Hitting a Nerve

Recently, Canada announced new regulations on tobacco, with warnings printed on individual cigarettes, such as “poison in every puff.” This is on top of the packaging already required to have 75% of its space devoted to similar warnings, often with graphic pictures, of the potential consequences.

Make no mistake, I don’t like cigarettes and try to get smokers to quit.

But I have to wonder how successful this is going to be. I mean, you’d have to have lived under a rock for the last 70 years (or more) to not know that cigarettes (and tobacco in general) aren’t good for you, and can cause stroke, heart disease, and a multitude of cancers.

I suppose you could ban cigarettes, but that only opens up a black market. From 1920 to 1933 the United States set an example for the world with prohibition, showing how such an idea can backfire horribly.

Realistically, there are always going to be people making bad health decisions of one kind or another, including myself. Whether it’s tobacco, alcohol, or a cheeseburger and fries.

Tobacco, of course, has a much worse track record than that of the cheeseburger. We all have to eat, even though some choices are better than others. Tobacco has absolutely no biological necessity, as do food, air, and water.

But it’s remarkably addictive, not to mention profitable. Those factors will always guarantee it a place in society.

At this point, if people want to smoke, I have a hard time believing that they’re unaware of the health risks.

There’s a legitimate argument to be made in trying to keep people from starting. The teenage years, where we all tend to believe we’re immortal, are when a lot of habits (good and bad) form. If gruesome pictures and repeated warnings cut down on those numbers, then in the long run it’s a very good thing. Given that Canada’s goal is to cut tobacco use from 13% down to less than 5% by 2035, this could happen. Only time will tell how it plays out.

On a side note, here in the United States tobacco use is 19% of the population. This is actually somewhat surprising to me, as a brief, not particularly scientific, review of my charts for the past few weeks found that less than 5% of my patients do it. So either some are lying or (more likely), it’s just the demographics of my practice area.

But at some point it doesn’t matter how many warnings or gory pictures people see, or where they encounter them. Some will keep smoking out of habit. Some because they actually like it. Some to be defiant. Some just because they can. And no amount of warnings is going to change their minds.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

Recently, Canada announced new regulations on tobacco, with warnings printed on individual cigarettes, such as “poison in every puff.” This is on top of the packaging already required to have 75% of its space devoted to similar warnings, often with graphic pictures, of the potential consequences.

Make no mistake, I don’t like cigarettes and try to get smokers to quit.

But I have to wonder how successful this is going to be. I mean, you’d have to have lived under a rock for the last 70 years (or more) to not know that cigarettes (and tobacco in general) aren’t good for you, and can cause stroke, heart disease, and a multitude of cancers.

I suppose you could ban cigarettes, but that only opens up a black market. From 1920 to 1933 the United States set an example for the world with prohibition, showing how such an idea can backfire horribly.

Realistically, there are always going to be people making bad health decisions of one kind or another, including myself. Whether it’s tobacco, alcohol, or a cheeseburger and fries.

Tobacco, of course, has a much worse track record than that of the cheeseburger. We all have to eat, even though some choices are better than others. Tobacco has absolutely no biological necessity, as do food, air, and water.

But it’s remarkably addictive, not to mention profitable. Those factors will always guarantee it a place in society.

At this point, if people want to smoke, I have a hard time believing that they’re unaware of the health risks.

There’s a legitimate argument to be made in trying to keep people from starting. The teenage years, where we all tend to believe we’re immortal, are when a lot of habits (good and bad) form. If gruesome pictures and repeated warnings cut down on those numbers, then in the long run it’s a very good thing. Given that Canada’s goal is to cut tobacco use from 13% down to less than 5% by 2035, this could happen. Only time will tell how it plays out.

On a side note, here in the United States tobacco use is 19% of the population. This is actually somewhat surprising to me, as a brief, not particularly scientific, review of my charts for the past few weeks found that less than 5% of my patients do it. So either some are lying or (more likely), it’s just the demographics of my practice area.

But at some point it doesn’t matter how many warnings or gory pictures people see, or where they encounter them. Some will keep smoking out of habit. Some because they actually like it. Some to be defiant. Some just because they can. And no amount of warnings is going to change their minds.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

Recently, Canada announced new regulations on tobacco, with warnings printed on individual cigarettes, such as “poison in every puff.” This is on top of the packaging already required to have 75% of its space devoted to similar warnings, often with graphic pictures, of the potential consequences.

Make no mistake, I don’t like cigarettes and try to get smokers to quit.

But I have to wonder how successful this is going to be. I mean, you’d have to have lived under a rock for the last 70 years (or more) to not know that cigarettes (and tobacco in general) aren’t good for you, and can cause stroke, heart disease, and a multitude of cancers.

I suppose you could ban cigarettes, but that only opens up a black market. From 1920 to 1933 the United States set an example for the world with prohibition, showing how such an idea can backfire horribly.

Realistically, there are always going to be people making bad health decisions of one kind or another, including myself. Whether it’s tobacco, alcohol, or a cheeseburger and fries.

Tobacco, of course, has a much worse track record than that of the cheeseburger. We all have to eat, even though some choices are better than others. Tobacco has absolutely no biological necessity, as do food, air, and water.

But it’s remarkably addictive, not to mention profitable. Those factors will always guarantee it a place in society.

At this point, if people want to smoke, I have a hard time believing that they’re unaware of the health risks.

There’s a legitimate argument to be made in trying to keep people from starting. The teenage years, where we all tend to believe we’re immortal, are when a lot of habits (good and bad) form. If gruesome pictures and repeated warnings cut down on those numbers, then in the long run it’s a very good thing. Given that Canada’s goal is to cut tobacco use from 13% down to less than 5% by 2035, this could happen. Only time will tell how it plays out.

On a side note, here in the United States tobacco use is 19% of the population. This is actually somewhat surprising to me, as a brief, not particularly scientific, review of my charts for the past few weeks found that less than 5% of my patients do it. So either some are lying or (more likely), it’s just the demographics of my practice area.

But at some point it doesn’t matter how many warnings or gory pictures people see, or where they encounter them. Some will keep smoking out of habit. Some because they actually like it. Some to be defiant. Some just because they can. And no amount of warnings is going to change their minds.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

This little fellow greets you at my office. He’s been there for 25 years.

Dr. Block

I don’t know where he came from originally. When I started out he was up front with the physician I subleased from and when he retired he passed him on to me (thanks, Fran!).

From the beginning he’s been the first thing I see when I arrive each morning. Because of my suprachiasmatic nucleus kicking me out of bed between 4 and 5 each morning, I’m always the first one in the office and so I update him. At this point he’s as much a part of my morning ritual as coffee and tea. I juggle the cubes to change the day (12 times a year I change the month) and once this is done I don’t think of him again until the next morning.

Over time this whimsical character and the calendar blocks he holds have taken on a bigger significance, quietly counting out the days of my career and life. When I started setting him each morning I didn’t have kids. Now I have three, all grown. Patients, years, drug reps, and even a pandemic have all been marked by the clicking of his cubes when I change them each morning.

Now two-thirds of the way through my career, he’s taken on a different meaning. He’s counting down the days until I walk away and leave neurology in the hands of another generation. I don’t have a date for doing that, nor a plan to do so anytime soon, but sooner or later I’ll be changing his cubes for the last office day of my life as a neurologist.

What will happen to him then? Seems like a strange question to ask about an inanimate object, but after this much time I’ve gotten attached to the little guy. He’s come to symbolize more than just the date – he’s the passage of time. Maybe he’ll stay on a shelf at home, giving me something to do each morning of my retirement. Maybe one of my kids will want him.

Inevitably, he’ll probably end up at a charity store, awaiting a new owner. When that happens I hope he gives them something to pause, smile, and think about each day, like he did with me, as we travel around the sun together.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

This little fellow greets you at my office. He’s been there for 25 years.

Dr. Block

I don’t know where he came from originally. When I started out he was up front with the physician I subleased from and when he retired he passed him on to me (thanks, Fran!).

