Mediscieciology

Protection money

noreply@blogger.com (dmowen) — Wed, 06 Jan 2010 01:49:00 +0000

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

noreply@blogger.com (dmowen) — Wed, 21 Oct 2009 01:05:00 +0000

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

noreply@blogger.com (dmowen) — Fri, 21 Aug 2009 04:42:00 +0000

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

noreply@blogger.com (dmowen) — Fri, 14 Aug 2009 03:58:00 +0000

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

noreply@blogger.com (dmowen) — Fri, 19 Jun 2009 04:45:00 +0000

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

noreply@blogger.com (dmowen) — Sun, 14 Jun 2009 08:28:00 +0000

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

noreply@blogger.com (dmowen) — Sat, 21 Mar 2009 08:18:00 +0000

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!”

twitter vs. facebook

noreply@blogger.com (dmowen) — Wed, 18 Mar 2009 00:44:00 +0000

I tried several social networking sites- orkut, hi5, myspace, linkedin- before finding on Facebook a tool that has a critical mass of utility (ie users who were my real world friends). I joined about the time they started using the newsfeed function (3-4 years ago?) This feature, while much protested by the original undergraduate users, is what made Facebook useful for me in a way that myspace was not. You could see at a glance what friends from around the country were up to. You also got a sense of what your friends in your immediate circle were up to and could talk about it the next time you saw them.

I first heard about Twitter a few years ago while listening to the podcasts from the SXSW technology conference- it seemed to be all the rage among the technology crowd there, but I wasn't entirely clear on the concept. The users described the utility in terms of having a sixth sense of what was going on in the lives of the people around them. The newsfeed on Facebook pretty much does this for me.

The other thing I didn't understand was how it was used from a time managment standpoint. It seems like constantly updating your status would be a pretty big time suck, unless you were already used to texting from a mobile device on a regular basis. And where do you read your updates? Are people sending you texts every 30 seconds? Is it like IM which I find intrusive and difficult to use?

Anyway, these blog posts were helpful to me in trying to understand what it's all about:
http://www.twitip.com/twitter-versus-facebook/
http://www.twitip.com/the-misunderstood-uses-of-twitter-and-facebook-are-you-a-friend-follower-or-a-fool/

It seems like twitter is more about networking with people you don't necesarily know in real life, while Facebook is a tool for maintaining/augmenting your real-world social networks? Is this accurate? Twitter users out there- what do you do with it? I'm thinking about checking it out, but still don't quite understand if it's something that would be useful to me. On a side note, I also have kind of an aesthetic pet peeve about twitter/tweets. If you're going to send tweets, why not call it Tweeter? Or vice versa? Would I really be able to convey ideas I want to get across in 140 characters? I already find the limits for commenting on articles posted on facebook to be inadequate.

Like more:
email
facebook
phone
reading blogs, articles
ability to communicate with people I don't know
intelligent discourse on comments/message boards

Like less:
Text messages
IM, chatting
"pokes"
application requests
friend requests from people I don't know
hyperpartisan discourse on most comments/message boards

Should I use twitter? Do you use twitter? Help me out here!

Miro Tea

noreply@blogger.com (dmowen) — Mon, 23 Feb 2009 03:38:00 +0000

I stopped by Miro Tea in Ballard today to work on a presentation for school (and, in retrospect, to reformulate my philosophy on blogging). It's a cool place. I recommend checking it it out. They have good prices and a nice atomosphere. $4 for Earl Grey served in a glass Bodum pot warmed by a tealight. About the same price as a latte somewhere else, but larger volume and it stays warm for longer (another blog post I deferred was on my pet peeve concerning Seattle coffee shops that serve their coffee in bowls instead of mugs- the surface area to volume ratio is way off and your coffee ends up getting cold before you can finish it. Not so with the tealight-warmed pot! It stays warm for hours while you loiter).

Reminds me of getting a pot of tea at the shop on campus at Lancaster University for about 1 pound and it would last for 6 hours while you were craming for your immunology final exam which you put off studying for the whole semester because you were in England and the only grades were the midterm and the final, and there were no homework assignments...but I digress.

The atmosphere is also nice- bamboo, burlwood, and cast concrete fixtures. Danish Modern chairs. Cool art.

Tour of California

noreply@blogger.com (dmowen) — Mon, 23 Feb 2009 03:19:00 +0000

Does any one else find it ironic that the Tour of California bike race is sponsored by Amgen, the biotech company that got its start making erythropoietin? (Epo can be used by cyclists and other endurance athletes for blood doping) Isn't that kind of like a Steroid Manufacturer's Association Home Run Derby?

personal epublishing

noreply@blogger.com (dmowen) — Mon, 23 Feb 2009 02:52:00 +0000

essays, blogs, microblogging, links, status updates, etc.

