April 2002

    Laughable Loonie | Organ Trail | Mess In Texas | Medical Informatics' Midlife Crisis | In Praise Of Pathologists | Oil Out Early | So Tired | NHL Second Season Starts | HIMSS Oregon Spring 2002 Meeting: Informatics Value | Abercrombie's Marketing Glitch | Cameo Cafe: Heavy Half Acre | Visiting Triage | Earthly Treat | Portland Taiko: Unplugged | Fit Fan | Film: La Pianiste (The Piano Teacher) | Australian Assasins | Fast 500 | Restaurant: Mucho Gusto, Mucho Grande!

  • Mucho Gusto, Mucho Grande!
    Dorami-chan and I celebrated Cinco de Mayo early with a visit to the Mucho Grande Restaurant on Capitol Highway. On a cool, overcast Portland evening, we were transported to Mexico for an hour, thanks to the waiter's sunny disposition.

    (30 Apr 2002)
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  • Fast 500
    The counter on my homepage has registered 500 hits in just one month, the fastest increase this website has had since a number of years ago, when it was mentioned in The Globe and Mail newspaper. Who is doing all that visiting? Please leave a message in my guestbook!

    (29 Apr 2002)
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  • Australian Assassins
    In applying for work at a health informatics company with global operations, I wrote that I would be willing to work in Australia. However, after watching Australia's Little Assasins, an episode of PBS's Nature program, Dorami-chan has vetoed any move Down Under, now that she knows Australia is home to the most poisonous animals in the world.

    (28 Apr 2002)
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  • La Pianiste (The Piano Teacher) (Austria/France 2001; Dir: Michael Haneke) ***
    Isabelle Huppert plays a fascinating character.

      The Piano Teacher
      Elfiede Jelinek's novel
    • Prisoner's Songs
      Hardly any other actress in movies than Isabelle Huppert could inhabit this Viennese specimen without seeming ludicrous — and there may not be another who would care to.

    (28 Apr 2002)
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  • Fit Fan
    The Portland hockey fan leads a lonely life. Last year and the year before that, I watched the NHL playoffs with my fellow OHSU medical informatics student Stefan at The Cheerful Tortoise sports pub. This year, Stefan is otherwise occupied and there isn't another hockey fan in sight. (Why is Portland always mentioned as a possible new home for troubled NHL franchises?) So, instead of drinking liquid (such as Rogue Brewery's Dead Guy Ale) alone while watching the game, I am producing liquid (sweat) by watching the games at the gym while on a stationary bike or stair machine. Since we don't subscribe to cable at home, I must go somewhere that gets ESPN and ESPN2, the cable networks that carry the NHL playoffs in the United States. Given that it will be another month and a half before Lord Stanley's mug is finally won, I have an opportunity to become quite fit! In hockey-crazy Canada, I would be tempted to be a couch potato, since the games are shown almost to the exclusion of all else on the country's public broadcaster CBC-TV, whose signal can be received without cable.

    (25 Apr 2002)
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  • Portland Taiko: Unplugged
    Tonight Dorami-chan and I caught up with our friends in the local Asian America drumming group Portland Taiko by taking in their latest show, Portland Taiko: Unplugged. The idea comes from the MTV Unplugged concert series, which features rock stars performing with acoustic instruments in an intimate setting. Taiko isn't plugged to begin with, but they did achieve an intimate setting by using a small performance space above the Bridgeport Brewpub in downtown Portland's Pearl District, where new uses are being found for old warehouses.

    About half of the program was new compositions, including ones that made use of the giant okedo that debuted at last year's Sonic Boom Big Drum Concert. (It is 6 feet long and almost 5 feet across -- how they managed to get it up to the performance space I'll never know!) My favourite new piece was the most traditional one, brought from Hawai'i by new member Kristy Oshiro. The other pieces tried to blend taiko and Western instruments like a double bass and violin, but the drum inevitably seems to become subordinate background percussion in those kind of matchups.