From the beginning he’s been the first thing I see when I arrive each morning. Because of my suprachiasmatic nucleus kicking me out of bed between 4 and 5 each morning, I’m always the first one in the office and so I update him. At this point he’s as much a part of my morning ritual as coffee and tea. I juggle the cubes to change the day (12 times a year I change the month) and once this is done I don’t think of him again until the next morning.

Over time this whimsical character and the calendar blocks he holds have taken on a bigger significance, quietly counting out the days of my career and life. When I started setting him each morning I didn’t have kids. Now I have three, all grown. Patients, years, drug reps, and even a pandemic have all been marked by the clicking of his cubes when I change them each morning.

Now two-thirds of the way through my career, he’s taken on a different meaning. He’s counting down the days until I walk away and leave neurology in the hands of another generation. I don’t have a date for doing that, nor a plan to do so anytime soon, but sooner or later I’ll be changing his cubes for the last office day of my life as a neurologist.

What will happen to him then? Seems like a strange question to ask about an inanimate object, but after this much time I’ve gotten attached to the little guy. He’s come to symbolize more than just the date – he’s the passage of time. Maybe he’ll stay on a shelf at home, giving me something to do each morning of my retirement. Maybe one of my kids will want him.

Inevitably, he’ll probably end up at a charity store, awaiting a new owner. When that happens I hope he gives them something to pause, smile, and think about each day, like he did with me, as we travel around the sun together.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

This little fellow greets you at my office. He’s been there for 25 years.

Dr. Block

I don’t know where he came from originally. When I started out he was up front with the physician I subleased from and when he retired he passed him on to me (thanks, Fran!).

From the beginning he’s been the first thing I see when I arrive each morning. Because of my suprachiasmatic nucleus kicking me out of bed between 4 and 5 each morning, I’m always the first one in the office and so I update him. At this point he’s as much a part of my morning ritual as coffee and tea. I juggle the cubes to change the day (12 times a year I change the month) and once this is done I don’t think of him again until the next morning.

Over time this whimsical character and the calendar blocks he holds have taken on a bigger significance, quietly counting out the days of my career and life. When I started setting him each morning I didn’t have kids. Now I have three, all grown. Patients, years, drug reps, and even a pandemic have all been marked by the clicking of his cubes when I change them each morning.

Now two-thirds of the way through my career, he’s taken on a different meaning. He’s counting down the days until I walk away and leave neurology in the hands of another generation. I don’t have a date for doing that, nor a plan to do so anytime soon, but sooner or later I’ll be changing his cubes for the last office day of my life as a neurologist.

What will happen to him then? Seems like a strange question to ask about an inanimate object, but after this much time I’ve gotten attached to the little guy. He’s come to symbolize more than just the date – he’s the passage of time. Maybe he’ll stay on a shelf at home, giving me something to do each morning of my retirement. Maybe one of my kids will want him.

Inevitably, he’ll probably end up at a charity store, awaiting a new owner. When that happens I hope he gives them something to pause, smile, and think about each day, like he did with me, as we travel around the sun together.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

My use of drug names is a mixed bag of terms.

In medical school we learn drugs by their generic names, but it doesn’t take long before we realize that each has both a generic name and one (or more) brand names. I suppose there’s also the chemical names, but no one outside the lab uses those. They’re waaaaay too long.

There is, for better or worse, a lot of variability in this. The purists (almost always academics, or cardiologists, or academic cardiologists) insist on generic names only. In their notes, conversations, presentations, whatever. If you’re a medical student or resident under them, you learn fast not to use the brand name.

After 30 years of doing this ... I don’t care. My notes are a mishmash of both.

Let’s face it, brand names are generally shorter and easier to type, spell, and pronounce than the generic names. I still need to know both, but when I’m writing up a note Keppra is far easier than levetiracetam. And most patients find the brand names a lot easier to say and remember.

An even weirder point, which is my own, is that one of my teaching attendings insisted that we capitalize both generic and brand names while on his rotation. Why? He never explained that, but he was pretty insistent. Now, for whatever reason, the habit has stuck with me. I’m sure the cardiologist down the hall would love to send my notes back, heavily marked up with red ink.

There’s even a weird subdivisions in this: Aspirin is a brand name by Bayer. Shouldn’t it be capitalized in our notes? But it isn’t, and to make things more confusing that varies by country. Why? (if you’re curious, it’s a strange combination of 100-year-old patent claims, generic trademark rulings, and also what country you’re in, whether it was involved in World War I, and, if so, which side. Really).

So the medical lists in my notes are certainly understandable, though aren’t going to score me any points for academic correctness. Not that I care. As a medical Shakespeare might have written, Imitrex, Onzetra, Zembrace, Tosymra, Sumavel, Alsuma, Imigran, Migraitan, and Zecuity ... are still sumatriptan by any other name.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

My use of drug names is a mixed bag of terms.

In medical school we learn drugs by their generic names, but it doesn’t take long before we realize that each has both a generic name and one (or more) brand names. I suppose there’s also the chemical names, but no one outside the lab uses those. They’re waaaaay too long.

There is, for better or worse, a lot of variability in this. The purists (almost always academics, or cardiologists, or academic cardiologists) insist on generic names only. In their notes, conversations, presentations, whatever. If you’re a medical student or resident under them, you learn fast not to use the brand name.

After 30 years of doing this ... I don’t care. My notes are a mishmash of both.

Let’s face it, brand names are generally shorter and easier to type, spell, and pronounce than the generic names. I still need to know both, but when I’m writing up a note Keppra is far easier than levetiracetam. And most patients find the brand names a lot easier to say and remember.

An even weirder point, which is my own, is that one of my teaching attendings insisted that we capitalize both generic and brand names while on his rotation. Why? He never explained that, but he was pretty insistent. Now, for whatever reason, the habit has stuck with me. I’m sure the cardiologist down the hall would love to send my notes back, heavily marked up with red ink.

There’s even a weird subdivisions in this: Aspirin is a brand name by Bayer. Shouldn’t it be capitalized in our notes? But it isn’t, and to make things more confusing that varies by country. Why? (if you’re curious, it’s a strange combination of 100-year-old patent claims, generic trademark rulings, and also what country you’re in, whether it was involved in World War I, and, if so, which side. Really).

So the medical lists in my notes are certainly understandable, though aren’t going to score me any points for academic correctness. Not that I care. As a medical Shakespeare might have written, Imitrex, Onzetra, Zembrace, Tosymra, Sumavel, Alsuma, Imigran, Migraitan, and Zecuity ... are still sumatriptan by any other name.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

My use of drug names is a mixed bag of terms.

In medical school we learn drugs by their generic names, but it doesn’t take long before we realize that each has both a generic name and one (or more) brand names. I suppose there’s also the chemical names, but no one outside the lab uses those. They’re waaaaay too long.

There is, for better or worse, a lot of variability in this. The purists (almost always academics, or cardiologists, or academic cardiologists) insist on generic names only. In their notes, conversations, presentations, whatever. If you’re a medical student or resident under them, you learn fast not to use the brand name.

After 30 years of doing this ... I don’t care. My notes are a mishmash of both.

Let’s face it, brand names are generally shorter and easier to type, spell, and pronounce than the generic names. I still need to know both, but when I’m writing up a note Keppra is far easier than levetiracetam. And most patients find the brand names a lot easier to say and remember.

An even weirder point, which is my own, is that one of my teaching attendings insisted that we capitalize both generic and brand names while on his rotation. Why? He never explained that, but he was pretty insistent. Now, for whatever reason, the habit has stuck with me. I’m sure the cardiologist down the hall would love to send my notes back, heavily marked up with red ink.

There’s even a weird subdivisions in this: Aspirin is a brand name by Bayer. Shouldn’t it be capitalized in our notes? But it isn’t, and to make things more confusing that varies by country. Why? (if you’re curious, it’s a strange combination of 100-year-old patent claims, generic trademark rulings, and also what country you’re in, whether it was involved in World War I, and, if so, which side. Really).

