Cell Death

The university-wide study also found 51 percent of students said they knew their concentration was being adversely affected by phone use and 52 percent said the phone affected the amount of information they receive during class.

Post Trauma

Peter S. Goodman, The Huffington Post:

… [T]he same company bearing the name of the newspaper that uncovered Watergate, that published the Pentagon Papers, and more recently revealed the existence of secret CIA-operated prisons in Eastern Europe now draws its largest share of revenues from an enterprise that seems on par with subprime mortgage lending in terms of its commitment to public welfare.

[The Washington Post’s publisher] spend[s] his days defending the interests of Kaplan, a company that increasingly looks like a machine built to gobble up burgeoning quantities of federal financial aid dollars while selling students’ bogus dreams…

A doctor until recently affiliated with a university hospital…

… has been arrested for running a pill mill empire.

We will see more and more of these cases, and some of them, UD predicts, will involve not merely people who have hospital privileges, but people who teach in the medical schools.

Between April and October of this year, [83 year old Dr. Felix] Lanting allegedly wrote a staggering 3,029 oxycodone prescriptions to various patients through his private practice. That translates to an average of 15 prescriptions a day, seven days a week, according to court papers. …Neighbors estimated Dr. Lanting saw anywhere from 50 to 140 patients a day.

83 years old and he sees a hundred people a day! Inspiring.

From UD’s Christmas Reading:

“The best thing about America is its universities. Not Harvard, Yale, e tutti quanti: though marvelous, they are not distinctively American – their roots reach across the ocean to Oxford, Heidelberg, and beyond. Nowhere else in the world, however, can boast such public universities. You drive for miles across a godforsaken midwestern scrubscape, pockmarked by billboards, Motel 6s, and a military parade of food chains, when – like some pedagogical mirage dreamed up by a nineteenth century English gentleman — there appears… a library! And not just any library: at Bloomington, the University of Indiana boasts a 7.8-million-volume collection in more than nine hundred languages, housed in a magnificent double-towered mausoleum of Indiana limestone.

A little over a hundred miles northwest across another empty cornscape there hoves into view the oasis of Champaign-Urbana: an unprepossessing college town housing a library of over ten million volumes. Even the smallest of these land grant universities—the University of Vermont at Burlington, or Wyoming’s isolated campus at Laramie—can boast collections, resources, facilities, and ambitions that most ancient European establishments can only envy.”

The Memory Chalet, Tony Judt

UD, an English professor…

… doesn’t see that many pre-med students. Those she sees in her classes tend to be exceptional students, impressive in both the arts and sciences.

Although this blog follows with some care perennial, notorious, headline-grabbing medical school scandals – professors who put their names on pharma-subsidized, ghostwritten research papers; professors guilty of investment-related, or other forms of mercenary conflicts of interest – it has had little to say about where pre-med students go when they leave undergraduate classrooms. And that’s because the institution of the American medical school is rarely written about in the press.

One knows vaguely about our shortage of MDs. (Though if you’re UD and you live in wealthy Bethesda, Maryland, you see the opposite of this, a place as jammed with MDs as it is with lawyers.) In many places – say, Oneonta, New York, a place not far from UD‘s upstate house – you’re more likely to be treated by a DO than an MD.

The DOs, foreign doctors, American doctors with foreign degrees, physician assistants with some prescribing privileges, etc. etc., that thrive in the United States in part because of our MD-shortage are rarely the focus of major news articles; but a recent New York Times piece about how

New York State’s 16 medical schools are attacking their [largely Caribbean] competitors. They have begun an aggressive campaign to persuade the State Board of Regents to make it harder, if not impossible, for foreign schools to use New York hospitals as extensions of their own campuses.

has generated a great deal of reaction. UD will write in more detail about this after her Christmas lunch (with, among others, her niece, who’s an American-trained MD, and her niece’s husband, a Boston University medical student). Hold on.


**************************

Hokay. Yikes. Medical education, as UD feared, is an immensely complicated, immensely contested business. UD enters the business as in a first-level dream (Last night, she and her Cambridge family watched Inception.), so be patient with her…

It’s obviously incredibly important that medical education, above all other forms of education, be excellent; and the intensity, rigor, and duration of American medical education is reassuring. But:

1. There aren’t enough doctors, or rather there aren’t enough geographically dispersed primary care doctors.

2. The medical establishment, in the form of the AMA, remains a trade-restricting force, even though few doctors actually belong to the organization.

3. There are so few American medical schools producing so few doctors (and so few doctors among this group who want to go into primary care) that a thriving secondary educational establishment has emerged over the last few decades, mainly based in the Caribbean. Here, Americans unable to gain admission to domestic med schools get their first two years of coursework, and then enter American hospital programs for their second two years of clinical work.

