ROB GORSKI, MD

Medical chart of the day: Maslow’s Heirarchy of Needs.

Thu, 23 Feb 2012 11:33:00 -0500

Medical chart of the day: Maslow’s Heirarchy of Needs.

Medical typeface. From the archive of Amanda Pastenkos.

Sun, 29 Jan 2012 22:17:00 -0500

Medical typeface. From the archive of Amanda Pastenkos.

Cole Porter’s “The Physician” by Gertrude...

Fri, 11 Nov 2011 11:31:25 -0500

Cole Porter’s “The Physician” by Gertrude Lawrence, London, 1933.

CONTRAST

Tue, 15 Feb 2011 02:06:00 -0500

life/death. we removed the mechanical respirator from an older woman because her family requested it be done. over the next few minutes her skin gradually changed from pink to pale as the remaining oxygen in her blood was consumed by her tissues. her heart slowed and then it stopped. it was a moving scene.

THE 2012 BUDGET OF THE UNITED STATES. THE BOX FOR MEDICINE IS...

Mon, 14 Feb 2011 16:58:00 -0500

THE 2012 BUDGET OF THE UNITED STATES. THE BOX FOR MEDICINE IS THE BIGGEST. DUBIOUS.

"Professional Judgement" is a Matter of Profession

Thu, 03 Feb 2011 03:31:00 -0500

Quoted from my brother’s college textbook, Financial Accounting, which I borrowed and have been perusing. Chapter One = balance sheets. This is the same brother that gave me a photocopied set of every annual letter Warren Buffet has ever written to his shareholders for Christmas two years ago. Thanks Dave.

“A characteristic common to all recognized professions—such as medicine, law and accounting—is the need for individual practitioners to resolve many problems with their own professional judgement. The problems encountered in the practice of a profession are often complex, and the specific circumstances unique. Consequently, no written set of rules exists to provide answers in every situation.”

In medicine this is certainly true and will always remain such—this is somewhat obvious—but what is less obvious is that this rule is becoming ever more inconsequential. Here’s why: medical judgment has become more and more standardized over the last several generations at a rate that does not have historical precedent. Over the last two decades, especially, very smart physicians have stratified risk factors mathematically, calculated numbers needed to treat (NNT’s) for nearly every medical and surgical intervention, defined ranges of normal and abnormal for all conditions, and forumulated practice standards and checklists for most every medical decision pathway. (These practice pathways extend exactly to the very point of confounding molecular experimental conditions that leave us with drugs and interventions that are equally as likely to harm us as to help us). These advances underpin the successes of medicine historically, of course, but of even more importance for the present state of the profession they represent potentially huge implications for society and industry that have yet to be put forth. For when such repeating patterns and systems are given to the lay population in a conceptually simple fashion, which is no doubt technologically feasible in our time for many circumstances, the economy of medicine will shift.

Physicians, when contrasted to the other professionals mentioned—lawyers, accountants, musicians, etc.—have a very unique profession due to the fact that they spend years being taught to perceive the subtleties of the human biologic mechanism as opposed to systems based in man made conceptual convention. This distinction is important to realize when ordering a system of medical understanding.

Medical knowledge at its root is composed of a set of physical phenomenon that have always existed and have been discovered, rather than created. Our domain is not a rule produced by the collective human mind as is, say, “constitutional law” or “corporate income tax” but rather simply the compendium of biologic causes and effects which have always existed and only subsequently—in the recent historical timeframe of the last 150 years—been observed, recorded and taught. Once they are learned they tend to remain constant and very seldom change. Other professions such as law and accounting, in contrast, are rooted fundamentally in fabrications of the human mind and are by their very definition subject to changing tides of politics, era and philosophy, as are art, music, fashion, etc. Legislation and popular vote can change tax law but it will never change the classic symptoms of appendicitis, cholecystitis, or meningitis. Thus non-medical professional applications root themselves in a combination of human social history and community, while medicine remains focused on the individual who is in practical, biological terms unchanging.

