Zach London

Zachary London, M.D.
Associate Director, Neurology Residency Program, University of Michigan;
musician, songwriter, The Hard Taco Project

Tottered on: 25 December 2006
Temperature: 37F
Ceiling: gloomy
Ground: soggy
Wind: NNE at 5 mph

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TT with HD: Zach London

[Ed. note: The Hard Taco Project discussed below is a recording project for which Zach London has made the following commitment: "I will write and record one song a month, every month, until I am dead." The Taco Bell robber mentioned below, who believes he is the Messiah, is discussed in more detail in December's Hard Taco Digest.

Dr. London describes his preference in reflex hammers below. Useful background: the Med-Psych Network has compiled a history of the reflex hammer that includes a tale of brawling neurologists (no kidding).

Dr. London also mentions below that he is a member of No Free Lunch, an organization encouraging medical professionals to refuse any kind of hospitality or gifts from the pharmaceutical industry. The UMHS website includes a detailed discussion of the UM Health System policy on drug reps and samples. ]

HD: Welcome to the teeter totter!

ZL: Thank you!

HD: Let's actually get some teetering action going here.

ZL: That's really the most important order of business.

HD: Yeah, exactly. So I wanted to dive right into The Hard Taco Project, but we can get to neurology later. It's quite an audacious goal to commit to writing and recording a new song every month.

ZL: Well, it isn't really that hard, if you just do it for a short period of time.

HD: Right, but you've been doing it since 1993, right?

ZL: Right.

HD: Although some of the songs, I noticed, are copyrighted in 1991?

ZL: I think 1993 is when I started recording. I started song-writing a little bit before that. I was in high school at the time.

HD: Yeah, I was trying to figure out where in your life history that would have come.

ZL: I'm 30 years old right now. '93 would have put me senior year in high school, and that was when I bought my first 4-track tape recorder. So I think that's when I first started recording.

HD: This was before the age of iMacs and the built-in recording software.

ZL: Exactly. Which is actually really impressive right now. Anybody who buys any Apple computer, they now come standard with Garage Band, which is ages beyond anything that was available in a home studio even five years ago. But I've talked to a lot of people who are song writers, who tell me, Well, a song a month isn't that hard to do. But I think if you commit to doing it for your entire life, it becomes a bit more of a project.

HD: Yeah, right now, for example, you've got January 2007 looming on the horizon. Do you have something in your back pocket ready to go for January, or are you thinking, Oh, god, I've got one more week ...

ZL: ... sometimes those deadlines loom. This particular month I have something ready that I just finished last night. Sometimes I'm a couple of months ahead of time. I think the latest I've gone is six days into the month. Because technically it has to be released at least sometime that month. But I try to do it on the first of the month if possible.

HD: So you say you just finished something last night?

ZL: I finished mixing it last night. I actually have the CD in my car. I was going to listen to it on the way home today to do what I call the 'car test', because you have to hear it on different speaker systems before you decide if it's appropriate. So far, I decided I like it on the headphones, but if it sounds okay in the car, that's usually a good sign.

HD: Currently, then, you've go a more sophisticated system than the old four-track?

ZL: Right. It's done on PC's now. I'm a PC guy, not a Mac guy, but that's not because I don't like the Mac software, it's just because that's what I happen to own. And with modern recording software, you can do unlimited numbers of tracks and all the effects you could possibly want. There's really almost no reason for your average high school band to go to a recording studio any more. Which is why, I think, so many recording studios are going under, except for the really high end ones.

HD: Yeah, there was actually a nice piece in the Ann Arbor News yesterday or the day before on Big Sky Recording. It's one of the local studios that's actually managing to not go under.

ZL: What's their secret?

HD: I don't know, I didn't read through the article in a lot of detail. But it seems like they offer a very down-to-earth and comfortable as-if-you're-in-somebody's-living-room type experience. I don't know. So would you say that every one of these songs is a jewel, or would you concede that some of them were, you know, just to satisfy the one-a-month requirement?

