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Half-century climb in computer’s competence colloquially captured by Nobelist Michael Levitt

Half-century climb in computer's competence colloquially captured by Nobelist Michael Levitt

ancient computerOn October 9, the day Stanford macromolecule-modeling maven Michael Levitt, PhD, won his Nobel Prize, I wrote him a note of congratulations.

He wrote back six days later: “Thanks so much. It has been one wild ride! It will be good for the field, though, and I will learn to disappear and still have time for myself.” It’s a wonder he got back to me as soon as he did, crushed as he must feel by the cheering throngs dogging him at every turn since Nobel day. But he has made a point of replying quickly and gracefully to not only well-wishers but deadline-driven reporters.

Although his Nobel was for chemistry, the lab Levitt operates in is stocked with shelves full of ones and zeroes. His expertise lies in the field of computer science, a field of which Alfred Nobel had no inkling when he created the awards in his final will, written in 1895.

As we all know, Nobel made his millions in the explosives field. No explosion he could have imagined in 1895 has been more profound, in recent decades, than the explosion in computing power pithily encapsulated in Moore’s law. In the late 1960s, Levitt began constructing his increasingly detailed simulations of the giant biomolecules that animate our cells and, in a sense, our souls as well, by pumping punchcards into what was then among the world’s most potent computers (dubbed Golem in memory of a powerful, soulless giant of medieval Jewish folklore) at Israel’s Weizmann Institute.

Since those seminal days, the ones-and-zeroes game has picked up speed. Responding to an e-mailed query from science writer Lisa Krieger of the San Jose Mercury News, Levitt put it this way:

The computer that I used in 1968 allowed me 300 [kilobytes] of memory, or about 1/10,000th of the memory on a smart phone. [An extremely complex,  fifty-step computation] took 18 minutes on the Golem computer… for a cost of about five million 1965 U.S. dollars ($35 million today). The same calculation takes 0.18 seconds on an Apple MacMook PRO laptop costing $3,500. This means that the calculation is… 6,000 times faster on a computer costing… 10,000 times less.

If cars had changed in the same way, Levitt drolly noted, “a 1965 Cadillac that cost $6,000 in 1965 dollars ($40,000 today) would actually cost just four dollars. More amazingly, it would have a top speed of 600,000 miles an hour and be able to carry 50,000 people.”

Makes me wonder: Just how long will it be before we can no longer tell our computers from ourselves?

Previously: But is it news? How the Nobel Prize transformed noteworthy into newsworthy, Nobel winner Michael Levitt’s work animates biological processes, No average morning for Nobel winner Michael Levitt and Stanford’s Michael Levitt wins 2013 Nobel Prize in Chemistry
Photo by kalleboo

Health Policy, Medicine and Literature, Patient Care, Stanford News

Abraham Verghese on health-law battle: “We’ve worried so much about the process, not the patient”

Abraham Verghese on health-law battle: "We’ve worried so much about the process, not the patient”

In the ongoing political struggle over the implementation of the Affordable Care Act, a key component - the patient - remains under-discussed, argues Abraham Verghese, MD, a professor of medicine at Stanford. Verghese recently gave a talk at the University of Denver, and his thoughts on the new law, and his call for judicious use of medical tests and procedures, and attention to bedside manner, were among the topics of discussion. Barbara Ellis of the Denver Post reported in a blog piece earlier this week:

“We’ve worried so much about the process, not the patient,” Verghese said. “If the purpose of Obamacare is to help people get health insurance; if its purpose is to not punish people with pre-existing conditions; if its purpose is to promote quality health care … then what’s so bad about it?”

“Whatever Obamacare does, it will put a premium on not ordering medical tests willy-nilly,” he said. “It will force physicians to come up with a rational idea of what to do next.”

Verghese also talked about technology and how it can improve the quality of care, so long as physicians address the patient first. “A physical exam is a ritual. Someone is telling me their intimate details, allowing themselves to be touched,” he said, according to the Post. “That’s a ritual that’s important to patient care.”

Previously: Abraham Verghese’s Cutting for Stone: Two years as a New York Times best sellerA call for extended bedside-manner training and Can the use of devices among physicians lead to “distracted doctoring?”

Aging, Chronic Disease, Health Costs, Medicine and Literature

Examining end-of-life practices and Katy Butler’s “Knocking on Heaven’s Door”

How long is too long to hang on when the end of life calls? Abraham Verghese, MD, Stanford physician and best-selling author, discusses the emotional and financial costs of extended end-of-life care in a New York Times book review of Katy Butler’s “Knocking on Heaven’s Door.” In the book, Butler details the drawn-out descent of her father after a stroke and sheds light on the unseen hardships of caring for the slowly dying, both for families of the ill and hired home workers.

