What Good is a Stinkin’ iPad?

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My good friend SY wrote me yesterday asking basically, “what good is a stinkin’ iPad?”

Hi Mike!

How are you??
My husband and I bought an iPad for my dad, but he decided he didn’t really have use for it (i.e. he uses his laptop and his phone and can’t get Java to work on the iPad so he can’t play ba-dook on it).

So now we are deciding whether to take it back or keep it for us–How useful is it really? You can’t edit documents or talks on it can you? Is it good for taking notes at conferences? Isn’t the wireless plan expensive on it? I pretty much bring my Mac everywhere with me, but I’m not sure it’s more than an indulgent toy for us.

SYP

I wrote back.

Hi Sung Yun. I have been asked this same question many times and can answer in the affirmative that tablets are overall great for reading and looking at stuff on. For editing and taking notes, it depends on what you are used to. And for portability, tablets>laptops. Tablets in general get a lot done, and of the tablet choices that you have, the iPad is still, for now, the best tablet a lot of money can buy.

I went all in when the first iPad came out, buying not one but two iPads. It occurred to me from the start that the pain of lugging my 15 inch Macbook Pro was soon to be relieved by the magic iPad, but I was worried that I would not be able to multitask. I normally keep several desktops and multiple windows going at the same time on my laptop, and to get a similar functionality from tablets, I feel you have to have multiple tablets. I also figured two iPads were still more portable than a single Macbook Pro (2007 issue).

The first great use of the iPad was as a reader. I own several Kindles and while I love reading books on my Kindle Paper White 3G, I equally enjoy reading them on the larger screen of my iPad. The skeuomorphic iBooks with their faux page turns are fun, but the iPad Kindle App with an Amazon Prime Account is reading heaven. Toss in FreeBooks app that feature everything out of copyright, and you have a public library in portable form. Overdrive reader app lets you access your local public library -you can look up and check out eBooks from your library! If you read magazines, most magazines feature an iPad App. Harder to find magazines can be found in newsstands like Zinio, but the killer app for magazines is Next Issue which for a monthly 8 to 15 dollars features hundreds of magazines like Esquire, Time, and People. I can’t live without my New Yorker magazine, and now rather than a mess of magazines around the house, they are all in my iPad.

The next use of the iPad is as a portable widescreen TV. While iTunes lets you purchase and then download movies and TV shows from iCloud onto your Mac, AppleTV, or iOS device (iPad, iPod Touch, iPhone), the streaming app trio of Hulu, Netflix, and Amazon Prime gives you access to thousands of current and vintage movies and television shows. Hulu Plus, a monthly subscription, gives me access to every episode of South Park, the Daily Show, Colbert Report, Community, and The New Girl. It also features the Criterion Collection of critically acclaimed but difficult to find foreign films -I am in the midst of watching Riso Amaro (Bitter Rice), an Italian post war film of lust and crime in the Italian rice paddies. Movies-Riso_AmaroNetflix has a great selection of movies and TV shows as well, and the ability to have DVD’s mailed to you. Amazon Prime’s video player also features many recently released films for streaming, and beats iTunes by letting you stream rather than download then watch rental movies. Amazon also has every Ken Burns documentary, if that is your thing.

These two features are the core of how the adults in the house use the iPad. Jen enjoys watching Downton Abbey in the bed while I read the NY Times and listen to Paloma Faith on Spotify. The NPR app, by the way, lets you listen to all the NPR that you missed during your busy day. The boys love watching their shows anywhere, anytime. The funny thing is, because we watch shows on our terms, the TV goes the whole week without being turned on except for family movie night or when dad watches sports. During baseball season, by the way, I buy an MLB season ticket to watch major league baseball games -usually as a ten minute summary of outs and hits the next morning, but often I stream the live radio broadcast just to hear John Sterling howl, “Yaaaaaaankeeeees Winnn!”

The third feature is up to you to decide if you want in the house. The iPad is a great gaming platform. While not as immersive or complicated as an XBox, Wii, or Playstation, games on the iPad are no less fun or addictive. Words with Friends pops on a larger screen. Pinball is a great stress reducer. My boys play all manner of games -most of which are free or cost 99 cents which is a lot cheaper than the average XBox game.

