Listening to NPR’s Wait Wait, Don’t Tell Me last night, I heard a trivia news fact about the CDC that really bugged me.

Last month, the CDC came out with its latest Behavioral Risk Factor Surveillance System (it’s the nation’s largest telephone survey to try to get some statistics on overall health). Fine, right? Only the big spin-doctoring machine came out in full force, “adjusting” the list of exercise activities to include several that, I’m afraid to realistically report, *aren’t* exercise. The CDC is supposed to be the nation’s public health squad. They research, they report; they don’t fudge data or alter methods to get better results. But in this case, they did. (Were they doing to get in trouble if they didn’t try to show some sort of improvement?) Secretary of Health and Human Services Tommy Thompson said that Americans should realize that “small steps toward a more physically active life yield significant health benefits.”

What’s the big deal, you might ask? Relax, Graham. But hold on. Wait, wait–let me tell you. Here’s a small sample of the list of newly added “light activities” (the last two being my personal favorites):

* coloring
* sitting in a whirlpool bath
* playing video games
* light office work
* making photocopies
* fishing (yes, while sitting in the boat)
* floating in water
* “purposeless wandering”

So where’s it end? Yesterday, I studied for 8 hours for finals tomorrow, I blinked a lot, washed my hands, spoke to friends–do those count? I also drank a lot of water, and ate a couple meals; techincally, my mandible-grinding and esophogeal peristalsis (food being pushed down your food tube) require energy. They exercise, too?

Oh, and what’s worse (ready for it?): even with those flimsy definitions of exercise, 55% of Americans still aren’t getting enough of their daily dose.

I generally rely on the CDC for accurate, objective information ( well, most of the time ). If it starts to cater to spin doctoring, does this make some sort of precedent? I mean, technically, you could say no Americans have “died” in Iraq; rather, their biological functions ceased to continue. Works for me.

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One of the worst things about taking a year (or years) off before med school is that you forget how you study, how you memorize, and how you quiz yourself. It took me a good three weeks before I could confidently remember how I organzed my life academic. Spirals or binders? Loose-leaf or bound? College-ruled or wide ? Pressing, dire questions for sure.

But really, until you remember how you organize and categorize all your knowledge, it’s tough to get much accomplished. If you’re a visual learner and you try to process info audially, you won’t get far. I generally have to write everything out, even if it’s in my illegible Graham-scratch, if only because it locks it in my head better. And then after that, I have to pace back and forth, and talk through everything aloud. Yeah, it’s strange, but I’ve done a lot weirder things (cutting my own hair on a whim at three in the morning, drawing on my toes, playing video games for 13 hours straight), so I’m not too concerned.

It gets really bad sometimes with mneumonics. Sometimes it’s more work to actually remember the whole scheme you’ve put together to remember something like the pronator quadratus (mine started with something complex, like “Pretend you’re a Republican, so your thumb will turn _down_ at Nader). Or what’s worse is when you come up with some synonym and then tell yourself, “Okay, just remember it’s the _opposite_ of that.”

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FDR’s polio is probably the best known, but Eisenhower had Crohn’s , 5 infarcts, and a stroke. Embalmers couldn’t get a needle into FDR’s veins. Bush Sr. vomited on the Japanese Prime Minister. For more, check out the Medical History of American Presidents . Lists all of them, a substantial number of researched illnesses and maladies, and even histories by organ system (judging from the list, I think our presidents have run the gamut, from balding to bladder cancer).

The president always has a lot of power to influence public opinion and behavior, and I don’t think it’s any different in the health arena. I remember there being some buzz about Bush Sr. not liking broccoli and the effect on the broccoli market; I’m sure people are reminded to get their routine physicals done because the president’s is mentioned on the news. As the site mentions, Betty Ford’s breast cancer and alcoholism were both wake-up calls to the public –telling people that yes, these diseases happen to real people, and cut across the classes and society. If more people knew about the history of presidential psychiatry they’d be more likely to seek counseling themselves, or at least lose some of their mental health stigma. (via Metafilter )

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I haven’t posted in, damn, almost a week. And that can very well mean one of two things: I either a) have nothing to say or b) have finals on Tuesday. After a 2-hour review session and 6-hour study session today, my brain kind of gave up. (As a dorky side-note, my brain is starting to take on a Frank-Starling mechanism , whereby the more information I feed it, the more it gobbles up. This is a Good Thing.) I’ve had a bunch of thoughts over the past week, but kept’em in my head. Time to extract:

* We dissected the forearm on Thursday, and the more I think about it, the less human I feel, and the more… mechanical? Robotic? Manufactured? I feel. Part of the mystery–and majesty–of myself kind of ended when I accidentally pulled at the Flexor Pollicis Longus (it moves your thumb toward your palm) and the thumb moved. It was a completely human movement–the gesture of the thumb–without the human behind it. And now, when I stare at my thumb, it no longer seems to be so attached to my self ; now it’s just a bone and muscle that move in a certain direction when a cord is pulled. I’m a puppet. We’re all puppets. Self-controlled, but still. Calcified sticks connected to organic strings. Hell, tendons don’t even look organic. They shimmer and tear just like the white plastic twine used to tie up packages and furniture at Ikea.

