The Year in Review III

After my final test in June, I felt a complex dipole of emotions. Having finished the first year, I was incredibly relieved, eager to set down the burden of studying, quick to relegate all the information I learned to the back of my mind. It was summer, time to relax, catch up with friends, sleep, and see the sun again. But on the other hand, there was some enormity in the realization that I had finished a fourth of an MD and that the material I learned in that past year would become critical when I started seeing patients very soon. Time will fly, I already know, and in just eight months, I'll be starting my first clerkship, stethoscope around my neck and panic in my mind. When I look back, I'm quite impressed. We covered a whole lot of information, and hopefully, I'll find it when I go spelunking down into the depths of my memory.

The diversity of the class in experiences, personalities, and talents is amazing and I really love hanging out with people in the class. It's so different seeing friends outside of the lecture hall, and people have so many incredible stories to share. I have become fond of San Francisco and the bay area; despite its quirks, it has a real charm to it. The school itself has immense resources, really tapping into the city's vast population of patients and doctors. I can't complain too much with my first year of medical school; I think I've grown a lot in many different ways.

Words

I really like words. I got this from an "AMA eVoice" (some sort of online newsletter thing) and it is written by the president Ronald M. Davis.

"The longest words containing the six vowels in alphabetical order are pancreaticoduodenostomy and pancreaticoduodenectomy.

Arteriosum (as in ligamentum arteriosum) and arteriosus (as in ductus arteriosus) are among the few words in which the five vowels (excluding y) occur once each and in alphabetical order. Subpopliteal contains the five vowels in reverse alphabetical order.

Pseudopseudohypoparathyroidism contains each vowel at least twice.

Asthma is one of the few words (with six or more letters) that begin and end with a vowel, but have no vowels in between.

There are seven consecutive consonants in Hirschsprung's disease. Postphrenic, postsplenic, and postsphenoid contain five consonants in a row.

Cytomegaloviruses, hypovitaminoses, paramyxoviruses, parasitological, tenosynovitides, and heterozygosity are among the longest words consisting entirely of alternating vowels and consonants.

Vesiculography (radiological examination of the seminal vesicles) is one of the longest isograms (words or phrases without a repeating letter).

Among the longest words that do not contain an e (the most frequently occurring letter in English) are uvulopalatopharyngoplasty, supradiaphragmatically, and macracanthorhynchiasis.

Only three words have as many as six c's, and two of them are medical terms-cholangiocholecystocholedochectomy and pneumonoultramicroscopicsilicovolcanoconiosis, a 45-letter word coined to be the longest English word, meaning lung disease caused by inhaling very fine silica dust found in volcanoes."

The Year in Review II

I wonder how I have changed since coming to medical school. I think I've become a little more focused on my future career whereas before, I put distance between myself and profession, pursuing whatever fancied me at the moment. Now I move with direction, purpose, and discipline. I find myself reading a lot of medical nonfiction, putting aside books that can wait. I think a lot about what discipline I want to enter and what steps I might need to take to get there. Much of my concentration now revolves around medicine.

I'm not sure whether that's good or not. I yearn for more time to try other things, to write, to think, to explore, to read. Sometimes, I think I need a less serious, more casual outlook, to be able to take things in stride with spontaneity and creativity. I have to avoid being locked down by this paradigm of education which squeezes us through a press of memorization and attrition. We all came into medical school with our unique talents, perspectives, and goals. It would be a shame if we let them grind these aspects out of us.

I'm not sure how else I've changed, though I can mention how I would like to grow. I hope that I get sharper at doorway diagnosis, the ability to assess and read people just by looking at them and hearing them talk. I want to improve my ability to synthesize large amounts of information into a probabilistic differential. Medical school, I hope, will expand my perspectives and knowledge base, making me more aware of myself, my limitations, my strengths, and how I fit into this community of doctors and patients. I struggle to maintain humility as I find myself fitting into deeper and deeper niches. Lastly, I have a tendency to be passive in most situations; I need to coax myself out of my comfort zone to face challenges head on.

