Links for Monday, October 15, 2018: Uber quantifies the curb, non-yelling coaches, criminal malpractice, and handlebar shapes

Uber—not a bus company—has proposed a formula for optimization of curb space that makes buses look pretty good:

(quoting directly from the article)

Activity/(Time x Space)

“Activity” is the number of passengers using the curb space by a specific mode, “time” is the duration of their usage, and “space” is the total amount of curb footage dedicated to that use.

Here’s the example that the consultants use in their report, where a 20-foot length of curb is used for four hours as a parking spot by a single car carrying two people:

2 passengers/(4 hours x 20 feet) = .025 passengers/hour-feet, or 0.5 passengers per hour per 20 feet of curb

But if that space is instead used as part of an 80-foot bus stop serving 100 people in that four-hour block, the equation looks like this:

100 passengers/(4 hours x 80 feet) = .3125 passengers/hour-feet, or 6.25 passengers served per hour per 20 feet of curb

Clearly, the bus stop is a better use of public space. And naturally, those Uber cars that don’t take up curb parking look good, too. No surprise there, considering the source.

John Gagliardi is dead, which means that the Nick Saban school of coaching just got a little stronger. That’s a tragedy

My antipathy toward football is cresting (just search for “football” in this site and you’ll see why). But who can argue with a philosophy like this one?

“Gagliardi essentially preached a philosophy of anti-coaching, one that prized self-reliance and self-motivation and abhorred cruelty and authoritarianism. These were not bullshit, repackaged, supposedly out-of-the-box ideas like you find coming out of Silicon Valley. Gagliardi’s philosophy was deeply HUMAN, and deeply trusting. It also happened to be highly effective, so much so that similar techniques are now widely used in parenting books, academic teaching, and other fields.”

One thing the best coaches I’ve had did well—in sports, medicine, music, or other—was to make me feel good about what I was doing. They made me feel good about the process of improvement, no matter my starting point in terms of skill. They essentially told me, “I know you’re a person who tries hard. Let me help you direct that effort in the way that will get the most out of your foundational ability.”

A Texas neurosurgeon was so bad at his job that he got life in prison

When I was a resident, a local doc prescribed so many narcotics to so many patients at such outrageous doses that admitting one of his patients was a near certainty on any overnight call shift. But what did the guy in wasn’t that he was committing malpractice on a daily basis; it was that he improperly supervised his wife as a mid-level provider, leading to money laundering and conspiracy convictions.

We in medicine do a bad job of policing our own. The surgeon who body-checked Dr. Death away from the operating table in Texas deserves major credit.

On a lighter note, What Bars? lets you compare the shape, drop/rise, and weight of a few dozen different handlebars

Links for Tuesday, October 9, 2018: Overtreatment of subclinical hypothyroidism, altruism and specialty choice, and Roman wiping technology

Treating your TSH level of 10 mIU/L with thyroid hormone probably won’t make you feel better

But your doctor will probably try to talk you into it, anyway (paywall):

“Although current guidelines are at first sight cautious with treatment recommendations, more than 90% of persons with subclinical hypothyroidism and a thyrotropin level of less than 10 mIU/L would actually qualify for treatment. However, results of this meta-analysis are not consistent with these guideline recommendations.”

Are altruistic students more likely to choose lower-paying specialties in medicine?

This paper is complex and paywalled, and I won’t pretend to understand it. But yes, it does seem that altruism is related to choosing lower-paying specialties and more underserved areas:

 <$300,000 per year is defined as a lower-paying specialty, which calls my career choices into doubt.

<$300,000 per year is defined as a lower-paying specialty, which calls my career choices into doubt.

How did ancient Romans wipe without toilet paper?

Let’s all share a collective shiver at the thought of a communal, stall-less bathroom with sponges on sticks, shall we?

Links for Wednesday, September 5, 2018: docs are nervous about weight loss meds, risky low-carb diets, why I'm not a pediatrician, and continuity of care is good

Why don't more docs prescribe weight loss medications?

Speculation: 1) cost (and by extension, prior authorization requests); 2) residual fear from fen-phen, as one of the docs interviewed alluded to. We can surely put this to bed, since the current crop of meds has been on the market much longer than fen-phen had been when its harm was revealed; 3) nihilism. Five percent weight loss is meaningful from a medical perspective, but unless the doc is consciously, prospectively measuring outcomes like blood pressure, lipids, and fasting sugars, it won't knock her socks off. Patients won't be thanking her for getting them ready for bikini season; and 4) the old Risk Evaluation and Mitigation Strategy (REMS) for Qsymia was such a PIA that it scarred some docs to prescribing these meds.