From the review:

Butler finds that the health care system — and society — seem quite unprepared for a patient like her father. Had he received a diagnosis of a terminal illness, the family would have been supported by a Medicare-funded hospice team.

“But there is no public ceremony to commemorate a stroke that blasts your brain utterly, and no common word to describe the ambiguous state of a wife who has lost her husband and become his nurse.”

The review compares the sometimes six-figure cost of an end-of-life ICU stay to a home health-care worker’s salary, which Butler describes as typically “immorally low.”

Verghese writes:

My hope is that this book might goad the public into pressuring their elected representatives to further transform health care from its present crisis-driven, reimbursement-driven model, to one that truly cares for the patient and the family.

Previously: A conversation guide for doctors to help facilitate discussions about end-of-life careHow a Stanford physician became a leading advocate for palliative care, Honoring an exploration of the “cost of dying”, Exploring the psychological trauma facing some caregivers and Is $618,616 too much to (try to) save a life?

Autism, In the News, Media, Medicine and Literature, Mental Health

The Reason I Jump: Insights on autism and communication

As I write this, I’m keenly aware that communication is one of the most common, and perhaps most difficult, things we do. That’s why I was both humbled and heartened when I read about Naoki Higashida’s book The Reason I Jump on Biographile today.

The book is described as a “stunningly clear-eyed look into the experiences of a boy with autism.” But, as explained in the review, many of the themes Higashida addresses in his book, “reveal truths about communication and connection that all humans should contemplate.”

In the Biographile interview, Higashida, who was 13 when he wrote the book, describes hard-to-grasp, prickly concepts such as communicating with compassion, and why good communication is hard work but worth the effort, with bell-like clarity. I cannot wait to get my hands on the book.

From the review:

Some people tend to assume that individuals with all kinds of disabilities have a less than mature understanding of language. But in many cases, even when speech and language production are impaired, understanding is not. Higashida explains to readers that baby talk is disheartening for him to hear as a young man. He encourages people not to talk down to people with autism, or anyone. “True compassion is about not bruising the other person’s self respect,” he writes, revealing not only an expert command of language but also wisdom beyond his years.

To share his experiences and his fiction with the world, and even to communicate basic needs to his family and caretakers, he painstakingly spells out the words on alphabet grids while others transcribe. He admits learning to communicate independently was hard work and at times, he felt “utterly beaten” by the process. But, Higashida reminds us, “to live my life as a human being, nothing is more important than being able to express myself […] it’s about getting across to other people what I need and what I need them to understand.”

Holly MacCormick is a writing intern in the medical school’s Office of Communication & Public Affairs. She is a graduate student in ecology and evolutionary biology at University of California-Santa Cruz.

Previously: More Stanford findings on the autistic brainA mother’s story on what she learned from her autistic sonUsing music to improve communication skills in children with neurodevelopmental disorders and Stanford study reveals why human voices are less rewarding for kids with autism

Medical Education, Medicine and Literature, Podcasts, Stanford News

Starting a new career in academic medicine? Here’s a bible for the bedside: The Academic Medicine Handbook

Starting a new career in academic medicine? Here's a bible for the bedside: The Academic Medicine Handbook

Roberts_book_coverWhen I spoke with Laura Roberts, MD, chair of psychiatry at Stanford, for a 1:2:1 podcast about the new book she edited, The Academic Medicine Handbook, I told her I thought every profession needs what she’s created, a hands-on guide on how to achieve success. Think about it. How much of our professional success is determined by skills we were never taught in college or grad school? In Chapter One, she writes, “…my sense is that nearly all early-career faculty members experience, as I did, an unsettling combination of feeling overly schooled and yet, still unprepared. Decades of formal education, as it turns out, are insufficient for some of the unexpected and labor-intensive everyday duties of the instructor/assistant professor…”

So here it is, a soup-to-nuts manual that gives academics in medicine a road map for how to excel.  It covers the basics, with chapters on how to manage time, how to give a lecture and how to prepare the best curriculum vitae. And it gets even more sophisticated, with how to evaluate an offer letter, how to understand flaws in clinical research and how to prepare an IRB application. The bottom line: If you’re a young professional just beginning a career in academic medicine, here’s a bible to have along your bedside.