So the medical lists in my notes are certainly understandable, though aren’t going to score me any points for academic correctness. Not that I care. As a medical Shakespeare might have written, Imitrex, Onzetra, Zembrace, Tosymra, Sumavel, Alsuma, Imigran, Migraitan, and Zecuity ... are still sumatriptan by any other name.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

Summer is here. Well, technically not for 3 weeks, but in Phoenix summer as a weather condition generally runs from March to November.

The suprachiasmatic nucleus (yes, the one you learned in neuroanatomy) is pretty tiny, but still remarkable. Nothing brings that into focus like the changing of the seasons.

No matter where you live on Earth, you still have to deal with day and night, even if each is 6 months long. We all have to live with shifting schedules and lengths of night and day and weekdays and weekends.

But what fascinates me is how the internal clock reprograms itself, and then doesn’t change.

Case in point: Except for when I’ve had to catch a flight, I haven’t set an alarm in almost 10 years. Somewhere early in my career (back when I did a lot of hospital work) I began getting up between 4-5 a.m. to start rounds before going to the office.

Today the habit continues. It’s been 14 years since I last did weekday hospital call but I still automatically wake up, ready to go, between 4 a.m. and 5 a.m., Monday through Friday. Without me having to do anything this shuts off on vacations, holidays, and weekends, but is up and running as soon as I have to go back to the office.

It’s fascinating (at least to me) in that the suprachiasmatic nucleus didn’t evolve many millions of years ago so I could get to work without an alarm clock. Early animals needed to respond to changing conditions of night, day, and shifting seasons. Light and dark are universal for almost everything that walks, flies, and swims, so given enough time a way of internally keeping track of them developed. Bears use it to hibernate. Birds to migrate with the seasons.

Of course, it’s not all good. In some people it’s likely behind the bizarre predictability of their cluster headaches.

In the modern era we’ve also found ways to confuse it, with the invention of time zones and air travel. Anyone who’s made the leap across several time zones has had to adjust. It’s certainly not a major issue, but does take some getting used to.

But still, it’s pretty fascinating stuff. A reminder that, for all we do in our every day lives, the brain does things on autopilot that we don’t even think about.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

Summer is here. Well, technically not for 3 weeks, but in Phoenix summer as a weather condition generally runs from March to November.

The suprachiasmatic nucleus (yes, the one you learned in neuroanatomy) is pretty tiny, but still remarkable. Nothing brings that into focus like the changing of the seasons.

No matter where you live on Earth, you still have to deal with day and night, even if each is 6 months long. We all have to live with shifting schedules and lengths of night and day and weekdays and weekends.

But what fascinates me is how the internal clock reprograms itself, and then doesn’t change.

Case in point: Except for when I’ve had to catch a flight, I haven’t set an alarm in almost 10 years. Somewhere early in my career (back when I did a lot of hospital work) I began getting up between 4-5 a.m. to start rounds before going to the office.

Today the habit continues. It’s been 14 years since I last did weekday hospital call but I still automatically wake up, ready to go, between 4 a.m. and 5 a.m., Monday through Friday. Without me having to do anything this shuts off on vacations, holidays, and weekends, but is up and running as soon as I have to go back to the office.

It’s fascinating (at least to me) in that the suprachiasmatic nucleus didn’t evolve many millions of years ago so I could get to work without an alarm clock. Early animals needed to respond to changing conditions of night, day, and shifting seasons. Light and dark are universal for almost everything that walks, flies, and swims, so given enough time a way of internally keeping track of them developed. Bears use it to hibernate. Birds to migrate with the seasons.

Of course, it’s not all good. In some people it’s likely behind the bizarre predictability of their cluster headaches.

In the modern era we’ve also found ways to confuse it, with the invention of time zones and air travel. Anyone who’s made the leap across several time zones has had to adjust. It’s certainly not a major issue, but does take some getting used to.

But still, it’s pretty fascinating stuff. A reminder that, for all we do in our every day lives, the brain does things on autopilot that we don’t even think about.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

Summer is here. Well, technically not for 3 weeks, but in Phoenix summer as a weather condition generally runs from March to November.

The suprachiasmatic nucleus (yes, the one you learned in neuroanatomy) is pretty tiny, but still remarkable. Nothing brings that into focus like the changing of the seasons.

No matter where you live on Earth, you still have to deal with day and night, even if each is 6 months long. We all have to live with shifting schedules and lengths of night and day and weekdays and weekends.

But what fascinates me is how the internal clock reprograms itself, and then doesn’t change.

Case in point: Except for when I’ve had to catch a flight, I haven’t set an alarm in almost 10 years. Somewhere early in my career (back when I did a lot of hospital work) I began getting up between 4-5 a.m. to start rounds before going to the office.

Today the habit continues. It’s been 14 years since I last did weekday hospital call but I still automatically wake up, ready to go, between 4 a.m. and 5 a.m., Monday through Friday. Without me having to do anything this shuts off on vacations, holidays, and weekends, but is up and running as soon as I have to go back to the office.

It’s fascinating (at least to me) in that the suprachiasmatic nucleus didn’t evolve many millions of years ago so I could get to work without an alarm clock. Early animals needed to respond to changing conditions of night, day, and shifting seasons. Light and dark are universal for almost everything that walks, flies, and swims, so given enough time a way of internally keeping track of them developed. Bears use it to hibernate. Birds to migrate with the seasons.

Of course, it’s not all good. In some people it’s likely behind the bizarre predictability of their cluster headaches.

In the modern era we’ve also found ways to confuse it, with the invention of time zones and air travel. Anyone who’s made the leap across several time zones has had to adjust. It’s certainly not a major issue, but does take some getting used to.

But still, it’s pretty fascinating stuff. A reminder that, for all we do in our every day lives, the brain does things on autopilot that we don’t even think about.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

A few weeks ago we went to Phoenix Theater’s production of “A Chorus Line.” As with all their shows, it was excellent.

The penultimate scene is where one of the auditioning dancers suffers a career-ending injury, forcing the others to consider what they’d do if they couldn’t dance anymore, and facing the fact that sooner or later it will happen to all of them.

Let’s flip it onto us: What if tomorrow you couldn’t practice medicine anymore? To keep it from getting too depressing, let’s say it was because of paperwork. Your medical license expired and you weren’t warned in advance, and because of some legal glitch you can’t ever renew it now.

It’s a good question. I mean, I’ve wanted to be doctor as long as I can remember. (Actually I wanted to be Batman, then a scientist, then a doctor. Though I’d still rather be Batman. I’m even the same age as he was in The Dark Knight Returns.)

For all the paperwork and insurance fights and aggravations the job brings, I still love doing it. I get up on weekday mornings and feel good about going to the office. I generally feel good about what I’ve done to help people (or at least did my best to try) at the end of the day.

During my first year of residency (30 years ago) I remember telling my parents that, if even if I were phenomenally wealthy, I’d still do this job for free. Well, I’m not phenomenally wealthy, but I still enjoy the job.

If I couldn’t do it anymore, I’d be pretty sad. I mean, it’s not like I couldn’t find something else – consulting, research, writing, joining my daughter at her bakery – but I doubt I’d like it as much. Even if money weren’t an issue, there’s only so many jigsaw puzzles to do and books to read.

What about you?

Realistically, most of us won’t do this for the rest of our lives. Our expiration date may be longer than that of a professional dancer, but we still have one. Even if the mind stays sharp, sooner or later we all reach a point where it’s time to move on and leave the field in the capable hands of the next generation, just as a prior group of physicians left it to us. As the line in the song states, “the gift was ours to borrow.” And yes, I still see being able to do this for a living as a privilege and gift. But inevitably we all have to pass it on to the next ones, as will they someday.

But I’ll miss it. An oncologist I know was retired for a few months before he signed up for a nonmedical volunteer job at his old hospital, helping people find the rooms and departments they need to go to. He’s happy with it.

Being a doctor, and the desire to help others, becomes so ingrained into our personalities, and is such a central part of who we are, that it’s hard to walk away from it.

But when you do, you need to do your best to do it without regret. After all, you got to do something that many only dream of. Helping others and (I hope) having a job you enjoy.

