From the NYT:
Pre-Med’s New Priorities: Heart and Soul and Social Science
By ELISABETH ROSENTHAL
... In addition to the hard-science and math questions that have for decades defined this rite of passage into the medical profession, nearly half of the new MCAT will focus on squishier topics in two new sections: one covering social and behavioral sciences and another on critical analysis and reading that will require students to analyze passages covering areas like ethics and cross-cultural studies.
The Medical College Admission Test is, of course, much more than a test. A good score is crucial for entry into a profession that is perennially oversubscribed. Last year, nearly 44,000 people applied for about 19,000 places at medical schools in the United States. So the overhaul of the test, which was announced last year and approved in February, could fundamentally change the kind of student who will succeed in that process. It alters the raw material that medical schools receive to mold into the nation’s future doctors.
Which is exactly what the A.A.M.C. has in mind. In surveys, “the public had great confidence in doctors’ knowledge but much less in their bedside manner,” said Darrell G. Kirch, president of the association, in announcing the change. “The goal is to improve the medical admissions process to find the people who you and I would want as our doctors. Being a good doctor isn’t just about understanding science, it’s about understanding people.”
The public are idiots. I want Dr. House to diagnose me. I almost died in the 1990s because my nice guy doctor told me that the lump in my armpit, my night sweats, and my loss of energy was probably just a muscle pull. The cancer doctor who saved my life had a lousy bedside manner, but he had access to Rituxan years before everybody else did because he knew more about non-Hodgkins lymphoma than anybody else in the upper Midwest.
The adoption of the new test, which will be first administered in 2015, is part of a decade-long effort by medical educators to restore a bit of good old-fashioned healing and bedside patient skills into a profession that has come to be dominated by technology and laboratory testing. More medical schools are requiring students to take classes on interviewing and communication techniques. To help create a more holistic admissions process, one that goes beyond scientific knowledge, admissions committees are presenting candidates with ethical dilemmas to see if their people skills match their A+ in organic chemistry. ...
Where will students find time to take in the extra material? How to prepare pre-med students long primed to answer questions like “Where are the serotonin receptors 5-HT2A and 5-HT2B mostly likely to be located in hepatocytes” to tackle more ambiguous challenges, like: “Which of the following explanations describes why the Identity vs. Role Confusion stage likely affects views about voting and being a voter?”
... “With the growth in scientific knowledge, we were focused on making sure doctors had a good foundation in hard science,” Dr. Kirch said. Indeed, from 1942 to 1976, the MCAT had included a broad-based knowledge section called “Understanding Modern Society.” Liberal arts questions were eliminated in 1977. ...
Some experts have long identified the MCAT as a stumbling block in the often-failed quest to produce more caring, attentive doctors. It is a test that selects more for calculation skills than empathy. ...
And so the Association of American Medical Colleges began three years ago to redesign the MCAT, surveying thousands of medical school faculty members and students to come up with a test tailored to the needs and desires of the 21st century. In addition to more emphasis on humanistic skills, the new test had to take into account important new values in medicine like diversity, with greater focus on health care for the underserved, Dr. McGaghie said.
As a result, there will be questions about gender and cultural influences on expression, poverty and social mobility, as well as how people process emotion and stress. ...
The mere fact that psychology, sociology and critical thinking will be on the MCAT is likely to change priorities, prompting science majors to think harder about topics like the perception of pain, informed consent, community awareness and the ethics of the Tuskegee Syphilis Experiment.
Okay, let me toss out a guess: The current American medical establishment wants more of their own children and grandchildren to make it as doctors, which, mathematically, means fewer Asians. So they are making it sound like they are changing the test to get more blacks and Hispanics, but they are small change: it's really a plan to cut down on the Asians.
And here's a prediction: it won't much work. Whatever they put on the test, within a few years, the Asians will memorize it and spit it back.
Another possibility is that this is all part of a plan to liberalize Asians, to turn them into Nice White People, before they completely take over the world. That's not necessarily a bad idea. But of course the Nice White People couldn't imagine directly confronting Asians over their various bad habits, like, say, the caste system. Instead, the NWPs are attempting another classic triple bankshot by telling the Asians that Yes, the Tuskegee Syphilis Experiment Will Be on the Test.
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98 comments:
There are certain programs at some of the best medical schools that accept students who haven't taken the MCAT or any pre-med courses:
http://www.nytimes.com/2010/07/30/nyregion/30medschools.html
It seems kind of insider-y, something you'd hear about and utilize successfully if you're connected.
I don't care about this, just so long as the good folks who formulate this test break out these sections as sub-scores which John Hopkins, Yale, and Stanford can ignore. The best medical schools will talk up this nonsense about the importance of diversity and bedside manner but in the end, they want students and faculty to be among the best and brightest, as demonstrated by high scores on math and science tests.
Adding squishy stuff to the MCAT is supposed to boost NAM test scores, I suppose, but as we all know it will just end up boosting everybody's score, leaving relative scores the same. The motivation for trying to make NAMs more competitive for medical school seems obvious to me. Obamacare, aka GhettoCare, mandates that med schools, heavily supported by NIH dollars, will train more NAM doctors with the inevitable below par diagnostic skills to serve the NAM community -- it's a social justice thing. Of course, training more NAM doctors has little to do with providing the poor with a higher standard of medical care and more to do with adding extender to the black and Hispanic professional classes by diverting fees to NAM quacks that might otherwise go to Iranian, Indian, or Vietnamese doctors with huge Medicaid practices. But that's fine. For example, if a Mexican stayed in Mexico, he'd be treated by a lackadaisical Mexican doctor with a droopy mustache and a stained lab coat. Let him be treated by the same kind of doctor in the US. And let Michael Jackson and Whitney Houston get their recreational meds from Dr Indahouse.
I just want to know that I will draw the Jewish oncologist or WASP trauma surgeon when I'm in extremis.
If verbal is more g-loaded, then won't this improve the g-loadedness among med students? I've not been real impressed by the doctors I've met, so I don't see the problem with this change. If this means more smart people go to med school instead of law school, that's a good thing.
Oh yeah, because when a medical school has its accreditation threatened for a lack of "diversity," they mean there are too many Asians.
http://www.denverpost.com/ci_13914153
Steve,
Yes, I think they are changing the MCAT for the same reason that UC is dropping the SAT Subject test requirement. They already have affirmative action (legal or not) to bring in blacks and Hispanics.