The Year in Review I

It's hard to sum up a whole year's worth of emotion, struggle, fear, and accomplishment, but I wanted to write something about finishing the first year of medical school. In some ways, I feel very comfortable in the setting of a classroom, multiple choice exams, and powerpoint presentations. After all, I've been in school for nearly the last two decades. It's an odd thought; school selects out people who are good at school, and whether that translates to being good at a particular profession, I'm not very convinced.

I am glad I'm here though. I love the material. Though I've found out exactly how much I can procrastinate, the human body and diseases are absolutely fascinating. While as an undergraduate, classes presented human diseases as interesting but extraneous applications of basic science, now I realize we know an amazing amount and yet exceedingly little about ourselves. My favorite topics are the more problem-solving ones (organ physiology, medicine) rather than visual (histology, anatomy, radiology) or memorization ones (pharmacology). I've really become fascinated by the process of differential diagnosis and clinical reasoning. And unsurprisingly, I've really liked learning about weird rare diseases. I can probably explain Brown-Sequard better than I can explain multiple sclerosis. Oops. How much do I retain? Hopefully enough.

I've really enjoyed the patient-oriented stuff we've had so far. I think I'm fairly okay at taking a history, though I'm quite hesitant on my ability to examine a patient. I can go through the motions, but I don't really have the experience to comment on what I find. When I think about it though, I am awed of the privileged position I have in the lives of patients and their illnesses. It probably goes along with the whole "noble tradition" and "hallowed profession" of medicine. Medical school is about building skills as well as learning information.

Back to School

Tomorrow is the first day of second year. Summer has passed so swiftly I'm almost caught by surprise. As per my usual habit of being behind, I'm going to catch up on some topics like reflecting on the first year of medical school and explaining what shenanigans I've been up to this summer. I'll also have to decrease the frequency of blogging; I don't think I'll be able to manage daily blogs anymore. But we'll see.

The Symmetry Argument III

The symmetry argument, if you take it to be coherent, aims to show that our attitudes about prenatal nonexistence and posthumous nonexistence are inconsistent. In order to meet temporal symmetry, you must either wish you were both born earlier and die later or not care whether you are born earlier or die later. But is this symmetry premise really compelling?

Imagine this scenario, first described by Derek Parfit in Reasons and Persons. You are in some remote location out of contact with the world when receive a letter regarding your mother, who you haven't heard from for many years. You find that she's fatally ill with a disease that will cause a lot of pain and suffering. She will die in a month, and you are unable to see her. Consider how you feel about this. But the next day, you receive another letter. It says that you were partially misinformed, not about the disease itself, but about the timing. Your mother has already suffered intensely for a month but is now dead. Consider how you feel about this.

Derek Parfit argues that our intuition is that the suffering is no less evil if it were in the past rather than the future. That she will suffer for a month is equally bad as that she has suffered for a month. He thinks this shows that we hold temporal symmetry for others.

Here's another scenario. You have some disease which is completely curable but the process takes a month and is intensely painful. Luckily, there is a drug given at the very end that will act as an amnesic and erase the memory of the pain. In the first case, you wake up and the doctors say you are ready for the procedure which will cause intense pain for a month. In the second case, you wake up and the doctors say that the procedure was a success; you were in intense pain for a month, but now you are fine and you don't remember anything. Are the two cases equivalent? Which one would you prefer?

We have a different intuition here favoring temporal asymmetry because it is our subjective experience. This distorts our values; we consider situations differently if they are happening to us rather than someone else. Is this a good thing or a bad thing? After all, we can't escape our conscious experience, except through intellectually imagining it. But a Lucretian might say that this is what we should do to remain completely rational and unswayed by our narrowminded perception of the world. This would be support for temporal symmetry.

The Symmetry Argument II

An initial reaction is that this argument is ridiculous. It doesn't make any sense and it's unconvincing. And who thinks of this kind of thing anyway? Well, there are several ways to level an objection. You can deny the first premise and say you do regret not being born earlier. You can argue that the two premises don't entail the conclusion. But most people go straight for the symmetry premise.

