First they came for the photo printer.
Then they came for the ink jet.
Now they’ve come for the rest.
Amazon return package label printing now includes ‘email to a friend’ and ‘request label by mail'
Yes, mail. Handled by people.
End an era, yes, but which era?
Thirty years back — when we all had dot matrix printers?
One hundred and fifty years back, when typewriters became common?
Or do we go back to when paper became common in homes ...
Bruce Springsteen and the E Street Band was the apex of my popular music connection. In a weird adventure of late childhood I attended Winterland's (San Francisco) last-but-one performance — featuring Springsteen.
These days my kids control the radio. So I hear a lot of country-pop and pop-pop. I assumed that music was made more or less the same way that Bruce did his work 30 years ago.
I couldn’t be more wrong. This month’s Atlantic Magazine included a short article that was the most surprising thing I’ve read in years [emphases mine]. It’s a review of John Seabrook’s book ‘The Song Machine’...
The biggest pop star in America today is a man named Karl Martin Sandberg. The lead singer of an obscure ’80s glam-metal band, Sandberg grew up in a remote suburb of Stockholm and is now 44. Sandberg is the George Lucas, the LeBron James, the Serena Williams of American pop. He is responsible for more hits than Phil Spector, Michael Jackson, or the Beatles.
After Sandberg come the bald Norwegians, Mikkel Eriksen and Tor Hermansen, 43 and 44; Lukasz Gottwald, 42, a Sandberg protégé and collaborator who spent a decade languishing in Saturday Night Live’s house band; and another Sandberg collaborator named Esther Dean, 33, a former nurse’s aide from Oklahoma who was discovered in the audience of a Gap Band concert, singing along to “Oops Upside Your Head.” They use pseudonyms professionally, but most Americans wouldn’t recognize those, either: Max Martin, Stargate, Dr. Luke, and Ester Dean.
Most Americans will recognize their songs, however. As I write this, at the height of summer, the No. 1 position on the Billboard pop chart is occupied by a Max Martin creation, “Bad Blood” (performed by Taylor Swift featuring Kendrick Lamar). No. 3, “Hey Mama” (David Guetta featuring Nicki Minaj), is an Ester Dean production; No. 5, “Worth It” (Fifth Harmony featuring Kid Ink), was written by Stargate; No. 7, “Can’t Feel My Face” (The Weeknd), is Martin again; No. 16, “The Night Is Still Young” (Minaj), is Dr. Luke and Ester Dean….
… The illusion of creative control is maintained by the fig leaf of a songwriting credit. The performer’s name will often appear in the list of songwriters, even if his or her contribution is negligible. (There’s a saying for this in the music industry: “Change a word, get a third.”) But almost no pop celebrities write their own hits. Too much is on the line for that, and being a global celebrity is a full-time job. It would be like Will Smith writing the next Independence Day.
… We have come to expect this type of consolidation from our banking, oil-and-gas, and health-care industries. But the same practices they rely on—ruthless digitization, outsourcing, focus-group brand testing, brute-force marketing—have been applied with tremendous success in pop, creating such profitable multinationals as Rihanna, Katy Perry, and Taylor Swift...
.... “It’s not enough to have one hook anymore,” Jay Brown, a co-founder of Jay Z’s Roc Nation label, tells Seabrook. “You’ve got to have a hook in the intro, a hook in the pre, a hook in the chorus, and a hook in the bridge, too.”
Sonically, the template has remained remarkably consistent since the Backstreet Boys, whose sound was created by Max Martin and his mentor, Denniz PoP, at PoP’s Cheiron Studios, in Stockholm. It was at Cheiron in the late ’90s that they developed the modern hit formula, … Seabrook describes the pop sound this way: “ABBA’s pop chords and textures, Denniz PoP’s song structure and dynamics, ’80s arena rock’s big choruses, and early ’90s American R&B grooves.” ... music is manufactured to fill not headphones and home stereo systems but malls and football stadiums. … Session musicians have gone extinct, and studio mixing boards remain only as retro, semi-ironic furniture.
The songs are written industrially as well, often by committee and in bulk. Anything short of a likely hit is discarded. The constant iteration of tracks, all produced by the same formula, can result in accidental imitation—or, depending on the jury, purposeful replication….