We doctors have historically attempted to hone in on a finite target from a position of curiosity and previously unknown variable. In contrast those practices founded in human conception move in the opposite direction—their funds of knowledge have sprung from the elemental nature of humanity to create complex and artful systems of conception, language and order which did not previously exist. The system of medicine is regressive, in a sense, as it looks into the past and towards the miniscule, while the others are forward moving, taking the fundamentals without questioning their cause and creating new orders and laws from it. While neither system better or worse for such characteristics, this distinction is important and carries significant practical implication for the medical profession philosophically at this unique point in history where our introspection into the body is yielding less and less practical information per unit of time invested in it.

A lawyer must by definition understand the legal system of a specific state within the context of a relative community, historical precedent, era, etc. As a fundamental corollary such a professional could never hope to practice in a foreign land for these very same reasons. Medical doctors, by contrast, are free to skillfully apply their knowledge on any human body and in any counry regardless of where a person resides relative to a map. This unique characteristic of the medical profession will be, I believe, when realized fully, associated with vast implications for investors, governments and society because when data is married to technology allowing parts of the traditional domain of the doctor to be rendered clearly to lay persons independently, judgements medical doctors were once paid to make will become less needed. And once this is reached it may not change. Bad for doctors, perhaps, but good for society.

This realization, then, taken inseparably from a hypothesis that medical breakthrough is reaching the point of practical diminishing return, would be a logical jumping-off point for the profession to purposefully rethink it’s role in modern society and prompt transition from discovery of new information to more efficient representation of well-tried data in realms of education and care delivery. The teaching of conceptual professions requires mastery of a constantly shifting field of reference specific to time and place, which will always be a relative education. Medicine, however, requires only thorough exposure to the set of constants that are relatively unchanging. It is true, of course, that medical constants only begin to become apparent over time periods and physical scales that are both vastly smaller (molecules) and larger (decades) than the human is trained to perceive with his five senses, and that traditionally this has required years of study and experience in a hospital and with cadavers and microscope, however, it does not mean that such hurdles can’t be overcome by the power of data collection and modern media capability. Medical logic, because of its ever-decreasing amount of subjective debate on a practical level, is distinct in that it possesses the possibility of being taught similarly to to how a language or an alphabet is learned.

Any language will seem complex to a novice, especially at first, and of course not everyone will understand and speak languages with the same fluency… but not every lay person needs to be stuck in the contemporary pattern of simple lay medical grammar and limited by webMD access. Exposure to the language, like exposure to anything consistently observable and reproducible, can shift an individual’s ability to use it and interpret it. Technology can now make the subtle sets of data more evident visualy, reproducible and available to the basic logicigal bases we reason by. This may be the key to a new system that could create a solution to our modern medical problem at the root.

The health breakthroughs available to our five senses—experiments and treatments that are repeatable under controlled circumstances without causing more harm than good, undertaken in a clinically applicable timeframe—may be nearing exhaustion. We may have reached the point of diminishing returns from a perspective of cost/benefit. And while it is obviously imprudent to argue that professional judgment would ever become irrelevant to the field of medicine it is not illogical to suppose that its domain could be decreased by a defined set of rules given to the population in understandable terms, thereby moving the task of medical decision making from doctor to patient, along with a significant portion of the 17% of GDP which is currently spent on American healthcare. Properly conveyed knowledge of constants could shift economic expenditure away from medicine and towards more beneficial contemporary social causes.

Such a transition would alter the profession and society in a significant way and perhaps be reason to rationally shift a large portion of our societal spending from discovery of ever-less applicable medical minutia to fundamental education of the population with the wealth of knowledge we already possess. It will likely be that the modern physicians whose names will be memorialized in textbooks for the next generation of students will be those individuals who can collect and visualize data patterns spanning the scales from molecules to centuries and communicate these clearly, rationally and visually. Gone are the days of palpating a gallbladder and assigning your name to the painful grimace a jaundiced patient reflexively makes. We’re due to move on as a profession. The low hanging clinical fruit has been picked and catalogued and much of the remaining knowledge may forever remain outside of the realm of rational understanding due to matters of scale and exponential variability. This is a big idea… if it is true.

