Protection money

I got a call today from WellsFargo’s fraud protection folks. Apparently someone in California has been trying to use my check card. This is impressive given the fact that the card has been in my wallet the whole time. Charges totaling about 30 bucks went through but larger charges of $200-400 were declined. In any case the lady on the phone was very helpful and aside from the inconvenience of not having access to my check card for a week or so while I wait for them to mail me a new one, everything should work out fine. However at the end of the call she asked if she could transfer me to another number for more information about how I could protect myself from identity theft. Sure, I thought, that sounds helpful. It turns out this helpful information is a third party selling identity theft protection. Presumably this company pays WellsFargo for these referrals. Now is this just an example of trying to make a buck while being helpful? A combination of customer service on their part and good targeted marketing by the third party? Or is it a predatory business practice, using an unfortunate event to prey on people’s fears and sell them something they don't need? The thing has the feel of “Hey, we just found this guy trying to break your window. Don’t worry, we stopped him this time, but you know it’s dangerous out there, you never know what could happen. Oh, did I mention I’ve got these friends that will keep an eye on your windows, you know, for a small fee?” Thoughts?

Pteryble diagnostic skillz

At surgery clinic today I saw a patient with something in her eye (incidental finding, she was there for an umbilical hernia evaluation). My internal monologue: "Ooh, look! It's a ptery-something! Pterygoid? No, those are in your skull. Pterydactyl? Nope can't be that, those are extinct. Pterygium! Yeah, that's what it is!" Nice to know that obscure medical knowledge is still down in there somewhere.

Texas lotto, statistics, and the principle of double effect

I've been thinking about the lottery a little bit today because one of our nurses received a lottery ticket from a friend and was asking us how to find out if she won. So given an important clinical question (a question asked in clinic is a clinical question, right?) I did a little research on the Texas lottery website. Per their site the odds of winning the jackpot are 1:25,827,165. However the numbers go from 1 to 54, so I calculate 54*53*52*51*50*49 = 1:18,595,558,800 almost 1000 fold worse odds. Mathematicians/lotto fans can you tell me what I'm doing wrong? Do I have some fundamental misunderstanding of how the lottery works? If their odds are correct, it seems like rational economics would tell you that you should buy a ticket anytime the pot is > $25 million. But that can't be right because a syndicate would form and buy the pot if it were that easy. What's going on here?

On another note, growing up I was taught that gambling was immoral. However, this has not prevented me from making some charitable contributions to a few select Indian tribes who just so happen to run gaming establishments. Which brings me to the principle of double effect. In medical ethics this most often comes up in the context of pain control and end of life care. It is considered morally permissible to give large doses of morphine with the intention of treating pain, even though there is the foreseeable double effect of hastening death through respiratory failure. Can a similar principle of double effect make gambling morally permissible? ie if I view playing the lottery as a voluntary tax to support Texas education but with the double effect of a small but non-zero chance of hitting the jackpot? Similarly, is gambling in an Indian casino morally superior to gambling in a commercial casino in Vegas because you expect to be benefiting a historically repressed minority? On the flip side, if you gamble with the expectation/intention of winning, is it better to do it in Vegas because you'd be taking money from a less vulnerable entity?

Mathematicians and ethicists, send me your thoughts! Need to make a decision by Saturday about whether to buy a ticket :)

Death panels

There's been a lot of talk/distortion about "death panels" and how the government is plotting to kill your grandmother. Here's a reality check and thoughtful discussion among some respected doctor friends (names removed because I lifted this exchange off Facebook without asking):

----------------
Counseling on End-of-Life Issues
Today at 3:44pm

Counseling on end-of-life issues is a good thing, an important thing. Do you want to be on a ventilator for two weeks to two months, possibly intermittently conscious, only to experience a tube down your throat, lines snaking in and out of your body, unable to speak to voice your pain or desires? Do you want someone pounding on your chest, probably breaking your ribs, only to bring you back from the edge of death, without knowing if they brought you back in time for your brain to have survived the process, in all likelihood becoming a vegetable who will eventually drain whatever's left of your family's financial resources? I know there's an inherent bias in the way I've presented these end-of-life issues, but at least it highlights the fact that it's a decision not to be taken lightly, to be seriously weighed, and certainly not ignored or to be fearful of. I know the way our society views death as something large and scary rather than just a natural part of life predisposes us to avoiding these issues altogether, but it's important, and part of why it makes sense for it to be part of any health care reform bill in our near or distant future.

Certainly not a death panel of any sort. That's just silly, an obscene, fantastical distortion of the truth. It's like saying that prenatal counseling was comprised of a panel of people who would decide if they were going to take your baby.

