Author: James Vornov

I'm an MD, PhD Neurologist who left a successful academic career on the Faculty of The Johns Hopkins Medical School to develop new treatments in Biotech and Pharma. I became fascinated with how people actually make decisions based on the science of decision theory and emerging understanding of how the brain works to make decisions. My passion now is this deep explanation of what has been the realm of philosophy, psychology and self help but is now understood as brain function. By understanding our brains, I believe we can become happier, more successful people.

8 second intervals on the road

This week in Baltimore we had record high temperatures- reaching 70°F yesterday. So I needed to get out on the roads and do some bicycle riding. The 20 min interval session of 8 seconds of work, 12 seconds of recovery works well indoors on a trainer. I was faced with how to push the intensity in a similar way on the bike.

On a quiet stretch of road, I was able to keep an eye on the elapsed time readout of the Garmin 305, but it’s not a reasonable way to ride. Eventually, I figured out that it was about 12 full pedal strokes in 8 seconds, so I pushed for 12 and then let up. On a short ride, I got into a rhythm of pushing 12, resting for about the same, driving my heart rate up to the same zone that I did on the trainer for a 20 minute session. On a longer ride, I just threw in 8 second intervals keep my heart rate up during a longer 90 minute extensive ride.

Neurology Notes

Not Practicing

It looks like I’m not alone in Maryland as a non-practicing physician:

State lacks practicing physicians — baltimoresun.com: “While the state has about 25,000 licensed physicians, the second-highest rate per capita of any state, nearly 40 percent are engaged in teaching, research and administrative duties, according to the study, and some of the rest spend part of their time in such nonclinical work.”

One the insights that I had many years ago was that in practice, one had no way to leverage one’s activities. Economically a physician is valued for their direct time in providing care. And procedural activity, like surgery or angioplasty, is valued per unit time way above examining and diagnosing. In research and business, there are value multipliers as others participate in the enterprise. The return on time is potentially much higher for a phyisician outside of practice.

Low FDA Approval Rates

The rate of new drug approvals for the pharmaceutical industry is dropping. One reason may be FDA delay:

Eye on FDA: Impact of Approvable Letters 2007 – Part 1: “However, it is important to think about the implications of so many approvable letters.  They represent more than an inconvenience to companies and to patients who are awaiting therapies with serious implications for both, as well as for investors in companies, particularly smaller companies that do not yet have a product on the market.  ”

The drug is safe and effective, but is not yet allowed to market. This in between status for a drug can drag on for years, destroying companies.

First Composite Image

Trees Watch Trees

Late this afternoon I went out into my backyard with the express intent of harvesting images for use in Photoshop compositing. While I sometimes have problems in images capturing a full range of intensities, I am more often frustrated by focus problems. Even with the small sensor and relatively small apertures, I often which that I had more real front to back focus.

In this image I combined an image with the foreground trunks in sharp focus with one that had the rear trees sharp. As it turned out, I used the image with the foreground in focus and painted in the trees in the back along with the fence behind. Like a high dynamic range photo, it creates a bit of a “hyper-real” impression because photos usually lack this kind of selective focus. I hope it helps guide the eye back from left to right and front to back through the image space, landing on the nicely lit fence.

I’m building a small portfolio of these tree images, but I’m still exploring the possibilities in their arrangements and patterns.

Neurology Notes

Worth the Subscription

I subscribe to the online edition of The Lancet Neurology. The 2007 Round-Up was worth the subscription price itself. I need to keep up very broadly and these are the kind of overviews that help me the most.

Also in The Lancet Neurology:

The Lancet Neurology: “We used a unique response-conditional crossover design to provide rescue treatment if needed, and patients who showed an improvement in inflammatory neuropathy cause and treatment (INCAT) disability score during treatment were re-randomised into a 24-week extension phase.

I’m reading this both to gain some insight into immunologic treatment successes, but I’m trying to figure out how useful the trial’s design might be. I’ve been skeptical of enrichment designs in the past, but this may be a more clinically relevant way to study the reality of clinical responses.

