Rhyme and Reason

Rhyme and reason

 

Why must a poem rhyme?

Rhyming is so inconvenient sometimes,

Calling for the twisting of language, like a weed,

Just to complete some aesthetic need,

Where used are strange words

And bad similes, like turds,

And where verses and lines end in

Odd places, before they’re fin–

 

Is rhyming even needed at all?

Or is it but a cover, a shawl,

Veiling desire to mention extraneous facts

Like the names of my two cats:

Goldie and Blackie; Or maybe it’s an

Excuse to showcase a poet’s diction,

Which is often complex, causing confusion

With sesquipedalian vocabulary and obscure allusion.

 

Is such a fixation with rhyme worth

the trouble, for a bit of auditory mirth?

Embrace instead those words shunned from lines

For their incompatibility with rhyming designs,

And abandon this arbitrary, restrictive form

Filled with red roses, off-color violets, and other such norms,

But that rejects the poor orange,

Because nothing rhymes with orange.

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Poems

One of my favorite parts of riding the subway in NYC (OK, maybe my only favorite part – the subways are pretty dirty and smelly overall…) are the poems. On some of the subway cars, in the back corner, are short poems by what I presume to be famous New York poets. I really enjoy these poems, so I thought I’d dabble in a little poetry of my own:

 

Untitled

 

I mop the floors and clean the sinks

I brave the cold to beg for food

I patrol the streets to keep them safe

I see them, but do they see me?

They whisk by

Without a second glance

 

I serve them meals and hand them drinks

I haul the bricks and pave the streets

I haul black bags away in trucks

I see them, but do they see me?

In this city of millions

Of invisible people

Trust me, I’m a Doctor

The doctor’s white coats, shining white, conjure associations of health, cleanliness, and truth. But the coat, along with the sleek veneer of the hospital itself, is a mirage, obfuscating an unfortunate reality – that many times, a trip to the doctor’s office may do more harm than good.

Let’s start with the coats themselves. The loose white coats of doctors are sanctuaries for bacteria. Even worse, because these coats receive so much exposure to the various chemicals floating around a hospital, those bacteria are heavily resistant to drugs. But as symbolic as it would be for doctors to ditch the whites, the issues with the institution of medicine are not simply one layer deep; they stretch both through medical history and across medical disciplines

Medicine has long been an inexact science, riddled with remedies that were not simply ineffective, but actually deleterious. We can skip over the misguided therapies of the pre-industrial age, when leeching, bleeding, and shock therapy were fixtures on the therapeutic scene. But even in relatively modern times, there are several instances of frightening medical practices.

In 1935, Portuguese neurologist Antonio Egas Moniz performed the first ever lobotomy, sparking a decades-long trend during which the practice served as a popular “cure” for mental illness. But evidence against the procedure was mounting; Moniz won the Nobel Prize in medicine 1949, but in 1950, lobotomy was outlawed in the Soviet Union. Unfortunately, in other countries, including the U.S. where over 40,000 lobotomies were performed, the practice persisted for years longer.

In oncology, breast cancer was long treated by radical mastectomy, a procedure in which the breast, underlying chest muscle, and lymph nodes are all removed in an effort to excise every last remnant of a tumor, to prevent any possibility of relapse. Unfortunately, it didn’t work – the surgery led to no improvements in outcomes compared to more modest procedures. It did, however, leave patients horribly disfigured. Nevertheless, radical mastectomies were the default treatment for breast cancer for over a hundred years, until it was generally abandoned in 1975.

Perhaps most horrifying, though, are instances of drugs harboring dangerous, unknown side effects. Thalidomide was first commercialized in 1959 to treat many of the symptoms of morning sickness. It was widely hailed as a “wonder drug”, but was soon banned after it was linked to severe birth defects in the children of women taking the drug. Over 10,000 children were born with Thalidomide-related disabilities worldwide, with several of these children missing some or all of their limbs. In the 1990s, estrogen pills were recommended to postmenopausal women to lower risk of heart disease. It wasn’t until 2002 that a careful trial established that estrogen pills don’t decrease the risk of heart disease, and may in fact increase it. Darvon & Darvocet was a pain reliever that killed over 2000 people from 1981 to 1999. The list goes on, too lengthy to feature in full.