Updated 7 hours ago · Comment · Like / Unlike · Report Note

Commenter#1
Yes but- don't you think REQUIRING people to sit through this type of counseling is violating their basic rights? I mean- people aren't required to sit in on counseling regarding how serious a decision it is to have a baby, or whether or not they should have a baby, or the option of abortion. That's a very personal decision and one that people vary WIDELY on in terms of their views and values. And the end of life counseling is being proposed for people later on in years, middle aged, correct? But accidents that could lead to the emergency trauma actions you are describing above, or to a vegetable like state, could occur at any time of life. Why not make people go through this kind of counseling as soon as they are old enough to understand it- like 12 or 13? I just think this kind of counseling really seems like it is designed to encourage people to strongly consider ending their life once they get old or too expensive for the health care system.
6 hours ago

Commenter#1
Should we force parents of children with disabilities or diseases to go through counseling about ending their child's life? Seems like a similar thing to me.
6 hours ago

Commenter#2
It is not "violating" anyone's basic rights. It is putting people in control of their life so that if a time comes when they cannot make decisions we know what they would have wanted.
5 hours ago

Commenter#3
seriously, it's not violating their rights because odds are you will have to engage in this discussion at some point. it's far better that i take place in a placid environment that is not as emotionally distressing as an intensive care unit, and it's better to have it with a doctor you know, rather than someone who is meeting you and your family for the first time in a difficult setting. this is not a right to life issue as the people who are exploiting this as a talking point want others to believe.
4 hours ago

Commenter#4
Question. Would patients be required to have this counseling under one of the proposed plans or would it just be covered if they choose to have the counseling?
4 hours ago

Commenter#5
It only has to be offered. No obligation to attend. The VA has a similar requirement and many vets decline the discussion all the time.
3 hours ago

Commenter#6
Ending life is different than prolonging death.

If it were required for all hospital admissions, maybe even all PCP visits, I wouldn't be opposed. Making a family member decide whether to pull the plug on you or not is a horrible thing to put them through. More often than not they choose full code because who wants to live with the thought of killing off their parent? Then you're stuck with a patient slowly knocking off organ systems one by one over the course of a couple weeks, maxxing out on pressors...memorable way to go. Plus you have the family sleepless every night or sleeping in the ICU waiting room 'cuz they don't know when the patient's gonna finally succumb to death. Great experience for them.

That and the decision to not define preferred intensity of care costs more, and results in less patient's-family satisfaction

http://www.harvardscience.harvard.edu/medicine-health/articles/end-life-conversations-associated-with-lower-medical-expenses
2 hours ago

Commenter#7
Making it optional (and covered) seems fair. Practically, it would help a lot families make these difficult decisions ahead of time, especially with the future patient/family member's input. Given the likelihood that more will opt for ending life (compared to the current families-in-the-waiting-room situation described above), overall it will probably save more money for the families and the greater health care system.

Requiring people to go through this counseling however, may be stepping on some toes; some people simply don't want to make these decisions nor are they ready. This requirement piece is key, I think. I'm still not clear whether it's an issue here.

No doubt in certain places there have been some bizarre distortions about this issue. And that's unfortunate.
52 minutes ago

Texas music

Someone once asked me what “Texas music” was when I told them it was one of the genres I enjoy. I’m listening to some now on KHYI 95.3 via the internet while I work. It’s a broad, loosely defined genre encompassing country, alternative country, folk, bluegrass, singer/songwriter, etc. The “Texas” part comes from some combination of being produced in Texas (as opposed to Nashville), composed by musicians from Texas, and/or songs with Texas and Texas themes as the subject. Politically it can range from progressive (like Steve Earle) to reactionary (comic pseudo-earnest reactionary?) like this song I just heard with lyrics that cracked me up for their blatant embrace of stereotype:
“Guns and Religion/ Religion and Guns
I cling to ‘em both/ apoligizin’ to none
They both can save you/ when trouble comes
Guns and Religion/ Religion and Guns”

Norman Brinker

I was flipping through Time magazine today and saw that Norman Brinker passed away. I met Mr. Brinker when my high school swim team went to a retreat at a ropes course he had on some land outside of Dallas. He came out to say hi since he was also a swimmer and told us that even in his old age he swam a mile a day to stay in shape. That impressed me, along with the fact that he started Chili’s, the restaurant where I hung out with my youth group and other friends on innumerable occasions growing up (and most recently with friends on a ski trip in CA). Other restaurant concepts created by Mr. Brinker’s Dallas-based Brinker International include On the Border (I’d eat at the one in College Station when my parents came to visit me at A&M) and Maggiano’s (My sister and a friend from med school each had their rehearsal dinners there, and I celebrated a birthday there). Seattle doesn’t have a whole lot of chain restaurants compared to Dallas. But I guess part of the reason is that in Dallas many local restaurants ARE chain restaurants. And that doesn’t diminish the experience of spending time with friends over a good meal. Thanks for the present and future memories and rest in peace Mr. Brinker!