ZL: [laugh] Well, the Hard Taco Project really is about quantity rather than quality. I guess I would say that not all of them are jewels.

HD: Well, for example, like there was this one--I couldn't find the actual music to it, the MP3 file--but the lyrics to 'Don't Do that to My Heart'?

ZL: [laugh]

HD: It's just that one line over and over again. I thought, Hmm, I wonder if this was one where it was just tossed off as, Oh, okay, I gotta do something this month, this'll work.

ZL: That song didn't actually make it on as a monthly song. But it was recorded. Two or three albums ago, I released an album called Tender is the Heart, and it's supposed to sound particularly cheesy. I was accused of not writing enough love songs, so I decided that I would tack on at the end of this album ten or fifteen love songs that were all less than a minute long. Just kind of cram them into a small space. None of those were monthly songs, they were all just added to the album. 'Don't Do that to my Heart' was one of them.

HD: Alright. Well, speaking of love songs, I suppose you're familiar with the Stephin Merritt, Magnetic Fields project, 69 Love Songs, which was heralded as this monumental effort in terms of sheer quantity ...

ZL: ... sure. I'm a big fan of that.

HD: But it seems to me that a song a month until you die is an even more impressive statement that just setting out to write 69 love songs.

ZL: Well, it's not that hard right now. I imagine that if I get old and demented and disabled and lose and arm ...

HD: ... that might make it easier, you know, to be demented?

ZL: Good point. I could do the same song every month. But so far, I've managed to find time in my schedule. I went through internship and residency and was able to do this and those are both very busy times.

HD: So it's bound to get easier.

ZL: Yeah, and I now have a daughter who is almost two years old and she has been kind of a time suck, in a good way, ...

HD: ... so is she a critic?

ZL: No, she actually likes it a lot. When we're in the car, she'll say, Daddy, rock music! That means she wants me to put on the Hard Taco CD.

HD: Does she have particular favorites she's able to request at this point?

ZL: She likes the song that came out a couple of months ago, 'The March of the Elephant and the Bee'. She'll say, Elephant, Bee! and that means that's the one she likes. I don't think she knows the others by name.

HD: So there's a lot to these songs. It's not just you going and strumming on a guitar. It sounds like there's a whole herd of people involved. And I know for a fact that there's at least some other people involved, because you credit them. But seriously, it sounds like it requires the coordination of a tremendous number of other people than yourself. Or is that just the magic of editing?

ZL: It's a combination. There are definitely songs where I do everything myself or I do everything except the vocals, which my wife often does. But I've actually seen it as one of my goals in the last couple of years to try to recruit more people to get involved. Because a lot of the people I work with--doctors, medical students--a lot of them are musicians that don't have the opportunity to play their instruments or express themselves that way any more. And if I can get somebody to whip out their old trumpet that they used to be a virtuoso at, but who hasn't played in five years, I actually feel like I'm doing them a favor. And they're obviously doing me a great favor, because I can't play any of those instruments ...

HD: ... so what instruments do you play?

ZL: Guitar is my first instrument, just like everybody else and his dog. And I also play the bass, the keyboards, mandolin, accordion, penny whistle, and a little bit of banjo. Mostly string instruments. Most things that involve the mouth, I'm not very good at.

HD: So when you prepare something, say, for your wife to do backing vocals or even the lead vocals on, do you write out notes, or do you just sort of play it and say, This is sorta how it goes and here's the lyrics, now sing?

ZL: She's somebody who can just hear it and sing along. There have definitely been people who I've recorded with, who need to see it in note form, and that's usually people who are classically trained on a instrument. I did a couple of songs with one of my college roommates back when we were in school, who was this amazing piano player--just really a virtuoso, he would play with the college orchestra as the soloist. But when I asked him just to play like, this song goes G-chord, F-chord, C-chord, he couldn't do it. I actually had to sit there and manually write out the notes. So that was a pretty short-lived relationship. My knowledge of music theory allows me to do that, but it takes me twice as long as it would if that was my training.

HD: So it's called the Hard Taco Project, but I mean, you're not Hispanic.

