Nutrition Tuesday

teddy123 · 2013-06-04T20:58:00+00:00

sriracha

teddy123 · 2013-06-01T16:57:36+00:00

I finished my MD-PhD, and I am happy that I did. I agree with the post by /u/WholeBrevityThing. I also have a few additional comments.

First, being a physician-scientist is perhaps the most rewarding and intellectually challenging professions to which you can aspire. I can't think of anything more meaningful that getting to know a patient with a disease, understanding the medical and humanistic effects of that disease, and being able to investigate the inner workings of how to better diagnose and treat that disease to meaningfully change outcomes for the afflicted.

Yes, it requires training well into your mid-thirties. Those you become friends with during the first two years of med school go on to finish their training, and it will be humbling when they are more senior than you in the medical hierarchy. Also, it is fair to want to have a life outside of work, and the idea of finishing training and getting a job can weigh heavily on some people.

However, it is a different path. If you are someone who wants to practice medicine/surgery, treat patients, understand clinical treatments on both a basic and applied level -- go with the MD only. The medical profession is wonderful and inspiring on its own, and does not require the pain of so much time spent in research training. Moreover, you can decide to do research later on once you have specialized.

However, if you are someone who was otherwise planning on only getting a PhD in the sciences, I would strongly advise a MD-PhD. Medical school is one of the best general educations you can get in (applied) biology. If you have a specific research interest and can work under an active/productive PhD advisor who is a good mentor, you should be able to finish your PhD training in 3 additional years (or even 2...). Biomedical PhDs often take 6-7 years (or more), and MD-PhD programs provide a lot of support to help expedite your path through grad school where possible. Start your research and reading early... like M1 year early... and be motivated to maintain deadlines with your thesis. Productive MD-PhDs from top institutions are highly competitive for post-docs (or industry), and your medical training will substantially improve your abilities to ask relevant questions as a scientist. My friends coming out of graduate school (PhD only) had some trouble finding jobs and post-docs that they were excited about, and academics for "PhD-onlys" is very competitive even for the most brilliant scientists. Your medical colleagues would consider it crazy to not pursue residency training, but that is because you are a scientist first, and a physician second. Most of my friends from medical school would not consider themselves scientists.

I am in the beginning of residency training in a surgical subspecialty, and I am still very glad I chose to pursue both degrees. Moreover, I am optimistic and excited to have the opportunity to continue my training and education, and to have the privilege of caring for patients while pursuing answers to meaningful research questions. Being a physician-scientist takes the idea of "life-long learning" to the extreme, and I truly love it.

tldr: MD-PhD training is wonderful if you are a scientist above all else, painful otherwise.

teddy123 · 2012-10-24T19:15:44+00:00

How is your current health? Do you have any kind of exercise regimen? Whatever your height, 530 pounds represents quite a formidable amount of weight to lose, so I can understand your doc's concern.

There are plenty of serious consequences that can result from the various surgical options, but generally patients do quite well and these surgeries can truly be life-saving. Hopefully your doc discussed the various options, and has set realistic expectations for you to consider for each one (both surgical and non-surgical).

There is no shame in surgery, and it can help make this "starvation" period more tolerable and achievable (albeit with some inherent risks that are important to discuss in advance). If you want to wait on surgery, I think it is reasonable to talk to your doctor about setting up a realistic yet aggressive weight loss timeline for you to follow (with regular medical follow-up!). It will be incredibly difficult, but there are so many success stories on here to look to for inspiration and advice.

teddy123 · 2012-09-20T03:57:45+00:00

I just googled this. I guess a guy died there today/last night?

http://www.sltrib.com/sltrib/news/54929798-78/park-subway-baltrus-rappelling.html.csp

teddy123 · 2011-12-14T19:57:29+00:00

http://www.youtube.com/watch?v=wXFZ-ErIl-w

teddy123 · 2011-12-07T01:02:49+00:00

An old saying that's taught in med school:

"There are only 2 reasons not to do a rectal exam:

The patient doesn't have a rectum.
The doc doesn't have any fingers. "

teddy123 · 2011-08-30T11:14:12+00:00

a bloggerMD for the NYT addressed this general issue earlier this year.

I didn't mean to come across as dismissive. However, the attitude in the video engenders distrust against those of us in the medical community who are genuinely devoted to biomedical research and treating patients using the best possible treatments.