Can we stick a fork in low-carbohydrate diets? (Ba Dum Tss)

What's a 32% increase in mortality among friends? Investigators (in a study that, to my knowledge, has not yet been published, so caveat emptor) found an association between the lowest quartiles of carbohydrate intake and death:

 NHANES data. Model 1 is unadjusted for other risk factors. Model 2 is adjusted. These are ugly, ugly numbers.&nbsp;

NHANES data. Model 1 is unadjusted for other risk factors. Model 2 is adjusted. These are ugly, ugly numbers. 

Remember: we can't draw causality from this. There is some chance that people who are sick and more likely to die from heart disease, cancer, or stroke are more likely to adopt low-carbohydrate diets. But it doesn't seem likely. The people at highest risk in this study were those over age 55 and "non-obese."

Reason # 1,001 I'm not a pediatrician:

Can. Not. Do. It.

Special shout-out to the 100 cell phone text alerts during the video. 

If lack of continuity is a mark against telemedicine, then it's a mark against the hospitalist model in general

Links for Tuesday, August 21, 2018: patients love good news. And weed. Patients love weed.

Patients liked a blood pressure app better because it was inaccurate

If I were to pick a single study that wraps all my angst about medicine up into a tidy bow, it would be this one:

"...user enjoyment and likelihood of future BP monitoring were negatively associated with higher-than-expected reported systolic BP. These data suggest reassuring app results from an inaccurate BP-measuring app may have improved user experience, which may have led to more positive user reviews and greater sales."

A better writer could hold forth on how doctors (and devices?) are so bad at giving negative but meaningful information to patients that patients simply avoid the process altogether, leading patients to seek a relationship with their doctors that more resembles that between a shaman and a subject than that of a modern, informed, dynamic doctor-patient exchange of information.

*head explodes*

Dr. Robert Badgett, on seeing this study, reminded me of a quote by Voltaire:

"The art of medicine consists in amusing the patient while nature cures the disease."

I certainly feel like I'm in the entertainment business some days.

With wider availability of cannabis comes wider use and wider abuse

"Public-health experts worry about the increasingly potent options available, and the striking number of constant users. 'Cannabis is potentially a real public-health problem,' said Mark A. R. Kleiman, a professor of public policy at New York University. 'It wasn’t obvious to me 25 years ago, when 9 percent of self-reported cannabis users over the last month reported daily or near-daily use. I always was prepared to say, ‘No, it’s not a very abusable drug. Nine percent of anybody will do something stupid.’ But that number is now [something like] 40 percent."

I knew guys in college who were stereotypical "potheads," and I think my bias at the time was that all but a few of them would be reined in by the relative difficulty of getting the drug (not that it was difficult). Now that the reins are off, we're stuck addressing possible solutions to the problem. This is not an argument for going back to hard-core criminalization. As Annie Lowrey points out, the US still arrests more people for marijuana offenses than it does for all violent crimes combined. That seems, shall we say, excessive. 

I've had several Impossible Burgers. They're amazing

A few years ago I made a choice to eat very little meat. Everyone who comes to a this dietary decision gets there for one of several reasons. For some, it's a matter of animal welfare. For me, it was the impact of excessive meat intake on my personal health: meat, particularly red meat and processed meat like bacon, has been linked to increased risk of heart disease, cancer, and other diseases. Plus, beef in particular is astonishingly carbon-intensive; were people to forgo only red meat in favor of beans (while, mind you, continuing to eat pork and poultry), the U.S. would come very near Paris Accord carbon emissions goals, all without a change in driving habits or other energy production from fossil fuels, and without a change in efficiency. 

Giving up meat for me was astonishingly easy. I don't miss it. Were you to ask me to give up sweeteners, we'd have a problem. I like desserts more than I should, and despite my frequent screeds against bug juice, I have an occasional caffeine-free Diet Coke. But no meat? No problemo. Part of the reason for this is that we've had a big increase in the availability of meat substitutes in the past decade or so. This doesn't affect me so much as it affects people who eat with me. I can make meals that are almost meat that I can serve to carnivorous friends and family without feeling like I'm depriving them of anything. But hamburgers, the quintessential American food, have been a problem. I've tried multiple veggie patties and black bean patties. They're all mostly okay, but they're no substitute for real meat. You have to have in your mind that you're not eating a hamburger to enjoy them. You tell yourself, "This is a good veggie burger," but you can never convince yourself that you're eating a real-for-real hamburger.

