Hi There!

If you'd like to chat, check if I'm on Yahoo Messenger now or not.

Welcome to my online journal! Please leave a note here and feel free to comment on my entries. Let me know who you are, how you found me, etc. I can see the IP address of each person who visits me, so it would be a pleasure to connect a name to a visitor.

I've been writing regularly for several years now and am always delighted to meet a new person.

However, for greater privacy, I'm making all my personal entries friends-only from now on. All new public entries will be impersonal.

If you'd like to be my LiveJournal friend and read my hidden, personal entries, please read this and create a LiveJournal account.

Then go to my user info page and click on the + sign to add me as a friend. I will only add back people I know or grow to trust.

Warm wishes and enjoy your time here,

Raymond
Email: rayning (at) yahoo (dot) com

I am starting to train for a triathlon, and I have started a new blog to document my progress. It's called tri_blog.

I will NOT post here for several months.

Thank you.

I've organized all my posts on Sicko and universal health care here.

Lawrence K. Altman, M.D. is a full-time health journalist for the NYT. He used to work for the CDC.

Rise of a Deadly TB Reveals a Global System in Crisis (NYT):

By LAWRENCE K. ALTMAN, M.D.
Published: March 20, 2007

LOS ANGELES — The spread of a particularly virulent form of tuberculosis in South Africa illustrates a breakdown in the global program that is supposed to keep the disease, one of the world’s deadliest, under control.

During a tuberculosis outbreak in South Africa, patients often infected one another in clinics not designed to allow a quick quarantine.

The program was intended to detect tuberculosis cases, make sure patients were taking their antibiotics, test patients for resistance to those drugs and monitor the spread of the disease.

But international tuberculosis experts say the system is in deep trouble for an array of reasons: misuse of antibiotics; other bad medical practices, like failing to segregate high-risk patients in hospitals and clinics; and cuts in government spending for such basics as adequate supplies of drugs and laboratories to do the testing.

Such factors have led to the rise of drug-resistant tuberculosis bacteria, a menace the world has only begun to appreciate.

Mycobacterium tuberculosis, the microbe that causes the disease, was discovered 125 years ago this month. Today, the bacteria infect 8.8 million people a year and cause 1.6 million deaths. They are spread in tiny droplets when patients cough.

Tuberculosis is curable, as long as the bacteria are susceptible to antibiotics. It becomes deadlier when it attacks people who are also infected with H.I.V., the AIDS virus. And when the tuberculosis bacteria become extremely drug-resistant, the death rate soars.

That was the case in Tugela Ferry, a rural town in KwaZulu-Natal province in South Africa, when an outbreak of extremely drug-resistant tuberculosis — XDR-TB for short — killed 52 of its 53 victims, all of whom were also infected with H.I.V. The outbreak was detected in 2005, but it did not receive international attention until it was reported at the international AIDS meeting in Toronto last August.

The World Health Organization calls the extremely drug-resistant form “a grave public health threat” because of its potential explosiveness among the millions of H.I.V.-infected people in poor countries. It seems to be a lesser threat among people who do not have H.I.V., though it could be dangerous to the millions with weakened immune systems from treatment for cancer and other diseases.

XDR-TB is defined as tuberculosis that is resistant to the two most important antituberculosis drugs (isoniazid and rifampin), along with two other drugs: a member of the fluoroquinolone class and at least one of three others (capreomycin, kanamycin and amikacin).

A step lower on the resistance scale is a form of the disease called MDR-TB, for multidrug-resistant tuberculosis. An outbreak of that form struck in New York City in the early 1990s, and cost at least $1 billion in emergency measures to control and manage tuberculosis patients.

Experts say the tuberculosis outbreak in South Africa is the deadliest one that they can recall.

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Scar-free surgery? New ways to skip the scalpel: Going through the body's natural openings can reduce pain, recovery time (AP)



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Duke MBAs Fail Ethics Test (BusinessWeek): Thirty-four Fuqua School of Business students are accused of violating the school's honor code by cheating on an exam.

