Matula Thoughts. September 2, 2016.

DAB What’s New Sept 2, 2016

Matula Thoughts. September 2, 2016. News & views.

3821 words

 

Sept 2016

One.   Summertime news.  Yesterday was the beginning of meteorological autumn and tomorrow is Michigan’s first football game of the season, here at home with Hawaii. Ann Arbor days were hot this summer, but are getting shorter, although not so short yet since we can travel between home and work in daylight at least in one of the directions. [Above: the drive on Huron Drive] September was the seventh month in the old Roman calendar when March served as the first month of ten in the year (see April 1st Matula Thoughts). Calendar reform added January and February to create a 12-month year and September got demoted to the ninth month, but retained its historic name.

       We had a good summer, overall, in spite of local, national, and worldwide tragedies admixt with the ongoing environmental degradation of which we are no longer innocent. Our particular geographic microcosm, however, has been mostly pleasant and constructive with the entry of new house officers, promotion of their seniors, incorporation of new fellows, and initiation of first year medical students. We enjoyed the Ann Arbor Summer Festival, Art Fairs, Chang-Duckett-Lapides lectureships, White Coat Ceremony, and lovely three-day weekends that come to an end with Labor Day on Monday. A few weeks back Mani Menon from Henry Ford Hospital gave a brilliant Grand Rounds talk on his remarkable achievement of translating radical prostatectomy to the robotic platform, and thus introducing a new paradigm of therapy worldwide (below: Mani Menon, Khurshid Ghani, Andy Brachulis). Stu Wolf had his last day a week ago and will now be doing his part to build a new medical school in Austin, Texas.

Menon

In mid-August we lost a wonderful colleague and pediatric surgeon, Dan Teitelbaum (pictured below), after a difficult struggle with brain cancer. Dan partnered with us in the Disorders of Sex Development program and was a world authority on pediatric gastrointestinal problems both clinically and in the research world. Dan was more than just a colleague, he was a kind, skilled, and reliable partner-in-care and his excellence made us better. We could always count on Dan. Brain cancer, all cancer, is an evil destroyer of the good things in life. We are making progress against cancers on many fronts, but not in time for Dan.

Dan

A road trip this summer to Toronto featured Sick Kids Hospital’s Gordon McLorie symposium for the latest news in pediatric urology. [Below: McLorie Symposium] The Olympics captured much attention during my visit north of the border and, flipping back and forth on television, it seemed that Canadian coverage favored more actual sports and news than broadcaster celebrities and opinions on American networks.

McLorie Symposium

Bruce Hornsby & The Noisemakers appeared back in Ann Arbor at the Summer Festival one evening. Many of us (of a certain age) recall the classic song, The End of the Innocence, Hornsby wrote with Don Henley in 1989. At the Power Center Hornsby and the Noisemakers expanded the piece into an amazing long version with riffs, explorations, and pleasing dissonances. I wondered if the composers intended some reference to Songs of Innocence and Experience by William Blake in 1789 and 1794, but in any case the piece struck me more meaningfully this summer than when I first heard it years ago. Jeff Daniels joined the Hornsby ensemble for an encore and performed his new composition on the iconic environmentalist Henry David Thoreau.

EO & JD

Back in 2009 Daniels and E.O. Wilson received honorary degrees from The University of Michigan (pictured above). Wilson, above on left, is our planet’s most credible spokesman for biodiversity. Recognizing this at a dinner in their honor, Daniels commented self-effacingly something like: “I really don’t know why I am here, for after all, my claim to fame is a film called Dumb and Dumber.” In fact, both honorees are substantial contributors to society and they have comfortably crossed intellectual boundaries. Daniels’ work, for example in The Newsroom, not only entertains, but also speaks to the better nature of mankind, offering an example of a trustworthy television journalist navigating the challenges of corporate broadcasting. Wilson, on the other hand, successfully ventured out from his academic world with the novel, Anthill.

Blake - innocence

[Title page: Songs of Innocence and Experience Showing the Two Contrary States of the Human Soul. 1826 edition. At Fitzwilliam Museum, Cambridge, UK]

 

 

Two.   Experience. A new season of academic medicine begins each September and renews the process of turning innocent medical school graduates into experienced urologists. Medical students cram our urology services to test out the idea of careers in urology and audition for 4 available PGY1 (intern) slots, while our residents quickly ascend their ladders of experience and our faculty hone their practices.

