most bitchin' use of drawers ever

and possibly by bitching, I mean pretty. But when that old dresser of mine goes by the wayside, I'm going to totally do THIS to it. Recycle, reuse!

City Lights

All this time, she had been waiting for someone or something to be that key that would fit the lock of the complicated machine that was her soul, and to click the gears in place. Now she was not sure that there were such a key. Perhaps it was the gears themselves that would change. However, at times, she found this metaphor disturbing.

The vastness of the city was reflected in its ever-burning lights, and she breathed in the sight from the hilltop. How she loved the city lights! Beyond mere loveliness, each light seemed to her a declaration of defiance against the natural darkness. Each light a person struggling to affirm their own brightness amidst the cold callousness of mere existence.

She walked around until she felt her knees go lax, and then she went home, more at peace.

thank you

All of you. I'm ready for the new year now.

Culmination

Well, peds is done, and that godawful Shelf exam is over with. Whew! Overall, I really really loved my first semester of rotations, and there were even a few moments where I could say to myself, "Good job, me! You can be a good doctor yet!" Next semester promises to be a lot more intense, and I'm hoping I'll hold up alright in it. In the meantime, I'm looking forward to winter break. Main goals? Get in some good sleep, do what I need to do for school and future, and enjoy the precious time I have with my friends and family. Now THOSE are the kinds of ambitions I like :-)

(ps) Lydia just offered me an opportunity to go to Spain with her over Spring Break. Can we say HELL YES???? God, I love that girl!

it doesn't take much

Feeling nauseated, waiting for my roommate to come home so I can help him take his car to the shop, and then maybe some dinner, which may or may not be crossed off to list due to nausea.

Also realizing that when you're young and feeling inadequate/angsty/confused, one of the constellations of your "world is going to shit" storyline is that your parents are definitely - even if they have said nothing to indicate it - getting divorced. Every argument counts!

Good to Know

I was just reading about the value of evidence in science today, and lo and behold, out comes this article about one of the most hotly debated topics in women's health: hormone replacement. HRT has been controversial for some time in medical circles because physicians could not reach consensus on how to interpret the results from the WHI (stopped in 2002 because of a surprising and alarming increase in CVD and breast cancer rates in users of HRT compared to placebo). Some, however, argued that the increase reflected long-term use of HRT in older, postmenopausal women, and did not accurately reflect risk in younger women who were using HRT short term.

Even as I started medical school, the conventional wisdom was that it was acceptable to use HRT in women just entering menopause with severe symptoms (eg, hot flashes), but not to use it to prevent osteoporosis or other problems associated with decreased estrogen. But that was the educated guess. Now a new study from the WHI has come out that gives us a better sense of timeframe of the risks of HRT, and thus better guidance for physicians.

In brief, the new WHI study states:

Three years after stopping hormone therapy, women who had taken study pills with active estrogen plus progestin no longer had an increased risk of cardiovascular disease (heart disease, stroke, and blood clots) compared with women on placebo. The lower risk of colorectal cancer seen in women who had taken active E+P disappeared after stopping the intervention. The benefit for fractures (broken bones) in women who had taken active E+P also disappeared after stopping hormone therapy. On the other hand, the risk of all cancers combined in women who had used E+P increased after stopping the intervention compared to those on placebo. This was due to increases in a variety of cancers, including lung cancer. After stopping the intervention, mortality from all causes was somewhat higher in women who had taken active E+P pills compared with the placebo.

Based on the findings mentioned above, the study’s global index that summarized risk and benefits was unchanged, showing that the health risks exceeded the health benefits from the beginning of the study through the end of this three year follow-up. The follow-up after stopping estrogen plus progestin confirms the study’s main conclusion that combination hormone therapy (E+P) should not be used to prevent disease in healthy, postmenopausal women. The most important message to women who have stopped this hormone therapy is to continue seeing their physicians for rigorous prevention and screening activities for all important preventable health conditions.

An article summarizing the findings can be found here.

So what does this mean for physicians? I still think that we should prescribe HRT to women who are suffering intolerable symptoms of menopause. However, given the study's results, I would be more vigilant about screening them for breast cancer while they are on HRT, and be more aggressive about weaning them off of HRT as they reach the 3 year mark in usage. I've seen so many women who have been on HRT for years and years and years (I'm talking like since 1980 when they had their hysterectomy), without close follow-up. Sometimes, we'll get them in clinic and they can't even tell us why they're on HRT. With this new data, there is a lot more incentive to be clear about the proper uses of HRT, and to prevent this sort of "slipping through the medication regime cracks."

The next study to come out is on women who have been only using estrogen, and not estrogen and progestins. That ought to be enlightening too, as hysterectomies are becoming an increasingly common procedure in the field of ob-gyn.

Summer Sandals

"Flip Flop, Flip Flop," or so Natalie Angier describes them in The Canon. That's also the way I feel about what I'm going to declare in January. For a while I was feeling confident about psych, then I did ob-gyn, loved the rush, and was ob-gyn all the way. Now that I'm distanced from both of them (I'm on my pediatrics rotation at the moment), psych is tugging at me again and the allure of vaginas and surgical tools are starting to fade.

Flip flop, flip flop, and I'm back at square one.

I've made the lists of pros and cons of both fields, but it hasn't been terribly helpful. When it comes down to it, these two fields appeal to two different sides of me, have their own distinct virtues, and I can see myself loving a career in either one. I think I'm taking the rights steps - namely, getting additional exposure to both fields by doing a few days at Wesley Woods at Emory over break, and then doing an elective in REI in March at MCG - but I'm scared that even after those, it'll still be a last-minute, "hope I will never regret this" kind of impulsive decision.