I have dancers, and retired dancers, in my practice. The retired ones still miss it, but very few of them leave. They do volunteer teaching at community theaters, or just keep dancing on their own in groups of like-minded friends, as best they can. While medicine has made us one of the longer-lived mammals, it doesn’t stop the years.

When it’s time to walk away and point to tomorrow, do it without regrets, and remember that, even with the sweetness and the sorrow, it was what you did for love.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

A few weeks ago we went to Phoenix Theater’s production of “A Chorus Line.” As with all their shows, it was excellent.

The penultimate scene is where one of the auditioning dancers suffers a career-ending injury, forcing the others to consider what they’d do if they couldn’t dance anymore, and facing the fact that sooner or later it will happen to all of them.

Let’s flip it onto us: What if tomorrow you couldn’t practice medicine anymore? To keep it from getting too depressing, let’s say it was because of paperwork. Your medical license expired and you weren’t warned in advance, and because of some legal glitch you can’t ever renew it now.

It’s a good question. I mean, I’ve wanted to be doctor as long as I can remember. (Actually I wanted to be Batman, then a scientist, then a doctor. Though I’d still rather be Batman. I’m even the same age as he was in The Dark Knight Returns.)

For all the paperwork and insurance fights and aggravations the job brings, I still love doing it. I get up on weekday mornings and feel good about going to the office. I generally feel good about what I’ve done to help people (or at least did my best to try) at the end of the day.

During my first year of residency (30 years ago) I remember telling my parents that, if even if I were phenomenally wealthy, I’d still do this job for free. Well, I’m not phenomenally wealthy, but I still enjoy the job.

If I couldn’t do it anymore, I’d be pretty sad. I mean, it’s not like I couldn’t find something else – consulting, research, writing, joining my daughter at her bakery – but I doubt I’d like it as much. Even if money weren’t an issue, there’s only so many jigsaw puzzles to do and books to read.

What about you?

Realistically, most of us won’t do this for the rest of our lives. Our expiration date may be longer than that of a professional dancer, but we still have one. Even if the mind stays sharp, sooner or later we all reach a point where it’s time to move on and leave the field in the capable hands of the next generation, just as a prior group of physicians left it to us. As the line in the song states, “the gift was ours to borrow.” And yes, I still see being able to do this for a living as a privilege and gift. But inevitably we all have to pass it on to the next ones, as will they someday.

But I’ll miss it. An oncologist I know was retired for a few months before he signed up for a nonmedical volunteer job at his old hospital, helping people find the rooms and departments they need to go to. He’s happy with it.

Being a doctor, and the desire to help others, becomes so ingrained into our personalities, and is such a central part of who we are, that it’s hard to walk away from it.

But when you do, you need to do your best to do it without regret. After all, you got to do something that many only dream of. Helping others and (I hope) having a job you enjoy.

I have dancers, and retired dancers, in my practice. The retired ones still miss it, but very few of them leave. They do volunteer teaching at community theaters, or just keep dancing on their own in groups of like-minded friends, as best they can. While medicine has made us one of the longer-lived mammals, it doesn’t stop the years.

When it’s time to walk away and point to tomorrow, do it without regrets, and remember that, even with the sweetness and the sorrow, it was what you did for love.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

A few weeks ago we went to Phoenix Theater’s production of “A Chorus Line.” As with all their shows, it was excellent.

The penultimate scene is where one of the auditioning dancers suffers a career-ending injury, forcing the others to consider what they’d do if they couldn’t dance anymore, and facing the fact that sooner or later it will happen to all of them.

Let’s flip it onto us: What if tomorrow you couldn’t practice medicine anymore? To keep it from getting too depressing, let’s say it was because of paperwork. Your medical license expired and you weren’t warned in advance, and because of some legal glitch you can’t ever renew it now.

It’s a good question. I mean, I’ve wanted to be doctor as long as I can remember. (Actually I wanted to be Batman, then a scientist, then a doctor. Though I’d still rather be Batman. I’m even the same age as he was in The Dark Knight Returns.)

For all the paperwork and insurance fights and aggravations the job brings, I still love doing it. I get up on weekday mornings and feel good about going to the office. I generally feel good about what I’ve done to help people (or at least did my best to try) at the end of the day.

During my first year of residency (30 years ago) I remember telling my parents that, if even if I were phenomenally wealthy, I’d still do this job for free. Well, I’m not phenomenally wealthy, but I still enjoy the job.

If I couldn’t do it anymore, I’d be pretty sad. I mean, it’s not like I couldn’t find something else – consulting, research, writing, joining my daughter at her bakery – but I doubt I’d like it as much. Even if money weren’t an issue, there’s only so many jigsaw puzzles to do and books to read.

What about you?

Realistically, most of us won’t do this for the rest of our lives. Our expiration date may be longer than that of a professional dancer, but we still have one. Even if the mind stays sharp, sooner or later we all reach a point where it’s time to move on and leave the field in the capable hands of the next generation, just as a prior group of physicians left it to us. As the line in the song states, “the gift was ours to borrow.” And yes, I still see being able to do this for a living as a privilege and gift. But inevitably we all have to pass it on to the next ones, as will they someday.

But I’ll miss it. An oncologist I know was retired for a few months before he signed up for a nonmedical volunteer job at his old hospital, helping people find the rooms and departments they need to go to. He’s happy with it.

Being a doctor, and the desire to help others, becomes so ingrained into our personalities, and is such a central part of who we are, that it’s hard to walk away from it.

But when you do, you need to do your best to do it without regret. After all, you got to do something that many only dream of. Helping others and (I hope) having a job you enjoy.

I have dancers, and retired dancers, in my practice. The retired ones still miss it, but very few of them leave. They do volunteer teaching at community theaters, or just keep dancing on their own in groups of like-minded friends, as best they can. While medicine has made us one of the longer-lived mammals, it doesn’t stop the years.

When it’s time to walk away and point to tomorrow, do it without regrets, and remember that, even with the sweetness and the sorrow, it was what you did for love.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

There’s been some recent news about medical schools gradually dropping the long-established practice of legacy admissions. This is where people related to successful alumni and/or big donors can get preferential admission, possibly over more qualified people.

All of us likely experienced this from one side or another, though realistically I haven’t thought about it years. My kids went to the same state school I did, but I’m pretty sure I had nothing to do with their being accepted. I never gave the school a single donation, nor did I call anyone there to try and get them in. Not that anyone would have known who I was if I’d tried. I’m just another one of many who went there, preserved only in some filing cabinet of transcripts somewhere.

I’m all for the legacy system ending, though, for one simple reason: It’s not fair.

If someone is qualified, great. They should be admitted on their own merits. But if they’re not, they shouldn’t get into medical school just because one (or both) of their parents went there, or is a VIP, or paid for a new library wing.

The reason I’m writing this is because the recent reporting did bring back a memory.

A long time ago, when I was in college, I hung out with other premed students. We knew we were all competing with each other for the same spots at the state medical school, but also knew that we wouldn’t all get in there. That didn’t make us enemies, it was just the truth. It’s that point in life where ANY medical school admission is all you want.

Pete (not his real name) was a nice guy, but his grades weren’t the best. His MCAT scores lagged behind the rest of us in the clique, and ... he didn’t care.

Pete’s dad had graduated from the state medical school, and was still on staff there. He was now on the teaching staff ... and on the school’s admissions board. To Pete, tests and grades didn’t matter. His admission was assured.

So it was no surprise when he got in ahead of the rest of us with better qualifications. Most of us, including me, did get in somewhere, so we were still happy. We just had to move farther and pay more, but that’s life.

I really didn’t think much about Pete again after that. I was now in medical school, I had a whole new social group, and more importantly I didn’t really have time to think of much beyond when the next exam was.

Then I moved home, and started residency. During my PGY-2 year we had a changing group of medical students assigned to my wards rotation.

And, as you probably guessed, one of them was Pete.