Consult DB

Above you see Julian Wan at Grand Rounds presenting awards to residents Duncan Morhardt, Amir Lebastchi, and Parth Shah for their achievements with consults in Julian’s innovative Tour de Consult. The next picture shows faculty and residents that same Thursday morning at 7 AM listening to talks from medical students. The newly redecorated conference room is a big improvement over its previous 1986 version, although we still run out of space.

Grand Round

Our residents, however, are enjoying ample private space in their new residents’ room we gained recently and which was significantly upgraded thanks to contributions by Jens Sönksen (Nesbit 1996) and a number of other alumni. [See picture on our matching departmental Instagram https://www.instagram.com/umichurology/, courtesy Pat Soter]

This autumn we expect 21 clinical clerks (six 4th year medical students from UM and 15 from other medical schools) to rotate with us. The individual Grand Rounds presentations they make during their stints over the course of my career at Michigan get better and better in sophistication of presentation skills and subject mastery, indicating that the next generation of urologists should surpass us. Later this autumn a subset of our faculty will personally interview about 40 other students from a pool of 350 applicants. In December we will rank all applicants just as they will rank us, a computer will do the matching and by February we will know the names of our next 4 entering residents.

Autumn will also be busy with sectional and subspecialty conferences, national meetings of the American College of Surgeons and other organizations. Abstracts will be due for next year’s big clinical congress of The American Urological Association in Boston. Family life restructures for many of our faculty when children head back to school. Also this fall a presidential election will take place, so make arrangements now so you can vote on Tuesday, November 8.  I’ve learned from sad experience that busy clinicians and staff cannot count on finding a voting window during election day unless they have made deliberate plans, like absentee ballots, far in advance. Unprepared, you may get lucky – or not.

 

 

Three.

Radio tuner 1920s

Far from the town crier and printed circular, radio was a big step in the dissemination of news. Radio itself began in 19th century, arguably with the wireless telegraphy patent of Guglielmo Marconi in 1896, but the first tuning system, patented a century ago, brought choice and accessibility to the public. Ernst Alexanderson, an engineer for General Electric in Schenectady, New York, developed the selective tuning system. Station choices grew on AM radio [Above: vintage radio tuner c. 1920s, Wikipedia] and later with FM, thanks to generous regulation and commercial competition. When I spent a year training in Great Britain as a resident in 1976-77 only 4 radio choices were available on my radio, in addition to an off-shore “pirate” station, because government tightly controlled airwaves.

1939_RCA_Television_Advertisement-1

[Radio & Television Magazine X (2): June, 1939. NY: Popular Book Corporation]

Television portended the end of radio after the first public television broadcast in 1927 and color TV in the 1960s made the medium even more irresistible. The prophecy was wrong, however, as radio rebounded with multiple new consumer channels and TV became just the newer communication layer. Radio stations provided “narrow networks” of sports talk shows, partisan political commentary channels, business news stations, religious channels, local news, weather, and some splices to television channels. Reemergence of radio’s early variety shows appeared with Garrison Keillor and the ubiquity of NPR gave radio large new audiences; the final broadcast of A Prairie Home Companion this past July 2 completed its extraordinary 42-season run. Commercial satellite radio produced an explosion of new radio species for an astonishing range of human interests from Elvis to POTUS Politics. Cable TV ended the domination of broadcasting networks, although the proliferation of new television channels added only precious few of quality.

Radio and television “news”, however maintained a sense of integrity with trusted journalist/broadcasters such as Edward R. Murrow who told it clean and straight, in contrast to advertising or propaganda. At some point, however, the term “content” subsumed “news” and clarity began to vanish. Entertainment mingled with news broadcasts and trusted news broadcasters appeared in fictional stories further blurring the border between truth and fiction.