There's not a particularly big Asian-white gap on the MCAT, is there? Or has that changed very recently?
If it hasn't, and the test gap isn't huge, then it's pointless to change the test. Changing the GPA weight is more important. I suspect that the gap in med school admissions is more a function of college GPA than MCAT scores.
Observationally, I haven't seen a huge Asian-white score gap open up on the LSAT, which is a very difficult test that can, nonetheless, be prepped for. Nor did one ever open up on the GRE verbal--very difficult, can't be prepped. Asian-white test score gaps seem to show up in tests that have a high unforced error rate (the SAT, GMAT) and can be prepped. And, of course, they still do better on "purely" math and science tests that are extremely difficult (but then, many high ability whites don't prep--see below).
But GPA is the big issue, I think, not test scores. Asians work test scores because they know they're being compared to other Asians with high GPAs. Whites don't do a lot of test prep because their GPAs knock them out of the game before it even gets to the test.
"Adding squishy stuff to the MCAT is supposed to boost NAM test scores, I suppose, but as we all know it will just end up boosting everybody's score, leaving relative scores the same."
No, it will boost the scores of the people who most aggressively test-prep. Which happens to be-ta da!-the Asians. The simple fact is that if you want to minimize the Asian advantage, you should make the test as hard to prep for (ie, as g-loaded) as possible. Yes, East Asians have a slight (5-7 point) IQ advantage over European Caucasians, but coming from a culture with centuries of test-prep behavior, making tests that can be more influenced by prepping only increases their advantage.
Incidentally, whites are actually the least likely race to prep for standardized tests, so making tests more easily influenced by prepping is essentially another part of the war on white people.
Medicine is a tough field, don't take away the prestige or you will lose the cohort who do it for the title. I don't care if a doctor treats me properly because he loves me, or because he want to raise his batting average.
Doctors have to be sparing with their time, because they are the highest status people that most common people will ever meet, and these people yearn to boost their self esteem and validate their lives by garnering the doctor's attention.
Doctor's attention is a zero sum game. My demand for a lighthearted chat means someone else suffers. The general population should be taught in high school what a zero sum game is, and also teach them to collect important data and have it at hand when you see the doctor - out of respect for the job and because you will get a better diagnosis.
It is silly to think that premed students haven't been socialized by the time they finish college, they are who they are - live with it.
"If verbal is more g-loaded, then won't this improve the g-loadedness among med students?"
It may have been back when a large part of it was analogies, but is verbal more g-loaded now? I took the "revamped" SAT several years ago, which doesn't include the analogies section, and the SAT verbal basically seemed like a reading and vocabulary test. This was fine for me (I got an 800 on the verbal), because I have a fairly extensive vocabulary, but I didn't think it had a whole lot to do with my overall level of intelligence.
I hope it fails.
I'd be more supportive if they were more open about wanting to support their own particular part of white America.
It's still be wrong, considering they'd be using Daddy Gub'mint to support them, but it would at least be honest.
But if they did that, other white tribes would be able to advance their own interests. And that would be ebul.
Nurses and PAs, and other non-MDs are gaining more authority to do diagnoses. It seems the way doctors could ensure that they make more money and keep their higher status is to reinforce the public's awareness of skills they have that nurses lack. Instead, doctors are making themselves more like nurses with the new admissions rules. Acting against self-interest? Steve's theory is logical, but what percentage of influential docs are white MDs hoping cynically to grease the wheals for their mediocre kids? My guess is 30%.
I know someone who just finished interviewing at medical schools (she interviewed at 17 this year), and she noticed a trend that suggests an alternate/complementary theory:
What she noticed:
*Specialists who make lots of money are less friendly than primary care folks, and they are disproportionately represented in administrative positions where they have considerable authority.
*The primary care doctors in administrative posts usually seem like go-along-get-along types.
*All medical schools stress the need for more primary care docs, especially in rural areas. (Why not just give Nurse Practitioners and Physicians Assistants, greater authority to act as referral centers or clearinghouses?)
*Many admissions deans warned the interviewees it is inevitable that doctors will make less money in the future.
What all this means:
I think specialists are are driving the admissions changes because they see that Nurse Practitioners and Physicians Assistants and others are poised to drive the pay of some doctors way down. These specialists want to make sure it is not the specialists, but the primary care docs who become the social and economic equivalents of nurses and PAs. To make sure of this, the specialists are tweaking the admissions criteria for MD programs to favor two types of people: very smart people, and random nice (but not extraordinarily bright) folks. This will enhance the status of specialists as a super-guild within a guild. The go-along-get-along primary care doctors tend to be okay with the change because it affirms the value of their soft skills, even though it will drive down their pay in the long-run.
M.D here- there was similar talk when I was coming up (early 1990s) and they acted like it was brand new back then too. "We need more humane doctors so lets let in more humanities majors!" You know, because the words are similar and all science majors are kind of like Mr. Spock.
As a science major I always wondered whether they bothered to do a study with objective criteria to determine whether this worked or not.
And here's a prediction: it won't much work. Whatever they put on the test, within a few years, the Asians will memorize it and spit it back.
Well said, Steve.
You could change the MCAT's curriculum so that it strictly covers Martin Luther King/black history as well as "Chicano Studies" and the Asians would quickly adjust to outperform NAM's, at about the same rates as they do now...
There's not a particularly big Asian-white gap on the MCAT, is there? Or has that changed very recently?
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I would imagine an Asian might be 5x more likely to take the MCAT than a white student so there shouldn't be much of a gap because the Asian test takers include those being draw from the deep bench.
The Med profession has been hearing this pressure for years and finally they will feel the heat to make changes. I wrote on this a while back.
http://28sherman.blogspot.com/2011/09/medical-profession-handles-diversity.html
The end result of all this is to make good health care harder to get and more expensive (because of a smaller supply of good doctors), which has always been the AMA and AAMC's mission.
I aced the MCAT a while back and but still didn't get it (I'm asian). They don't need to change the MCAT just to keep us out, because they have plenty of other criteria from which to choose in justifying their choices. I think it's due more to an ongoing arms race with the test prep industry. Its needs a good shakeout after 20+ years of the same format.
With the coming rationing of health care along with the inevitable death panels perhaps they're looking for a kinder, gentler type of doctor who'll hold people's hands as they die.
It seems to me that we should be opening up more doctor positions in general, in order to bring prices down. Medical care is way too cartelized in its present form.