"It" doesn't get talked about very often.

Thu, 03 Feb 2011 03:28:00 -0500

It needs to be more affordable.

It’s a right not a privilege.

It should be free.

Who pays for it?

Insurance companies meddle with it up.

Market choice fragmentation increases the cost of administering it.

Canada has it. France has it.

The government controls it.

Electronics record it.

The internet will revolutionize it.

So what exactly is healthcare? This is the interesting fundamental question and this is where the potential for massive marketing confusion and political smoke and mirrors lay. The fundamentals of healthcare hardly ever get talked about on the evening news and, indeed, it seems “the dream of reason did not take power into account,” as Paul Starr stated beautifully with the first sentence of his very good book on healthcare. Regardless, the basic fixes are not that political or sexy in terms of marketing. They are just a set of relatively simple rules based on collective observation.

For over a century the white coat has been an emblem of medicine at its best.

Sun, 14 Nov 2010 17:17:00 -0500

(Thomas Eakins, The Gross Clinic, 1875)

Medical history is remarkable. This quotation is excerpted from a NYU Medical Center publication I was reading while passing time as a lay person the waiting room of the labor and delivery ward while my sister-in-law was giving birth. I find it interesting because it describes the obvious change in the presentation of the physician influenced by the understanding of the microscopic. The past 125 years have bore witness to a truly remarkable shift in the paradigm of the cause/effect understanding of why we become sick and these two photos represent this change nicely.

Suppose, however, that we could be coming to the end of the ride of reason advancing clinical outcome in high yield ways. Were this true it would be even more profound in implication than the medical golden era as it would last for much longer than 125 years of human history. After all the scientific advances may slow (breakthroughs vs. time vs. NNT graphed over the past century would certainly evidence this) and issues of lay-education and politics will likely become more prominent. The “purity of intent of the physician”, though, will likely not change in spite of the shifts in daily practice that result. It will hopefully be accompanied by greater education and data visualization on the part of our patients, allowing them the wisdom to understand their own essence and avoid us in the first place. (Public, heal thyself?) What will a post-microscopic society look like? (One that reaches a finite endpoint of microscopic discovery and intervention and thus realizes it is left with a constant set of conundrums that will not meaningfully change. Fascinating to think about).

“In 1875, when Thomas Eakins—who had considered a career in surgery before becoming one of the most important artists in America—painted The Gross Clinic, surgeons still wore black garb. By the time he created The Agnew Clinic in 1889, the principles of infection prevention had become widely accepted, and white was the standard color of both surgical gowns and hospital coats.

For over a century, the white coat has been an emblem of medicine at its best. Medical students aren’t entitled to call themselves “doctor” until they graduate four years later, but the first time they feel like a physician is the moment they don their white coats during a ceremony that began in 1993 and is held each August at most of the nation’s 145 schools of medicine and osteopathy. In the world of medicine, perhaps no symbol is more vivid and ubiquitous, no rite of passage more momentous.

Exactly where, when, and how the white coat came to achieve its current status remains a medical mystery, but just over a century ago, it became the standard uniform of the profession. Prior to the late 19th century, physicians wore black garb, as black was (and still is) the color of formal attire, and medical encounters were considered serious matters. In the 10th century, medicine came to be known as a truly scientific enterprise, and hospitals came to be seen as institutions for healing rather than houses for dying. White, the color of hope, was a fitting symbol for the infinite promise of modern medicine. The Latin word candidus, meaning white, is the root of the word candor, and truth, after all, is the foundation of all professional societies.