Then I heard about Impossible Foods and their bleeding vegan hamburgers. I was intrigued, but there was no place near home for me to try one. But last summer I was in Houston a week or two before Hurricane Harvey. We found a Hopdoddy just west of Rice Stadium:

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This was directly adjacent to Rice's semi-famous 1/3 mile "Bike Track," whose popularity I assume is at least partly due to the apocalyptic artillery-grade roughness of the surrounding streets. Hopdoddy was pushing the Impossible Burger hard:

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But that didn't mean they didn't have the customary pile o' beef in their kitchen:

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And it didn't mean that when I ordered on the waitress wouldn't say I was "brave." But when it arrived, so far, so good:

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My burger looked like a million bucks. But I didn't get a chance to find out if my burger bled; it was well-done:

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Impossible Burger has the look and feel of beef. It has the mouthfeel of beef. It just does. For all intents and purposes from the consumer end, this is beef. I tried a bite of my son's regular patty for a taste test. I'm a bit of an unreliable witness here; my enthusiasm for meatless foods taints my impression of these things. But honestly, the only difference was that his real burger was saltier. I suspect Impossible keeps the salt content lower to avoid dryness.

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I liked the one I ate so much that I convinced my then-ten year-old daughter, a notorious carnivore, to try one. She will eat veggie patties, begrudgingly, the way somebody who's tasted whole milk will settle for almond milk on her cereal if they don't have a choice. But after tasting mine, she was enthusiastic to get her own. And she's had several since.

The primary ingredients are wheat, coconut oil, potatoes, and heme. Heme is part of the molecule that carries oxygen in your bloodstream: "hemoglobin." Impossible gets its heme in the form of soy "leghemoglobin." Their website says they chose it because of taste and lack of allergenicity. I suppose this means people won't get a rash if they eat it. Not that I knew hemoglobin allergies were a big problem.

If you're the anti-GMO type (I'm most certainly not), beware that Impossible's leghemoglobin is produced by a genetically modified yeast. But it is 100% vegan. It's not gluten-free, which is a bummer for the small fraction of the population with celiac disease. For the remaining 99% of us, it's neither here nor there. Impossible burger patties are kosher.  Halal are anticipated later this year.

My second Impossible Burger was in Washington, D.C., for a work trip. My daughter's, ironically, came with bacon:

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My wife's medium-rare (not ordered that way, but delivered that way) patty gave us a chance to taste the heme without the searing. It definitely loses something. The seared heme is important: 

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I tried to convince my daughter that the tater tots were also "Impossible," but that since they were naturally made of potatoes the impossible factor was figuring out how to make them out of animals. She didn't buy it: 

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Impossible Burgers are now served in more than 1,500 restaurants. Since April, White Castle has been selling Impossible Sliders for just $1.99. After trying Impossible Burgers myself, I'm convinced that meat production in the way we've been practicing it for the past 100 years has an expiration date. We simply won't tolerate the health and environmental consequences of it when we have alternatives that are this good. I'm not here to tell you that Impossible Burgers represent any kind of achievement. Quite the contrary: as good as they are, they're just the beginning. Meatless "meat" is the worst today that it ever will be. It will only get better from here. Next phase vegetarian chicken? Faux eggs? Faux seafood

My remarks from the Wichita Business Coalition on Health Care's Obesity Forum this morning

Thanks for inviting me to kick off this very important event. Let’s start with a healthy dose of intellectual honesty. Obesity is a disease. It has arguably been so since the beginning of time, but it was made official in this country in 1985 when the National Institutes of Health issued a statement following its Consensus Development Conference on Obesity. This was followed by the report of the World Health Organization’s Consultation on Obesity and then the report of a committee of the Institute of Medicine, now known as the Health and Medicine Division of the National Academy of Sciences. Finally, the American Medical Association in 2013. Obesity is a disease because it is a “definite, morbid process with characteristic symptoms which affects the entire body; and has a known pathology and prognosis.” Obesity shouldn’t need this label in order to be taken seriously. Whether we--our institutions and organizations--pay for obesity treatment should ultimately depend more on what outcomes we value and the cost of achieving those outcomes. That is, the material inputs and outputs of the process, not our opinions of the people or behaviors that lead to them. A materialist versus spiritualist argument. I recently spoke at the Chronic Disease Alliance of Kansas meeting. Some of you were there. I made the argument that even if you are a spiritualist by nature, if you’re interested in medicine or public health, you must invest in a materialist point of view. That means you have to provide evidence for your assertions. How does this little philosophical cul-de-sac apply to obesity? Because I would argue that in spite of ample evidence and the label of disease applied by the NIH, the National Academy of Sciences, the AMA, and others, we don’t treat obesity in this country as a disease.