I'm not sure how much of a "Who? Whom?" interpretation I'd attach to this move. There is a very sincere effort in the medical profession to encourage the more "humanistic" end of things, however well or ill advised that may be.
One thing I would have liked them to have pushed (and this is at least possibly included in the move toward the social sciences) is a mastery of some statistics. It simply boggles my mind that physicians have no training in statistics when virtually their entire profession and science is predicated on its use. How can they even understand studies in their own field without such a background? Virtually EVERY difficult medical decision my family has ever faced has come down to a subtle question of statistical interpretation, given what studies seem to have shown. And it has been like pulling teeth to get a coherent explanation from medical doctors on these points, who seem comfortable only with making a party line pronouncement, based on the policy that their particular institution has settled upon.
"Adding squishy stuff to the MCAT is supposed to boost NAM test scores..."
That isn't Steve's theory, it's yours. Steve thinks it is to add more whites to medical school.
Could be. The Mt. Sinai thing sure sounds like a you-have-to-know-somebody deal. And they're nowhere near the best in NYC.
Still, I had heard women were behind this. They wanted doctors to understand their feelings and such.
There are times I wish I were gay.
dunk the flunk rule.
"The public are idiots. I want Dr. House to diagnose me."
I want Dr. Watson to diagnose me, but getting humans out and computers in is tough. (For some reason, humans vote and computers don't.)
God Lord Steve!, I always thought that I was the top pessimistic cynic (and I've put out a lot of posts here towards that end), but you seem to take the cynical biscuit here.
Saying that I have to agree with your diagnosis and prognosis, especially the bit about Asian world domination in general and Asian domination of the American medical profession.
As another post hinted, any ethnicity that isn't cohesive and nepotistic will be eaten up, chewed up and digested by one that is.
Ironically this may increase the yield of abstract and non linear thinkers. Something that may help on the research side of medicine.
Just to get it over with, this is the file everyone on here wants:
https://www.aamc.org/download/161696/data/table19.pdf
>>I almost died in the 1990s because my nice guy doctor told me that the lump in my armpit, my night sweats, and my loss of energy was probably just a muscle pull.<<
Yes but if you had listened to your nice guy doctor and died, much less money would have been spent. I think that's the idea.
If verbal is more g-loaded, then won't this improve the g-loadedness among med students? I've not been real impressed by the doctors I've met, so I don't see the problem with this change. If this means more smart people go to med school instead of law school, that's a good thing.
Verbal ability is not as g loaded as it used to be. On the WAIS-III, the 2 most g loaded subtests are math related: figure weights and arithmetic. The vocabulary subtest saw a precipitous decline in its g loading. It used to be you could measure someone's IQ just from vocabulary alone. That's no longer true, despite the fact that the WAIS-III vocab test is long and reliable
And here's a prediction: it won't much work. Whatever they put on the test, within a few years, the Asians will memorize it and spit it back.
This is absolutely true. And as in all other fields where this has happened, I doubt this will lead to higher quality practitioners in that field.
What a curve ball to the system Asians ended up being! Evolution designed them to be the best test takers in the world, yet to never match that test taking ability in real world situations.
Just as innovation has declined in all other scientific fields, medical innovation will probably now slow down as well.
Ah, a long period of stagnation is upon us indeed. Well, I suppose the world needs a few hundred years to assimilate everything that has been invented already. A few centuries of stagnation and intellectual trusteeship wont be so bad, and no one better suited to this role than phlegmatic Asians.
I'm an ER doc. This is how I'd interview a candidate and what I'd look for in my replacement:
--Very high IQ fast learner.
--Superb analytic thinking. you will be inundated with junk studies. You must slash through this sloppy junk to find what's true for your patients.
--Strong backbone. Tell me how you've shown courage. You'll need it to stand up to manipulative patients and administrators.
--Social skills. You must relate to patients, their unrealistic expectations, their frailties; without humiliating them.
--Conflict managing skills.
--Preferably, be a woman like me.
Think said nice white people would ever just stop opposing attempts to limit immigration?
Interesting.
Are NAMs a device by which whites sabotage Asians via affirmative action to weaken the competition?
Or are Asians useful for taking the brunt of affirmative action so whites can grant affirmative action benefits to NAMs without being impacted themselves?
Or both?
Seems like the process is in full force already. Saw this link to a resident program in the U Michigan, Ann Arbor system:
http://www.stjoesannarbor.org/currentresidents
Personally, I was shocked to see so few European faces (less than 10%). So, how representative is it? To find out, I typed "internal medicine new mexico our residents" in Google. The result are these UNM residents:
http://medicine.unm.edu/residents/housestaff/housestaff3.html (looks to me that whites are exactly 33%)
Next, let's try Iowa maybe? Here you go, in the heartland of America, only 58% of future doctors are whites (the state itself is 91% white):
http://www.int-med.uiowa.edu/residency/Residents/R3s.html
I have worked with Chinese and Indian PhDs for nearly 30 years, lately in groups numerically dominated by Indians and Chinese. While one or two stand out as wonderful people I'm proud to have known, I am continually startled by the simple venality of both groups, even the PhDs with high-ranking social status. Not cheating when you expect to get away with it appears unusual, in particular among the Chinese. (You'd be crazy not to use pirated software, for instance, "everyone does it".) It's all about the money, gaming the system, and getting ahead so you can get more money.
Twenty years or so ago it was a given that cheating, particularly plagiarism, was common among Chinese computer science grad students, for instance. When caught, the response was invariably "It's a cultural thing, we are taught that copying is a sign of respect, that that is what education is about".
Widespread culturally accepted venality is an insidious danger to Western civilization. While I want a doctor that's technically as strong as possible, I also don't want said doctor to be completely in it for the money, to the point where I worry he has an organ harvesting business on the side or other "arrangements".
Let's stop playing by the liberal script. Let's not call conservative states 'red states'. Let's call them 'red, white, and blue states'. As for liberal states, call them 'black, brown, and pink states'.
As an Asian I find myself generally uncomfortable and distrustful of other Asians. It's an unfortunate situation to be in.
The difference between whites and Asians in fluid intelligence is small. The difference in the willingness and perhaps even in the ability to memorize tens of thousands of facts is larger. If the new MCAT sections are like the critical reading sections on the old SAT and GRE, then a greater percentage of the overall score will depend on fluid intelligence. A smaller percentage of the score will depend on memorization. That may take away some of the Asian advantage.