… Hits are shopped like scripts in Hollywood, first to the A-list, then to the B-list, then to the aspirants. “. The most-successful songwriters, like Max Martin and Dr. Luke, occasionally employ a potentially more lucrative tactic: They prospect for unknowns whom they can turn into stars. This allows them to exert greater control over the recording of the songs and to take a bigger cut of royalties by securing production rights that a more established performer would not sign away...
… K-pop, a phenomenon that gives new meaning to the term song machine. Lee codified Pearlman’s tactics in a step-by-step manual that guides the creation of Asian pop groups, dictating “when to import foreign composers, producers, and choreographers; what chord progressions to use in particular countries; the precise color of eye shadow a performer should wear in different Asian regions, as well as the hand gestures he or she should make.”
In K-pop there is no pretension to creative independence. Performers unabashedly embrace the corporate strategy that stars in the United States are at great pains to disguise. Recruits are trained in label-run pop academies for as long as seven years before debuting in a new girl or boy group—though only one in 10 trainees makes it that far...
Of course it’s hardly surprising that pop songs have evolved to match the most common interests of the biggest audience. What fascinates here is the fusion of the modern corporate model with the peculiar talents of three Scandinavians and one American, and the purity of “star power” required of the modern pop performer.
I wonder when the nsAIs (non-sentient AIs) will displace those Scandinavians. Apple is famously vertical and AI-pop is the obvious next step after K-pop.
I’d love to read a Madonna essay on the topic, she seems now a bridge between the old world of Springsteen and the new world of Katy Perry.
If you want to take a mildly demented barely ambulatory nonagenarian out of his nursing home bed for a six hour flight to San Francisco you may be insane or murderous. Or perhaps your 93 yo WW II vet is in better shape than mine.
Or maybe you’re prepared.
I did this. Actually, my brother and I did this together, except for the plane flights where I went solo with Dad. We did it because my 93yo father had one request left in his life — to see his younger sister in San Francisco. And, thanks to an accident of Quebec’s healthcare and his disabled vet status, he had money to pay for the trip.
Of course when I agreed to fulfill his wish he was 3 months younger than when we actually went — and significantly stronger. Old old age is like that.
Stil, we went. And because my brother joined us in San Francisco it went pretty well. Luck helped — we had perfect flights and transportation.
I don’t know anyone else who has done this, but I’m sure hundreds have. Somebody gets those old vets out for Normandy ceremonies. On the other hand, I suspect those guys are in better shape than Dad (some of ‘em probably run foot races and jump hurdles).
If you want to do something like this, and before I dump all my trip memories (we aren’t doing this again), here’s what I learned:
There’s more but that’s enough for now — and probably the most I can remember since most of the traumatic memories are already fading. The good memories, because this trip actually, amazingly, worked, are getting stronger.
It could have gone quite badly though. This isn’t for the faint of heart.
Donald Trump as the voice of the non-college 50%. TNC on the mass (black) incarceration society - and reparations. Hundreds of colleges produce no earnings boost (but lots of debt).
There is a common thread. America needs 40 million non-college jobs that pay $30 an hour.
That is our 21st century “Manhattan project” class challenge.
Get creative.
I knew Google Trends was “a thing”, but it had fallen off my radar. Until I wondered if Craigslist was going the way of Rich Text Format. That’s when I started playing with the 10 year trend lines.
I began with Craigslist and Wikipedia...
Some of these findings line up with my own expectations, but there were quite a few surprises. It’s illuminating to compare Excel to Google Sheets. The Downs Syndrome collapse is a marker for a dramatic social change — the world’s biggest eugenics program — that has gotten very little public comment. I didn’t think interest in AI would be in decline, and the Facebook/Twitter curves are quite surprising.
Suddenly I feel like Hari Seldon.
I’ll be back ...
See also:
My 2010 RockShox Monarch RT3 rear shock is on its deathbed. It needs a rebuild or replacement (much more expensive), but it’s hard to know if parts are available. It’s easy to find parts for the 2012 model — but are they compatible?
The net was little help — until now. Buried in a footnote in the 2012 Rockshox spare parts manual: "2011-2012 Monarch parts are not compatible with pre-2011 Monarch rear shocks."
When Emily saw repeated comments online about a tick bite causing allergies to red meat we first assumed it was a mass medical delusion.
Turns out the belief comes from a Vanderbilt University allergy researchers claims and a 2009 WaPo article.