Think of what happens if you have, say, osteoarthritis of the knee. If you go to the doctor complaining of knee pain that fits the pattern of knee osteoarthritis, within some small confidence interval, you’ll get the same treatment regardless of what doctor you visit: x-rays to confirm the diagnosis, then some initial combination of anti-inflammatory drugs plus or minus strength training or physical therapy; then possibly an injection of hyaluronate or another agent; then a surgical procedure. All backed by some degree of clinical evidence as to their efficacy, with a set of professional guidelines that dictate the order and intensity in which they’re used.

And treatment for the disease--osteoarthritis still--is not limited to the clinical environment. We live under a robust set of laws, regulations, and expectations surrounding the humane treatment of people with osteoarthritis: handicapped parking stalls, construction standards around accessibility (curb cuts and whatnot). Furthermore, an enormous industry exists which caters to osteoarthritic people’s needs: handrails, higher toilets, special bathtubs, purpose-designed kitchen utensils, and others. For all its imperfections, this set of guidelines and expectations has the hallmarks of science: organization of knowledge, adaptability, the ability and willingness to change as evidence evolves.

But what happens if a patient goes to see his or her doctor for obesity? Even if the patient is lucky enough to encounter a doctor that considers obesity a disease and not a personal character failing, no such predictability exists. Doctor one may prescribes meal replacements, a la Nutrisystem, Weight Watchers, or dozens of competitors. Doctor two recommends avoiding “carbs.” (once called Atkins, now called paleo or ketogenic diet; it never goes away, we just change the name every ten years or so to convince people to avoid whole grains, the single most protective dietary component against diabetes) Doctor three prescribes phentermine, or if the patient is lucky, one of the drugs actually approved by the FDA for weight loss, all of which are exorbitantly expensive and modestly effective. Doctor four recommends the Diabetes Prevention Program. Doctor five recommends bariatric surgery. Doctor six recommends probiotics or another microbiome-directed treatment.

When the patient leaves the doctors office, she enters a built environment designed to be maximally obesogenic. Four-lane arterial roads replacing walkable, bikeable streets, even though we know beyond certainty that trips taken by car, rather than by bike, foot, or public transportation, are perfectly, directly related to the obesity rate in any community. And the amount of money any community spends on car-related transportation is perfectly aligned with obesity rates. Our patient pays sales taxes on obesogenic foods (red meat, refined carbohydrates, sugared beverages, and fats) at exactly the same rate as protective, high-fiber, unprocessed fruits, vegetables, and whole grains, in spite of evidence that Pigovian taxation, in which unhealthy foods are taxed at a rate equal to their the social cost and healthy foods are subsidized, has a powerful effect. Similarly, crop insurance and subsidy programs--in whatever form they take--favor meat and dairy production over fruits and vegetables.

When a peer gets cancer, we offer words of encouragement and give her rides to the doctor. We judge those with obesity and say they’re getting what they deserve for their weakness and sloth. We consider people who are competent, functioning members of society to be somehow constitutionally flawed and subject them to various levels of social discrimination. Obesity, along with intelligence, seems to be one of the final acceptable targets of discrimination; we casually make jokes about fat people and stupid people with none of the anxiety that accompanies insensitive remarks about race or sexual orientation. This is surely short-lived; over 80 million people in the U.S. have an I.Q. less than 90, and over 100 million are obese by body mass index criteria. These are groups large enough to fight back.

Viewed by an outsider, this set of circumstances does not resemble science. This is not the end result of a materialist view of the world. It resembles religion: a cultural system of competing behaviors, world views, and ethics that relate humanity’s problems not to the laws of the universe, but to supernatural elements. This elevation of the spiritual realm above the material realm is perfectly fine on Sunday mornings. I’m not here to make an anti-religion argument. Religion and spiritualism are vital in mobilizing public passion and opinion. NIH director Francis Collins, who discovered the gene mutation responsible for cystic fibrosis and later directed the Human Genome Project, is an evangelical Christian who advocates that religious belief can not only be reconciled with acceptance of scientific evidence, but that spirituality is vital to the responsible advancement of science. But spiritual thought in the absence of material evidence is unacceptable in the pursuit of a public health solution.