    The rest of the program was slightly reworked existing pieces, with new introductions adding meaning and significance. Particularly effective were the young hapa girls who did kung fu moves -- almost dancing -- during To Fly, a piece inspired by Maxine Hong Kingston's Woman Warrior. Now Dorami-chan wants to learn kung fu! The show wrapped up with a raucous and jubilant street matsuri-like piece, made possible by the group's new portable okedo drums.

    Another fine PT show, and potentially our last, depending on what happens with my medical informatics job search between now and their fall concert.

    (24 Apr 2002)
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  • Earthly Treat
    Today was Earth Day, a day to think about the threats facing our global environment and what we can do about them. Ice cream makers Ben & Jerry's, a longtime supporter of environmental causes, had an all-day offer of a free ice cream cone for anyone who came in to one of their scoop shops.

    Portland has two Ben & Jerry's. Dorami-chan and I have been to the one in the Hawthorne district on the city's east side, so we went to the one in the Nob Hill district in northwest Portland, across the street from the Cameo Cafe, where we had breakfast last weekend. We thought it might be less crowded -- wrong! At 7 p.m., the line wound around the store and on down the block. When we got our cones -- Chocolate Chunk for Dorami-chan and The Full Vermonty (pralines and cream) for me -- it was a little before the 8 p.m. closing time, and the line behind us was still lengthy.

    Ben & Jerry's free ice cream offer certainly got the public's attention, but I'm not sure how much it raised awareness of Earth Day. Most people walked right by the table of informational pamphlets inside the store. We did, and found that we are already doing many of the suggested things on a personal basis to curb global warming, like recycling, keeping the thermostat low, and driving less.

    It would have been interesting to see how the shop dealt with those who were still waiting in line at closing time, but I had to get to my recreational league hockey game. We quickly went down 3-0 in the first period, and my line was on for every goal against. Dairy products contain L-tryptophan, a natural sedative, so I don't think having a pre-game ice cream cone was such a good idea.

    (22 Apr 2002)
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  • Visiting Triage
    Somebody has come up with a term for a way of dealing with having too many people to visit in too little time: the triage of visiting. Prioritize your friends on the basis of who needs to be visited the most. This sounds cold and calculating, but for those who know a lot of people, it is the only way to stay sane -- a too-densely scheduled Christmas holiday in Edmonton a number of years ago convinced me of that. If you sleep in or your car won't start (as happened to me), your itinerary is toast! But friendships hopefully endure. My major concentrations of friends are in the 'Chuck, Vancouver and Toronto. On the Escape From Toronto III Tour, Dorami-chan and I didn't triage, but instead had big get-togethers with our friends along the way. This method brings everybody to one place at one time, but you still end up not spending as much time with each friend as you would like.

    (21 Apr 2002)
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  • Cameo Cafe: Heavy Half Acre
    Dorami-chan and I woke up early on a weekend day for once, and decided to reward ourselves by going out to the Cameo Cafe, a cosy place tucked away in a corner of the Nob Hill district of northwest Portland that is consistently voted one of the Rose City's best places for breakfast. Dorami-chan had some nice French Toast, but the signature morning dish here is the Half Acre Pancake, a hefty flapjack that is about one foot in diameter and, if you want, chock full of fruit such as blueberries, strawberries or bananas. Mine arrived with much of a large dollop of butter already melted in, more than I would have preferred. It would have been nice to have gotten the butter on the side. Still, it tasted fine, and I managed to finish the whole thing -- barely, which put me in awe of myself for having eaten a Whole Acre Pancake (two Half Acres) a few years ago when I came here with my sister. My stomach has shrunk! The service was very attentive -- our coffee cups never got less than half full -- but we were almost the only customers there. Business started to pick up around 9:30, and all the tables were full when we left at 10:00, although the layout of the room is such that we could not see that was the case until we made our way out. Not much fun for people watching! The bill was a bit on the hefty side, but considering the neighbourhood (Nob Hill has some of Portland's trendier and more expensive restaurants) that is not surprising. Cameo Cafe is a nice as a staging ground for a day of shopping in the area, but otherwise, we prefer The Original Pancake House.
    Cameo Cafe Northwest, 2340 NW Westover Road, Portland, OR 97210-5535, Phone: (503) 221-6542

