It's not exercise, it's training

The shit is going to go down.  Probably.

A few years ago, I suddenly noticed the need to purchase pants a waist-size bigger.  I was out of college and generally inactive, while my diet had remained consistent with the high metabolism that led a high school football coach to suggest an intestinal worm infestation.  Enter Christopher Barefield.  An old friend, Chris and I began growing closer as we committed ourselves not to regular exercise, but to training.  Why do we train?  We train for when the shit goes down.

What, might you ask, does this shit going down entail?  And how might one train for it?  We're not sure.  But over the span of human history, it seems as though for many societies, it happens.  So we train.

That training has taken many forms over the years, from regular pre-dawn runs through Highland's parks to hours spent pulling plastic at the climbing gym.  And while preparation for the imminent going down of said shit is an important motivator, the sheer satisfaction of physical fitness is what must drive any training.  Now don't get me wrong - I'm certainly not a meat-head and I fall far short of training with the intensity I'd like.  I am in full agreement with Tyler Durden of Fight Club when he says, "Self improvement is masturbation."  But I find a much needed escape from the boxes of my world in challenging and improving my physical fitness.

In recent years, Chris has taken an interest in Mountain Athlete, a training gym in Jackson, Wyoming.  He passed along this article, "Everything You Know About Fitness is a Lie," which calls us to reconnect with the simple training methods that are the foundation of any real training program.  I find it both convicting and affirming.

It's funny how people feel more at liberty to tell you how they felt about your mustache once you've shaved it off.

Are US Medical Graduates Turning to Primary Care?

Robert Centor, an internist and an Associate Dean at UAB School of Medicine, publishes a blog on internal medicine, american health care and health education called db's Medical Rants.  This week he posted on the results of the US medical graduate match.  For those unfamiliar, the match is run by the National Residency Matching Program, and functions frighteningly similarly to the undergraduate sorority matching system, but replacing ice-water teas with interviews and "squeal day" with match day.  After a lengthy application and interview process, residents-to-be list out programs in order of their preference, and programs rank the applicants, and then a computer (not quite so sophisticated as Watson) runs the numbers and determines who will be placed where and for which specialty training.  For instance, I had friends match nearby at UAB in fields from internal medicine to radiation oncology, and as far away as Portland, Maine, and Portland, Oregon in emergency medicine and otolaryngology.  Anyway, recent trends have shown increases in the number of US medical school graduates filling residency spots in specialties considered to be primary care, including pediatrics, family medicine and internal medicine.  For years, these have been among the least attractive fields for US seniors (in terms of percentage of spots filled) due to a variety of factors, including lower earning potential and what is perceived to be a more stressful working environment.


Centor is encouraged that this year's preliminary results show an increase in the number of US medical seniors choosing primary care specialties.  However, I disagree with his analysis of the data.  In fact, the results are nothing more than a numbers game.  In the last decade, most medical schools expanded class size by about 10%, and a few new schools popped up.  As he Centor points out, there has been no correlating expansion in residency spots.  The only place for the excess US grads to go is into less competitive specialties – those where US graduate matching rates are below 60%, like internal and family medicine.  An important point to remember is that US medical grads are not the only applicants competing for spots - osteopathic medical school graduates can also apply to those spots, as can international medical graduates (including US citizens trained at off-shore medical schools).  I don't believe the results reflect a growing appeal of primary care so much as necessary spillover.  Students are still overwhelmed by the weight of debt with which they graduate, and they are still drawn to specialties that assure "good" compensation.  So long as dermatologists make half again a pediatrician's salary without working on Fridays, rest assured that the specialty will remain that much more competitive.  You also make a excellent point that the number of primary care physicians cannot grow until residency training spots increase.  All in all, the results are good PR for medical schools and residency programs, but lacking in real substance.

Friday Pick of the Week

This week is the 25th iteration of South By Southwest, an annual music, film and media festival held in Austin, Texas.  SXSW is perhaps the nation's premier venue for indie bands.  Four Birmingham bands will be representing Alabama this week, and I had the good fortune to catch them this past weekend at Birmingham Magazine's Second Saturday Listening Party at Urban Standard.  The bands are Delicate Cutters, Green Seed, Through the Sparks and Great Book of John.  The last is the source for this Friday Pick of the Week.  Happy travels.

Find more artists like The Great Book of John at Myspace Music

Nuclear Meltdown and Libertarianism

Harold Meyerson recently published an editorial in the Washington Post on three supposedly infallible structures - the American financial system, deep-water oil drilling and nuclear power.  He sites our current faith in the infallibility of science and technology as a potential Achilles heel, as evidenced in the recent economic recession, BP disaster and Japanese nuclear crisis.  He sites the danger of a hands-off, libertarian policy towards such structures, calling instead for regulation in the realms of food safety, economic and environmental policy.  A quote:


"The market may in time punish bad actors, which is the ostensible safeguard that libertarians prefer to regulation. Yet as the people sealed inside their homes in the vicinity of Japan’s malfunctioning nuclear plant could tell us, untold numbers of innocents may pay a much higher price, more quickly, than the executives and shareholders of offending companies. "


While I believe his calls for "active, disinterested government regulation" are a bit naive (government is never disinterested), I think he makes a sound point against libertarian philosophy that assumes inherent morality in the free market.


