Blessed by the Potato

My friend Julia tried to kill me tonight.

It was awesome.

She had the bright idea of going out to the Fanshawe Lake conservation area, where there is a ~20 km bike path around the lake. Including the biking to Fanshawe Lake and back, that was a 36 km trip for us — nearly double my last furthest ride! I figured what the hell though, I needed to get off my butt and get in better shape, the weather was awesome for it, and it sounded perfectly lovely: after all, London has a great paved trail system along the river in town. I was expecting much the same around the lake.

I was wrong.

It turned out to be The Cycle Path of Death, Awesomeness, Darkness, and Fireflies.

First off, we had a plan to leave around 6pm so we could do our trek and get home before dark (or, at worst, back to the lit city streets before dark). Unfortunately, I have to accept all the blame there as I didn’t get out of work until 6pm, and then had to have a bite to eat, change, mix up some gatorade, find my bug spray, pump up my tires… and we didn’t leave until nearly 7pm. Still, anticipating a leisurely cruise around the lake, that should have been plenty of time.

We get to the toll gate for the conservation area and find out we have to pay to get in ($5.50 per bike). I didn’t do my research and wasn’t prepared for this, but thankfully Julia spotted me. The cashier manning the gate knew nothing about the park — she had never been on the trail itself, couldn’t tell us if it was paved or gravel or what. She just gave us a map, offered to sell us a season’s pass ($77), and sent us on our merry way. Now, I’m going to be quite critical of the path through here, but we did have a lot of fun, and I think it was worth paying admission for (at least once) — but what are they doing with that money? The signage needs serious improvement in there. If I go back, I’ll be very tempted to go in with a bottle of spray paint and re-mark the damned trail myself.

So, she sends us on our merry way, and notes that today is an even day, so cyclists have to do the trail clockwise. We bike off down this nice paved two-lane road (shared by cars and bikes) and think that that was an awful strange, OCD requirement. When we do finally find the bike trail (which, BTW, involved biking around a barrier put across the entrance, presumably to keep cars out, but with no signage) we see why: it is very much a single-file bike trail. Most of the trail is just dirt and mud, with no effort made to clear out the mini-boulders and large tree roots that block the way. It was tough slogging. In some parts, the foliage was so thick and grabby that we felt like we should have been chased by a smoke monster (the passing trains in the middle distance did add the appropriate sound effects though).

There were many parts where we just had to get off the bikes and “portage” – either because of super-steep hills, or big rocks/branches/roots blocking the way. Lots of mud, too.

Perhaps needless to say, but I feel the need to say it anyway: our timeline was fucked. This was a much slower (and harder!) slog through 20 km than we had planned for. Around the 6 or 7 km mark, we ran into two guys who were turning around because they didn’t think they could make it to the end before dark. That was at 8:25 pm. At that point, it had taken nearly an hour for us to get in the first ~6 km, but we figured we still had an hour and a half of light, and that somewhere along the way (soon, we had hoped) the trail incorporated some paved sections where we could burn through the miles. We made the call to keep going around. This was also because we wanted to finish this course, and did not want to return to work the next day with the stench of failure and turning-around-in-the-face-of-darkness on us.

We were quite mad, you see.

The trail continued on, and got progressively worse (hillier, rockier, darker). The darkness was not so much due to the setting sun — which at 8:30 was still decently above the horizon, but because the damned foliage just got so thick the light couldn’t get in! I was having visions of Mirkwood from LotR (and indeed, was attacked by a spider and either a different kind of spider, or a tick). We knew from the map (and my Blackberry’s GPS) that we had to meet the road soon, but the damned trail ended at a small creek, and I didn’t know we were supposed to cross it (there was “black diamond” trail turn-off right around there too, so I thought that’s what the crossing at the creek was). So we had a little detour there down an even denser, less-well cleared path that dead-ended at the lake.

