PA-C

At my doctors' office the other day I noted that the staff includes a "PA-C."  Um, that would, perhaps, stand for "physician's assistant--certified?"   And the point is that she doesn't want to bear the obloquy of being a CPA?  Forgetting Molly Bloom Goldberg who delighted in telling the neighbors that her new son-in-law was a CPA--"cleaning, pressing and altering!"  Or forgetting Normie from Cheers, who thought that being a CPA was almost as good as knowing CPR.

Footnote on The Emperor of All Maladies

I'll restrain myself just another five-star review (322 already at Amazon) for Siddartha Mukherjee's fine Emperor of All Maladies, the definitive (for the moment) history of cancer, but I will offer a couple of afterthoughts and a more general suggestion.

Specifically: it's at least two books--one a social history of the war against cancer, particularly in its early, gorier chapters (think savage surgery, brutal chemo).  Second, it is a richly detailed account of the microbiology of cancer--a story which doesn't really get traction until the 70s, when J. Michael Bishop and Harold Varmus teamed up to unravel the secrets of the retrovirus (retrospective hat tip to Peyton Rous, who propagated a spindle-cell sarcoma back in 1910, and had to wait more than 40 years for his Nobel Prize)..

The point is that there wasn't a lot to tell about the gritty innards of cancer until scientists began making some serious headway with microbiology and that, as high school freshmen now know, didn't really happen until Crick and Watson untangled DNA in the 50s--and even such big ideas as DNA take time to sink in. So at this point, not only the substance but also the style of Mukherjee's book changes: the pace quickens, the glittering array of factoids begin to scatter their way across the stage.  

It's all a wonder--the story and the telling, yet ironically, the nearer he gets to the present, the harder it is for Mukherjee to tell his story with conviction.  Which brings me to my general point: I suspect what we're seeing here is not a failing in the author but a structural failing in this kind of material.  As he approaches the moment, his tale morphs from history into journalism.  Nothing wrong with journalism per se, no siree, mighty proud to say it.  You have to start somewhere. But ten, maybe 20, years from now  he'll be able to retell the story with more structure and more critical detachment--and perhaps with a whole batch  of insights that will make us , wonder "how could we not have known?"  FWIW, I think this insight sank into me as I made my way through so many (often excellent) histories of the late uproar on Wall Street, blessed with comparable virtues and saddled with similar defects.  Journalism is indispensable, but side by side with history it's always going to look weak and incomplete.  Because, well, it is and has to be.

More on Where the Doctors Are

The Wichita Bureau offers some intriguing comments on that chart of where the doctors are:

I think the stats are somewhat misleading in the map: “Office” may mean more than one doctor – and a lot of the big city specialists fly out to rural areas for monthly consults with specialized need patients. Lawrence is probably over doctored – it is one of the few places in Ks with pretty easy access and a good ER (which ends up providing a lot of medical care for the students – free).  ...  There are great swatches of the western part of the state that are practically unpopulated. Not only are there no doctors or dentists (there is no dental school here in KS) but there are NO LAWYERS. Of course much of the population in western KS is either elderly or Hispanic. And most of the health care is falling on the local hospital – if there is one. One thing the GOP hasn’t figured out here is that by paying low wages and no benefits, most of the big farm operations are pushing the health care for their often illegal employees off on their neighbors.

 Also:

I wonder how they count the Mayo Clinic? It’s “one office” in Rochester – but there are something like 800 doctors (and fellows?) who see patients there. Rochester probably has more doctors per population (and more hotel beds) than any similar sized city (100K) – but there are a lot of clinics modeled on the Mayo method of seeing patients (Hint: it’s like the carwash). ...

One interesting note: when Greensburg KS got hit by the F5 tornado five years ago, it pretty well leveled the place: HS, hospital, courthouse (jail) and most of the businesses. The population dropped by 50%: the elderly residents who were living out their golden years in the tiny town took their insurance money and moved near their families. The county seat functions, the school and the hospital were rebuilt (in green tech) – and they cleared out the only tourist attraction in town, the world’s largest hand dug well. But there ain’t much left. I suspect the doctors are still there – but specialized care requires a trek to Wichita.

 World,s largest hand-dug well, bleah.  He's got a point re multiple offices.  Shasta County CA gets an A on the "doctors" chart; nearby Butte gets only a B plus. But Butte has a big medical center while Shasta is a recreation spot.  Big offices in Butte, solos in Shasta?

Two Things I Never Knew Before: Smallpox and Pap Smears

• Why do they call it smallpox?  Because the legions are not as big as the lesions in largepox, AKA syphilis.

• Why do they call it a pap smear? It's named after Georgios Papanikolaou, the inventor.

I got the word on smallpox from a fascinating series on epidemics at the Yale open course page.I met Papanikolaou in Siddartha Mukherjee's history of cancer, the Emperor of All Maladies. Papanikolaou, I should add, is a wonderful story. He showed up in the United States with a European education in science but no money and no connections. He underwent an unproductive but mercifully brief apprenticeship as a carpet salesman at Gimbel's. He finally wangled a lab job at Cornell, scraping of the cervical cells of guinea pigs with Q-tips.  He graduated from female guinea pigs to real women; at one point he used his wife as a guinea pig.  In time he learned that the cells sloughed off from the cervix could foretell the stages of the menstrual cycle. Since most people already knew how to foretell the stage of the menstrual cycle, he didn't find a ready market. At last at struck him that he could use the same technique to foretell other transitions--for example,  to cancer.  Even armed with his insight, it took him more than 20 years to get support for a fullscale field test.