Physician Burnout and Stress Now Reaching Critical Levels (PRWeb):

Scottsdale, AZ (PRWeb) April 12, 2007 -- Physician stress increased dramatically over the past twenty years. In spite of achieving career and financial success, today's physicians are stressed and overworked, often losing sight of their career goals and personal ambitions. The resulting frustration, anger, restlessness, and exhaustion are known as physician burnout and adversely affect the quality and costs of patient care.

"There is a growing body of scientific evidence that leading a balanced, integrated life is integral to preventing physician burnout. Furthermore, evidence also indicates that physician satisfaction is a significant contributor to patient satisfaction," said Howard Silverman MD MS.

Survey results suggest that levels of professional dissatisfaction among physicians have doubled in only a few decades. In 1973, less than 15 percent of several thousand practicing physicians reported any doubts that they had made the correct career choice. In contrast, surveys administered within the past 10 years have shown that 30 to 40 percent of practicing physicians would not choose to enter the medical profession if they were deciding on a career again, and an even higher percentage would not encourage their children to pursue a medical career.

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From these physician assistant job ads:

Correctional Facility, CA - Part-Time or Full-Time Physician Assistant

Opportunities at many CA Correctional Facilities throughout the state. Ten hour shifts. $95-135/hr depending on prison. Basic Urgent Care work. Need to be independent contractor with own malpractice insurance which we would assist you in obtaining.

Wow. California has a prison health care crisis---overcrowding, poor conditions, mismanagement, and a big health worker shortage. Contractors get HUGE pay.

JUDGE GRANTS RECEIVER’S REQUEST TO RAISE SALARIES FOR PRISON MEDICAL STAFF: State law to be waived---Action will improve quality of care, help fill vacancies, reduce cost of contractors.

About the federal receiver, Robert Sillen.

In June of 2005, Judge Thelton Henderson ordered California to place its prison health care system in a federal receivership with these scathing remarks: "By all accounts, the California prison medical system is broken beyond repair. The harm already done... to California's prison inmate population could not be more grave.... an inmate in one of California's prisons needlessly dies every six to seven days due to constitutional deficiencies..." In July, the federal receiver appointed by Judge Henderson reported that the California prison health care system suffers from "bureaucratic paralysis," with "almost every necessary element of a working medical care system" either nonexistent or "in abject disrepair."

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Amazing. Taken from crasch. I'm feeling my love handles now. :(

John Stone took pictures of himself every day for 479 days from January 6, 2003 until April 28, 2004, then every month on the first of the month to the present. He says that his physique changed solely due to diet and exercise (no steroids). You can
watch a video of his transformation here. (2.4 MB Quicktime)



Skeptical? Check out his blog of how he resculpted his body, with photos.

Read his FAQ.
How does he stay so disciplined?

His site gets between 1 and 2 million hits a day. He went from 30% body fat to 8%.

A creative solution to our insane housing costs, as well as an antidote for our need for excess...

Small houses challenge our notions of need as well as minimum-size standards (San Francisco Chronicle):

By Carol Lloyd, Special to SF Gate

Friday, April 27, 2007

Photos: Artist-builder Jay Shafer stands in front of his 96-square foot house...


Down a rambling residential road on the outskirts of Sebastopol, the dream house sits like a testament to discriminating taste.

This dream house is the love child of artist-builder Jay Shafer, who lovingly hand-crafted it. The stainless-steel kitchen, gleaming next to the natural wood interior, is outfitted with customized storage and built-ins. From his bed, Shafer can gaze into the Northern California sky through a cathedral window. In his immaculate office space, a laptop sits alongside rows of architectural books and magazines -- many featuring his house on the cover. And from the old-fashioned front porch, he can look out on a breathtaking setting: an apple orchard in full bloom.

But in an era when bigger is taken as a synonym for better, calling Shafer's home a dream house might strike some as an oxymoron. Why? The entire house, including sleeping loft, measures only 96 square feet -- smaller than many people's bathrooms. But Jay Shafer's dream isn't of a lifestyle writ large but of one carefully created and then writ tiny.

