The Patient Will See You Now: The Future of Medicine is in Your Hands

By Dr Eric Topol

Ebook

Dr Topol's first book The Creative Destruction of Medicine was great. A survery of the convergence of the smart phone and medicine, it spoke of revolution. His latest provided updats and even more astounding information from the front lines of the information age, and how it relates to medicine.

25 "Later AMA revisions and documents on ethical affairs in the 1980s included two statements that give considerable authority to physicians based on their judgment. On informed consent, the AMA contended that physicians should be entitled “to treat without consents when the physician believes the consent would be ‘medically contraindicated,’”and maintained that “disclosure need not be made when risk disclosure poses such a serious psychological threat of detriment to the patient as to be ‘medically." I remember this being invoked only once in 30 years of nursing.

27 "The term doctor’s orders has to go. It conveys the problem. Going forward, the doctor should never order anything. Any medications, lab test, scan , procedure, or operation needs to be fully discussed, making the decision to act a shared one." Careful Doc the othernwill shun you if they catch you being nice to nurses.

30 "This highly frustrating end-of-the-hospital-stay experience reeks of disrespect for the patient, and is yet another flagrant example of not-so-benevolent paternalism." Yes, i agree. All of.the indignities we suffered at the hands of medicine discharge day was always the worst. And I agree itt showed a complete lack of respect.

31 "That usually doesn’t matter in the courtroom, however, so physicians seeking to avoid lawsuits often follow the guidelines to the letter. 45 Paradoxically, it has been pointed out that “patients can face grave risks when doctors stick to the rules too much.” Lawsuit driven medicine is counterproductive and often harmful to patients.

32 "Do you know your LDL?”Doctors around the country were evaluated by “quality metrics”as to whether their patients had reached target LDL levels. But in 2013, the new guidelines eliminated these target numbers. The panel of experts pointed out that there was no scientific basis for the target numbers in the first place." Federal Governmemt, ie. Medicare, driven medicine is counterproductive and.ofter harmful to the patient. The new paradigm will be pt driven medicine.

"Statins, particularly potent ones, induce diabetes in at least 1 of 200 individuals treated. That reduces the overall benefit of statins by 25 percent, right off the bat." 

33 "Of note, the cost of treating patients with a lipid abnormality that shows up in a lab test, but without any evidence of heart disease, increased from $ 9.9 billion in 2000 to $ 38 billion in 2010.  This is the highest growth rate (14.4 percent) of expenditures for any of the top ten medical conditions, and the only one driven not by the incidence of a disease or actual symptoms, but only by a single lab value." Lucrative yes.

"This embodies the “tyranny of experts”and what has been referred to as “eminence-based”rather than “evidence-based”medicine." Ha! I want to work with this Doc.

34 There are many times unecessary care is given baes on false premise. The PSA cause alot of  grief for alot of pts. Also not needed are well visits. Studies show the more tou stay away from the Dr, the better your results will be. 

40 "More recently, Nate Silver, in The Signal and the Noise, asserted that the industrial revolution of 1775 was sparked by the printing press." The author stresses the importance of the printing press and thenrevolution that it created. He equates that the importance of the digital revolution

Books

Patient, Heal Thyself Robert Veach

Emperor of All Maladies, Siddhartha Mukherjee

Elizabeth Eisenstein classic two-volume book The Printing Press as an Agent of Change.

Marshall McLuhan, The Gutenberg Galaxy

Dead Wake: The Last Crossing of the Lusitania

By Erik Larson

Audio book

Started this one at the gym today. This huge ship with  the distinct  4 exhaust profile,called the "Lucy wen down on May 7, 1915. Sunk by the Germans, whose relentless submarine warfare was the terror of the seas.

Great story about a important historical event and read by Scotti Brick.  Yes Lets do this.

Data-ism: The Revolution Transforming Decision Making, Consumer Behavior, and Almost Everything Else

By Steve Lohr

Library book

2 Data mining makes the invisinle visible. A typical ICU can "generate 160,000 data paoints a second."

4 Data mining will function as a layer of artificial intellegemce on top of the decision making process.

5 Data as a tool is as important as was the telescope or the microscope. 

10 "You can't manage what you can't measure." W. Edward Demming.

15 New Term "data scientist"

24 When exploring a new subject, use Hammerbacher's 3 book rule. "Read at least three books from different prospectives to 'subtract out the author bias'." I like this guy.

28 This guys math instructor at Harvard  was Paul Bamberg,co-founder of Dragon systems. We have the Dragon system at work.

38 whats needed is a GPS for ICU patients. One that,"doesn't need to wrestle with the underlying data."

43 Watson is now available in the cloud. No longer just a Jennings whooping Jeopardy pro, Watson is now.ready for some serious data crunching. IBM's new initiative is.to get developers to write software for it. 

