The Clark County Health Department (the county where I work), was giving out free swine flu vaccines to health care professionals yesterday.
So I took the MAX to the Expo Center, and then rode my bike over the Columbia into Vancouver.

It seems they were expecting a bigger turnout than they got. There were about 20 volunteers, but only 3 people getting vaccines. I got the squirt up the nose and rode on back. (after getting lost at the Jantzen Beach Supercenter for half an hour)

So, my nasal passages are full of live attenuated H1N1 viruses!

Why does the phrase "a wingless, blunt-body manned vehicle that would reenter on a ballistic path" take me back to my childhood in Huntsville?

The best article on the swine flu that I've seen yet.


But H1N1 has also homed in on the weaknesses in our heads — hovering in the blind spots where our risk analyses break down, just beyond the view of our mind's eye. What is the defense for the mind games of a virus?

...

Whether it (the vaccine program) works will depend partly on science and partly on our ability to navigate the shadowy negotiations going on inside our heads.


People's reaction to influenza has always intrigued and frustrated me. Some view vaccines as sinister poison foisted on them by a paternalistic government. Others view vaccines as foolproof magic bullets that will protect them against respiratory illness of any kind. Often the latter become cynical when they get a cold during flu season, and see the flu shot as a waste of time.

Tillamook Extra Sharp Cheddar Cheese
Made in Oregon, aged 2 years. Good stuff.

Missy and I did a fairly grueling pub tour today. It was the Tour De Lab, and stopped at the three Lucky Labrador Pub locations. It was a benefit for a local animal shelter/hospital.

We went up the highest hills I've ever tackled on my single bike, and we've never done anything like this on our tandem.


I'm pretty happy with how we did. We only had to walk the bike once, on the very last hill. It came up by surprise, right as we turned from a stoplight, after we thought we were done with hills. The tandem's actually a pretty good hill-climber. I figured we'd be the slowest people on the road, but we passed quite a few people.

This was one of the most exhausting things I've done. We had a problems at the end, that I was almost two weak to restart the bike at a green light, and I was having trouble keeping the bike (and Missy) vertical when stopped. But we think we're doing pretty well, after 5 months of tandeming, we've not fallen over.  We have the bike pretty well customized with new saddles and handlebars. As tired as I was, my knees, back, elbows and wrists feel absolutely fine. That probably means it fits me pretty well. I think Missy needs some small adjustments.

We were having a lot of problems with shifting down into the smallest chainring. I'll have to look into that in the near future.

The ride was more of an accomplishment than actual fun. We'll probably stick to flatter stuff in the near future.
We're really happy with getting the tandem for our anniversary. It's much more versatile, efficient, and useful than 2 bikes, and is tons of fun. And kids always like it when we ride by.

For the last year or two, I have had the Orwell Diaries on my LJ friends page. Basically, it's a publication of George Orwell's personal diary in blog form, with a 40-year time shift.

Mostly it's been semi-interesting stuff about some travels in Morocco and quaintly boring stuff about his chickens and vegetable garden. But in the last few months, pressure has been building as Germany's military buildup has quickened. His charting of the political mood in the UK is fascinating. I also didn't realize that Germany and the USSR were allies at the start. The British were scared witless by this (and rightly so). I don't even want to imagine how the war would have went with the Soviets on the Axis side. But I guess in 1939, it was all the Brits could think about.

Yesterday's post was quite dramatic, with threatening moves toward Poland. This got me thinking, when did Germany invade Poland? Holy Crap! In four days.

Apparently they had Soviet help. Why didn't I know this?

Here's the LJ feed, if you want Orwell on your friends page.

The Monkees' "Last Train to Clarksville" refers to Clarksville, TN (adjacent to Fort Campbell, home of the 101st Airborne) and is about being drafted. As many times as I've driven through Clarksville, I kind of feel like an idiot for not picking up on this.

