Marcus' World

Infinite Patience

Thanks to Adam for leading me to A Supposedly Fun Blog, which is (mostly) the reflections of people who've tasked themselves with reading David Foster Wallace's 1,079 page Infinite Jest this summer.  It's all part of Infinite Summer, which gathers masochistic readers together for this good cause.  I'm reading at my own pace rather than with the group, and mark my progress a percentage at a time.

Last fall, Wallace's untimely demise caused me to take belated notice of his talent.  I blogged about him often, focusing to excess on his Midwestern roots.  But I always figured I'd leave Infinite Jest for others, until Infinite Summer came along.

Let me tell you: it's a slog, but it's a glorious slog.  There are so many digressions, and excessive adverbs, and plot points that could be dispensed with if Wallace had a firmer editor.  (He admitted his problems with editing to Charlie Rose in 1997, a year after Jest appeared.)  But it is oh so hilarious, and so very brilliant. 

If you're going to break every single rule of clear and concise writing--cardinal rule: don't bury in endnotes information that would be useful in the narrative--you'd better be able to carry it off.  Foster Wallace could. 

There are many trying times along the way in IJ, but at approximately 14% in it is most definitely worth the effort.

And the funny thing: all those seeming irrelevances and excesses have a point.  It all connects, to the point that footnote 21 links up with footnote 211.  My favorite footnote so far is 24, an exhaustive filmography of one James O. Incandenza (best movie title: The Night Wears a Sombrero), which is a tour-de-force parody of archival arcana.  I was pleased to read this just for kicks, but according to the commenters on Supposedly Fun Blog it all makes sense in the end.

That's pretty awesome. 

Twitter, Iran and Social Revolution

For over a year now I've had a Twitter account, and the UCSF Library recently began a Twitter feed of its own.    For almost that whole period I've not known what to do with Twitter, reasoning that other people would figure it out and that my humble Facebook status updates served the same purpose.

Within the past two weeks talk of the "Twitter revolution" in Iran--Clay Shirky said, "[T]his is it. The big one. This is the first revolution that has been catapulted onto a global stage and transformed by social media"--has caused me to rethink the value of Twitter.  Some effective debunkings of this sentimenet have emerged, and even Shirky included the caveat that it is challenging to draw big lessons as events are unfolding. 

The main criticisms:  more people outside Iran than inside Iran are tweeting; most tweets are simply repeats, leading to a huge quantity of heat for very little light; and social media is documenting the revolution but not leading it.  These are valid critiques,  and I'll admit to being swept away on the Twitter wave.   But even if Twitter must come down a notch in our estimation,  there's still something liberating about the thought that it can make it harder for repressive regimes to do their deeds.  As the Times reported last week (thank goodness for the old fashioned newspaper article, which has no 140 character limits!), the beauty of Twitter is that so many platforms are available for disseminating posts, which makes it very hard to shut down.  From a repressive regime's standpoint, my old friend Facebook is wearing a bullseye. 

Twitter's versatility and ease of use leads to that glut of posts, most of them useless, mentioned above.  But you have to take the good with the bad.

In the middle of all this social foment came awesome library news re Twitter: the Library of Congress is going to compile all tweets about Sonia Sotomayor's Supreme Court nomination (well, at least those on #Sotomayor.)  I am proud that librarians and archivists are already thinking about how to preserve this nascent form of communication, even though we are far from having any idea about what it means.   Sometimes you just have to jump in and do it.

And so that's what I've done on Twitter myself this past week or so.  I've become much more active, and would like to share these observations in closing:

• The 140 character posting limit is a constraint, of course, but one that forces clarity and economy of thought.   Haiku does something similar, proving that everything old is new again. This is "tweet-ku."
• If you follow lots of people, don't read tweet by tweet--that seems ridiculous to me, although I suppose that's what people do.  I like gathering the tweets up over the course of a day and reading them all at once, like a digital flip book.

From Iran (although not as much as we wanted to believe) to San Francisco, Twitter rocks.