The symmetry premise is: If I do not regret or fear being born earlier, then I should not regret or fear dying earlier. Prenatal nonexistence is equivalent to posthumous nonexistence. I will bring up several ways in which this jars with our intuition. The Lucretian response is that these replies are simply attitudes we have towards death. They are insufficient counterarguments because they are subjective and irrational.

First, the imagination argument. I can conceive of dying later, which is why I value that; I cannot conceive of being born earlier, so I do not value that. One response is that this is simply an illusion that results from the fact that our birth is a defined day in the past whereas death is (or seems to be) an undefined day in the future. But this shouldn't matter. Say you get to add a year to either your past or your future. Certainly, you can imagine that. And you should be able to value that year whether it is added before your birth or after your death. It may be easier to imagine living longer, but it is not inconceivable to imagine being born earlier.

Well, you reply, how about a causality argument. We have causal power over future events but no such power over past events. Who cares if you give me a year I've already used; I want a year in which I can do what I want. This response depends on where you are relative to your timeline. Indeed, we are all somewhere after our birth and before our death. But if we had been born a year earlier, we would have done stuff and had causal power during that extra year. I am unconvinced that this is significantly different from having a year ahead of us in which we can cause things. I think that our desire to have a future year rather than a past year simply stems from where we are in life. If we were to step outside of time, so to speak, and look at the situation objectively, a year, whenever it is, will be the same in terms of causal power. This argument can be adapted for things like "opportunities."

So there's the controversy. Our vantage point is from a time in life after birth yet before death, and from this perspective, a year in the future may be preferable to a year in the past. It is both impractical and unrealistic to pretend to be outside of time, looking in. The Lucretian response is that this is simply an attitude we have and it is irrational; we need to examine the situation objectively where we will realize the symmetry argument holds water. Even if we are "stuck" in our own timelines, we can intellectually remove ourselves from them and look at our situation from an unbiased perspective where we will realize that temporal asymmetry is not an objectively rational thing to believe. Tomorrow, I'll try to show that our attitude towards temporal asymmetry is less certain than we might think.

The Symmetry Argument I

Now that the idyllic lazy days of summer draw to a close, and we again face the pangs of last remembrance, I draw my pen towards contemplating what I find to be one of the most beautiful philosophical arguments I have encountered. I find this argument immensely satisfying because of its simplicity, elegance, and durability under the duress of philosophical inquiry. But furthermore, it counters our intuition about death yet is incredibly difficult to argue against. Lastly, it was first described by a Greek philosopher who was not Socrates, Plato, or Aristotle. I tend to be convinced by this argument. I'll present it today and discuss it tomorrow.

This is from De rerum natura by the Epicurean poet Lucretius who argues that we should not fear death.
1. I do not regret or fear not being born earlier. That is, I don't lament the fact that I was born in 1984 rather than 1980.
2. By symmetry, I should not regret or fear dying earlier. I should not regret or fear dying in 2020 rather than 2024.
It hinges on a claim that our past nonexistence is equally unimportant as our future nonexistence, and hence, if we do not fear or regret our past nonexistence, we should not fear or regret our future nonexistence (that is, death).

Euthanasia II

Is the movement for euthanasia a response to the medical need for control? In the previous posts, I have proposed that medicine accepts that we will die. It is not the goal of medicine to make us immortal. Yet medicine seeks to close off all the avenues to dying. We treat those diseases we can, and seek to treat those we have yet to solve. Does this mean the way out of the paradox is to put death under the purview of medicine? But should doctors, purely aligned to life and living, also put on this second hat of responsibility and gatekeeping?

Euthanasia I

Euthanasia is the practice of killing a terminally ill patient to relieve him of unbearable and intractable suffering. It's a highly charged topic, and one I don't understand fully. Some people argue that our right to do what we want with our bodies encompasses allowing us to decide how and when we die. Other people argue that it is mercy in the face of unresolvable and unimaginable suffering. And the confluence of these two distinctly separate yet interrelated ideas puts the issue into the focus of medicine. The principle of autonomy in medical ethics allows patients to choose how they deal with their bodies. And one of medicine's goals is the relief of suffering.

