The Demise of Junk DNA and Implications for Medicine

[Personal Note: I'm trying to avoid schoolwork on Sundays (Mark 2:27), so I came back to my room to decide what to do. I remembered having a conversation with a few people on a few occasions this weekend about junk DNA. I said things which I believed but couldn't confirm (e.g. about the history of the term "junk DNA"). I figured I'd do that for a bit and then decide what to do, but then 5 hours went by. And I had written this. I like to write, but usually don't have the time, and don't know if I will ever again.

I've tried to make this accessible, so I'll need double forgiveness. My medical school readers, pardon me for explaining what DNA does... again. I know you're paying attention in MoBio. For my non-med school readers, I apologize for all the jargon I don't know is jargon. If anything is unclear, please tell me so I can remember how normal humans talk outside of the kingdom of Medschoolandia.

I know it's long, but comments would be much appreciated.]

Introduction

As you probably know DNA is our code. We used to think that DNA only coded for protein. Proteins are the machines in our cells which do everything from contract our muscles to filtering our blood and everything in between. We have about 25,000 proteins encoded in our body to do every conceivable function. The strange part is that these protein coding sequences are only a few percent of the total genome. The mystery thirty years ago was: why do we have a 3 billion-letter code when we only need 60 million for proteins?

History Lesson

The initial answer came from the theory of evolutionary. If we evolved by random and accidental processes, it is reasonable to believe that seemingly useless codes are actually useless, vestigial organs or genetic fossils. If there were no designer concerned about the elegance and efficiency of his code, then one ought not expect elegance.

This was formally postulated in the early years of DNA sequencing. This view was first offered by Susuma Ohno who wrote in a 1972 article titled So Much ‘Junk DNA’ in our Genome, “Our view is that [junk DNA segments] are the remains of nature’s experiments which failed. The earth is strewn with fossil remains of extinct species; is it a wonder that our genome too is filled with the remains of extinct genes?”

This was the dogma for almost three decades. Searching the literature (ISI Web of Knowledge; a database of most of the peer-reviewed science writing) for the phrase “Junk DNA,” one finds it used initially in 1972, then used throughout the 80’s and 90’s. Scientists built their theories on it and operated under the assumption that the ‘junk’ was useless.

One group even made a computer simulation to prove that evolution predicts junk DNA. In an article in the journal Science (one of the two superpowers in the scientific world) “Computer Genome'' Is Full of Junk DNA the author writes, “The simulation clearly shows that eukaryotic genomes…will evolve to a large size most of which sequences are vestigial in some way” (everything more advanced than a yeast cell is ‘eukaryotic,’ including humans). He continues to say that, “Most of the DNA in eukaryotic genomes…did nothing at all.” Then he waxes poetic to conclude, “Molecular maps … of DNA are characterized by islands of transcribed sequences [proteins code] in a sea of silent DNA.” This captures the mood of the era.

As an aside, there is something you should know about biologists: they, like most scientists, are loathed to challenge dogma (It surprised me to find that they actually admit to this diction in scientific papers and say things like “…consistent with the postulate of the ‘central dogma,’” and “…without infringing Crick's central doctrine…”). There were very early, weak suggestions that junk DNA might have some purpose (when you screw it up, it screws up the animal), but nothing to speak of until the 90’s.

The first explicit attack on the Junk DNA notion wasn’t from a biologist (who, above all else, seemed terrified of boat-rocking), but a cryptographer named Simon Shepherd. He figured, “nature would not go to all that trouble [to copy junk DNA] without reason.” In 1993, he used signal analysis to guess at a purpose for junk DNA. His conclusion, with absolutely no background in biology and analyzing only sections of the genome (the human genome project wasn’t finished yet), was that the non-coding sections between genes was an error correcting code making sure that proteins came out properly (The cryptographer who took a crack at 'junk' DNA. New Scientist, 26 June 1993; it turns out that he correctly guessed one of the purposes of it). Though significant historically speaking, the journal he published in doesn’t have much say in where science goes.

