On the demise of sheet music, or why different types of wireless have altered society

So the other day my wife brought out a whole bunch of sheet music that she had found in some auction or op-shop. Classic stuff from the height of the big band and jazz era. An era that happened to coincide with the pinnacle of radio or as it was known, wireless. I note the term “wireless” because today it has a totally different meaning. In days gone by it was the radio-set that a family would gather around to get its’ entertainment around a common source. Today wireless is the set of invisible waves that allows family members to each do their own thing and often in different rooms of the same household.

It was common in the original era of wireless for the family to gather around the radio-set but if there was a piano in the house they also got the sheet music from their favorite songs and played them together.

I’m not really aware of people doing this now. Who gets the latest Lady Gaga or One Direction and sits around the piano and sings the songs. And before you get started, sure there are nerds doing this on Garage Band but who is doing it as a communal, family thing. Not my household….and certainly not without complaints from the juniors.

Technology changes everything: maybe home mix-tapes were the pinnacle of civilization.

Why (or are) hipsters good for the economy and quality of life

So hipsters, especially the male ones, come into a lot of flack. But I think they’re probably a lynch-pin of the new, or maybe the old economy.

I live in the Inner West and have noticed positive changes in the past 2-3 years which I think are driven not only by outrageous Eastern Suburbs property prices but rampant hipsterism. Whilst I lament the loss of the second hand bookshops the op-shops are slowly being squeezed down King Street up Enmore road and towards St Peters. In their place are hipster craftiness. Right now it is focused on fashionable food, craft brewing and other culinary stuff but this is these are the easily learned and commodifiable crafts. There are many definitions of hipsterism and although at face value it seems like a conformist culture some of the key principles are making it yourself, bespoke work, craftsmanship and quality not quantity. We are seeing this in raw produce, bread, coffee and brewing.

So what we are seeing are moving out of the hippies and moving in the hipsters.

As I see it in 5 years King Street and Enmore Road will be transformed. Already, with relatively underground bars, artisan gelato and new restaurants the place is becoming ‘go to’. The challenge will to be not the next Paddington in the sense that we don’t want to be decimated when the next Westfields comes along.

This type of alternative is mainstream and that’s not such a bad thing.

And if nothing else the profession of barber has new-found prominence….

The problem with health food stores

Today my wife and I cooked pound cake but instead of equal parts sugar, flour, butter and eggs we substituted almond and hazelnut meal for the flour and stevia for the sugar. The recipe was from a book by Peter Reinhardt that contains gluten ad sugar free recipes. It might sound bizarre to want sugar-free cake but our current diet is heavily influenced by Gary Taubes’ book on Why We Get Fat – which lays the blame on carbs and sugars (not fats and /or total calories). This got me thinking about health food stores.

Many of these stores are no doubt profitable but what is their purpose? Health food stores send extremely mixed messages – the users can be looking for unusual cooking ingredients, be after weird and unproven alternative medicines, gluten-free, organic food, free-trade food, locavore food, body-building supplements, or peace, love and mung bean sprouts, just to name a few things.

I think the problem is that health food stores themselves haven’t defined what constitutes health, let alone health food. Essentially it could be anything that isn’t in the supermarket next door….although they are creeping in on the market.

I’d like to see heath food stores be more pro-active and evidence-based: let them define what they consider to be health and then sell stuff that fits the evidence and the vision rather than a bit of everything for everybody.

Getting the specialist training job you want

When I was starting out in medical oncology my colleagues used to fret about there not being any jobs when we finished training. This wasn’t the case but it is starting to be true now. Although there are some early signs of exit block into consultant positions the emerging gap seems to be in advanced training positions. The reality seems to be that there are more potential trainees than jobs and this is starting to be a problem for all specialities. So if you want to progress from basic training to an advanced training position here are a few tips:

(1) Obviously pass the exams

(2) Treat every day as a job interview: you may not know who your future employers are

(3) Make your interests known but don’t be cocky or overbearing

(4) Do your due diligence – find out about the department you are interested in: talks to registrars already doing the job

(5) Pre-interview – meet your potential future supervisor

(6) Do something that makes you different from the rest of the pack: don’t just be somebody who has been to medical school and passed exams.

(7) Tell the interviewers about what makes you special

(8) Find out what types of question are asked at the interview and think of good responses

(9) At the interview always use personal anecdotes and experience in response to the questions

(10) Have a back up plan

The Art of War in Oncology

“Strategy without tactics is the slowest route to victory. Tactics without strategy is the noise before defeat.”
― Sun Tzu, The Art of War

So a bit of brainstorming / mind dump ahead of a lecture on Saturday.

Oncology has come a long way in the last two decades. Some cancers, even when metastatic, have become chronic diseases. In particular this is the case for beast, colon and prostate cancer, and in some selected cases even lung cancer. This raises some important considerations about how oncologists approach the treatment of cancer.

In the past a die was cast and essentially the patient chose to take the poison (chemo) or not and if they took it and it worked then fantastic, and if not, well that’s the way it was meant to be.

Now, for many cancers, there are multiple lines of therapy. There are options for intermittent and maintenance treatment. And the paradigms are changing. In the past ‘systemic diseases’ were not treated with locoregional therapies but now it may be appropriate. We are moving to an era where the combination of targeted therapies and selective surgical cytoreduction, regardless of cancer type, becomes the norm rather than a situation where the rules are being broken.

So for the oncologist we must start thinking strategically about the goals of treatment.

If the aims change from achieving tumour response or prolonging life to cure (in the case of metastatic colorectal cancer) or achieving 5 year survivals in the metastatic setting then fundamentally different strategies are needed. Specific tactics we might pursue are maximal cytoreduction whether by chemical or surgical means, maintenance therapy, toxicity reducing therapy, planned treatment interruptions, immunotherapy and other maneuvers. Thinking not just what will be first-line therapy will be but looking ahead to the long-term strategy is required. Do you hold some treatments in reserve?

It is also important to think about chronicity and the effect it has on the whole person. I find my patients are stunned when I run out of conventional treatment options an yet they remain well, apart from the toxicities already inflicted. In this case there must be a lot of preparation for the eventual physical but not psychological surrender. It must be understood that many battles will be fought and won but the overall war could be lost but it doesn’t constitute giving up.

It must also be remembered that strategy is created in the midst of conditions of uncertainty. This can be communicated but only addressed by making life as normal as possible.

In addition to setting