Monthly Archives: November 2012

Inspirational – Morten Lauridsen’s Lux Aeterna

Morten Lauridsen’s amazingly beautiful Lux Aeterna. I first heard this choral music in a cathedral in Florence, and am thrilled to be singing it this weekend with The Collegiate Singers here in New York.

I’ve been singing The Lux for 5 days straight now and I swear, such a sense of incredible peace has invaded me. The only thing I can think is that it is this music – it is so calming, yet lush and expansive. (Thanks Elena for those adjectives…)

You can hear the entire piece on You Tube (there are three parts).

Remove Restrictions on Emergency Contraception

The Reproductive Health Technologies Project is sponsoring a petition to remove the current restrictions on emergency contraception and allow it to be placed on pharmacy shelves next to the condoms.

In December of 2011, the FDA was prepared to make emergency contraception accessible to consumers without restriction, based on more than a decade of medical research and policy debates. Instead, HHS Secretary Kathleen Sebelius overruled the FDA, putting politics ahead of women’s health. Her decision created unnecessary confusion for women and couples at a moment when clarity and timing matter most.

Despite Secretary Sebelius’ December 2011 decision, no evidence suggests that making emergency contraception accessible leads to risky behavior among teens. What it does do is give teens a second chance to prevent and unintended pregnancy so they can stay in school…

Emergency contraception is a safe, effective back-up method of birth control that can prevent pregnancy after unprotected sex or contraceptive failure. A woman is healthiest when she can decide the timing and spacing of her pregnancies. Let’s ensure that any woman who needs EC can get it safely and quickly.

Both the American College of Ob-Gyn and the American Academy of Pediatrics have released opinions supporting over the counter EC Access.

And as I’ve written before, emergency contraception is safer than Tylenol.

‘nuf said. Go sign the petition. (I did)

Understanding Mammogram Over-Diagnosis

This video from H. Gilbert Welsh, the author of the recent controversial NEJM paper on mammogram screening, should be required viewing for every woman and her doctor. (HT to Gary Schwitzer for bringing it to my attention.)

 

Bottom line – three decades of mammogram screening has had only a modest impact on the incidence of late stage breast cancer, and leads to over-diagnosis and over-treatment of early stage cancers in return. Declines in mortality are modest, and can be attributed in large part to advances in breast cancer treatment.

Overall, mammograms are thought to lower breast cancer mortality by about 15-20%. Which ain’t nothing. But it’s a lot less than most people think.

If you want to see what a highly effective cancer screening intervention looks like –

Let’s look at pap smears and cervical cancer screening – in this case in the UK, where a nationwide cervical cancer screening program was introduced in the late 80’s. Note the dramatic decline in the incidence of cervical cancer resulting from screening and subsequent treatment of pre-cancerous lesions-

With a concomittent large decline in cancer mortality that has not been disputed (note how the angle of the decline drops significantly in the late 80’s when screening is introduced) .

What is not shown in these graphs is the sharp increase in precancerous cervical disease that went along with the decline in invasive cancer and later stage disease – exactly what you’d expect from a highly effective cancer screening intervention. Pap smear screening works because cervical cancer has a relatively long precancerous phase during which screening and treatment can be done to prevent progression to cancer. (Colon cancer screening works the same way).

Mammograms are just not working as well as pap smears and colon cancer screening works. Either they don’t find the treatable early or pre-cancerous lesion in enough cases to make the kind of impact we were expecting, or more likely, not all so-called “early” breast cancers are destined to progress or cause death if diagnosed later or left untreated. This is supported by the fact that increases in the diagnosis and treatment of DCIS (Ductal carcinoma in situ) has not led to much of a decline in later stage breast cancers in the same way that treating cervical carcinoma in situ prevents invasive cervical cancer and cervical cancer deaths.

We are beginning to think that there are different types of breast cancers – those that are slower growing and less likely to metastasize and kill, and those that are aggressive from the get-go. Screening tends to pick up the former (hence the term “over-diagnosis”) and miss the latter, since they grow and spread so quickly.

This does NOT mean that no woman should get a screening mammogram.

It is saying that we need to have a more realistic understanding of what mammograms can and can’t do, and supports the recommendation that we make make decisions about mammogram screening that are based on that reality.