So how should we handle obesity as a health problem? As Kansans, we’re lucky to have perhaps the best model in our collective memories. We have Samuel Crumbine, early 20th century Dodge City physician who revolutionized the treatment of tuberculosis and other infectious diseases. At the outset of Dr. Crumbine’s career, infections were the leading cause of death by far and were dealt with in a quasi-spiritual manner. The consumption of tuberculosis was seen as God’s wrath. But Dr. Crumbine applied common sense strategies to limit the spread of the disease. He helped established sanitaria for tuberculosis patients, to isolate them from the public until they were no longer contagious. He spearheaded laws against spitting on the sidewalk (remember the bricks?), against shared drinking cups (you have him, indirectly, to thank for the modern bubbler-style drinking fountain), and against shared towels in public bathrooms. He advocated for fly-swatting campaigns. And all the while, he still promoted medical interventions for people already infected. Better antibiotics were developed. The entire specialty of cardiothoracic surgery grew not out of a need for coronary artery bypass grafting, but out of the need to drain tuberculous abscesses from the chests of infected patients.

When applied to obesity, I’m aware that lines blur. Calling something a disease moves individuals across a gauzy barrier between personhood and patienthood. You’re a person up until you’re labeled with a disease, then you’re a patient. The label inherently causes the patient to adopt a role in which he or she is excused from responsibility for his/her condition. This is healthy and appropriate; we know that the vast majority of lung cancers are caused by cigarette smoking, but we do not argue that smokers should be denied treatment. And the label creates an obligation for treatment that many obese people may not want. Roxane Gay and others have argued eloquently against the over-medicalization of body weight. And if this process (labeling of a disease, applying that label to people) entails an obligation for treatment, who will consent to pay the costs for that treatment? This social negotiation is just as big a part of what we need to address as any specific decision on the appropriateness or order of interventions.

I’m no Samuel Crumbine. I don’t even have a mustache. But if I channel Dr. Crumbine, I can see continued progress starting today. I can see the further development of a bike and pedestrian infrastructure, sensible parking policies, and street design that encourages higher density development with widely available green spaces. This can be partnered with local laws and regulations, a more sensible crop subsidy program, and a food tax system that encourages the production and consumption of quality foods over obesogenic foods. For patients who choose to seek help from their doctor, I can see a set of community-wide standards that promote a practical, stepwise approach to treatment that incorporates dietary and behavioral interventions alongside policies that make proven drug and surgical interventions more affordable. I can advocate for the development of a unified, science-based approach to obesity, motivated by spirituality but guided by material evidence.

Disclaimer: Health ICT was also a presenter, and the Forum was supported through a grant offered by the National Alliance of Healthcare Purchaser Coalitions and Novo Nordisk.

I'm changing the way I talk about walking

I spend a lot of time trying to convince people to be more physically active. I spend time on top of that trying to convince people that we should change the built environment, parking policies, and traffic laws to allow people to be more physically active.

One of my old standby stories is of a person who's spent most of his life sitting on the couch watching TV. He goes in for a routine operation, has a catastrophic adverse event, and ends up paralyzed as a result. When he wakes up the surgeon and the anesthesiologist gather to tell him the bad news. The first question out of this man's mouth, a man who has not walked further than from the bed to the bathroom, the bathroom to the kitchen, the kitchen to the sofa, or the car to his office cubicle in years, is this: "When will I walk again?"

I've even posted the story here from time to time

My point with the story has always been to get people to approach the world from a perspective of abundance. Don't take for granted the gifts you have today. Our bodies were designed by millions of years of evolution to move bipedally. If we forsake that, we end up less healthy and less happy. 

But yesterday I listened to Enter the Exos, a new-ish episode in Rose Eveleth's always thoughtful series Flash Forward. 

In the episode, Rose spends a predictable amount of time talking about the possibility that robotic exoskeletons, or even powered clothing, will make us faster, stronger, and less prone to injury:

 I'm talking about the one on the left.

I'm talking about the one on the left.

But she spends an even greater amount of time talking with people with various disabilities about their perception of exoskeletons. This is the part that got me. William Peace, blogger of Bad Cripple, has this to say

Your typical bipedal person exposed to a barrage of misleading news stories is led to believe all paralyzed people share one goal in life--walking. Please cue the soaring inspirational music accompanied by the brave and noble young man or woman struggling to walk surrounded by health care professionals, computer scientists, and engineers who share the same ritualized ideal. 

