I’ve decided to take a course at Yale University called Astronomy 161 – Frontiers and Controversies in Astrophysics. Yale has agreed to allow me, a family doctor who enjoys astronomy without rigorous mathematics, to take this course for free. Although I will earn no official credit from Yale, I will be able to listen in with all the other Ivy League students in the class. Since I’m kind of busy, Yale has agreed to teach me in my bedroom when I get sleepy.

Yale and a bunch of other universities will do this for you, too.

I’ve known for some time that there are universities sharing online lectures, notes, and syllabi over the internet with the general public. Finally I got around to finding and starting a course. It is fascinating, and provides a nice break from all the continuing medical education in which I’m usually immersed. Although we’ll miss the “real college” weekends of partying and pulling all nighters, we would all be foolish not to sit in on a few of these courses when able.

Here is a list of some great sites that offer online courses. Some only share lecture notes, others stream entire semesters of esteemed professors lecturing. I’ll add more links to this page as I learn of them.
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His father and I were once young together, runners of long distances, across fields and suburban drives and teenage battlefields.

Tonight he’s carrying his baby boy, and walking with his wife and me back to their hotel, which looks far away down the concrete city sidewalk.

Revelers in hats and soaked heavy coats celebrate with laughter and drink. There’s only moments left in the old year.

Despite the wintry night we suddenly, naturally take off running, again, towards the glowing hotel. With us is an infant boy with a snotty nose. His eyes are wide, and he’s a spark of fire hurtling through the cold and damp night. He’s smiling, and we are promethean.

With wind in my lungs, spirit in my belly, and an electric storm in my muscles I’m practically flying. I’m giddy. Orion is constant in the firmament as the rest of the Earth streams by. I look ahead and see mother and father dashing on with their cherubic boy, their hope made flesh, laughing wildly as we all run like giants across the spinning globe.

There is no disease, no heartbreak, no sorrow, and no end. We are reckless and young evermore, and despite keeping their child awake on a dreadfully frigid New Year’s Eve, and running like scamps, wildly through the raining city lights – they are among the best parents in the world. I’m certain of it.

Like fabled marathoners, we are all runners in the night, carrying hope, light, and the battle-glorious news that life must go on for another year. It must be met bravely, and the act of living should make running hearts pound with joyful abandon at times.

I’ve lived long enough not to expect justice in this world,
Yet I haven’t given up in its pursuit.

Being sued as a doctor,
for imperfections,
for the inevitable bad outcomes that befall us all,
diminishes and consumes your very spirit:

A doctor’s account, from The New York Times.

What did we learn in 2009?

The editors of Journal Watch, a publication of The New England Journal of Medicine, have compiled a top ten list for the most important clinical pearls of 2009. These stories and findings are consequential and should effect the daily practice of physicians. Although patients may sometimes be frustrated to learn that once-sage advice can be rendered obsolete with new evidence, it is good that modern medicine keeps striving for proof that what we practice is beneficial to health.

Here are the editors’ choices for top medical stories of 2009.
[Hopefully Journal Watch won’t mind that I’ve reproduced them here, since I find great value in my $99 subscription and encourage other clinicians to join, too!]

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What has been the top medical advancement of the 2000’s?

As the first decade of the 21st century comes to an end, it is interesting to look back and reflect on the most significant medical advances we’ve seen. I’ve presented 12 medical advances that I consider to have been the most important over the past decade, added one from commenters’ suggestions, and then narrowed the field down to just 10 finalists. Now I’d like to ask you, the wider world, to vote:

(brief descriptions below; you can vote for up to 3 choices; polls close New Year’s Eve; winner gets the most votes)

So, here is a list with brief explanations:
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It’s morning, and in the shower he reaches a trembling hand up towards his face and strokes his jugular lymph node chain, searching for any indications that the small lumps palpable within might have gotten larger. He feels the same familiar bumps, rolls them like jelly beans inside a package, and wonders if at least one lymph node is rotting with cancer.

As he dresses for work he follows the sinews of his neck down to his thyroid gland, a bowtie beneath his skin. The right side is larger than the left, and this asymmetry surely indicates a malignancy. He’s read that thyroid cancers are actually quite curable, unless he has one of the rare kinds, which he almost certainly does. Three years to go before death, full of surgeries and chemo, if he’s lucky.

At work he’s had a headache for the past week, which is unusual. It is centered above his right eye, and seems to increase in intensity every few minutes. He rubs his forehead to assuage the dull ache, careful not to rub too hard because that might trigger the underlying aneurysm to explode, reducing him to a jiggling heap of jelly on the floor. Conversely, the headache might be a brain tumor.

Driving home he notices an ache in his right shin, most likely from running into the dresser last week. Less likely but still possible is osteosarcoma. The treatment for that sort of thing involves removing the entire lower leg.

After dinner he is reminded that his bowels have been loose of late. Crohn’s Disease, parasitic infection, and colon cancer (probably metastatic) are all possible. Blood in the stool would be a late finding of invasive colon cancer, and when it shows up he’ll know his days are severely numbered.

He knows his thoughts are ridiculous. They are exhausting.

There is no way he could have five distinct cancers at once, yet a feeling of dread lingers. His hands are clammy, his heart beats quickly, and he’s fearful most of the day. He laments the absurd vulnerability of his human condition, rages against the body that would betray his spirit. Sighing deeply and shaking his head he attempts to move on with the rest of the evening.

He’s distracted from reading his book as he runs through the list of today’s symptoms in his mind, and ponders their possible mortal significance. It is somehow calming for him, like thumbing the beads of a rosary while reciting grave prayers.

By bedtime the headache has lifted. The pain from a brain tumor would be constant, he thinks with a measure of elation. Despite the constant fear and anxiety about illness, there is one good thing about his worrying. He’s overcome at least a hundred types of cancer, and averted multiple catastrophic heart attacks, strokes, and seizures. He is perhaps the world’s most resilient being.

At night he smiles as he lays his head down on the soft pillow of his bed. He thinks to himself that there is something gloriously brave about having cheated Death every precarious day of his life.

With all the controversy about the utility of mammography, optimal Pap smear intervals, and risks of prostate cancer screening, you have to ask yourself – what are the most beneficial and cost effective preventive services we should be focusing on?

Here are the top 10 preventive services. These items were chosen by the National Commission on Prevention Priorities, and highlight those preventive services including immunizations, screenings, preventive medications, and counseling that give “the most bang for the buck.”  For an in depth discussion of methods and results, read Am J Prev Med 2006;31(1):52–61

{The Top Ten}:

Discuss Daily Aspirin Use
This counseling does not mean everyone should take aspirin to prevent heart attack and stroke, but rather that individuals at moderate to high risk should weigh with their doctors the risks of bleeding and ulcers against the benefits of reducing cardiovascular disease. Heart attacks, strokes, and peripheral arterial disease accounts for over 900,000 deaths in the United States each year. According to Up To Date, net benefits of aspirin have been proven in secondary prevention for those who’ve already suffered a heart attack, occlusive stroke, TIA, angina, or coronary bypass surgery. Acute ischemic syndromes such as acute MI, unstable angina, and acute occlusive stroke also benefit.

Aspirin use for primary prevention of a first cardiovascular disease event is the most controversial, with recent trends favoring only using aspirin for those found to be at moderate to high risk. The National Commission estimates that “Physicians advising all high-risk adults to consider taking aspirin would save 80,000 lives annually and result in a net medical cost savings of $70 per person advised.”

The discussion with a doctor if aspirin is appropriate for you is very tricky, and is currently undergoing some changes based on new evidence, but the discussion may save your life, either way. Continue reading →