Books

C P Snow The Two Cultures

Pagans: The End of Traditional Religion and the Rise of Christianity

By James O'donnell

Library bcook

This looks good. Lets do this

Before montheism, The Romans had many Gods. They had a God for everything, except premature but I hear even that one was coming quickly.

63 Check out these books by Walter Burkett, University scholar of the ancient world.

72 Killing animals for God, and other pious and ignorant rituals attest to the delusions of man in this plague we call religion. Everybody knows exactly what to do to be "holier than though." And now, to prove I'm holier than you, I'm going to kill you too. Pretty darned ludacris if you aske me.

78 Tertullian AD 200 (Which is now annoyingly 200 CE) was one the early stuanch chroniclers of Christian montheism.

Tertullian was another big name of early Christianity. These are the people who help shaped the Christian mythology. 

The Romans, had no concept of dyimg for gods. To them that was ridiculous. They wanted the Christians to just get in line and put on thr sprimkle of blood or whatever dumdass ritual was being done and.call it.a day. They, the Romans, knew they didn't believe it. That was fine. They went through the motions.to appease the curremt people im power. Not only would the Christians refuse to go along, they would begin to.speechify. Theybwould haughtily preach about how great and pious they were and how this other religion is nonsense. Stop! You're both right. It's all self servimg nonsense.

"Take me to chuch I'll worship like a dog at the shrine of your lies."

94 Josephus on Augury. Josephus tells of am army on the match stopped by an Augur who is staring at a bird in a tree. The General says,"What's the holdup here?" The Augue explains, "I'm watchingt that bird to see which way he flies. That direction must also be our direction for surely this bird knows the future. The General shoots the bird dead with an arrow and as the bird falls to the ground he turns to the Augur and asks, "Then why couldn't he predict that?" This is such a great story.that illustrates wonderfully the complete insanity of claiming to see into  the future. From sacrifice to augury to haruspicy and oracles to the "Psychic Friends Network to the Long Island Medium and to organized religion, its all a show people. These are the conventions of man and not the work of  "Gods." Wake up! 

101 Some earlynworks are lost amd are omly kmown through quotations in the works of others.  Celsus, who wrote arond the year 170, is only know from quptes in the rebuttal by Origen. He has some truthful things to say about the Cult of Christianity then surfacing in Rome. Definetly worth a read.

109 The two maxims on the wall at Delphi were "know thyself" and nothing in excess." Thats some pretty sage advice.

The author says the Cristians invented the Pagans in a sense. They used the word Paganni, wich roughly translates to our "baxk woods hick," to denote those who beleived in the old ways. Its only with the triumph of Christianity that the pagans as a unit were born. Interesting concept.

193 FOM Nicean Council of 380. This is wherentthe Nicean Creed comes from? I though the one in 325 was the olny one.

So Theodosiius ascends the throne and prefers "homoousios." That he believes God and Jesus are of "the same" devine spark. Which leaves Arianism and its doctrine of "homooisisios" or simialr in devine spark. There is leterally one iota (greek word for I) of difference. But it is these subtle difference that cause schisms and much suffering.

For the first time,under Theodosius, the "word Catholic used consistently as a proper adjective."

"It took time but the Creed [the Nicean Creed] and the term homooisisios  [of the same] won out."

In the 5th Century "questions of Christology" would lead to "Nestorianism and Monophysitism" for.close variants of orthodoxy.

Books

Apuleius The Golden Ass

George Frazier The Golden Bough

Hamlets Mill

Losing Our Way: An Intimate Portrait of a Troubled America

By Bob Herbert

Audiobook

So this was frieghtening. From failed wars to failed infrastructure, the American Dream is in peril. Tjis is angood survey of all that is wrong currently.

Eye of the Beholder: Johannes Vermeer, Antoni van Leeuwenhoek, and the Reinvention of Seeing

By Laura J Snyder

Library Book

Who would have thought that two great geniuses in optics would be living right across the street from each other and perfecting their crafts within hailing distance of each other. Leuwenhoek, would dicover a whole new world as yet unseen by anyone else with deziens he would call "animacules." Meanwhile, across the street, Vermeer would perfect the use of a device called the camera obscura to bring three dimensional light and shadowsnto a two dimensional painting. I love the premise of this book. Can't wait to get into it.

7 The 1600's were a time of scientific revolution. The motto was trust no man, observe for yourself. This period was detailed wonderfully in Holmes "Age of Wonder." At the heart of it all was the revolution in optics allowing things heretofore invisible to be studied. And Vermeer said,"Let there be light."

134 So the term camera.obscura is misleading. While is does "obscure" the.image.to a.certain degree, it enhances many aspects. CContempories wrote "that the camera obscura displayed more than  ould be seen with the naked eye." In addition,"it revealed optical laws and the way light works." Art and science hand in hand.