They say you'll just "know" when you hit the right rotation in medical school, but so far, I haven't found that to be the case. There has only been time in my life where I've felt something to be undeniably true, and let's be honest, that incident didn't particularly do me any favors. Some of my classmates pray, but I don't even know who to pray to, or what form my prayer should take. Or if divine intervention is really the solution I'd want to my problem. I know that I've made the right choice by going into medicine, I have no regrets or doubts about that. But what's the next step??

Washington Irving once said that great minds have purposes, while little minds only have wishes. Right now, I don't know what my purpose is, and am treading water because of it. I wish I didn't feel like I was throwing punches in the dark. Ah, wishes of the little mind...

Take a cue from my picture above, God, and shed some light on my life. In the meantime, I'll just do what I keep telling my little sister to do, which is to pick something - or two things - and keep getting engaged in them. Even if we have two loves, we eventually pick one, and it's the matter of which/whom grabs our heartstrings first when the time is right.

Some Funny Sex Acts

I thought I had heard it all, but these are new to me...

3. The Stranger - Sitting on your hand until it falls asleep and then jerking off, eliciting the feeling of a hand job from someone else.

57. The Flaming Amazon- This one’s for all you pyromaniacs out there. When you’re screwing some chick, right when your about to cum, pull out and quickly grab the nearest lighter and set her pubes on fire, then extinguish the flames with your jizz!

72. The Homolic Maneuver -Using your penis to dislodge an object blocking a choking victim’s windpipe.

80. The Fat Lip - If you get poison ivy and finger a girl, her labia lips will swell. A la, the fat lip.

(found off of "The 99 Most Degrading Sex Acts" on nerve.com)

Site of the day: Jocelyn's Corner

Whoever writes this satirical blog is just brilliant. Some excerpts:

Christmas shopping made easy!

The way most people do their Christmas shopping just makes me sick. Waiting in stupid long lines for Black Friday specials. Putting tons of new debt on their credit cards. Wasting their hard earned money on gobs of overpriced crap that none of them even need. It's depressing, and it's senseless. This season should be about having fun, and not about spending a lot of money!

You won't find me at those Black Friday sales until just after the stores open. I park my van in a handicapped accessible spot, and watch those first few lucky customers come striding out, smiling over the purchase of a few limited supply items. I follow them from that parking lot to wherever they shop next. Most of them head to the mall. Then, once they've gone inside, I perform a quick smash and grab out of their parked car. Nothing could be easier! Phil is really going to love his new 36" HD television!

Another fun way to stock up on holiday fun is to steal packages from people's doorsteps. I bought the cutest little UPS girl outfit a few Halloweens ago, and it's becoming an indispensable part of my holiday routine. Nobody even notices me when I'm out on my lunch break, hitting up front stoops of houses for a "pick-up". It's nice when the companies put their logos on the shipping boxes so you know what you're getting. I hope my three year old enjoys her new laptop computer!

There's also the option of charitable sources, like Toys for Tots. I apply to those programs with falsified information so my kids can get a few extra gifts out of it. You should see the look on those volunteers faces when they have to deliver that stuff to our well furnished townhouse! But this method doesn't allow you to select what types of toys they bring. So go out earlier in the month and rummage around in their donation bins at the front of stores, and in office buildings. That kid-sized robotic dinosaur I snagged is going to knock little Brandon's socks off!

My final technique is a no-brainer. Folks are always looking for babysitters this time of year. All you need to do is post a few signs up on bulletin boards. Once the baby is asleep you can snag a few items from under their tree and move it out to your trunk before they get home. If you can find extra wrapping paper around you can always empty the boxes and rewrap them. This way you won't arouse any suspicion. My daughter is going to be so excited when she opens up the sassy new Dallas Cowboys jacket I took for her, and all the baby toys I swiped will be perfect for welcoming her unborn baby!

Also, check out her myspace! I'm a fan!

I don't know why this makes me giggle so much but...

it def has the right combination of irony, smartass, and nerdiness to make it onto my blog

GAAAH

The power is out in my house, and it won't be fixed until after 10 pm. So I guess I'm stuck at the Tifton Starbucks. I wouldn't complain so much except I'm feeling especially antsy today with all the rain, and I desperately want to dance around with my headphones on (my normal 8-9 pm routine), but obviously, I don't want to look like a retard in public. Boo Hoo.

Thought of the day:
"My wants arrange themselves, I can only prioritize my efforts."

deal with it...

Reading nerve, I can finally confirm what I've suspected all along: Women are narcissistic. Of course, I don't consider that a bad thing, or any case, a quality that makes women worse than men. Because men are narcissistic too :-)

Funny chat status of today (stolen from Viren): "Motion to kick friend whilst down passed."
It's terrible and so wrong, but also kind of hilarious...

Cultural Competence

Interesting article linked off of the Economist. I think it has a few good observations about intellectualism in this generation....
***

THE AGE OF MASS INTELLIGENCE

By John Parker

Created 04/12/2008 - 00:11

We’ve all heard about dumbing down. But there is plenty of evidence that the opposite is also true. Is this, in fact, the age of mass intelligence? John Parker reports...

From INTELLIGENT LIFE magazine, Winter 2008

Russell Southwood is queuing outside his local cinema in south London, listening to his iPod. Hip-hop and jazz, as usual. What is less usual is what he is queuing up for: not a film but a live transmission of this season’s opening night from the Royal Opera House. “I like hip-hop and opera,” he says. “Not a big deal.”

That’s increasingly true. Every other Saturday, Darren Henley is at the Priestfield football ground cheering on his beloved Gillingham. In the evening, he goes to a concert by the Royal Liverpool Philharmonic or the London Symphony Orchestra, because he is also the boss of Classic FM, a radio station that sponsors those orchestras.