Pete was in his last year of medical school. But we’d both started in the same year, and now I was 2 years ahead of him. I didn’t ask him what happened, but another medical student told me he wasn’t known to be the best student, but the university refused to drop him, and just kept setting him back a class here, a year there.

Maybe they’d have done the same for anyone, but I doubt it.

I never saw Pete again after that. When I looked him up online tonight he’s not listed as being a doctor, and isn’t even in medicine. Granted, a lot of doctors have left medicine, and maybe he did too.

But the more likely reason is that Pete never should have been there in the first place. He got in as a legacy, taking a medical school slot from someone who may have been more capable and driven.

And that just doesn’t seem right to me. It didn’t then and it doesn’t now.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

There’s been some recent news about medical schools gradually dropping the long-established practice of legacy admissions. This is where people related to successful alumni and/or big donors can get preferential admission, possibly over more qualified people.

All of us likely experienced this from one side or another, though realistically I haven’t thought about it years. My kids went to the same state school I did, but I’m pretty sure I had nothing to do with their being accepted. I never gave the school a single donation, nor did I call anyone there to try and get them in. Not that anyone would have known who I was if I’d tried. I’m just another one of many who went there, preserved only in some filing cabinet of transcripts somewhere.

I’m all for the legacy system ending, though, for one simple reason: It’s not fair.

If someone is qualified, great. They should be admitted on their own merits. But if they’re not, they shouldn’t get into medical school just because one (or both) of their parents went there, or is a VIP, or paid for a new library wing.

The reason I’m writing this is because the recent reporting did bring back a memory.

A long time ago, when I was in college, I hung out with other premed students. We knew we were all competing with each other for the same spots at the state medical school, but also knew that we wouldn’t all get in there. That didn’t make us enemies, it was just the truth. It’s that point in life where ANY medical school admission is all you want.

Pete (not his real name) was a nice guy, but his grades weren’t the best. His MCAT scores lagged behind the rest of us in the clique, and ... he didn’t care.

Pete’s dad had graduated from the state medical school, and was still on staff there. He was now on the teaching staff ... and on the school’s admissions board. To Pete, tests and grades didn’t matter. His admission was assured.

So it was no surprise when he got in ahead of the rest of us with better qualifications. Most of us, including me, did get in somewhere, so we were still happy. We just had to move farther and pay more, but that’s life.

I really didn’t think much about Pete again after that. I was now in medical school, I had a whole new social group, and more importantly I didn’t really have time to think of much beyond when the next exam was.

Then I moved home, and started residency. During my PGY-2 year we had a changing group of medical students assigned to my wards rotation.

And, as you probably guessed, one of them was Pete.

Pete was in his last year of medical school. But we’d both started in the same year, and now I was 2 years ahead of him. I didn’t ask him what happened, but another medical student told me he wasn’t known to be the best student, but the university refused to drop him, and just kept setting him back a class here, a year there.

Maybe they’d have done the same for anyone, but I doubt it.

I never saw Pete again after that. When I looked him up online tonight he’s not listed as being a doctor, and isn’t even in medicine. Granted, a lot of doctors have left medicine, and maybe he did too.

But the more likely reason is that Pete never should have been there in the first place. He got in as a legacy, taking a medical school slot from someone who may have been more capable and driven.

And that just doesn’t seem right to me. It didn’t then and it doesn’t now.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

There’s been some recent news about medical schools gradually dropping the long-established practice of legacy admissions. This is where people related to successful alumni and/or big donors can get preferential admission, possibly over more qualified people.

All of us likely experienced this from one side or another, though realistically I haven’t thought about it years. My kids went to the same state school I did, but I’m pretty sure I had nothing to do with their being accepted. I never gave the school a single donation, nor did I call anyone there to try and get them in. Not that anyone would have known who I was if I’d tried. I’m just another one of many who went there, preserved only in some filing cabinet of transcripts somewhere.

I’m all for the legacy system ending, though, for one simple reason: It’s not fair.

If someone is qualified, great. They should be admitted on their own merits. But if they’re not, they shouldn’t get into medical school just because one (or both) of their parents went there, or is a VIP, or paid for a new library wing.

The reason I’m writing this is because the recent reporting did bring back a memory.

A long time ago, when I was in college, I hung out with other premed students. We knew we were all competing with each other for the same spots at the state medical school, but also knew that we wouldn’t all get in there. That didn’t make us enemies, it was just the truth. It’s that point in life where ANY medical school admission is all you want.

Pete (not his real name) was a nice guy, but his grades weren’t the best. His MCAT scores lagged behind the rest of us in the clique, and ... he didn’t care.

Pete’s dad had graduated from the state medical school, and was still on staff there. He was now on the teaching staff ... and on the school’s admissions board. To Pete, tests and grades didn’t matter. His admission was assured.

So it was no surprise when he got in ahead of the rest of us with better qualifications. Most of us, including me, did get in somewhere, so we were still happy. We just had to move farther and pay more, but that’s life.

I really didn’t think much about Pete again after that. I was now in medical school, I had a whole new social group, and more importantly I didn’t really have time to think of much beyond when the next exam was.

Then I moved home, and started residency. During my PGY-2 year we had a changing group of medical students assigned to my wards rotation.

And, as you probably guessed, one of them was Pete.

Pete was in his last year of medical school. But we’d both started in the same year, and now I was 2 years ahead of him. I didn’t ask him what happened, but another medical student told me he wasn’t known to be the best student, but the university refused to drop him, and just kept setting him back a class here, a year there.

Maybe they’d have done the same for anyone, but I doubt it.

I never saw Pete again after that. When I looked him up online tonight he’s not listed as being a doctor, and isn’t even in medicine. Granted, a lot of doctors have left medicine, and maybe he did too.

But the more likely reason is that Pete never should have been there in the first place. He got in as a legacy, taking a medical school slot from someone who may have been more capable and driven.

And that just doesn’t seem right to me. It didn’t then and it doesn’t now.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

Try practicing inpatient medicine without nurses.

You can’t.

In a world where doctors get top billing, nurses are the unsung heroes that really make it all happen. We blow in and out of the rooms, write notes, check results and vitals, then move on to the next person.

But the nurses are the ones who actually make this all happen. And, amazingly, can do all that work with a smile.

But in our current postpandemic world, we’re facing a serious shortage. A recent survey of registered nurses found that only 15% of hospital nurses were planning on being there in 1 year. Thirty percent said they were planning on changing careers entirely in the aftermath of the pandemic. Their job satisfaction scores have dropped 15% from 2019 to 2023. Their stress scores, and concerns that the job is affecting their health, have increased 15%-20%.

The problem reflects a combination of things intersecting at a bad time: Staffing shortages resulting in more patients per nurse, hospital administrators cutting corners on staffing and pay, and the ongoing state of incivility.

The last one is a particularly new issue. Difficult patients and their families are nothing new. We all encounter them, and learn to deal with them in our own way. It’s part of the territory.

But since 2020 it’s climbed to a new-level of in-your-face confrontation, rudeness, and aggression, sometimes leading to violence. Physical attacks on people in all jobs have increased, but health care workers are five times more likely to encounter workplace violence than any other field.

Underpaid, overworked, and a sitting duck for violence. Can you blame people for looking elsewhere?

All of this is coming at a time when a whole generation of nurses is retiring, another generation is starting to reach an age of needing more health care, and nursing schools are short on teaching staff, limiting the number of new people that can be trained. Nursing education, like medical school, isn’t a place to cut corners (neither is care, obviously).

These days we toss the word “burnout” around to the point that it’s become almost meaningless, but to those affected by it, the consequences are quite real. And when it causes a loss of staff and impairs the ability of all to provide quality medical care, it quickly becomes everyone’s problem.

Finding solutions for such things isn’t a can you just kick down the road, as governmental agencies have always been so good at doing. These are things that have real-world consequences for all involved, and solutions need to involve private, public, and educational sectors working together.

I don’t have any ideas, but I hope the people who can change this will sit down and work some out.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

Try practicing inpatient medicine without nurses.

You can’t.

