Wednesday, April 16, 2014

If a nuclear bomb exploded in downtown Washington, what should you do?

Funny question in the headline, yes?

But since President Obama worries more about the threat of terrorists' improvised nuclear device going off in a major American city than anything Russia can throw at us, I was wondering if the government had deigned to share with us citizens any tips for, you know, surviving something their own intelligence points to as the likeliest unlikely Black Swan event.

Well, no. And yes.

No — very few people in Washington, D.C., who work for the government have any idea what they would do if a 10-kiloton nuclear device exploded at the intersection of 16th and K streets.

You can always look to movies to figure this stuff out, right? And in movies, since nuclear radiation is BAD, the thing to do is to get away from it as quickly as possible. In the movies, electronics are fried, too, the response is chaotic, and hundreds of thousands of people die.

Interestingly enough, though, the government has done quite a bit of work to figure out what exactly would happen if a suitcase nuke — which, I know, doesn't really exist, but, for the sake of this example, bear with me — actually did explode a few blocks from the White House.

And curiously, and perhaps hearteningly, it turns out that there is quite a lot that you or I can do if we get stuck in Washington when something like that happens. Choices we make could very well make the difference between our imminent death and a relatively full and happy life, assuming the bomb is a one-off.

The Lawrence Livermore National Laboratory released a report in 2011 that spells all this out. It hasn't gotten nearly the attention it deserves.

It's called the "National Capital Region Key Response Planning Factors for the Aftermath of Nuclear Terrorism" and it makes for fascinating reading.

Did you know, for example, that:

1. The WORST thing for someone to try to do, in the aftermath of a nuclear explosion that they survive, is to get in a car and drive away.

2. Unless you're within about a third to a half a mile radius of ground zero and the shelter options are poor, the BEST thing for someone to do is to find a stable location inside a well-built apartment or office building — the majority of which will remain standing outside that half mile radius — and stay there for 24 hours.

And if you were very close to ground zero and you did survive — and a lot of folks will — the best thing for you to do is to:

A. Take immediate shelter somewhere, because fallout will rain down on you if you don't.

B. Wait an hour.

C. Then, walk about a half-dozen blocks laterally until you find intact large buildings to shelter you.

3. The electromagnetic pulse from a ground burst will NOT, in fact, knock out all types of communication. Some? Maybe.

4. If you live in a single-family house with thin walls, your chances of surviving in the immediate aftermath of a blast and not getting cancer later are exponentially higher than if you seek shelter in a bigger building, even one that might literally be next door.

5. Rescuers should NOT put on radiation protection gear if it will slow them down. So long as the fallout has stopped falling, they're best advised to turn out in their normal gear.

6. Though thousands of people will die from the blast effects, almost all — about 96 percent — of the other potential casualties could be avoided if people understood the basics of what to do in the event of mass radiation exposure.

7. Did I mention that the worst place to be in the immediate aftermath of a nuclear blast is in a car trying to get away? The so-called DFZ — the Dangerous Fallout Zone — will extend out as much as 20 miles, but it is likely to be extremely narrow. (If it's not, that means the concentration of radioactive particles will be lower.) The vector and location of this zone depends on the wind. And its size will shrink with every passing hour.

8. Penetrating trauma from broken glass is probably the largest treatable cadre of blast injuries.

I admit that I don't know what forum the president or anyone else could use to educate people in major cities about this stuff. Government never wants to alarm people. But maybe a little bit of alarmism is worth it, if it turns out that a terrorist's nuclear blast is a lot more survivable than we might think, if only we do certain things.

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Horrible confessions from fast food workers

Hilarious flight attendant safety speech

The facebook baby invasion might be a figment of your imagination

Getty Images
Last year, I experienced a Facebook trauma that made me question if I could ever trust my News Feed again. There I was, scrolling away and minding my own business, when the photo of a sonogram popped up: “The arrow is pointing at baby’s scrotum/peepee!!” the caption exalted. “That’s our boy!!! Mommy and Daddy love you soooo much!!!!” For some reason, I hadn’t registered that this would be my News Feed’s natural progression after all of those engagement ring, “OMG I SAID YES, NOW CHECK OUT THIS ROCK!,” photo shoots. And like that, I started seeing baby Facebook photos everywhere.