135 The Dutch were natural collectors, with their home "cabinets" displaying the ecclectic of items from around the world.

137 Painters in the Dutch Golden Age emloyed a sense of realism in their paintings. But the artists also had to be skillful enough to use illusion to.trick the eye as well.

141 Experiments would prove the eye to be nature's camera obscura.

144 There is evedence that suggests the first use of the camera.obscura ny Vermeer was for his "only know cityscape...A View of Delft."

145 The Procuress and The Sleeping Maid both show sings of faulty prospective, ie the split screen in the former and the table in the latter, that appear resolved with later paintings. This is seen as a new familiarity with the camera.obscura.

149 Davinci taught us that even shadows have colors. This is a concept I had never thought of before. This shows in the dark blue shading of tje woman's blue wrap in The Milkmaid.

157 Vermeer, instead of tracing images with his camera obscura, used it more as a guide and to play around with the scene before committing it to canvas. Vermeer was in no was a slave to it.

160 The author speculates that the man in The Geogrpher, pictured on the cover of this book, is Leuwenhoek. Not sure about that though.

167 The Treaty of Westphalia in 1648 ended the 80yrs was and gave Independence to the Dutch Republic. It also ened the 30yrs war in the Holy Roman Empire.

192 Where science is in agreement with the church, it flourishes: Where it is not, it dies.

198 Hookenalergic to paint, puts down the brush and picks up the microscope. He coinsnthe term cell for the "little boxes" he sees in his observations.of a cork. Art and science. Hooke's Microgrphia was published in 1665.

207 1672 Rampjaar the year of catastrophe dawned and With the attack of the French and English, Vermeer joins the Army.  

212 Vermeers "specular" higjlights is a.good.topic for further study. The master of light and shadow continues.to amaze.

215 "What Vermeer was painting was the way the eye actually sees, not the way the mind thinks it sees." The human eye, in conjuction with the brain, automaticall adjusts vision to "make sense" of the input. What you see is the end result of this play. Vermeer understood this and tried to omit this "after bias" by painting what the eye actually sees and not the adjustment.

216 Not overly prolific,"Vermeer painted 45 pictures in total, of which roughly 35 are known to us today.

Vermeer loved maps and globes,"[this] obsession beomes apparent in Vermeer's later works." Vermeer used this device "9 times in all, [and] 4 times in his final 9 pictures."

234 Although never published in book form, like Hooke's Micrographia, Leewenhoek's observations were published in the form of letters to the Royal Society.

239 One of the  recurring metaphors throughout this book is "making the invisible, visible.

Public disections became a.form of public entertainment,  but you were not allowed to take home any parts.  Hey whole stole the liver? Come on, give it up. I guess its not anymore grusome than an episode of CSI. 

243 For a sjort while, in this period [1600's], that the woman amd man must achieve orgasm in order to conceive. Goos thing that wasnt the case or there wouldn't have been many babies. Man first discovered orgasm at the dawn of time. Women first discovered orgasms...oh around 1967. 

250 And then, in a letter to the Royal Society dated Setember 7, 1674,Leewenhoek first reported on seeing his "animacules." 

253 "Imagine the shock of realizing, for the first time, that wayer contained a wholenworld of living creatures completely invisible to the naked eye. Up to that time the objects were all inanimate. For the first time a living world was viewed in plain water. This was truly a "day the universe changed."

261 Scientists and others of this time.were reluctant to give away the secrets of how they acoomplished what they did. The tradition of alchemy was to comceal by code names and such to disguise what was really happening in their experiments. There are some who belive old nusery rymes contain specific recipes for experiments. Again, the church was not.jappynwith this type of experiments and even Newton realized tjis and keep his side experiments occult. The fact that Leewenhoek would tell the Royal Society the details of how he did things, infuriated them.

264 Hooke, at this time, was more interested in the study of light and not available to afirm or refure Leewenhoek for the Society, fornwhich he was later censured. He was too busy arguingnwith Newton over what made up light. He proposed it was waves and Newton thought it was particles. Later Einstein, like the Miller Beer commercial, would say "stop you're both right."

266 Then, November 15, 1677, it happened. Hooke was finally available and able.to replicate Leewenhoek. The society members marveled at what they saw as though first looking into "Chapman's Homer." 

Stillwell and the American Experience in China, 1941-1945.

By Barbara W Tuchman

Library Audiobook

Who better to talk about China and Stillwell than Tuchman. Much enjoyment listening to this at the gym

Books

Red Star Over China

Shakespeare Saved My Life: Ten Years in Solitary with the Bard

By Laura Bates

So this is a pretty interesting book I guess. It's about an English professor who teaches Shakespeare to death row inmates. Nice hobby I guess if ya dont like gardening. I guess some of them get it.

Read half but real chore to try the rest but maybe...