In a world where doctors get top billing, nurses are the unsung heroes that really make it all happen. We blow in and out of the rooms, write notes, check results and vitals, then move on to the next person.

But the nurses are the ones who actually make this all happen. And, amazingly, can do all that work with a smile.

But in our current postpandemic world, we’re facing a serious shortage. A recent survey of registered nurses found that only 15% of hospital nurses were planning on being there in 1 year. Thirty percent said they were planning on changing careers entirely in the aftermath of the pandemic. Their job satisfaction scores have dropped 15% from 2019 to 2023. Their stress scores, and concerns that the job is affecting their health, have increased 15%-20%.

The problem reflects a combination of things intersecting at a bad time: Staffing shortages resulting in more patients per nurse, hospital administrators cutting corners on staffing and pay, and the ongoing state of incivility.

The last one is a particularly new issue. Difficult patients and their families are nothing new. We all encounter them, and learn to deal with them in our own way. It’s part of the territory.

But since 2020 it’s climbed to a new-level of in-your-face confrontation, rudeness, and aggression, sometimes leading to violence. Physical attacks on people in all jobs have increased, but health care workers are five times more likely to encounter workplace violence than any other field.

Underpaid, overworked, and a sitting duck for violence. Can you blame people for looking elsewhere?

All of this is coming at a time when a whole generation of nurses is retiring, another generation is starting to reach an age of needing more health care, and nursing schools are short on teaching staff, limiting the number of new people that can be trained. Nursing education, like medical school, isn’t a place to cut corners (neither is care, obviously).

These days we toss the word “burnout” around to the point that it’s become almost meaningless, but to those affected by it, the consequences are quite real. And when it causes a loss of staff and impairs the ability of all to provide quality medical care, it quickly becomes everyone’s problem.

Finding solutions for such things isn’t a can you just kick down the road, as governmental agencies have always been so good at doing. These are things that have real-world consequences for all involved, and solutions need to involve private, public, and educational sectors working together.

I don’t have any ideas, but I hope the people who can change this will sit down and work some out.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

Try practicing inpatient medicine without nurses.

You can’t.

In a world where doctors get top billing, nurses are the unsung heroes that really make it all happen. We blow in and out of the rooms, write notes, check results and vitals, then move on to the next person.

But the nurses are the ones who actually make this all happen. And, amazingly, can do all that work with a smile.

But in our current postpandemic world, we’re facing a serious shortage. A recent survey of registered nurses found that only 15% of hospital nurses were planning on being there in 1 year. Thirty percent said they were planning on changing careers entirely in the aftermath of the pandemic. Their job satisfaction scores have dropped 15% from 2019 to 2023. Their stress scores, and concerns that the job is affecting their health, have increased 15%-20%.

The problem reflects a combination of things intersecting at a bad time: Staffing shortages resulting in more patients per nurse, hospital administrators cutting corners on staffing and pay, and the ongoing state of incivility.

The last one is a particularly new issue. Difficult patients and their families are nothing new. We all encounter them, and learn to deal with them in our own way. It’s part of the territory.

But since 2020 it’s climbed to a new-level of in-your-face confrontation, rudeness, and aggression, sometimes leading to violence. Physical attacks on people in all jobs have increased, but health care workers are five times more likely to encounter workplace violence than any other field.

Underpaid, overworked, and a sitting duck for violence. Can you blame people for looking elsewhere?

All of this is coming at a time when a whole generation of nurses is retiring, another generation is starting to reach an age of needing more health care, and nursing schools are short on teaching staff, limiting the number of new people that can be trained. Nursing education, like medical school, isn’t a place to cut corners (neither is care, obviously).

These days we toss the word “burnout” around to the point that it’s become almost meaningless, but to those affected by it, the consequences are quite real. And when it causes a loss of staff and impairs the ability of all to provide quality medical care, it quickly becomes everyone’s problem.

Finding solutions for such things isn’t a can you just kick down the road, as governmental agencies have always been so good at doing. These are things that have real-world consequences for all involved, and solutions need to involve private, public, and educational sectors working together.

I don’t have any ideas, but I hope the people who can change this will sit down and work some out.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

What is the most dangerous animal on Earth? Which one has killed more humans since we first began walking upright?

The mind leaps to the vicious and dangerous – great white sharks. lions. tigers. crocodiles. The fearsome predators of the planet But realistically, more people are killed and injured by large herbivores each year than predators. Just watch news updates from Yellowstone during their busy season.

Anyway, the correct answer is ... none of the above.

It’s the mosquito, and the many microbes it’s a vector for. Malaria, in particular. Even today, one to two people die each minute from malaria on planet Earth. Even the once-devastating bubonic plague is no longer a major concern.

What do Presidents Washington, Kennedy, Eisenhower, Lincoln, Monroe, Grant, Garfield, Jackson, Teddy Roosevelt, and other historical VIPs like Oliver Cromwell, King Tut, and numerous kings, queens, and popes all have in common? They all had malaria. Cromwell, Tut, and many royal and religious figures died of it.

You can make a solid argument that malaria is the disease that’s affected the course of history more than any other (you could make a good case for the plague, too, but it’s less relevant today). The control of malaria is what allowed the Panama canal to happen.

I’m bringing this up because, mostly overlooked in the news recently as we argued about light beer endorsements, TV pundits, and the NFL draft, is the approval and gradual increase in use of a malaria vaccine.

This is a pretty big deal given the scope of the problem and the fact that the most effective prevention up until recently was a mosquito net.

We tend to see malaria as someone else’s problem, something that affects the tropics, but forget that as recently as the 1940s it was still common in the U.S. During the Civil War as many as 1 million soldiers were infected with it. Given the right conditions it could easily return here.

Which is why we should be more aware of these things. As COVID showed, infectious diseases are never some other country’s, or continent’s, problem. They affect all of us either directly or indirectly. In the interconnected economies of the world illnesses in one area can spread to others. Even if they don’t they can still have significant effects on supply chains, since so much of what we depend on comes from somewhere else.

COVID, by comparison, is small beer. Just think about smallpox, or the plague, or polio, as to what an unchecked disease can do to a society until medicine catches up with it.

There will always be new diseases. Microbes and humans have been in a state of hostilities for a few million years now, and likely always will be. But every victory along the way is a victory for everyone, regardless of who they are or where they live.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

What is the most dangerous animal on Earth? Which one has killed more humans since we first began walking upright?

The mind leaps to the vicious and dangerous – great white sharks. lions. tigers. crocodiles. The fearsome predators of the planet But realistically, more people are killed and injured by large herbivores each year than predators. Just watch news updates from Yellowstone during their busy season.

Anyway, the correct answer is ... none of the above.

It’s the mosquito, and the many microbes it’s a vector for. Malaria, in particular. Even today, one to two people die each minute from malaria on planet Earth. Even the once-devastating bubonic plague is no longer a major concern.

What do Presidents Washington, Kennedy, Eisenhower, Lincoln, Monroe, Grant, Garfield, Jackson, Teddy Roosevelt, and other historical VIPs like Oliver Cromwell, King Tut, and numerous kings, queens, and popes all have in common? They all had malaria. Cromwell, Tut, and many royal and religious figures died of it.

You can make a solid argument that malaria is the disease that’s affected the course of history more than any other (you could make a good case for the plague, too, but it’s less relevant today). The control of malaria is what allowed the Panama canal to happen.

I’m bringing this up because, mostly overlooked in the news recently as we argued about light beer endorsements, TV pundits, and the NFL draft, is the approval and gradual increase in use of a malaria vaccine.

This is a pretty big deal given the scope of the problem and the fact that the most effective prevention up until recently was a mosquito net.

We tend to see malaria as someone else’s problem, something that affects the tropics, but forget that as recently as the 1940s it was still common in the U.S. During the Civil War as many as 1 million soldiers were infected with it. Given the right conditions it could easily return here.

Which is why we should be more aware of these things. As COVID showed, infectious diseases are never some other country’s, or continent’s, problem. They affect all of us either directly or indirectly. In the interconnected economies of the world illnesses in one area can spread to others. Even if they don’t they can still have significant effects on supply chains, since so much of what we depend on comes from somewhere else.