Personal website, Facebook, Digg, Twitter, Blogger...so many options with overlapping functions.

I haven't really found the ideal way to manage online communication. I currently do this primarily through Facebook status updates, notes, links to articles, and rarely by updating my blog. Sometimes though I would like to write a status update that's about a paragraph long. Clearly too long. But I consider it too trivial to write a blog post about. And also off topic from what I'd like my blog to be about: science, medicine and society. On the other hand, I rarely update my blog and when I do it comes out more like an essay that I spend a couple of hours writing, editing, inserting links & formating them to popup in a new window, uploading pictures, etc.

I also sometimes run out of room to comment on an article link shared on Facebook. These should probably be blog posts instead. So I'm going to be more active about using my blog as a communication tool and relax my criteria for what's on topic. There will probably still be a lot of medicine/science content. But also other interests like politics, art/design, business/economics, random observations and other stuff I've been up to or thinking about. Which I guess is the point of a blog.

testing image uploads

noreply@blogger.com (dmowen) — Mon, 23 Feb 2009 02:32:00 +0000

From weblink:

From computer:

T. Boone Pickens

noreply@blogger.com (dmowen) — Thu, 27 Nov 2008 02:01:00 +0000

I just finished reading T. Boone Pickens’s autobiography Boone (autobiography #1 out of 3). I first heard of Pickens a couple years ago when someone mentioned a donation he made to my medical school, UT Southwestern. The terms were that he would give UTSW 50 million, but we had to grow that money to 500 million over 25 years, otherwise the returns on the investment would be given to his alma mater, Oklahoma State University. Recently he has made news by promoting the “Pickens plan” for US energy security, which includes building huge wind farms and promoting natural gas as an alternative fuel for cars. He was also featured in the September Texas Monthly and has a new bookout. He’s a pretty fascinating person. He started out as a traditional oilman with a background in geology before he left to form an independent oil company, Mesa Petroleum.

The book makes the point that for an oil company to be sustainable (in as much as a company whose business model is natural resource extraction can be sustainable) it has to replace its reserves every year through new discoveries. Otherwise the company is just liquidating its assets. Boone originally got into the merger and acquisition business (for which he is probably most well known as a corporate raider) as a means of replacing Mesa’s reserves with the proven reserves of other companies at a lower price and more predictably than through new exploration. As he looked around at the decline in new oil discoveries he became convinced that most oil companies were too large to be sustainable. He thought they were basically just liquidating their assets in an inefficient way by spending their large cashflow drilling lots of dry holes in search of massive new discoveries that would justify their large size, when what they should be doing is distributing that cashflow to shareholders and trimming down their operations. They needed to adapt to new realities in order to thrive. Towards this end he promoted shareholder activism and attempted several hostile takeovers of oil and mining companies.

His passion now is doing what he can to promote a plan for US energy security (while making money at the same time). Despite the flaws, I’m kind of a fan of these guys who make a lot of money but also have a vision for civic responsibility. The ones who write books and use their money and influence towards their vision for improving society- people like Boone Pickens, Ross Perot (full disclosure: I’ve benefited from his support of the UTSW MSTP program), George Soros, and Warren Buffet. I like how they remain dynamic and engaged even into old age (Perot, Soros, and Buffet were born in 1930, Pickens in 1928) when they could be just kicking back and enjoying their money. Soros’s theory of “reflexivity” provided some good insight into the potential for market irrationality, even before the rise of behavioral economics. His support of “open society” contributed to the collapse of communism. Buffet, through the Gates Foundation, is going to improve the lives of millions of people in the developing world. Perot ran a credible presidential campaign, polling higher than both incumbent George HW Bush and challenger Bill Clinton for a while in the 1992 campaign.

These guys were trendsetters and remain relevant. Check out the Pickens plan website. It is similar to Obama’s campaign website in its understanding of new media and attempt to build grassroots support for a plan. If you watch the whiteboard presentation video on the site, it is reminiscent of Ross Perot’s chart-filled infomercials during the 1992 campaign. It is interesting to note how the precedents such as writing books, using media to build a grassroots support base, and communicating through infomercials demonstrated during Perot’s campaigns would prove key in Obama’s successful presidential campaign over 15 years later. Boone’s understanding of grassroots campaigning probably comes from his experience in building support among shareholders for proxy fights. (Tangent- The part of community organizer Saul Alinsky's book Rules for Radicals that I liked best was where he advocated proxy fights as a means for democratic control of corporate power.) Pickens was also ahead of his time in talking about corporate bailouts and the idea of reducing health care costs through preventive medicine. Here are two passages from the biography published over 20 years ago:

“The automobile industry is a perfect example of an industry paralyzed by bureaucratic inertia. The Japanese and Germans focused on building better automobiles while the U.S. automakers rested on their laurels. Then, when the rest of the world caught up, Detroit ran to Washington for bailouts and protection.”