Or maybe, like many other Internety 20-somethings, I was just being melodramatic. Because according to a piece on Wired,which enlisted the help of Microsoft Research computer scientist Meredith Ringel Morris, there really aren’t that many baby photos out there.
After a child is born, Morris discovered, new mothers post less than half as often. When they do post, fewer than 30 percent of the updates mention the baby by name early on, plummeting to not quite 10 percent by the end of the first year. Photos grow as a chunk of all postings, sure—but since new moms are so much less active on Facebook, it hardly matters.
New moms undershare. I’m probably more likely to see someone taking a selfie with Crab Cakes Eggs Benedict than their progeny. But I am probably less prone to be shocked by bacon and eggs than I am by a peer entering the parenthood stage of life.

Morris said that another reason why baby photos might seem to show up more frequently could be because they get a disproportionate amount of likes and, thus, get promoted on feeds. I’ll admit, I panicked and liked the “Peepee” shot… I’m part of the problem!

So what it all comes down to is, we all need to chill out and stop whining about the baby pictures. Even though some people definitely do overshare—a Twitter employee recently live tweeted her own labor—it’s not that big of a deal.

Tuesday, April 15, 2014

On the anniversary of the Boston Marathon bombing: One victim's story

How being a doctor became the most miserable profession

By the end of this year, it’s estimated that 300 physicians will commit suicide. While depression amongst physicians is not new—a few years back, it was named the second-most suicidal occupation—the level of sheer unhappiness amongst physicians is on the rise.

Simply put, being a doctor has become amiserable and humiliating undertaking. Indeed, many doctors feel that America has declared war on physicians—and both physicians and patients are the losers.

David Ramos/Getty
Not surprisingly, many doctors want out. Medical students opt for high-paying specialties so they can retire as quickly as possible. Physician MBA programs—that promise doctors a way into management—are flourishing. The website known as the Drop-Out-Club—which hooks doctors up with jobs at hedge funds and venture capital firms—has a solid following. In fact, physicians are so bummed out that 9 out of 10doctors would discourage anyone from entering the profession.

It’s hard for anyone outside the profession to understand just how rotten the job has become—and what bad news that is for America’s health care system. Perhaps that’s why author Malcolm Gladwell recently implied that to fix the healthcare crisis, the public needs to understand what it’s like to be a physician. Imagine, for things to get better for patients, they need to empathize with physicians—that’s a tall order in our noxious and decidedly un-empathetic times.

After all, the public sees ophthalmologists and radiologists making out like bandits and wonder why they should feel anything but scorn for such doctors—especially when Americans haven’t gotten a raise in decades. But being a primary care physician is not like being, say, a plastic surgeon—a profession that garners both respect and retirement savings. Given that primary care doctors do the work that no one else is willing to do, being a primary care physician is more like being a janitor—but without the social status or union protections.

Unfortunately, things are only getting worse for most doctors, especially those who still accept health insurance. Just processing the insurance forms costs $58 for every patient encounter, according to Dr. Stephen Schimpff, an internist and former CEO of University of Maryland Medical Center who is writing a book about the crisis in primary care. To make ends meet, physicians have had to increase the number of patients they see. The end result is that the average face-to-face clinic visit lasts about 12 minutes.

Neither patients nor doctors are happy about that. What worries many doctors, however, is that the Affordable Care Act has codified this broken system into law. While forcing everyone to buy health insurance, ACA might have mandated a uniform or streamlined claims procedure that would have gone a long way to improving access to care. As Malcolm Gladwell noted, “You don’t train someone for all of those years in [medicine]… and then have them run a claims processing operation for insurance companies.”

In fact, difficulty dealing with insurers has caused many physicians to close their practices and become employees. But for patients, seeing an employed doctor doesn’t give them more time with the doctor—since employed physicians also have high patient loads. “A panel size of 2,000 to 2,500 patients is too many,” says Dr. Schimpff. That’s the number of patients primary care doctors typically are forced to carry—and that means seeing 24 or more patients a day, and often these patients have 10 or more medical problems. As any seasoned physician knows, this is do-able, but it’s certainly not optimal.