The color of the doctor’s coat functions on other levels, as well. It symbolizes not only cleanliness, but purity of intent—a visual reminder of the physicians’s commitment to do no harm. LIke the black robe of a cleric or judge, it is a form of nonverbal communication—a pledge of trustworthinesss, confidentiality, and proper professional distance. Its power lies in its simplicity, representing dignity and authority, and commanding honor and respect. Above all, the white coat is a cloak of compassion, the hallmark of a true caregiver.

The white coat represents the importance of what we as physicians do every day, and the value of medicine to those who come to us seeking help,” says Mark Hochberg, MD, professor of surgery and director of surgical clerkship, who has written about its history. ”It symbolizes one of the best concepts of society—that individuals are devoting their lives to truly helping people who are ill, who turn to us with anxiety and hope. More than anything else, the white coat is emblematic of the fact that we can help people, physically and emotionally. As such, it should only be worn for interactions with patients and in a healthcare setting. It should not be worn carelessly around town because that diminishes its importance as a symbol. The white coat gives physicians the standard against which they must measure their every act of care to the patients who trust them.”

(Thomas Eakins, The Agnew Clinic, 1889)

The Standard Kilogram

Thu, 28 Oct 2010 01:17:00 -0400

The standard kilogram. It is kept in a vault outside of Paris. A significant portion of the world’s commerce is based on this piece of metal, directly or indirectly, which was created in 1795. Standards are a good thing. Contemporary medicine needs more and better. Picture data visualization standards which incorporate objective image as well as time. Picture stop-action animation all grown up.

THE FRAUD OF PERPETUATING AN "EXPLOSION" OF NEW MEDICAL INFORMATION

Wed, 27 Oct 2010 15:25:00 -0400

I respectfully disagree. There is no medical information explosion. There isn’t. Certainly not in the way this junk mailing implies. It arrived in my mailbox today and is typical, I I think, of how society perceives modern medicine.

It is a wonder to me that physicians are encouraged by educational tradition to perform basic research and publish new “breakthroughs” that today, by all practical measurements, lie exceptionally far out on the cost/benefit curve. It is astounding really, and even contrary to science itself, perhaps—this pursuit of decreasingly applicable medical information—yet it remains a rite of passage for medical students, residents, and doctors of supposed merit.

Here are a few titles from the inner flap of the above pamphlet supporting the “explosion of medical information”:

Magnesium infusion might improve outcomes after subarachnoid hemorrhage
Comparing face mask ventilation techniques in edentulous patients
Automated chest compressions increase blood pressure
Emergency department use of Droperidol in adolescents in the ER

These are for the most part breakthrough studies that yield little practical knowledge yet the pamphlet implies that in order to stay “current and relevant” doctors should study these journal articles or risk being left behind by the wash of new information. Is this true?

In the first example—a study of a group of people who fell hitting their heads causing bleeding around their brains—it was found that during medical treatment, in addition to standard protocols, Magnesium, given intravenously, might help patients in such unfortunate circumstances. Or, as an obvious corollary, it might not.

The study was inconclusive

(a research paper would otherwise reflect positive findings in its title by convention). Thus a physician having read this article will discover only that a new treatment is relatively ineffective versus a standard therapy of non-intervention.

In the next title, “Comparing face mask ventilation techniques in edentulous patients”, the researchers studied a group of patients so old that they no longer had teeth (edentulous) that also required face mask ventilation (a circumstance which implies exceptionally advanced pulmonary disease, emphysema, etc). After reading this a physician will have gained some vestige of knowledge, yet whatever it may have been, it benefits only a small segment of society (toothless, elderly, lifetime smokers), and likely to a miniscule degree at that. Hardly groundbreaking stuff. Yet I’m sure the physician who wrote it was lauded by his colleagues or stepped up a rung in the hospital pecking order. The ER, of course, would still overflowing the entire time whilst this occurred.