… Scott Commins, an assistant professor of medicine and lead author of the U-Va. study published in the Journal of Allergy and Clinical Immunology, said that in susceptible people such as Newell, a tick bite that causes a significant skin reaction seems to trigger the production of an antibody that binds to a sugar present on meat called alpha-galactosidase, also known as alpha-gal. When a person who has the antibody eats meat, it triggers the release of histamine, which causes the allergic symptoms: hives, itching and, in the worst case, anaphylaxis.
But many questions remain unanswered, said Platts-Mills, whose research is continuing. His lab has collected data on more than 300 patients from across the country and abroad.
"We're sure ticks can do this," he said. "We're not sure they're the only cause." Nor do researchers know why anaphylaxis is so delayed or why only some people develop a problem after tick bites. They do know that the allergic reaction is dose-related: Eating a tiny amount of meat probably won't cause a serious reaction. A large steak will….
The University of Virginia’s Thomas Platts-Mills is pushing the tick theory — though a recent abstract (article is $40) equivocates (emphasis mine) ...
The alpha-gal story: Lessons learned from connecting the dots
Our recent work has identified a novel IgE antibody response to a mammalian oligosaccharide epitope, galactose-alpha-1,3-galactose (alpha-gal). IgE to alpha-gal has been associated with 2 distinct forms of anaphylaxis: (1) immediate-onset anaphylaxis during first exposure to intravenous cetuximab and (2) delayed-onset anaphylaxis 3 to 6 hours after ingestion of mammalian food products (eg, beef and pork). Results of our studies and those of others strongly suggest that tick bites are a cause, if not the only significant cause, of IgE antibody responses to alpha-gal in the southern, eastern, and central United States; Europe; Australia; and parts of Asia.
So the belief that a tick bite is causing a meat allergy has a basis in at least newspaper reporting and at least one team’s publications.
From my literature search it’s not clear anyone but Plats-Mills and his collaborators are making the strong connection to tick bites, much less to the Lone Star tick. I’d file this one under “suspect”. Of course that means that if Plats-Mills is right about the tick connection he will be well rewarded.
I’d bet he isn’t.
One of the interesting things about being old (45+, sorry to tell you that) and active and is that we develop conditions that we then get to read about.
That's typical. But if you're old and active and a physician there’s a twist. You get to compare the medical textbooks (and web references to your personal experience, and because of the old-part this reading is further informed by a finely tuned bullshit detector.
The bullshit detector is first developed in medical school. No, it’s not when we learn that following the exam preparation advice of professors is suicide — that’s the betrayal and pit-of-knives detector. For me it was the illuminating moment when I realized my 1986 renal physiology professors really had no idea how the kidney really worked. In their hearts they knew this, but there were exams to write and textbooks to teach to — so they faked it.
Later we run into seemingly erudite residents and medical students who we sooner or later realize are just spinning during medical rounds. Attendings varied in their response, I think some were hapless while others found it amusing. Or not amusing.
Much later, sometime after the first few years of practice, we realize that most journal articles are rather like those residents. (More recently reproducibility studies have made this rather more apparent.) We begin to spot the handwaving in textbooks — and to treasure the few that are relatively honest about ignorance.
Which brings me to my the pain below my left patella (knee cap). It could be related to the patellar tendon, to the “fluid-filled sacs” (bursa) that are usually said to be [1] under and around various tendons and neighboring bones, or the knee joint (cartilage/arthritis).
The cause is important to treatment. There’s nothing much to do for arthritis except rest and general muscle strengthening. Patellar tendonosis is treated with knee extension exercise starting at 90 degrees, but something (I’ll get to that) called “patellar-femoral syndrome” is treated with knee extension exercise starting close to full extension. So it’s good to differentiate those two.
The differentiation turns out to be relatively simple. If pain hurts coming down stairs (down > up) it’s likely “patella-femoral syndrome”; you won’t be able to do resisted extension at 90 degrees of flexion but you’ll be fine doing it at at 10 degrees of flexion. Also, “patello-femoral syndrome” is much more common than patellar tendonpathy. A related characteristic is that discomfort is maximal between 15 and 35 degrees (stair descent) — so I have no discomfort extended or in a deep squat.
