This was, in fact, a trick question. They are all stalactites, the ones at the bottom being a mirror image reflected in a perfectly still shallow pond.

Caves are fascinating.

Today is Election Day in America. By law, this is the first Tuesday after the first Monday in November.

Why pick such an impractical day for voting, when people need to take time off work and kids have to miss school?

Because Americans used to be a bunch of farmers. Of course.

Turning Red for adults. It works.

This wishing well in the Luray Caverns must be the most American thing I’ve seen yet. Nature: check. Money: check. Altrusim: check-check (all the money is donated). Note — the water is clear, but the stones underneath are green from oxidized penny-derived copper.

Ka-ching.

Which ones are stalactites and which are stalagmites?

• If anyone ever tells me again that America is stagnating and points to China’s skyscraper forests that sprang out of nowhere, I’ll point them to Nashville. More cranes there than at a crane festival.
• Ditto for the line about American cities being more and more alike, so that it doesn’t matter whether one lives in the suburbs of Albuquerque or Atlanta. Take a walk up and down Broadway at 1pm on a Monday, count the number of live music venues packed side to side, and tell me of any other place in the country that has the same number per meter squared.
• Corollary to the above: if you can’t stand the smell of stale beer, probably best to stay out of downtown.
• There was a time between Vanderbilt University being founded and Grand Ole Opry exploding in popularity when the city was known as the Athens of the South. This was even before they built a full-scale replica of the Parthenon on the city’s centennial, in 1897. ⊕ The one from 1897 was made of plaster and torn down shortly after the World Fair it was built for. The more permanent one still standing is itself 100 years old now, being built in 1920. So yes, the Parthenon was so nice they built it twice. They were an industrious bunch.
• Speaking of engineering feats: North America’s largest non-casino hotel & resort is in Nashville, ready to give you that indoor river cruise experience you could otherwise get only in Vegas.
• Six bullet points in, and only now do we get to food? Well, it’s good! Much better food and service dollar-for-dollar than anything you will get inside the D.C. beltway at either end of the pricing spectrum. Hot chicken and banana pudding are favorites, though for full transparency I should add that none of puddings we had came close to the one from Bernard’s in Roanoke, VA.
• Some good murals as well.
• “Sarah Cannon Research Institute (SCRI) is a research organization focusing on therapies for patients which include drugs that are in development. With corporate headquarters in Nashville, Tennessee, United States, it conducts community-based clinical trials in oncology, cardiology, gastroenterology, and other therapeutic areas.”
• We would pack our bags and move tomorrow if the summers weren’t as humid as D.C.’s. Also, catastrophic flood from as recently as 10 years ago would make me think twice. But it’s on the list!

No.

To quote myself and colleagues in JAMA Internal Medicine:

Among the drugs approved on the basis of response rate, there was only a weak correlation between cost and the magnitude of the response rate gain; the same was true in the categories of drugs approved on the basis of PFS and OS gains. This suggests that cancer drugs are priced based predominantly on what the market will bear. Correcting this trend is vital for the solvency of health care and pharmaceutical development.

The following caveats apply:

• We looked at median wholesale price, not the retail price. Wholesale cost is what the drug companies think their products are worth. Retail price is what the markets think they are worth. But there are such things as anchoring and, as the accompanying editorial nicely reviewed, the biggest players on that market Medicare and Medicaid are forbidden by law to bargain.
• We only reported overall survival (OS), progression free survival (PFS) and overall response rate (ORR). We looked at other things as well, like mechanism of action and how novel the drug is, which will be reported separately.
• We only looked at the last 6 years of approvals.
• We only looked at cancer drugs.

But if you are a medical student or a resident and want to do some important work while buffing up your CV, feel free to copy our methods and apply them to other areas of medicine! Something like this for cardiology or endocrinology would do a whole lot more good than yet another case report of something presenting as something else.

Downtown Nashville TN, October 15 2022, 1:15pm CT.