The utility of tablets is that eliminating the keyboard frees you to interact with the computer in a far more natural way. Drawing and music creation are two ways I put mileage on the iPad. My favorite art app, Paper, was the App Store’s App of the Year last year, and I doodle constantly. The Brushes app is used by David Hockney and other artists to create serious art. I frequently use Adobe Ideas to sketch on top of CT scans for patient consultations.

For note taking, there are innumerable apps for taking freehand notes and the better ones allow you to record the presenter’s audio synced to your notes. My favorite second brain app is Evernote which lets me data dump important files, notes, and ideas for access across all my gadgets. If you type fast, you probably aren’t going to change note taking tasks but I have to mention that it’s less intrusive to write notes on iPad than click clack away on a keyboard.

This brings me to the last part -work. I composed this blog entry on an iPad using the Logitech Slim Keyboard Case, which I recently reviewed. It turns the iPad into basically what the Microsoft Surface wants to be, a post-laptop work device. While Office for iOS isn’t out in the wild yet and probably never will be, there are many options for writing and editing. Pages is a good word processor, but Word is more universal and more importantly has collaborative editing and version control that is superior to anything on iOS. That said, Pages is unmatched in its ability to layout documents. That’s how I use it -after composing the content in a simple text processor like iA Writer, I open up and prettify it in Pages and save it as a Word file for sending out.

For presentations, Keynote is how I make all my presentations. I can make them on the fly during and after cases to present complex operations to patients and their families. You can export into Powerpoint or PDF, but equally powerful is the ability to present directly off your iPad, either via a cable or wirelessly to an AppleTV (an unpromoted feature). The usual way I create presentations is I upload all the pictures and graphics to a Dropbox folder and then compose the presentation on my iPad after taking intraop photos with my iPod Touch or iPhone. I’ve uploaded a sample presentation SFA-POP-Tibioperoneal Trunk EndoRE that I created right after a case for explaining what I did for a patient’s family.

The wireless plan is pricey if you’re not needing it, but I find it indispensable because my iPad 3 with Verizon 4G has a hotspot function which will allow me to tether other devices like a Macbook Pro or iPod Touch at high speeds. The typical use scenario is on long car trips where the iPad is the hotspot for streaming video to the boy’s tablets and I listen to This American Life episodes (every episode ever is available on their app). In a pinch, the iPad can act as a ridiculously large phone via the Line 2 app, which gives me a phone number (in Manhattan no less) for non-work use.

Now here is the last tip -I suggest you trade in your iPad for an iPad Mini with Verizon Wireless. The big screen is great, but impossible to carry around the hospital in a white coat. The 8 inch size fits perfectly. I’m holding out for the retina display iPad Mini which hopefully is next. For now, my Android Tablets fulfill this in the pocket function, and match the iPad largely feature for feature except for speed (they are older single processor devices) and ease of use. I think if you are adventuresome, the Nexus 7 is probably hits the sweetspot of price (about 200 bucks) and size (fits white coat pocket), but for cheaper, you don’t get the cellular wireless or nifty form factor, and you have to geek out on Android.

Hope that helps.

Mike

RIP RIM

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The day has arrived when I get to swap out my Blackberry 9930 for an iPhone 5. I had given up using the Blackberry as anything but a text/phone device because getting on the Internet was tricky at best. The 9930 is a device conceived by a committee of people who don’t understand how people use technology. I used my iPod Touch as a daily communicator and Internet surfer over the BB 9930. Fact is I had high hopes over its beautiful screen and okay keyboard but these could not overwhelm sheer misery in the browser, email (yes email) and paucity of apps to get things done. Goodbye.

Our Jackie Robinson

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Jeremy Lin is not basketball’s Tebow. He’s a barrier breaking Jackie Robinson for Asian- and Harvard-Americans. For years, all they thought we could do was be attorneys or urologists, but this shows there is more than one way to pass the rock. Now scouts will have to notice that non-black, non-Croatian dude dribbling the ball so well with the four color pen in his short pocket. Asian Harvard-Americans from Orange County to Westchester County are rejoicing. Free at last, free at last, thank God almighty, free at last.

Living Fossils

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This rock on a Pacific coast beach was weathered over thousands of years, and revealed within its sandstone this harder rock which is likely the fossilized remnant of an ancient coral or related creature. It reminded me that we have these fossils within our own DNA.