If the critical reading section consists of long, complicated multi-clause sentences, like in the old SAT and GRE Verbal, NAMs won't be helped at all.
I'm going to suggest something totally different. This development has to do with the implicit acknowledgement by the medical professional that doctors don't do science any more. In the old days, doctors' education could really encompass almost all of medical knowledge, and doctors were really expected to "figure out" treatments, and they also pioneered treatments. Today, doctors can't possibly know everything there is to know about the body, let alone pathophysiology. Most of them just follow algorithms written by medical societies or the government, and R&D is basically done at university centers or by for-profit companies, and by PhDs.
See the change in the switch from male to female students in med school. Soon, like nursing, the medical profession will basically be a woman's world. I predict public health will go the opposite way. The future of healthcare is: treatment modalities and policy will come down from male-dominated spheres and be instituted by female-dominated spheres where mutli-tasking and compassion will be valued more than creativity. Competence will suffer, but only at the margins, as most work done by most doctors is mostly routine.
The fix is simple. You kick the AMA in the nads by making it impossible to limit the number of med school slots as they today do, by decredentializing their credentialization process. This will mean a doubling in medical schools as places like Wyoming start med schools. (See Sowell-or was it Walter Williams-for the correct analysis of that part.) There will be a lot more doctors and the power and prestiege of doctors will be attenuated. But also this: As a "Moderate White Nationalist" I can go to nice white doctors for my routine medical needs and prickish but really good Chinese, Brahmin or Ashkenazi ones if I think I'm really afflicted.
Alleged concern for diversity is really just camoflouged racism. When the diversicrats argue for diversity, they couldn't give a shit about whites. If a medical schools for 13% black, 14% Hispanic, and 73% Asian they would consider that adequately diverse. Also adequately diverse: if 100% of the white "share" of medical school slots were filled by Jews.
Second, the implication that only NAM doctors work in NAM neighborhoods actually acts to free white & Asian doctors from any perceived obligation to work in NAM areas. Ultimately this cannot be good for blacks & Hispanics. Even if NAME neighborhoods do get enough NAM doctors, those doctors will glut the market with subpar providers.
Redneck Lawyer says:
Frankly, I'm kind of shocked that the number of places in law schools is about 6x the number of places in medical school. That's about a dozen different kinds of not right.
And I have to suspect this is at least in part about getting more women into med school. Not to be crudely stereotypical or anything, but you want more caring, more empathy, and less obsessive focus on hard stuff like science and math? And also to stay on the good side of a government where Hillary Clinton is regarded as a distinguished statesman (stateswoman, statesperson, whatever) instead of a dangerous lunatic? Then you need more women.
Next year's installment, why you need more lesbians in med school. (Rectification of historical disapproval and exclusion, and lower tendency compared to straight women to have babies and decide that the profession is too demanding, would be two leading reasons.)
ObamaCare requires 40% of all Med School students be Black or Hispanic. That's a huge load. Nice White people love this. They LOVE LOVE LOVE this.
Here's how it works. Government mid-tier to upper tier (its inherited too BTW) folks and the princelings and princessess (Patches Kennedy, Chelsea Clinton) get good to great care by mostly White and some Asian doctors (most of the Asian doctors in and around Orange County are miserable, one who is the Chair of a certain UCLA medical department knew nothing of the latest research I as a casual reader knew) at high expense, paid for by the Government.
EVERYONE ELSE will get cheap-rate care by semi-curanderos, near literates, and the like, think Dr. Conrad Murray. At dirt-cheap prices.
THAT is the whole point of ObamaCare. Replicating the Red Prince/Princess model of China here in this country. A hereditary rulership with more goodies (faux-social uplift to semi-literate lunatics) to hand out, and punishment of ordinary people. Nice White people HATE HATE HATE ordinary White people. The way Puritans hate the Hillbillies.
C'mon Steven, be serious. There is no gap in MCAT scores between White and Asian medical school matriculants. Even more ridiculous is the assertion that the individuals responsible for reshuffling the MCAT did it for the sake of SWPLs and their progeny. ROFL.
Most respected profession a while ago; From a scale of 1 to 10 [1 being the best] was
1. Academics
2. Engineering
9. Medicine
10. Law
I always cam out feeling the doctors I consulted were after Money. There definitely are doctors of worthy of great respect.
I agree that the public are idiots on this point, Steve. There are people right here on iSteve who think that health care prices are high because of the steep barriers to becoming a doctor and think that that's a bad thing. The idea, I suppose, is to open the market to any quack who wants to practice medicine and let the public decide between the Dr Houses and the Dr Nicks, assuming they can tell them apart.
Then there are the people who claim they love having a nurse practitioner or PA as their primary care provider because they're so much "nicer" and "really listen to" them, even though these folks cannot tell you anything you can't find out for yourself on the internet.
Oh, and among surgeons surgical skills are not necessarily related to extremely high intelligence, so your advice applies mostly to the medical side of things.
"If it hasn't, and the test gap isn't huge, then it's pointless to change the test. Changing the GPA weight is more important. I suspect that the gap in med school admissions is more a function of college GPA than MCAT scores."
And you'd be wrong about GPA because there's not a premed major really, only premed requirements. This means a white or NAM who doesn't major in a hard science can achieve a high GPA in any major, take the lower level science requirements at the local com college and still have plenty of time & energy to do well in the handful of upper level sci courses necessary for entry into med school.
Also I think there's something lacking in doctors critical thinking skills in relation to how their patients live and think. I've been disappointed with most medical advice I've received other than from the GP I had as a child who was a MD prior to that 1977 change in the MCAT. He worked seamlessly with my family's style of avoiding all but the absolutely necessary in medicine and medical interventions. For instance, I was allowed to outgrow my yearly tonsillitis which not only saved us money but seems to have left me immune to sore throats of any type since about age 12.
PS. The GRE verbal didn't seem any harder than that on the original SAT. Are you ill?
This change in MCAT will allow the med schools to go after non-STEM hi-IQ students.
My sister ( now recently disabled ) was a professor at a medical school and was on the admissions board of four medical schools as well as being involved in the testing of internists for getting their boards. She did this for over a quarter of a century.
She has told me that the quality of students applying to medical school has dropped since the 70's. Most really bright males are choosing other fields more and more.
She also told me students are now lazy in comparison to students 25 years ago in medical school.