Most patients have experienced the rushed clinic visit—and that’s where the breakdown in good medical care starts. “Doctors who are in a rush, don’t have the time to listen,” says Dr. Schimpff. “Often, patients get referred to specialists when the problem can be solved in the office visit.” It’s true that specialist referrals areon the rise, but the time crunch also causes doctors to rely on guidelines instead of personally tailoring medical care. Unfortunately, mindlessly following guidelines can result in bad outcomes.

Yet physicians have to go along, constantly trying to improve their “productivity” and patient satisfaction scores—or risk losing their jobs. Industry leaders are fixated on patient satisfaction, despite the fact that high scores are correlated with worse outcomes and higher costs. Indeed, trying to please whatever patient comes along destroys the integrity of our work. It’s a fact that doctors acquiesce to patient demands—for narcotics, X-rays, doctor’s notes—despite what survey advocates claim. And now that Medicare payments will be tied to patient satisfaction—this problem will get worse. Doctors need to have the ability to say no. If not, when patients go to see the doctor, they won’t actually have a physician—they’ll have a hostage.

But the primary care doctor doesn’t have the political power to say no to anything—so the “to-do” list continues to lengthen. A stunning and unmanageable number of forms—often illegible—show up daily on a physician’s desk needing to be signed. Reams of lab results, refill requests, emails, and callbacks pop up continually on the computer screen. Calls to plead with insurance companies are peppered throughout the day. Every decision carries with it an implied threat of malpractice litigation. Failing to attend to these things brings prompt disciplining or patient complaint. And mercilessly, all of these tasks have to be done on the exhausted doctor’s personal time.

Almost comically, the response of medical leadership—their solution— is to call for more physician testing. In fact, the American Board of Internal Medicine(ABIM)—in its own act of hostage-taking—has decided that in addition to being tested every ten years, doctors must comply with new, costly, "two year milestones." For many physicians, if they don't comply be the end of this month, the ABIM will advertise the doctor's "lack of compliance" on their website.


In an era when nurse practitioners and physician assistants have shown that they can provide excellent primary care, it’s nonsensical to raise the barriers for physicians to participate. In an era when you can call up guidelines on your smartphone, demanding more physician testing is a ludicrous and self-serving response.

It is tone deaf. It is punitive. It is wrong. And practicing doctors can’t do a damn thing about it. No wonder doctors are suicidal. No wonder young doctors want nothing to do with primary care.

But what is a bit of a wonder is how things got this bad.

Certainly, the relentlessly negative press coverage of physicians sets the tone. “There’s a media narrative that blames physicians for things the doctor has no control over,” says Kevin Pho, MD, an internist with a popular blog where physicians often vent their frustrations. Indeed, in the popular press recently doctors have been held responsible for everything from the wheelchair-unfriendly furniture to lab fees for pap smears.

The meme is that doctors are getting away with something and need constant training, watching and regulating. With this in mind, it’s almost a reflex for policy makers to pile on the regulations. Regulating the physician is an easy sell because it is a fantasy—a Freudian fever dream—the wish to diminish, punish and control a disappointing parent, give him a report card, and tell him to wash his hands.

To be sure many people with good intentions are working toward solving the healthcare crisis. But the answers they’ve come up with are driving up costs and driving out doctors. Maybe it’s too much to ask for empathy, and maybe physician lives don’t matter to most people.

But for America’s health to be safeguarded, the wellbeing of America’s caretakers is going to have to start mattering to someone.

Tuesday, April 8, 2014

"Twin Peaks" is almost 25 years old...but still a television masterpiece

ABC
Nearly 25 years after it first premiered on ABC, Twin Peaks — the brainchild of David Lynch and Mark Frost — continues to exert an inescapable gravitational pull on the imaginations of viewers and on the television landscape as a whole. Yes, there is still the totemic power of such influential series such as The Wire, or Six Feet Under, or The Sopranos, but Twin Peaks remains a powerful shorthand for ethereal, riveting mystery, and for good reason.