    (20 Apr 2002)
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  • Abercrombie's Marketing Glitch
    Hip clothes sellers Abercrombie & Fitch aren't so popular with Asian Americans these days. New T-shirts hit A&F stores and the company's online catalogue last Friday, featuring slant-eyed caricatures and silly puns on Chinese names and Buddha. Company officials say the shirts were designed to appeal to young Asians. What market research consultants were they using? And since when have they tried to appeal to Asians? Their advertisements feature young white men and women only for the most part. Asian American students at Stanford University were quick to express their displeasure with an e-mail campaign. It is a sign of the times, that Asian Pride is strong enough to generate such a response, and that the Internet can facilitate such activism. The Internet also allowed A&F to respond quickly, by pulling images of the shirts off of their website, though not (yet) with an apology.

    (19 Apr 2002)
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  • HIMSS Oregon Spring Meeting: Informatics Value
    Today I attended the HIMMS Oregon Spring 2002 Meeting, which had the theme "Show Me The Value!" Spending on information technology in healthcare is less than half that of other industries, such as manufacturing and transportation and retail. As a result, Wal-Mart can track the progress of a roll of toilet paper across the country through its inventory control system, yet doctors at a hospital cannot find out what treatment a patient of theirs received at a clinic one city block away. Despite this, the executives and boards of healthcare organizations are reluctant to increase IT spending because they are not convinced that those dollars will yield a return on investment (ROI). Thus, an informaticist's duties are not confined to technological matters, but must also include collecting evidence that demonstrates the positive effect of IT interventions on the bottom line.

    • CIO IT Value Research Center
      Connecting the dots between IT expenditures and financial benefits.
    • IT Economics 101
      CIOs who let the general managers focus on IT costs, rather than the relationship between costs and benefits, will lose the organizational survival game.

    This HIMMS Oregon meeting was much bigger than the last one, with about 100 attendees. The majority were white, middle-aged men, and most of the rest were white, middle-aged women -- par for the course for any mainstream organization in Oregon. I was one of only five visible minority faces, all Asian, but two were members of the Chapter Executive. At my table were people who are actually working in medical informatics, at Oregon-based Providence Health System, whose Chief Information Officer Rick Skinner won this year's HIMSS CIO of the Year award. This was more encouraging than the last time, when most of the folks I met had been recently laid off. There actually are jobs in informatics!

    (18 Apr 2002)
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  • NHL Second Season Starts
    The 2002 National Hockey League playoffs begin tonight. This is the start of a two-month road that will culminate in a Stanley Cup championship for the most durable team sometime in June. The postseason is so long, it deserves the name "second season". It will be a challenge to stay interested for the duration. For what it is worth, here are my fearless first-round prognostcations (predicted series winner in CAPITALS)

    Western Conference
    DETROIT vs. Vancouver - though Canuckleheads might pull off an upset
    COLORADO vs. Los Angeles - Forsberg rejoins Sakic, Roy, Blake, Foote, etc., etc.
    SAN JOSE vs. Phoenix - Coyotes' desert miracle ends here
    ST. LOUIS vs. Chicago - Weighter rejoins Pronger, McInnis, Tkachuk, etc., etc.
    Eastern Conference
    BOSTON vs. Montreal - Bs have too much depth for Habs
    PHILADELPHIA vs. Ottawa - Flyers tougher than Sens
    CAROLINA vs. New Jersey - Devils are old and tired, and Gang Green's goalie says don't bet against the 'Canes' Arturs Irbe.
    TORONTO vs. NY Islanders - Memories of Lanny

    (17 Apr 2002)
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  • So Tired
    I have always needed a lot of sleep, so pathology was a good fit for me with its relatively regular work hours compared to other medical specialties. But my current combination of work and school (and maintaining this website) is cutting seriously into my shuteye time. When I transition to an informatics job, I don't think it will be on the programming side of things, with its intense all-night coding sessions -- at least not without some pharmaceutical help!