The changed MCAT will permit the size of the applicant pool to enlarge. According to my sister the MCAT from the 1960s and 1970s was highly correlated with IQ. Could that be true? If so, why not just give an IQ test to screen applicants? To be politically correct just make the IQ test an optional one: either take the MCAT or take an IQ test. What medical school would turn down an applicant with an IQ over 135?
Dan Kurt
Steve, I grow weary. As HL Mencken said You cannot argue with an idiot.
Why the hell wouldn't you want more Asian doctors? They are damned good and it is not like doctors are looking at a bright future given that a growing proportion of folks will not be able to pay.
It's clearly much more important that a patient dies in the hands of an incompetent but right thinking compassionate doctor than that he lives in the hands of a competent wrong thinking callous doctor.
"Indeed, from 1942 to 1976, the MCAT had included a broad-based knowledge section called “Understanding Modern Society.” Liberal arts questions were eliminated in 1977."
Hmmm, I wonder if this is related to the doctor draft which began a year before Pearl harbor and only ended in 1973. the SAT was an offshoot of the military's GT exam for draftees, I wonder if the Pentagon had their own criteria for doctor-officers.
Why shouldn't asians game the tests when whites are constantly tinkering with tests trying to find some magic combination that will decrease Asians in school.
Doctors had to have better bedside manner in the old days because they essentially couldn't do much beyond set a bone, tell you whether your condition was fatal or not, and tell you if your heart was good enough to go into the army. Doctors killed more than they saved until about 1950, the result of a gradual 100-year transition to actual science.
I wonder if this is driven by other health professions disliking working with jerk doctors, more than by patients.
I'm thinking your conjecture is incorrect. I'm betting on The reason being to graduate more doctors that will quietly follow the new Obamacare regulations and the initiative-crushing directives soon to follow.
Standing in line is for Commies and social science enthusiasts.
I think what Chris says makes sense: a handful of brilliant guys (and some gals) will make up artificial intelligence systems for diagnosing diseases and nice but also tough middle-aged ladies will walk patients through them even if it takes hours. The current system where expensive internists make diagnoses off the cuff in a few minutes can't be the best possible.
This proposal not only targets Asians but reinforces existing efforts to limit the slots available to non-WASPish, non-Jewish, non-Hispanic Whites. The same few White subgroups that are obsessed with racial diversity see nothing wrong with excluding Whites they see as "other:"
"Most elite universities seem to have little interest in diversifying their student bodies when it comes to the numbers of born-again Christians from the Bible belt, students from Appalachia and other rural and small-town areas, people who have served in the U.S. military, those who have grown up on farms or ranches, Mormons, Pentecostals, Jehovah's Witnesses, lower-middle-class Catholics, working class 'white ethnics' [such as Polish- and Italian-Americans], social and political conservatives, wheelchair users, married students, married students with children, or older students first starting out in college after raising children or spending several years in the workforce. Students in these categories are often very rare at the more competitive colleges, especially the Ivy League. While these kinds of people would surely add to the diverse viewpoints and life-experiences represented on college campuses, in practice 'diversity' on campus is largely a code word for the presence of a substantial proportion of those in the "underrepresented" racial minority groups."
http://www.mindingthecampus.com/originals/2010/07/how_diversity_punishes_asians.html
Jews, OTOH, make up 2% of the population but 20-25% of most elite colleges. (If Whites make up half the college, then Jews receive 40-50% of the "white" slots.) WASPs also receive a disproportionate number of slots.
What better way to exclude gifted Whites from the Rust Belt, Applachia, and the backwoods of Eastern Europe than a completely subjective test that assesses whether they can think and act like Jews or WASPs? Even a perfect GPA and SAT score is no protection against being excluded for 'thinking like a plumber' or not sharing the ethical views of Peter Singer, Stanley Fish, or Cass Sunstein. If a minority gives the 'wrong' answer, it can be dismissed as a sign of their "rich, full culture;" if a working-class or rural White gives the wrong answer, it will be held that they are too racist and ignorant to be allowed into medical school.
I knew some Asian-Indian kid who went to University of Chicago medical school and got the grades to make it to Harvard by Harvard rejected him and so he went to NYU.
If you're a hindu, you gotta score very very high to make it to the top.
I like the comment about the need to teach doctors statistics. This might be the kind of thing that the medical establishment is rightfully worried about, but doesn't want to admit in public that doctors tend to be innumerate about all the studies they are supposed to interpret. So, let's talk about Tuskeegee!
OT: First intelligence gene found.
New Genes Linked to Brain Size, Intelligence
"I knew some Asian-Indian kid who went to University of Chicago medical school and got the grades to make it to Harvard by Harvard rejected him and so he went to NYU. If you're a hindu, you gotta score very very high to make it to the top."
"The top" being a university founded...by WASPs, in a town founded...by WASPs, in a state founded by...WASPs, in a country founded by...WASPs (WASPs in the broad sense, at least).
Indians pissed by the alleged inequality in America are perfectly free to return to the paradise of eqality-loving India. Given how beautiful and prosperous it must be I'm rather shocked they ever left.
If I have a choice I always prefer a white male MD who went to a US medical school for my doctors. The system is stacked against them so I know they are smart to make it through. Lots of Asians are bright enough but I think they test prep a lot. I'd prefer a super high IQ white male who can solve problems outside of the box/textbook rather than some Asian who crammed away on tests and got grades way above his IQ. That being said I don't think I've run into any bad Asian doctors. As for Indians, I don't think they're that smart.
Anonymous said...
New Genes Linked to Brain Size, Intelligence
Wonder what the hapmap says, but I'm going to bed.
All you white people, please visit India and get Surgery from our Affirmative action [Reservation] Sc/ST [Schedule Caste/Schedule Tribe] Surgeons.
Jesus will be waiting at the end of the White Tunnel of Light.
"I like the comment about the need to teach doctors statistics." -Sailer
This is what makes House great. He can do math. Of course, he's also willing to break the traditional reading of the "do no harm" rule when the math dictates it.
Hopefully, universal genetic sequencing and the Tricorder X-Prize will devalue all doctors.
It simply boggles my mind that physicians have no training in statistics when virtually their entire profession and science is predicated on its use.
I concur. I had to take statistics in first year medical school around 1996. It was part of a short course that included medical research.
Coming from a top STEM school, I was appalled at how poorly the subject was taught, understood and tested. The instructor himself seemed innumerate and he reduced the course down to shallow memorization without understanding.
When your a hammer everything looks like a nail.
Personally, I don't know if medicine is overcredentialized - I do know that a relationship between number of doctors and many health indicators is completely absent.