But here are some thoughts. If autonomy and the right to do what you want with your body is the justification for euthanasia, why limit it to people who are suffering? Why not allow anyone to request suicide if the ruling principle is that he can decide what he wants to do with his body? On the other hand, if euthanasia is justified by relief of suffering, why limit it to people who can give consent? People who are mentally retarded, have psychiatric illness, and minors may be suffering just as much, but why deny them relief of that suffering if that is the basis for euthanasia?

Obviously we don't want people deciding to commit suicide unless they are terminally ill and facing immense suffering, and we don't want to kill those who would have denied euthanasia if they could have given consent. But the point here is that euthanasia cannot simply be justified either by a patient's right to autonomy or by relief of suffering. It somehow needs a marriage of these two ideas, but this combination seems to me artificial: a patient's right to decide what to do with his body extends to suicide if and only if he is experiencing the right suffering. That doesn't seem to be a priori self-evident. Is it really something that can be ethically and philosophically justified?

General and Specific

There is a classic syllogism. All men are mortal. Socrates is a man. Therefore, Socrates is mortal. I think most people find this argument valid, sound, and convincing. We all know we are going to die. And we accept such a fact. Yet, when it comes down to specific mechanisms of death, they all seem to be in theory avoidable. If only we had caught it earlier, if only we had given the right antibiotics, if only we were able to administer tPA in time. There doesn't seem to be a single disease that, in principle, cannot be overcome. There is no disease that doesn't have active research working towards treatments, no disease that we have given up on. Yes, there are diseases and disorders that are fatal, but we think this is a limitation of our knowledge and medical ability, not an insurmountable foe.

This leads to an interesting impasse. We all know we are going to die. But every possible way in which we could die - every disease or accident - could be eliminated. And hence medicine has picked a fight such that no matter how many battles we win, we will always lose the war.

Summer Thing of the Week

My last topic for this summer will be on death. I've written about death a bit in the past and it's always fascinated me because it straddles the domains of medicine and philosophy. It is something everyone thinks about and inevitably faces, and yet, doctors aren't trained very well on how to approach or consider it.

Waterfall

Iguazu Falls at the border of Argentina and Brazil, one of the most beautiful places I have ever been. Summer 2005.

Here's an old quote by Alex Penn. We went to the same high school and college, and he is now in the UCSF-Berkeley JMP (MD-masters) program.
"Bio is so stressful. I think I need some helicase to unwind or some topoisomerase to loosen up. We can go over the material on a cell phone. Seriously, if this were standup comedy, the crowd would be like an amine: a leaving group. Wow, I think I'm quite the comedian. Someone call the lac, I need a promoter."

Fortune

This gelato picture is from Florence, November 2004.

I actually got a fortune cookie that says: "Promote literacy. Buy a box of fortune cookies today." Quite amusing.

The Farm

This image is from this year's graduation; we have a tradition called "wacky walk" where people wear costumes during the commencement "exercises." It was really fun. This year, I spotted a picnic, a slip-and-slide (despite being banned), and lots of "Palm Drives." Here, I like the worm and the tree as well as the usual balls and balloons being thrown into the audience. I love Stanford's fun and casual spirit; I suppose the next graduation I'm in I'll have to be all serious and solemn.

Inspiration

You know those inspirational posters you sometimes see at dentists' offices?


"Smoking is one of the leading causes of statistics." - Fletcher Knebel

Adopt a Microbe

http://adoptamicrobe.blogspot.com/ is a pretty interesting website where the author draws pictures of and describes various microbes. Good for preparing for our next block on infection, immunity, and inflammation.

Science

Love Poem

Tell me why the stars do shine,
Tell me why the sky is blue,
Tell me what makes the ivy twine,
and I will tell you why I love you.

Fusion reactions make the stars shine,
Rayleigh diffusion makes the sky blue,
Auxins and tropins make the ivy twine,
Gonads and hormones are why I love you.

Summer Thing of the Week

As my last few posts have been extra wordy, I figure I should be lazier this week. This week, my posts will be more of a hodgepodge of pictures, quotes, and links to nifty websites. They may or may not have anything to do with medicine.