Podcasts, cable and satellite media, and other innovations offered content to seriously compete with network television and the movie industry. Home Box Office (HBO) produced its first original movie for cable TV in 1983 (The Terry Fox Story) and other memorable films and series followed including Breaking Bad (2008-2013) and The Newsroom (2012-2014) with Jeff Daniels who should inspire a future generation of good journalists. (What Game of Thrones inspires is not so clear). Personal phones, computers, and video streaming bring yet newer layers and innovations to communication, information, and entertainment. Mini-series binge-watching eroded prime time network television while Netflix’s video streaming expanded into a new model of content production. Abandoning the pilot and sequential release of episodes, House of Cards (2013) offered an entire series for immediate consumption. The bottom line: new communication technologies add new layers rather than replacing the older media.

 

 

Four.

Alex Zazlovsky

Quorum sensing.  A few months ago at Grand Rounds Alex Zaslovsky, representing the lab of Ganesh Palapattu, gave an excellent presentation showing how platelets communicate with tumor cells to help them metastasize.

A process much like bacterial quorum sensing seems to be occurring, and perhaps this type of communication is prevalent throughout all life forms, whether gaining a consensus in a microbial biome to release endotoxin or a majority in a society for an election or an action on an issue. Strictly speaking, quorum sensing is a matter of individual gene regulation in response to news of cell population density. In other words, gene expression is coordinated according to the size and needs of the population. In the larger sense, quorum sensing allows individuals, that by themselves may be insignificant, to become superorganisms. Bacteria thus act in congress like multicellular organisms and this process works in bigger species such as social insects, fish, mammals, and likely all biologic creatures in ways we have yet to understand. This phenomenon brings us back to the seminal work of E.O. Wilson who linked ant pheromones to sociobiology and then to human consilience.

Quorum sensing is basically a matter of getting news, that is acquiring information about the environment so as to change or maintain behaviors. Weather (temperature, humidity, and pressure) is a form of news, but news about other creatures (one’s own species and different ones) also has great relevance for the immediate and intermediate future. Just as people learn individualistically, they collect news idiosyncratically. A hurricane or a full solar eclipse in mid-day gets everyone’s attention, but most news we need or crave is more discrete, while the media we employ to collect it are many and increasing in variety. Newspapers, radio, television, personal computers, and smart phones expand human quorum sensing and newsgathering far beyond the wildest expectations of Gutenberg with his printing press. New forms of social media layer upon each other and get tested in the market. Michigan Urology has its regular What’s New email, web site, Facebook page, Twitter Account, Matula Thoughts blog, and will now test out a weekly Instagram photograph that we hope will attract not only viewing interest, but also contributions from the readership.

We started putting Matula Thoughts on a web site three years ago mainly as an archive and an alternate access because our What’s New email list was getting cumbersome. While we don’t know much of our ultimate email audience, due to multiple forwarding, the matulathoughts.org web site provides visibility of readership as seen in the snapshot below of the first 6 months of 2016.

MT readership 2016

 

Five.   Thoreau away thoughts.  Coming into work one day this summer I was listening to an audio book by Chris Anderson, the head of TED Talks, and had just come to his optimistic conclusion about mankind when I stepped out of my car on the Taubman lot and was offended by a bunch of pistachio nutshells someone had dumped on the deck. My first thought was “What jerk did this?” but after reconsidering I thought Why should I care?

Pistachio

After all I was wearing shoes and those shells weren’t going to hurt my feet. They don’t harm the environment, aside from minor aesthetic degradation, and even so some modern artist might consider the pattern a compelling expression of random human graffiti. Possibly I myself had been such a jerk making similar transgressions in the past, before my sensibilities (presumably) matured. No sharp demarcation exists between the clueless citizen and the clinically certified narcissist, although most of us can tell the difference at any moment. Another label for the parking lot perpetrator springing to mind was the less complimentary anatomical term for the gastrointestinal tract terminus, a word that has an important place in organizational theory (RI Sutton, The No Asshole Rule, The Hachette Book Group, 2007). Thanks to the ubiquitous cell phone camera I was able to record this minor breech of civility for a teaching opportunity. The lesson being that the environment is our nest, but general appreciation of its limits is poor, in spite of great thinkers from Lucretius to Henry David Thoreau to E.O. Wilson who have tried to raise our sensibility.

