I made a montage in Photoshop for my UB Grand Rounds presentation. It depicts my take on the current disease care system and how it bumps up against Waddington's concept of an 'Epigenetic Landscape'.

Thought some of you might get a kick out of it.

Just finished Life's Solution: Inevitable Humans in a Lonely Universe by Simon Conway Morris. Interesting book. He had a reproduction of this humorous drawing showing the size of a compound eye that would be required to have the same spatial resolution as a human eye. Looks heavy and is apparently keeping the owner from doing much exercise.

Busy writing weekend-- made more enjoyable by having finally migrated to topics that do not require much of an educational pre-buildup; just good old simple depictive writing. Grab this, measure this, do that. Went over to my little sailboat yesterday with Martha and together we managed to get most of the jackets, bottles, and whatnot out and into the garage. It was a great summer sailing around Long Island Sound. The winds were kind and consistent and the kids are now old enough to savor the experience. Winter just seems extra long and dreary when you can sail with your family and friends in such a great body of water.

Getting the boat over to the winter mooring was a scream. Literally. That day featured absolutely stupendous seas and 30 knot winds. Photographs never seem to do justice to the height of waves, but this photo of your humble blogger (with two sweaters underneath his coat) gives a slight idea of the beating my friend and I took that day. I don't normally wear my hats "homeboy style", but if the visor was in front I can assure you that the hat would have been floating some place in the background.

The other night we made salmon on a plank of cedar wood. I used a ginger-soy dressing that was wonderful, plus lots of garlic. You soak the plank in water for 15 minutes, then put the fish on it, add the fixings, then pop into the over at about 450 for about 15 minutes per pound. Some sautéed squash and onions, rice and we had a feast. Be advised though that the plank does make some smoke and if you have smoke alarms, you'll need to get your exhaust fans going!

After a week home writing, it's nice to be back in the clinic. The combination of the two (writing and seeing patients) rounds out the day nicely, especially if I can get in a bit of exercise. Someone showed me an article in one of the glossy weekly magazines about how an actress named Jennifer Lopez is following the BTD as an aid to having a healthy pregnancy. Good for her! It can't hurt, and often accomplishes miracles by itself when other methods of fertility have failed.

Speaking of miracles...

Time magazine had a discourse between Richard Dawkins and Francis Collins breathlessly advertised on the cover as "Science Versus God" or some similar dribble. In a rather underwhelming exchange, atheist Dawkins seemed to come out ever so slightly the worse, since Collins appeared every bit as rigorous a scientist, but felt compelled to admit that there were things in existence that he felt could not fall under the realm of scientific scrutiny. On the other hand, I got the impression that Dawkins rules out the existence of God simply because he feels that God is an improbability. Thus my problem with cover sales pitch: It should have been titled, "Science Without God Versus Science with God", since Collins (the coordinator of the US Human Genome Project) is not exactly the type of guy to go around blowing smoke out his mouth, dancing in a grass skirt.

I rather enjoy both of their writings, but each for different reasons. Dawkins, best known for his book The Selfish Gene, has a great clarity of vision that I admire and his thoughts are usually laid out in a rational step-wise order that a computer programmer geek (such as I) can appreciate. However, there is a persistently Cromwellian vehemence to some of his writings; especially when it comes to having a belief in anything other than the belief in having no belief.

Collins, who recently wrote The Language of God, is far cuddlier. He feels that "moral law" (as characterized by the writings of Kant) indicates there is such a thing as right and wrong, and there are some things that you "ought" to do, and some things that you "ought not" to do. In the Time discussion Dawkins pretty much makes it clear that he views things as having the ability to be bad or good, but denies that there is a bad or good.

I bring this point up because these types of media discussions just further convince me of the relative bankruptcy of language --which itself is a sure sign that the discussion is headed towards philosophy and away from any sort of objectivity.

My advice is to, skip the Time article, read Dawkin's The God Delusion and Collins' Language of God. Finally, read Stephen Jay Gould's classic article on nonoverlapping magisteria and draw you own conclusions.

Thomas Kuhn's little book The Structure of Scientific Revolutions identified the problem almost fifty years ago: Normal science tends to reward "puzzle-solvers" who choose only to work within the existing paradigm. Rival paradigms are incommensurable; they simply cannot understand each other through their own conceptual framework and terminology.