Of course, this shouldn’t be surprising, given the perverse alignment of incentives between the pharmaceutical and medical industries. Drug manufacturers frequently sponsor doctors, paying for them to fly out to conferences and to trial drugs, and this sponsorship predictably impact doctors’ behaviors. The correlation between the sponsorship doctors receive and the amount of related medications they prescribe suggests that the drug market is not entirely a meritocracy; patients are likely not being prescribed the drug that is most suited to their symptoms.

Pharmaceutical companies are also highly involved in the drug approvals process itself, often funding the studies that test a drug’s fitness for public use. These studies are far from unbiased: tests funded by pharmaceutical companies whose drugs are being tested, are much more likely to find those drugs safe and effective, even when controlling for study design. Furthermore, pharmaceutical companies often employ former FDA employees in a potentially dangerous relationship. The cumulative result is several drugs of low or no effectiveness being pushed into the market, and then pushed onto doctors to prescribe.

But pharmaceutical companies are not alone at fault; doctors must face some of the blame. Medical technology that can now detect smaller and smaller issues, along with the push toward early detection, is leading to unnecessary testing, financial and emotional stress in patients undergoing said testing, and even many cases of entirely unnecessary operations. But there’s another, more nefarious, force at play – conflicts of interest among physicians. As stated earlier, doctors can receive significant funding from drug manufacturers, and this funding affects their behavior. Additionally, doctors often have stakes in medical device companies – and these companies sell their products to the hospitals in which these doctors work in or preside over – another questionable relationship. Some surgeons even own surgery and advanced imaging centers, incenting them to suggest more and costlier treatments. In fact, patients were referred to an MRI scan 7 times more frequently in physician-owned institutions than non-physician owned institutions. The very payment model used by most institutions, fee-for-service, encourages doctors to perform more tests and provide reactive care, rather than focusing on patient outcomes.

These problems are large and complex, and they won’t be fixed overnight. Some are unavoidable: limits of on knowledge will always exist, as will limits on the resources realistically available to test drugs. But there are issues that can be addressed.

Science writer John Horgan has a few recommendations: “First, the fee-for-service model should be replaced with a different compensation scheme—perhaps one that gives physicians a flat salary with bonuses for improved patient outcomes. The Mayo Clinic and other hospitals that have adopted this practice deliver better care at lower cost. Second, malpractice laws should be revised so that doctors don’t prescribe tests simply to avoid lawsuits. Third, we need better evaluations of the efficacy of all medical tests.” Fourth, consumers should try to educate themselves about the risks and benefits of tests.”

You may have read this piece and become discouraged. Perhaps your trust in the medical system was slightly shaken. That was never my intent. Modern medicine has saved countless lives and is still by far our best tool to improve our health and wellness. But even our most venerable institutions are not above scrutiny – how else will they improve, and evolve? My intent, rather, was to aid Horgan in his fourth recommendation – to help us become more responsible consumers, patients, and citizens (and perhaps future doctors). So that the next time you visit the doctor’s office, you can be aware of the risks, ask the right questions, and, collaborate with your doctor to reach the best outcome possible.

Bibliography:

White Coats as a Vehicle for Bacterial Dissemination – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3471503/

The doctor’s white coat: A valuable tradition of a dangerously dirty habit? – http://www.georgiahealthnews.com/2016/10/doctors-white-coat-valuable-tradition-dangerously-dirty-habit/

12 Crazy Historical Medical Practices That Did More Harm Than Good – http://www.huffingtonpost.com/nathan-belofsky/crazy-historical-medical-_b_3516415.html

The Surprising History of Lobotomy – http://psychcentral.com/blog/archives/2011/03/21/the-surprising-history-of-the-lobotomy/

History of mastectomy before and after Halsted – https://www.ncbi.nlm.nih.gov/pubmed/19623880

The history of breast cancer surgery: Halsted’s radical mastectomy and beyond – http://www.amsj.org/archives/3019

Evolution of cancer treatments: Surgery – http://www.cancer.org/cancer/cancerbasics/thehistoryofcancer/the-history-of-cancer-cancer-treatment-surgery