To cheer ya'll up on a Monday morning, I give you this:





(The end credits to my favorite movie about a physicist-neurosurgeon-rock star-samurai-astronaut-superhero)

"Rationing" has become a big negative buzzword in the current health care debate. As in, "we don't want any rationing of our medical services." We already have horrible rationing, and anyone who thinks we don't isn't paying attention.

Repeatedly I've heard tales of the rationing present in the Canadian system. Often I've heard the specific example of long waiting lists for joint replacements, or patients being denied knee replacements because of factors like age.

I have had plenty of real-life patients with bad knees and demanding jobs. The following case is an amalgamation of 3 or 4 cases I've seen.

Two patients both have jobs in the housing industry, and both of them need to go up and down ladders. These bad knees make it really hard to go up the ladders. Both have been hit by the lagging construction industry, sharply reduced demand for new homes, and have had to cut back on hours. We'll call them Bob the Builder, and Chris the Constructor.

Bob works for a large company, and has standard private insurance. He got a knee replacement pretty quickly. After recovery, he feels much better. He can't go up the ladders like he used to, but because of the reduced hours, he's working OK at the moment.

Chris is a self-employed small business owner. He used to have 1-3 part time employees, but he doesn't have work for them. I think he used to have insurance, but he had to drop it, because his business is not making any money. He doesn't qualify for Medicaid because of his assets. He's not getting a knee replacement anytime soon. Potentially he could sell his business, and get a job for a company, tough it out on the ladders until he gets insurance, and then get the surgery, but nobody's hiring. It's possible the economy could recover before he is unable to work, and he could get insurance or pay cash for the surgery. Best-case scenario, he gets a knee replacement in a year or two. Worst-case scenario, he never gets the knee replacement, blows through all his assets, ends up on state support with Social Security Disability, Medicare, and Medicaid and (maybe) gets his knee replacement in 2-4 years. By that time, he will probably never re-enter the work-force. Or maybe the worst-case scenario is that he ends up homeless on the street. That happens too.

This is how health care is rationed in this country. In Canada, both Chris and Bob would get knee replacements in say, 3-6 months. I don't want us to end up with an exact copy of the Canadian system.  We spend about 16-18% of our GDP on health care, and Canada spends 9-10%. So we should get something better, because we pay more.

I think it's actually reasonable, at a level of 17% of our GDP, that we could pay for all necessary health care for all Americans. That's a lot of money, and it should go a long way. If an American pays twice as much per capita than a Briton, it stands to reason our product should be twice as good. But health care in the US is currently so inefficient, fails to cover 12% of our citizens.  There need to be major changes in the entire delivery system before we can get the maximum bang for our buck. I suspect this would probably be with a single-payer system,
similar to Canada's. Or we could end up with something closer to Germany's. (It seems to be the country closest to the Democrats' model) That's going to take a concerted effort, and probably a decade or two.

But in the short term I doubt we can provide health care for everybody without some form of rationing. Currently we ration on factors (employment status, size of employer, student status, parental employment status) that make no sense.

P.S.
Most of the current debate is on the "public option." In Germany, 87.5% of people choose the public option. The private insurance companies seem afraid to compete with the U.S. Government, and for good reason: they suck. I can't think of another industry with worse customer service. Large portions of their business model consist of denying or delaying reimbursement for services paid for by their customers. If the Government offered a viable alternative, people would run from the private insurers in droves, and they know it.

P.P.S.
All this assumes that you (like most bloggers and talking heads) consider short waiting lists to be a major health indicator, rather than infant mortality and life expectancy (like most public health experts).

We got a new (used) car today. A 2005 Ford Focus Station Wagon. I'm not sure if I mentioned this, but I managed to total the Sonata in an 8mph fender bender.

We settled on the Focus because it is surprisingly comfortable for someone 6'4". The seat scoots all the way back, it has a telescoping steering wheel, adjustable seat height, and my knees don't hit the console. We got the station wagon because we're in Portland, and if don't have roof racks full of bikes, snowboards, and kayaks, you're doing it wrong. We think we're going to be able to do a lot of adventures on the tandem once we can get it mounted on the car.

The color is white, we may have pictures up soon.