It also will hopefully help to dispel the prevailing myth that if every woman just got a mammogram every year, there would be no deaths from breast cancer.  Sadly, that is just not true.  Mammograms do prevent some deaths from breast cancer.  But not all of them. And the price we pay for preventing the deaths we do prevent is over-diagnosis and over-treatment of some women who may never have died from their cancer in the first place.

The problem, of course, is that at  present we have no way of knowing which women we are over-treating and which women we are saving.

Until we can do so, we must and will continue to offer screening mammograms.

When to start that screening, and how often to have it, is the question each woman must ask and decide with her doctor.  Hopefully, videos such as this one will help in making those screening decisions informed and reality-based.
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Recommended Reads

Tarragon-Cream Turkey Pot Pie

I awoke late today, feeling a bit melancholy. Eldest daughter left very early to go back to school, younger daughter is heading off with a friend to a museum, and the hubbub of the Thanksgiving holiday is over. As one who thrives on hubbub, I am a bit thrown by the quiet.  Although I had been counting on this free day to get quite a few things done, I find myself uninterested in doing anything, and since it is too cold for a bike ride, I instead waste the morning in front of the computer, allegedly handling email but in reality accomplishing nothing.

My husband, the math teacher, appears unfazed and is preparing math contest problems for his class. He brings a particular difficult one to me for help in solving, and though I remember little about geometry I do find his error – a simple math mistake. I decide that he too must be having trouble today as our little family once again rearranges itself from a quadrilateral to a triangle.

This realization reassures me somehow, and I am jolted back into activity. In short order, I shower, make the bed, eat breakfast, finish last week’s open encounters and lab result reviews online, write a few checks and finish a few odds and ends I’d been putting off doing. I then head out for a much needed mani-pedi, during which I start on my book club’s monthly selection (Age of Miracles, OMG you have to read it) and then come home to tackle dinner, which of course means the turkey leftovers.

Inspired by this recipe from Ina Garten, and remembering this delicious preparation for chicken breasts, I decide to make a pot pie using plenty of tarragon. This will also allow me to finish up that herb’s harvest before frost takes what’s left. (It did not survive last winter…)

Unfortunately, my younger daughter arrives home too hungry to wait for me to make the pies, so instead we compromise and serve half the filling over penne tonight (delicious), with the rest in small individual pies that cook while we eat dinner.  They finish baking just as we finish the dishes, and they are gorgeous. We’ll serve them tomorrow night, but of course I take a small taste – yep, this recipe is a keeper.

And so was this day.

Tarragon-Cream Turkey Pot Pie

The tarragon gives a light feel to what could otherwise be a heavy dish. (Much the same way adding lemon can lighten a dish). I made individual pies, but you can make one large pie if you prefer. If you don’t have time for a pie, make the filling and toss it with some penne pasta (pass the Parmesan when serving it).

  • 1 double recipe Pate Brisee
  • 2 tbsp butter
  • 1 tbsp olive oil
  • 3 large leeks, rinsed and into large dice
  • 3 large stalks celery, cut into large dice
  • 3 large carrots, peeled and cut into large dice
  • 10 ounces Crimini mushrooms,stemmed and cut into quarters
  • 2 cloves garlic, minced
  • 3-4 tbsp chopped fresh tarragon leaves
  • 1 tbsp fresh thyme leaves
  • 4-5 cups leftover turkey, shredded or cut into bite size pieces
  • 1 cup chicken broth
  • 1 cup cream or half and half
  • 1/2 cup white wine
  • salt and pepper to taste
  • Beurre manie  -1 tbsp flour mixed with 1 tbsp soft butter in a small bowl (optional)
  • Egg wash – 1 egg whisked with 1 tsp water

Prepare pastry and roll out half to line individual tart pans. Preheat oven to 375 degrees fahrenheit.

Heat olive oil and butter is a large skillet. Saute leeks, celery and carrots till they start to soften. Add mushrooms and cook till they just give off their liquid Add garlic and saute another minute. Add turkey, tarragon, thyme, chicken broth, cream and wine and heat to boiling, then turn down heat to low and thicken with flour-butter mixture (if necessary). Cool slightly and pour into tart pans. Roll out top pastry and cover tarts, crimping the edges to close the pastry. Cut three small slites in the top of each tart. Brush with an egg wash. Place on baking sheet and bake for 45-50 minutes, till crust is brown and sauce is bubbling.

Makes 8 individual or one large pie.