Addendum: I didn't realize this until adding the links for this post, but he was also instrumental in founding the Susan G. Komen foundation which funds breast cancer research and puts on events like Race for the Cure which I ran in memory of my grandmother.

Twitter experiment day 4

I joined Twitter a couple days ago (@aggiemudphud). I had heard that much of the value of Twitter related to the ability to connect and share ideas with people you don’t know. At least that was my goal since it seemed redundant and a waste of time to replicate my real world/Facebook network on another platform. Since I want them to serve different purposes I have not linked my twitter posts to my Facebook status updates.

[Aside] I still can’t bring myself to call them “tweets” although the terminology makes more sense now with the bird icon. To convey a similar idea, but with a more congruous link between the name of the service and the name of the posts I would call it “Chirpy” and “Chirps”. No, actually Chirpy is still dumb. I would call the service “Cricket” and the updates “Chirps”. Then you also incorporate the idea of swarms/mobs by using an insect as the underlying theme. [End aside]

I did not set up Twitter to work with my phone because I can’t fathom how it would be manageable unless you were only following a handful of close friends. And they can text you anyway. I mean, do some people really get the equivalent of their Facebook newsfeed showing up as constant stream of text messages? The interruptions would be incomprehensible! But maybe I don’t fully understand how this works. I think the mobile aspect would be pretty useful once I get an iPhone as long as it doesn’t alert me to each incoming message. Right now I just use it from the website or via TwitterGadget on my iGoogle homepage.

In any case, I’ve been trying to read up on Twitter ettiqutte and how people use it. As a passive information aggregator it seems to overlap with how RSS readers work (although I haven’t actually used RSS feeds). It has an adaptable architecture that lets it mold to a variety of uses, but I’m not sure how well it can adapt to multiple simultaneous uses. To build a following you would probably need to pick one primary identity such as "I’m going to post on science/medicine" vs. "I’m going to post about current events, design, medicine, economics and gardening. And also what I had for breakfast." I’m sure you could cultivate a network of people around a shared interest in say, alternative energy +/- community gardening, but would those same folks stick around if you start throwing out a lot of posts about clinical studies or gene mutations or your opinions on religion and economics? I’m not sure. For now I’m just going to post about whatever is interesting to me and see what happens, but in the future it seems like you will need a way to cultivate separate networks. Facebook seems to be moving in this direction by letting you group people in lists.

It’s not immediately obvious how you build up networks of people you don’t know, grouped around common interests. So far I’m just using the search function on the Twitter homepage. I’ve found a venture capital guy to follow based on looking up people that posted on the same topic as me (a research OpEd), and a med student in Hungary with an interest in applying web2.0 technologies to healthcare. Also added some NY Times columnists I read and Angela Hunt, the Dallas City Council member who represents the area near UTSW.

Other stuff I looked up after seeing them in posts: hashtags (#keyword) are a way to tag a keyword in a post. RT means ReTweet. Kind of like an email forward. I also didn't understand what TinyURL were for until I tried to add links within a 140 character message. The other thing I’ve glanced at are trends on the search page. After seeing goodnight trend on the search page around bedtime for a couple nights in a row, I clicked on it and felt a strangely moving sense of community. You imagine this sea of people across the country laying down and turning off the light. Like the end of the Waltons- "Goodnight John Boy", etc.:

goodnight my fellow tweeps :)

Goodnight, Twitterland and all who inhabit it.

OK, I'm putting the laptop away and I'm going to sleep. I will still have the BB handy in case I need to emergency tweet. Goodnight tweeps

And with that I'm off to bed. Goodnight internets!! Sleep well. :)

Goodnight everyone. Look forward to talking to you all tomorrow.

OK time for bed, goodnight Tweeps!

goodnight twitterverse.

Goodnight beautiful tweeple!

I think Twitter is going to be good because whenever I try to blog like this, it always ends up being really long and taking a couple hours to edit my thoughts into something (somewhat) readable. Twitter is more stream of conciousness. Alright, in the words of my new tweeps:

@everyone who read this far: RT “Goodnight beautiful tweeple!”