Cord Blood

This will be more applied ethics oriented. Umbilical cord blood is pretty interesting stuff; it's full of hematopoietic stem cells and can be banked as a future source of stem cells for transplantation. Cord blood has been used to treat a variety of hematologic and immune diseases like leukemia and Fanconi's anemia.

Now what's interesting is that you can do autologous transplant with cord blood. If your cord blood is collected and banked as a newborn, and you acquire a disease later on which can be cured with a cord blood transplant, you can use your own blood to save yourself. (Nevertheless, a 2005 article notes the probability of needing this is less than 1 in 20,000).

But take a hypothetical situation. You and your spouse have your first child, and unfortunately, he has leukemia. One treatment is a cord blood transplant, but there are no matches to be found. What are the ethical implications of having a second child solely or partly in order to collect cord blood with a 25% chance of being a perfect match and 50% chance of being a partial match? Indeed, this may cure your first child and poses little risk to the second child (cord blood collection poses no danger to mother or baby; however, there's the interesting question of what if the second child could use an autologous transplant later?) There are pure medical ethics issues such as donor consent; you're asking for a tissue donation from a person who doesn't exist. And there are religious and moral issues about bringing a new person into this world solely or partially to help a sibling.

Ayn Rand

I feel that an unfortunate number of people my generation has been unduly influenced by Ayn Rand, who wrote The Fountainhead and Atlas Shrugged. Wikipedia notes that "her ideas have attracted both enthusiastic admiration and scathing denunciation." I will confess, I am of the latter party.

Her ethical stance is what bothers me the most. She claims, "Man - every man - is an end in himself, not the means to the ends of others...The pursuit of his own rational self-interest and of his own happiness is the highest moral purpose of his life." In objectivism, the ideal person is completely and fundamentally selfish; you do only what makes you happy. She considers happiness a way of measuring how good you are doing at life; it's a barometer the body evolved to determine how successful one is. She does protect her philosophy against hedonism; it is instead rational egoism.

The problem is that objectivism rejects as immoral any action taken for some ultimate purpose external to oneself; it denies altruism. You cannot justify your existence by service to others. There are interpretations which argue that mutual helpfulness and mutual aid between human beings is compatible with objectivism. But still, I find it very difficult to reconcile objectivist ethics with being a doctor. As a physician, your primary aims are those of your patient, not those of yourself. Your role is completely selfless; you should not exploit patients for your own gain. Modern medical ethics centers itself around values like beneficence, autonomy, non-maleficence, and justice. These are simply not compatible with objectivist ideas. Ayn Rand may be a moving writer. But her philosophy, as such, should not be blindly adopted, especially in the context of medicine.

Kant's Ethical Theory

Immanuel Kant (praise be his name*) is an incredibly influential 18th century German philosopher who is the hero of many philosophy professors (mostly because he published his groundwork Critique of Pure Reason in his late 50s, giving hope to those who think their careers could be late-blooming). His works are incredibly beautiful, yet impossibly difficult to read and understand. Stanford scholars love him (in the same way that Oxford philosophers love Wittgenstein).

In Groundwork of the Metaphysic of Morals, Kant puts forth the Categorical Imperative, which encompasses our moral obligations and duties. We must follow the categorical imperative if we are to be moral (under Kant's view); it is an unconditional obligation. He has several formulations of the categorical imperative. One of them is that you "always act according to that maxim whereby you can at the same time will that it should become a universal law." The second formulation is that "the rational being, as by its nature as an end and thus as an end in itself, must serve in every maxim as the condition restricting all merely relative and arbitrary ends." This means that human beings must never be treated merely as a means to an end, but as an end in themselves.

You can see why Kant can be somewhat difficult to understand. And my interpretations probably botched up the intricacy of his arguments. Nevertheless, I feel that his moral philosophy (later leading to deontological ethics) helps me justify those decisions I consider moral. Being a doctor allows me to treat human beings as an end rather than as a means. On the other hand, a utilitarian might justify being a doctor by saying caring for people creates a greater good in society, or treating an infectious disease prevents an epidemiological outbreak, or giving preventative care will save money in the long run. But all a Kantian needs to know is that he is obligated to serve his patients and doing so justifies that very action. He does not need to appeal to economic cost-benefit analysis, the impact on society, or even the happy feeling he gets when he helps someone.