Cultural incongruities are popping up everywhere. When the Guardian, which sponsors the Hay-on-Wye [1] literary festival, picked ten visitors to interview, one turned out to be a check-out clerk at Tesco who saved all his money during the year so he could go to the festival for his holiday. He was far from the most unlikely visitor who might have been found. High-ranking officers from the SAS (Special Air Service), Britain’s crack covert-operations regiment--who have to remain anonymous--have been known to spend their holidays each year travelling from their base at Hereford to Hay for lectures on Wordsworth and Darwin.

The sharpest of all these cultural contrasts, though, was the one taking place at the Royal Opera House itself the night Russell Southwood was queuing. Every seat had been taken not by the furs-and-cufflinks brigade but by readers of the Sun, a newspaper not noted for its opera coverage. Amid huffing and puffing from connoisseurs, 2,200 readers of Britain’s biggest-selling daily, accompanied by a trio of page-three girls (modestly attired), descended on the house of Handel and Callas for Mozart’s “Don Giovanni”. The paper celebrated with an inch-high headline: “Well Don, my Sun” [2].

In most rich countries, the old distinction between high and popular culture is breaking down. Isolated examples of this have been seen for a long time. In the 1960s Karlheinz Stockhausen, a doyen of avant-garde music, appeared on the cover of the Beatles’ “Sgt Pepper” [3]. In the 1990s the Three Tenors found a mass audience for Puccini. But what used to be a characteristic of individuals or particular occasions is now becoming the defining feature of the whole culture.

Millions more people are going to museums, literary festivals and operas; millions more watch demanding television programmes or download serious-minded podcasts. Not all these activities count as mind-stretching, of course. Some are downright fluffy. But, says Donna Renney, the chief executive of the Cheltenham Festivals [4], audiences increasingly want “the buzz you get from working that little bit harder”. This is a dramatic yet often unrecognised development. “When people talk and write about culture,” says Ira Glass, the creator of the riveting public-radio show “This American Life” [5], “it’s apocalyptic. We tell ourselves that everything is in bad shape. But the opposite is true. There’s an abundance of really interesting things going on all around us.”

That may seem Pollyanna-ish. But consider these straws, all blowing in the same direction. In 1999/2000, there were 24m visits to Britain’s biggest museums. In 2007/08, the figure was 40m. Between 1999 and 2001, Britain scrapped entry charges, so the increase is partly attributable to that. Still, it was a lot of people. And another factor is the popularity of blockbuster exhibitions, such as the Terracotta Army show [6] at the British Museum--which are seldom free, so scrapping charges cannot be the sole explanation. In most of the great cities of the West, museums now dominate the lists of most popular tourist attractions. More people go to the Louvre each year than to the Eiffel Tower; in London, three museums--the Tate, the British Museum and the National Gallery--each attract more visitors than the London Eye.

In 2006 the New York Metropolitan Opera started an experiment to reach a new audience. It began transmitting opera performances live to cinemas. In the first year it broadcast six productions to 98 movie houses in America; 325,000 people watched. The second year, it transmitted eight operas to 935,000 people. This year, there will be 11 productions, 850 cinemas in 28 countries and a forecast audience of 1.2m: roughly 100,000 people per show, compared with just 3,700 at the Met itself. A few dress up in finery. Many more stood outside in Times Square, New York, this year staring at the digital displays that usually advertise Panasonic or Disney, watching the Met’s opening-night concert.

* * * * *

One of the commonest complaints by cultural doomsayers is that nobody reads good books any more. Yet in the past two years, the Oprah Book Club [7] in America recommended Tolstoy’s “Anna Karenina” [8] and three novels by William Faulkner [9]--good by any standard, and they all made the bestseller lists. This year, Waterstone’s, which owns over 300 bookshops in Britain, asked two celebrated novelists, Sebastian Faulks and Philip Pullman [10], each to choose 40 titles and write a few words of recommendation. The chain then piled copies of the books on tables next to the entrances of its main shops and waited to see what would happen. Faulks and Pullman hardly dumbed down their choices: they included Fernando Pessoa’s “Book of Disquiet” [11], Rudyard Kipling’s “Kim” [12], and Raymond Queneau’s “Exercises in Style” [13]. The sales increases for these books over the same period the year before were, respectively, 1,350%, 1,420% and 1,800%--clear evidence of latent demand. If you offer it, they will come.

Literary festivals show the same thing. The Arts Council tries to keep track of their number: 43 in Britain in October alone. Some are tiny, like a weekend festival in Mere, a village in Wiltshire. Others are huge. Next year, the Hay Festival expects to sell 165,000 tickets for events over two weeks. When it began, in 1988, there were 2,000 visitors. Its director, Peter Florence, says the audience has grown, about 15% a year for the past 20 years. Now, he is branching out abroad, helping organise festivals in Cartagena (Colombia), Granada, Havana, Nairobi and Beirut. Not far from Hay, in Cheltenham, another literary festival has also grown, from 67,000 visitors in 2005 to over 87,000 this year. It, too, has children: the Cheltenham jazz, science and classical-music festivals have all flourished on the back of the literary one.

Of course, it may be just that there is more of everything, from serious-minded literary gabfests to drunken holidays in Benidorm. “In the past 20 or 30 years”, says Ira Glass, “there have always been little pockets in the culture where people do interesting work. But now there are so many more places, so many more people who are willing to try anything. The result is that there’s a lot of crap, but there’s also more stuff that’s good at every level.” And the internet, with its instant searches and e-mail newsletters, makes it much easier for people to know what is happening and how to get it.