COVID, by comparison, is small beer. Just think about smallpox, or the plague, or polio, as to what an unchecked disease can do to a society until medicine catches up with it.

There will always be new diseases. Microbes and humans have been in a state of hostilities for a few million years now, and likely always will be. But every victory along the way is a victory for everyone, regardless of who they are or where they live.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

What is the most dangerous animal on Earth? Which one has killed more humans since we first began walking upright?

The mind leaps to the vicious and dangerous – great white sharks. lions. tigers. crocodiles. The fearsome predators of the planet But realistically, more people are killed and injured by large herbivores each year than predators. Just watch news updates from Yellowstone during their busy season.

Anyway, the correct answer is ... none of the above.

It’s the mosquito, and the many microbes it’s a vector for. Malaria, in particular. Even today, one to two people die each minute from malaria on planet Earth. Even the once-devastating bubonic plague is no longer a major concern.

What do Presidents Washington, Kennedy, Eisenhower, Lincoln, Monroe, Grant, Garfield, Jackson, Teddy Roosevelt, and other historical VIPs like Oliver Cromwell, King Tut, and numerous kings, queens, and popes all have in common? They all had malaria. Cromwell, Tut, and many royal and religious figures died of it.

You can make a solid argument that malaria is the disease that’s affected the course of history more than any other (you could make a good case for the plague, too, but it’s less relevant today). The control of malaria is what allowed the Panama canal to happen.

I’m bringing this up because, mostly overlooked in the news recently as we argued about light beer endorsements, TV pundits, and the NFL draft, is the approval and gradual increase in use of a malaria vaccine.

This is a pretty big deal given the scope of the problem and the fact that the most effective prevention up until recently was a mosquito net.

We tend to see malaria as someone else’s problem, something that affects the tropics, but forget that as recently as the 1940s it was still common in the U.S. During the Civil War as many as 1 million soldiers were infected with it. Given the right conditions it could easily return here.

Which is why we should be more aware of these things. As COVID showed, infectious diseases are never some other country’s, or continent’s, problem. They affect all of us either directly or indirectly. In the interconnected economies of the world illnesses in one area can spread to others. Even if they don’t they can still have significant effects on supply chains, since so much of what we depend on comes from somewhere else.

COVID, by comparison, is small beer. Just think about smallpox, or the plague, or polio, as to what an unchecked disease can do to a society until medicine catches up with it.

There will always be new diseases. Microbes and humans have been in a state of hostilities for a few million years now, and likely always will be. But every victory along the way is a victory for everyone, regardless of who they are or where they live.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

Last week, unbeknownst to most people, Dayton, Ohio, hosted the world championships of Winter Drumline. It’s a combination of percussion instruments, dance, and music, with a storyline. Think of it as a very fast-paced half-time show, with only percussion, in 6 minutes or less.

My daughter fell in love with it her second year of high school, and has participated in it through college. Her specialty is the pit – marimba, vibraphone, xylophone. This gives our house a cruise ship atmosphere when she comes home to practice on weekends.

Over the years my wife and I have gone to many of her shows and competitions, streamed others online, and always been amazed by the variety of costumes, choreography, music numbers, and overall themes different teams come up with. We’ve seen shows based on 1930s detective fiction, ocean life, westerns, science fiction, toxic waste, emotions, relationships, flamenco, pirate ships, and many others.

And, as always, I marvel at the human brain.

Only 2-3 pounds but still an amazing thing. The capacity for imagination is endless, and one of the things that got us where we are today. The ability to see things that don’t exist yet, and work out the details on how to get there. The pyramids, Petra, the Great Wall, flight, the steam engine, landing on the moon, the ISS. And, of course, Winter Drumline.

It’s a uniquely (as far as we know) human capacity. To look at a rock and envision what it might be carved into. To look at Jupiter and think of a way to get a probe there. To sit in an empty gym and imagine the floor covered with dozens of percussion instruments and their players, imagining what each will be playing and doing at a given moment.

It’s really a remarkable capacity when you think about it. I’m sure it originally began as a way to figure out where you might find shelter or food, or simply to outwit the other tribe. But it’s become so much more than that. Someone envisioned every movie you see, book you read, and the computer I’m writing this on.

In his 1968 novelization of “2001: A Space Odyssey” Arthur C. Clarke described the thoughts of the unknown civilization that had left the Monolith behind for us as “in all the galaxy they had found nothing more precious than Mind.”

I’d agree with that. Even after 30 years of learning about the 2-3 pounds of semi-solid tissue we all carry upstairs, and doing my best to treat its malfunctions, I’ve never ceased to be amazed by it.

I hope I always will be.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

Last week, unbeknownst to most people, Dayton, Ohio, hosted the world championships of Winter Drumline. It’s a combination of percussion instruments, dance, and music, with a storyline. Think of it as a very fast-paced half-time show, with only percussion, in 6 minutes or less.

My daughter fell in love with it her second year of high school, and has participated in it through college. Her specialty is the pit – marimba, vibraphone, xylophone. This gives our house a cruise ship atmosphere when she comes home to practice on weekends.

Over the years my wife and I have gone to many of her shows and competitions, streamed others online, and always been amazed by the variety of costumes, choreography, music numbers, and overall themes different teams come up with. We’ve seen shows based on 1930s detective fiction, ocean life, westerns, science fiction, toxic waste, emotions, relationships, flamenco, pirate ships, and many others.

And, as always, I marvel at the human brain.

Only 2-3 pounds but still an amazing thing. The capacity for imagination is endless, and one of the things that got us where we are today. The ability to see things that don’t exist yet, and work out the details on how to get there. The pyramids, Petra, the Great Wall, flight, the steam engine, landing on the moon, the ISS. And, of course, Winter Drumline.

It’s a uniquely (as far as we know) human capacity. To look at a rock and envision what it might be carved into. To look at Jupiter and think of a way to get a probe there. To sit in an empty gym and imagine the floor covered with dozens of percussion instruments and their players, imagining what each will be playing and doing at a given moment.

It’s really a remarkable capacity when you think about it. I’m sure it originally began as a way to figure out where you might find shelter or food, or simply to outwit the other tribe. But it’s become so much more than that. Someone envisioned every movie you see, book you read, and the computer I’m writing this on.

In his 1968 novelization of “2001: A Space Odyssey” Arthur C. Clarke described the thoughts of the unknown civilization that had left the Monolith behind for us as “in all the galaxy they had found nothing more precious than Mind.”

I’d agree with that. Even after 30 years of learning about the 2-3 pounds of semi-solid tissue we all carry upstairs, and doing my best to treat its malfunctions, I’ve never ceased to be amazed by it.

I hope I always will be.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

Last week, unbeknownst to most people, Dayton, Ohio, hosted the world championships of Winter Drumline. It’s a combination of percussion instruments, dance, and music, with a storyline. Think of it as a very fast-paced half-time show, with only percussion, in 6 minutes or less.

My daughter fell in love with it her second year of high school, and has participated in it through college. Her specialty is the pit – marimba, vibraphone, xylophone. This gives our house a cruise ship atmosphere when she comes home to practice on weekends.

Over the years my wife and I have gone to many of her shows and competitions, streamed others online, and always been amazed by the variety of costumes, choreography, music numbers, and overall themes different teams come up with. We’ve seen shows based on 1930s detective fiction, ocean life, westerns, science fiction, toxic waste, emotions, relationships, flamenco, pirate ships, and many others.

And, as always, I marvel at the human brain.

Only 2-3 pounds but still an amazing thing. The capacity for imagination is endless, and one of the things that got us where we are today. The ability to see things that don’t exist yet, and work out the details on how to get there. The pyramids, Petra, the Great Wall, flight, the steam engine, landing on the moon, the ISS. And, of course, Winter Drumline.

It’s a uniquely (as far as we know) human capacity. To look at a rock and envision what it might be carved into. To look at Jupiter and think of a way to get a probe there. To sit in an empty gym and imagine the floor covered with dozens of percussion instruments and their players, imagining what each will be playing and doing at a given moment.