ZL: [laugh] The Project part is only because hardtaco-dot-com was already taken. It was just supposed to be Hard Taco, but I had to add something else. I could either have been hardtaco-dot-net, or hardtaco-something else. But I wanted it to involve a hard taco.

HD: Because you like Mexican food?

ZL: Yeah! I do like the hard taco as a piece of food. Whenever I go to a Mexican restaurant, I always order crunchy tacos, and to me they seem to have sort of a metaphorical meaning, because they're not real Mexican food. I mean, they were invented by a Mexican. A Mexican man named Joe Valdez Caballero invented the hard taco ...

HD: ... now, is that real? Because I did some background research and found a reference to that saying he had died in 1989, but the reference was in The Onion, so you never know ...

ZL: [laugh]

HD: ... whether that's true or not.

ZL: It's all over the internet. If you Google his name that's what you come up with. I'm not surprised that you found that. But there's nothing else about him out there anywhere. I've actually tried to find out more information about him. They all say he died in 1989 at the age of 80 some years old and that he invented the hard taco shell. I'd like to find out more. If you know anybody who has the resources to research dead taco inventors ...

HD: In the December [Hard Taco] Digest you have this write up about this guy who robbed a Taco Bell, who apparently believes that he is the Messiah, the King of the Jews, Jesus Christ, etcetera. So I assume that the connection to the Hard Taco Project is just the Taco Bell part, right?

ZL: Actually that part was a coincidence. That was the icing on the cake. When I heard this story, and then I heard that this guy had actually robbed a Taco Bell, which was the reason he was in prison in the first place--there was already no contest that this was going to be the topic of the digest, but when I found that out, ...

HD: ... that just cinched the deal.

ZL: It really did.

HD: Well, then, maybe we could use that as a way of launching into a discussion of your day job--this guy who believes he's God. I think that maybe doctors are looked to as having god-like attributes by a lot of folks. Maybe some doctors have god-complexes--you're familiar with this famous speech by Alec Baldwin from the movie Malice, right?

ZL: I'm not sure.

HD: It's got to be one of the all-time great movie speeches, or soliloquies, well not actually a soliloquy, but anyway. It's a movie speech that ranks right up there, I think, with the Any Given Sunday halftime speech by Al Pacino, or the Kevin Costner speech from Bull Durham. I actually printed it off, so let me just lay it on you here.

ZL: Okay. Do we need to stop rocking here for a second so you can read?

HD: I've got it. So this is Alec Baldwin's character, who says: "I have an MD from Harvard. I am board-certified in cardio-thoracic medicine and trauma surgery. I've been awarded citations from seven different medical boards in New England, and I'm never ever sick at sea. So I ask you, when somebody goes into that chapel and they fall on their knees and they pray to God that their wife doesn't miscarry or their daughter doesn't bleed to death or that their mother doesn't suffer acute neural trauma from post-operative shock, who do you think they're praying to? Go ahead and read your Bible, Dennis, you go to your church and with any luck you might win the annual raffle, but if you're looking for God, he was in Operating Room Number Two on November 17th and He doesn't like to be second guessed. You ask me if I have a God-complex? Let me tell you something: I am God."

ZL: He must have been a surgeon.

HD: Yeah? So surgeons sort of have that kind of 'self-confidence'?

ZL: Well, that's the stereotype anyway. I think a lot of the sub-specialties have certain stereotypes that go with them. Surgeons are supposed to be the jerks and the family practice doctors are the touchy-feely ones.

HD: What are the neurologist like stereotypically?

ZL: Classically the neurologists are thought to be sort of the nerdy bookworm types with enormous glasses, who sit around and pontificate about disease rather than actually trying to help people. I think we're breaking down a lot of those stereotypes. I think there are definitely some people in the older generations that are like that, but ...

HD: ... but really these stereotypes that apply to various sub-specialties, like to surgeons, these are stereotypes that are surely not really known to the general public so much as to the medical community. So what's your sense of the general public's perception of the medical field? A lot of people, they get their impression of what doctors are like and develop their expectations from them, by watching medical dramas on TV. Do you watch any medical dramas yourself just as research?