Thalidomide – http://www.sciencemuseum.org.uk/broughttolife/themes/controversies/thalidomide

Thalidomide: The Canadian Tragedy – http://www.thalidomide.ca/the-canadian-tragedy/

Estrogen & Hormones – http://my.clevelandclinic.org/services/heart/prevention/risk-factors/estrogen-hormones

35 FDA Approved Prescription Drugs Later Pulled from the Market – http://prescriptiondrugs.procon.org/view.resource.php?resourceID=005528

Pharmaceutical industry sponsorship and research outcome and quality: systematic review – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC156458/

Industry sponsorship and research outcome – http://onlinelibrary.wiley.com/doi/10.1002/14651858.MR000033.pub2/abstract

Drug-Company Payments Mirror Doctors’ Brand-Name Prescribing – http://www.npr.org/sections/health-shots/2016/03/17/470679452/drug-company-payments-mirror-doctors-brand-name-prescribing

Is the FDA Too Cozy With Drug Companies – http://time.com/4510025/fda-drug-companies-pharmaceutical-industry-medical-reviewers/

Cancer drugs, survival, and ethics – http://www.bmj.com/content/355/bmj.i5792

TMI in Medicine: the Problem of Overdiagnosis – http://health.usnews.com/health-news/patient-advice/articles/2015/08/20/tmi-in-medicine-the-problem-of-overdiagnosis

What Can Patients Do In The Face of Physician Conflict of Interest? – http://healthaffairs.org/blog/2015/04/10/what-can-patients-do-in-the-face-of-physician-conflict-of-interest/

Higher Use of Advanced Imaging Services by Providers Who Self-Refer, Costing Medicare Millions – http://www.gao.gov/assets/650/648989.pdf

How Can We Curb the Medical-Testing Epidemic? – https://blogs.scientificamerican.com/cross-check/how-can-we-curb-the-medical-testing-epidemic/

Experimenting with a new format for sources that features fewer in-text hyperlinks. Would be great to hear thoughts on this, and the post above, in the comments!

What To Do If You Get Fired

Below is a post I made for the BHP Senior newsletter. Ccaggarawala told me to make a funny post piece about what to do if you got fired from your job, but I guess this was too funny for him, since it got vetoed by BHP staff. You may not get some of the references if you’re not in the BHP class of 2015, but I hope you enjoy it nonetheless.

_____________________________

It’s your first month on the job and you’re having a blast. Hundred hour weeks, piece of cake. The spreadsheets are practically filling themselves in, and oh man, the free food. You wish you had started working years ago. Definitely beats dozing through Poliodro’s management class, or whatever his name is. But then you get a email from your boss titled: We Need to Talk. Uh oh. Hopefully, this isn’t some new project where you’ll be staffed in Angola or Kansas or something. That would suck.

Still, it won’t be all bad, you suppose. At least you’d get to see the world. Maybe Kansas has some cool farms or some shit. You stroll over to your boss’s office, wondering how many years it’ll take until you have your own office. Not more than four, at the most. You’re going places. You take a seat across from your boss and ask him what’s up. Did you watch the game last night? He’s silent for a few seconds.

“Look, Kevin, I’ve been doing this a long time. It’s never an easy thing to say, but…”

You tilt your head to the side, quizzically. “But what?”

“But… unfortunately, we’re going to have to ask you leave. Times have been real tough, lately.”

You scratch your head. “So does this mean I get the day off?”

“No, Kevin, sorry if I was unclear the first time,” your boss responds. “You’re fired.”

You say the first thing that pops into your head: “You can’t fire me! I quit!”

Then you realize, by quitting you don’t get severance! Shit!

You head home dejected, head hanging low. You’re angry. You’re heartbroken. You’re devastated. You’re fired. Now what? Well look, Kevin, or whoever you are. It’s not the end of the world. Getting fired, sorry, getting laid off, opens up a whole new world of opportunities. But let’s not get ahead of ourselves. First things first, you need some money. Unemployment benefits, here you come!

Now that you have a steady stream of income, it’s time to pursue your dreams. You didn’t grow up wanting to be an investment banker. You hated it there anyway. That job was a cocoon, but now you’re a beautiful butterfly and you’re ready to spread your wings and fly. In fact, that’s the first thing you do. You’ve always wanted to see the world, so you book a ticket to Mexico City. First class, you deserve it.