So, the question remains, what do we do with nuclear power?  Many of the old-guard environmental activists have, in recent years, converted to a pro-nuclear stance.  They site the cleanliness of the energy and rising energy demands fueled by development and population growth.  I am reluctant to make decisions on policy in the midst of turmoil, but in the wake of Japan's emergency, what do we do with the obvious risks posed by nuclear energy production?


Props to Jim Rice of God's Politics for the Meyerson link.

The End of Poverty

One of my winter reads was Jeffrey Sachs The End of Poverty, a book promoting a worldwide plan to end extreme poverty by 2025.  The head of Columbia University's Earth Institute, Sachs is an economist who stumbled somewhat backwardly into the realm of international economic development.  He has since become a leading voice calling for debt forgiveness and other policies aimed at freeing the poorest countries from the cycle of poverty.  Sachs plays an interesting role: on the one hand, he is a harsh critic of the International Monetary Fund, the World Bank and the wealthy countries that use foreign aid to accomplish their political ambitions, and on the other hand he is an unashamed capitalist singing the praises of industrialization and free-trade.  He is a firm believer in the United Nations Millennium Development Goals (he helped draft them), and much of the book is dedicated to calling rich countries to fulfill their promises to the rest of the world.


Most Americans believe that upwards of 20% of our federal budget is dedicated to foreign aid.  With disasters like we've seen in the Haiti earthquake and Indonesian tsunami, the US is on the forefront in promising emergency relief.  However, Sachs points out that despite all of our promises, the US gives only approximately 0.2% of our Gross Domestic Product to international economic development.  In fact, the US agreed in 1993 to raise expenditures in foreign aid to 0.7% of GDP, a standard that the rest of developed nations agreed to in the 1970s.  Since pledging that number, foreign aid has actually declined, and much of that which is given funds "consultants" from the World Bank or IMF.  For those of you who prefer visual aids, the budget office provides a lovely pie chart here.


Sachs also does a brilliant job of outlining the need for economists who think like physicians.  Economic emergencies require experts that can examine a country, develop a diagnosis and apply a specific treatment plan for the country.  He outlines how this model was used with success during the Bolivian tin crisis and in Poland during the fall of the Soviet Union.


While my optimistic/pragmatic side agrees with many of Sachs' assertions and his overall plan, I must confess that his relentless industrial capitalism is a bit concerning.  My thoughts immediately return to the voice of Wendell Berry:

"We must see that the standardless aims of industrial communism and industrial capitalism equally have failed. The aims of productivity, profitability, efficiency, limitless growth, limitless wealth, limitless power, limitless mechanization and automation can enrich and the empower the few (for a while), but they will sooner or later ruin us all. The gross national product and the corporate bottom line are utterly meaningless measures of the prosperity or health of the country."

Despite my fondest affections for philosophy of Berry, I will admit that his calls to agrarianism are, unfortunately, unrealistic.  But I do believe his call to reflection is a critical component of any plan for development.  Sachs' unashamed cry that capitalism holds the answers left me uncomfortable throughout the book.  Over the years, he has been a voice crying for justice, fighting against the structures and powers of oppression.  And while his plans couple the words development and sustainable, I question whether the marriage between the two are realistic.  I think the fundamental question lies at how one defines development in the first place.


All in all, the book is challenging and encouraging, and despite my mistrust of some of his underlying premises, I believe he raises important issues and calls for movement in a necessary direction.  What say you?

Irrational Economics

One of my favorite professors in undergrad was Bryant Shaw, chairman of the Troy Department of History.  I gleaned numerous nuggets of wisdom from Dr. Shaw ("read broadly"), but perhaps my favorite was his take on knowledge: "Information is gathered within a discipline; knowledge occurs at the intersection of disciplines."

Thus, perhaps my favorite thing about classes at UAB's School of Public Health is the breadth of disciplines that cross over in my curriculum.  I have been lectured by physicians and psychologists, by statisticians and economists, by chemists and engineers, by sociologists and epidemiologists.  This semester we've been assigned a pair of behavioral economics readings, one of which I recently finished.  Dan Ariely's Predictably Irrational is a fun, quick read that explains behavioral economic theory in simple terms.

From the days of Adam Smith, economic theory has assumed one simple idea - that humans make rational decisions.  For some reason it took centuries for economists to come to a different realization: we don't.  Humans are irrational.  This is why trans-disciplinary collaboration is so important.  Psychologists have long realized that people are irrational (it is why the field exists).  Anyway, Ariely provides some great insight into irrational decisions we make, and offers some solutions to how we can protect against them.

Ariely does an outstanding job of translating scientific experiments into easy to understand anecdotes, all the while preserving the meat of the research (A quick glance at a scientific journal reveals this is no easy task).  His experiments range from the fallacies of supply and demand to alterations in our decision-making depending on our level of sexual excitement.  His precepts could be quickly adapted to enhance a business's bottom line, but more importantly, they outline some important considerations when planning public policy.  Ariely does an excellent job of weaving his story through the book, and I quickly saw myself in some of the examples he lays out.  I highly recommend the book.