It’s really a remarkable capacity when you think about it. I’m sure it originally began as a way to figure out where you might find shelter or food, or simply to outwit the other tribe. But it’s become so much more than that. Someone envisioned every movie you see, book you read, and the computer I’m writing this on.

In his 1968 novelization of “2001: A Space Odyssey” Arthur C. Clarke described the thoughts of the unknown civilization that had left the Monolith behind for us as “in all the galaxy they had found nothing more precious than Mind.”

I’d agree with that. Even after 30 years of learning about the 2-3 pounds of semi-solid tissue we all carry upstairs, and doing my best to treat its malfunctions, I’ve never ceased to be amazed by it.

I hope I always will be.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

STAT recently published an article on a new aspect of managed medical care.

They found that some Medicare Advantage plans are using artificial intelligence algorithms to make decisions on how long patients should (or shouldn’t) be in hospitals and receive treatments.

That’s ... kind of scary.

Certainly, computers aren’t bad things. In 2023 America you can’t practice medicine without them. They aren’t malicious. They can analyze a lot of data faster than we can (for the record, the average memory capacity of a human brain is 1 petabyte, so we’re still ahead of the average desktop in that regard).

Computers, though, are pretty uniform. I’m a Mac person, and I can go into any Apple store and buy one. Right off the shelf I know how to work it, how it will run a given program, and can predict how it will handle different commands and such. They’re pretty much the same.

People are not quite as easy. Anatomically and chemically we’re similar, but that’s not the same. There are immune, genetic, and multiple other factors that put a lot of variables into the equation. Part of our training is knowing that and taking it into account when making treatment plans.

Algorithms, and artificial intelligence, can only do so much of that. If they were right all the time sports betting wouldn’t exist. But it does, because sports depends on the participants, who are people (or horses), and they’re not exactly alike ... for that matter how they’ll perform varies from day to day for the same individual.

But medical care isn’t a sport (even though hospital call can seem like a marathon). The data we give computers to use is generally based on averages – a rehab stay of 16.6 days for an 85-year-old woman with a broken shoulder (per the above article). But they don’t realize that averages are actually a collection of data on a bell-shaped curve. An insurance company will be only too happy when one person completes their rehabilitation in 11.6 days, and then feel it’s unreasonable when another takes 21.6.

That said, many of the companies involved say the final decisions are made by humans and that the algorithms are just guidelines.

Maybe so, but the STAT article suggests they’re putting too much credence in what the computer says, and not the specific circumstances of the individual involved.

That ain’t good, at least not for the patients.

Medicine, for better or worse, is a business. In an ideal world it probably wouldn’t be, but we don’t live in one.

But it’s unlike any other business out there, and shouldn’t be run like one. A car repair shop knows what parts to order and generally how long repairs will take. Once they’re done the car should be ready to roll out of the shop.

People aren’t like that.

I understand the need to prevent abuse and overbilling for unnecessary days and services. Medicine, unfortunately, has plenty of opportunities for the dishonest to take advantage of.

It’s a thin line, but, at least today, turning treatment decisions over to algorithms and computers is a bad idea for the people we’re supposed to be caring for.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

STAT recently published an article on a new aspect of managed medical care.

They found that some Medicare Advantage plans are using artificial intelligence algorithms to make decisions on how long patients should (or shouldn’t) be in hospitals and receive treatments.

That’s ... kind of scary.

Certainly, computers aren’t bad things. In 2023 America you can’t practice medicine without them. They aren’t malicious. They can analyze a lot of data faster than we can (for the record, the average memory capacity of a human brain is 1 petabyte, so we’re still ahead of the average desktop in that regard).

Computers, though, are pretty uniform. I’m a Mac person, and I can go into any Apple store and buy one. Right off the shelf I know how to work it, how it will run a given program, and can predict how it will handle different commands and such. They’re pretty much the same.

People are not quite as easy. Anatomically and chemically we’re similar, but that’s not the same. There are immune, genetic, and multiple other factors that put a lot of variables into the equation. Part of our training is knowing that and taking it into account when making treatment plans.

Algorithms, and artificial intelligence, can only do so much of that. If they were right all the time sports betting wouldn’t exist. But it does, because sports depends on the participants, who are people (or horses), and they’re not exactly alike ... for that matter how they’ll perform varies from day to day for the same individual.

But medical care isn’t a sport (even though hospital call can seem like a marathon). The data we give computers to use is generally based on averages – a rehab stay of 16.6 days for an 85-year-old woman with a broken shoulder (per the above article). But they don’t realize that averages are actually a collection of data on a bell-shaped curve. An insurance company will be only too happy when one person completes their rehabilitation in 11.6 days, and then feel it’s unreasonable when another takes 21.6.

That said, many of the companies involved say the final decisions are made by humans and that the algorithms are just guidelines.

Maybe so, but the STAT article suggests they’re putting too much credence in what the computer says, and not the specific circumstances of the individual involved.

That ain’t good, at least not for the patients.

Medicine, for better or worse, is a business. In an ideal world it probably wouldn’t be, but we don’t live in one.

But it’s unlike any other business out there, and shouldn’t be run like one. A car repair shop knows what parts to order and generally how long repairs will take. Once they’re done the car should be ready to roll out of the shop.

People aren’t like that.

I understand the need to prevent abuse and overbilling for unnecessary days and services. Medicine, unfortunately, has plenty of opportunities for the dishonest to take advantage of.

It’s a thin line, but, at least today, turning treatment decisions over to algorithms and computers is a bad idea for the people we’re supposed to be caring for.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

STAT recently published an article on a new aspect of managed medical care.

They found that some Medicare Advantage plans are using artificial intelligence algorithms to make decisions on how long patients should (or shouldn’t) be in hospitals and receive treatments.

That’s ... kind of scary.

Certainly, computers aren’t bad things. In 2023 America you can’t practice medicine without them. They aren’t malicious. They can analyze a lot of data faster than we can (for the record, the average memory capacity of a human brain is 1 petabyte, so we’re still ahead of the average desktop in that regard).

Computers, though, are pretty uniform. I’m a Mac person, and I can go into any Apple store and buy one. Right off the shelf I know how to work it, how it will run a given program, and can predict how it will handle different commands and such. They’re pretty much the same.

People are not quite as easy. Anatomically and chemically we’re similar, but that’s not the same. There are immune, genetic, and multiple other factors that put a lot of variables into the equation. Part of our training is knowing that and taking it into account when making treatment plans.

Algorithms, and artificial intelligence, can only do so much of that. If they were right all the time sports betting wouldn’t exist. But it does, because sports depends on the participants, who are people (or horses), and they’re not exactly alike ... for that matter how they’ll perform varies from day to day for the same individual.

But medical care isn’t a sport (even though hospital call can seem like a marathon). The data we give computers to use is generally based on averages – a rehab stay of 16.6 days for an 85-year-old woman with a broken shoulder (per the above article). But they don’t realize that averages are actually a collection of data on a bell-shaped curve. An insurance company will be only too happy when one person completes their rehabilitation in 11.6 days, and then feel it’s unreasonable when another takes 21.6.

That said, many of the companies involved say the final decisions are made by humans and that the algorithms are just guidelines.

Maybe so, but the STAT article suggests they’re putting too much credence in what the computer says, and not the specific circumstances of the individual involved.

That ain’t good, at least not for the patients.

Medicine, for better or worse, is a business. In an ideal world it probably wouldn’t be, but we don’t live in one.

But it’s unlike any other business out there, and shouldn’t be run like one. A car repair shop knows what parts to order and generally how long repairs will take. Once they’re done the car should be ready to roll out of the shop.

People aren’t like that.

I understand the need to prevent abuse and overbilling for unnecessary days and services. Medicine, unfortunately, has plenty of opportunities for the dishonest to take advantage of.

It’s a thin line, but, at least today, turning treatment decisions over to algorithms and computers is a bad idea for the people we’re supposed to be caring for.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.