Where you can make direct comparisons, the serious end of a market is holding up as well as or better than the popular one. Take television. There certainly is no shortage of chewing gum for the eyes. But a clever quiz show such as “QI”, which one might have expected to have lasted a season, is now in its sixth year on BBC2. The even more upmarket radio programme “In Our Time” [14] was the BBC’s first podcast, in 2004, and it was an instant hit. Janice Hadlow, the new controller of BBC2, recently told the BBC staff magazine: “I want to see intelligence in popular programming. It’s good to see it cropping up in all sorts of different places--not just those programmes where you might expect it.” A series like “The Wire”, which its creator David Simon admits “requires thought and commitment to watch”, has survived poor ratings to become a critical smash. Barack Obama was one of many to call it the best show on television. The Los Angeles Times used it as an example of what “is generally acknowledged to be something of a golden era for thoughtful and entertaining dramas”.

Television, opera and perhaps museums might be said to be absorbed passively. But that is not true of literary festivals, nor of some of the new businesses taking advantage of changing public taste. In a former grocery shop in Bloomsbury, Sophie Haworth, who used to run the Tate’s education programme, has just opened the School of Life, aiming to bridge the gap between adult education and self-help. Haworth calls it “a one-stop shop for the mind”. It is more rigorous than most self-help groups and more fun than adult education. Its courses are sold out for months ahead. So are public debates for 800 people on propositions like “It’s wrong to pay for sex”, staged by Intelligence Squared. When the company started, says Jeremy O’Grady, one of its organisers, he was virtually offering free tickets to tramps on the streets to fill the hall. Now you can hardly squeeze in. “Marketing people always think the public is seduced by glitz and instant gratification,” says O’Grady. “But we’re less shallow than we think we are.”

Lastly, lest you think the School of Life and Intelligence Squared, which cater for thousands, are typical of the new cultural endeavours, consider Classic FM [15]. Before it came along in 1992, Radio 3 had a monopoly over Britain’s supply of broadcast classical music. But (as is often the way with monopolies) it catered for insiders far better than for anyone else. As Henley says, Radio 3 “super-served the connoisseur”. You almost needed permission from the Royal College of Music to listen to it. During the day, Radio 3 strode about in a corduroy jacket; in the evening, it changed into white tie and tails. “Classical music had a language and a set of values that made it very elitist,” argues Henley. “It said: ‘This is the music. This is what you wear. These are the rules.’ But when we talked to people, they said that while they loved the music, they all thought they were the only ones put off by the way it was presented. It was like a club where the door is always locked. From day one, our aim was to blow open the locks.”

Classic FM’s launch was nothing short of sensational. Within four months, it had 4.2m listeners--twice Radio 3’s audience at that point and a vivid example of latent demand. “The audience was always there,” Henley says. “We just identified a need that wasn’t being fulfilled.”

Now, with 6m listeners a week, Classic FM is easily the largest commercial radio station in Britain (BBC Radios 1, 2 and 4 are bigger but are not commercial). One in nine of Britain’s adult population are regular listeners. They are not just the cardigan-wearing classes, either. At least 1m Classic FM listeners also tune in to Radio 1. So do about 400,000 children under 15 and, during the spring, half of all those who call the station’s musical-requests programme are students who, it seems, switch from pop, rock or dance music at exam time to something that helps them concentrate or relax. The station’s presenters embody its crossover appeal. One, Alex James, was the bass player for Blur, one of the leading Britpop bands of the 1990s; another, John Brunning, was lead guitarist for the 1970s band Mungo Jerry.

Like any good marketing operation, Classic FM divides its audience into segments. It labels them nervous discoverers, background listeners, classics as pop, popular enthusiasts and connoisseurs, and it provides programmes tailored to each. In the morning, when there are more background listeners and nervous discoverers (the youngest of the groups, also the Radio 1 listeners), the music is bright, breezy and interspersed with news and talk. In the afternoon, programmes turn more soothing for the popular enthusiasts (older, affluent, more women than men). In the evening when listeners have time, and connoisseurs tune in, you get traditional concerts.

The station goes out of its way to be user-friendly. For new or occasional listeners, it sells guidebooks (“The Friendly Guide to Classical Music” [16]). For the enthusiasts, there is a monthly magazine. Last Christmas, it even held a “Barbie at the Symphony” concert in Liverpool’s Philharmonic hall--“The Nutcracker”, “Swan Lake”--for another target audience: doll-loving girls (and their parents).

This leaves it open to accusations of dumbing down. It is certainly true that a good deal of Classic FM’s output is undemanding; the most ferocious and rebarbative contemporary music is banned. But it plays the world’s greatest music in proper recordings. It takes the classical canon beyond the traditional audience of connoisseurs and, with its magazines and books, tries to engage new audiences more deeply with the music it plays. Darren Henley’s quest is unfinished. “I've no doubt”, he says, “that one day, everyone will listen to classical music, maybe not all the time, but at different stages of their lives. It offers people a spirituality, an otherworldliness that they want. We hear that from our listeners all the time.”

* * * * *

Philippe de Montebello, soon to step down after 31 years as director of the Metropolitan Museum in New York, is fond of saying “the public is a lot smarter than anyone gives it credit for.” He seems to be right. But why? It’s unlikely people are more intelligent than they used to be. Perhaps the elites that enjoy high culture are now bigger for some reason? Perhaps popular tastes have changed in such a way as to benefit high culture? Or perhaps it has nothing to do with changes in the audience, and more to do with the artists and institutions, who have become more skilled at attracting people? Answer: all of the above.