 

Of Haircuts and Vaginas

So I’m at my friend Wendy’s salon in Philadelphia today, getting one of the wonderful haircuts that only she can give me (plus color and eyebrow and upper lip waxing), on a day that she came in special because I was in from New York, even though the salon was closed, when she tells me she’s really worried about a little something she felt on the outside “down there”.

The thing about hair salons? They have plenty of gloves.

So we traipse down to the basement, and armed with my IPhone flashlight, amidst the boxes of product and with Wendy propped up on a stepping stool, I take a look and render my diagnosis – basically, nothing to worry about.

Wendy is exceedingly grateful and I’m happy to have been able to do her a favor in return for her coming in on her day off to cut my hair.

Later, as I hand her a credit card to pay the bill, Wendy says “Aren’t you even going to look at what I charged you?” and I’m thinking “Honey, you can charge me anything you want for this haircut – I absolutely love it!” but I take a look at the bill and holy cow! she’s practically given the whole thing away. I look at her, shocked.

Wendy smiles and says  – “I gave you the vagina discount.”

I love my job.

And my friend Wendy.

Candied Sweet Potatoes

Just a quick post to share this wonderful family Thanksgiving favorite.

And to remind myself not to let the fabulous food distract from what this day is really about – giving thanks.

It’s hard to do sometimes, when those we love are taken from us, when the forces of nature (and man) lead to death and destruction, and when it seems that the insanity of war will never end.

And yet here I sit, with the sun shining down on me from a clear indigo sky, in a home that has heat, electricity, water and plenty to eat, in the city I love more than any place else on this earth, surrounded by my husband and children, preparing to travel to the city in which I was born to share not one, but two delicious meals with my brothers and sisters, nieces and nephews, father and in laws.

What else can I be but grateful?

Candied Sweet Potatoes

Modified from a recipe in Gourmet, Nov 1991. I double this recipe that serves 8. Although I cut the potatoes crosswise, lengthwise, as described below, is better for the shape of the pan.

3 pounds sweet potatoes, peeled
3/4 cup firmly packed light brown sugar
2 tablespoons water
3 tablespoons unsalted butter, cut into pieces
1 teaspoon salt
1/2 tsp freshly ground pepper (optional)

Peel the potatoes. Cut them lengthwise in half. Place cut side down on counter and cut lengthwise into 1/2 inch slices.

In a steamer set over boiling water (I use a pasta inset w/ my 8 quart calphalon boiler) steam the potatoes, covered, for 10 to 15 minutes, or until they are just tender. Let them cool, uncovered. Arrange the potato slices in one layer, overlapping them slightly, in a buttered shallow baking dish. Combine the remaining ingredients in a small pot and bring the mixture to a boil and cook it over moderate heat for 5 minutes, stirring while cooking. Drizzle the syrup evenly over the potatoes, and bake the potatoes in the middle of a preheated 350°F. oven, basting them with the syrup mixture every 15 minutes, for 1 1/2 hours, or until the syrup is thickened and the sweet potatoes have deepened in color.

May be made 1 day in advance, kept covered and chilled, and reheated.

Cranberry Apple Pie – Doing Double Duty at Thanksgiving

Once again, since neither I nor my husband has ever been willing to give up Thanksgiving dinner with our respective families, we are gearing up for our annual schizophrenic Philadelphia holiday celebration, in which we join my family for an early afternoon dinner, followed by another meal at my in-law Irene’s home  later that evening.

Like us, this particular dessert will be found  at both family’s celebrations this year. It is a true harvest pie, with apples, cranberries, raisins and nuts,and quite delicious. Irene makes it every year for her dinner. I made it once a few years back for my sister’s dinner, and she requested I bring it again this year.

SInce we save dessert for the evening meal, I won’t get to taste the one I made. That’s okay – I’ll just eat a piece of Irene’s instead.

Happy Thanksgiving!