“As early as the 1960s, Mesa paid for employee memberships at the Amarillo YMCA…About three quarters of Mesa’s employees participate in the fitness program…The Fitness Center saves Mesa more than $200,000 in insurance claims annually. We know that employees who exercise regularly average $173 in medical bills a year, whereas it costs $434 for inactive employees.”

These things stuck out to me as examples of how experiences from the past are relevant in informing and shaping our present day. Rich, white, male, capitalists like Pickens and Perot contributed some great ideas, helped fund my medical education, paid for the fancy research building where our lab used to be located, and bankroll the foundations that may fund my research someday. However they will not be around forever. The American standard of living which was built up in large degree by men of their generation is being slowly liquidated. We need to “replace their reserves” by leveraging the investments they’ve made in society to diversify our portfolio and discover the men and women of all backgrounds who will lead our country in the new century. We too must adapt in order to thrive in a changing world.

Microfinace & microbrews meeting report

noreply@blogger.com (dmowen) — Wed, 12 Nov 2008 10:02:00 +0000

SeaMo, an organization which seeks to connect the Seattle microfinance community, hosted Evelyn Stark, the new program officer at the Gates Foundation’s “Financial Services for the Poor” office, as the speaker for their bimonthly “microfinance & microbrews” get-together this evening. Here are my takeaways from the meeting:

1) Microfinance = financial services for the poor, not just the microcredit programs that we traditionally associate with microfinance.

2) She asked for a show of hands of how many people thought the poor wanted access to credit. Most people raised their hands. Then she asked how many people thought the poor wanted to go into debt. Not so many raised their hands, even those these two positions are necessarily linked (aside: This reminds me of the saying “Everybody wants to go to heaven, but nobody wants to die”) The point was that credit IS debt and that while we in the U.S. are quite used to the idea of taking on debt, it may not be such an appealing idea to a person in poverty, especially in the context of some cultures where debt can lead to indentured servant/slave status. Just because we get excited about the microfinance concept doesn’t mean its benefits or likelihood of adoption and success are guaranteed in the target community.

3) This leads to Stark’s “Ready, Willing, & Able” framework for planning successful microfinance projects.
Ready- target population needs to be connected to the cash economy, access to markets
Willing- trust issues, must be convinced that you will benefit from taking out a loan
Able- address the cultural factors and context specific barriers to success

4) Savings rates among the poor (abroad) are around 20%. (average U.S. household has a negative savings rate). Possibility of village level savings & loan associations.

5) Question was asked about collateral and/or motivation for loan repayment. Many microfinance programs use a shared risk model where small loans are given to a group of 5 or 6 women who mutually guarantee one another’s loans. This mechanism works through 2 or 3 rounds of progressively larger loans and selects for group members with a track record of loan repayment. After round 3 or so, group solidarity is a less important motivator than an individual’s desire to be approved for future loans. This becomes analogous to our credit history/credit report mechanisms for incentivizing payment of unsecured debt.

6) One of the factors which made microcredit so successful in Bangladesh was population density. It is difficult to maintain cohesion and provide services when clients are distributed over a wide area as is the case in some parts of rural Africa.

Microfinance information and resources:
http://www.seattlemicrofinance.org/
http://www.seepnetwork.org/
http://www.microsave.org/
http://www.themix.org/

Also, if you haven’t checked it out yet, go fund a loan at Kiva, it’s fun!

Health, War, and Economics in Congo

noreply@blogger.com (dmowen) — Tue, 11 Nov 2008 09:39:00 +0000

Congo has been in the news a lot lately, so I was excited to attend the Quest Global Presence meeting tonight to hear Harper McConnell talk about the work that HEAL Africa does in the Democratic Republic of Congo. HEAL Africa runs a tertiary care/teaching hospital in Goma, Congo staffed by 16 Congolese doctors and 28 nurses who specialize in orthopedic and gynecological surgeries. These areas of specialization are the unfortunate result of a high volume of patients injured by the violence of war and rape.