Shafer, the founder of Tumbleweed Tiny Houses, began his love affair with diminutive dwellings about 10 years ago when teaching drawing at the University of Iowa in Iowa City. "I was living in an average-sized apartment and I realized I just didn't need so much space," he said. "I always envied people who had smaller homes, because they didn't have to do as much housework."

He bought an Airstream trailer, remodeled it and spent two years suffering the long, bitter winters before conceding that insulation was one amenity he was unwilling to forgo. "So I started from scratch and built myself a small house," he told me. He built the 100-square-foot home on wheels and parked it on a friend's farm outside of Iowa City. Eventually, he moved back into town but not without some difficulty. "I wasn't allowed to put the house on a city lot, because it was too small," he explained, referring to the minimum-size standards in the codes of many cities and counties across the country. So he bought a house, put his little house in the backyard and rented out the main house.

By 2000, he had decided this would be a way to channel his artwork, feed his hunger for simplicity and escape the rental rat race. After a friend asked him to build a house for him to live in, Shafer launched Tumbleweed Tiny House Co. in 2000. The friend went on to become the president of the Small House Society -- and thus was written one more episode of the small-is-beautiful movement. Shafer began building and designing little houses for people who wanted them as backyard retreats, second homes or primary residences. Eventually, he sold his own first home because he wanted something smaller and then built himself a 70-square-foot home on wheels (now called the XS House on his Web site).

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Here's the business report mentioned below: "Health Care in the Express Lane: The Emergence of Retail Clinics," by Mary Kate Scott. She's a principal of Scott & Company, a strategy consulting firm giving services to health technology firms and their investors. She's also a professor at USC's Marshall School of Business.

The two major health retail clinics I know: MinuteClinic and RediClinic. Both hire nurse practitioners. I'm not sure if they hire PAs.

Retail health clinics are a growing trend that let you get treated for a limited list of routine ailments without seeing a doctor. They are quick (15 minutes), cheap, first-come first-serve (no appointments needed), open 7 days a week (and at nights) and are inside drugstore chains like Walgreens or CVS (which just bought MinuteClinic).

From last year's news:

The Minute Clinic Movement: Model for the Future or 60 Seconds of Fame?: Retail health clinics offer convenience for basic care, but aren't for everyone; financial viability remains an issue

July 18, 2006

Located in mini-malls and discount stores and sporting catchy slogans such as "You're Sick, We're Quick," a new wave of retail health clinics promise to transform a small piece of the health care landscape, according to a report by the California HealthCare Foundation (CHCF).

The idea behind the clinics is this: As Americans are asked to pay more out of pocket for their medical care, they will begin to approach these purchases with more of a shopper's eye. It's an idea gaining in popularity. Last week, drugstore chain CVS announced that it will acquire MinuteClinic, an operator of 83 in-store clinics in ten states.

Proponents believe retail clinics offer a way to help reduce inappropriate use of hospital emergency rooms for basic medical services. For the un- and under-insured, the clinics offer an alternative way to access primary care services. According to the report, Health Care in the Express Lane: The Emergence of Retail Clinics, the number of retail clinics in the United States is poised to grow from fewer than 100 today to several thousand by the end of 2007.

"There's a scarcity of new ideas about how to improve the cost and delivery of health care, and retail clinics have the potential to bring much-needed innovation," said Mark D. Smith, M.D., M.B.A., president and CEO of the California HealthCare Foundation. "However, their survival isn't dependent on successfully competing with physicians; it's coffee shops, banks, even vending machines—whatever is the most profitable use per square foot for the retailer."

Thus far, consumers have mixed feelings about the clinics. A 2005 online Harris poll found that 78% of the public thinks the clinics could provide a fast, convenient way to receive basic medical services, but 75% had concerns about the quality of care. Only 7% of the survey's 2,245 respondents had actually visited a retail clinic.

Questions remain about how the clinics will fare as a business model. Most of the privately owned clinics are leasing space in retail outlets and they will stay in business only if they meet exacting profit targets. Some states, including California, have regulations on the scope of practice of nurse practitioners that make it more costly and difficult to operate such clinics, the study finds.