In the third paper titled “Automated chest compressions increase blood pressure”, the studied group is, by virtue of the title, so close to death that they are undergoing CPR and require chest compressions. Such compressions, then, are reported to have the effect of increasing blood pressure when performed by a machine versus when done by a person. How significant is this? Likely not very. No mention is made of whether the patients survived treatment or not, but simply that their blood pressure was increased during the effort. This is hardly knowledge that a practicing physician can’t live without.

In the end after reading enough modern medical research it becomes clear that the patients in these and similar studies (the majority populating JAMA, NEJM, etc.) usually progress according to their fates unchanged, or minimally so, in spite of the studied variables, and no profound medical breakthroughs are made. In most every example a larger underlying battle has likely been previously lost predicating the situation studied. I.e. aging, a terrible fall, cardiac arrest, decades of smoking, obesity, type II diabetes, sedentary lifestyle, genetic predisposition, bad luck, etc. Modern medical papers are filled with reports of little or no success when compared to either standard therapy or non-therapy. Some may argue that the there needs to be searches for needles in haystacks to bring about progress, but if a graph were made on a historical basis there is no doubt that it would show that modern needles are buried under larger and larger piles of hay.

By comparison, historical precedent in medical breakthrough was not always such equivocal business. In the early to mid 20th century our medical forefathers in western Europe and on the east coast of America published titles encompassing great and widely applicable scale. Examples have included:

Antibiotics Successful in Killing Bacteria
Fever, Right Upper Quadrant Pain and Jaundice Signal Gallbladder Disease
Gallbladder Discovered to Secrete Bile
Immunization Created Against Polio
Intra-abdominal Laparoscopic Surgery Performed
Anesthesia allows for Surgery

This era saw amazing forward advancement for the masses and by comparison the modern research titles, filled with esoteric details benefitting few, if any, clinically, read like parody newspaper headlines. In 2010 the question that begs to be asked is why are physicians still studying such things?

I would say that there is little justification from the cost/benefit perspective. Yet ironically, while the scale of breakthroughs has become ever-smaller and outcomes more fragmented, the pressure to perform research has increased. The reason is simple enough. 1) publish or perish. 2) that is how it has always been done. The professional advancement associated with clinical research still holds political and financial sway over departments and positions of power in spite of the fact the the literature itself is seldom widely applicable or influential to practical care of patients.

Publication is likely encouraged by our mentors and chairmen because the system remains enamored with the historical precedent of medical breakthrough made by the remarkable doctors of yesterday playing on a different field. Maybe some of these physicians are old enough to remember the fruitful legacy and retain the hope of recreating a new medical golden age via contemporary clinical research. Perhaps it is simply a matter of unexamined habitual force. Nobody seems to discuss, however, that our forefathers, by definition were working under more favorable conditions conducive to making fresh discoveries applicable to human health on a wide open scale (afterall the biologic and microscopic frontiers had yet to be discovered or were just recently brought to light). Today, on the other hand, low single digit percentage point improvements over predecessor therapies are vast money makers for industry and career changers for doctors and every modern study still ends with the caveat that “clearly more study is needed”, almost as an equivalent statement to “more marketing needs to be sold”. In the place of benefit for humanity studies have come to represent benefit for marketing firms and industry interest. In many instances further study is not necessary. Perhaps it might be as simple as honestly admitting that we’ve banged our heads against certain walls long enough.

The latter point—that marketing influences scientific inquiry—is important to realize as you can’t overlook the obvious fact that science sells. Study data is often complicated and thus can be manipulated to influence both physicians and lay people by industry. It can induce hope and fear, both powerful motivators, regardless of whether they are of any clinical benefit. Unfortunately, as a result science for the sake of science is seldom performed anymore and in its place stands science for profit. The endpoint of such efforts is a balance sheet rather than fundamental outcome.

As a profession it is clear that we have not considered from a serious and soundly reasoned perspective the possibility that modern clinical academic research may never again move the mountains it once did. We have also not considered that attempting to bring such results to fruition may be counterintuitive practically, societally, and financially for our patients, communities and country. The very attempt to continue on our current academic project has such enormous opportunity cost yet it yields such little useful information. It is simply unsustainable and unjustified.