Hard though it may be for professional pessimists to credit, educational standards have risen appreciably over the past 40 years. A good way to measure this is to look at how many people have degrees in each generation. The Organisation for Economic Co-operation and Development [17] (OECD) in Paris has worked this out and found that 29% of Britons between the ages of 25 and 34 have what it calls “type-A tertiary education” (basically, universities). But the share is little more than half that in an older generation (16% of those between 55 and 64). This reflects the expansion of universities in Britain since the 1960s. And in case you suspect the effect is merely a result of relabelling polytechnics as universities, the OECD has allowed for that, too. It calls the polytechnics “type-B tertiary education” (ie, vocational and higher training). Type B education in Britain has been flat. The growth has come from universities alone. In a literal sense, there has been an expansion of mass intelligence: more people have been trained at universities to want, or expect, more intellectual stimulation.

People with degrees are much more likely to go to museums than anyone else. Two researchers from Oxford University, Tak Wing Chan and John Goldthorpe, studied the influence of income, occupation, social class and education on whether people go to theatre, dance, cinema, music and the visual arts. They concluded that education is by far the most important factor. “The higher individuals’ education level,” they write, “the higher, one might say, is their capacity for cultural consumption.” They also looked at whether people tended to concentrate on one thing (going to the movies, say) or to engage with lots of art forms. They found that university graduates were far more likely to be “cultural omnivores” than “cultural univores”. Others have found the same thing. In 2007 the American research group MRI looked at the viewing and reading habits of the elite market, which it defined as those who went to, or subscribed to, at least two of the following: the New Yorker, Atlantic Monthly, The Economist, HBO, theatre, art galleries or classical concerts. They found that of this group, a third also read People magazine, watched “American Idol” and subscribed to the cable sports channel ESPN. One of the features of the market for mass intelligence is its heterogeneity.

There is a second, indirect link between education and culture, albeit one that is hard to pin down. Over the past two decades, education has been increasingly rewarded; in the “knowledge economy”, university graduates have done much better than others and the value of a degree has soared. People with degrees also go to cultural events more often so, though there is no necessary connection, there is a correlation: education, culture and income or status tend to go together. A study by the Pew Research Centre in America last year measured this correlation by proxy. It found that 60% of people with incomes of less than $20,000 a year said they had a low knowledge of current affairs; 15% had a high knowledge. For those on incomes of $100,000 and over, the shares were almost exactly reversed: nearly 60% high, less than 20% low. Keeping abreast of current affairs is obviously different from going to the opera or science festivals. Indeed, going to an arts event is often an escape from work. But it is also a way to gain status, to network and to use and burnish the thing that helps you at the office: knowledge.

An alternative explanation for the growth of mass intelligence comes from Peter Florence of the Hay Festival. Forty or 50 years ago, he argues, the public appetite for debate and intellectual curiosity was partly met by politics. The 1960s was a period of political ferment. Later, the current of public interest ran through television and radio; the BBC and ITV played a huge role in bringing theatre, opera and the rest of it to a wider audience. The tradition of public service, he thinks, “nourished an appetite for culture that has survived the splintering of monolithic public-service broadcasters and been encouraged by the rise of the internet”.

No doubt these long-run trends have played a role. But if they were the sole explanation, you would expect the market for mass intelligence to have developed slowly, imperceptibly. And one of its striking features is how rapidly it can appear--as Classic FM, Waterstone’s and the Met have all shown. The behaviour of arts providers makes a big difference too. Most successful arts organisations are busy blowing away a certain dustiness and injecting a sense of fun and style. Adult education and debating societies used to mean draughty halls and comfortless benches. The School of Life, in contrast, looks like a designer shop and the Intelligence Squared debates take place, says O’Grady, “in the most comfortable leather seats northern Italy has to offer”. This year’s Christmas programme at London’s Southbank Centre includes a Quentin Crisp lookalike contest and a concert by an orchestra using instruments scavenged from rubbish--drainpipes, traffic cones, discarded soy-sauce bottles.

When arts organisations do this, they can not only expand their audience but sometimes create new ones in the most unexpected ways. This is what Naxos Audio Books [18] has done with recordings of classic books on CD and tape. Its bestsellers include abridged versions of Milton’s “Paradise Lost” (three CDs) and a four-CD account of James Joyce’s “Ulysses”. Amazingly, Naxos sells thousands of copies of an unabridged version of “Ulysses” (22 CDs). “When I first proposed it, my colleagues thought I was mad,” says the company’s founder, Nicolas Soames. “At the start, it was just a hunch. I thought that if we read writers like Dante or Milton aloud, it would make them live again for a new audience.”

What was most remarkable was the origin of that audience. “I was a judo journalist,” Soames says, “and when I visited judo groups I found that everyone wanted to learn. The -do in judo means ‘the way’ and the concept inculcates in those doing the sport a strong desire to learn. These people would never sit down and read Dante or Joyce. But they would listen to them if they were read well enough. Now we know there is a group of people I call self-improvers who want a wide range of intelligent stuff, including the classics.”

From opera in cinemas to audio books for judo-players: the expanding market for intelligence is certainly unexpected. But what does it really amount to? Is it a profound cultural change or a mild shift upmarket? Here are three tentative conclusions. First, the growth of a market for intelligence may not imply anything about the quality of art being produced. Artists and patrons do separate, if related, things. Accusations of dumbing down are legion. On the other hand, the LA Times’s view that this is a golden age for serious television might be applied more widely. It is hard to believe that those who accuse arts institutions of dumbing down would want audiences to be smaller.

