Opinion : Sports Broadcasting

I have been watching a lot of ESPN lately (mostly background noise as I eat) and I am becoming disappointed.  I love sports, but I am not happy where cable sports broadcasting is heading.  There is very little actual sports shown and instead there is continuous news programming played on a minute loop.  While this is not a new format idea, several trends are making sports channels less watchable.
 First is the very narrow range of sports covered by the endless news programs.  Sportscenter yesterday spent hours yesterday talking about College basketball and NFL trades, with a little NBA and men's golf sprinkled in.  What about College Hockey or the NHL?  Soccer?  MMA? women's sports?  Baseball?   I understand that College hockey is not as popular as college basketball, but with over 6hrs of news a day, doesn't it warrant a few minutes of coverage?  

Second is the trend of airing news and documentaries instead of the actual sports.  At one point last week, ESPN was airing a documentary about Basketball players (Magic Johnson) when there were actual basketball games being played.  These are good stories, but ESPN is not the place.  as a fan who flips to a sports network, I want to see sports.  ESPN has a sister station ESPNnews  that was supposed to be the channel that allowed branded sports themed programming to be shown without displacing actual sports, but for whatever reason, ESPNnews is no longer in my cable package and its programming is constantly on the flagship network. I feel that this cheapens the whole brand.

Third, the competition is increasingly conforming to ESPN instead of innovating.  When NBC sports took over VS network, they started a branded sports news show and have moved away from the outdoor programming that defined the network.  They have even moved their offices to Connecticut.   Local sports networks keep getting bought out by the teams that they cover and get turned into a marketing exercise instead of a real sports broadcaster (See: Yes Network)  Networks founded by leagues seem to be an attempt to shake down cable companies as opposed to actually increasing the amount of programming available (see NFL network, Big Ten Network)

All of this has led mt to the following unfortunate point:  despite far more cable channels and broadcasting capabilities, there is no more live sports on TV than there was a decade ago (at least on my cable package on Comcast Philly).  This is a missed opportunity, as availability of sitcoms, reality TV and Movies has increased, sports has not kept pace.  I want to see more college and olympic sports and local coverage that extends past the major league level.  I can watch engineering lectures that are broadcast city wide by my college but I cant watch the school's lacrosse games.   The internet is great for stats and news but nothing beats watching sports live.

Opinion : the problem with the 2 party system

While I have supported both Mitt Romney and Barack Obama in the past, I am not happy about this up coming presidential election. Like many people, I feel that there is really no candidate that represents my interests. How have we come to the point where most of are elections are a choice between the lesser of 2 evils? One of the big problems is that our political institutions support an entrenched 2 party system. What America really needs is at least 4 distinct political parties, in a system that encourages compromise, similar to what exists in Europe.

It is easy to see how the uneasy alliances on each side of the isle would break to form 4 political parties. On the Liberal side there would be a intellectual activist group (similar to the Green party, could be lead by Al Gore and Obama) and a party of unionized workers (the Labor Party, led by Hillary Clinton?). This would allow all politicians to be more honest by unwinding some policy contradictions (like the UAW being opposed to environmental regulations). On the Conservative side, you have a party of wealthy libertarian types who do not care much for social policy (led by Mitt Romney and Donald Trump) and a party of social conservatives who want the government to legislate morality (likely led by Palin and Santorum). Again, with out having to please everyone under the "Big Tent", politicians could lead a much more honest public dialogue.

Unfortunately, The way our primary systems are set up, more than 2 political parties are currently impractical. If a 3rd party bid splits up 1 of the parties, the result will likely encourage the other party to stay together and win, not to follow suit to achieve needed reform (see: Ross Perot). Mediocre, insincere candidates will continue to be the norm for the foreseeable future, as these candidates have the best chance to unite the fundamentally fragmented parties.

opinion : the death of google labs (especially health)

It is a sad day, as I found out that Google is shutting down at labs applications. I've long been a fan of this part of the company and it will be disappointing to see it go I am particularly annoyed that many good applications are going to simply stop existing, particularly Google health. It is a little bizarre when you log on and they tell you to “please switch your information to Microsoft”. Looking at their blogs, it appears that Google closed the project down because it did not get the number of users that they had intended. Google is being foolish here however, as Health never got popular because it was never really marketed properly , or at all for that matter. Many people in healthcare did not even know that it existed, including many of my colleagues. Had Google advertised it to all these people using its other services(gmail or search ads), I have no doubt that the health service would've spread.