That's good news for Time. They can do this again next year.

I've found a neat quiz that purports to help determine your 'world view'.

What is Your World View?

What I especially like about this quiz is that you could agree with the premise along a spectrum, so that ticking a box in the middle translates into a sort of "I don't know, I don't care" answer, which is probably why I typed as a having a 'postmodern' world view.

"You scored as Postmodernist. Postmodernism is the belief in complete open interpretation. You see the universe as a collection of information with varying ways of putting it together. There is no absolute truth for you; even the most hardened facts are open to interpretation. Meaning relies on context and even the language you use to describe things should be subject to analysis."

Interestingly, the Blood Type Diet has been described in several articles as "The first postmodern diet."

If I remember correctly, in the Meyers Briggs world I'm something like a 'rational architect' or whatever, but I think this little quiz does a better job of putting you on the horns of a dilemma than does the MBI, which seems to just really attempt to describe you as something you probably already knew you were.

Coincidentally enough, I'm reading a little book called On Certainty by Ludwig Wittgenstein, which has a lot of interesting, aphorism-type stuff in it (in addition to some daunting philosophy and math). Right off the bat, a quote (p. 49) caught my eye and probably explains why my view of the world was such a dead-heat between existentialist and postmodernist:

"Knowledge is in the end based on acknowledgement."

Try it. You'll like it.

Writing, writing, writing. However, at least recently, it has been rather enjoyable. Like you might hurriedly turn the page of a good novel to see what is going to happen next, so I write The Genotype Diet -often rushing home after karate class or some other engagement just to get back to work and see what might organically follow what I had previously written. It may (or may not) surprise you when you read it, since it turns the entire field of nutrigenomics upside-down, substituting a low-technology, DIY approach for any and all of the high tech glossy stuff that passes for the field nowadays.

Now, I have no gripe with labs and lab testing, but as John Bastyr used to say almost three decades ago when one of us student clinicians would pony up with the latest sophisticated panel, "That's nice, but tests don't get anybody better."

A while back a lawyer friend showed me a very old cartoon of a cow, with one man holding the tail and another holding the horns. The guy holding the tail was labeled "plaintiff" and the guy holding the horns was labeled "defendant". In between, milking the cow, was a third guy, labeled "attorney".

Labs are sort of like that. The doctor looks intelligent and busy, the patient feels that something important is happening. But in reality, nine times out of ten, the only real winner is the lab. I'm constantly amazed at the reams of testing information that typically accompanies a new patient, and how often these tests would appear to have had no basis for being ordered in the first place. Wouldn't the patient have been better off getting a new sweater or some slacks rather than to be left with a photostat of some normal lab values --which most of the time no one bothers to explain to them anyway-- or to have paid good money for spurious or even questionable testing?

Also guys, c'mon, dump the normal test results from a decade ago. Although they may mean something to you, a normal lab result older than about six months is just about worthless to your doctor and forcing him or her to peruse them is apt to just cause something important to be missed. It's nice that your urine was healthy in 1986, but frankly, we're not very interested in that.

You'd think alternative doctors would be less seduced by fancy-pants testing but it seems to me that they are often more likely to order them. Perhaps it is some sort of insecurity, or a desire to look "doctorly". On the allopathic front, how many tests are ordered just so that if things come to some sort of litigation, one's proverbial gluteus maximus is covered. Of course the fact that Big Brother Insurance pays for it all adds to the carnival atmosphere.

I met a new patient recently who had reams of tests including the two most recent which showed a gradually increasing white cell count. However, apparently nobody had paid any attention to this. At first I thought it could be some sort of low grade infection, since she was a B non-secretor. But over the course of the interview she referred several times to a twinge on the right side of the abdomen, which made me think of perhaps a low grade appendicitis flare up. Nine times out of ten these resolve with a change in diet and supportive care, and right then and there nothing more needed to be done, so I just advised her to look for signs of an escalating problem, such as fever or severe cramps, and move on them.

Frankly, I think the over-reliance on obtuse lab testing erodes the doctor-patient relationship. Most patients would do better with a dose of reality, especially when it comes to an appreciation of their limitations.