So I don't have a huge problem with adding minor people skills burdens to the requirement to become a medic, really. We all know there is not going to be a large extent of these things.
...
The difference between whites and Asians in fluid intelligence is small. The difference in the willingness and perhaps even in the ability to memorize tens of thousands of facts is larger.
People assert this, but it may in fact be exactly the reverse. Asians do a lot better than Whites on pure tests of spatial reasoning and abstract reasoning (although the prime evidence for this is Raven's and there is confusion about how much here is due to reasoning and how much due to perceptual enhancement), but have more comparable (not inferior) results in knowing lots of facts about topics.
Of course, being able to memorise tens of thousands of facts is really useful for being a doctor. It's not really a subject oriented around being able to purely reason on new problems.
High ability to learn and remember information relative to "fluid rasoning" is not necessarily a bad thing - people with high fluid intelligence cannot really solve problems, no matter how high their fluid intelligence, unless they have access to the data. So long as you don't memorise irrelevant stuff.
People with high fluid abilities might be able to solve problems well if they're given all the necessary data on a platter (i.e. exams which aim to test abilities rather than knowledge - IQ tests being the purest example), but life isn't necessarily like that.
People actually need to know stuff, rather than being these facile "Rain Man" esque characters who don't really know anything about the world and are really just sort of a processing tool for people who do. All Gf and no knowledge base makes Johnny a useless boy.
I find people in the HBD community tend to lionise Gf (fluid intelligence) simply because it enables us to do away with objections that NAM groups are only lower in IQ due to low information access. I understand this.
But the fact of the matter is that people do actually need to learn information about the world to be any good at anything - people aren't computers that will just be spoonfed with interesting problems and all the information needed to solve them (particularly once you're beyond being a student and move to being a researcher or teacher). Sifting huge volumes of data for patterns requires that you know the data and where to look.
....
I like the comment about the need to teach doctors statistics.
So very true.
ER doc, like you deal with obnoxious patients and their families, and not the case manager.
"The Medical College Admission Test is, of course, much more than a test."
No, actually, it isn't. It's definitely harder than some other tests, like the DMV's, but it serves no purpose more exalted than winnowing the "oversubscribed" applicants.
I think what this reporter is trying to convey in her little argot is something about the inflation that's taken place with arbitrary status markers. Now that the B.A. has been diluted and the high school diploma destroyed, we must certainly press ever onward.
"And you'd be wrong about GPA because there's not a premed major really, only premed requirements. This means a white or NAM who doesn't major in a hard science can achieve a high GPA in any major, take the lower level science requirements at the local com college and still have plenty of time & energy to do well in the handful of upper level sci courses necessary for entry into med school."
This means exactly nothing. I said nothing of major. It doesn't matter what the major is. Asians get higher GPAs than whites, for reasons that do not appear to have anything to do with intelligence.
If med schools rely on GPA for admissions, and I believe they do, then this gives Asians an advantage largely unrelated to ability. Any reliance on GPA advantages Asians, full stop.
"PS. The GRE verbal didn't seem any harder than that on the original SAT. Are you ill?"
The SAT verbal has undergone two major changes in the past 20 years: first in scoring, then in format. The GRE verbal, until recently, had seen no changes at all. The original SAT verbal was just like the GRE. Therefore, the fact that I made the distinction at all suggests that I was not talking about the original SAT, but the one of the last 6 years.
So no, I'm not ill. You just don't seem able to make reasonable assumptions. Which suggests you should clarify more.
Georgia resident:
" This was fine for me (I got an 800 on the verbal), because I have a fairly extensive vocabulary, but I didn't think it had a whole lot to do with my overall level of intelligence."
You are correct that the revamped SAT verbal is much easier, but it is precisely because it *doesn't* rely so heavily on vocabulary.
But having a "fairly" extensive vocabulary does have a lot to do with intelligence. If one could memorize his way to a higher vocabulary, high verbal scores wouldn't be as rare as they are.
"I'm an ER doc. This is how I'd interview a candidate and what I'd look for in my replacement:
--Very high IQ fast learner.
--Superb analytic thinking. you will be inundated with junk studies. You must slash through this sloppy junk to find what's true for your patients.
--Strong backbone. Tell me how you've shown courage. You'll need it to stand up to manipulative patients and administrators.
--Social skills. You must relate to patients, their unrealistic expectations, their frailties; without humiliating them.
--Conflict managing skills.
--Preferably, be a woman like me."
Right. The next time I get a female ER doc, I'm walking, crawling or having my husband drag me out of the ER before I'll let her examine me.
A female ER doc gave me one of the worst experiences of my life. Went to the ER because I'd suddenly started coughing up blood during my morning ritual of coughing up all the post-nasal drip stuff. My first thought was TB so I had my husband take me and my little plastic container of blood-soaked tissues to the ER.
I told the female ER I had allergy and sinus trouble. I also told her I'd quit smoking a couple of years earlier so there was no need for her to employ scare tactics. Some X-rays were taken and she told me not once but twice that I could have lung cancer. I had to wait till the next evening when the test results came back to find out that I did not, in fact, have lung cancer.
I'd come in for diagnosis and treatment within minutes of first noticing this sympton, I told her I'd quit smoking, I agreed to be treated. There was no reason for her to say that. She could just as easily have said, "Sometimes this symptom indicates something very minor, sometimes it indicates something very serious. We won't know until the test results come back." Instead, she mentioned lung cancer and only lung cancer. It turned out I had pneumonia.
Her manner was for shit, too. Not a shred of sympathy. You would have thought I was chain-smoking in front of her, she was so disdainful.
I see by your smug listing of that last criterion that your people skills are about on a par with hers.
I like Asian doctors. I don't get the impression they look down on me.
"The top" being a university founded...by WASPs, in a town founded...by WASPs, in a state founded by...WASPs, in a country founded by...WASPs (WASPs in the broad sense, at least).
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But wasps set down the GOLDEN RULE where people will be judged on ability, not color. Should U of C favor a wasp hillbilly with IQ of 90 over Hindu with IQ of 140?
I'm a white guy that went to an Ivy League school. Got the 95th percentile on the MCAT about 8 years ago. I went to pharmacy school instead. A lifetime of debt slavery wasn't very appealing to me. In state pharmacy school was cheap. (Out of state is a different story.)