Quiet support for the theory of useful junk built up in the late 80’s and early 90’s, but no one openly and seriously challenged the term ‘junk DNA,’ at least not in the scientific literature. Then finally in 1994 a pair of articles in Science challenged, for the first time in the mainstream scientific literature, the notion of Junk DNA (“Mining Treasure from ‘Junk DNA,’” Vol. 263, No. 5147 pp. 608-610 published in February and “Hints of a Language in Junk DNA,” Vol. 266. no. 5189, p. 1320 published in November). In the earlier article, several possible functions of non-coding DNA were suggested by reputable researchers, (who published their work without using the term ‘junk DNA’). The article concludes with this: “Enough gems have already been uncovered in the genetic midden to show that what was once thought to be waste is definitely being transmuted into scientific gold.” The latter article concludes with a quotation from the Harvard biologist Walter Gilbert, “I think what we call ‘junk DNA’ will have a number of uses.”

1994 was the year the dam broke. Once there was mainstream support for “Junk DNA,” biologists jumped right on the bandwagon. Once Science said it was OK to say that Junk DNA had a purpose, many articles were published to that effect. Throughout the 90’s and into the new millennium, people began to find role after role for junk DNA. Everyone was bashing Junk DNA starting 1994 and lasting a decade. Here is a brief history of article titles throughout the years:

1972 - “So Much ‘Junk DNA’ in our Genome,” Brookhaven Symposium on BioLOGY

1986 - “’Computer Genome’ Is Full of Junk DNA,” SCIENCE

1994 - “Hints of a Language in Junk DNA” SCIENCE,

1998 - “Should scientists scrap the notion of junk DNA?,” J. NAT’L CANCER INSTITUTE

2006 - “Regulatory RNAs and the demise of 'junk' DNA,” GENOME BIOLOGY

In 2006, it seemed that people finally realized that the junk DNA horse was actually dead, and whipping it was no longer nearly as much fun as had been in the late 90’s. Unfortunately the term ‘junk DNA’ proved too sticky and did not un-stick, even to this day (people call it ‘junk DNA’ believing it has a purpose… that’s the trouble with catchy nicknames). It is interesting to notice the time gap between 1994 and 2006. In a little over a decade we went from ‘A hint of language’ to the ‘demise of junk DNA.’

Now it is believed that non-coding sequences may even be more important than the actual ‘coding’ regions. We have seen non-coding DNA control how proteins are expressed. In other words, non-coding DNA tells the cell how much protein to make. If the coding DNA is like the blueprint for a car, the non-coding DNA is the factory foreman telling deciding to make 1000 cars instead of 10). The non-coding DNA that does this is sometimes immediately around a code, sometimes interspersed between the code, and sometimes even tens of thousands of letters away (like a boss in New York ordering the Detroit factory to slow down production). We’ve seen RNAs which don’t ever turn into proteins further regulating things and doing things we thought only proteins could do. The “Crick Doctrine” and every other dogma we held about DNA have been overturned. Having overcome the arrogant assumption that what we don’t understand isn’t important, we have discovered a whole new world which we are just now beginning to explore.

Lessons Learned?

So what did we learn from this little history lesson? Firstly, that science makes mistakes. BIG mistakes. Going from 3% useful DNA to over 30% useful DNA (and climbing) is a BIG mistake (a tenfold error). Secondly, that science can correct itself, and it can do so relatively quickly. Making a 180 like that in a matter of a decade is laudable. Not that this is a good thing overall. I mean that we should praise a science as we praise a child when he apologizes for hitting his sister. It is a shameful thing that happened, but better than if the apology never came.

And that is the story on Junk DNA. So let us continue our discussion by looking at what got us into this mess to begin with: a bad theory. The bad theory was that we arose by a sloppily process. We theorized that the mechanism by which we came about was a messy one with a lot of errors and inefficiencies. It has turned out that this, at least when it comes to DNA, was simply and clearly wrong.

May I humbly suggest another theory? I propose we think of the life as arising from an elegant process instead of a sloppy one. We ought to form a better theory, one that conforms to our data: that whatever formed life as we know it behaves as if it was an artist, an engineer and a designer.