Memories

I did my MD, PhD training as well as my medical internship at Emory School of Medicine in Atlanta. I’m sorry, but not surprised that it may close.

A Safety-Net Hospital Falls Into Financial Crisis – New York Times: “Once admired for its skill in treating a population afflicted by both social and physical ills, Grady, a teaching hospital, now faces the prospect of losing its accreditation. Only short-term financial transfusions have kept it from closing its doors.”

When I trained, Grady was a resident’s hospital. Care was provided by residents under the direction of Chief Residents who had completed training and were often specialty fellows continuing training and a group of incredibly knowledgeable teachers who ran the services and provided checks on care through morning rounds. There were teaching attending physicians, but their function was to teach and supervise, not provide care.

After I left, medical reimbursement rules changed so that the attendings had to provide care and sign off everything if the school was going to be able to bill at all. Having to switch from resident care to medical faculty care kicked a big prop out from under academic medicine and was one of the forces that eventually led me to my career in industry.

On Deciding . . . Better 2.0 Is Off the Air

After 6 months of regular writing here, I took down my previous weblog. Because of it’s long life, decidingbetter.com had better page ranking than this weblog on Google. I’m redirecting the domain here for now and plan to hold on to it.

I looked over the referer log for the last 6 months and found that there was only one theme that was getting regular searches, which was some posts on chromogenic C41 process black and white film. That should be replaced, since I don’t think there’s a great deal of information on this alternative on the net.

But the site was ugly, was probably leading to occasional attacks on my home network and wasn’t where I wanted searchers looking for my net writing. For now then, I’ve consolidated here.

Ignoring Chris Carmicheal Since I’m Not Lance

I’ve been reading Vern Gambetta’s weblog for some time now.

Functional Path Training: Variation: “The human organism is highly adaptable so it must be continually challenged with new stresses and increasingly challenging movement problems to solve.”

As a pioneer in Functional Training, he stresses that conditioning programs- endurance or strength need to be designed as preparation for the activity itself. At first, I thought this meant staying away from weight machines and using medicine balls and agility drills, but I’m beginning to think that the idea has much broader implications.

As I’ve explored some of the websites that favor high intensity interval training for general conditioning (Hillfit, The 20 Minute Fitness Solution, Mark’s Daily Apple) I’ve begun to understand that we may have been damaged by the “Aerobics Revolution” just as we have with low fat dieting.

Mark’s Daily Apple » Blog Archive » A Case Against Cardio (from a former mileage king): “Unfortunately, the popular wisdom of the past 40 years – that we would all be better off doing 45 minutes to an hour a day of intense aerobic activity – has created a generation of overtrained, underfit, immune-compromised exerholics. ”

There’s a strong emphasis on relatively low intensity, extensive training across the fitness literature. It led me for years to take long fitness rides, keeping my heart rate down. In reading Joe Friel and Brian Clarke last year, I began to get some idea of work volume and hard easy training, but in the end, my fitness over a good bit of the year was stagnant, especially when training time was short.

I now think that the problem is that the professional atheletes that these approaches have been developed for can stress themselves with very large volumes at the moderate intensities. I can squeeze in a 3 hour ride on some Sundays, but not all. And I can’t get more than about 10 hours of duration in a week. Once I’m adapted to the 3, 2, 2, 1, 1, 1 hr training week, I can’t get anywhere since I’m adapted to it. At first I thought that there would be some adaptation since more work could be done during the same time, but I’m now seeing that such gains will be limited.

As a 50 year old who’s been active for years, my limiter is no longer my 2-3 hour endurance at 60-70% of VO2 max. And I would probably gain little developing my 3-5 hour endurance even if I had the time. My limiters are strength and oxygen utilization (VO2 Max). I need to stress those systems to force adaptation and improvement in my ability to hike, run and bicycle.

Returning to Vern Gambetta, cycling through different activities that empahasize different abilities, while maintaining the overall base is likely to be the most efficient and productive means of functional conditioning. I think he presents some of these ideas in a practical way in this article: Rethinking Periodization.