Presentation at SFPL: Wikipedia Meets the Library

Two nights ago I attended a presentation by Professor David Silver of the University of San Francisco, entitled "Wikipedia Meets the Library."   The San Francisco Public Library hosted his talk, and it is all on Silver's blog.   Unfortunately, the blog version doesn't do justice to Silver's engaging talk.

Silver specializes in digital media.  For two semesters now he has asked his class to edit the Wikipedia page about the University of San Francisco (USF).  The first time was last fall, with a class of 80 students.  He tried again this spring, with a seminar of 12 students.  In both sessions Silver hoped that his students would learn how Wikipedia works, and about the challenges and rewards of collaborating on a digital project.

A similar obstacle cropped up for both classes--the fussy editing the students received at the hands of Wikipedians, some of whom have powerful over-writing privileges over the work of others.  Wikipedia has become such a huge site that its original free-spirited ethos had to yield to a level of bureaucracy and systematization. 

But in Silver's telling, certain Wikipedians went beyond quality control into subjective territory such as encouraging students to model the page for USF after that of institutions like Harvard.   Wikipedia is not as democratic as it purports to be, or at least as its popular image suggests.  Whether this is good or bad depends on your point of view.

The persistence of editing by the Wikipedians was the main constant between the two sessions.  In many other respects Silver felt that the second session was more successful than the first (he began by pointing out that it is just as important to discuss what doesn't work as it is to trumpet our successes.) 

The first session was much larger than the second, making it harder to manage. But class size only counts for so much.  There were two critical reasons for the greater success of the second session:

• In Part II Wikipedia was contextualized within the panoply of Web 2.o tools, so that by the time students began to use it they were already familiar with Facebook, Google Maps, Flickr, and Twitter.  (Students used Twitter to post tips for each other as they were editing the Wikipedia page.)  Making the Wikipedia page was the culmination of their efforts, the chance to put what they'd learned to use.
• The second session featured better coordination with the USF library, so the librarians could point USF students to good sources for citing on their Wikipedia page.   Silver plans to expand on this collaboration in future versions of the class, so the libraries can be ever more helpful.  Much of his audience was librarians, so of course this went over well.

We've reached the point where people admit that they constantly go to Wikipedia; this is much less taboo than it was a few years ago.  That's fine as long as people know how Wikipedia articles are created and edited, and how to evaluate entries critically.  It's easy to underestimate the power of the valuable contextual clues interspersed within Wikipedia articles, such as "citation needed" flags and section labels that note controversial content.  And we tend to valorize the entries published in the Britannica, even though much of the "scholarship" of previous eras makes us cringe today.

Or maybe those battle lines are softening and I need to get with the times.  I'm not sure.  All I know is that Wikipedia isn't going anywhere, and that librarians can help with making sense of it as well as providing good sources.  Next month I'm teaching a class for high school students that will include an overview of Wikipedia.  Why bother telling them not to use it when we can talk about how to use it well?

UCSF Mini-Med School 6: The Limits of Reform

Two nights ago I attended the final session of this spring's session on Health Care Reform at the UCSF Mini-Medical School.   

Key arguments advanced throughout the six weeks:

• Universal health coverage will not do as much as we'd like to reduce disparities in care, because economic disparities are another important indicator for health outcomes.
• The wide variation in costs of care in different regions of the US leads to no appreciable difference in health outcomes.
• Health supply drives its own demand.  However many hospital beds are in a region are likely to be in use.
• Advanced procedures (such as stents and catheterizations) are often performed because they're easy to do at sophisticated facilities, not because they're necessary.
• America needs more primary care physicians, and less specialty physicians

The final session included two talks. First Claire Brindis, director of UCSF's Philip R. Lee Institute for Health Policy Studies, presented strong evidence that family-planning services can reduce the number of unwanted pregnancies and abortions. 

Then Daniel Dohan, Associate Director for Training at the Health Policy center, spoke about his ethnographic research.  (Dr. Dohan organized this session of the mini-medical school.)  Dohan observed physician-patient encounters, as unobtrusively as possible, and reports what he finds.  I've always been fascinated by ethnographers--even the University of Rochester's library has one.  So I really enjoyed Dohan's talk.