Medicine and Literature, Science

Medical journalist talks about history of – and problem with – embargos

Having not come from a science background, I admit to not knowing much (okay, anything) about embargos before coming to work here. I quickly learned the drill, though: Scientific journals set a designated time/date in which the media can run stories on a particular study - in an effort (in the words of my wise colleague Krista Conger) “to give media professionals enough time to prepare a thoughtful, well-researched story about the research without giving any media outlet a competitive advantage over another.”

Things have changed in the decade-plus since I first learned about this system (some journals are now embargo-free), but embargos are still very much in use – and breaking them is serious business. So I took great interest in a recent Communication Breakdown Q&A on the topic with journalist/Embargo Watch founder Ivan Oransky, MD, who says he’s been “obsessed with embargos” for years. In the Q&A, Oransky provides more background on the embargo system and discusses why he’s in favor of changing it:

The Ingelfinger Rule, which I’m now convinced is the real problem with the embargo system, was a policy then-New England Journal of Medicine editor-in-chief Franz Ingelfinger came up with in 1969. He didn’t call it that at the time, and it has evolved since, but the basic idea was that some researchers were going straight to the media with their “breakthroughs,” bypassing peer review and causing a lot of confusion and false hope. So he decreed that NEJM wouldn’t consider any papers whose results had already been publicized, whether in the mass media or other journals.

It’s important to remember that history because the fact is that Ingelfinger had a legitimate concern, and came up with a reasonable way to address it. The problem in the time since then is that the Ingelfinger Rule has become a gag order. Scientists are deathly afraid of talking to reporters, because it might jeopardize their publication in a prestigious journal. That fear is actually out of proportion to policies at major journals. But until it changes, it makes it very difficult for journalists to tell the real stories of science – which focusing on the study of the week, as the Ingelfinger Rule, aided and abetted by embargoes, encourages…

Previously: Stanford scientist sets sail on new publishing model with launch of open-access, embargo-free journal and Count down to stem cell news in 3, 2, 1

Medicine and Literature, Technology

Social media advice from a physician-blogger

Social media advice from a physician-blogger

For those physicians thinking of dipping their tools in the blogging waters, these “top-ten nuggets of wisdom on social media” from Kentucky cardiologist-blogger John Mandrola, MD, may be of interest. As may this story, which serves as an important reminder of patient privacy issues:

Years ago, early on in my blogging career, I wrote a post about a patient who presented to the ER with third degree heart block. She was dying before our eyes. As most doctors can attest, emergencies bring out the best in American healthcare. The patient was transferred immediately to the electrophysiology lab where I implanted a permanent pacemaker. She went home the next day alive and well. The teamwork that led to a life being saved made me tingle with delight. Adding to the joy was the fact that emergencies mandate jettisoning BS. You have to act first and check boxes later.

That night I sat down at the computer and celebrated the joy of doctoring with words. Mindful of privacy issues, I changed a number of details of the case (time, age and gender, for instance).

Then came the comment. My heart sank. Despite changing many of the specifics, a commenter thanked me for saving their family member. Though all were happy with the outcome, my attempt to maintain privacy had failed. This lesson has stuck with me.

Previously: Advice for physicians when interacting with patients online, 33Charts’ Bryan Vartabedian talks about physician blogging, How can physicians manage their online persona? KevinMD offers guidance and Physician 2.0: Do doctors risk becoming irrelevant if they ignore social media?
Via @ktpark6

Clinical Trials, Medical Education, Medicine and Literature, Stanford News

Stanford offers free “Statistics in Medicine” course, starting June 11

Stanford offers free "Statistics in Medicine" course, starting June 11

Does eating red meat increase your risk of being in a traffic accident? Should you be worried about lead in lipstick? These and other provocative medical questions will be analyzed and discussed in the Stanford School of Medicine’s new online course “Statistics in Medicine.”

This nine-week massive open online course — or MOOC, for short — aims to provide students with a foundational understanding of probability and statistics, teaching them the skills required to critically evaluate statistics in medical studies. It also shows students how to analyze and avoid common statistical pitfalls with their own research data.

“Statistics in Medicine” will use real-world examples from medical literature and popular media to reinforce its lessons. The course instructor, Kristin Sainani, PhD, is a clinical assistant professor of health research and policy and is a recipient of several teaching awards from Stanford’s graduate program in epidemiology. Her first MOOC, “Writing in the Sciences,” has had almost 70,000 students register since it launched last fall.  The self-paced version of both of these courses can taken at any time, minus homework evaluations and teaching assistant support.