Nominally about the investigation into the murder of homecoming queen Laura Palmer (Sheryl Lee), the serialized drama was responsible for creating the nightmares of many as it delved into both the seedy underbelly of a seemingly idyllic town in the Pacific Northwest and into a haunting dream world where giants and dwarves roamed the halls of the Great Northern Hotel, perfect cherry pie could be had at the local greasy spoon, and murder most foul could rip a town in two. The show itself embraced the somnambulist visuals of its co-creator, infusing the whodunnit with a lyrical, somber, and, at times, terrifying feel. (You all know which moments I mean: a tableau of lovelorn teenagers singing a song segues into a nightmarish encounter. A skipping record signals doom. Red curtains part to reveal horrors.)

For those of us who experienced the show as it aired, tuning in each week to gather more clues about Laura’s killer and marvel at the deductive reasoning skills of the show’s resident Sherlock, FBI Special Agent Dale Cooper (Kyle MacLachlan), it’s almost impossible to describe the strange appeal that Twin Peaks had and the hunger to solve the murder in the days before Twitter, Television Without Pitymessage boards, or social media at all. It was a true watercooler show in the days when such things as watercooler conversation still existed. It caused many a sleepless night as you pondered just what the dwarf meant, or whether Laura’s lookalike cousin Maddy Ferguson (also played by Lee) was connected somehow to the specifics of her death.

But Laura’s murder was a MacGuffin of sorts: It was intended merely as an introduction to this odd little place and these very strange individuals that populated the town of Twin Peaks. And that town itself represented a sort of thwarted and idealized past, one stuck in the facade of the 1950s, a great society that prided itself on its saddle shoes and fitted angora sweaters, where unspeakable acts occurred behind closed doors. What the show did was take the viewer inside the conscious and subconscious minds of those quirky denizens, giving us a saintly hero in the form of Cooper who would be tempted again and again with the easy lures of lust, power, and complacency. Teenagers investigated the murder of their peers, biker gangs squared off as torch singers swayed in the half-darkness at boozy backwater bars, femme fatales ran their red lacquered nails over the backs of their oblivious lovers. Twin Peaks took our collective desires and dreams and ran them through the dark prism of classic film noir.

It’s Laura’s best friend, Donna Hayward (Lara Flynn Boyle) — reeling from the murder and a blossoming affair with Laura’s secret lover James Hurley (James Marshall) — who says it best: “It’s like I’m having the most beautiful dream… and the most terrible nightmare, all at once.”

And that’s Twin Peaks in a sentence, really.

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This device can charge a cell phone in 30 seconds



If you have a smartphone, you probably know the horrible feeling of packing up to leave the house, only to realize it is about to die.

Such a situation leaves you in a pickle. Do you risk being late for a couple minutes of precious, precious charge? Or do you resign yourself to an afternoon without email, Instagram and Candy Crush?

Enter StoreDot, an Israeli tech startup that hopes to make this exact conundrum a thing of the past. The company claims to have created a new battery pack that can fully charge your phone in a mere 30 seconds. Yes, even if you're at 0 percent.

The pack, which premiered Monday at a Microsoft Think Next event in Tel Aviv, relies on microscopic magnets called "nanodots" to enable its game-changing charger. As you can see in the above video, the prototype attaches to a phone that is then juiced up in half a minute.

Sadly, you shouldn't expect your own 30-second charger anytime soon. The battery pack is still in the prototype stage, and a company spokesperson says mass production won't commence until 2016, according to TechCrunch.

In the meantime, StoreDot will face two major challenges: Figuring how to shrink the technology so that it can fit in existing smartphone designs, and how to get the cost down. As of now, it will come out to twice the price of the average phone charger,according to The Wall Street Journal.

But having raised $6.25 million to date, StoreDot is confident that "nanodots" represent a big opportunity for the future -- and not just in terms of charging phones. According to the company's website, Bioorganic Nanodots could potentiallyrevolutionize TV displays, digital storage, batteries and bio-medical technology.

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