Following the 1994 genocide in Rwanda, Hutu militias were forced across the border into Congo. Since that time a number of factions and rebel groups, some backed by neighboring governments, have been at war in Congo. The current fighters around Goma include the Tutsi rebels lead by General Laurent Nkunda whose stated aim is to protect Congolese Tutsis from the Hutu FLDR militias. However, they are also considering overthrowing the Congolese government, so they are fighting the government troops and the pro-government Mai-Mai militias as well as attacking the UN peacekeeping troops. Here are a few articles with background info:

http://news.bbc.co.uk/2/low/africa/7720738.stm
http://news.bbc.co.uk/2/low/africa/7714629.stm

I don’t know a lot about the history and politics of the conflict, but from a healthcare perspective one of the major results is civilian casualties. The doctors and nurses in Goma are doing heroic work to take care of patients wounded by the conflict, and you can donate via the HEAL Africa website (a surgery costs around $400).

In addition to caring for individual patients, public health principles teach us that some of the greatest value per effort comes from primary prevention and attacking the root causes of disease. In this case that means attacking the economic base of support for rebel groups (running an army is pretty expensive). As was the case with conflict diamonds, natural mineral resources play an important role in financing the fighting in Congo. Specifically, coltan (columbite-tantalite) is an ore that can supply the raw material for tantalum capacitors found in most cell phones, laptops, etc. 80% of the coltan reserves are found in Congo, so Senators Brownback (R-KS) and Derben (D-IL) have introduced bipartisan legislation to set up a certification process for coltan in order to ensure that the manufacture of your cell phone and laptop is not indirectly financing the killing of women and children in Congo. A globalized world requires us to exercise global responsibility, so I would urge you to write to your senators and ask them to co-sponsor or support SB 3058, the Conflict Coltan and Cassiterite Act of 2008. You can find a sample letter here and your senators' contact info here.

HIV 2008

noreply@blogger.com (dmowen) — Mon, 04 Aug 2008 07:17:00 +0000

The AIDS 2008 17th annual international HIV/AIDS conference kicked off today in Mexico City. I haven't really looked through the schedule yet, but I imagine some topics of interest will be progress and plans for scaling up antiretroviral therapy (ART) programs in developing countries, the US's renewed and expanded commitment to PEPFAR, and controversies/cultural issues related to the recent studies showing a 60% risk reduction in HIV aquisition for circucised males. Most of the talks are available as podcasts courtesy of the Kaiser Family Foundation and can be found here. I enjoyed listening to some of these last year and expect to again this year. I'm particularly interested in the ones from the Ecumenical Advocacy Alliance's preconference (available here). This is a network of Christian churches and organizations who believe that living out the Gospel in our current world means engaging with the AIDS pandemic.

I will be interested in hearing the practical suggestions from these talks because our church currently has a team in Tanzania that is investigating how we can partner with and support St. Peter's Anglican Church in the village of Chamwino as they seek to serve their community which is affected by AIDS and other issues of poverty, education, and economic development.

On a kind of related note the 2008 Principles of HIV & STD Research Course was held the past two weeks here at the University of Washington. I was able to sneak away from the lab to attend a couple of the lectures, but one that was particularly interesting was given by Dr. Elioda Tumwesigye from Uganda. Dr. Tumesigye became personally involved in fighting HIV after losing his older brother to the disease in the early days of the epidemic (the first recoginition of the AIDS epidemic in Africa was in Rakai, Uganda in 1982, only a year after the first reports in the US). He had attended the UW course ten years ago and is now a member of the Ugandan parliament where he chairs the comittee on the government's response to AIDS. He talked about home-based HIV counseling and testing as a tool for community education/awareness as well as a portal of entry into the healthcare system for those who test positive. Many African countries are now providing free access to ART, but in order for this to be effective several things have to happen: People have to want to know their status (education, overcome stigma, believe that HIV is not a death sentence), they need to have access to testing, and they need to have transportation to the major cities where these centers are located, or there needs to be a massive scale up of health infrastructure (trained nurses, CD4 monitoring, etc) to bring these programs to the village level. I look forward to working with some people from our church and the church in Tanzania as we explore how to overcome some of these barriers.

skiing, healthcare reform, & birthdays

noreply@blogger.com (dmowen) — Wed, 27 Feb 2008 11:38:00 +0000

It’s been over 6 months since my last blog post, so I’m about on schedule for another one. I went skiing last week at Whistler and had a great time. I’ll post some pictures on my website after I steal them from Alan’s facebook page. This was my first trip to Canada and it completely shattered my stereotypes. I was under the impression that Canada was completely covered in snow, whereas in reality it is only partially covered in snow. Furthermore, not everyone in Canada says “eh”. Some of them play hockey. The Mini made the trip up and back without any problems and I definitely want to go back and spend some time in Vancouver which looks like a really cool city. I also have two days left on my Edge card if anyone wants to join me on another weekend trip up there sometime before ski season ends.