It was recently revealed that up to 2-3 percent of the genome of non-Africans have Neanderthal genes and a third human species, the Denisovans were found to be lurking. But this is just the recent past, being merely 20-50,000 year distant.

I was reviewing the lymphatic system in our bodies –it is the often overlooked third blood vessel system after arteries and veins, and its roots are older than either being present in our distant relations, the tunicates. Where arteries and veins are connected in a closed loop, the lymphatics are open to the extracellular space, and once in the past, to the ocean. This link to primitive chordates goes back nearly half a billion years.

They are now saying that there may be millions if not billions of earth like planets around middle aged stars, even in just this galaxy alone. Over cosmic time, and given those numbers of planets, it is a statistical certainty that life is common and not rare.

This feeling that life is a rare circumstance in an otherwise sterile universe has its roots in the narcissism of an idiot. The assumption that our clever ideas, petty jealousies, and unending appetites are unique is from the cosmic hayseed’s provincialism that gives certainty to the notion that a hundred years is a long time and that the universe disappears when you shut your eyes.

Starting from a single cell, our complexity is layered on like a gobstopper. Our DNA is not just a blueprint, but also a blog of life over three billion years. We are living fossils.

Addendum:

The fossil pictured above is Tiktaalik, a lobed finned fish from the Devonian. What it has that is unique is that it has a humerus, radius, and ulna along with shoulder, elbow and wrist that is the rubrik for all land vertebrates. The pattern of one bone with two distal bones are what we experience every time we eat chicken wings, and we owe  it to this class of fish which may be a direct ancestor or closely related to it.

Tilted Sideways, a Colander of Death

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The tragedy in Italy comes so soon after our cruise vacation that I felt compelled to comment. We were passengers aboard the Ruby Princess over Christmas. It is in many respects a sister ship to the unfortunate Costa Concordia, built by the same ship builder with similar tonnage and sibling like launch dates (2006 and 2008). The thing that struck me about our voyage was this: it was very clear that the ship was well run. The ship’s commander was Commodore Giuseppe Romano, whom we briefly met. The whole ship ran with obvious discipline with the first order of business on leaving Ft. Lauderdale being an evacuation drill where we understood the series of events in the event of a disaster before the first shrimp cocktail was served. During the cruise, there were several crew based drills, and I could appreciate the importance of top down leadership.

This is further contrasted by the events last week in Italy, which will be studied extensively, not just in a court of law, but in business schools as a case study of poor leadership. Bad decisions and bad discipline compounded by the elements made this the perfect example of why we have rules and expectations about professionals and their behavior. It also is a sobering reminder of how far we’ve strayed from chivalric ideals of women and children first. In a classroom, the idea of chivalry can be seen as revanchist, antiquarian, vestigial, and oppressive, but in the scrum of a mob climbing towards a lifeboat, the reports of grown men cutting in line, stripping life jackets from pregnant women, and abandoning the disabled all headed by this captain illustrates something.

It’s the death of honor.

Egg in a Basket -from V is for Vendetta movie

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Inspired by the egg dish in V is for Vendetta, it was called eggy in a basket. The circular toast that comes out of the center is fun for eating yourself or for toddlers. Want to know from my UK friends if this actually exists as a breakfast dish.

Apple’s Impact on CES

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It seems CES is all about reacting to Apple -Ultrabooks that are indistinguishable from MacBook Airs, smartphones that try to beat iPhone on features, cloud services that plagiarize Steve Jobs presentation slides, TV’s you talk to that try to preempt a Siri hosted Apple TV. The best stuff is when they try to be themselves, like Windows Mobile which is not very Microsoft in that it is stylish and easy to use, again like Apple.

When irony is so obvious, it no longer is ironic. It’s just sad. It’s just a bunch of small fish in a small pond. A tall hobbit contest.

Iowa, Nice

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This video has gone viral and is a reaction to all the negative coverage about Iowa. I have always said that Iowa plays a critical role as America’s great filter. I believe this because Iowa has the highest percentage of educated and reasonable people in the US. In fact, it is Iowa’s number one export.

When I was in New York and we had to have any kind of group interaction, the ability of the group to function predicated on a minimal number of stable, reasonable people. The reasonable persons index is basically the number of reasonable people divided by all the people in the group. A midtown modification of this is all the reasonable people and their entourage divided by the people in the room and their intended audience, but I digress.