Second, the growth of intelligent interest may help resolve an argument that exists in universities between those who say culture is really all about class or income, much as it always was, and those who say that, no, sweeping statements about class are no longer relevant, and that these days personal taste, not class or money, is what matters. The new audience suggests both schools are partly right (or wrong). Taste has become fantastically heterogeneous: people do indeed watch and read whatever they want; intellectual snobbery is breaking down. But as Drs Wing and Goldthorpe have shown, one group--those with university degrees--read more, watch more and mix and match more than anyone else.

Third, what does all this say about the widespread view that societies are dumbing down, educational standards are crumbling and people’s ability to concentrate is collapsing? The reply must be that it cannot be true across the board and that for a significant number, the opposite is the case: people want more intellectually demanding things to see and hear, not fewer. Surely both things are happening at once: part of the population is dumbing down, part is wising up. But something has changed. H.L. Mencken, the so-called sage of Baltimore, said: “No one in this world...has ever lost money by underestimating the intelligence of the great masses of the plain people.” A growing number of people are proving him wrong.

slippery bastards

This is so true, for med school, love school, and life school....

who the hell is writing Nerve's horoscopes now??

First they're a week late, then the entries blow. Look, bitches, I don't want to have to read someone else's horoscope to understand my own, ok?? It's not supposed to be a series of personal jokes for YOU!

Seriously, look at this crap:

Aries (Mar. 21-Apr. 19)
You are a squirrel. As such, you do not understand why your forest seems to be exploding. You are very concerned.

How the hell am I supposed to plan my life from this????

grandparents

Randomly thought of my grandparents today. Well, maybe not so randomly. I had to write a short paragraph for peds on why I wanted to become a physician, and I realized their attitudes towards life and society had a lot to do with it. But it's not like they ever sat me down and talked to me about that. It was just in all the little everyday things they did that showed me what they believed. That made a far deeper impression upon me than any grandstanding they could have done.

(Those, by the way, are my paternal grandparents. My maternal grandparents have also made a deep impression upon me, but less upon my choice of career. More on them another time.)

I hope they are well. I realize they are getting on in the years, and it's hard for me sometimes to reconcile that fact with the spry, playful grandparents I remember from my youth. I'd really like to go back to China after graduation; originally, they were planning to come here to see me get my MD, but I don't think their health will allow for that now. So it's my turn to go to them.

Finally, I hope I grow up to be someone's hero like they are mine.

the most touching dating confession i've seen

"I always miss you...you used to tell me you missed me too...I miss that most of all."

see more at nerve.com

Playlist

I saw a first outbreak of herpes for the first time today. It was terrible. Poor girl.

On a brighter note, the 3 songs on rotation on my ipod right now:

Race and Class

I like this short blurb from TIME magazine because it draws attention to the fact that racial tensions in America are increasingly gaining meaning as class tensions, and not merely as issues of color. Race still matters, but in this modern age of interracial offspring and the black middle-class, the conflict lies more in cultural and lifestyle differences than in differences of complexion. In the future, it would be prudent for the NAACP to pay attention to the growing rift between the haves and have-nots in the black community. At the same time, they would be wise to use this moment in history to integrate black disadvantages into the more generalized picture of American poverty. I don't deny that poor blacks face somewhat unique circumstances, but to continue to stand apart from Americans in general - that is, to insist that their economic history is fundamentally and permanently different - invites only division, and not useful discourse.

***
National Association for the Alleviation of Credit Pandemonium

Nov 19th 2008

At 100, the NAACP still has a mission

Corbis

The struggle of the century

Barack Obama’s campaign for the White House raised many questions, for all Americans, about what it means to be black in America today—just in time for the centenary of the nation’s oldest civil-rights organisation, the National Association for the Advancement of Coloured People

The NAACP was formed on February 12th 1909 (itself a centenary, of Lincoln’s birth) by a bi-racial group of reformers. It promised to fight for equal rights and opportunities for black Americans. Primarily using litigation and legislation, it has been fighting the good fight, with varying degrees of success, ever since.

Does the election of the first African-American as president mean the battle has at last been won? NAACP members gathering in New York in July 2009 for its 100th annual convention could be forgiven for wondering how much their organisation still matters. Mr Obama and other young black leaders, such as the Massachusetts governor, Deval Patrick, embody the successful black middle class; and for many 20-something African-Americans the NAACP’s mission apparently means little when they feel overt discrimination is no longer an issue.

Hoping to make the NAACP relevant to that new generation is Benjamin Todd Jealous, a 36-year-old Californian who is the youngest chief executive in the NAACP’s history. Mr Jealous has plenty to do.

When he took over the helm in September 2008, the NAACP had been in turmoil for several years. Never a mass organisation, its membership now languishes at around 300,000, from a high of around 600,000, the association claims, just after the second world war.

Mr Jealous launched his tenure with an ambitious online voter-registration programme aimed at young blacks. As priorities for the coming year the NAACP is also targeting discrimination in the criminal-justice system, improving public schools, increasing black political and economic empowerment and boosting African-American representation, for example as surgeons, in the upper reaches of the health sector.

However, the credit crunch could prompt a shift in that strategy. African-Americans account for a disproportionate share of subprime loans, and tougher lending rules and tighter credit threaten to erode many of the gains made in recent years by black households.

The NAACP is suing 14 mortgage companies for discriminatory practices but it will need to do more, from expanding financial-literacy programmes to helping its constituents recover from financial crisis. In doing so, the NAACP might just find it matters once more.

How Georgia Stacks Up

(facts courtesy of the Guttmacher Institute for Sexual and Reproductive Health. Information is current as of Nov 1, 2008.)