Since I was gone last week I missed a session of an elective class I’ve been taking called “healthcare in underserved communities”. As a makeup assignment I wrote a paper on healthcare reform. It was written in a few hours before class this evening, so it’s kind of half-baked and not very developed, but if you want to read it click here. Overall the class was kind of interesting, but also kind of disappointing. The class was more focused on introducing you to the concept/existence of underserved communities than on discussing how to actually improve health in underserved communities. One thing I did really enjoy about the class though was the practical requirement to work an afternoon clinic at the Aloha Inn, a transitional housing program here in Seattle. I got to meet two patients, one a young person about my age who had recently learned that they were HIV+. I usually think about HIV/AIDS in the context of Africa, Bono, PEPFAR, etc. and have met older patients in the US who were HIV+, but this was the first young, recently infected person I have met. It is depressing to realize that despite all the public health messages and over ten years of access to antiretrovirals, HIV continues to spread in the richest country in the world. The other patient was an older person complaining of hearing loss. They had a “bad” right ear (bone conduction>air) and a worse left ear (recent tympanic membrane rupture). They also had some crackles in the left lung and clubbing from chronic smoking. Overall it was cool to see so many interesting physical exam findings in a patient since I hadn’t done an exam in about a year. On the other hand it’s not so cool for the patient. That’s a challenge that’s hard to figure out what to do with- balancing the fact that you find the pathophysiology interesting, but depressing that understanding the pathophysiology doesn’t always correlate with being able to offer a treatment to make things better.

This past weekend was close to perfect. I got to listen to some live music, hang out with my roommates, have breakfast with really cool people, be a wannabe hipster shopping the record store and trendy clothes stores in Ballard, enjoy the sunshine, picnic at Greenlake, go out to dinner downtown with old friends, watch a movie, sleep in, get a little lab work done, go to church, go to a birthday party, work on the kayak… I wish it was the weekend everyday! More on the birthday party- This was Darwin’s birthday party/fundraiser. This is a cool idea for a birthday party. You get to hang out with friends and support a cause you care about. In this case Darwin was selling his photography to benefit the Filipino Youth Project.It’s a pretty sweet deal- I got some cool art for my wall and got to help send a kid in the Philippines to school for a year. I think I might have to steal the idea and organize some kind of party/fundraiser for my birthday in June (except I don’t have any cool photography)!

Seattle, one month on

noreply@blogger.com (dmowen) — Mon, 09 Jul 2007 08:30:00 +0000

Ok, I haven't been keeping up the blog, so here's a post to try to get back into the habit. Here's a little bit about what's been going on lately: I moved to Seattle (pics from the trip and my new place here). The lab is up and running, doing experiments and getting ready to go to ASV next week. Trying to get into the Seattle spirit by growing a vegetable garden, recycling, reusing (RE Store, free stuff, chemicals), riding bike to work, getting involved in community (Quest church and running club), taking part in water sports- sailing and building a kayak (more to come on this subject). The weather is beautiful. There's daylight from 4:30am to 9:30pm (not looking forward to the converse of this in wintertime). Roomates are cool people- they write code for Adobe, build buildings, respond to emergencies, take care of sick people, teach English abroad, and other generally productive things like that.

Since this blog is supposed to be occasionally about science and medicine, check out this article on a new model for primary care. It seems like a good idea if it works out. It makes sense to me from a sustainability standpoint to cut the for-profit insurance middleman out of the picture for primary care. People will still need insurance for emergency and specialty care, but we could save a ton of money on specialty care if people had good acess to primary care so we could catch and manage disease processes in the early stages, spend more time on patient education and primary prevention. If you have a chance, read the Healthy Dallas task force report. Here is one amazing conclusion from the report concerning the potential impact of primary prevention:

"Fifty percent of health outcomes are a result of poor health conditions caused by habits and behaviors, such as poor nutrition, lack of physical activity, tobacco use and alcohol abuse. Specifically, it is estimated that these four behaviors drive over 40% of deaths in the United States."