Previously: Free Stanford online course on child nutrition & cooking
Photo of Bayes’ theorem by MattBuck

Medicine and Literature, Science

Science writer Deborah Blum on blogging: “There were many smaller stories I wanted to tell”

I’ve been a fan of Pulitzer Prize-winning science writer Deborah Blum since a colleague gave me Blum’s book “Sex on the Brain” more than a decade ago. (Another reason to like Blum: She teaches journalism at my alma mater.) So I was interested to see a Q&A with her over on the Communication Breakdown blog today. There Blum discusses, among other things, her move from writing news stories to penning books, her propensity to delve into the history of science in her writing, and her decision to start blogging:

CB: You started the Elemental blog on Wired Science in 2010, while still continuing to write freelance news pieces and working on your books. Given all of the outlets that you had for your writing, why start a blog?

Blum: Really it was the reverse process of “The Monkey Wars.” There I wrote a newspaper series and realized that there was a much larger story I wanted to tell, that it justified a book. Here I wrote a book ["The Poisoners Handbook"] and realized there were many smaller stories I wanted to tell – poisons that I still wanted to write about, stories that I’d left out of my book. And I wanted to bring the subject forward – to connect the toxicology of the past with chemical exposures today. That’s really important to me.

Previously: Science writing that’s fun to read and Public Library of Science launches new blog network

Medicine and Literature, Stanford News

Sowing the seeds of change: Medical students pen book on leadership, action and social innovation

Sowing the seeds of change: Medical students pen book on leadership, action and social innovation

Back in 2002, Stanford medical student Jennifer Przybylo traveled from her home state of Illinois to Washington, DC to attend the Prudential Spirit of Community Awards, which honors middle- and high-school students for outstanding community service. During an ice-breaker session, she met West Virginia resident Nina Vasan, and the two became fast friends. They remained close through college and medical school, and this week the duo are releasing their first book, Do Well Good.

As Przybylo explains in the following Q&A, the book aims to sow the seeds of social responsibility by guiding “young adults through the process of effecting positive, sustainable change in their communities starting from square one.” Do Well Good helps readers understand their core values and personal strengths, identify causes matching their interests and skill set, and generate and refine potential solutions with a strong emphasis on “out-of-the-box” thinking. It also includes major tenets to consider when formulating and implementing an action plan and “how-to” chapters on everything from fundraising to establishing a 501(c)(3). Mixed in are anecdotes, humorous illustrations and case studies to keep things interesting.

Below Przybylo discusses what inspired her and Vasan, who starts her residency at Stanford in July, to author the book and how she hopes to advance the larger public movement toward greater social responsibility.

What was the catalyst for writing the book?

The seed was actually planted at the same ice-breaker session where we met. Discussion in our group had turned to the lack of what we felt was a good “how-to” manual for social change. All the existing resources were either too theory-based and not accessible to the average student or way too simplistic. There was a need for a book that combined theory and evidence-based practice with real experience, personal anecdotes and skill-building exercises. Nina and I took up this challenge in college, hoping to create a resource that would help students and young adults make lasting, sustainable changes in their communities. Along the way, we asked other students whose work we respected to join the effort and take the helm of a subset of chapters related to their specific areas of expertise. The end result is a cooperative effort built on the collective experiences (both successes and failures!) of many young leaders from founders of non-profits to social entrepreneurs and political activists. And because we wanted the book to be a fun read, we made sure to add a dash of humor and good spirit wherever possible!

How did your commitment to social responsibility take root and evolve over the years?

My first community service experiences were those sponsored by my grade school, the Academy of the Sacred Heart in Chicago. The school made a number of service opportunities available to us and encouraged us to complete a certain number of volunteer hours by graduation. These experiences made a strong impression on me at an early age. When I went through a particularly difficult time in high school, I found that I naturally gravitated toward volunteer work to help the homeless. It was a great comfort to know that I could help others, even if only in some small way. In college, I began to incorporate my longstanding interest in medicine into my activities, working to advance the efforts of Students for Organ Donation and serving as a peer health educator on campus. It was also during college that my co-author and I began work on this book. We felt that while our individual service experiences were personally fulfilling and a big part of who we were (and are!), we could make an even bigger impact by writing a book to help fill the void in the young adult literature on this topic. Seven years and several units of blood, sweat, and tears later, it’s our hope that Do Good Well will help those with an interest in social responsibility turn their good intentions into effective, lasting change in their communities.

I also don’t think it’s any coincidence that both my co-author and I are medical students. Medicine is a phenomenal career path for those interested in social responsibility. We both feel extremely lucky to be in a field that allows us to serve others on a daily basis, with ample opportunities for both patient and political advocacy. This is a particularly exciting time for medicine with many opportunities to work for changes that will lead to better care and ultimately healthier patients.

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