ZL: [laugh] No, I don't. I've seen Scrubs a few times, and I think ...

HD: ... but is that just because the guy's name is also Zach?

ZL: Well, we do have a lot in common [laugh], probably the only thing we have in common. You know, I don't know. People, I think, have a certain respect for doctors in general, but there's a lot of mistrust of Western medicine. I'm always surprised how many people don't want to talk to their doctor about things that they're doing, because they think they're going to be judged. Particularly if they're using herbal remedies or seeing a chiropractor or an acupuncturist, a lot of times they'll keep that secret. It's really a large majority of our patients are actually doing things that are not considered to be a part of conventional Western medicine. And so that sometimes makes care difficult, because you're not getting the whole story. But obviously they have that impression, because in the past somebody has judged them for doing those things.

HD: So what is your day-to-day work like as a neurologist? You go to the hospital and do rounds, I guess? Or what?

ZL: I just got off of a stint on the hospital wards. I'm doing that in two-week blocks a few times year. But most of the rest of the year I don't see the hospital in-patients. I spend my time either doing clinics or doing EMG studies. My sub-specialty in neurology is neuro-muscular disease. And these EMG's are electric tests of the nerve and muscle to diagnose diseases of the peripheral nervous system--not the brain and the spinal cord ...

HD: ... so stuff out there in the arms and legs?

ZL: Exactly. And I probably spend about half my time either seeing patients in clinic or doing EMG's. And the rest of the time is sort of administrative and academic stuff, working on teaching, and research and those sorts of things.

HD: So the EMG, is that an actual machine?

ZL: The EMG is an actual machine. Now it's actually just a computer, but it's got wires hooked up to it that we can put skin electrodes over people's nerves and give them a little shock and measure how fast the nerve is conducting and how well it's conducting. And you take these thin little pins that are also hooked up to the machine and you can stick them into any muscle in the body and basically listen to it. It's like a microphone. Really it's actually a lot like music recording, because you get the big wave form up on the computer screen.

HD: So have you ever thought of just mixing together people's muscle wave forms and releasing a musical compilation?

ZL: [laugh] That's a good idea. Well, there's some diseases that are more musical than others. If you've ever heard of myotonic dystrophy, if you stick a needle into the muscle of someone with myotonic dystrophy, it makes this great revving motorcycle noise.

HD: Really?? So could you diagnose that just based on hearing that noise coming out of the machine?

ZL: Mm hmm.

HD: Well, that's pretty cool.

ZL: There are other diseases that can cause that same noise, but you get it down to a pretty narrow differential.

HD: So is that a disease of the nerves, or is that basically a symptom of something else that's expressed through poor nerve function and really caused by something else like diabetes, or?

ZL: That's actually a genetic disease that affects a whole lot of systems, and one of them is the muscle. So it's the abnormalities in the muscle itself that you're hearing.

HD: How often is it the case that you wind up diagnosing some other illness based on decreased nerve function? So where you'd see a patient, you get a referral as a neurologist and you look at it and say, Oh, well your real problem is you've got diabetes, buddy.

ZL: That happens all the time.

HD: Does it really??

ZL: One of the bread-and-butter diagnoses I see is peripheral neuropathy, which causes numbness and tingling in the hands and feet. We say that it's the most common disease that nobody's ever heard of, because a lot of people aren't familiar with that term. But it's very common. And diabetes is probably the number one cause of it worldwide. Actually, until about five years ago, the number one cause worldwide was leprosy. We don't see much of leprosy in the United States. But diabetes has been number one in the U.S. for a while and it's increasing in prevalence to the point where it has finally surpassed leprosy worldwide. So if we find this neuropathy, we'll often send people for a battery of tests to figure out why they have it. Oftentimes we find that people have diabetes or sort of a pre-diabetic condition.

HD: So besides the EMG, you use other gadgets? Like do you still have a little rubber hammer at all?