In contrast, this is from my friend, a new nursing grad from Johns Hopkins who just left her job at UCSF, after 11 weeks of exhausting and frustrating training. She had wanted to become a nurse practitioner, but now she wants to go back into the business world and help with clinical trials.

I have the greatest admiration and respect for nurses, the vital and important work they do, and what they must endure to do it. Bravo to them. One of my classmates told me she thought I would have been a good nurse. But I wouldn't have been a GREAT nurse.
________________
From my UCSF friend:

I have felt like a juggler trying to multitask my patients. It's difficult to spend quality time with them, especially if the acuity level is high and there are too many patients to handle. Here's an article I found in the NY Times which resonated with me. No wonder many new nurses leave the general hospital floor in search of other avenues of nursing.

The Last Shift (NYT):

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She is behind on her charting. She is ''way late'' in delivering yet another medication to Mr. Niemann to lower his blood pressure before his liver biopsy. And she has heard there are four patients down in the emergency room, all of them candidates for Mr. Finder's recently vacated bed. There is pressure, too, to discharge Mr. Tempel, despite Mitchell's worries that he is too weak to go home. Her phone rings again with the nurse's aide on the line: Mr. Beaudry is insisting that the button he pushes to release pain medication has stopped working.

''First thing in the morning, I can conquer anything,'' Mitchell says. ''But by 11, reality has set in. I give up on the idea that my day's going to have any organization to it.''

All things considered, Mitchell is reasonably fortunate. She lives in a state where the nursing shortage is significant but not yet dire, and she works in a hospital that courts nurses with signing bonuses and flexible scheduling. On 3 East, the vacancy rate hovers around 5 percent, meaning the unit is normally short a few nurses. But this is the point: a few nurses matter. Whereas Mitchell says she is at her best dividing her time between two critically ill patients, she more often is tending to three or four. Even under decent conditions, the nursing shortage acts like a slow bleed, draining the optimism of its hardiest veterans.

Karen Mitchell is careful not to impugn the hospital, careful to note that she believes her patients get good, if less than perfect, care. And yet she admits to feeling a deepening fatigue. ''During a hard shift, when I can't get to everything and I know that patients aren't getting what they deserve, it's like, Why do I come back?'' Mitchell says as we spend her 30-minute lunch break in the hospital coffee shop. ''What's the point?''

It is an uncomfortable, downbeat moment for Mitchell, one that feels confessional, like a good soldier admitting to a single treasonous thought. At first I think she is simply being too hard on herself, but later I wonder whether Mitchell's guilty despair is a reflection of a larger symbolic load nurses carry. If nurses are the human face on our health care system, then when that system is failing -- and who can argue that it isn't? -- it is nurses who are left to articulate that failure personally to their patients. The pressure on nurses today is perhaps as psychological as it is physical, and it's taking its toll. Research shows that a registered nurse is three to four times as likely to be dissatisfied than the average American worker. And young nurses tend to have their idealism quickly dismantled: one in three hospital nurses under 30 reports she is planning to leave within a year. ''Frankly, I'm so sick of teaching new kids on the block,'' Mitchell tells me, ''because they just turn around and leave.''

After lunch, I wander into 3 East's break room, a windowless space dominated by a single long table, where a group of nurses linger over cups of yogurt and microwaved leftovers. When I remark that the unit seems busy today, Tina Janiak, a straight-talking, brown-haired nurse who started at the unit in 1995, laughs. ''This is average,'' she says. ''Sometimes, especially on weekends, they've got two nurses to 10 patients. It gets to a point where it's just not safe.''

This sets off a chorus of commentary. ''Every single one of my days off, I get a call from the hospital, asking if I can come in and work,'' says another nurse. ''I'm too burned out already.''

''I don't want to be doing this 10 years from now,'' Janiak says. ''It's too exhausting.''

''I don't want to be doing it in five,'' says a third. Somebody else checks her watch. Break's over. One by one, the women adjust their stethoscopes and shuffle from the room, tossing their garbage into a can by the door. Until there is only one nurse left, a doe-eyed woman in her 20's who has been quietly reading a book at the far end of the table. Getting to her feet, she looks at me and shrugs, indicating she has nothing to add. ''I'm new,'' she says, almost apologetically. ''I'm not bitter yet.''