When we see a genetic code, let’s not dismiss the 97% of the code as ‘junk’ when we don’t understand it. When we see a new protein, we ought to first assume it is part of an elegant system, not a useless piece of trash left over by an idiotic process. When we see an organ that we don’t understand, instead of first assuming a useless piece of flesh handed down by a process too stupid to take it out, let us be agnostic on its purpose and encourage ambitious scientists to try to figure it out. We have asserted our assumption when there is no data. We’ve pointed at the poor little organ and, for a century, shouted at it, “Useless!” I wouldn’t work under those conditions either.

It’s a good thing Duke researchers are leading the way by rejecting the old theory, or at least behaving like they did. Last year, they showed that the appendix has a useful role in repopulating good bacteria in the intestines and may be important in surviving intestinal diseases like Cholera (Hampton, T. A Use for the Appendix? JAMA. 2007; 298(21):2474).

You may think that all this talk about theories is simply an academic point, that we can agree to disagree, and that you can believe your way and I mine. But this is truly a life-and-death issue.

There was a huge reluctance to spend time or money studying non-coding DNA because of the assumption that it was junk. It turns out now that many diseases are actually caused by mutations in non-coding DNA. We can now do genetic counseling preventing transmission and are beginning to develop treatments. But this has only happened very recently because, until about a decade ago, we were still comfortable in our assumption that non-coding DNA was useless. The same goes for the appendix; 321,000 Americans were hospitalized in 2005 because of the appendix. How many lives may have been saved if we tried to figure out how the organ worked fifty years ago instead of dismissing it as another mistake by our sloppy friend evolution? How many people have died because of our stubbornness in clinging to a bad scientific theory?

Even if we were to assume atheistic evolution, I'm only suggesting that maybe we don't know who evolution really is, deep down. Maybe it is a process misunderstood. We may look at a man's desk and say he is sloppy and stupid, but that man may turn out to be a genius whose brilliance is hidden under a messy desk. Maybe, just maybe, evolution is that genius. We should, upon seeing the brilliance of evolution, reject the notion of it being stupid and embrace and even expect its genius.

And another one bites the dust...

Weeks. The title is talking about weeks (and an incredible Queen song).

So it's Friday night, half past midnight, and I'm done with another week. I'm sure you're wondering how I feel. Regardless of the presence or absence of wonders, I will tell you. To sum it up, good. Spiritually, emotionally, socially, and even academically, good.

I did a lot this week. For one, [warning, for those with weak stomachs, skip this section] I held a human heart in my (gloved) hand, and was able to find the Left and Right Cardiac Arteries. I learned all about DNA transcription, repair and proofreading (which is pretty freakin' cool, if you ask me). I also learned how to give PPDs and draw blood (I suck at both, but I know how to).

As far as work is concerned, there is a lot to do. I have online quizzes on Histology and Molecular Biology due by Sunday. There are probably 100 pages of Cells to Tissues to understand and a denser 30 pages of Molecular Biology. And I've got a scientific paper to read on Telomerase. But that's all I have to do, and I'm not being sarcastic.

I don't have a million other obligations taking up time. I can no longer spend Saturdays in Mexico, so I'll probably spend it studying. I'm still of the opinion that I won't study on Sunday to rest one day of the week (God said it was a good idea, right? ...We'll see how long my integrity lasts). I played Ultimate footba-occer today (and now am sore and ache... I must be getting old) this afternoon. I'm probably going to a party tomorrow night. What else have I to do in the remaining 16 hours per day but study? I try not to study alone, so it's a discussion on the stuff. When I'm thinking in a group, it's almost fun. Especially when I get to study with people I like (which, of course, is everyone :). Sometimes I study with people I don't really know (even though I know most of the 86 by name). It's sort of like a perpetual finals week. It's quite enjoyable.

Some people are really stressing. From what the second years have said and even the professors, it shouldn't be that hard to pass. There is a lot of information, but worrying about it never helped anyone except in getting them to work; it's the work that counts, not the worry. I guess I could cut out a few more hours of fun and replace them with study. But I don't think that would be prudent. As for the stressing, I learned a while ago (namely April of 2005... while preparing for the MCAT) that this whole thing is in God's hands and will work out for my best (whether that's passing or not, Romans 8:28); I need only to do my best. So far my best + God's will has led to Stanford, so there's no reason to change course now. Stress, at least in the academic realm, wasn't necessary and, I don't believe, will be. Again, we'll see how long my integrity lasts.