ZL: Absolutely! The reflex hammer is always in my pocket, always have it at my side. I have the Tromner reflex hammer, which is really the Cadillac of all reflex hammers. German-engineered. Costs like sixty dollars. Those little tomahawk-shaped ones with the little red triangle, those things are worthless.

HD: So yours is not tomahawk-shaped.

ZL: It's got a thin metal stem and a rubber ball on each end of the head, which is fat on one side and thin on the other side. It's just weighted appropriately, so you get a lot of leverage.

HD: So how long have you had this particular one?

ZL: I got it when I was a third-year resident, so I've only had it for a couple of years. I used to use what's called the Bobinski hammer, which has sort of a round disk stuck on top. And one of the attending neurologists that I was working with, she was rounding on consults with me and she kept borrowing my hammer, because she didn't carry one around with her. She got so sick of using this Bobinski hammer that she actually went out and bought me the Tromner, because I was too cheap to buy one for myself.

HD: I see. Okay, but she basically bought it for you just so she could borrow it.

ZL: Right.

HD: Actually before, what I was going to ask is if people have their own personal hammer and treat it the same way a baseball player might treat a favorite bat?

ZL: Well, everybody has their own. And some people actually prefer some of these different models. Several of the doctors I work with actually like the Bobinski style better than the Tromner style. So I guess we fall into different camps in that regard. But people do have an attachment to them. I got a mass email a couple of weeks ago, because somebody had misplaced their hammer and was worried that somebody else had taken it, or ...

HD: ... so is it really important that it be that specific hammer or is it just the make and model?

ZL: I think that some people do develop an attachment to their hammers, if they've had it for a long time. Mine has my name engraved on it.

HD: Wow. Like in the metal part?

ZL: Right, but that was part of what came with the gift.

HD: So does it say, 'Zach', or 'Dr. London', or what?

ZL: I actually don't remember. I think it may say 'Zachary London, M.D.'

HD: So is it possible to tweak the balance at all, to 'tune' the hammer in some sense? So that you could make it your own in that way?

ZL: I don't think so. Because the stem is attached to a very specific part of the head. Now, you can unscrew the ball off of one end, and I suppose that would affect the weight, but I don't think that would make that big of a difference in checking the reflexes.

HD: Do you keeps stats at all for your hammer, like, With this hammer I've diagnosed three peripheral whatevers, or seven of this other disease?

ZL: Somewhere there probably is a master record of what's been diagnosed with each hammer, but we prefer not to share that with the public! [laugh]

HD: Oh, okay. So how long does it take to get really good with the hammer?

ZL: It's not as easy as it looks. A lot of times, the medical students, they tend to choke up on it too much. They try to hit the reflex with the hammer head, instead of swinging it. It's really all in the wrist. It's kind of like throwing a Frisbee. You want to get as much leverage and spin as you can. Of course, you have to aim well, too.

HD: Is that something you can just practice on yourself, or something you have to recruit your roommate for? I guess for your knee, you could do yourself?

ZL: A lot of the reflexes, like up in the arm, instead of hitting directly onto the reflex, what we'll actually do is put a couple of fingers over the tendon. Helps you feel where the muscle tendon is, and it also helps sort of diffuse the pressure when you hit it, so you can't really do that on yourself. You can't hit your own fingers. Medical students are notorious for practicing on each other. For everything. Blood draws and checking reflexes and things like that.

HD: But with a hammer, can you really tell much of anything other than, Okay, that's not working! or Yep, that works! Or can you get more fine-grained?

ZL: Well, reflexes are relative. So for instance, if I hit my left knee and I get a certain reflex, it's either there, it's not there, or it's somewhere in between.

HD: Okay, so there's an in-between quality you can see.

ZL: Sure. Someone can have a normal reflex or they can be hyper-reflexive, meaning that it's too brisk, or it can be hypo-reflexive, meaning that it's not brisk enough, or it can be a-reflexive, which means it's not there at all. And really what's important is that you're comparing side to side. Because what's hypo- for me might be normal for you. If my left knee jerks a little bit, but when you hit my right knee, I fly off the teeter totter, then you know either there's one kind of problem on the right side, or ... Some diseases cause reflexes to be low and some diseases cause reflexes to be high. If they're asymmetric, you know that the high side is too high, or the low side is too low and you have to put it together with the rest of the physical exam to figure out how that's significant.