I work in a hospital now in a nice suburb of a major city. What I see on a day to day basis is a lot of African doctors, nurses, and pharmacists. Lots of Nigerians, Ghanians, and a few from other countries mostly among the nurses. Some of them are decent. But the bad ones are VERY bad. And the bad ones aren't that rare. Are they caring? Ask yourself how caring you think the average Nigerian internet entrepreneur is.
Most of my smart friends from college never considered going to medical school. Med school was for suckers. They went to work for Goldman Sachs or Morgan Stanley. (I did too before the market crashed.) We knew that hot women don't try to land themselves doctors any more, they try to land themselves a banker. If you want more guys like Dr. House, take (financial) power away from bankers and give it back to doctors. If you want the smartest people to solve the most important problems, pay them to do it. Instead we pay our smartest people to create financial pyramid schemes or design electronics to be made in sweat shops in Asia. We don't have to give doctors ten million dollar bonuses, but if we stop paying bankers outrageous sums of money and restore some quality of life to doctors, perhaps we will get more smart people in the field.
Smashing down physician salaries worked to drive out many of the Americans that would have gone into medicine a generation or two ago and send them into banking. In their place, we get imports of Africans. People from countries where an MD salary still sounds like a good first generation job in the US. Sure beats gardening. What will the next generation do? Who knows? What could possibly go wrong?
"a white male MD who went to a US medical school for my doctors. The system is stacked against them so I know they are smart to make it through."
What kind of doctor you prefer is very personal. After all, it's your body & body functions, and you may feel you need someone who has actually experience all that him or herself. It is one area where I really can see the point of having doctors who "look" like the patients. However, females are no longer the beneficiaries of AA in med school, to my knowledge, unless they are black or "hispanic." They must meet the same criteria. The one category I'd stay away from, because of experience, and awareness of their med school status, are black and most hispanic doctors. Though even among those there must be some good ones.
Clemster: There will be a lot more doctors and the power and prestige of doctors will be attenuated.
Why do people think that making medicine a low(er)-paying, low-prestige occupation will improve things?
1) How much has doctor pay really contributed to cost inflation in health care?
2) Smart people avoid low-pay, low-prestige fields. (But hey, what a cost savings if we can only fill the field with the not-so-bright!)
I've never understood the objection to doctors' making good money. I want my doctor to make good money. I can think of a whole hell of a lot of people who make way more money than they're worth to society, and doctors don't make the top 100.
Assistant Village Idiot: Doctors had to have better bedside manner in the old days because they essentially couldn't do much beyond set a bone, tell you whether your condition was fatal or not, and tell you if your heart was good enough to go into the army. Doctors killed more than they saved until about 1950, the result of a gradual 100+-year transition to actual science.
I dunno, AVI. My mother was a sickly child back in the Dark Ages (pre-antibiotic) of medicine, and formed a bad opinion of doctors thereby. When in old age she got sick enough to consent to consulting a doctor, she was pleasantly surprised: "When I was young, doctors usually couldn't do a damned thing for you beyond telling you you were going to die, and they were arrogant jerks. Now, when they can sometimes actually cure you, they're much, much nicer".
It's funny how so many Isteve readers seem to want to smash the medical profession into the ground. I'm not sure why any sane, soundly-reasoning person would want to deter competent individuals from pursuing medicine as a career. Unless you're planning to suffer instant death at a young age, chances are you WILL need medical care at some point in your life. Furthermore, the efficacy of that care is a huge determining factor for the quality-and extent-of your life subsequent the onset of your health issue.
So I guess what I'm saying is, if you want some 110 IQ ape to be put in a position to make life and death decisions for you, keep hoping doctor salaries go down and the "cognitive elite" begin to look at the medical profession with distaste. Almost nobody practices medicine for the sake of spending more than a decade in school and dealing with the disgusting fluids leaking out of sick bodies. Those secure, mid six-figures salaries are what motivate smart people to enter medicine.
OK, folks, I need some help:
Having experienced incompetent black physician, next time I want to explicitly ask for a white one. Naturally, it will create a furor and endless indignation at how racist I am. I want to be able to counter with pure statistics and facts:
I am not a racist, I am merely maximizing my chances. Affirmative action inequality made me do it. Ceteris paribus, based on [these facts] a random white/East Asian is more likely to be competent/better prepared than a random black.
Could you please provide as many relevant links to [these facts] as possible. Thanks a lot! Keeping track of sources is not my strong point. I've seen many of these data over the years but digging them all anew is turning to be difficult.
I think the most telling thing I ever read about doctors was how they responded to the idea that they were transmitting germs, because they weren't washing their hands before and after treating people; they were offended at the idea that they were "unclean" or that their hands were dirty.
They were arrogant #@!$s long before they actually started to have a clue what they were doing.
Can doctors be arrogant? Sure. I know a lot of them. But so what? I think part of the problem here is similar to what Steve points out about cops and fireman. Cops can save your life, but they can also hassle you and write tickets. Fireman are more universally beloved because they carry you out of burning buildings.
Doctors can save your life, but they can also tell you to stop drinking and smoking and that you're fat and you should stop eating till you're morbidly obese. Thus people got lots of enjoyment knocking them down a notch. Perhaps fireman would not be so loved if they told you they threw their backs out trying to carry your fat ass out of the house and now they will retire at 40 and collect a disability pension for the rest of their lives.
The public is stupid. They've demanded knocking doctors down a notch and they've got it. Congrats!
Just worry about the best....this is the link you need to see, 90% white -- the most desired specialty in the most desired place
http://dermatology.yale.edu/education/program/residents.aspx
"As for Indians, I don't think they're that smart."
The ones who make it to med school are pretty damn smart, you better believe it. They are the ones the system is stacked against, not whites.
"This means a white or NAM who doesn't major in a hard science can achieve a high GPA in any major, take the lower level science requirements at the local com college..."
Stop right there. Most medical schools look down their noses at science courses taken at a community college. The instructors are often as good as those at universities, but the grading curve is skewed.
"Why the hell wouldn't you want more Asian doctors? They are damned good and it is not like doctors are looking at a bright future given that a growing proportion of folks will not be able to pay."
Flooding the health care market with Asian doctors will do for medicine what flooding the STEM market with Asian PhDs did for engineering: salaries will get driven down severely and nobody can get hired outside of an incredibly narrow specialty. Soon, the best and brightest citizens will eschew medical careers as they have careers in information science and engineering.
It's bad enough that medical students need to go through over a decade of training and residency programs before they can begin paying off their $200K in loans. Now, they will have a $60K income to look forward to after years servitude in various hospitals and HMOs.