The key lessons here:  Decisions at the individual patient level often seem rational, even if they aren't rational at the national level.  Sure--there are many unnecessary catheterizations performed each year.  But if you're a patient with angina, and the doctor says this could help, you don't care at all about the overall statistics.  After all, your catheterization might save your life.

And there's the rub--we have so much medical prowess in the US that it's hard to use it rationally.  The incentives and subtle pressures to maximize treatment are intense, and unless that changes with the pending health system reforms we might be swimming in the same soup for many more years.

At the Movies: "Tyson"

Tonight I ventured on over to Berkeley to watch Tyson, the new documentary about Iron Mike by James Toback.

It is excellent, and I came away with a much deeper appreciation of just how insightful Tyson is.  Sure...he was ferocious and intimidating in the ring, and--oh my God--he bit Evander Holyfield's ear twice in the same fight!  And he also was convicted of rape, a charge he strenuously denies to this day. And he used drugs and lost lots of money.

All conceded.  But Tyson is also very perceptive about his flaws and those of authors; extremely tender about his relationship with his first manager, Cus D'Amato, who saved him from a life of crime; and genuinely amazed that he lived to be 40 years old (he's now 42).   And his life remains a mixture of remarkable highs and terrible lows: within the past few weeks his young daughter died and he remarried for the 3rd time. 

As Tyson says at the end, "What happened in the past is history, what comes in the future is a mystery."  This sounds much better when he says it than when I write it, and bespeaks a radical sense of fatalism and powerlessness at the heart of someone who used to be one of the strongest people in the world.  That's what makes the film great, as A.O. Scott's review attests: the sense that we really get inside the heart and mind of someone who has been a caricature for years.

Random notes:

• As a native of Columbus, Ohio, I was happy to remind myself thatJames "Buster" Douglas --who defeated Tyson in an enormous upset in 1990--is a Columbus native.  That was huge news for weeks when I was in seventh grade, but there is no doubt that Tyson had a bad night and was the better fighter. 
• The early parts of the film focused on his upbringing in Brooklyn and upstate New York, which made me miss the Northeast.  But most of it takes place in a nice house on the West Coast, as Tyson spills his soul to Toback.  Looks like I'll be staying here a while myself.
• Everyone should watch David Carr's interview of Tyson at Sundance, which is available from A.O. Scott's aforementioned review. 

UCSF Mini-Med School 5: Variation in Health Care Quality and Cost

Tonight we were back to PowerPoint at the Mini-Med School, but the lecture was by an MBA.  R. Adams Dudley also has an MD, and n 2005 he received the Robert Wood Johnson Foundation's Investigator Award in Health Policy Research.

Dr. Dudley is a pulmonary cardiologist, which is a specialty role.  So he offered a different perspective than the primary care physicians who have predominated until now--if I only take away one thing from this lecture series, it will be that America needs more primary care physicians and fewer specialists.

Dr. Dudley didn't address that controversy directly.  But he did present extensive research that shows how specialists often rationalize advanced treatments even when they know, intellectually, that more traditional medical care will work just as well.  This doesn't mean that the specialists are venial, just that the health care system's incentives and culture facilitate unnecessary interventions.  There is extremely solid evidence, which has been presented in some form during every week of this series, that more expensive health care does not lead to better health outcomes.

So the solution--much easier said than done--is to provide appropriate incentives for the outcomes we wish to see.   One powerful incentive is public praise or shame.  In an example of the kind of reporting Dr. Hal Luft called for last week, Dr.  Dudley has been the main force behind CalHospitalCompare, a voluntary rating registry for many California hospitals.   This is the public face of the California Hospitals Assessment and Reporting Taskforce (CHART).  On this web site people can compare how hospitals in their region are caring for patients for numerous conditions.  Detailed instructions on how to use the data are here.

Intuitively, it makes sense that public reporting will cause the workers in health systems to behave differently than they might otherwise.  However, I am not sure how to make a tight link between this good idea and changing the psychology of specialists that Dr. Dudley described earlier in his talk. They seemed like two interesting, but separate, presentations.