Week One Done

So I am now officially through one week (and almost one weekend of medical school). The second day of class was much the same as the first: lots of information but useful information.

There came a point today for the first time (and I don't expect it to be the last) where I was trying with all my might to focus, but the information was coming so fast, I could not even follow what was being said. I've zoned out before, but that's just my being lazy. I think this is the first time my brain reached it theoretical limit. The rain came down, the reservoir filled, and then the water poured right over the dam. Let's hope its a concrete dam.

I had a spectacular day going to church, having a great lunch with friends, and then enjoying some good, quality time with God in a beautiful, secluded oak grove very near the center of campus. Here is what I had to deal with today (left). And here is who I spent the time with (right; I took the photo today at the Stanford Church). Can Sunday get any better?

Much less inspiring, but much more funny was what happened in Histology on Friday. We had our first Histology class (looking at slides of cells). We had an hour of lecture with example cells, describing what to look for. Then we got our microscopes and tried to find the cells on our slides that they described.

I thought, "Great! This looks really easy! I'm pretty good at identifying shapes! Gee Golly Gosh!" And I looked at my first slide. I had used a microscope pretty extensively in my old lab, so the controls were very familiar. I saw other struggling with their microscopes. "Amateurs," I thought. "I'll condescend to their level and help out the poor devils with the focus. So sad..." I helped out as I could with loading the slide, and focusing on the cells. Child's play. Then I sat down at my microscope, loaded the slide, then quickly and efficiently moved down to the appropriate zoom. And I didn't recognize a single cell.

My heart raced. I began scanning violently around the slide. "Where in the **** are the Neutrophils?! ****! For that matter, where the **** are the Erythrocytes. I can't even find the ****ing Erythrocytes!!" Thus was my thinking (**** represents, 'world', 'shucks' 'heck', and 'bi-concaving', respectively).

I turned to my neighbor (who seemed to actually know what the **** was going on) and asked if I could look at her slide and she could point something out to me. And from thence came my deliverance. It was a different slide. I could clearly see Erythrocytes, Neutrophils and even an Eosionophil on her slide (peripheral blood smear looks like left) . I talked to the TA and got my own slide. I waxed prideful again, able to easily identify every cell type on the peripheral blood smear. I confidently moved onto the bone marrow slide.

"****," I thought. "They all look exactly the same. Probably another mislabel." I checked again with my neighbor. "****," I thought again, "It's just like mine." I went back and tried harder to look for differences. There were no differences! They were all purple dots that looked exactly the same. And I was supposed to tell the difference between promyelocytes, early myelocytes, late neutrophilic myelocytes, and metamyelocytes, and I couldn't even tell the difference between a myocyte and an erythroblast!

I looked for help. The TAs were occupied. Some people were packing up. Finished! And I just started my second slide! "Oh no! I had expected to be the dumb one. And it begins now, on day two!" I bemoaned to myself.

One of the TAs had projected his slide onto a TV screen and began describing the differences. And he did a darned good job. I then was able to see the subtle differences and remembered them fairly well. And by the end of that hour I got pretty good at blood histology, and actually (but just a little) started to like it.

P.S. The photo is from Wiki public domain, so don't worry course administrators, I haven't posted course materials

Day One

Wow!

Last night I struggled with insomnia. It took me 90 seconds rather than the usual 30 to fall asleep. Needless to say, I was anxious about my first day of class.

I got up before my alarm, which is usually the start to a good day. I made a sandwich and packed my lunch, pretending like I'm going to have time to do that this year. A tasty roast beef sandwich with fresh tomatoes, onions and lettuce, topped with mild cheddar, olive oil, vinegar, sea salt, and freshly ground pepper. Mmmmmm. It took me 1/2 an hour that I didn't have to make my lunch. I'll be quicker tomorrow.

Off to class!