Thoreau

Thoreau was a curious fellow, best known for his Walden Pond seclusion, possibly because he didn’t consider himself very sociable. The above daguerreotype was taken in response to a request by Calvin R. Greene, a Thoreau disciple living in Rochester, Michigan. Greene began corresponding with Thoreau in January, 1856 and asked for a photographic image, that Thoreau initially denied, saying: “You may rely on it that you have the best of me in my books, and that I am not worth seeing personally – the stuttering, blundering, clodhopper that I am.” Greene’s persistence paid off and in June of that year Thoreau sat for three daguerreotypes at 50 cents each in Worchester, MA at the Daguerrean Palace of Benjamin Maxham. Henry David must have at least liked the third image, sending it to Greene, noting: “… which my friends think is pretty good – though better looking than I.” [Image and description, National Portrait Gallery, Washington, DC]

 

 

Six.   News. It’s a nice coincidence that NEWS could be an acronym for north, east, west, and south. The reality, though, is that the English term arrived in the 14th century as a plural form of “new” information. For 14th century English village folk, relevant news included weather, gossip, crop issues, births & deaths, accidents, plague, and war. In turn over time town criers, newspapers, radio, and television carried news among villages, through cities, and across continents. A new profession arose as journalists pieced events together and investigated them to derive factual stories. Photographs and today’s video clips offer powerful encapsulations of news in images and voices. Aggregation of news and targeting it to audiences with narrow interests is not new, we saw it in People magazine, the Racing Form, and Popular Mechanics, but daily news aggregation on the internet compiles information on a global scale and devastated the business model of investigative journalism. The Newsroom attended to the tensions between regurgitated information, narrative truth, and corporate self-interest. Human quorum sensing is immeasurably more complex than that of E.coli, although the basic principles must be quite similar. The variety of ways to collect and disseminate news from quorum sensing to Instagram will continue to expand, and each of our growing number will adapt our own methods and devices to capture what we will.

Newsboys Pose c 1890 copy

[Ann Arbor newsboys c. 1890]

 

 

Seven.    Urology news & Ig Nobel Thoughts. Later this month the 2016 Annual Ig Nobel Prize Ceremony takes place at Harvard’s Sanders Theater (September 22) to introduce 10 prizewinners for accomplishments “that make people laugh then think.” We expect no winners from the ranks of UM Urology, although it is worth mentioning that one winner last year was a study of mammalian urination times that found “golden rule” wherein urination times ranged around 21 seconds regardless of the species or bladder volume. This work, published in PNAS (a curious acronymic homonym), begs further investigation to explore gender differences, age effects, and the relations to various pathologies such as BPH [Yang et al Proc Nat Acad Sci 111:11932, 2014]. Notably, the first reference in the paper was Frank Hinman, Jr.’s book On Micturition (1971). The Ig Nobelists, however, missed Hinman’s smaller limited edition book called The Art and Science of Piddling [Vespasian Press, San Francisco, 1999] Hinman (shown below) playfully censored the retromingent stream of the rhinoceros on the book cover. To what end this unusual direction of micturition has evolved remain unclear, but extinction may void the species before an explanation is discovered.

Piddling

Hinman-office copy

 

 

Eight.   Photography. If you happen by the National Archives, as we did on a brief visit to Washington this summer, you might spot the Daguerre Memorial on Ninth Street by the Department of Justice. American sculptor Jonathan Scott Hartley (born in Albany, NY 1844, deceased 1912) produced the relief bust of Louis Daguerre honored by a female figure representing fame while a garland encircles the globe in homage to the universality of photography. Harley also made busts of Nathaniel Hawthorne, Washington Irving, and Ralph Waldo Emerson, Thoreau’s friend and colleague.

Daguerr Statue

Daguerreotypes transitioned to portable film cameras and now digital images on universal camera phones that allow great visibility of the particulars of the world. Visual images are fundamental to modern communication and newsgathering. Walking near the Daguerreotype monument we noticed a discarded snuff can in a planter box similar the pistachio shell arrangement shown earlier, further evidence that the great pageant of humanity marches forward and continues to leave its mark, although now subject to universal documentation.