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=============================================

From my UCSF friend, who worked in a step-down unit. A step-down unit is designed to provide care for those who need less monitoring than those in the Critical or Intensive Care units, but still require more monitoring than those on the medical or surgical units. She is Asian. She wrote this:

I finished my 10th week of orientation last week (which was supposed to be my last), but the unit manager extended it another week. She said she didn't feel I could be a safe nurse on my own; she was not sure if the floor could give me enough resources to safely care for my patients (meaning that I could not handle taking care of 4 complex patients on a busy floor).

I had 3 complex patients yesterday, one of which was a handful. She was an extremely obese Afro American woman who was HIV positive, had congestive heart failure and was a terror who had been on the floor for awhile. She was also extremely rude and yelled at everyone. On my shift, she was bleeding out large blood clots from her butt. Plus she was incontinent, so she pooped all over; fortunately, she was on a Foley [catheter] for her pee. So we must have changed her sheets, chux, and wiped her bottom at least 10 times in 2 hours (I kid you not). It looked like she was internally bleeding to death. But as we took blood samples and inserted a new IV, her CBC (cell counts) showed her hemoglobin and hemocrit (called H and H) going up, not down, which did not make any sense. The doctors could not figure out what was wrong with her.

Plus, she had a racist attitude. "You look all yellow. You must be sick." (meaning that she was being rather derogatory and she knew it.) She also said the same thing about the 24 hour Asian sitter that was hired to watch over her. A, my preceptor, was Caucasian and said that the patient could not say things like that to me and could call A names instead. The patient would say no to everything, including taking blood samples, but A had to coax her to let the phlebotomist take it or to have me do procedures on her. The doctors asked that an NG tube (nasogastric tube) be put down her nose. I was going to do it, but she did not like the way I looked and refused to let me touch her. So A did it, but the tube ended up going from her nose into her mouth and we could not tell if she was bleeding in her stomach or not. (Later on, another doctor would try and he would not succeed either; she was belligerent and would not hold still.) If I had that patient on my own, I don't know if I would have been able to care for her.

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I still have access to my university library online, so I can read medical/nursing journals and entire medical books online, free. This is from the Journal of the American Academy of Physician Assistants (JAAPA).

A Day in the Life (JAAPA):

by Michelle Grisonichi, MPAS, PA-C

Michelle Grisonichi is completing the PA surgical residency program at Duke University Medical Center, Durham, North Carolina. She has indicated no relationships to disclose relating to the content of this article.

When I started PA school at the University of North Texas Health Science Center, I knew I would focus on surgery. I had worked in the OR as a clinical assistant for 3 years while attending college, and becoming a surgical PA was definitely at the front of my mind. But not until my clinical rotations during my third year of PA school did I research attending a PA surgical residency program. I wanted to hone my skills as a PA in surgery and get more experience with larger cases, patient management, and multitasking before settling into a surgical position. I also wasn’t sure which surgical field I wanted to go into, and attending a surgical residency would let me rotate through many while exploring my options. I was accepted to Duke University Medical Center’s surgical residency for PAs.



0500 HOURS

I arrive at the hospital and find the intern who was covering the night shift. We go over my list of patients on service, and the intern tells me what happened overnight. Luckily, this time none of my patients had had any problems and all were stable. I go over their lab, culture, and pathology reports so that I can report any new findings to my chief resident. If any patient has an abnormal lab value, I circle it and try to put together a possible differential diagnosis and care plan before rounds.

0530 HOURS

The interns, residents, and chiefs meet to discuss who will be on what surgeries for the day. I am listed on three surgeries for that morning. The first case starts at 0815. I find my team, which consists of a chief resident and a fourth-year or third-year resident.