Sexual Education and Family Planning

Issue: Sexual Education

• Nation: Most states require that public schools teach some form of sex or STI/HIV education. Guidance on sexual activity is heavily weighted toward stressing abstinence; contraception, if it is covered, is not required to be stressed. Most states also have opt-out clauses so parents can remove their children from sex ed classes.
• Georgia: Sexual education is mandatory in the state of GA, and abstinence must be covered whereas contraception does not. Information about STI/HIV must also be covered, with the emphasis on abstinence again. Parents can opt their children out of the curriculum.

Issue: Family Planning Funding

• Nation: Beginning in the 1990s, a small number of states imposed abortion-related restrictions on state family planning funds. Some ban the use of state family planning funds to provide abortion counseling and referrals to women who have unintended pregnancies. Additionally, these restrictions often require strict separation between organizations providing state-funded family planning services and organizations providing abortion-related services. Currently, 4 states explicitly prohibit the use of state family planning funds for abortion counseling and referral.
• Georgia: Guttmacher offers no information on Georgia legal restrictions on family planning funding, but as of Nov 11^th, Georgia’s state budget for family planning clinics was cut by a whopping 34%. Governor Sonny Perdue had only specified that state programs be cut by 6%.

Issue: Physician and Pharmacist Refusal

• Nation: Most states allow private physicians and individual institutions to refuse to perform abortions. The real issue here is the topic of referral. ACOG has more or less stated that it is a medical obligation to refer to a professional that will provide the services you refuse.
• Georgia: Allows both individual physicians and institutions to refuse to provide abortions. 1 of 4 states that allows pharmacists to refuse to dispense contraception, although pharmacies themselves are not given explicit permission to refuse. As for the topic of referral, community sentiment decides whether Georgia healthcare providers will give meaningful referrals.

Issue: Emergency Contraception

• Nation: On August 24, 2006, the FDA approved Plan B as an over-the-counter medication for those aged 18 and older; it remains a prescription-only drug for minors. 16 states require hospital emergency rooms to provide emergency contraception–related services to sexual assault victims. 15 states require emergency rooms to provide information about emergency contraception. 4 states explicitly allow pharmacists to refuse to dispense contraceptives, including emergency contraception.
• Georgia: No laws mandating that ERs provide information on EC or dispense it upon request. No rules to allow pharmacists to dispense EC without physician prescription, even though the FDA has recommended it as OTC for individuals over 18 YO. No requirements that pharmacies stock or fill valid prescriptions for EC. Explicitly allows individual pharmacists to refuse to dispense EC (one of 4 states).

Issue: Insurance Coverage of Contraception

• Nation: 27 states require insurers that cover prescription drugs in general to provide coverage of the full range of FDA-approved contraceptive drugs and devices; 18 of these states specifically require coverage of related outpatient services.
• Georgia: Requires that insurance covers prescription drugs and devices, but not outpatient services. No provisions allowing for refusal to provide for employers, insurers, etc.

Abortion

Issue: Who can legally provide abortions?

• Nation: Most states require that only licensed physicians (and hence not Physician Assistants or licensed nurses) perform abortions, and that a 2^nd physician be involved after a certain point in fetal development (often after viability or 3^rd trimester).
• Georgia: Pretty much in line with the rest of the nation. Georgia prohibits abortions except in cases of mother’s health after the 3^rd trimester (28 weeks GA).

Issue: Reporting Abortions

• Nation: For the last three decades, the CDC has collected aggregate statistics on abortion in the US; states are not required to submit abortion data but the overwhelming majority of them do. Information gathered generally includes information about the facility, the patient’s demographic characteristics and medical history, and the abortion procedure itself, including the method used and gestational age.
• Georgia: Required reporting with information on the procedure performed.

Issue: Funding

• Nation: First implemented in 1977, the Hyde Amendment, which forbids the use of federal funds for abortions except in cases of life endangerment, rape or incest, has guided public funding for abortions under the joint federal-state Medicaid programs for low-income women. 32 states and the District of Columbia prohibit the use of state funds except in those cases where the woman’s life is in danger or the pregnancy is the result of rape or incest. In defiance of federal requirements, South Dakota limits funding to cases of life endangerment only. 4 states restrict coverage of abortion in private insurance plans to cases of life endangerment.
• Georgia: Public funding of abortion limited to cases of rape/incest/endangerment. However, anecdotal stories support the idea that women rarely use state or federal monies for their abortions due to the burdensome requirements placed upon the women to acquire that money. Georgia has no limitations to coverage by private insurance.

Issue: Mandatory Counseling

• Nation: 17 states mandate that women be given counseling before an abortion that includes information on at least one of the following: the purported link between abortion and breast cancer (6 states), the ability of a fetus to feel pain (8 states), long-term mental health consequences for the woman (7 states) or information on the availability of ultrasound (6 states).
• Georgia: All women receive verbal counseling about the specific procedure they are getting, while receiving written information on all common abortion procedures. They are verbally told the gestational age of their fetus, while given written material on fetal development throughout pregnancy. Patients are given both verbal and written information on the ability of the fetus to perceive pain. According to Guttmacher, the written materials detailing the risks of abortion and the emotional responses thereafter are accurate, although some abortion clinics may still be using outdated (and inaccurate) state pamphlets on abortion.

Issue: Ultrasound

• Nation: Some laws and policies require that a woman seeking an abortion receive information on accessing ultrasound services, while others require that a woman undergo an ultrasound before an abortion. Since routine ultrasound is not considered medically necessary as a component of first-trimester abortion, the requirements appear to be a veiled attempt to personify the fetus and dissuade a woman from obtaining an abortion. Moreover, an ultrasound can add significantly to the cost of the procedure. Only a few states (6) require verbal counseling or written materials to include information on accessing ultrasound services.

• Georgia: Providers must give verbal information on how to access ultrasound services. If an ultrasound is performed as part of the procedural workup, the patient must be offered an opportunity to view it.