*I adopted this habit from one of my friends; whenever we mention Gottfried Leibniz (praise be his name), we always append that phrase as he was an amazing philosopher and mathematician (Wikipedia even calls him a polymath). But as I am unlikely to write a blog about Leibniz (praise be his name), and I have such awe for Kant's work, I figured it couldn't hurt for him to get a nod towards his genius.

Evidence Based Medicine

In this post, I will put forth my argument that evidence based medicine is a paradigm, and as such, it has limitations. Medical schools and medical practice have been strongly touting evidence based medicine as the ideal way to go about being a doctor. In evidence based medicine, the best practice is determined by the strength of the clinical studies supporting it. It is a uniform way to take all the data published, weigh it by how good it is (ie. whether it was a double blind randomized control trial) and then recommend to doctors what they should do. These studies often use endpoints such as mortality, morbidity, quality of life, complications, etc. For example, why are beta-blockers given in congestive heart failure? Because the MERIT-HF study demonstrated a 34% decrease in all cause mortality after administration of Metoprolol CR/XL in patients with stable New York Heart Association class II-IV congestive heart failure receiving standard medical therapy. This is supported by other trials such as the CIBIS I, CIBIS II, Carvedilol Clinical Trial Program, and COPERNICUS. Evidence based medicine uses these publications to support the administration of beta-blockers in heart failure.

But I have reservations about this paradigm of evidence based medicine. Its assumption is that medicine is justified if evidence shows it improves outcomes. This may seem very self-evident. But I believe this assumption has a lot of problems.

For example, our justification for giving beta-blockers in CHF makes no mention of molecular mechanism of action or reversal of pathophysiology or any basic science whatsoever. Evidence based medicine looks only at well-designed clinical trials. But we don't really have a clear idea why beta blockers actually work. They might reduce oxygen utilization, prevent dislodging of coronary plaques, increase the threshold for ventricular fibrillation in the presence of ischemia (atenolol and bisoprolol), reduce detrimental myocardial remodeling (all beta blockers), reverse abnormal intracellular calcium handling, enhance secretion of atrial natriuretic peptide (carvedilol), or increase myocardial endothelial nitric oxide synthase (eNOS). Or any combination of these mechanisms. But does this paradigm of medicine care?

Evidence based medicine hamstrings basic science by saying it doesn't matter why things work as long as they do. If someone randomly finds a compound that cures a disease and shows it through the right clinical trials, it doesn't matter if we have no idea how that compound works. That bothers me. This paradigm discourages scientists from thinking from first principles (which I admit is philosophy, probably explaining why this bothers me so). True, first principles may eventually give rise to clinical evidence, but there's no value in first principles in and of themselves. That's something in the domain of science, not in this paradigm of medicine.

Nevertheless, evidence based medicine saves more patients than thinking from first principles. Indeed, in congestive heart failure, the heart isn't squeezing hard enough and you might think that to save the patient, you want to squeeze it harder - that is, give a beta-agonist or inotrope. It makes scientific sense and it failed miserably. We now do the counter-intuitive thing by giving beta-blockers which decrease the contractile force of the heart. But this simply means we haven't fully understood the complexity of molecular cardiology and should motivate us to pursue the basic labwork necessary to elucidate this system.

Perhaps we're not ready for a new paradigm. We don't have enough understanding of the basic sciences to use that to justify our medical decisions. Indeed, evidence based medicine will save more patients because that's what it's built around. But does it teach us to have the right attitude toward how basic science drives medicine? I'm not so sure on that account.

Most of the science in this post is drawn from a lecture entitled "Beta-blockers: How do they really work?" by Dr. Patterson from Stanford University. There are also several other problems with evidence based medicine, such as the problem of induction, which I don't have the room to discuss.