Roadtrip day #1

noreply@blogger.com (dmowen) — Tue, 05 Jun 2007 07:03:00 +0000

Mom and Dad requested that I blog my roadtrip/move from Dallas to Seattle, so here's the first entry: I'm driving from Dallas to Seattle with my friend John and our goal was to leave at 7:00am so we could make it to Flagstaff, AZ to spend the night. I got off to a late start however, because I still needed to pack the car, put some more stuff in storage, vacuum, etc. I got pretty much everything done for leaving except unloading the dishwasher (Sorry Alan!). I got over to John's apartment about 10:00am and Chris came over to say goodbye. We booked a hotel in Las Vegas for Tuesday night and then got the Mini inspected, picked up some cash from the ATM, and hit the road about 11:15. We had lunch at Arby's in Wichita Falls and continued on 287 to Amarillo where we stopped for gas. Along the way we discussed the morality of war, the nature of the Trinity, and space travel. We drove through some rain and then got to Albuquerque about 9pm and had dinner at Buca di Beppo. Another 2 hours in the car brought us to the Days Inn in West Gallup, NM which, fortunately for you dear reader, has free wireless internet.

Movie Reviews

noreply@blogger.com (dmowen) — Tue, 09 Jan 2007 06:40:00 +0000

On Friday I went to Blockbuster with a friend to rent a movie. We ended up getting What the Bleep? Down the Rabbit Hole, a movie that purported to be about quantum physics, and An Inconvenient Truth, a movie about global warming. As you can tell, we are complete nerds. In any case, I decided to review these fine (or not so fine) movies because I know how much you enjoy reading reviews of nerdy movies.

Down the Rabbit Hole: This movie starts with a semi-decent explanation of quantum physics as related by interviews with physicists and an animated superhero professor. Inexplicably, these clips are interwoven with a storyline that follows the life of a tense high-strung deaf photographer on psychotropic meds (she has hallucinations and body dismorphic disorder) and her free spirit artist roommate.

The best part of the film is a good (although incomplete) animated description of the slit experiment. In this experiment, electrons fired individually through a screen with two open slits form an interference pattern on a detector in the opposite wall. The results of this experiment show that a single electron is able to interfere with itself, suggesting the unusual conclusion that the same electron somehow went through both slits. (see wikipedia for a better description of this experiment) When you try to observe which slit the electron passes through, it goes through only one and there is no interference pattern. The film takes this as evidence that consciousness in the form of the observer changes reality. (The change actually happens because the detector must block whichever slit you are observing, thereby negating the possibility of interference).

From this high point the film goes rapidly downhill as it describes “experiments” in which participants change the output of a random number generator by concentration or “intentionality” and water droplets freeze into more beautiful snowflakes when people think happy thoughts on their behalf. New Agey pseudoscientists talk about how we can change the world with our minds through right thinking. While it is true that we can change our reality by altering our thinking (this forms the basis for cognitive-behavioral therapy) the mechanism whereby it occurs is explained by sociology and human nature, not some kind of mystic channeling of energy.

Finally, we are treated to the wisdom of Ramtha, a mystic guru woman in her late fifties. Despite being kind of scary looking, Ramtha gains some cool points in my book by smoking a Sherlock Holmes-style pipe. All in all, the movie was a piece of heretical garbage, but it did prompt a good discussion on theology and attempts to create our own grand unified theory of physics

An Inconvenient Truth: This is basically a film of Al Gore giving a powerpoint presentation. If that doesn’t sound like an exciting premise for a movie, I don’t know what does! However, I must say that I enjoyed the movie and highly recommend seeing it if you haven’t already.

It's easy to be skeptical about global warming because climate change is not something we can easily perceive. Before seeing the movie I was kind of on the fence about global warming. My thought was: “well, yeah it’s probably happening- that seems to be the general consensus of smart people, but it’s probably not that big of a deal. I mean, the earth heats up, the earth cools down, it’s happened before and the earth is still here, right?” After seeing the movie, however, I felt a strange urge to hug a tree. (OK, not quite)

The film did present very compelling data that, yes, CO2 levels and temperatures are rising, and, yes, human beings are responsible for this rise. The film manages to present this message in a pretty balanced way. It does not rely too heavily on emotional appeals or bashing big business, but places responsibility for our future squarely on ourselves. It ends with a hopeful message and practical tips on how we can change our behavior. I’m in the process of switching out my lights to compact fluorescent bulbs and I dialed my thermostat back to 67 degrees. (Also see this article on Walmart pushing CFLs).

Wow, this was longer than I intended. Thanks for reading this far. Next time I'll address Ryan & Sarah's blog tag or maybe Arnold's universal healthcare!

New Years Resolutions

noreply@blogger.com (dmowen) — Tue, 02 Jan 2007 02:13:00 +0000

I guess I should start the New Year by praising God for another year spent with friends, family, and school (20 years of education and still not done!). I also thank God for the blessings he’s provided in the form of a place to live, financial security, health, etc.