The medical knowledge/bullshit detector bit comes with reading about "patello-femoral syndrome”. As far back as 1990 one of our texts, “Practical Orthopedics” by Lonnie Mercier, refreshingly admitted that this might as well be called something like “sore knee syndrome”. It’s probably a bunch of things involving some degree of irritation of the bursae and tendons (patellar, iliotibial) beneath and below the patella along the course of the patellar tendon. We used to think it had something to do with the cartilage below the patella, but as far back as 1990 Mercier’s text suggested that “chondromalacia patellae" was relatively infrequent, not clearly related to symptoms, and ought to be carved out as a separate diagnosis.
Reviewing a 2007 AAFP article it looks like nothing fundamental has changed [2]. So points to Mercier.
I wasn’t able to find a persuasive evidence-based treatment program for “sore knee syndrome”; I liked Dr Lee Cohen’s PDF for its guide to resuming exercise [3]. Basically I’m avoiding what hurts (flexing knee on stair descent), doing what doesn’t hurt (high rep, low pressure cycling and swimming), doing near-full-extension quad cybex-style weight. I'll increase extension range as the knee improves, and I’ll try some of Dr. Cohen’s routines. I don’t like NSAIDs because of repeated studies showing they delay tendon healing, so not doing those.
Once I can do squats with 50 lbs or so (very light) and run a mile or so without discomfort I’ll go back to CrossFit...
- fn -
[1] human anatomy is more variable than the diagrams suggests
[2] I don’t particularly recommend that article btw. It reminded me a bit of 1986 renal physiology.
[3] Low intensity mountain and road biking feels fine, so I’m doing that. I’m “on leave” from CrossFit until I can do squats without pain or swelling — one of the great things about contract-free CrossFit at our gym is they’ll stop fees if we’re out for 2 weeks or more.
Update 9/12/2015: Occurred to me that I should change to flats on my mountain bike until the knee is done healing (it’s improving well). Normally SPD cleats allow a lot of lateral mention, but sometimes my mountain pedals get jammed with sand. That’s a formula for worsening my knee problem. So flats for now (which, these days, work pretty well anyway).
Update 11/24/2015: I learned a few more things, which really ought to be in a textbook.
My own knee did get better after a few weeks of CrossFit abstention, a bit less mountain biking (week off), and quad strengthening. Subsequently, however, I found CrossFit didn’t bother it much at all, but heavy mountain biking could be annoying. Since mountain biking season ended I have been mostly doing CrossFit and ice hockey — and it is now better. I ended up thinking the mountain biking was probably the greater aggravating factor.
Ahh, but there’s a twist as well. I have since learned that what mountain biking and stairway descent have in common is 15 degrees of flexion, which is when the patella is most in contact with the femur. At greater degrees of flexion strong quadriceps pull the patellar undersurface away from the femur — which is why my strong quadriceps limited the pain. Alas, the clinical presentation cannot distinguish inflammatory arthritis (idiopathic, as in OA involving primarily the synovium), from psoriatic arthritis (less idiopathic, with tendon involvement). In my case other clinical findings point to more chronic conditions - psoriatic arthritis or idiopathic inflammatory arthritis (aka, erosive osteoarthritis). So I’ll write a bit more about that sort of thing over time.
I’m taking my family medicine board exams one last time. This is not entirely sensible. It’s been 21 years since I did family medicine, and 17 since I last saw a patient. I’m unlikely to practice again. The exam will be difficult; my brain is old and cruddy. (Long ago I did rather well on these, but it does help to actually practice medicine.)
Still, for one reason or another, I’m committed to doing the exam this November. I’ve slogged my way through the ABFM’s intricate preparations, including, for the non-practicing candidate, 6 self-assessment modules (SAMs) and one “alternative” module (which was quite awful and may have been since withdrawn). I even managed to meet the under-documented CME requirements [1]. The expensive Self-Assessment Modules varied from quite good to rather poor; alas the simulations are not worth continued investment [2].
When I’m done I’ll revise this post with what I end up with. By far the best guide I’ve found for someone like me was something written in 2008 (*cough*). I’m basically following my old recommendations (including ignoring audio CME/podcasts). For example:
I’m alternating topical work (reviewing Sanford, relearning EKG interpretation) with review designed to rebuild old memories. My medical knowledge network is frayed and fragmented, but there’s a lot of it. Much of my preparation is really resurrection. I've brute memorization ahead - reading, closing eyes, regurgitating. Then exam-guided note review and expansion.
It will be interesting to see how it all goes. Failure is certainly an option.