The Structure of Scientific Revolutions

Thomas Kuhn's The Structure of Scientific Revolutions was a landmark work in the history of science; indeed, it is one of the most cited books, especially in the social sciences. His main argument in this book is that science is inextricably set within a paradigm: a framework of rules, definitions, and assumptions that allow for a coherent body of knowledge. As science progresses, however, anomalies arise such that scientists must work to patch up the paradigm. Eventually, a pioneering scientist will resolve the anomalies by constructing a whole new paradigm, forcing observed phenomena into a more coherent model.

This is all pretty abstract. The commonly cited paradigm shifts are of course the Copernican revolution and the development of quantum mechanics. Newtonian physics was going fine until anomalies like black body radiation and the photoelectric effect led Einstein, Planck, Boltzmann, and others to propose that energy comes in discrete units. But this theory of quantum mechanics was heresy for a long time while scientists struggled to move from one paradigm to another. Paradigm shifts are fundamental changes in the way scientists think because they undermine so many assumptions in how the world operates.

Indeed, if science progresses in such a fashion, I think I would want to work at understanding the paradigm, the assumptions, and the framework. "Normal science" (as Kuhn calls it) working within a paradigm elucidating knowledge about the world is interesting, but real brilliance comes out when things don't make sense. It is easy enough to make predictions about how an experiment will play out given the rules that you know, but it takes guts and insight to figure out how to make a whole new set of rules to explain what you have.

Summer Thing of the Week

I wanted to write a bit about philosophy, especially in relation to medicine and the sciences. Indeed, philosophy has more to do with science than most people realize. Many famous philosophers were scientists (or perhaps, many famous scientists were also philosophers). Even with the ancient Greeks, Plato and Aristotle studied the properties of matter and the laws of physics. Many don't realize that scientists like Galileo, Descartes, Newton all the way to Poincare, Bohr, and Einstein had fundamental influences in philosophy of science. Furthermore, within the last few decades, there's been a rise in biomedical ethics and discussions about morality and science. These are two major ways in which my ideas of philosophy influence how I view science; I hope to explore these in my blogs this week.

Sluggy Freelance

Sluggy Freelance is a long-running daily webcomic drawn by Pete Abrams. I love it. One of the things about this comic is that it relies heavily on story arcs that span months to years. This means to understand the comics, you have to start from the beginning (August 25, 1997). But it's a ridiculously fun adventure. It's hard to describe the comic, but I really like the daily gags, the masterful storytelling, and the artwork. It takes a bit of time to really get immersed into the Sluggy world, but it's totally worth it; I read the comic religiously.

If you're looking for a short diversion, Sluggy does hilarious parodies. My favorite is "Torg Potter and the Sorcerer's Nuts" (Torg is one of the key characters in the comic strip). It's a pretty standalone story (though it helps if you've read the first Harry Potter book):
Torg Potter
My favorite comic of that story

Bedside Manners

House's personal relationships are all messed up, but everyone tolerates him because of his clinical expertise. Indeed, an ongoing theme through the seasons is his ability to read and manipulate his superiors, peers, and employees. His bedside manners are terrible. But his sarcasm, wit, and cunning personality are quite amusing. I'm not sure what I'd do if I met a person like House in real life. He seems so rational, driven, and intellectually curious and yet so indifferent, emotionless, and even malicious.

House

I really like the TV show House, MD. Set at a fictional Princeton Plainsboro teaching hospital, it focuses on master diagnostician Gregory House and his posse. Every episode, the team takes on a medical case that befuddles all other doctors. House's methods are unorthodox; he is completely focused on solving the medical mystery and wastes little time on caring for the patient. He rarely believes what the patient says ("Everybody lies") but his medical genius is apparently an indispensable contribution to the hospital.

I really enjoy the medical mysteries. They are often combinations of rare presentations of rare diseases; that is, things that could never conceivably happen in real life. But it's still fun to see how House's problem solving narrows down the differential. While the medical-ness isn't completely accurate, it's pretty good for a TV show I think. It's funny, I notice sarcoid and (in earlier seasons) paraneoplastic syndrome get proposed a lot (since they can cause lots of nonspecific symptoms). But it's never lupus.