* The more I learn in molecular biology, the more I discern in histo, the less my notions of God seem to come into play. Every mystery is explained away as evolutionary advantage; every organ, vessel, anastomosis , and molecule
is primed for efficiency and survival in a prehistoric world. Everything is a means to an end. Everything is predictable and statistical and understandable. Nothing is left to chance or enigma. I’d be curious to see how many scientists are agnostics or atheists–the pressure to trust in Science completely must be enormous. But as my friend Hugh (wise old soul) noted, there’s still room for spirituality. Just because we _can_ explain things through science, doesn’t mean Science is the End All. Not that religion was ever a big thing for me, but, I guess it was bigger than I realized it to be. Another item to add to the “took for granted” list.

* You can’t get very far in medical school without friends. I tried it. It didn’t work. Studying alone can only get you so far (namely, exhausted and cranky). But when I study with my classmates, it’s a whole different story. I spent 3 hours in the anatomy lab thinking only one had past. We’re stress-relievers for each other, emotional supporters, socializers, partiers, diners, entertainers, teachers–you name the role, someone in the class probably fills it for me or someone else. And it doesn’t take much, either, which is nice, since we’re fairly busy. I was feeling a little down earlier this week, and all it took was a “Graham, how have you been?” from a friend to cheer me up. Reminded me that we’re all in the boat together.

* I’m seriously frightened that my pasty, bare chest may be coming to a San Jose Business Journal in your area. My good friend Ben was interviewed about our new curriculum, and the paper wanted some pictures of Ben in some sort of doctorly pose. And, thinking the wise editors, “What better place to do it than the doctoring class where we learn how to palpate and use our stethoscopes!” I was paired up with good-friend good-pal Ben, and the photographer took a nice 15 or so shots of Ben stethoscoping me, my Steve Buscemi-like musculature up close. (My only hope is that my lack of color somehow reflected the flash and caused all the shots to be overexposed, rendering them useless.) Otherwise, let me please, *please* apologize in advance. No. Really.

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Maybe it’s just my healthy number of neuroses, but it seems like I’m constantly keeping my body’s routines at the back of my mind lately. It’s some sort of over-compensation for my 23 years of ignoring them. Or at least, not appreciating them. There’s a little cartographer that now maps out my body’s reactions. I jump on the treadmill, and it reminds me that my muscle fibers are twitching, that my mitochondria are cranking up their speed, and that my glucose stores are being dumped into my bloodstream. I go for a swim, get out, and wonder if I’m going to pass out from the vasodilation and gravity shift. I wake up thirsty and think of the signals that set it in motion. I get my butt pinched at a club, and I try to recall which nerve is sending the action potential (L5?). I used to annoy the hell out of my friends by talking about alcohol dehydrogenase when we’d drink, but this is a couple steps more ridiculous.

I imagine this could be beneficial, in some sort of bio-feedback or visualization sense. I visualize my adipocytes (fat cells) hearing the call of glucagon and emptying themselves from my body. Or I do some weightlifting, and see my muscles sucking up the protein I give it post-workout. Okay, okay, I’m skeptical too, but it can’t hurt, right? Might as well put some sort of positive use to all this knowledge that I’m gaining that I can’t yet apply, right?

And no, I’m not about to see how much longer my bladder’s transitional epithelium can last with the power of the mind. I’d prefer not to make a puddle.

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From the third of the Molecular Bio Professor Triumvirate, Mark Krasnow :

A patient comes in to see his doctor, and presents with a frog coming out of his forehead. He sits down and, astonished, the doctor asks, “How’d that happen?” The guy shrugs and says, “I don’t know doc, but it all started with a wart on my ass!”

Moral of the story: don’t assume anything about patients or their problems, you can’t always look at problems from one perspective, and, uh, get those warts checked out by a dermatologist.

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Nobody Likes My Educational Background!

(Neutrophils, Lymphocytes, Monocytes, Eosinophils, Basophils)

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It’s only been three weeks, and I feel like I’m only biding my time until I get cancer. (And I haven’t even _touched_ Pathology yet). It’s probably the beginnings of my med student syndrome , but it’s occurring slightly different than I had thought.