    (15 Apr 2002)
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  • Oil Out Early
    This year I have to write my obituary early for my favourite National Hockey League team, the Edmonton Oilers. Typically their season ends with a first-round playoff defeat, usually at the hands of the Dallas Stars, but tonight they were mathematically eliminated from 2002 post-season play in the second-last game of the regular season by losing 2-0 to the archrival Calgary Flames.

    I believe The Oil were a good enough team talent-wise to qualify, but their downfall was their apparent lack of respect for teams below them in the standings. Subpar efforts against the likes of the Nashville Predators, Atlanta Thrashers, Columbus Blue Jackets, and the Mighty Ducks of Anaheim led to losses and precious points being frittered away over the course of this season. Hopefully the Oiler players will take this as a learning experience and approach every game next year with a more professional attitude. It is an expensive lesson: the Oilers management had calculated first round playoff gate receipts into the 2001-2002 operating budget, but now the team will lose an estimated $4 million, not small change for a franchise on the financial brink. To Edmonton management and players alike: Don't count your pucks before they are in the net!

    If there is a bright side to the playoff picture, it is that three teams with among the top payrolls in the league (New York Rangers, Dallas Stars, Washington Capitals) won't be going Cup Crazy either. Maybe the NHL owners will notice that high salaries don't necessarily result in success. (Wishful thinking!) Also, this year four Canadian teams will participate in post-season play.

    So, who to support now in this year's quest for Lord Stanley's mug? A.B.D.: Anybody But (odds-on favourite) Detroit ! The Vancouver Canuckleheads have been on a gutsy roll down the stretch. Le club de hockey Canadien de Montréal are the feel good story of the year, with the return of captain Saku Koivu from the cancer ward. And the Toronto Maple Leafs are the only Canadian team with a realistic hope of going deep into the playoffs. Dorami-chan will of course be cheering for Joe Sakic, Patrick Roy and the defending champion Colorado Avalanche.

    • C is For ...
      Canadien ... captain ... cancer ... comeback. Saku Koivu is one helluva story.
    • Completing the comeback
      Saku Koivu redefines the art of the possible with his return to the ice.
    • Wow, Canada
      Let's put those "Woe, Canada" headlines to rest. Hockey in The Great White North is alive and well.

    (12 Apr 2002)
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  • In Praise Of Pathologists
    Despite (or maybe because of) living in the United States for the past four years, I still maintain a subscription to Maclean's, Canada's weekly newsmagazine, to keep up on events in Canada. It is usually a fairly benign read -- not too thought provoking or controversial. One article in a recent issue got my goat, however. Written by Dr. Jim Paupst, the personal physician of federal Industry Minister Allan Rock, it relates the politician's brush with prostate cancer as a way of promoting screening tests for the disease. Dr. Paupst's account of Mr. Rock's diagnostic workup and treatment acknowledges by name the radiologist and urologists who participated in Mr. Rock's care, but neglects to recognize in a similar way the contribution of pathologists to the case. Reading Dr. Paupst's article, one gets the impression that it was the radiologist who made the diagnosis of cancer, and it was the urologists who determined how far the cancer had spread, when in fact both of these important pieces of medical information were generated by pathologists after assessing the diseased tissue with a microscope.