Google has clearly not learned its lesson from the days of Google video. Google video was a service similar to YouTube (but technically superior) that Google did not do much marketing for either. As a result Google video was crushed in popularity by YouTube and Google was forced to spend billions of dollars to buy YouTube to compete in the segment that they had innovated in. This is a great example of how a company will suffer if it has many great engineers but not enough good business people to capitalize on their innovations. Google health is not the only labs application that has suffered in this regard. I'm sure that many more people would've used Google squares and several other innovative programs had Google pushed them on its regular users more aggressively.

The fact that Microsoft is going full speed ahead with their health portal also suggests this is a big area in the future. It is a matter of time before electronic medical records become common, and as patients become more interested in seeing in controlling their data, the appeal of health records applications will be huge. Google will learn its lesson when future versions of Microsoft Office are sold to doctors at marked up prices because they include health vault software, and will then be forced to buy some start up competitor to compete.

Now let's just hope that they do not get rid of Google Body - my current favorite Google application.

opinion : lowered residency work hours makes better physicians

A recent discussion with an attending highlighted an important generational gap in academic medicine, one that has become much more pronounced with the changing resident work hour requirements. The issue is that older doctors feel that the end-all of learning as a student and a resident is achieved by maximizing the hours spent in the supervised clinical setting (“on call”). Most younger doctors tend to avoid these on-call hours, which the older attendings often believe is because of laziness or lack of dedication to medicine. This is a misconception that needs to be corrected however. Young doctors do not like structured clinical on-call hours because we recognize that they are sub optimal for learning.

The first reason that traditional on-call hours are sub optimal for learning has to do with what is expected of doctors during those hours. Most of the work done during these hours is “scut” work, both patient and institutional paperwork that had nothing to education. The second and more important reason however is that people in my generation who have grown up with computers and online resources have come to realize that self-directed, active learning is by far the most effective means to learn the vast quantity of data required to be a competent physician.” Back in the day”, the only way to get information from a good medical lecture was to sit physically in the room and listen to that person talk(some hospitals had physical tape recordings?). Today almost all lectures from any medical school are available to be instantly streamed on the Internet. Throughout medical school, most students have learned to maximize their study time by using their personal preferred online resources. While current residents often spend 100 hours per week learning medicine just as their predecessors did, we understand that is much more effective to have less time with direct patient care and more time in front of our computers studying in the areas that we are weakest on. While this does not necessarily apply to procedure oriented specialties such as surgery, information oriented specialties such as medicine and radiology clearly benefit from residents having extra time when they're not on duty to study as they see fit. In this light, it is easy to see that a resident who spends 80 hours on call and 20 hours studying on their own time is going to be a more knowledgeable resident and one who spends 100 hours on call faxing pharmacy requests and rewriting safety checks. There was a time when the only way to see rare cases was to be on call when these cases came to the hospital, but instant access to electronic resources has made this an issue of the past, especially in radiology.

The idea that you can be a better resident in less time is hard to understand to someone who grew up in an era where commitment and quality were measured by number of cases seen and amount of time put in. It is difficult for many old-timers understand that you can be a better doctor by putting in less time as long as that extra time is used correctly. Young doctors can in fact be better trained in fewer hours.

opinion : manners (or lack there of)

this silly parenting website has a list of manners that they say every kid should learn. (formatted as a annoying online slide show) based on my daily interactions, I would say that they are not aiming high enough however. Here is my directly copied and modified list, manners that everyone should learn:

1. When asking for something, say "Please."

2. When receiving something, say "Thank you."

3. Do not interrupt others who are speaking with each other unless there is an emergency.

4. If you do need to get somebody's attention right away, the phrase "excuse me" is the most polite way for you to enter the conversation

5. When you have any doubt about doing something, ask permission first. It can save you from many hours of grief later

6. The world is not interested in what you dislike. Keep negative opinions to yourself, and do not offer criticism unless you are also offering a constructive solution.

7. Do not comment on other people's physical characteristics unless, of course, it's to compliment them, which is always welcome.

8. When people ask you how you are, tell them and then ask them how they are.

9. When you have spent time at someone else's house, remember to thank them for having you over and for the good time you had.

10. Knock on closed doors -- and wait to see if there's a response -- before entering.

11. When you make a phone call, introduce yourself first and then ask if you can speak with the person you are calling.

12. Be appreciative and say "thank you" for any gift you receive. In the age of e-mail, a handwritten thank-you note can have a powerful effect.