0540 HOURS

We begin rounds. Today we have eight patients on our service, but sometimes I am managing 15 to 20 patients on the floor. As we round, I present each patient to my chief resident. We go over labs, vital signs, and the plan for the day. When rounds are finished, I put in the orders for all my patients. I fill out discharge paperwork for a patient who is 3 days post-op after an appendectomy and fill out scripts for his discharge medications. I finish early with all my orders, so I dictate his discharge summary now rather than wait until later. I know it will be a busy day.

0615 HOURS

I go to the M&M (mortality and morbidity) conference, which we have every Wednesday morning. All the general surgery interns, residents, chief residents, and attending physicians are there. The chiefs present surgical cases in which a death or complication occurred. When my chief presents a patient I have taken care of, it is interesting to replay events and hear ideas about how the patient could have been managed differently. The chiefs usually present four or five cases, and the attendings discuss and pose questions about management or treatment.

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This is HILARIOUS! If you're wondering what else you could do with your life, here are a few ways to be profitably and pleasantly (if uselessly) employed, from Stanley Bing's book, 100 Bulls**t Jobs … and How to Get Them.

For example:

Job #41: Political reverend
Turn public issues to personal advantage.

$$: Millions, if you've got a good TV gig going on. A lot less, if you don't.

The upside: All kinds of people hugging you, throwing money at you.

The downside: You have to be careful when you check into that motel with Lurleen.

The dark side: What do you mean, the IRS is on line two?
___________
Job #43: Quantum physicist/string theorist
Produce theories about the nature of the universe that are not amenable to proof by normal human means.

$$: Academic professor salary. If you become a cultural icon, like Brian Greene or Stephen Hawking, you can be one of the few who attain rock star status equal to that of, say, the host of a popular cooking show.

The upside: In your hands you hold the secret to the machinery that runs the universe. That's heady stuff, which is good--because you're a head case, dude! But seriously. The media loves you. Your last book was a best seller that everyone bought but nobody read, which, as you know, is the very best kind. And while other guys from your class are playing with petri dishes, you're accelerating fictional particles at hyperspeed underneath the mountains of Switzerland.

The downside: None of what you do helps anybody understand anything.

The dark side: Tomorrow... next week... perhaps a year or two from now... some sharp kid is going to come along with a theory that takes a wicked detour directly from Einstein, goes completely around quantum theory, and explains the entire universe in simple, elegant terms that do not need a billion-dollar machine to prove. Your entire realm of endeavor will be relegated to a footnote on the twentieth century, the way the nineteenth was obsessed with phrenology--the science of reading head bumps.
______________
Job #40: Poet
Drink, write very little, diddle students, generally have license to misbehave while sponging off friends and other nonprofit organizations.

$$: $350 per annum from your actual poetry or if you're serious about a career in the business, you earn whatever college professors are making this year, plus what you get from these very cool writer-in-residence gigs you can apply for.

The upside: Unlimited sex from adoring fans. The knowledge that your pain can be turned into something of artistic and/or commercial value. The right to drink all night and wake up at dusk.

The downside: You give a reading of your work at a small lecture hall of a university that does such things. They put you up at the Travelodge. The night of the reading, you go to dinner with the head of the English department at a sad, empty place that still features a blue plate special. Eight people show up at your reading. One of them has a bottle in a brown paper bag and is dressed wrong for the season. Afterward, you go out for drinks with him.

The dark side: You are a dead caboose sitting empty on a neglected piece of track somewhere in a forgotten rail yard. You tell yourself that when you're dead, you will be appreciated. All things considered, that seems like a long time to wait.

Where you go from here: Greeting card writer.

Wow! Tim Ferriss's book, The 4-Hour Workweek: Escape 9-5, Live Anywhere, and Join the New Rich, is now ranked #8 of all Amazon.com top-selling books! It just got published yesterday!

He's ranked higher than new books by Lee Iacocca, Russell Simmons, and Dr. Jerome Groopman. Almost as high as the new Harry Potter (#1). By the way, I am thinking of buying Dr. Groopman's book, How Doctors Think. It's excellent. I think all future doctors should read it.

This guy really knows how to market and sell! (Of course, I've been helping him here, too.)

Tim wrote the steps he took, as a first-time author, to get his book published by Random House, the world's largest publisher.

