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If you would like to meet for coffee in downtown Palo Alto at 5 pm on Wednesday, October 12, please email me (philg@mit.edu) to arrange a precise place. I have dinner at Jing Jing at 6:45 pm.

Update: Because I can’t bear the idea of paying less than $5 per cup of coffee or the idea that a machine might do the dripping of hot water… Blue Bottle Coffee on University Avenue in the old theater building. Yelp reviews say that there is a nice courtyard.

Further Update: Pete’s just west of Blue Bottle (closed for private event).

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A friend linked to “Bay Area Traffic Up 70 Percent In 6 Years” from her Facebook status. She is a nurse who commutes from the East Bay to the city. Here’s what she said: “Leaving at 0510 these days to hit the bridge before major back ups! Still taking about 45-55 mins for the 22 mile trek.”

Would it make sense to let the big employers build high-rise dorms right next to their offices? (Right now that wouldn’t be possible, presumably, due to zoning restrictions.) So Facebook would have a 30-story tower in place of a current parking lot. Just imagine how many cars could be taken off the road if every company had dorms big enough for at least half of the employees (might not work that great for workers with children, but most of these firms seek to hire primarily the young and childless).

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“How decades of divorce helped erode religion” (Washington Post) is kind of interesting for those interested in statistics and/or the evolution of American society away from two-parent households for children:

People whose parents divorced when they were children are significantly more likely to grow up not to be religious as adults, the study found. Thirty-five percent of the children of divorced parents told pollsters they are now nonreligious, compared with 23 percent of people whose parents were married when they were children.

A link from the article points out that Americans who don’t identify with any religion are reliable voters for Democrats. Thus the Democrats could ensure long-term national political dominance by adjusting state law to make divorce more lucrative (the more cash that can be obtained from a divorce lawsuit, the more likely a plaintiff is to file one).

The cited study may be limited going forward because it doesn’t seem to account for the modern-day trend of family court litigation between people who were never married to begin with.

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A recent email… (edits within **)

Subject: Alert – Clown Sightings

Body:

message from *HAPPY VALLEY* SCHOOL DISTRICT

Dear Families, Faculty, and Staff,

There have been reports in the news about persons wearing scary clown costumes making threatening gestures towards people. In addition, there have been reports of the use of social media to make threats about actions to be carried out by malicious clowns.

I have been in communication with Police Chief *Bozo* and Detective *Mystere* regarding this situation. There have been no instances of these behaviors in our community or nearby. However, we do want all members of our community to be aware and to report any suspicious behavior to the *Happy Valley* Police or school administration immediately. Remember, if you see something that doesn’t seem right or makes you uncomfortable, it is always best to err on the side of safety and report the situation to our public safety officers.

Thank you,

*Chuckles Calvero*, Superintendent

[Extra credit: rewrite this as an FAA NOTAM]

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From our anonymous insider…

Dissection investigated the shoulder joint. Our upper limb is similar to our lower limb in bone and joint structure. However, while most of our weight is translated through bone in our lower limbs, most upper limb weight is translated through muscles, the most fascinating of which is serratus anterior. This muscle originates on the front of the upper ribs, wraps around the body, under the shoulder blade, to insert on the anterior side of the medial border of the scapula (shoulder blade). This “boxer” muscle pulls the shoulder blade against the thorax ensuring it slides along the back when other muscles act upon it.

Lectures continued the discussion of metabolic processes, including the role of lysosomes, the recycling centers of the cell. Extracellular debris, and cellular parts are trafficked to these small vesicles to be degraded by powerful enzymes. Our patient case was Hunter’s disease, a lysosomal storage disorder caused by a mutation or deletion in a lysosomal enzymes’ genetic code. There are only about 500 Americans afflicted with Hunter’s, which affects nearly every organ system and can result in heart valve malformation, respiratory problems, liver/spleen enlargement and severe neurodegeneration. Individuals suffering from Hunter’s, which typically manifests by age 2, frequently cannot speak or comprehend basic stimuli. Life expectancy varies from 10-20 years.

A pediatric geneticist described treating Hunter’s patients with Elaprase, a recombinant enzyme replacement therapy that replaces the mutated or absent lysosomal enzyme. This “orphan drug” costs over $300,000/year (see Forbes), but can’t get through the blood-brain barrier to enter the nervous system and improve neural development. The geneticist explained that orphan drug prices are passed on to private insurance companies at an undisclosed negotiated price, paid in full by Medicaid without negotiation, or are paid for by the manufacturer when the patient has no insurance. Shire reported worldwide 2015 Elaprase sales of $552 million (press release).

We were done every day before 5:00 pm. I studied 1.5-2 hours after class each day in preparation for the exams that are three weeks away. There is a medical school test prep industry that includes phone-based flashcard systems such as Anki and Firecracker ($300 for two years). I haven’t subscribed to any paid products yet because skimming through lecture slides and notes, then taking practice exam questions, is effective.