HD: How much time do you spend thinking about the fact that you're working within this very broad large context of our health care system? Are there aspects to that where you wish that, If only pharmaceutical companies would do business this way, instead of the way they do? Or, If only insurance companies would have a system for doing thus and such? Or do you basically just run your EMG machine, and hit with your hammer, and you're content to diagnose disease and just go about your own business?

ZL: I think that with regard to health care I'm largely apolitical, but with one exception. My personal crusade has to do with the way that pharmaceutical industry representatives interact with doctors, and specifically with the marketing tactics of the pharmaceutical industry.

HD: So they give you mugs with their logo on them?

ZL: Exactly. I'm a member of an organization called No Free Lunch, which essentially endorses physicians not accepting any free gifts from pharmaceutical representatives. And that's actually, I think, a fairly far-reaching problem. You asked me before what people think about doctors, and I think that the public probably doesn't even know how bad this problem is in general.

HD: And when you say 'this problem' you mean the relationship between marketing folks and physicians.

ZL: Right, how many doctors are on the take. It's not as bad as it used to be ...

HD: ... now when you say 'on the take' are you exaggerating for rhetorical effect, or are you just referring to accepting a coffee mug and then thinking, Hmmm, why don't I just prescribe Zoloft, because this coffee mug right here says, 'Zoloft'. I mean that doesn't really count as being 'on the take' in a criminal sense, right?

ZL: Right. And there is nothing criminal about this. I mean, it's all legal, and it's all typical marketing practices that happen in every other commercial field on the planet. But I think it's different with medicine, because patient care is on the line. So I think doctors have an obligation to behave differently than they would if it was just somebody buying a car or something like that. So yes, taking coffee mugs and getting free lunches, that's something that almost everybody does.

HD: I assume there's some schwag that's better than coffee mugs?

ZL: Basically, the better schwag is honoraria for giving talks and paid trips to conferences and things like that.

HD: So giving talks about how well all your patients are doing on their drug, or?

ZL: Supposedly that's not supposed to happen directly, but in reality, it does. A lot of times, what they'll do is they'll find a doctor who sort of does actually believe in their product and pay them to go around and talk about it. But research shows that doctors who accept gifts from drug companies are much more likely to prescribe those drugs, much more likely to request that they be added to their formulary. And that's just the research that we have. The drug companies probably have research that shows the same thing, even stronger, or else they wouldn't be doing it. Obviously, it works.

HD: So to what extent do these marketing campaigns targeted at patients, where they're encouraged to basically request the drug from their doctors, do they actually work? Do you see evidence of that strategy working in actual practice? Do you have patients coming to you saying, Do you think Ketamine might be right for me?

ZL: [laugh] I've had a lot of patients ask me if Ketamine is right for them, but not because they saw it on TV. No, that does happen all the time. One of the diseases that we treat, which is very common, is migraines. So I've had people come in and ask for migraine medicines like Relpax or Imitrex that they've seen on TV. And a lot of times, the drugs you're seeing advertised on TV fall into the category of what we call 'me-too' drugs, which means that they basically do the same thing as something else that's out there, and they're just a different company putting a different spin on it. They alter the molecule subtlely, so that it's essentially the same class of drug, but many of them are very similar in terms of what they do. So a lot of doctors don't really have an incentive to prescribe one over the other. And if a patient asks for one in particular ...

HD: ... then why not?

ZL: Yeah, why not. I think it's fairly sleazy, but on the other hand, the patients aren't the ones prescribing the drugs, the doctors are. So I think it's up to the doctors to make the most educated, unbiased decision, regardless of what the patient has been shown. If they're accepting gifts from drug reps, they might not be able to do that in an unbiased fashion.