Camera Theft

Sadly, Michael David Murphy has had his camera and lenses stolen. One only hopes that his blogging at 2point8 didn’t make him a target for camera theft. Certainly his film cameras won’t fetch lots of cash on the market. And there’s clearly sentimental attachment to the tools.

This is something that we have lost in the digital age. My digital cameras are expensive pieces of consumer electronics. No sense forming a long-term relationship with them.

Neurology Notes

Video: Trepanation

Retrospectacle: A Neuroscience Blog: “Trepanation is a procedure where a hole is drilled into the skull, exposing the dura mater and brain for either medical (releif of pressure) or mystical (supposed heightened consciousness)purposes. ”

Pharma Marketing

For reasons I don’t really understand, this report is getting lots of attention in the media and pharma-related weblogs. These are large businesses with shareholders expecting return on investment. They market where they believe the return will be found. The same is true of R&D and the relative rate of spend between the two.

Big Pharma Spends More On Advertising Than Research And Development, Study Finds: “A new study by two York University researchers estimates the U.S. pharmaceutical industry spends almost twice as much on promotion as it does on research and development, contrary to the industry’s claim.”

Up and Coming: Metabotropic Glutamate Receptor Modulation

It seems that since the September announcement by Lilly showing efficacy of a metabotropic glutamate receptor agonist in Schizophrenia, there’s more activity in the area than I’ve ever seen before:

Pfizer’s in:

Pfizer Inc. and Taisho Pharmaceutical Finalize Deal on Schizophrenia Drug; to Pay Initial $22M – News, Search Jobs, Events: “TS-032 is a novel mGluR (metabotropic glutamate receptor) agonist that may offer a new treatment option for central nervous system disorders. Although the characteristics of mGluR are still only partly understood, mGluR is believed to play a role in the transmission of glutamate and other substances in the brain. Abnormalities in the neurotransmission through mGluR may be one cause for symptoms related to schizophrenia as well as other CNS disorders. Data show that mGluR agonists, such as TS-032, offer potential as new treatments for schizophrenia.”

As is Merck:

Addex Pharmaceuticals : 3 January 2008 ADX63365: “Allosteric modulation company Addex Pharmaceuticals (SWX:ADXN) announced today that it has entered an exclusive worldwide license agreement with Merck & Co., Inc. (“Merck”) to develop ADX63365, an orally available drug candidate for the potential treatment of schizophrenia and other undisclosed indications. Allosteric modulators are an emerging new class of therapeutic agents. ADX63365, currently in preclinical development, is a positive allosteric modulator (PAM) that targets the metabotropic glutamate receptor 5 (mGluR5), which is believed to be important as a target for the treatment of schizophrenia and other conditions. The deal also includes mGluR5 PAM backup compounds discovered by Addex.”

Vincent Versace’s Flickr Group

The Three at the Side of the Road

Great news for those who have been learning digital methods from Vincent Versace’s “Welcome to Oz”. There’s now a Flickr group dedicated to the book. Vincent is participating a bit and left a very nice comment on one of my recent images:

The Sky Reflected on Flickr – Photo Sharing!: “Nice use of form and shape. Good gesture too. The only thing I’d say to consider is toning down the hot spot that rides the top edge on the right. if that were pulled down just a bit, the wonderful texture and use of light and contrast of the center leaf would stand out even more. There are several ways to do this. If you’re interested in how I would suggest to do this please send me an e-mail. But this is a really nice image.”

This image was captured last night during a walk around the neighborhood in late afternoon. It was taken in the grove of trees right across the street from my house. As I’ve worked through the techniques in Oz, I see that many of the manipulations across time and space that are done depend on the camera being on a tripod. While I sometimes use one, I prefer a more spontaneous way of working with a handheld camera. It may be worth some experimentation if I can correct some of the exposure and focusing problems that I run into with my current style.

The Noble Wounded Tree



The Noble Wounded Tree, originally uploaded by jjvornov.

Sometimes documenting the suburban landscape is like street photography in that one violates personal space. However, it’s not the bubble we cloak ourselves in when on a busy city street, but rather the privacy expected in the suburban neighborhood.

I am continually struck by the beauty that surrounds us wherever we are. There is a world there to enjoy.