We got Labor Day off and our student affairs dean held a dinner party for those who stayed in town. We learned that for the past two years, approximately 20 percent of graduating students have gotten engaged to one another.

Statistics for the week… Study: 10-12 hours; Sleep: 6 hours/night; Fun: 3 nights out. Example fun: a Friday after-class soccer match followed by a BBQ with Jane’s family.

The Whole Book: http://tinyurl.com/MedicalSchool2020

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“A Decade Lived in the Dark” (New Yorker) is about a woman in England who believes that she is “sensitive to light” and has to live in the dark. The article is kind of interesting on its own account, especially given that the sufferer has written a successful book about her experience.

I wonder if this shows a good evolutionary adaption to a more crowded world. In the mid-20th century a middle class American could afford a standalone house within a reasonable commuting time of a job. The standalone house would have windows on all four sides and therefore there would be plenty of light inside the house from sunrise to sunset. As the U.S. population is headed toward a number previously associated with India or China more of us will have to live in apartments, which may get light from only one side (like a hotel room). Given that Americans spend a lot of time indoors, I wonder if our more crowded country means a generally darker experience for the average person.

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From our anonymous insider…

In anatomy, we dissected the anterior thigh, lower leg and foot. Before this week, I did not realize there were two bones between the knee and ankle: the tibia and fibula. (To feel your fibula, locate the protrusion on the lateral side slightly below your knee and follow it down to a protrusion on the lateral side of the ankle.) One of the most interesting parts of this three-hour dissection was the opening of the knee capsule, which requires ripping through tough layers of ligament on both lateral and medial sides to arrive at the treasures: the anterior and posterior cruciate ligament (ACL, PCL, respectively). These are named for the criss-cross structure they form in the interior knee. Once we cut the ACL, a beautiful bundle of fibers from the anterior side of the tibia to the lateral condyle of the femur, it is amazing how much we could move the tibia in relation to the femur.

After the anatomy lab, orthopedic surgeons taught us how to conduct a lower leg exam. We learned to isolate specific axes of rotation to evaluate ligament integrity and range of motion. Tragically ironic, a classmate’s boyfriend injured his knee the next day. She conducted the exam and felt an increase in medial rotation of the knee and offered the diagnosis of a loose lateral collateral ligament. When asked what he should do, she responded, “I don’t know, ask me in three years. Your LCL is messed up.”

Our patient case had type 2 diabetes, which includes two distinct phases. The first involves the desensitization of target cells to the action of insulin. Insulin acts as a “signal of construction” by stimulating target cells to uptake available energy and molecular building blocks such as blood glucose. As blood glucose remains high, pancreatic cells that secrete insulin become overworked and die. As pancreatic islet function is degraded, the patient transitions to the second phase, a severe, irreversible form of type 2 diabetes that mirrors type 1 diabetes. Importantly, patients who manage their diabetes before entering this second phase can reverse the entire disease. The lecturers, an internist and a PhD researcher, agreed that determining the mechanism of insulin resistance would win a Nobel prize.

One common drug class used to manage type 2 diabetes and to depress blood glucose is sulfonylureas. Sulfonylureas function by increasing beta-cell release of insulin. One of my classmates asked, “Isn’t treating type 2 diabetes with these drugs accelerating the degradation of beta cell function?” The internist responded “Yes, but sometimes we have to use them. When a patient’s glucose levels are off the chart, you have to use every option. Second, sulfonylureas are much cheaper than alternatives such as insulin injections. Many of my patients cannot afford anything else.”

With exams in a month, a few classmates are already freaking out. We aren’t being given the graded homework assignments to which they are accustomed and from which they could gauge their progress. We are supposed to determine what style of independent learning works for us. Instead of concentrating on learning, these classmates are worrying about exactly what is going to be on the Week 9 exam. Our drama for the week is that they apparently brought their uncertainty up with the Office of Student Affairs. I would have hoped that they’d have more faith in the system with which they are entrusting four years and more than $300,000 (tuition, room, and board).

Statistics for the week… Study: 8 hours (6 hours devoted to anatomy); Sleep: 6 hours/night; Fun: 4 nights out. Example fun: Friday night about 15 of us had a “jam session” dinner party. After spaghetti and homemade meatballs, we broke out the beer and instruments. The group included a classically trained cellist, two pianists who would have been welcome in most jazz clubs, and a harmonium(!) player. I was glad that I had brought my guitar, but I’m not sure that these real musicians were similarly glad.

The Whole Book: http://tinyurl.com/MedicalSchool2020

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“Bariatric Surgery: The Solution to Obesity?” (New Yorker) shamelessly cheerleads for surgical modification of the human body to deal with changed environmental conditions:

“We are meant to fast and feast, like the other carnivores,” I once overheard a flight attendant say to another on an overnight plane. “But there’s always a feast around.”

Given enough time is it possible that the human body would evolve to avoid weight gain even in the presence of unlimited food? Do thin people have more children than fat people, for example?