There is so much to unpack there. I walk, and I like doing it, so I've always thought that other people without the ability would want it. And maybe they would, if the technology were developed that could be applied to people with all kinds of disabilities (cerebral palsy is a lot different than spinal cord injury is a lot different than post-polio, etc). But bipeds like me have a hard time imagining that someone wouldn't want to get closer to the way I move, just like people with normal hearing are mystified by deaf culture. When I put myself in the position of someone who is in a wheelchair or needs another assistive device, I can see and hear the condescension in my words.

So I'm changing my pitch. I'm going to lean more on the "move through space" message and delete the "walking" part. I plan to work harder on the infrastructure message, with curb cuts and tactile crosswalks and protected walking lanes and a hundred other easy fixes that make life better not only for differently abled people, but for people who can walk and bike without difficulty like me.

And I'm going back to my perspective of abundance: we don't have functioning exoskeletons or other sexy fixes for paralysis or weakness yet, but we're all cyborgs already. Most of us carry a device in our pocket that literally has the world's knowledge at our fingertips. We should harness that technology to find safer routes for human-powered transportation of all kinds. And people who can't walk have a 235 year history of constantly improving wheelchair technology whose potential could be unleashed with a little more attention paid to the way we design our environment and laws.

Pedal powered vehicles are some of the best parts of the Air and Space Museum

The post about Skylab's probable clipless pedals was fun to write. But the sweet 70's leisure suit vibe of the Skylab ergometer couldn’t touch the wood-wheeled elegance of this bike, one of five (5!) surviving bikes built in Dayton by the Wright brothers. Tim Moore, the author of Gironimo!, who completed one of history‘s hardest Giro d’Italia courses on a wood-rimmed bike from the teens, would kill for this bad boy:

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Its price in 1898 was $42.50. The inflation calculator from the Bureau of Labor Statistics indicates that  this works out to a little over $1000 in 2018 money:

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Since the calculator only goes back to 1913,  I assume we can tack on a few bucks, although I think inflation was pretty low at that point in time. And knowing that this bike, the St. Clair, was Wright Cycles' mid-range model below the Van Cleave, it’s at least in the price ballpark of modern day bikes.

Here's the St. Clair with the original Wright Flyer in the background:

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That’s the actual bike next to the actual airplane that flew at Kitty Hawk in December 1903. The Wright Flyer is five years newer than the St. Clair. That's what I call A-U-T-H-E-N-T-I-C-I-T-Y. It will not surprise you to know that I was more excited about the bicycle. And not because the Wright Flyer has been re-skinned twice since it flew.

Lucky for me, just around the corner was the Gossamer Condor to merge my interests:  

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To explain the significance of this Saran-wrapped beauty, you have to step back a few years. In 1959, the Kremer Prize was established by London’s Aeronautical Society. The rules were simple: a human-powered plane had take off by itself (no catapults allowed) and climb to an altitude of ten feet to clear a marker. Then the plane had to make a 180° left turn, travel to another marker a half-mile away, and make a 180° right turn before clearing the same ten-foot marker prior to landing:

 https://hackaday.com/2015/01/27/retrotechtacular-the-gossamer-condor/

https://hackaday.com/2015/01/27/retrotechtacular-the-gossamer-condor/

This was a beast of a challenge, and not just because it pre-dated the metric system. Even the strongest cyclists (who, I'm guessing, aren't the best pilots in most cases) can only sustain about half a horsepower for any meaningful amount of time on a good day. Which means that any human-powered aircraft has to be really, really light. It also introduces a chicken-and-egg paradox: is it easier to teach a cyclist to fly, or is it easier to train a pilot to generate the necessary wattage to keep the fragile plane aloft? Gossamer Condor builder Paul MacCready tried it both ways. First, his son Tyler flew the Condor because of his small size and his experience flying hang gliders. Then, racing against what they thought was a Japanese team with a balsa-and-paper plane, MacCready hired professional cyclist (and onetime US National Team member and 1989 contestant in the Human-Powered Vehicle Race across America) Greg Miller as pilot. Greg proceeded to set the world record for man-powered flight in the Condor, but he reportedly couldn't negotiate the Kremer course and crashed in a later test flight (see the video below). When Greg had to go to Europe to race, MacCready found Bryan Allen, an avid amateur cyclist and hang-glider (and now scientist at Jet Propulsion Lab), to do the penultimate Kremer test:

The Flight of the Gossamer Condor, of which this clip is an excerpt, won an Academy Award for Documentary Short Subject in 1978.

Let's geek out over the similarities and differences in the Wright Flyer and the Gossamer Condor:

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