Finally, we hit the road and put on some speed. In no time we covered a good 6 km of the distance. We decided to skip over one section of the path. That part followed the water, and would have been a shorter distance, but definitely would have taken us longer. We got back on the path with a good ~5 km left to go, the sun had definitely set, and it was getting twilighty and dark out (about 9:15pm). It wasn’t bad on the road at all to see, though some giant black moths had come out to attack us on our journey. We discussed sticking to the country roads and taking the long way back home, going by the airport, but figured we could still see and it wasn’t that much further, so we got back into the woods.

These were the thickest damned woods yet, at least overhead (the path itself wasn’t too bad). It was dark in there. Even though it kept getting later as we rode through there, it was much brighter when we finally broke out of the woods. Here’s a shot of the sunset at one small break in the trees at about the 4 km point.

It was kind of surreal biking through this narrow, hazardous path through the woods at nearly-nighttime. The fireflies were out and blinking at us. At first they were on the border of the path, looking to guide us along. Then one or two flashed at me from deeper in the brush, and I nearly turned to follow them (nearly). There were only a few smatterings of fireflies though — Julia was surprised there weren’t more, figuring that they probably come into prominence later in July. I was glad to see any; they’re a neat thing to see, and I haven’t seen any for years now. If they are in abundance out there later in the summer, I may have to plan another late bike ride through there (with flashlights though!).

As it got darker, we got slower, which just made it get darker. Here’s a picture I took with about 3 km to go. After this, I wasn’t allowed to stop and take any more pictures.

So we’re picking our way through the boulders and tree roots, up hills and down hills all in the rather dark (it wasn’t completely dark, and I claimed that “we did manage to finish before it was dark!” when we got out and there was still a tiny bit of twilight left, but it was pretty damned dark in the woods). As it gets noticeably darker, I start to think about these recurring nightmares I had as a child about running through a supernaturally dark forest while being chased by wolves. I didn’t say anything out loud though, and Julia picks just that moment to ask:

“Hey, do you know what I heard lives around here?”

“The next word out of your mouth had better not be bloody wolves.”

“No, a puma actually.”

“Oh, that’s much better.”

I had turned my safety lights on around the time we were on the road. These, for the record, are not flashlights. They are weak-ass little LEDs that aren’t focused so that cars in front of me can see me approach. And it was getting dark enough for them to actually kinda work as flashlights.

Finally, the trees start thinning out, and it gets a little lighter, then we’re on a completely unmarked gravel road. We take it, since we can’t see another option (it’s possible the bike path branched there to continue along the water a little further before meeting the road again later, but if it did, we couldn’t see it!). The orange glow of sodium lamps starts peeking through the trees, and we can see the dam, our starting point not too far ahead. We made it!

From there, it was a breezy ride back along the city streets at night.

In the end, it was a lot of fun, but there was definitely a lot of adrenaline pumping as we tried to beat the darkness on our way back. Especially since the path was not as novice-rider friendly as we had hoped. Someone could have easily been hurt out there, and after we passed the two guys who chose to turn around, we were the only ones out there.

Oh, it ended up taking us about an hour and a half to finish the course, so turning around would have definitely been the faster option. But we can now say that we did it (and to be fair to me, if the path wasn’t so closed-in, there would have been plenty of light in the time we had remaining there; also, if it was better marked, we could have easily saved 15-30 minutes.

So, to sum up: this is not a path for novice cyclists. It is not a path for road bikes. I can’t recommend starting out at 7pm or later (adjust for the length of the day — in mid-June here sunset’s about as late as it’s going to get). The path is not well-marked, and the Blackberry GPS is so handy!

On the topic of the Blackberry GPS, it’s not a true GPS. For some reason Bell wants a subscription fee to activate the antenna in the device to passively receive the signal from the GPS satellites and determine my location. That’s BS. It also doesn’t have maps stored in it (though with an 8 GB SD card, I should be able to devote ~1 GB to maps of NorthAm at least). What it does, AFAIK, is the handy-dandy Google Maps app will triangulate on the cell towers the phone can pick up on and determine location that way. It’s not as accurate as GPS, and requires a signal (presumably from more than one tower), but it works as well as I need it to. I do also, of course, need a signal to load the map, since the maps aren’t stored locally. So I’m not going to use it in the complete boonies, but how often am I completely without a signal?