4. As American medical schools slowly increase their number of slots (under pressure of an impending shortage which will in a couple of decades be far worse than the shortage we now have), and as new med schools open up here, there’s suddenly competition for hospital slots from the established Caribbean schools — and the for-profit Caribbean schools have an advantage in placements because, unlike the American non-profit schools, they pay the hospitals quite a lot to take their students. Plus their graduating classes tend to be much bigger than American graduating classes.

Details here. This is the most I can write for the moment. Off to lunch. Major snowfall here.

More later.

“[M]aking a copyrighted and owned drug-company textbook available to students [is] objectionable.”

Slowly, slowly, slowly, American and Canadian universities begin to react to the scandal of drug companies corrupting their institutions.

Stanford’s industry-compromised professors are today’s big news; but smaller, just as important stories – like this one from the University of Toronto – give UD just the tiniest bit of hope that in the struggle between pharma and ethical people, ethical people can win the occasional tussle.

A Toronto med student in a pain management course featuring a pharma-paid guest lecturer – who gave free copies of a pharma-written book to the students – reported this circumstance to two UT med school professors. The son of one of these professors died not long ago of an accidental OxyContin overdose, and the professor wasn’t happy to see that OxyContin’s manufacturer was essentially the author of the book.

In the book, notes another UT professor:

“[O]xycodone … is listed as a moderate-potency opioid, when I think everybody agrees it’s a very strong opioid, up to twice as strong as morphine.”

While it’s appropriate to prescribe oxycodone for severe acute pain or cancer pain …the book suggests that physicians can prescribe the drug for chronic non-cancer pain with relative safety for the patient.

… “When you prescribe to people with chronic non-cancer pain, it’s very difficult to do that safely,” he said, noting that the book pays little attention to issues of addiction and deaths from overdose.

“The book in several places makes reference to a claim that the rates of addiction if opioids are used for chronic non-cancer pain are very low. And they’re not nearly as low as is claimed in the book.”

In fact, a study by [this professor] and colleagues published last year showed prescription rates for opioids — including OxyContin, a long-acting form of oxycodone — soared in Ontario over the last two decades, as did the number of deaths linked to the narcotic.

What’s of greatest concern, of course, is how such information imparted to medical students as part of their curriculum will affect prescribing practices once they become doctors…

UT has announced that the course will be revamped, but who knows? An obvious huckster and his wares happened to get noticed by one student ; that student was enterprising enough to contact the right professors about it, etc. See how unusual it is for anyone to do anything about this? How risky? (Why isn’t the medical student named?) How much in denial the university remains? (The guy in charge of the pain program says there wasn’t any real conflict of interest.)

One of the UT professors who complained to the administration puts it very bluntly.

“It is in the interests of the drug company to have physicians prescribing as many opioid medications to as many patients as possible.”

Finally.


UW-Madison Professor Solves Mystery of How Sea Urchins Keep Their Teeth Sharp

UD will be on the road…

… for the next couple of days.

Going to Cambridge for Christmas.

Then she’ll be in Vermont over the new year.

Blogging continues, with interruptions.

“Yeshiva University had investments worth more than $100 million with Madoff but has not been sued.”

And why not? You’d think the reporter for the Jewish Chronicle would at least think to ask the question. Everyone else is getting clawback-sued, and they didn’t – like Yeshiva – have the Madoff/Merkin Partnership on their board of trustees.

Florida’s Own Diploma Mill Grad Lectures Floridians on Quality Education.

A Jacksonville reporter asks:

I wonder if any of the audience at the River Club who heard Lt. Gov.-elect Jennifer Carroll speak about education reform remembers the disclosure a few years back that Carroll had paid good money while in the Navy to get a master’s degree from an unaccredited diploma mill?

More commentary on the absence of an ethics code…

… at the American Economic Association. Also on lack of disclosure, conflict of interest – the stuff Stanford University’s You CAN Have It All! medical staff is dealing with at the moment.

The New York Times recently noted the AEA’s amoral ways.

You can argue that things like ethics codes don’t make no nevermind one way or the other; but somehow their absence, when every other professional organization has something along these lines, feels like a statement in itself.

Asked about this, UD‘s acquaintance James Galbraith (economist; brother of Peter) says:

You can’t have an ethical code unless ethical people design it. No sign of that sensibility at the AEA. I think what should happen is the formation of small societies with codes joined by subscription. Then people could distinguish between economists who avoid or disclose conflicts, and those who do not.

UD’s pal Dave…

… sends her the latest Ivy League drug bust news.