Scale is also a problem seldom mentioned when research is discussed and conclusions presented. In 2010 the medical community’s basic research that is thought by society (and the media) to hold so much promise is largely aimed at issues scaled on such minute proportions that they are almost incomprehensible to rationally approach. At some point microscopic variables become impossible to control for. The irony in the end is that the modern medical questions that remain unanswered are rooted in scales we cannot technically visualize, both in terms of absolute distances involved (molecules, atoms) and length of time needed for properly controlled experimental conditions (nanoseconds in the case of molecules or decades in the case of populations). Said otherwise, the low hanging fruit has already been picked and few things will be able to reverse this trend outside of a new set of physical rules. This is especially true when considered from a cost/benefit perspective.

It is borderline crazy that we continue to celebrate minimally incremental efforts and advance the careers of those amongst us the most skilled at making statistics appear impressive on paper in spite of the outlandish numbers needed to treat they represent for our patients (review the concept of NNT). Perhaps we as a profession know of no other way. Perhaps this persistence is synonymous to a freight train which has not yet started to put on the brakes and will take time to come to a full stop. Perhaps it is a manifestation of fragmented doctors failing to address communal problems we see each day in our individual daily practices. Perhaps it is as simple as nobody liking a short seller, as is said in business terms. Certainly we doctors all feel the root causes of the true contemporary medical frontier yet we don’t seem to have the vocabulary to express it. Instead we find ourselves in a cycle of bazaar professional stasis antithetical to our heritage of doing no harm.

Times have changed and our profession’s measures of ‘academic’ success must change. Our data has become more complex and our judicial values must become similarly complex. Cultural success of “medicine” needs to be measured and included at the top of any contemporary healthcare grading sheet. We need to develop the ability to peer review our collective pursuits from a societal perspective and secondarily build mechanisms to wisely direct our microscopic curiosities.

As a side note, I would, of course, never purchase the service advertised above. I might entertain the idea of selling shares of the company short based on a bet that reason will prevail, sooner or later, and that this type of marketing organization will be dubbed shortsighted in retrospect as a result of the realization that such papers have no clinical effect on the health of the individual or the population. As a professional who is learning the language of medicine at the source via daily practice I can see how much misinformation and secondary gain exists within contemporary academic journals.

The bottom line is that medical reality is not changing as fast as industry and the media would have you believe and because of this you should not be afraid of things you cannot change and you should also realize that a new market is being created for those who can figure out how to sell/encourage restraint to the layman.

Brooklyn Emergency Rooms. Been there, done that. They are...

Sun, 03 Oct 2010 11:09:00 -0400

Brooklyn Emergency Rooms. Been there, done that. They are wonders. After one spends enough time getting to know them the repetition of the human condition becomes remarkably succinct. The superficial details of each patient’s subjective perception become obvious amidst a grand medical democracy (the wealthy Russian man and the poor hispanic woman have different ways of expressing symptoms of a heart attack, yet the measured language their bodies communicate is exactly the same) and the reproducible, objective, patterns of human condition stand out in blunt contrast. Herein lies the opportunity for the marriage of internet, data collection and human experience which has the potential to create new standards by which lifestyle choices can be validated and modeled after.

Photo by Matt Jones, MD, a former colleague at the New York Methodist Hospital Emergency Medicine Residency.

Hypomania in the context of business

Sat, 18 Sep 2010 21:32:00 -0400

“A thin line separates the temperament of a promising entrepreneur from a person who could use, as they say in psychiatry, a little help.

Consider that the man displays many of the symptoms of a person having what psychologists call a hypomanic episode. According to the Diagnostic and Statistical Manual — the occupation’s bible of mental disorders — these symptoms include grandiosity, an elevated and expansive mood, racing thoughts and little need for sleep.