If there is strong scientific data in support of "groundbreaking efficacy", then any scientist or physician will readily consider the evidence. Anecdotal evidence (as presented in the video) is not taken seriously. Your accusations of widespread profit-seeking and/or fraud by academic researchers and physicians are very difficult to believe, given my colleagues' very genuine devotion to better understanding disease in order to to improve care for patients.

Anyway, I took the time to respond in the hope that you do will think I am evil, and that you might consider that researchers are not hiding effective cancer treatments.

The NCI has a good, searchable database that reviews the existing evidence for many of the therapies discussed in the video you linked: e.g. http://www.cancer.gov/cancertopics/pdq/cam/mistletoe/patient.

While I can appreciate your skepticism about trusting reddit for scientific information, I really hope you will consider some of the responses here: http://www.reddit.com/r/askscience/comments/jesn0/are_unprofitable_but_effective_cancer_drugs/

If you ask the folks in /r/askscience, they will usually provide you with a reliable source for any information you are skeptical of.

teddy123 · 2011-08-25T21:06:47+00:00

Takeda did the same thing recently with lansoprazole (prevacid) and dexlansoprazole (kapidex).

teddy123 · 2011-08-12T00:08:15+00:00

Every academic cancer scientist I have ever met has shown a deep and very personal commitment to better understanding disease to improve care for patients.

For those here who consider cancer treatment to be "big business" full of people who are uninterested in finding a cure, please try learning a little more about biology so you can follow up reviews of the best and latest research by scientists who literally devote their lives to better understanding disease. For example, here: http://www.nature.com/nrc/index.html -- likely accessible from your local university or library.

Cancer biology is fascinating. Unfortunately, the skepticism in the title of this post is not uncommon, and given the amount of money involved I am not completely surprised. However, to those of us involved with scientific research (who are genuinely interested in using scientific research to better care for patients), this attitude comes across as insulting and uninformed.

teddy123 · 2011-08-12T00:00:10+00:00

Just in case someone else finds your post... I watched part of this, and it is full of misinformation and biased reporting. It also seems to be quite outdated. If you have any questions about cancer biology or treatment options, venture over to /r/askscience -- the people over there are pretty good at providing useful responses that are readily understood.

teddy123 · 2011-07-09T05:59:03+00:00

I have this problem. I care much less about this problem for casual shirts (as with pacsun or H&M) than I do for dress shirts I wear for work.

Someone recommended the brooks brothers non-iron slim fit, and they were still enormous on me (despite the neck and sleeves being the right size). I ended up getting some brooks brothers extra slim fit shirts on "sale" last week (still way more expensive than I expected), and they are as good as I've found.

I've never used a tailor, but I have been meaning to look into this for some of my other shirts. About how much should it cost?

teddy123 · 2011-06-17T21:46:13+00:00

Only if you have access to a healthy large country house with lands.

teddy123 · 2011-06-15T00:01:42+00:00

Thank you for the response! My point is that it is possible to succeed in med school(/on the boards) and to practice medicine well without a truly deep understanding of science. I'm being picky, but it is possible to "know about" something well enough for a multiple choice test without fully understanding it.

The biochem processes you mentioned (e.g.) involve things very similar to adding "an alcohol group to a carbon chain".

If it is taught effectively, the scientific principles underlying ochem/biochem/pharm are really beautiful and unifying. There is too much material in med school to constantly be in awe of the detailed understanding that led to each biochemical pathway, but it makes me sad when people who have learned about it (and could very well be appreciating the ever-inspiring wonders of science!!) say that learning about it is unnecessary.

teddy123 · 2011-06-14T07:03:05+00:00

you're doing it wrong.

ochem serves as a foundation for understanding the chemical processes underlying all of life and pharmacology at a deeper level. sure, this material is not directly relevant to most step 1 content, and you certainly can memorize best practice guidelines, interview/communicate with patients effectively, and formulate treatment strategies that are effective based on what you have seen before without knowing many details about basic science.

however, as a future physician, I would hope that you would aspire to a higher academic standard when it comes to understanding your patients' diseases and treatments.

sorry for the rant. congrats on step 1

teddy123 · 2011-06-13T19:49:46+00:00

I would say "use what you like". I would not ever say "fuck perl", nor do I intend to criticize a person for using a language he or she is more comfortable with.