The minimal index for a group to function in my experience is 0.20, meaning one in five of any group has to be a reasonable individual. The average New York City subway car has an index of 0.05. The average city council meeting, 0.15. The average fully loaded cab headed to three different stops on a rainy day, 0.00, my apartment, 0.50. What I noticed in various committee meetings that was part of my job back in New York was that the reasonable people were either Jamaican or from the Midwest, and of those from the Midwest, the least insane were from Iowa.

When I moved to Iowa, for obvious reasons, I realized the impact of the high reasonability index when I visited the motor vehicle department for my Iowa Driver’s license. It was packed, and there was a sign asking me to please take a number and wait for it to be called. My wife was pushing my son, then a toddler, in a stroller, and was immediately offered a seat by several reasonable Iowans, including some who needed the chair far more than my wife. As we sat, the numbers were called and the people moved up to the desk with a beautiful dignity –none of the expected sighing, looking up to the sky, and loudly complaining into the cell phone that would have been expected behavior back in New York. When our turn came, the clerk noticed I hadn’t filled out a section properly and patiently waited while I filled out the missing parts. My wife who is the typical non-patient type A New Yorker was smiling Mona Lisa-like through the whole experience –a surreal, psychedelic ethereal moment of serendipity.

The average Iowa is college educated and well read. I have a patient who is a farmer. He holds a dual masters in agricultural sciences and business. While he sits in his air-conditioned combine feeding the planet, he is trading commodity futures on his Blackberry. We had a nice discussion about the writing program at University of Iowa where his sister, a budding novelist attends. He’s skeptical of climate change, but only so far as he is skeptical of anything on the Huffington Post, but has noticed the wetter summers and is adjusting his farming accordingly. He has an investment strategy based on climate projections and economic growth data –in a name Brazil, and he has prospered. He has never visited Manhattan and sees no need to, being very comfortable in his maxed out Ford F-150 which has all the appointments of the coziest leather chair in a quiet corner of an exclusive midtown club. He doesn’t see what the fuss is about gay marriage, but is very upset about our wars abroad. He wishes the Republicans would field a more reasonable candidate, basically an Iowan like him, and is on the fence.

When candidates crash and burn on the Iowa Caucus stage, it’s usually because the Iowan reasonableness burns through the spin. Howard Dean, fun guy, would have been a terrible president and scared Iowans to death with his primal scream. And people focus on the GOP caucus which is the one place where the reasonability index falls below 0.50. You should look at the people Iowa rejected and understand what is going on. Howard Dean, John Edwards, Hilary Clinton (narrowly), Gingrich, Bachmann, Paul, Perry, Mitt Romney ‘08 and I would argue ‘12. The more I listen to Governor Huckabee, who won in ‘08, the more I respect him for his reasonableness on many issues, even though I disagree with him on some very important ones –and that is why he won in Iowa.

The caucuses are Iowa’s Exposition of American Democracy. If you show up, you vote physically by moving around the room and gathering (caucusing) for your favorite candidate. That candidate may even show up or prior to that, at your favorite lunch counter, bistro, or living room. In the hyperconnected, hypercaffeinated media world, the Iowa Caucuses are a time warp to the 19th century of mustachioed men orating on soap boxes. Given the audience that the candidates face, it is no wonder that the least reasonable just wilt. It wasn’t the internet spawned image of Bachmann fellating a corn dog at the Iowa State Fair that lost her. She lost by failing to convince Iowan’s that she deserves to lead the country. Got that? Not money, though it helps, but on fitness to lead. Isn’t that the whole point?

So as we move our attention to New Hampshire (state reasonability index of 0.02, both of them from Iowa), and South Carolina (-0.35, negative when person so unreasonable that they negate the positive of those around them, like some in-laws), I think we should all celebrate and be grateful for Iowa, America’s pith.

Inside of MacBook Air Looks as Good as the Outside

I ran out of hard drive space on my 2010 MacBook Air, and so I decided to upgrade the SSD. The OtherWorld Computing SSD kit and instructions are very straightforward. Opening th MBA reveals shockingly clean lines that are frankly beautiful and fits with the Jobsian aesthetic of being beautiful in the totality of the device. I felt like I was looking at an alien artifact. The fan which you didn’t realize was there has silent gears and fits in organically. It was like operating, changing out the SSD.

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