HD: So basically the way you see it, there's nothing really ethically wrong with creating self-empowered patients who are asking for specific drugs, but the check on that should be doctors who approach that equation without a bias?

ZL: Well, a lot of the drug companies think that they're doing the public a favor by putting out these ads, because they're describing the symptoms of diseases that people might not even realize that they have. But, of course, if you look at the things that are advertised, they're basically drugs for common problems that rich people have, that are usually chronic problems that can't be cured. You don't see ads on TV for an anti-biotic, something that you just take for a week. You see ads for allergy medicines, and medicines for acid reflux, and anti-depressants and things that people will be on for the rest of their lives. And those are the drugs that people are spending all their advertising dollars on, because they can get some rich person to be on them for the rest of their life.

HD: So what would you envision as a better way of doing business? I mean, your part of the equation, I can understand is, that as a doctor, what I can do today is not accept that coffee mug or key chain or brand new car, whatever it might be they're dangling. But ultimately not every doctor is going to be like you. So what do you see as a healthier way of doing business for the pharmaceutical companies?

ZL: Well, it's hard to put the blame on the industry, because they are just that. I mean, they're trying to make money, they happen to be in the health care field. But you can't really blame them for wanting to sell more of their product. And you can't blame the patients for wanting to take an active role in their own health in asking about something they see on TV. So I really think that by and large it does fall on the doctors. And while you can't make somebody not-biased and you can't tell a doctor they can't be exposed to these influences--the University of Michigan, for instance, has taken a stance whereby the drug reps aren't allowed to come and talk to the residents or the medical students without being specifically invited. And that actually is fairly groundbreaking for a large institution. There's only a handful of other places in the country that have large academic programs that have taken as strong of a stance. I think this came down from the Dean, I'm not even sure how it happened.

HD: But it's just the medical students and residents they have to keep their hands off of?

ZL: Actually, they're not supposed to come into the building at all. This is a fairly new development. Two years ago, every single talk that we had, there would be some of these guys standing around in suits, and they were usually young good-looking men or women, who were very well dressed, and know how to talk the talk, really glad-handers. And they would be at every single one of our lectures and they would bring with them a great spread of whatever--Chinese food or some other catered thing, which is much better than the hospital cafeteria food--and they'd hand out articles--of course, articles that endorse their product, ...

HD: ... now when you say, 'articles', you mean?

ZL: Journal articles, studies. You know, every drug that's approved by the FDA has some studies that say it works. They don't hand out the ones that say it's not as good as something else.

HD: Understood. So is there anything that equates to this marketing strategy that happens just, say, in a bar, where you have some guy who's paid to go in and ask for some particular beer and to really talk it up? Or it wouldn't have to be a beer or a product associated with a bar. You know, this sort of stealth marketing, where it's just some guy who says, Oh, you're a doctor, well, I'm a doctor, too, and you know what I find really works for my patients is ...

ZL: ... that's a great idea. Or you could hire a patient to run around in the clinic waiting room and say, Gosh that Neurontin has worked so great for my epilepsy! I've been seizure-free for months, you guys should all talk to your doctors about this!

HD: Well, listen, is there anything else on your mind this fine, um, well, gloomy morning.

ZL: I don't think so. It's sort of a white Christmas, if you're counting the sky. Nothing else on my mind. I don't want to keep you from your holiday duties, whatever those might be.

HD: Yeah, I'm not sure if I have any.

ZL: Well, then I don't want to keep you from thinking about what they should be.

HD: Maybe I'll put on a Christmas CD later in the afternoon. Do you have any Christmas songs in the Hard Taco Project collection? I would guess not.

ZL: I haven't done a Christmas song yet. Because I'm Jewish. But I have been very interested in doing a Christian rock song. And I've done things that have been sort of theological. I'm afraid if I did a Christian rock song, it would be viewed as ...

HD: ... as just making fun?

ZL: Well, yes. because it probably would be.

HD: [laugh]

ZL: Which is why I haven't gone to the trouble of recording it yet.

HD: Well, listen thanks for coming over!

ZL: Thanks for having me. It's been fun!