Since New Year’s is the time of making resolutions, I thought I would also take stock of where I’m at and lay out goals for 2007. I’m hesitant to make resolutions that are too ambitious, but I think it’s a better idea to aim high and wish for the best while at the same time planning and safeguarding against the worst. So if resolving could make it so, here is what I hope I will be like in 2007: A driven, disciplined person who wakes up early, plans and works ahead, achieves a good balance between work and play, engages in social interactions that build people up, exercises on a disciplined schedule, eats healthy food, budgets wisely and manages finances well, works in everything as doing it unto the Lord, pursues excellence at work, is devoted to God in such a way that my actions and speech draw others toward Christ, champions the cause of social justice, and devotes energies to improving the quality of life for the poor and marginalized at home and abroad.

However, here is what I know I’m like: A person that is chiefly self-interested, a sinner pursuing my own desires and gratification above service to God and others, a person who is at times lazy, often procrastinates and does just what is expected or required, and just in time, not exceeding expectations or living up to God-given potential.

I therefore take comfort in the words of the Apostle Paul:

“ 16Now if I do [habitually] what is contrary to my desire, [that means that] I acknowledge and agree that the Law is good (morally excellent) and that I take sides with it.
17However, it is no longer I who do the deed, but the sin [principle] which is at home in me and has possession of me.
18For I know that nothing good dwells within me, that is, in my flesh. I can will what is right, but I cannot perform it. [I have the intention and urge to do what is right, but no power to carry it out.]
19For I fail to practice the good deeds I desire to do, but the evil deeds that I do not desire to do are what I am [ever] doing.
20Now if I do what I do not desire to do, it is no longer I doing it [it is not myself that acts], but the sin [principle] which dwells within me [[c]fixed and operating in my soul].
21So I find it to be a law (rule of action of my being) that when I want to do what is right and good, evil is ever present with me and I am subject to its insistent demands.
22For I endorse and delight in the Law of God in my inmost self [with my new nature].(D)
23But I discern in my bodily members [[d]in the sensitive appetites and wills of the flesh] a different law (rule of action) at war against the law of my mind (my reason) and making me a prisoner to the law of sin that dwells in my bodily organs [[e]in the sensitive appetites and wills of the flesh].
24O unhappy and pitiable and wretched man that I am! Who will release and deliver me from [the shackles of] this body of death?
25O thank God! [He will!] through Jesus Christ (the Anointed One) our Lord! So then indeed I, of myself with the mind and heart, serve the Law of God, but with the flesh the law of sin. “ (Romans 7:16-25, Amplified Bible translation, The Lockman Foundation)

So while resolutions may fail, God is faithful. Indeed “[we] can do all things through Christ who strengthens [us]”. Best wishes for 2007 and may God give you the strength to do the things he has put you here to do!

Holiday reading list

noreply@blogger.com (dmowen) — Fri, 29 Dec 2006 07:36:00 +0000

I just had dinner with some friends who were in town for Christmas and they reminded me that I have not posted anything recently. You can see their more faithful blogging at www.sarahandryan.net. In addition to seeing old friends (and celebrating the birth of Christ!), one of the things I enjoy about the Christmas break is sitting by the fireplace with a good book. I have organized my current picks into a Venn diagram of overlapping subject matter (because I’m nerdy like that). All you need to do is decide which subject(s) you’re interested in and read the corresponding book. Enjoy!

1) Ten Books on Architecture (Vitruvius)
2) Warrior Politics (Robert Kaplan)
3) The Mighty and the Almighty (Madeline Albright)
4) Design Like You Give A Damn (Architecture for Humanity)
5) The Bible (God, et al.)
6) Building Green (Clarke Snell and Tim Callahan)
7) The Ragamufffin Gospel (Brennan Manning)