A 26-year-old Cornell senior, a woman, an English major, a witty writer in the campus newspaper, and someone who, if my Googling’s right, used to be a seriously competitive doubles skater, was arrested in a sketchy part of town with enormous amounts of uncut heroin. She’d apparently been selling out of her off-campus apartment for some time. Her mottled, miserable, and frightened mug shot suggests she’s been using for some time too.

Let me free associate in response to this story.

All streets in time are visited, writes Philip Larkin in Ambulances; and so it is with universities. All in time are visited by narcotics units, because everyone knows lots of narcotics are traded and used on and off American campuses. Tips are received, and here come the authorities. Too many students die in drug overdoses, and the school, or someone, decides to call in the police. UD has covered zillions of these, and related, stories.

Most tend to go unreported unless they feature Ivy League, or near-Ivy League schools, or if they involve, as San Diego State did a couple of years ago, the arrest of so many student dealers that extensive, weaponized, often fraternity-based, conspiracies were clearly in play.

The Cornell story will get more than its share of play because it’s part of a trend, because it happened at an Ivy League school, because it involves desperate icky heroin rather than giggly collegiate marijuana, and because it involves a woman.

Most of my free associating, to be frank, has to do with this woman. In her Facebook photos, she plays up her tough girl thing — cig hangs from her mouth, she flips the bird, she features a fuck-all quotation from Hunter Thompson… I dunno. A woman like this becomes addicted to heroin and, feeling it’s impossible to stop being addicted, throws herself down one of the gorges and becomes part of the Cornell suicide story…

I wonder too about her physicality, her having been a serious athlete. I’ve read a lot of stories about college athletes and drug addiction… My friend Courtney sent me this long essay by a climber who has years of serious drug addiction behind him.

The essay ends like this:

If you’re an outdoor athlete and you’re good at it, you’re probably like I once was: a selfish, self-involved son of a bitch. It’s always more, more, more and me, me, me, and I was no different. I wanted to be the best. I wanted to do the hardest sport routes, to be the boldest on high, killer walls.

Why? Why not? I was addicted to climbing, and then to starvation, and when that wasn’t enough, I became addicted to drugs.

Maybe you see some of my method in your own madness. And perhaps your obsessions are “healthy”: wheatgrass, long runs, body sculpting, rock climbing. That’s great. But I tell you now, absent your passions you will feel the sharp scrape of withdrawal — just like any fixless junkie bug-eyed in a January alley. Reality can be reduced, at its sparest, to chemical reactions, our body craving the release of GABA, oxytocins, endorphins, serotonin, dopamine. It doesn’t care about their provenance. It just doesn’t. Cut off the source—any source—and you will pay.

Freezing on my back deck…

… with my black alpaca thrown o’er meself, I’m watching it now, the lunar eclipse, with my mother’s clunky old binoculars.

How is it I awoke, without an alarm, at exactly 3:17? Exactly the moment one was told to wake up to see the thing in its prime?

And here’s this full gorgeous orange-shaded orb, surrounded by bright stars, and… a shooting star! As if the spectacle weren’t amazing enough, a shooting star just shot by the moon…

*********************************

I keep going out there to sneak a peak at its copperiness, getting cold, rushing back in…

There’s a thin lighter-orange line that curves along its edges — the faintest halo — and — it’s so celestial — I’m seeing the vast smudges on its surface as angel wings…

*********************************

Here’s the closest rendering I find in Google’s image stock.

**********************************

Update, 3:57.

Sing it, Billie.

You’ve changed.
You’re not the orange I recall.
The moon is now a different ball.
You’ve changed.

It’s silvering up again.

***********************************

No, no — now you’re gray, with an immense brightness along your crown, like a north pole, or like a sunrise.

***********************************

Now the moon’s down among the clouds and the trees, and it’s just as well. So cold out there.

Poem for a Boyfriend

Winter Labyrinth on the Night of a Lunar Eclipse

What Yeats called the labyrinth of another’s being
Has nothing in common with this mythic path’s release,
The pith-and-substance aftermath, the freeing –
Once you’ve circled the maze – into peace.

When she was seventeen she thought she was seeing,
In his twisty allure, a mystery-lover’s feast,
Enigma variations for beginners, a pebbled circuit of meaning…
Even now she loves him; but she’s come ’round, at least,

To the true geometry of her own heart’s weaving:
How the coiling and coiling then was her own bully-beast,
Wanting him to be the mechanism of her freeing.

Mysterious, how the love never ceased.

A remarkable valedictory…

… by Christiane Amanpour.

He was a very clever man, but in his work he also never lost sight of the moral dimension. He was not a moralist, not by a long shot; but he was a moral man, and he was genuinely committed to using American persuasion and power to lessen the cruelty in the world.

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