    Pathology has serious public relations problems. Most of the public and even many clinical physicians (possibly including Dr. Paupst) have no idea what a pathologist's role is in today's healthcare system. Part of this is the profession's own fault -- most pathologists maintain such a low profile that they are easily overlooked. In a small step to try to remedy this situation, I wrote a letter to the editor of Maclean's. In case it doesn't get selected for publication, here it is:

    Dr. Jim Paupst takes the time and space in his account of Allan Rock's prostate cancer story ("In praise of testing", 01 April 2002) to mention by name the radiologist who scanned and biopsied Mr. Rock's prostate gland, and the two urologists who performed Mr. Rock's prostatectomy. Yet Dr. Paupst does not acknowledge the pathologist(s) who rendered the diagnosis of cancer on the biopsies, and determined from examination of the resected organ that "the tumour was one millimetre away from the capsule surrounding the prostate." Many patients and even clinical physicians do not realize that such assessments do not come from a "black box" machine in "the lab", but are made by pathologists, skilled medical doctors who have specialized in the study of diseased tissue and are key contributors to the continuum of healthcare.

    (11 Apr 2002)
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  • Medical Informatics' Midlife Crisis
    I popped into the OHSU Library for the first time in a while to look at some recent medical journals. Just arrived as of last week was the January 2002 issue of Methods in Medical Informatics, a special issue that presents the print version of some serious navel gazing that went on at a workshop sponsored by the International Medical Informatics Association in Madrid, Spain in March 2001 (2002; 41(1): 1-60). The article titles reflect the difficulty medical informatics has had carving a niche for itself and gaining acceptance as a legitimate research endeavour:

    • "Challenges for Medical Informatics as an Academic Discipline",
    • "Medical Informatics as a Discipline at the Beginning of the 21st Century"
    • "Medical Informatics: Between Science and Engineering, Between Academia and Industry"
    • "Medical Informatics: Searching for Underlying Components"
    • "Health Care in the Information Society: What Should Be the Role of Medical Informatics?"

    "Health informatics is having a mid-life crisis. It is a 45-year-old profession wandering about the desert to find itself." -- Yuval Shahar, 2001

    I often find it difficult to define medical informatics to people outside the field, but as this shows, the leaders of the academic medical informatics community have just as much trouble.

    (09 Apr 2002)
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  • Mess In Texas
    This weekend I represented Oregon Health & Science University at a one-day cancer pathology seminar in Dallas TX sponsored by Southwest Oncology Group, a National Cancer Institute-supported clinical cancer research group.

    (05-07 Apr 2002)
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  • Organ Trail
    Here is a report about the illicit harvesting of human organs that is occurring in hospitals in Turkey and South America. Apparently people undergoing surgery for unrelated reasons come out of the operating room without a kidney. I don't think the same thing could happen in North America, because surgeons are required to document what procedures they performed in the Operative Report they dictate after every case, which becomes part of the patient's medical record. Also, pathologists are required to assess all the tissue that is removed in the course of an operation, thereby playing an important surveillance role, confirming (or refuting) what the surgeon said was done.

    (03 Apr 2002)
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  • Laughable Loonie
    Yesterday was April Fool's Day, when practical jokes are played all over North America. The prank I remember best was in the late 1970s, when Edmonton radio station K97 announced a Beatles reunion concert to be held at Commonwealth Stadium. They interviewed someone who did a perfect John Lennon imitation, and I was completely taken in. Of course, the Beatles didn't back together then, and now that John and George are gone, they never will.

    This year, there was a gag which similarly had a sad side to it: a website announced that Canada's respected federal finance minister Paul Martin was going to retire rather than become the nation's next prime minister. Some currency traders fell for it, dropping the value of the Canadian dollar to 62.52 cents US. What is sad is that the ranks of credible politicians are so thin in Canada that the anticipated retirement of one would make such a difference. I spent my early working life amassing retirement savings in Canadian dollars, but over that same 25 years, the government has allowed the value of the loonie to shrink 30%. Now that's a cruel joke!

    (02 Apr 2002)
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