I got out the door at about 8:30 for a 9:00 class. Another beautiful bike ride across a beautiful campus with beautiful weather (forebodingly warm at a quarter to nine) put me in an even better mood. I sat down next to two amazingly cool people in the front row of my first class ever at Medical school and got ready to start. The lecturer came in and started talking about the history of molecular biology. What surprised me was 1) he was a good speaker, 2) he actually wanted us to learn 3) he was funny 4) we talked about how prions are basically exactly the same as the Borg in Star Trek, a point we expanded for about 10 minutes. So I was sold on my Molecular Bio professor.

After two incredibly interesting hours of class, we went on to a Cells to Tissues class. The lecturer here started at about 25% the speed of light and never slowed down. This class was also very interesting. We talked about cells and stem cells (normal ones in adults) and how powerful they are. I am continually blown away (and expect this will not end) by how incredibly well designed the human body is. One reason why stem cells stay so rare is to minimize copying errors; they only grow when they need to, and they stay as close to the target tissue as they can. And the balance is also incredible. If intestinal tissue grew only 5% faster than it should, after one year of growth, it would increase its size by 10 times. Cancer is a small imbalance (~1%) of too much growth (or too little death). It's amazing that we don't always have cancer everywhere.

I ran over to the Financial Aid office to ask for money on my lunch break, but got back with plenty of time to eat my delicious delicious sandwich and chat some more (it happened to be about water infrastructure... oops).

The post-lunch lecture was Anatomy. This class I was a bit concerned with as I have never taken an anatomy class. The good thing about the class is that both the professors are Brits, which makes for endless entertainment and makes them seem inconceivably smart. We learned about the chest cavity. We had about an hour lecture on it before we headed off to the Anatomy Lab... dun dun dun.

Before we got to meet our cadavers, we had to change into our scrubs. It was like high school gym all over again. 40 guys in a locker room stripping and putting on funny blue clothes brought back memories.

We entered the Anatomy Lab and found our table. There were two sections of the room with twelve tables each. On the table was a blue fake leather bag with a big black zipper on it, each with the shape of the body visible by the folds in the bag. We walked over to the table, received instructions, observed a moment of silence for the donors, and unzipped the bags.

The cadavers were covered with a damp sheet, with an additional cloth over the hands and the face. The skin didn't seem real; it was too plastic-ey and pale. I took the plunge and made the first incision for my group along the clavicle. At first, it seemed unusual, but not as eerie as it should have been. We took off the layer of skin and fascia to reveal the pectoralis major.

To get to the serratus anterior, we needed to move the arms out to the sides. We took off the cloths and moved it out. This is when it started to feel like a body, once we could see the hands. Also noticing the armpit hair and other things which I didn't expect reminded us that it was actually a human we were working on. Even then, it was only a passing thought; the really interesting part was the intercostal muscles and the corticoid process and the other parts of the anatomy, not as much as I would have expected, the emotional side of the body.

We completed the dissection and washed up. We went back to the locker room and changed back into normal clothing. It was 5pm. We had class 9-5. And we will have class 9-5. We are all really tired and it's only the first day. I expect we will learn to strive at this pace, but we have not learned that yet.

That being said, medical school doesn't seem to be that hard. There was nothing today which I had trouble learning. The only challenge is keeping this up. Can I learn that much every day for two years? Medical school is a marathon, and one we have all been training for. If I can maintain this pace, I'll pass with flying colors (not that my colors will fly any more than the next man with a Pass/Fail grading system). I do not have significant fears that I will grow weary, but this, I suppose, is a great risk.

The second, and more likely, is distraction. There are about a billion opportunities for doing great things here. I just cannot get too distracted from class. Nothing seems to be immediately threatening, but those would be the two predicted 'modes of failure' (as Civil Engineers say), so should be protected against or reinforced.

P.S. I still smell like formaldehyde.

The Exodus

I've just written about what I like about Stanford. Now comes the previously untold story of how I got here. "Here" being after Day 1 of Orientation. And not "How" like in a philosophical or historical sense, just how I drove up the 5 and stuff like that.