In the meantime the author claims that we can actually save money on healthcare by cutting into the abdomens of anyone who shows signs of gaining weight:

Bariatric surgeries, which can cost as much as thirty thousand dollars, are covered by many major insurance companies. (Most studies suggest that the expenses are recouped within two to three years, because the surgeries avert future obesity-related medical expenses.)

What do readers think? Can this be right? Maybe we do need to speed up evolution because we aren’t adapting fast enough to the continuous casino and cruise ship buffets. But is surgery the answer? Why not wait a few years for CRISPR to be perfected? Modify our genes so that donuts don’t taste good anymore.

Related:

• Obesity, population growth, global warming, and the role of veterinarians
• Whales, Technology, and Obesity
• American Economic Association Meeting in Boston (scroll down to the article on free school breakfast)
• Expanding preschool = expanding waistlines?

 

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I didn’t catch the vice presidential debate. What happened? The transcript suggests that mostly the VP candidates talked about the presidential candidates rather than about what each might do personally. Is this conventional?

The transcript shows a long discussion about police, which seemed odd because running police departments is mostly done by states and cities, no? Most interesting to me was Pence’s comment: “Police officers are the best of us.” Can that be true? Pence implies that it is because they risk being killed: “African-American, Asian, Latino, Hispanic, they put their lives on the line every single day.” But the risk of death for a police officer is negligible compared to the risk incurred by a front-line combat soldier. Why wouldn’t it be “Combat infantry second lieutenants are the best of us” if the standard is risking one’s life for fellow citizens?

Kaine presents himself as the defender of women: “Donald Trump [should apologize] for calling women slobs, pigs, dogs, disgusting.” A scholar told me that in the old days we presented our enemies as subhuman, e.g., portraying the Japanese during World War II as monkeys. Now we point to their treatment of women and say that we are going to rush in with our military to defend those women. Kaine seems to be doing the same thing domestically.

Pandering to voters by telling them that they are going to get great stuff from the government but won’t have to pay for it with taxes seems to still be in style. The moderator: “According to the nonpartisan Committee for a Responsible Federal Budget, neither of your economic plans will reduce the growing $19 trillion gross national debt. In fact, your plans would add even more to it.” Pence seems to think that Americans are going to get off their sofas, put down the Xbox controllers, and return to the labor force: “when you get the economy growing, Elaine, that’s when you can deal with the national debt. When we get back to 3.5 percent to 4 percent growth with Donald Trump’s plan will do, then we’re going to have the resources to meet our nation’s needs at home and abroad, and we’re going to have the ability to bring down the national debt.” But he doesn’t say that he will scale back the programs listed in Book Review: The Redistribution Recession that make it irrational for Americans to work (or encourage states to adjust child support guidelines so that it becomes less profitable to have sex with a dermatologist than to go to college and work).

Kaine promises a Soviet-style planned economy for achieving economic growth: “First thing we do is we invest in manufacturing, infrastructure, and research in the clean energy jobs of tomorrow. Second thing is we invest in our workforce, from pre-K education to great teachers to debt-free college and tuition-free college for families that make less than $125,000 a year.” The “we” here seems to be the government’s central planners. “Third, we promote fairness by raising the minimum wage, so you can’t work full-time and be under the poverty level, and by paying women equal pay for equal work.” The central planners will decide how much each American should get paid, just as was done in the Soviet system. As the Democrats are solidly in the lead I would say that this demonstrates the continuing desire of Americans to enjoy a planned economy (see “Citizens for a Planned Economy”).

It seemed as though mostly the candidates talked about stuff that is too complex and technical for the average voter to know or care about. Was there an obvious winner?

[Meanwhile my Facebook feed continues to be filled with hatred of Donald Trump and celebration of Hillary’s wisdom. Hillary supporters have come to the conclusion that all Trump supporters are either stupid or sexist/racist or both. This makes some statistical sense because less than half of the voting population supports Trump and roughly half of Americans are less intelligent than average. I wonder if anyone has followed up by administering an IQ test to voters to determine if in fact IQ can be used to predict voting behavior.]

 

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A friend took the same photos with his Samsung Note 7 (with latest battery!) and my iPhone 6 Plus. It was close to high noon on an overcast day. Most of the iPhone images were unusable due to motion blur (both cameras were in fully automatic mode; the iPhone selected ISO 32 and a shutter speed of 1/60th of a second while the Samsung picked ISO 64 and a shutter speed of 1/120th to 1/150th). Here are the results:

• from the iPhone 6 Plus
• from the Samsung Note 7

And just today DxOMark declared that the Google Pixel delivers better performance than any other smartphone camera. I do like the idea of a normal perspective lens on a phone (iPhone 7 Plus), but I wonder if Apple spent too much time on Social Justice Wars (and avoiding corporate income taxes) and not enough on squeezing in a bigger sensor.

Related

• Samsung Galaxy S7 review
• Falling out of love with the Samsung Galaxy S7

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