For the curious, here is my expanded first draft; I should say emphatically that my coauthors on that paper are not responsible for what’s said here, this is all BbtP baby. As you can see, a lot was cut out to fit in the space provided, and to not come off as some guy ranting on a blog. Fortunately, this is the perfect venue for an article that comes off as a guy ranting on a blog! For those who have no idea what this is a first draft to, don’t worry about it, this stands on its own.

In Science (vol 327, p931, 19 Feb 2010) a little article came out describing the difficulties researchers in China were having with their studies of functional magnetic resonance imaging in children specifically to get healthy children to volunteer for a scan to act as controls for their patient group.

Intending to enroll children in the study, university students last December handed out fliers at a primary school. But they came away empty-handed: Parents were worried that MRI scans might harm their children. […] parents are reluctant to expose children to strong magnetic fields.
[…]
After 3 decades in the clinic, MRI is considered safer than x-ray scans and proton emission tomography, says physicist Yihong Yang, chief of the MRI physics section at the National Institute on Drug Abuse in Baltimore, Maryland. The main danger is for people with a pacemaker or other metal in their bodies. “Millions of people have been examined with MRI so far; thus it seems now very unlikely that there would be a side effect,” says Arno Villringer, director of cognitive neurology at the Max Planck Institute for Human Cognitive and Brain Sciences in Leipzig, Germany. […] Recruitment goes more smoothly in the United States, where “many parents will allow their children to take the test…”

There is some balance though:

…that reassurance cuts little ice with many parents—and some scientists. “I would not dare to allow my children to be tested by MRI,” says radiologist Han Hongbin of Peking University Third Hospital. “Nobody can ensure that there is no potential danger,” such as during nonroutine MRI scans that use extremely powerful magnetic fields, he says.

This is a very tricky ethical dilemma, for a number of reasons.

Stating that “millions of people have been examined with MRI so far; thus it seems now very unlikely that there would be a side effect,” is an irresponsible statement to make in the face of empirical evidence to the contrary. We know that there are deterministic effects of the fields used in MRI: strong, rapidly changing gradient fields can stimulate nerves to fire; radiofrequencies can cause heating; strong static fields can create projectiles out of metal objects. There are safety limits and procedures in place to attempt to control these effects in MRI scans, but there may still be stochastic effects present. Indeed, it is well known that at high fields some people may experience nausea/vertigo, or a metallic taste. Several studies have examined the effects of the time-changing fields. These effects are not necessarily negative: Rohan et al. [2004] found that a particular MRI scan could improve mood in bipolar patients, and the undesireable effects are subtle and fairly easily managed. The effects are also not necessarily chronic, but the possibility that more exist that we have not yet discovered must be accounted for, particularly when imaging subjects that will have no medical benefit from the scan.

This becomes a particularly touchy issue when children become involved. There are many processes that affect developing organisms more severely than fully matured ones. Some early research into the effects of electromagnetic fields suggests that this may be the case for something like an MRI as well. The fact that millions of adults have been scanned over the past ~30 years may be cold comfort to a parent volunteering their child.

For some biological effects there may be a long latency time as well, before effects can be observed. Solid tumor formation, for example, may take over a decade to manifest after ionizing radiation exposure. Good, long-term epidemiological studies will be needed in the future, alongside basic experimental studies on animals and cell cultures, to arrive at a good answer to the question of whether there are biological or behavioural effects of MRIs, and what they might be. Indeed, it is well known that there is a slightly increased risk of cancer formation from the ionizing radiation present in an x-ray/CT scan. However, if we were at the same point in ionizing radiation-based imaging as we are with MRI — millions of patients scanned, but little long-term follow-up looking specifically for effects — we might not be able to find that risk! Absence of evidence is not proof of the absence of risk, and it is widely accepted that there are small, but non-zero risks associated with CT. Accordingly, it has been appropriate to adopt the precautionary approach, and apply the dictum of ALARA – as low as reasonably achievable – to ionizing radiation dose.