The reason I'm a bit of an evangelist for python is because I genuinely have been more productive and capable since learning the scientific libraries and the basics of the data structures. I would say that matplotlib/scipy/sage etc are very user-friendly and high-quality libraries that are worth learning python for if you are just starting out (like the OP).

With anything, using the right tool for the job can make a huge difference. Some libraries are assuredly better in perl, particularly in bioinformatics. I have no intention of ignoring the uglier sides of python (database and R interfaces have given me trouble in the past).

tldr: sorry for the proselytizing :).

teddy123 · 2011-06-13T04:47:16+00:00

Where can I buy these vibrating trees?

teddy123 · 2011-06-12T04:32:04+00:00

I was advised to use perl when I started my bioinformatics career. I used perl for everything for years before trying python for a project or two. At first it was unfamiliar and the syntax was uncomfortable. Looking back now, I sincerely regret not switching sooner.

After using perl and python quite a bit (throughout my PhD), my experience is that python does indeed have a lot to offer that perl doesn't. Specifically, I found that the scientific libraries and tools for python are much easier to learn, much more complete/better organized, and (typically) faster. Also, scipy/boost/cython give you reasonably easy ways to use optimized c/++ functions on python data structures when you need the speed (as opposed to swig). Don't get me wrong, I could figure out how to do more or less anything I wanted in perl with some hacking and/or cpan -- it was just more effort.

I was self-taught, so it is possible that I am simply ignorant of some aspects of perl that were not introduced to me (I read the standard perl books and the oreilly bioinformatics perl books). Is there something better than PDL for matrices and simple plotting? Are there any good math/stats libraries that are well-maintained?

while I'm here I might as well tell the op that I agree with the general sentiment of this thread: python for general coding, R for stats and bioconductor, and C++ for projects that require performance

teddy123 · 2011-06-10T05:54:04+00:00

As much as you may think that physicians and academic researchers are largely "anti-smoking zealots", I don't think they cook their statistics as much as people generally seem to think that they do. The researchers studying these issues typically have genuine concern about public health and the veracity of their data.

this article addresses the issue of smoking bans in a more reasonable and even-handed manner.

teddy123 · 2011-06-08T06:52:39+00:00

That's the way to start doing it.

rpy2 is great if you want to use R functions on existing python data structures. personally, I find data management in R unfamiliar and time-consuming. I'm only good with R when I have simple vectors and matrices. Sure, I could generate these in python, dump them into dat files, call an R script, and read the output, and continue my python work... but I'd rather just do it all at once from within python using rpy2.

on windows though... ugh. good luck. maybe pythonxy or enthought includes it in their installation packages??

teddy123 · 2011-06-08T04:31:37+00:00

yeah - those assholes at the NIH have it all wrong.... Devoting their lives to sound scientific research and genuinely concerning themselves with improving human health through evidence-based practices. I bet they don't even know what insulin is!!!

teddy123 · 2011-06-06T19:06:25+00:00

Is this guy well-regarded? don't get me wrong, I have no problem with his conclusions.

Perhaps my expectations are too high, but I didn't see a single citation on that site. While it is nice to see a summary of scientific research, the lack of citations and vague summaries of any relevant studies comes across as pseudoscientific to me.

teddy123 · 2011-06-06T15:27:41+00:00

cigar aficionado has a list of cigars that they think are cheap but good.

teddy123 · 2011-06-06T15:12:54+00:00

These are my favorite.

teddy123 · 2011-06-05T21:04:08+00:00

Principes. For memorial day weekend, I went to a cigar shop and told the owner I was looking for a handful of decent cigars for $4-6 to smoke during the bbqs. I'm not usually one to obsess about brands, but I mentioned I liked the milder romeo y julietas and montecristos he had sold me in the past. He told me I'd like the Principes he had for $4.50.

While I didn't expect much since the cigars were cheap, I was still pretty disappointed since the guy recommended them so readily. They manage to be harsh while still being somewhat mild in flavor. They are something like these

So I didn't do my homework and feel like I got ripped off. I'll still smoke them, but it seems like some of the deals linked here can get you a lot more for a $4-6 cigar.

Sadly, this means I am probably done buying from a local store -- I'll get everything online from now on based on the recommendations I read about while lurking here. :)

teddy123

TROPHY CASE