Moving
I drove up to Stanford a week ago Monday. For whatever reason (but probably because I hate doing paperwork and usually protest by doing it poorly), I did not get have any information on things like where I was living and where to meet for the get-to-know-the-class camping trip called SWEAT, (Some Weird and Eccentric Acronym-Thing). I thought it was Tuesday, but that was the end of my knowledge. I had learned by this point that my phone, which was a very nice PDA, did not do phone-things like receive calls ever and made them only when it felt like it. It was under these circumstances that I drove a Prius up to Stanford loaded with all of my earthly belongings. 15N->210W->5N = 7 hours.

The drive was mostly nice. I like Kettleman city, but decided to stop at Bakersfield instead because I was too hungry. After a half-hour of clogging my arteries, I continued on. It took me about 7 hours to reach Sacramento, where I would stay on Monday night with my buddy at Davis Med. We met up, and he pretended to study while we talked. I crashed at his place.

The next morning I left early and headed for Stanford. I didn't have a map of Stanford, but I did have one of California, so I followed signs into campus. Once there, I tried to find the housing office. Not knowing anything about Stanford, I was unsuccessful. I had found a single phone number online for the housing department, so I called that. After 4 attempts of failed transfers and leaving messages, I was finally connected to someone who knew where it was. I drove right there, told them my name, showed ID, and was given a key. Simple as that.

Having figured out my housing, I decided to call Josh, the guy who was leading the camping trip (and ironically enough, the guy who used to tell me to wash dishes at UCLA), and he told me where to be the next morning. I then moved all my stuff up to my room (6th floor).

The way my roommate wanted to partition the room, I've basically got a studio to myself (instead of a shared bedroom + living room), which is fine by me. I've got a great view of the campus from my window, and privacy. Not that I really understand privacy, having had at least one person sharing my room since college began (in one case, 3 others shared my room). I kinda like it, though I can see the potential for greed in having MY space (which should always expand and never be infringed upon); I've never really had the luxury, but am certainly enjoying it (hopefully with minimal greed).

Camping
The next day we left for SWEAT. I was driving for one of the car-camping groups. Just to save my precious reputation, I wanted to go with the hard-core backpackers, but for the aforementioned loathing of paperwork and procedure, didn't sign up early enough.

Our leader was a second year, and he guided us with his fancy phone GPS. We tried to meet another group of people in Stockton for lunch, one of the girls told us they drove south from where we were. It turned out that by "south" she really meant "north," but with corroboration by the GPS, we headed south. Once we were clearly outside of any recognizable city in "French Camp," I got off the freeway and turned around amidst cries of, "It's a GPS, it can't be wrong!" It turned out that it was. We ended up finding them and getting some really good Mexican food in a sketchy part of Stockton.

We arrived and the lounging began. The three days were filled with mostly eating and waiting to eat again. We did typical camp stuff (day hikes and swimming) the first day. When it came time to build a fire, nobody knew anything about fires (except me, of course, being an Eagle Scout). Not that I was particularly good at building fires, but, being the only backpacker, my paltry knowledge was sufficient to bedazzle the poor group of campers. The concept of tinder->kindling->fuel was black magic to those who looked on in awe of my powers to control the flames. So thus I established myself as the great and wise woodsman. You know what they say: "In the land of the blind, the one-eyed man is king." [As a side note, it was pointed out to me that the saying would be more accurate if it went "In the land of the blind, the one-eyed man is stoned to death," thought the traditional story was what applied to me.]

The second day we decided to go for another day hike. A group of us decided to extend the day hike into a long day hike. One girl said she wanted to do it, I said I'd go to, and before we knew it, another four people had peer-pressured each other into going. Fortunately at that point, nobody knew that it was probably 4 miles each way or else they would never have attempted it. So a group of green campers embarked on a journey that very well could have killed them. Fortunately, they all survived and with minimal griping, so little in fact that no violence was done even to the most whiney among us. Everyone was proud of themselves upon completing the journey.

The last day we did a skit. Being the car camping group, we had procrastinated our task of coming up with a skit until the last minute. We discovered that it was not the last minute, because other groups actually started after we did. In the end, we came up with a very funny skit mocking our own laziness. The other groups ranged from obscene to confused. After a little bit more socializing, we drove back home that night.