I’m not in any way trying to be fear-mongering: fuller understanding of the processes is needed to mitigate these potential risks. Gadolinium-DTPA was for a long time used as a contrast agent and was understood to be safe. Recently, it has been determined that it can have severe side-effects in some people. These risks can be managed, for example through kidney function tests to determine who may be at risk. Any behavioural or biological effects of MRIs may likewise be managed in the future once they are better understood.

Hoping that there are no effects, without rigorously pursuing the matter in a scientific manner, will not be beneficial in the long run. More research on the potential biological effects of MRI, especially in children, is needed.

We can’t say for sure yet, and will indeed never be able to say with full confidence that there are no biological effects of the fields used in MRI. At this point we can probably agree that any effects, in adults, are not so severe as to counterbalance the usefulness of MRI as a diagnostic and research tool. As more research is done, we will either uncover what the effects are exactly, or continue to narrow down the maximum effect that we could discover with the population tested. With children, however, the studies have not been done, and our confidence that MRIs have no effect is not particularly strong.

And note that I say this as someone who depends very much on having volunteers step up to get an MRI for research purposes, and as someone who’s had a dozen MRIs himself. For an adult, having an MRI is safer than going for a short cruise in your car, a risk that people take for trivial benefits on a regular basis, so I completely understand when someone steps up to help science (and make a few bucks themselves). For children though, we just don’t know. Ultimately it’s the parents’ decision, but informed consent means that the researchers should try to educate them about both sides: the benefits and research aims as well as the potential, unknown risks.

A study is going to be better scientifically if it uses healthy controls to compare to a patient group (in this case, ADHD), rather than a different patient group (such as epilepsy) where the region of the brain being studied is likely not affected. However, that has to be balanced with the ethical realities of doing research.

I haven’t done one of these for a while. There was some bad weather for a few weeks there, and I didn’t get on the bike at all for a fortnight. Not owning up to my downfalls in the exercise routine kind of defeats the point of the public update/shaming, but I also reasoned that I didn’t have any links I wanted to share, either.

The last two weeks have been much better though: I broke the 20 km barrier, and rather easily at that, returning home feeling like I still could have done more, and wasn’t much sore the next day. Now the problem is going to be that to keep pushing myself to be able to bike further (e.g., to train for the Rona/MS bike tour), I need to start committing serious time. I did a (fairly hilly) 18 km on holiday Monday, and that took me about an hour and a half — I just don’t have the time right now to push it any further than that.

Diet: aaaah, you don’t even want to know. So far the multivitamin seems to be keeping away the scurvy.

Random thoughts:

Realtors to Canadians: Chill Out

“There will be no drastic drop in Canadian housing prices, the Canadian Real Estate Association said Thursday, because house prices will stabilize and climbing household income will make owning a home more affordable.”

Wow, I barely included tautology in my list of logical fallacies because I couldn’t think of any examples where it really came up, and circular reasoning is usually fairly easy to spot. But, here it is: there will be no drastic drop in house prices because house prices will not drop drastically.

Then that last tack-on about incomes doesn’t mention a timeframe. Incomes rise at about the rate of inflation, say 2%/year. If houses are 10% overvalued on average (and 30-50% in Toronto and Vancouver), that could be a very long period of flat-lining. If even the CREA is saying that the best case is a flat-lining of house prices for years, then why be in any hurry to buy, especially with uncertainty about where rates will go?

And if everyone’s in no hurry to buy, then won’t sellers have to lower their prices to attract buyers back? I just can’t see a stagnation as a likely scenario. Yes, house prices have stagnated for long periods of time before, but not usually so far from equilibrium, and not following such epic volatility (down ~10% in ’08, and then bouncing back ~20% in ’09!).

Plus there’s the issue that Canada is not homogeneous… a nation-wide decline of just a few percent could very well mean that Toronto and Vancouver got smashed while the rest of the country stagnated…

Michael James has a good set of links in his roundup this week, including a couple on your financial advisor, and whether small investors have no choice but to become DIYers.