“It’s about degrees”, says John D. Gartner, a psychologist and author of “The Hypomanic Edge.” “If you’re manic, you think you’re Jesus. If you’re hypomanic, you think you are God’s gift to technology investing.”

Excerpt from an interesting article in the NY Times today.

The cloudy tell tale of bacterial meningitis. Some things never...

Wed, 16 Dec 2009 00:21:00 -0500

The cloudy tell tale of bacterial meningitis. Some things never change (faster than natural selection, that is).

The average human life expectancy extrapolated to the infinite future will look like this.

Thu, 10 Dec 2009 20:17:00 -0500

“During the Roman Empire, Romans had a approximate life expectancy of 22 to 25 years. In 1900, the world life expectancy was approximately 30 years and in 1985 it was about 62 years, just two years short of today’s life expectancy.”

Due to issues of scale and the limitations of our senses (and the technology they produce) people generations from now could very well look back on our hopeful sentiments about aging and feel nostalgic about our lack of foresight. ”How passe”, they will chuckle as they tip back a drink with friends.

The upward slope of life expectancy we experienced during the medical revolution of the last century cannot possibly continue. Diminishing returns will be the rule in spite of our hope otherwise. Policy will adjust accordingly. Markets will adjust accordingly. Some [biologic] things will never change.

Early adopters will realize that there is a major historical discrepancy between the slope of the line in 2009 and the dollars being spent trying to increase it.

North Dakota

Thu, 10 Dec 2009 19:35:00 -0500

North Dakota

Can a capitalist society do the opposite of this?

Can it value natural states without harvesting the largest monetary value from them? Can this once-prairie ever again reach it’s climax state of biological succession in light of the forces of profit and subdivision? I say that it couldn’t.

It could be argued that the Nature Conservancy is a potential answer but I’d say that this is neither capitalist nor regenerative. A private game park? There are no historical examples and the scale of those that exist is much too small. The obvious conclusion is that there is no significant ecosystem claw-back potential from private market forces, regardless of how a hypothetical majority might feel (or vote). The mechanism does not exist.

If you break it down to fundamentals here is what has happened: a conscious act of man took control over a natural process creating a new product which, depending on your values, is either good or bad. That process of reformation had countless externalities not accounted for by capitalist balance sheets, and, centrally, some of these externalities preclude the ability of the original to ever exist again. This is significant.

Medicine has countless analogous examples. Whoever realizes them and succeeds in bending the system to reason accordingly will have a financially lucrative disruption on their hands.

Modern times demand modern tailoring. Introducing the new white...

Thu, 03 Dec 2009 21:31:00 -0500

Modern times demand modern tailoring. Introducing the new white coat for medical doctors. www.thelabcoat.org

Photo

Thu, 03 Dec 2009 15:09:21 -0500

Under Construction

Wed, 02 Dec 2009 17:17:51 -0500

Under Construction. Beware.

Exhibit notes from the medical museum of Charite Hospital, Berlin.

Tue, 01 Dec 2009 23:44:00 -0500

“In the middle of the 19th century, the laboratory took its place next to the pathologist’s dissection hall as a central location for medical research. Young researchers transferred the latest insights from biology, physics and chemistry to human beings. Their aim was to perform pure science and not lose themselves in philosophical speculations about the essence and meaning of life. According to them, organic life was joined indivisibly with the solid structures and liquid parts of the body. Using special experimental devices, they wanted to find, define, measure, note and evaluate the mechanisms of life - in the healthy as well as the sick - that can be perceived with the senses. The experiments should be run with controls and be repeatable at any time in any place. These standards reflect the expectation that objective models of the functioning of the human body could be developed in order to derive sustainable diagnostic and therapeutic measures.”

Very good. But what’s next?

The Broselow Cart. 16x24’ framed archival prints...

Tue, 01 Dec 2009 20:38:00 -0500

The Broselow Cart. 16x24’ framed archival prints available. Series of 20. $150. It would look good in your office. Abrasive and colorful, like medicine.