Like in the NHS in England, soon all doctors in the US will be quacks imported from the Middle East, China, and South Asian.
Well, if docs real terms salaries stay static while other real terms salaries fall, let alone their real terms salaries rise, who cares if they're in for it for the six figure salaries, if no one can really afford it?
Medicine has been a useless pseudoscience practiced by rentseekers for most of its history - scepticism is always in order to it.
Smart people avoid low-pay, low-prestige fields
Unless they have challenging problems to solve there and less so elsewhere. I wonder if the US has a doctor pay inflation because it makes other academic options more open, compared to Western Europe (for example)?
@Anon
Asians do a lot better than Whites on pure tests of spatial reasoning and abstract reasoning (although the prime evidence for this is Raven's and there is confusion about how much here is due to reasoning and how much due to perceptual enhancement),
Thank you for being honest about this. Most Asians will seek to hide the fact that the evidence for greater Asian g is based primarily on the unreliable Ravens, and that it is unclear how much the Asian edge on this test depends on that portion of the test that is more spatial-loaded than g-loaded.
BTW, you probably know that the Flynn Effect shows up primarily on the Ravens - almost entirely on the Ravens, in fact - further suggesting that it is highly unreliable as a measure of g, lol.
http://www.nytimes.com/2012/04/17/science/rise-in-scientific-journal-retractions-prompts-calls-for-reform.html?pagewanted=1&src=dayp
Perhaps this is the future of a medical science under the new dispensation.
Looks like its already with us. Yup, like I said, now that the West has declined its stagnation for the world for the foreseeable future.
"We knew that hot women don't try to land themselves doctors any more, they try to land themselves a banker."
In New York County (Manhattan), yes; in the other 3142 counties in America, not so much.
I go to Kaiser Oakland for my medical care. That's good. Consumer Reports just published ratings of all the medical insurance providers in the nation. Kaiser Oakland did very well coming in at number 14 among 300 or so in the US.
My doctor is Korean. That's not too unusual. Every single doctor at Medical Station #3 is either Chinese or Korean. That's about a dozen doctors.
Oddly enough in all of the lobby photographs of the medical staff there are no oriental faces. But there are a lot of black faces. There are almost no actual black doctors. But there are plenty of black nurses and technicians. They get their pictures on the wall.
"Doctors can save your life, but they can also tell you to stop [...] eating till you're morbidly obese."
Any doctor who doesn't know that obesity is largely the result of a fucked-up endocrine system and simply assumes obesity is always caused by weak will & gluttony is a pretty bad doctor. And let's face it, the dietary advice dispensed by doctors is usually outdated & wrong ("stay away from arterycloggingsaturatedfat and be sure to eat lots of healthy whole grains"), yet they continue to dispense it anyway, which kinda makes them quacks, doesn't it? Very well-paid quacks.
One day, it'll be robot doctors.
Cops can save your life, but they can also hassle you and write tickets.
I wonder what the ratio of time spent saving lives to writing tickets is for cops, on average? 1:10,000?
Could you please provide as many relevant links to [these facts] as possible. Thanks a lot! Keeping track of sources is not my strong point. I've seen many of these data over the years but digging them all anew is turning to be difficult.
What, about AA? Probably not the way to go. What you need is an IQ test for your doctor. A proxy, anyway. Like seeing his SAT scores. Or put him through a wordsum test. That kind of thing.
Then, if he doesn't measure up, you just say you want a doctor who does.
I asked Steve to write about affirmative action in med school during my 2nd year of med school at a very large public school in a very corrupt state. A large number of students were aa admits with shockingly low intelligence. Nearly as large a number were politically connected students who were also very dim.
My undergrad and grad education was in engineering and I did not study for the mcat but took it after growing disillusioned with my phd work. I scored a 31 and was granted interviews at less than half of the schools applied to (male wasp, no connections). I had much better luck wih residencies after scoring well on the usmles. I matched at a top cancer program and am now in private practice doing work I love. People would be shocked to know how dumb you can be and still make it. Changes in the mcat and the cost of med student education will no doubt make things worse.
Any doctor who doesn't know that obesity is largely the result of a fucked-up endocrine system and simply assumes obesity is always caused by weak will & gluttony is a pretty bad doctor. And let's face it, the dietary advice dispensed by doctors is usually outdated & wrong ("stay away from arterycloggingsaturatedfat and be sure to eat lots of healthy whole grains"), yet they continue to dispense it anyway, which kinda makes them quacks, doesn't it? Very well-paid quacks.
Got to be more to it than that. Too much increase in the past 40 yrs. This is v. well documented. Sodas are a main reason--most people don't think of liquids as having many calories. General increase in snack/junk even as healthy options become more and more ubiquitous.
Anyway, the massive increase among the young. Also, few Europeans (except maybe English) are like the U.S. When I was in a train statino in Switzerland I saw a very obese, young woman from the back. Hips like something alien was attached. I had been in Europea for a while and wasn't used to seeing bodies like that, esp on the young. Sure enough, heard her talking and she was American.
Actually, one thing they *should* test, but don't, is psychomotor skills. Aside from the obvious surgical specialties, many others also require dexterity and good hand-eye coordination: OB, anesthesiology, radiology (sticking needles and catheters), gastroenterology (tubes both ends, and snipping and banding stuff), hematology (bone-marrow biopsies).
There is not a great correlation between high IQ and good hands, so you may be manhandled (often while semi-conscious)by a brilliant klutz.
Too much increase in the past 40 yrs. This is v. well documented. Sodas are a main reason--most people don't think of liquids as having many calories.
It's not just excess calories. It's also the KIND of calories. There's also the fact that once your metabolism is "broken", it doesn't respond properly to most conventional weight-loss diets. In any case, the point is that most doctors haven't got a clue when it comes to diet, nutrition, obesity, etc., yet feel no compunction about dispensing bad advice. Then, when the patient follows the doctor's advice but fails to improve, the doctor blames the patient for being "weak willed". Same thing happens with diabetes: doc tells patient to follow the American Diabetes Association's recommended diet, which includes lots of carbohydrates, and when diabetic patient naturally gets worse, doctor prescribes meds, advises surgery, etc.
But yes, you're right that high-fructose corn syrup is a major contributor to the "diabesity" epidemic.
Right, we need this because most doctors aren't crappy enough already...
I am 100% in agreement with you about Dr. House...
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