My Bell bill arrived for the month, and I was greeted with a $30 over-usage charge. Bell’s cap of 25 GB is way more restrictive than Rogers’ 60 GB one (and even that is getting tight as more and more uses for the internet come out but the cap hasn’t changed in years). So even though I had a fairly moderate month (~40 GB in usage, well under what my cap was when I was with Rogers), that qualified me for the full $30 overage fee. What really ticked me off is that even though they have my email address (and phone number) they never notified me that I was getting close to (or exceeding) my cap. I thought I was being good. You can bet I’ll be switching to Teksavvy (with a 200 GB cap!) when my contract’s up…

Stephen Novella has another interesting post up on science and public perceptions. “[P]eople find stories much more compelling than data.”

Spoilers ahead!

Borderlands: I finally finished this thing. I had no idea I was that close to the end… it just simply ended. I must say, it was very unsatisfying. The beginning of the game had so much promise (and with multiplayer it would probably still be fun), but it felt like they rushed through it and did a little too much cut ‘n paste, as the charm and humour from the first little bit seemed gone completely by the end. It was a grind-fest basically. The reward for beating the final boss? The ability to run through the game all over again on a higher difficulty to unlock “achievements”. Whoopee. The last boss didn’t even drop any epic loot! Oh, and there is no treasure vault: the vault is a prison for some kind of Eridian demon thing, that is unlocked every 200 years by the alignment of the moons, which gives our hero the chance to finish the demon off once and for all. To quote the PA guys: “It is at this point that people begin to question the wisdom behind moon-powered demon prisons.”

This week was better for the working out.

I started off by hitting all my basic exercises on saturday, then went shopping, then went in to work, then briefly went out for a friend’s birthday party, then went for a long walk afterwards. It was probably 8-10 km of walking all day, but just over 6 km at the end all in one go. I was even on such a walking roll that I walked right by my house :)

Unfortunately part of that shopping trip involved discovering roasted soy bean snacks, which are good in the sense that they have good stuff in them like lots of protein and some fibre, but are bad because they still have a fair bit of fat (less than peanuts, but that’s not saying too much) and are very calorie dense. Plus, you know, creme eggs. So diet not so good this week, either.

Sunday I was at work so I did next to nothing.

Monday I got the bike out for a nice 7 km ride. I stopped in the park by the river and saw some ducks fighting, which I don’t think I’ve ever seen before. I always thought ducks were nice and hilarious (hehehe, they wiggle their bums when they’re happy and go quackwackwackwackwack), so I thought Marshall was out of line when he said “Have you ever been in a fight with a duck? Ducks are jerks.” And yes, they were jerks. This one duck jumped up and stood on the other duck’s back, and got a ducky head-lock on by biting her on the back of the head.

Tuesday I got my bike ride in early, but my butt is still not used to the seat so I packed it in early and instead spent 12 hours in front of my computer at work snacking. Excellent alternative.

By Wednesday I realized that I’m already starting to get that “I don’t feel so fat and slow” feeling, where all that hard work of exercise starts to actually have benefits. So I biked all the way up to the mall… and got candy at Bulk Barn. Hey, it’s 10% off for students on Wednesdays, I’m weak!

Thursday I was moderately good as well, and the weather was great for a bike ride. However, I didn’t sleep well and was busy with work, so Friday didn’t see any exercise, and now I’m taking the weekend off as well (taxes, weather).

However, after spending a lot of late nights in the lab working on analysis in front of the computer (and all night Thursday), my back started spasming, and hasn’t stopped for 3 days now. So that’s going to limit any upper-body work for the next little while, but hopefully the biking will continue if the weather gets better (and there was snow on Saturday morning, so there’s lots of room to improve!).

The Globe and Mail has an article today on Ontario’s Bitter Pill to Swallow, the recent changes to generic drug pricing that has pharmacies up in arms.

Once again, I think I’ve got to side with the public good on this: it’s a kick in the nards for pharmacies, but the government isn’t exactly bankrupting or socializing them. From the article:

At Lovell, Ms. Winn estimates each of her stores gets about $300-million [sic] annually from generic drug makers, in exchange for exclusively stocking their products. Like it or not, she says, without that money there are no funds to keep operating, since the margin on the drugs is minuscule; dispensing fees – the $10 to $12 that she collects on each prescription of which $7 is covered by Ontario for its public plan – have not been increased in years.