Mexico City es muy divertido! Your Spanish is coming along well, you bought yourself an awesome sombrero, and you now have a glorious handlebar moustache to match. But your signing bonus is almost gone, so you book a flight back to los Estados Unidos, economy this time. You wish you had gotten that severance package. Just one more week here would have been so divertido.

They foreclosed on your place, since you didn’t pay rent while you were in Mexico. So you move back in with your parents. Not that there’s anything wrong with that. The home-cooked food is sweet too, since you’ve had enough burritos to last a lifetime. But your parents start pestering you and pestering you, so you decide it’s time to start applying for jobs again. You were in the Business Honors Program back in college, so you have great resume. In no time, you’ve got a bunch of interviews lined up. It’s time to get back in the game, Kevin. You’ll probably be asked this, so just remember: you didn’t get fired. You quit.

Fiction Writing

As many of you know, I’m currently working on writing short stories for my Fiction Writing class. Some of you have asked, so I will be posting my short stories here for your reading pleasure. I’m still working on the first one (it’s coming soon!), but in the meanwhile, below is a link to one of my all time favorite pieces. I think you all will enjoy.

http://americanshortfiction.org/2014/08/01/wormhole/

Fantasy Fantasy

Like most members of the Roundtable, I am in a fantasy football league. And while I love the game, I really wanted to take it to the next level this year, so me and my buddy Vikram decided to do a fantasy fantasy football league. Yeah, you read that right. A fantasy fantasy football league. What does this mean? Well, our league is a standard scoring 10 team league, and from that pool of 10 teams, Vikram and I will draft our own fantasy team of fantasy teams.

In this post, we’re going to go through the strategy for a fantasy fantasy league and walkthrough our draft.

First, here’s our league, in all it’s glory. I’m in a respectable second place, and land fourth in the points for metric. A novice fantasy fantasy player might simply just draft based on the standings, going straight down the list. But past performance does not predict future performance, especially in a game as fickle as fantasy football. No, my fantasy fantasy criteria is much more elaborate. But before we dive into that, it’s important to know the rules of any league you’re participating in. Here are our rules:

  • 3 Starter Teams, 1 Bench Team – So two teams are going to be left out as free agents. How embarrassing. More importantly, the bench space is quite small relative to the starter space.
  • Scoring: Each starter team scores points equal to the points they score in the fantasy league. Each week, the fantasy fantasy team with the most points is awarded a win. If both teams have the same record at the end of the season, the fantasy fantasy team with the most total points wins. Pretty simple stuff.
  • Waivers: Doesn’t really matter. Two of the teams in our league suck, so they will probably go on waivers and stay on waivers.

Ok, so now to my drafting criteria:

  • Team Strength – Obviously, you need a team with great players who are going to score a lot of points.  Moving on…
  • Team Depth – This is a huge one. Over the course of a grueling fantasy football season, injuries happen. Several have happened already.  I definitely don’t want a team that will be derailed by injuries or lack production during bye weeks.
  • Management – In my opinion, this is going to be hugely underrated on draft day. A fantasy team is not going to win on its own, and a good owner can transform a decent team into a great one, through a combination of waiver wire pickups, good trades, and smart start/sit decisions. Likewise, a crappy owner can easily mess up and screw up a top tier team.

Now let’s see how this criteria plays out in practice. Without further ado, here’s the draft:

  1. Team Vik – ZeeSean McCoy
  2. Team Shrin – Graham Crackers
  3. Team Shrin – Team Pham
  4. Team Vik – Los Cunados
  5. Team Vik – ()
  6. Team Shrin – Team Nayak
  7. Team Shrin – New England Murderers
  8. Team Vik – Johnny Hiesmanberg

Free Agents – Hakeem Snickers, Rice Owls

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I meant to post this four weeks ago when we had our draft…so the above draft order might seem weird to you now. But anyway, now that I didn’t post it, I have four weeks of results to fill you in on!!

Team Shrin 4-0

Team Vik 0-4

Fantasy fantasy championship here I come!