Final point: Dr. Dudley made a passionate call for much more funding for health services research, which is research into how to improve the overall health system.  I first learned about health services research at the NLM, which supports the National Information Center on Health Services Research and Health Care Technology (NICHSR). The acronym never accommodated health care technology anyway, so perhaps NICHSR should tighten its focus to core health services research (well, NICHSR might do this if thought leaders in the field pushed in that direction.)  It's the technology--the shiny new toys--that can be seductive in health care, even if they aren't effective.

Moving Up and Moving On

Two years ago today I interviewed for the position I now hold at the UCSF Library (during my presentation I said that librarians needed to be like jazz musicians rather than orchestra composers, advice that makes me smile today.)  Helen had already been accepted to the MBA program at Haas, so we knew we were moving in any case.  I'm grateful that I landed in a job I really like and care about.

While I was interviewing, Helen was across the bridge in Berkeley scouting out apartments.  That morning she saw the posting on Craig's List for the place we eventually took, at 2491 Ellsworth in Berkeley.  This was in the Picardo Arms, a building name that seemed appropriate for Niles Crane on Frasier.

I loved that apartment, more than any I've ever lived in.  You could see glimpses of the Bay and a broad sweep of SF on the other side.  There was an ironing board in the kitchen wall, and an old fashioned phone with two clanging bells (it didn't work) on the wall in the tiny foyer.   Other features: a sink that was perpetually dirty, pipes that often didn't work (when I'd complain, Helen would remind me that this is what it meaned to live in a building with "character"), and a nice walk in closet with a built in dresser.

I've been living in San Francisco permanently since April, but still had keys to the old place and my name was still on the lease.  Helen moved out yesterday, at the end of May.  So I was back in Berkeley a lot this weekend--on Saturday to decide what I wanted to take over to SF; Sunday morning, with a Penske truck and the excellent aid of Uri and John to help me move; and Sunday afternoon and early evening to help Helen with the final clean up and apartment inspection.  (She's now living in Berkeley with friends, before moving to London later this month.)

In every move previous to this we'd faithfully moved many possessions, literally across the country.  But now there were many things I didn't want, and Helen has to travel light since she's moving abroad.  So we threw away whatever couldn't be sold, or left it in the basement for the neighbors if we thought it could be useful.  It felt surreal to casually dispose of so many possessions that had gathered over the years.

As we were packing, Helen set aside a corner for final things I could take back to the Mission (some more artwork, sandwich bags...a true hodgepodge.)  The apartment inspection was done around 7:30 pm.  Then I went to dinner at Mario la Fiesta on Telegraph--on what turned out to be its final day at that location--before returning to the apartment to collect that hodgepodge.  I handed in the keys just before 9:00 pm, and the Berkeley years were officially over.

I've now realized that Helen and I were never the same after we came to the Bay.  We used to be so much better at making time for each other and at keeping up the rituals and traditions that sustained us.  It hasn't been two years of misery since we came here by any means, but it was a relationship that wasn't operating at its best.  Earning an MBA from such a great school stimulated Helen's natural independence and ambition to see the world, just at the time I wanted to make something of my career and start a family. 

These were "irreconcilable differences" indeed.

Since we decided to get a divorce, Helen has been extremely firm and very reluctant to engage in any looking back.  I've looked back constantly, but by this point know for sure that we'll both be happier apart than we would have been together.  I have  no illusions that we'll get back together, and no desire to do so.  All I want now is recognition that we had something special for a very long time.

That came today, as Helen started going through the greeting cards I'd given her over the years (at one  point, I singlehandedly kept Hallmark in business.)  She sent me an email describing some of the cards and explaining her reasons for wanting to split up.  This was the first time she'd ever done this since the night we decided to get a divorce, and her reasons mapped to mine very well. 

Helen closed by saying that she believes that good things--"really good things"--don't last forever.  Sometimes this is true, sometimes it's not.  But either way whatever came first was a really good thing.  That's what we had, and I'm very touched that Helen knows it.