Clearly I’m aware of the percentages of people who are affected with Chronic myelogenous leukemia or a lung carcinoma, but we talk about the causes so much that I’m amazed that it doesn’t happen to all of us. We’re fortunate that our bodies have developed tumor suppressor genes , and it’s probably a sign of how common tumors are in the body, but I think the average person would be surprised at how seemingly common DNA errors are (but usually repaired by a repair enzyme).

If it’s not sunlight that causes thymine dimers, it’s a chromosomal cross linkage in a stem cell, or some bacteria or virus that gets into our system and poisons us from the inside out. Or inserts its DNA into *our* DNA. Or this. Or that. There’s so many ways that we can go, and I know I’ve probably only learned about .01% of them. I’m beginning to think we’re all just biding our time until something gets us, and we all just take a certain number of calculated risks to try to maximize the “Living” part of life, while avoiding the “Death” part of life at the same time.

But we’re not completely negative in molecular biology; if it weren’t for the heaps of bacteria, we wouldn’t have the antibiotics and treatments we have today. According to Pat Brown , *human* Weapons of Mass Destruction are pretty weak and trivial compared to the bacterial arsenal. It’s a “kill or be killed” all out battlefield in the bacterial universe, fighting cell-to-cell for limited resources. And when you think about it, half of what doctors do is basically targeted killing. In oncology (cancer), you try to selective kill the cancer cells while leaving the others. Antibiotics get rid of bacteria that are making us sick; even the “fluids and rest” regimen is done in hopes of helping the body’s own natural killer cells . (In a similar vein, my other professor Gil Chu thinks we’re all just gigantic, walking universes for bacteria to sit on. Which then begs the question, is the Earth just a marble in some Higher Being’s pocket?)

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Okay, okay, so web design guru Jeffrey Zeldman commented about this terrible Flash intro for Histology-World! , and well, yeah, it’s pretty bad. But really, can you fault the designer for trying dancing text and crappy electronica music to make histo that much more interesting? Granted, it reminded me that I need to study, but still, picking apart fascia and connective tissue beats microscopically differentiating between developing granulocytes anyday. (How’s _that_ for technical jargon?)

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Unbeknownst to me, my name somehow came up as the “Stanford Medical Student Association First-Year Rep” due to several members of my class. A couple hours and a rousing 30-second speech later (announcing my past experience as “high school secretary” and “vice president of my dorm”), I was running for the position and was somehow elected.

It was just the opportunity my classmates were waiting for; immediately requests came in from virtually nowhere. “New ping-pong paddles!” “A Playstation 2 for the student lounge!” “The new curriculum is messed up!” “I was overcharged on my student account!”

I’ve now collected my class’s concerns (from the financial to the funny), and I’m ready to throw my political weight around the ring. There are definitely issues that need to be addressed, or at least voiced–some of the new curriculum is better than the old, with more clinical correlations and early clinical exposure. But other parts definitely need work. To the administration’s credit, some of the changes have been made quickly: our Histology class was an absolute mess the first week, but the confusion’s been cleared up, and we’re back on track. We’ve got a class called “Practice of Medicine” that’s pretty hit-or-miss at this point; it’s seemingly a lump of classes that don’t fit anywhere else, but are generally important, things like nutrition, cultural competency, computer skills, quantitative analysis and biostatistics. Each “thread” as they’re calling it is taught by a different instructor, and we’re all fairly confused about where to go, what to read, and who to contact. As first years in a small class (86 of us), we of course follow the “herding cattle” style of decision making: one person, who appears to know the way to the next class, leads, and the rest follow. Same applies for information about classes. When one person gets some snippet of information about a class, test, or quiz, it’s instantly disseminated (with 25% accuracy) to the rest of the class. It’s seriously an adult version of the “Telephone” game. If there are any social scientists or personal networks academics out there, we’re worth a dissertation or two; we’ve got Friendster beat anyday.

If there’s one thing I can applaud Stanford for, it’s our class’s diversity. Diversity was a big buzzword at my alma mater , but I don’t think I really ever understood the concept or appreciated it until I came here to California. In our class we’ve got a little bit of everything–and I think it really reflects California itself. I was in Wal-Mart the other day and heard a little girl switching between English and Spanish like the two were the same language; at Ikea I heard more non-English than I heard English, and on the bus I took yesterday, I was the only white guy. Coming from Chicago it’s different. And coming from Kansas , it’s a whole other world here.

Our class is fairly unified as far as I can tell; we haven’t cliqued off yet, everyone’s invited to parties and get-togethers, and we all have a merry old time. Everyone’s very mellow and relaxed, which is just what I need to help keep the overly-anal side of me at bay. You can be as social or as anti-social as you want, and nobody bats an eye.

And on that note, I should probably get off this computer and either go a) socialize or b) study.

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