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I was recently in Chicago as part of my software expert witness life. Around the corner the musical Hamilton was opening and people were lining up to purchase tickets for 6-12 months in the future. Given that the producers have historically cast only black actors in certain roles I am wondering if a passionate (white) musical theater fan couldn’t shortcut the line by applying to play Aaron Burr or George Washington, including a photo of a boring white male face. Once rejected for the job, the fan files a race discrimination employment lawsuit and agrees to settle the case for a few mid-orchestra seats.

There is presumably a flaw in the above scheme but I am not sure what it is.

[Separately, the theater is in a Hampton Inn. At least for the duration of the show would it make sense for the hotel to be renamed the “HamiltInn”?]

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This article on the Angelina Jolie divorce lawsuit (previous posting) is kind of interesting for the light it sheds on the American divorce industry:

As of October 8, The Richest claims [the defendant] is worth $240 million while Jolie is worth a bit less with an estimated net worth of $200 million.

[the defendant] and Angelina Jolie were attempting to sort out an agreement for the division of their properties, temporary support for Jolie and the kids, and permanent financial support for the family.

In other words, if this doesn’t settle, taxpayers will be funding judges and other court personnel to sort out the question of the extent to which a person with $200 million in assets needs financial assistance in order to take care of a few children on a part-time basis.

Related:

• Cash value of Angelina Jolie’s children: roughly $50 million tax-free

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If you’re running out of ways to signal virtue on Facebook, here’s a prepackaged posting…

Accompanying text: “Share if you want to help the Bubble Children.”

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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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