- fn -
[1] Dear ABFM: Please note the current cycle progress tracker omits CME requirements but the future cycle includes CME requirements. Could be fixed.
[2] In the late 80s through early 90s we used to get 360K floppy disks each month with a unique DOS based medical simulation. I cannot, just now, remember what medical publisher did them (something Cardinal?). I remember them as quite excellent, I featured them in our residency computer-based training program. Several clinicians, likely retired now, did some serious work on those. There really is no modern equivalent. Which is a kind of interesting.
[3] UpToDate is by far the dominant online resource for medical information — and it’s very expensive. (Priced for organizations.)
[4] See [2]. Also the movie Groundhog Day.
Update 11/22/2015
I don’t know my exam results yet, but it went more or less as expected. The test environment worked well — though it took me a while to realize I had to select text then click a secondary highlight icon that floated nearby to get highlighted text for review. My foot pulled a power cord out, but when our proctor fixed it everything worked. For most modules and sections there was ample time. We do get markers and writing material, I didn’t see that mentioned in the ABFM exam descriptions.
The AAFP board review questions and the ABFM provided residency training exam questions were a good guide. The AAFP questions generated CME credit, but I liked going back and forth. Whenever the questions exposed an unfamiliar topic I went off and did guided studying. There’s an AAFP board preparation page that provides USPSTF screening guidelines that’s quite useful.
FP Notebook was, and is, outstanding. I wouldn’t make many changes to my studying, but I’d have stared using FPN intensively sooner than I did. It is a perfect way to bring old knowledge on board, to identify obsolete knowledge, and to extend the sample exam question critiques. It’s also a great way to review medication information. Beyond FPN I mostly used American Family Physician articles and a handful of textbooks.
My key book references were The Washington Manual, Sanford antimicrobial therapy, MPR Prescribing Monthly, Emily’s ACLS “cards” and my venerable med school EKG primer. That’s similar to 2008, but since then my presbyopia has not improved. This year I found the app versions more readable than the paper versions; the Sanford and Washington Manual print text seemed microscopic. The Sanford app is a $40/year subscription, but Emily uses it too (we share same AppleID for purchases). My paper Washington Manual came with a free code for the electronic version, hosted by inkling.app (iOS). I barely looked at the paper manual, but I used the inkling version often.
The ABFM Maintenance of Certification examinations (I had to do 6!) were not particularly useful preparation for the board exam. I don’t think the maintenance exams a useful guide to real world practice either — they are much too esoteric. I regret the time and money I spent on those, but of course we don’t get a choice.
Even though most physicians would have key references like Sanford, Up To Date and drug information at their fingertips our board exams still rely on brute memorization. I suppose they’d be too easy otherwise. Given the years since I’d done family medicine (1994), and the years all by themselves, memorization was not particularly easy. I had to interact with information. I took handwritten notes on exam questions that I knew I’d never look at — but the writing process was important. I created my own spreadsheets of drug information for antimicrobials, antidepressants, anticoagulants, and, above all, oral diabetes meds (mercifully lipid therapy has gotten much simpler!). In each case I created my own groupings (med classifications), frequently reorganizing them. It helped to organize medications but their modern use, rather than by the sequence in which I encountered them. For the oral diabetes meds I would attempt to recreate my classifications by memory, then see where I got them wrong, then repeat… At about 30-40min of painful memory work a day it took 3 days to learn them.
I moved my old notes into OmniOutliner Pro 3 — itself an old piece of software. This was a ‘back to the future’ moment as my notes started out decades ago in a similar product - Symantec’s MORE 3.1. After a couple of weeks of study I could recognize what was worth keeping, what needed to be rewritten, and what should be deleted (much of lipid therapy!). I updated my old references with FP Notebook on a separate screen; this process helped tie old knowledge to new knowledge.
The old knowledge was important — during the exam I found myself dredging things up from 25 years ago. I was surprised I could get anything from that far back, but really most of my medical base is from that era. For this exam I was largely refreshing and resurfacing it.
I’ll find out some weeks from now whether I need to do it again in a few months, or years, or perhaps never again.
Update 1/25/2015
I passed the exam by a substantial margin. If the maximal score represents percentile I scored about the 75th. That’s much lower than my score when doing academic practice, but it’s not bad for 20 years without patient care.
I did well in all the areas I studied. I didn’t do as well in obstetrics and gynecology, but I strategically omitted them.
My studying approach worked quite well for me.