Issue: Waiting Periods

• Nation: 24 states require a woman seeking an abortion to wait a specified period of time, usually 24 hours, between when she receives counseling and the procedure is performed. 6 of these states have laws that effectively require the woman make two separate trips to the clinic to obtain the procedure.
• Georgia: Mandatory 24 hour waiting period, but no mandatory trips to the clinic for counseling (can be done over phone prior to procedure).

Issue: If Roe v. Wade were Overturned

• Nation: 20 states have laws that could be used to restrict the legal status of abortion.

• 4 states have laws that automatically ban abortion if Roe were to be overturned
• 13 states retain their un-enforced, pre-Roe abortion bans.
• 7 states have laws that express their intent to restrict the right to legal abortion to the maximum extent permitted by the U.S. Supreme Court in the absence of Roe.

• Georgia: Has not passed any explicit resolutions in this matter recently, but there is good reason to believe that Georgia legislators would attempt to impose restrictions on abortions should Roe v. Wade be overturned (see recent legislation proposed in Georgia: NARAL ProChoice BillTracker and Planned Parenthood Legislative Update )

Issue: Choose Life License Plates

• Nation: 17 states allow production of “Choose Life” license plates. 7 states donate the monies to anti-choice organizations, 13 states donate the money to agencies or organizations that provide adoption assistance, and 8 states specifically prohibit using the funds raised from aiding organizations that provide abortion services, counseling, referrals or advertising.
• Georgia: Choose Life plates are allowed, although Choose Choice plates are not allowed. Funds go explicitly to maternity/adoption services agencies. Unclear which these agencies are (for example, Crisis Pregnancy Centers, which are notoriously anti-choice in their operations).

Parenthood and Minors Access

Issue: Minor’s Access to Prenatal Care

• Nation: 35 states allow minors to access confidential prenatal care. Of those, 12 allow physicians to inform parents that their minor daughter is seeking or receiving services when they deem it in the best interests of the minor.
• Georgia: Explicitly allows minors to consent for prenatal care, without any rules allowing the physician to notify parents.

Issue: Minor’s Access to Contraception

• Nation: Most states have adopted laws supporting Supreme Court rulings that extend the constitutional right to privacy to a minor’s decision to obtain contraceptives.
• Georgia: Explicitly allows all minors to consent to contraceptive services

Issue: Parental Involvement in Minors’ Abortions

• Nation: 22 states require one or both parents to consent to the procedure, while 11 require that one or both parents be notified and 2 states require both parental consent and notification. All of these states also provide for an alternate way of obtaining the procedure in the absence of parental consent, usually via judicial bypass. Some states even allow grandparents or other adult relatives to be involved instead of the minor’s parents, and some states waive the consent altogether in cases of rape or incest
• Georgia: Georgia has a parental notification law, as opposed to a parental consent. There is an option for a judicial bypass if parental notification is not done. There is an exception to this rule in cases of a medical emergency, but not in cases of abuse/assault/incest/neglect.

Issue: Minor’s Rights as Parents

• Nation: Though most states require parental involvement in a minor’s decision to terminate a pregnancy, they overwhelmingly consider minors who are parents to be capable of making critical decisions affecting the health and welfare of their children without their own parents’ knowledge or consent. Nearly every state permits minor parents to place a child for adoption. Moreover, most states authorize minor parents to make health decisions for their children, and some allow minor parents to authorize surgery.
• Georgia: Minors can consent to placing their children up for adoption without 3^rd party involvement, and minors can consent for medical procedures/services for their child.

Issue: Drug Use During Pregnancy

• Nation: No state specifically criminalizes drug use during pregnancy. However, several states had expanded their child-welfare requirements so that prenatal drug exposure can provide grounds for terminating parental rights on an individual basis (DFACS involvement, usually). Further, some states authorize civil commitment (such as forced admission to an inpatient treatment program) of pregnant women who use drugs. A number of states also place a priority on making drug treatment more readily available to pregnant women.
• Georgia: Legally, in GA, substance abuse during pregnancy is neither considered grounds for child abuse or for civil commitment. There is no state required reporting or testing. There are no targeted programs for pregnant women, but they are given priority in general treatment programs.

Issue: Safe Haven Laws

• Nation: Every state, beginning with Texas in 1999, has enacted a provision intended to provide a safe and confidential means of relinquishing an unwanted infant. These infant abandonment measures—also referred to as “safe haven” or “safe surrender” provisions—typically allow a parent or other specified party to relinquish an infant under certain circumstances without threat of prosecution for child abandonment.
• Georgia: Parents may abandon their children up to age 7 days to any health care provider. There is no specific law protecting anonymity. The acceptor does not need to provide ID bracelets, ask for health information, or investigate “missing child” status.

I wonder...

- Why the kids on the Tifton peds wards just stay in their rooms all day? They should really get out more, and play in the open spaces. It sucks just being in your own stinky room all day, and unfortunately, there is no coordinated system for getting the kids outside (reading hour, crafts time, etc).

- "If a wound heals and you don't notice when or how, is that good or bad"? (courtesy of Ozge Samanci at ordinarycomics.com)

- Why emotions are always so much stronger at night?

Thanksgiving

Rachel Maddow of MSNBC says that 1 in 10 Americans will be on food stamps this holiday season. And AP News reports that soup kitchens and food banks are expecting an all-time high in needy this year. Here are two links to organizations in Augusta and Atlanta that can help feed the needy this season. Please get involved - I know I will.

Madonna v. Lady GaGa

You decide.

Some Great Fails

because I don't feel like thinking too much tonight, and because these amuse me...
(courtesy of FailBlog.org)