[…]

Before the day is done, they will fill 300 prescriptions, about one every two and a half minutes. There are three pharmacists on duty, along with three pharmacy technicians to help fill bottles and blister packs with drugs, and a cashier to ring through the purchases.

[…]

The province requires that the allowances are used for activities that directly benefit patients, and pharmacies must submit their spending to be audited each year. But the Ontario government figures that almost 70 per cent gets used for salaries, bonuses and fringe benefits.

Yes, the new rules are definitely going to pinch profits — but this article neglected to point out the offsets that the government is bringing in. Those kick-backs were supposed to be used to improve patient care, but many were simply used for salaries/profits. So now there is a direct payment for counselling and some other new services (flu shots). Those pharmacies that fully serve their patients should come out pretty close to how they did before according to the government*; those that are just bottle-filling robots will see a profit cut.

Speaking of bottle-filling robots, look at the numbers given in the article: 300 prescriptions a day, at $11 per just for the filling fee (i.e., on top of the markup on the drugs themselves – and that’s assuming just one fee per script; I know Wayfare generally has four or more dispensing fees every time she hits the pharmacy). $3300 per day, $16500 per (5-day) week, over $800k per year. I don’t know how much overhead the store has, but there is some mark-up on the drugs (even under the new rules), so let’s assume that covers the overhead**. That $800k split between 3 pharmacists and 3 technicians looks pretty healthy to me — and those dispensing fees will be going up a bit under the new rules (~14+%), despite their lament that they haven’t gone up in the past few years.

All this gnashing of teeth and fighting and threats to cut services or go out of business coming from the pharmacies rings false with me. I know it sucks to have this great profit orgy and have the government come in and smash it up, but I don’t think any pharmacists are going to go hungry under the new rules (except perhaps the students Shoppers and Pharma Plus decided not to hire this summer as part of their temper tantrum with the government). If any pharmacies do have to close, it’s probably because there were too many pharmacies to begin with. Near my old house in London there were three pharmacies within 500 m of each other on one street, and it wasn’t even all that densely populated an area (with people or doctors’ offices). Within the ~4 km² area of downtown London, there are nine pharmacies that I know about, and quite possibly more.

* – sorry, lost the source where I read that one. If anyone finds the article where that was mentioned, I’d appreciate being able to reference it!
** – again, using the reported numbers of $0.50 per script for mark-up under the new stricter rules, that’s $3.3k/mo — I don’t know what the lease and other overhead is on a store that “could fit inside the cosmetics department of a Shoppers Drug Mart” but that sounds like it’s in the ballpark to me.

This week, Ms. Winn and her staff began drawing up a list of services they now provide free, which they may need to charge for in the future. Everything from faxing prescriptions to calling doctors offices comes at a cost, and may need to carry a fee at some point in the future.

It’s a model similar to a law office, where every hour of the day is accounted for, with a value attached to it. Ms. Winn says she isn’t sure what services to charge for though, but feels the pressure to cover costs without the allowances.

Last week, a teenager came in to get a prescription filled and, as Ms. Winn puts it, “was overmedicated.”

The 19-year-old was on six other prescriptions.

“When he came to the counter, I could just tell by looking at him, he didn’t understand a word I was saying.”

The pharmacy spent about 20 minutes to a half hour on the phone with the doctor and talking to the man about how to manage his medications properly. Ms. Winn admits she’s not sure what that time is worth.

In that case, I’ll tell you exactly what that time is worth: $50 (damn, another case for capital numbers). Yes, that is pretty much exactly the definition of a 30-minute consult under the MedsCheck program. A pharmacist reviews a patient’s medications, and bills OHIP for providing the service (and of course, they have to actually account and bill for those services, instead of just handwave and rake in the cash like under the old system).

I’m going to conclude by stealing the thunder from another article I’ve been working on: health care costs are going to be perhaps the defining issue of the coming decades, due to population demographics as much as anything else. I completely support the government’s effort to start getting prescription costs under control now, even if it pisses off a few druggists.