Apologies if I got any of this wrong. I went to a school district that had abstinence-only sex ed, and despite passing both Human Development and Endocrinology/Reproduction in med school, never had a lecture about pregnancy.) If women and men don't have access to basic contraception, and education about its use, abortion rates ("real" abortion, that is) will just climb.

What I find especially interesting (disturbing?) is that the proposal cites a NEJM study that found that 86% of physicians feel they should present all available options to a patient (and 71% would refer the patient to another physician in the case of religious/moral conflict), yet promptly rejects that overwhelming professional opinion in favor of a 2001 Zogby poll that found that 49% of respondents believed "abortion destroys a human life and is manslaughter." Dunno how the Zogby people feel about contraception, but given that 40% of American women use hormonal birth control, I think I can guess.

As a future physician, I'm aware that my personal beliefs may, at times, conflict with those of my hypothetical patients. But, like 86% of physicians, I think that patient need is superior to provider religion. Hey, HHS? What's your definition of paternalism?

The objections of the President of the United States to the contrary notwithstanding

Raise your hand if you thought "Congressional action" was an oxymoron.

Yeah, me too. The system was, of course, designed to move as sloooooowly as possible. Between committee referrals and hearings and filibusters, it's a procrastinator's dream come true up there on Capitol Hill.

Which makes today's events all the more surprising. After just 4 of his allotted 10 days of consideration, Bush vetoed the Medicare bill this morning. After lunch, the AARP held a rally on the West Lawn of the Capitol. Two hours later, the House voted to override the veto; the Senate vote took place about two hours after that. This is the equivalent of hyperspeed for Congress! Good for them! (Even more surprising: more people voted to override the veto than voted in favor of the bill in the first place. Buh?)

My other task today was attending a Global Health and Poverty luncheon. Irony is eating ham and havarti on rye and drinking raspberry white tea while copying down statistics on how many sub-Saharan African children suffer from malnutrition.

High drama on the Senate floor!

While I was in New York, stressing over where I'm going to live next year, the Senate was tackling a sliiiiightly more important issue: the Medicare vote.

Act I: The Exposition, or Let's Screw Doctors
For those of you who didn't hear, Medicare was set to have a 10.6% reimbursement cut, effective July 1. CMS, which handles claims, said they'd put a hold on processing claims for two weeks until Congress decided whether to delay the cuts, as they have done every year since Time Immemorial. (I learned today that CMS doesn't process claims for 14 days anyway, so the hold was more semantic than real.)

Act II: The Rising Action, or Let's Put on a Band-Aid (TM)
The House rushed through a bill on June 24 to delay the cuts. (355-59; definitely veto-proof; See how your guy/gal voted.) Following the procedures outlined in Schoolhouse Rock (and, you know, the Constitution), the bill went to the Senate. Given the time crunch, Sen. Reid of Nevada moved to invoke cloture, which meant that the Senate would skip committee, debate, amendment, and the inevitable compromise-with-the-House quagmire and pass or reject the bill in its House form. That motion fell 2 votes short of passage. Not voting were Sens. Kennedy of Massachussetts (understandably) and McCain of Arizona (not so understandably). Here's the roll call.

Intermission
Then Congress went on a ten-day picnic and the American Medical Association went beserk.

Act III: The Climax, or Let's Applaud for Two Minutes
On Wednesday, more than a week after the cuts were scheduled to go into effect, the Senate reconsidered cloture. In possibly the most dramatic moment in Senate history since Preston Brooks caned Charles Sumner, Sen. Kennedy arrived, specifically to vote in favor of cloture. He flew back to MA for more chemo directly afterwards. But thanks to his appearance, the hard work of the AMA and AARP, and plenty of grassroots pushing, the motion passed, 69-30. Again, a veto-proof majority. Again, Sen. McCain did not vote.

Act IV: ?, or What You Will
Bush has repeatedly threatened to veto the bill. Schoolhouse Rock (I mean, the Constitution!) says the president can sit on the bill for 10 business days before deciding what to do. Probably he will veto it after all, so the veto-proof majority in both houses is an important fact. So important that I spent most of the day today writing to my senators to thank them for their votes in favor of cloture and urging them to continue to support access to care. You should too! There's a cool new online system accessible at [lastname].senate.gov, so you don't even have to spend on stamps! And you get automated replies:

Senator Warner is snuggly
Thank you for your email. It is my goal to reply in a timely fashion to every email that I directly receive from a fellow Virginian. I appreciate your views and look forward to responding to you.

Senator Webb is not
Your comments have been submitted.

In any case, it's all very restorative in the Power of Democracy: Congress CAN do things, grassroots letter-writing and phone calls DO make a difference, legislation DOES affect you, me, and that old guy who sits outside the Metro station and plays the pan pipes.

I think I'll go home now and watch Mr. Smith Goes to Washington. Sappy enough for you?

We have summer reading! Again! As BH, who is in math grad school (taking classes like "topological algebra" and "partial semi-differential hand-waving") said when I told her: "Buh?"

Last year's summer reading was on The Spirit Catches You and You Fall Down, a rather sad story of cultural clashes. It frustrated me no end, which I suppose was the point. We were supposed to discuss in small group but never actually got around to it, so my understanding of cultural competence, $60k later, is not really much better than what it was around this time last year. (I do, however, have a much better understanding of rotation of the gut, for what it's worth. Everyone has situs inversus.)

This year's summer reading is Mountain Beyond Mountains, Tracy Kidder's biography of Paul Farmer. I'm holding off judgment until I actually receive it (could be a while, given the Fourth of July shipping delays), but it should be an interesting read, if nothing else. I'd like to do international work eventually, and Dr. Farmer's kind of a Big Deal in the global health arena. It is gratifying to see that idealism can actually work.

Slow day at work?

I've settled into a bit of a summer routine by now. Up at 6:30, out of the house by 7:15. I carpool with my parents, who drop me off outside their office and I walk across to my own. I usually get there well before the office opens, so I duck into a Borders across the street and read till 9. (Currently working on Kate Atkinson's Behind the Scenes at the Museum; highly recommended to anyone who liked Middlesex.)

I go to a lot of Congressional hearings. They are becoming a commonplace now, but when I stop and think about them, it's really a remarkable experience. I always seem to arrive just after a tour group of obese Midwesterners; that's summer in DC for you. After I shuffle out of the oppressive humidity (the city retains the atmosphere of its swampy origins) through metal detectors, I head up a marble circular staircase to whatever committee room the hearing will be in. There's usually a long line for the public; often I have to stand in the back or along the sides. The committee sits at a large dais, Democrats and Republicans on either side of the chairman's throne. Witnesses sit facing the committee at a long table, with microphones and water glasses. After opening statements by committee members and testimony by witnesses, the fun part -- the questioning -- begins. I've seen committee members rip into witnesses, and you can really tell when someone loses their cool or has been "rehearsed." The whole thing takes an hour or six. Then I go back to the office and write up a summary for whoever is in charge of that issue.

What has struck me most about these hearings is the almost total lack of clinical representation. Since these are mostly Health subcommittee hearings, the witness panel usually includes a physician, but generally a researcher rather than a clinician. Lots of MPHs, lots of PhDs. It's a little surprising, given that members of Congress appear to respond better to "clinical vignettes" about anonymized children than statistics about disease prevalence. So why not bring in the people who actually care for these kids? Demands of the profession? Less experience with law? 'Tis unfortunate, because it means that Congress is dictating from on high with very little input from the people who would actually be affected by this legislation.

Grassroots stuff -- letter-writing and phone calls and petitioning -- can work, but there's nothing as effective as sitting in front of ten or fifteen Senators arguing your case.