I met Tim at this party in San Francisco last Friday. He gave me a free advance copy of his book. In his introduction, he says he got into Princeton with SAT scores "40% lower than average" and his high school admissions counselor telling him to be more "realistic."

Arnold gave this fantastic speech at Georgetown University last Wednesday, promoting his new environmental push in California. (Click to see video, which also includes his Q & A. He's a master at dealing with people.)

I wrote about Schwarzenegger here and linked to the video of his Charlie Rose interview.

His enthusiasm, creativity, practicality, and bipartisanship are amazing! I worked in California government before, for one of the most powerful people in California. I know how much gridlock we've had in the past, between past Legislatures and Governors.

His main point: environmentalists need to change their marketing strategy. For too long they have been Puritans, trying to motivate people with guilt, nagging, and scolding. That does not work, and they came off as people on the fringe. We need to show people that environmentalism is mainstream, is practical, is sexy, and can lead to more ECONOMIC progress. We can have BOTH environmental progress and create business and jobs.

We need to do it the right way, by promoting and developing new clean technologies. Here are changes the Governor is working on for energy and the environment. He says the environmental movement and attitudes on global warming are now at a "tipping point," where momentum and public acceptance have changed.

His speech at Georgetown:
________________
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Now, I know this is an environmental conference, but I do want to start talking first about bodybuilding. And the reason is because bodybuilding is another passion of mine, as you probably know, and it has similarities there. Bodybuilding used to have a very sketchy image. As a matter of fact, so much so that some people that worked out seriously and pumped weights didn’t admit they were doing bodybuilding. As a matter of fact, say in the old days, some of the very famous Hollywood actors like Kirk Douglas, Clint Eastwood, Charles Bronson, and the list goes on and on, they all worked out with weights, but they never admitted it publicly because they didn’t want to be associated with the gymnasiums that were like dungeons and that had fanatics, and that had weird people training in there. That is the kind of an image that it had.

But we changed that, we consciously changed that. And what we did was, we came out with a book called Pumping Iron—I know a lot of you are familiar with that, especially the students—then the movie Pumping Iron, and that changed bodybuilding, the image of bodybuilding, dramatically. As a matter of fact, the perception of bodybuilding began to change and it became more and more hip and more and more attractive. And then all of a sudden, everyone wanted to exercise. As a matter of fact, today you can go to any place in the world and you will find a bodybuilding gymnasium or a place where you can do weight resistance training, and you can go into any gymnasium and you will find ordinary people talking about their abs, their lats, their deltoids, body fat, and all those kinds of things. So this is how much it changed. It became mainstream, it became sexy, attractive.

And this is exactly what has to happen with the environmental movement. Like bodybuilders, environmentalists were thought of as kind of weird and fanatics also. You know, the kind of serious tree huggers. Environmentalists were no fun; they were like prohibitionists at a fraternity party. (Applause)

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Now that President Bush has helped tilt the Supreme Court to the right, watch out. They had always allowed abortions in case of medical emergency, when the woman's life was at stake. Now that has changed.

A Woman's Choice (Newsweek): I needed that now-banned procedure known as 'partial-birth' abortion. Why the Supreme Court's 5-4 decision to outlaw it was a dark day for American women.
_______________
Supreme Court abortion rule chills doctors (Reuters):

WASHINGTON, April 23 (Reuters) - The U.S. Supreme Court's ruling last week that outlawed a certain abortion procedure could be a first step of greater government intrusion into private medical decisions, doctors said on Monday.

The ruling will also almost certainly intimidate doctors who provide any type of abortion services, according to a series of commentaries in the New England Journal of Medicine.

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Alta Charo, a professor of law and bioethics at the University of Wisconsin, said the law would only directly affect a handful of abortions -- with just 2,200 out of 1 million abortions in 2000 having been intact dilation and extraction procedures.

But they are done when physicians consider them medically necessary, she said. This is the first law that does not consider a woman's health, Charo said.

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From addict to physician -- a determined life (LA Times): Donald Kurth beat his heroin addiction to become a doctor and now is also Rancho Cucamonga's mayor.