Pre-Orientation
The weekend following SWEAT, I kept busy. I did a lot of sleeping in, a bit of shopping and lots of eating. I got a bike from Target so that I could be like everyone else. Normally a statement like that is hyperbole, but I'm pretty sure every one of us will own a bike by the end of this week. So I had to fit in. So I went to Target with two friends and we bought two bikes. We successfully fit two bikes and three people inside my Prius. That's right. It's a hybrid.

On Sunday I went with seven others to attend Abundant Life Christian Fellowship nearby. It was amazing! It looked like it used to be a Black Southern Baptist Church; it had a Gospel Choir, very upbeat music, and good, loud singing. The preacher was black, so the traditional white conservation of energy on the podium was not visible. There was no lack of power in the message, and more importantly, it was Biblically based. I'm going to try out some other churches, but I doubt I'll find anything better.

Orientation
Orientation started today, and it was pretty, pretty, pretty good. We had a very inspirational speech by our Dean, an entertaining speech by our Associate Dean, and then a very interesting talk by an author/faculty member whose book I was supposed to have gotten and read. Neither had happened, the latter on account of the former, but the talk was very interesting nonetheless. We were supposed to have a 24-student discussion on ethics and balancing life with medicine which was quickly turned into a 6 student + 6 professor discussion.

In between all this were lots of breaks where I got to meet more and more of my class, who, as I previously described, are amazing.

Next Step
School starts officially on Thursday, and before then I've got a two-page of administrative things that I'm supposed to do. They're the kinds of things that nobody really wants to do, but are indicative of the developed world. Things like online registration and financial planning. I really like flying by the seat of my pants and am rather annoyed at having to use instruments.

I've got another two-day grace period of orientation, and Mom's coming on Wednesday, so I've got lots to distract me from the elephant in the room (the hardest class of my life starting full-force on Thursday). It's a pretty angry elephant, and I think addressing it further would only upset it, so until Thursday I plan to ignore it.

"Take no thought for the morrow: for the morrow shall take thought for the things of itself. Sufficient for the day is the evil thereof." - Matthew 6:34

Why Stanford Rocks

So I'm at medical school now, for those of you who don't know at Stanford. The last week has been something of a blur, the experiences smearing into each one another like colors on film. I don't exactly know how to sum it up, but I'll say this: I am certainly happy here and with my choice. And here are some of the reasons in no particular order:

Exciting thing A - Outstanding Class
My classmates are outstanding, I'm honored to have the chance to work with them. My choice to come here because of them was truly justified. The Dean spoke today about how Stanford doesn't just want to train excellent physicians, it wants to train leaders. The 86 of us all have that spark. We're all normal enough to hold a conversation. We're all brilliant in at least one area (most of us in several). We've all done something amazing, mostly post graduation. Some have PhDs and Masters, some are Fulbright scholars, some have started NGOs, some have published extensively. Everyone has done something amazing.

Exciting thing B - Christian Community
There are actually a good number of strong Christians here. I'm going to be able to go through this with people who share my convictions, and people with whom I can pray and grow spiritually. As supportive as church groups can be, having this core of people who will share life with me for the next two years at least will be very important.

Exciting thing C - Global Health Interest
Everybody wants in on Global Health. Though there is only a minority of people who actually have done work abroad, it seems that there is broad interest, even among the basic science people (lab rats), to help out globally. We have done some pretty spectacular things separately, and we really want to work together. We're at the beginning stages of a potentially large, collaborative project.

Other Exciting Things
The weather has not ceased to be spectacular.

The faculty has not lost their gravity of presence; when they speak, especially our Dean, they speak with authority. They are not pompous, but are such strong personalities that they command attention.

There have been several groups that I've been the only American-born person in the group. The national diversity is spectacular (though we are lacking in under-represented minorities).

We have an army of people working for us to make our life easy and our learning successful.

The food around Stanford is amazing. Thai, Chinese (dim sun), and Indian were all eaten in the past few days, most of these being ordered from the place by a person who spoke the relevant language.

Turkey

I am in Turkey working with the UNHCR and doing a lot of really cool work. I've been updating another website, so if you are a regular blog reader and want to keep up on what's happening in Turkey, go to:

http://sites.google.com/site/ankaraturkeytrip2008/

If you want to comment on any of the pages, email me and I'll give you collaborator access.