I've posted some photos from the Starlight Parade to Flickr. I'm sorry that the quality is so low, but they were taken on my phone. But at least it gives an idea of some of the things we saw.

Starlight Flickr Set!

My thoughts on the season finale:

( Cut for spoilers )

There is a long, but excellent article in the Atlantic about a study that has followed the physical and psychiatric health of 268 Harvard undergrads from the 1940s to the present. The research, among other things, has tried to define what makes someone happy or successful, or how you would even define that.

It's a fascinating, read and I highly recommend it.

From the article:

In 1946, for example, 34 percent of the Grant Study men who had served in World War II reported having come under enemy fire, and 25 percent said they had killed an enemy. In 1988, the first number climbed to 40 percent—and the second fell to about 14 percent. “As is well known,” Vaillant concluded, “with the passage of years, old wars become more adventurous and less dangerous.”

...


JFK is one of the study subjects, although his data is sealed until 2040.

Of course, Kennedy—the heir to ruthless, ambitious privilege; the philanderer of “Camelot”; the paragon of casual wit and physical vigor who, backstage, suffered from debilitating illness—is no one’s idea of “normal.” And that’s the point. The study began in the spirit of laying lives out on a microscope slide. But it turned out that the lives were too big, too weird, too full of subtleties and contradictions to fit any easy conception of “successful living.”

...

“Their lives were too human for science, too beautiful for numbers, too sad for diagnosis and too immortal for bound journals."

There's also a section on Anna Freud's defense mechanisms, which is an aspect of psychology that I think is the most useful and most overlooked by primary care physicians.

The CDC e-Cards are a blast. Especially the STD ones.

That was a great movie. It surpassed my expectations. Although nowhere near as campy as the original series or Doctor Who, they had just the right amount of goofiness and shameless comedy. It's a hard balance, staying true to the spirit of the original, while making the movie (new continuity?) modern and stand on its own. Somehow, JJ Abrams pulled it off. I felt the tone, visuals, and attitude were perfect.

( Cut for spoilers )

Although I miss the comfortable banter of Kirk, Spock, and Bones the characters didn't really know each other yet. There were little inklings of this, and hopefully their friendship will develop over future movies.

The New York Times has an excellent article on vacationing in Portland

Frugal Portland

From the article:

This joyful stress would begin with the city’s most important meal: breakfast. Despite its laid-back aura, Portland is an early-rising town, and its commuting cyclists need fuel for their morning rides.

...

In its place was a dedication to the things that really matter: hearty food and drink, cultural pursuits both high and low, days in the outdoors and evenings out with friends. It’s the good life, and in Portland it still comes cheap.

...

Today, there are almost 400 carts around Portland, most of them clustered into “pods” that ring parking lots, ... As a New Yorker I was jealous; as the Frugal Traveler, overjoyed at what I could find within a single pod.

The article sums up a lot of what we love about living here. Also, check out the slideshow

There's been a strange reversal this last week. Every year, I spend considerable effort trying to convince people that influenza is a Big Deal. Some people get shots. A lot of people brush it off, making excuses, questioning the shots' effectiveness, and using that classic fallacy "the shot gave me the flu." Most people don't seem to think that influenza is something worth worrying about

Since January First, an estimated 13,000 Americans have died of regular, garden-variety flu. This was a "light" flu season. Influenza killed thousands this year, it will kill thousands next year. Most of those were elderly, who may have died a year or two before their time. Some of those were children. 83 children died in the 2007-08 season. As a doctor, I have to consider most of those deaths preventable, and look at them as a motivation to work harder on prevention next season.

So far, I feel the CDC and my local health department's reactions have been sensible, level-headed and appropriate. Why have they raised the alarm? It's not because swine influenza is a scary superbug that's worthy of our panic. But the prospect of a second flu season truly is something to be concerned about. Influenza deaths are sadly routine. But by sensibly limiting international travel, closing some schools, and encouraging good hygiene, we may have the opportunity to prevent another 13,000 deaths this year. We may save the lives of 100 children.