By Jonathan Abrams, Times Staff Writer
April 23, 2007

Donald Kurth stood in a New Jersey courtroom in 1969 at the mercy of the judge.

A heroin addict, Kurth had been arrested for petty larceny and drug possession. His oversized jeans sagged at the waist. His belt had been stolen that week by a corner drug-seller in Harlem.

Perhaps seeing a speck of promise in the 20-year-old, the judge offered him drug rehab instead of jail.

Kurth balked. If he did the time, he'd be back on the street sooner.

Consider it a gift and take it, his attorney told him.

Nearly 40 years later, Dr. Donald Kurth still reaches back to that memory for inspiration. The judge's gift ultimately led to college and then Southern California, where he is chief of addiction medicine at Loma Linda University Behavioral Medical Center — and mayor of Rancho Cucamonga.

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I usually don't have time to look at computer games, but these look really cool! I haven't tried them yet. What do you think? Can you recommend other excellent business and medical simulators?

Abandonia is an excellent site full of "abandonware."

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The point is, Abandonia is chock full of hundreds of FREE major computer games from the 80s and 90s, of all types (my favorites are simulation and strategy)! Most of them you can download, free. I even found 1980s games like The Ancient Art of War (a military strategy game based on Sun Tzu's famous book) and Lode Runner, which I loved playing as a kid.

Medical people, check these out!

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2. Life and Death 2: The Brain (1990), developed by a doctor, lets you do brain surgery:




Because these games are for older computers, you need to run a DOSBox to use them. It emulates an old Intel 286/386 CPU.
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Business tycoons, check these out:

This first game is the COOLEST one!

1. IndustryPlayer (2005) lets you create and manage your own corporation in a virtual economy. It is the most realistic online Business Simulation Game. Be a virtual Entrepreneur in control of a globally operating industry holding. In real-time, you compete against hundreds of players from around the globe for profits and market share. Experience real competition within a simulation of real market forces.



The goal of this turn-based business strategy game is to maximize your market share and wealth. IndustryPlayer uses actual industry data and allows its 80,000 worldwide players to simulate real business conditions in a real-time, interactive environment. Start with ten million dollars, and buy and run up to five companies. Choose from among 225 product licenses in 16 industry sectors. Before making your selection, you can see the purchase price, production capacity, market demand, and competitive profile.

Manage raw materials, intermediate products, and finished goods. Learn to deal with takeovers, labor strikes, supply shortages, disasters, insurance, and credit ratings, or get beaten by your competition.

Download a free trial of IndustryPlayer. You may play on the first tutorial level for free. But you must keep paying to play. They say it can be as easy or complicated as you want, to play.

Business students at places like UC Berkeley's Haas School, the U. of Michigan business school, the Indian Institute of Technology, the Kellogg School of Management, the National U. of Singapore, Fudan U., and the U. of Hong Kong are also using IndustryPlayer to compete against each other, as entrepreneurs, in real-time!

2. Capitalism II (2001): "Create and control the business empire of your dreams. This in-depth strategy game covers almost every aspect of business that could be encountered in the real world. Use marketing, manufacturing, purchasing, importing, retailing and more to become a corporate CEO. This is the most comprehensive business simulation available."

I own this game. It's not free. It's hard to play and learn, and I don't have enough business/finance knowledge to fully use it.



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Here in the Bay Area, new nursing graduates make around $40 an hour, according to my friends who are new grads. That's not counting overtime pay, which is 1.5 times that.

Dana-Farber nurses easily approve new, generous contract (Boston Globe):

4/18/07
Nurses at the Dana-Farber Cancer Institute yesterday approved a contract that will make them the highest paid nurses in New England, according to the Massachusetts Nurses Association, with senior nurses making more than $140,000 a year by 2009.

The three-year contract, settled after only five bargaining sessions, will give the cancer center's 225 nurses cumulative pay increases of from 9 to 23 percent, depending on their specialty and experience, the union said. A fulltime registered nurse with 15 years experience would make $67.78 an hour, which translates to $141,000 annually.

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