Skoal

A yearly photographic competition of The Lancet, called Highlights,  further opens the door to the world’s cellphones and cameras. Last year’s contest yielded 12 winners detailing: a ruined hospital in western Syria, moments of patient care, community action, a poster showing health advantages of raised beds with mosquito nets, smoking prevention, Ebola hot zone management, road traffic accidents, cleft lip repair, and the politics of social justice. [Lancet. Palmer & Mullan. Highlights 2015: pictures of health. 386:2463, 2015]

 

 

Nine.   A somber note. Last month this column concluded with reference to the Hiroshima bomb, an existential threat that has increased since 1945 by many orders of magnitude. There is little question what Henry David Thoreau, among many wise thinkers of the past and present would say on this matter of nuclear weapons: they must be contained and their spread prevented. Failing that, a doomsday scenario is not unlikely and only luck has prevented this from happening so far. A new book, My Journey to the Nuclear Brink by William Perry (US Secretary of Defense 1994 – 1997), explains our precarious situation better than anything else I’ve read. You can understand his point in a “Cliff’s Notes” fashion by going directly to Perry’s website, but his book is quite compelling and readable. Perry, currently emeritus professor at Stanford University and senior fellow at its Hoover Institution, founded the William J Perry Project in 2013(http://www.wjperryproject.org/), a non-profit organization intended to educate the public on the current dangers of nuclear weapons. Addressing close calls of the past, Perry reveals that the Cuban Missile Crisis came far closer to the brink that most people suspected, but for two unreported “mistakes” on both sides of the conflict (USA and Soviet Union) that prevented nuclear deployment. Today the risk is greater and more complex as the weapons are far more massive and numerous than 71 years ago over Hiroshima. Opportunities for accidents, terrorism, rogue nations, territorial disputes, or mistaken perceptions of “responsible” nations are too many to count.

AtomicEffects-p7a

[Above, Hiroshima before blast, above ground zero, with 1000 foot circles marked; below, after the explosion with not much left standing.]

AtomicEffects-p7b

 

 

Ten.

Cassandra

Cassandra. In Greek mythology, Cassandra was a curious prophet, who turned out to be an ineffective communicator. Attempting to seduce her, Apollo gave her the power of prophecy, but when she refused his advances he spat into her mouth with the curse that no one would believe her prophecies. Prophecy skepticism has endured since her time. Right or wrong, but forecasts require consideration, especially when backed by information, whether in the form of news or other information. [Cassandra, in front of burning Troy, by Evelyn De Morgan, 1898]

The current likelihood of a nuclear incident is great and in recognition of this an exercise called Mighty Saber was held last year by the Defense Threat Reduction Agency at Fort Belvoir, Virginia to simulate a detonation in a US city and trace the origin of the device. An article by Richard Stone in Science concluded: “… to have any chance of unraveling the details of a nuclear attack, investigators have to lay the scientific groundwork – while hoping it will never be needed.” [Stone. Science. 351:1138, 2016]

The world is full of danger and nuclear devices are but one of a number of catastrophic threats. This fact needs to be acknowledged as people go to the polls to vote for their legitimate self-interests that may involve party loyalties, economic matters, civil rights, first and second amendments, immigration, border security, health care equity, public education, government size, gender issues, free speech, law enforcement, etc. Our ultimate self-interest, however, is immediate survival of our species and the security of our children’s future. With this in mind we individually must make the best choices we can for the elections at hand. Just as importantly we, as a society, must do a far better job of leadership succession to prepare educated and wise future civil leaders rather than leaving succession up to random populists, celebrities, or narcissists who crave power and the ultimate corner offices. Geopolitical and world market stability are severely challenged and we are terribly short of good leaders and great ideas. The grim political landscape at hand, however, doesn’t give anyone of us the right to be aloof from the politics and processes of representational government.

You may ask what does all this have to do with our profession, our patients, our trainees, and our science? The answer is – everything. Our successors won’t consider us innocent if we hand over to them a diminished future in a dysfunctional society on a damaged planet. Join the important political conversations, the next generation is counting on it.

 

Thanks for reading Matula Thoughts for this first Friday of September, and on future first Fridays if you are so disposed.

David A. Bloom

University of Michigan, Department of Urology, Ann Arbor

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