13. Never use foul language in public.

14. Don't call people mean names.

15. Do not make fun of anyone for any reason

16. Even if a play or an assembly is boring, sit through it quietly and pretend that you are interested. The performers and presenters are doing their best.

17. If you bump into somebody, immediately say "Excuse me."

18. Cover your mouth when you cough or sneeze, and don't pick your nose in public.

19. As you walk through a door, look to see if you can hold it open for someone else.

20. If you come across another person working on something and you have a minute, ask if you can help.

21. When someone asks you for a reasonable favor, do it without grumbling and with a smile.

22. When someone helps you, say "thank you." That person will likely want to help you again.

23. Use eating utensils properly. If you are unsure how to do so, look it up

24. Keep a napkin on your lap; use it to wipe your mouth when necessary.

25. Don't reach for things at the table; ask to have them passed.

and now for a few of mine:

26. do not ask about what you can look up.

27. do not interrupt an in-person conversation for a cell phone conversation (unless its an emergency)

28. look at people when you are talking to them.

29. If you borrow something, always return it in the same condition.

30. clean up after yourself, don't ever expect others to do it for you.

31. do not attempt to push a controversial opinion on others unless you know what you are talking about and can back it up.

32. when talking about politics, avoid these: http://www.logicalfallacies.info/

33. never take credit for what you did not do.

opinion : pharmaceutical R&D

This article published in slate summarizes a long running debate between the pharmaceutical industry and consumer advocates. while both sides make good points (drug development is high risk, but pharma industry estimates are certainly inflated), neither is making refference to any good data. I am not sure why this is the case - puplic companies are required to disclose there quarterly expenditures and most describe how many candidates are in the pipeline. It seems to me that a quick look at the annual reports would give exact numbers and allow for an informed argument about R&D costs vs profits. here is an example:

Pfizer

R&D expenditures (2009): $7.8 billion (http://www.pfizer.com/files/annualreport/2009/financial/financial2009.pdf)

drug dev projects: (sept 2010): 92 new drugs (http://www.pfizer.com/files/research/pipeline/2011_0228/pipeline_2011_0228.pdf)

avg spending per new drug product per yr: $84.8 million

multiplying the amount spent per yr x number of years that it takes to come to market (about 10) gives almost the number that the pharmaceutical industry claims it takes to develop each drug ($850 million by my estimate). activists claim that since only a few drugs actually come to market and much of the expenditure for R&D is on postmarketing licensing trials, these numbers are skewed however. While I concede that it is true that companies do not actually spend $850 million directly developing any one drug, it is reasonable to assign this value to the cost of bringing a drug to market based on company's actual R&D expenses.

full disclosure - i used to work in clinical trials for Sanofi-aventis

Big Blue and the future of medicine

This evening, I watched as the computer took on the jeopardy champions from the treadmill in the hospital gym. I cant help thinking that the computer would make a fantastic physician. In fact, it will likely not be long before similar systems start aiding, then replacing doctors, especially when it comes to formulating plans for diagnosis and treatment.

The jeopardy playing computer is an experiment in programing machines to mine a large data set to answer questions based on a random input. The system does this using Bayesian reasoning algorithms (i am assuming here) to determine %'s of each correct answer and uses a threshold to determine if that answer is correct. In theory, this is the exact same process that a physician uses to make a diagnosis (assuming they are using evidence based medicine (EBM), doctors should technically be assigning a probability that they are correct although I have yet to meet one that consistently does this. IBM needs to figure out how to program an Ego). If the data set entered into the jeopardy system is roughly the same size and complexity as the set of all medical data (I cant even guess this one) then that system should be capable of making expert medical diagnosis. If medical data is more complex, then it will be just a matter of time.

All this is depressing, because a computer should in theory be much faster and more efficient at parsing numerical data (epidemiology, trial data, testing sensitivities) then a human would ever be, and so computers should make better doctors. But what about the human touch? Certainly the person to person interaction adds value to the work of human physicians that computers will probably never match. However computers can add value by developing capabilities that go above what humans are capable of, such as faster learning, or enhanced sensory ability. Each part of the decision making process represents a technical challenge that can be chipped away at by engineers. This is why computers are evolving much faster than humans. Robotic surgery systems are clumsy and slow, but they are getting better. This is of particular concern for primary care physicians because in the modern healthcare field, the doctor's job is decision making and communicating the decisions with patients. (Secretaries and transcriptionists do the paperwork while nurses and techs provide the direct patient care). Watching the computer on jeopardy leads me to believe that in the not so distant future, machines will be better at making medical decisions than the physicians that humanity has relied on since the dawn of civilization. The evidence base and obsessive outcomes research that we had hoped would improve our profession may end up making us obsolete at the hands of machines that can use the research more effectively.