NY Times columnists

noreply@blogger.com (dmowen) — Mon, 23 Oct 2006 21:21:00 +0000

I listen to the NY Times pretty much everyday via audible.com. I really enjoy listening to the columns by Thomas Friedman and David Brooks because I share their outlook on most issues. The more liberal columnists Paul Krugman and Bob Herbert occasionally have good things to say, but today their columns were downright disappointing. They show how some in the Democratic party still don't get it when it comes to what the American people want. Krugman's column "Don't make nice" advocates that the Democrats engage in vicious partisanship if they win one or both houses of congress this fall. Huh? People want more partisanship?! I guess I didn't get that memo. The other column by Herbert, "The Obama Bandwagon", encourages Barack Obama not to run for president. I don't quite understand where the Democratic party is coming from sometimes. As a moderate, Obama is the only Democratic candidate I would consider supporting in a race against John McCain, and I suspect this is true for many others as well. Obama and McCain are appealing because they inspire Hope for those who long for a more collaborative, moderate, functioning democracy. If Democrats want to lose again, go ahead and nominate Hillary Clinton. Sure, she's been taking more moderate positions, but her personality won't fly. I heard a professor at my school who has talked to her and strongly supports her describe her as "intimidating". This is coming from a woman who I can't imagine being intimidated by anyone. That's my 2 cents worth anyway. I could be completely wrong as I am young and idealistic. However my feeling is that the majority of Americans want "uniters", not "dividers" to be their elected officials. I can only pray that this is true.

Blog archive

noreply@blogger.com (dmowen) — Fri, 13 Oct 2006 21:48:00 +0000

Blog archive

In the future I'm going to try to publish my blog simultaneously at myspace, facebook, and blogger.com, but in the meantime here are some previous posts:

Nobel Peace Prize/Microfinance
3:34pm Today | Edit Note | Delete
I was pulling for Bono to win the prize, but I was surprised and quite impressed with the actual winner: Muhammad Yunus. Mr. Yunus started the Grameen bank in Bangladesh, one of the first microfinance projects. Microfinance lifts people out of poverty not by massive transfers of foreign aid to corruption-prone governments, but by directly empowering individuals with small loans. If you want to get personally involved in microfinance, go to Kiva.org and make a loan to an entrepreneuer in a developing country. Your principal will be repaid, which you can then withdraw or loan again, but you won't get any interest. If you want to make microfinance loans, but also make a profit, check out Prosper.com. I've made loans through both sites and have had a good experience so far. I'd also love to hear your opinions on what a "fair" interest rate is and where you would draw the line between charity, mutual benefit, and exploitation.
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Fried Coke
12:48am Tuesday, Oct 10 | Edit Note | Delete
I went to the Texas State Fair this evening. As some of you may know, the State of Texas employs food scientists with advanced degrees in "Cooking Things in Boiling Oil". These scientists work hard to come up with a new fried food to introduce each year at the state fair. Past offerings have included Fried Twinkies, Fried Oreos, Fried PB&J, Fried Snickers, etc. This year all the buzz is about "Fried Coke". Fried Coke?! That doesn't even make sense! So I decided I had to try it. Basically, Fried Coke= donut holes in a cup with pecans, covered in Coke syrup and topped with whipped cream and a cherry. Its okay I guess, but not quite what I expected. I guess I was picturing some kind of coke-syrup derivative with Jello-like consistency, battered and fried. Nice try Fryologists, but I hope you come up with something better next year!
1 comment

Good Magazine
1:01am Friday, Sep 29 | Edit Note | Delete
I found a new favorite magazine over the weeked: Good magazine. It joins the ranks of previous favorite magazines Dwell and Wired. Good magazine is focused on making a positive impact on the world around you. Also, when you subscribe you can donate the $20 subscription fee to the charity of your choice. So you get to do some good and get a cool, free magazine at the same time! Check it out: www.goodmagazine.com

Bleeding for HIV research

noreply@blogger.com (dmowen) — Fri, 16 Jun 2006 05:05:00 +0000

I got an email from a friend yesterday asking for some of my blood to use in growing a stock of HIV (I don't have HIV, but the virus needs white blood cells to use as "food" to grow in the lab). This is not the kind of email you get everyday, but it is one of the things I enjoy about being in medical research: opportunities to participate in research at both ends of the spectrum, as both a scientist/health professional and as a patient/study subject. I recently went to a lecture and had lunch with Dr. Barry Marshall, winner of this year's Nobel Prize in medicine. He drank a culture of H. pylori bacteria to show that it was involved in causing stomach ulcers. One of my professors, Dr. Ellen Vitetta was among the first volunteers to receive the polio vaccine as a child, and she is now developing vaccines of her own to protect against ricin toxin (a study which I participated in as a volunteer). Craig Venter used his own DNA in Celera's sequencing of the human genome. The Nurses' Health Study has identified many of the dietary and lifestyle risk factors for developing cancer, heart disease, and other chronic conditions in women. All of these are examples of healthcare providers engaged in a kind of "research solidarity" with patients. The general public, however, plays the most vital role in medical research. They do this by supporting research financially through taxes and charitable contributions, as well as physically by serving as volunteers in clinical trials. For information about finding a clinical trial you can be involved with in your area, check out www.clinicaltrials.gov