Document filing system

I obsessively keep old documents and receipts, and I also continue to look for new ways to store and organize them. Many years ago I began scanning the documents to keep electronic copies and shredding the originals to save space. It is a lot easier to organize and find documents this way (especially if you run OCR on the pdf's) but there needs to be a fool proof back up system. To maintain my sanity, it became clear that I would need off site backup but I am far to cheap to pay for it. I tried a few different schemes such as zipping the files and emailing them to myself but all methods had obvious shortcomings.

I wanted a system that:

- was secure - password access but not part of my usual accounts (if someone hacked my email, they could not access my files) and encrypted connection for transfer

- was easy to use - i wanted instant recall and automated filing

- could handle both edocs and scanned paper files

- could be accessed from anywhere

Last year I did some work at a pharmaceutical company that was setting up a system to transmit FDA docs between research sites in a secure manner. It inspired my current filing system. I could not afford to pay consultants for custom software solutions, but I was able to rig up a pretty good system using Gmail. Here's how it works:

step 1: take out a new gmail account,(the documents acct) use secure settings and never share address or pw. (this provides the centralized, secure online storage)

step 2 : decide on filing categories (as mail tags) and set up a simple code for each category with custom filters so that by attaching the code to the email gmail automatically file the email in the correct category.

step 3: using another email account, attach any current files to emails and send them to your documents acct with the filing code in the body of the message. This allows you to store hardcopy documents (google now allows you to automate this process using gdocs but that involves more set up and will separate edocs from scanned paper ones making it more difficult to search them). I make sure to go to the sent messages and erase those emails after from my primary acct.

step 4: set up automatic forwarding for any ebills that you receive so that they all go to the documents acct without actually giving out the documents email address (prevents spam and ads in your archive). set up filters in the doc acct to auto file these forwarded ebills to the same categories as the scanned docs.

At this point every document, bill, and receipt i have had in the last 5 or so years is saved on a gmail acct that only i know about. If i need a certain doc, typing it into the search bar brings it up. I can review all of a type of bill by logging on and clicking the tag. I have been using this system for over a year and it works very smoothly. beyond the original setup, it allows you to operate a sophisticated filing system with little time input.

For the record: 2011 goals

Well, I have abandoned this blog for almost 2 years, but i still have opinions so i might as well go back to sharing them.

2010 was a good year for me. my long term goals are mostly on hold as I complete medical school clinical rotations and my life is consumed with academics. I have done well in all my classes so far and did well on Step 1 boards so academics are going well.

Financially I made less money but also spent a lot less money. I have not been able to do much work but my free food and housing easily makes up for that. I had no losses in the stock market this year and my modest investments grew at a rate that outpaced the interest on my student loans so my paying forward strategy is working well.

on the social front, my mother seems to be happily remarried and i have made efforts to improve my relationship with my sister. I have been visiting friends from high school and college to stay in touch despite my busy schedule. I also reached out to other relatives and visited my grandparents in florida.

as for life goals, I delivered a baby (6 in fact), scrubbed into surgery and

without further rambling, here are my 2011 goals:

-choose a specialty and apply for residency

-take the Step 2 boards and score as high as I did on Step 1

-honor at least half of my clinical rotations

-return to tutoring

-loose the 15lbs I gained in 2010

-travel to a foreign country

- watch at least 25 movies, read at least 5 books (not tb's), go to at least 5 concerts.

- at least 50 blog posts

well that was not very ambitious but it will keep me very, very busy

For the record : 2009 goals

To start with, I need to review 2008.  This has been another banner year as I got my aster's degree and got into medical school.  I found a great new apartment in Germantown, a new laptop and upgraded my car among other things.  I made a lot of money tutoring and working in the office at Drexel, although I came out in the red on the stock market (although only in the second half of the year like everyone else).  I got a passport and  went to Canada (twice) but did not leave N. America.  Also I did not manage to spend less money, but I had fun and saw a lot of cool things. i ended up publishing on emedicine and in school journals (nothing major though) and did  some community service but it was mostly for school requirements. Unfortunatly I did not do very much reading.  That said, here are my 2009 goals:

• Honor most of my classes
• do more publishable research
• spend less money
• excercise more frequently