Cranberry Apple Pie

This recipe hails from the November 1985 issue of Gourmet Magazine. Irene modified it by reducing the sugar.
  • 5 cups thin apple slices (Red delicious or other )
  • 1/2 cup golden raisins
  • 1/2 cup fresh cranberries
  • 1/2 cup chopped pecans
  • 1 tsp cinammon
  • 2 tbsp corn starch
  • 1/2 cup granulated sugar
  • 2 Pate Brisee pie crust recipes (top and bottom) – see below 
  • 3 tbsp butter, cut into small pieces
  • Egg wash – 1 egg + 1 tbsp cold water
  • 1 tbsp sugar

Combine first 7 ingredients in a large bowl. Roll out bottom crust and line an 11 inch deep dish pie or tart pan. Pour apple/cranberry/nut mixture into pan. Dot with butter pieces. Roll out the top crust and place atop the filled pie, sealing and crimping the edges. Cut 5 slits in a circular pattern around the middle. whisk egg and water together in a small bowl.Brush egg wash onto crust and sprinkle with 1 tbsp sugar.

Bake atop a baking sheet on the middle rack of preheated oven at 400 degrees fahrenheit for 20 minutes, then lower heat to 350 and bake another 50 minutes or until the juices start to bubble. Remove from oven and cool.

Can be made ahead and frozen. On Thanksgiving morning, remove pie from freezer and let thaw at room temp. Pop into a 350 degree oven to warm if you like.

Pate Brisee Pie Crust made with shortening and butter

This recipe makes one crust. For this pie, you will need to make this recipe twice for both a top and bottom crust . Alternatively, if your food processor bowl is large enough, you can simply  double the recipe and make it in one batch, then splitting the dough into two crusts.

If you want a butter-only Pate Brisee that is even easier to work with than this one, try this recipe instead.

  • 1 1/4 cups flour
  • 1/4 tsp salt
  • 3/4 stick cold butter, cut into equal size 1 inch pieces
  • 2 tbsp Crisco
  • 3 tbsp ice water

Pulse flour and salt once in food processor. Add butter and pulse till consistency of corn meal, about 15 secs. Add water through feed tube and pulse till dough comes together, about 10 secs. Remove dough from bowl, pat into a round and press flat. Wrap with plastic wrap and keep cold in fridge till ready to roll.

When the Pope Plays Doctor, Women Die

A pregnant woman presents to an Irish hospital with ruptured membranes and cervical dilation at 17 weeks of pregnancy.

This is called an inevitable abortion.

When the mother begins to develop fever and abdominal pain, infection has set in.  The treatment – antibiotics and delivery of the baby, no matter what the gestational age or viability of the fetus. Delaying delivery risks maternal sepsis and death.

There is no debate about how to manage this clinical situation.  There are clear standards. Even in Ireland.

In current obstetrical practice, rare complications can arise where therapeutic intervention (including termination of a pregnancy) is required at a stage when, due to extreme immaturity of the baby, there may be little or no hope of the baby surviving. In these exceptional circumstances, it may be necessary to intervene to terminate the pregnancy to protect the life of the mother, (italics mine) while making every effort to preserve the life of the baby.

(HT to @scanman for finding these Irish regulations.)

An yet, for some unknown, god-awful reason, doctors responsible for the care of Savita Halappanavar decided that in their “Catholic” country, they were required to wait until the fetal heartbeat had stopped before terminating her non-viable, life-threatening pregnancy.

“Savita was really in agony. She was very upset, but she accepted she was losing the baby. When the consultant came on the ward rounds on Monday morning Savita asked if they could not save the baby could they induce to end the pregnancy. The consultant said, ‘As long as there is a foetal heartbeat we can’t do anything’.

“Again on Tuesday morning, the ward rounds and the same discussion. The consultant said it was the law, that this is a Catholic country. Savita [a Hindu] said: ‘I am neither Irish nor Catholic’ but they said there was nothing they could do.

“That evening she developed shakes and shivering and she was vomiting. She went to use the toilet and she collapsed. There were big alarms and a doctor took bloods and started her on antibiotics.

“The next morning I said she was so sick and asked again that they just end it, but they said they couldn’t.”

At lunchtime the foetal heart had stopped and Ms Halappanavar was brought to theatre to have the womb contents removed. “When she came out she was talking okay but she was very sick. That’s the last time I spoke to her.”

At 11 pm he got a call from the hospital. “They said they were shifting her to intensive care. Her heart and pulse were low, her temperature was high. She was sedated and critical but stable. She stayed stable on Friday but by 7pm on Saturday they said her heart, kidneys and liver weren’t functioning. She was critically ill. That night, we lost her.”

Mr Halappanavar took his wife’s body home on Thursday, November 1st, where she was cremated and laid to rest on November 3rd.

What Savita’s husband is describing is medical malpractice, pure and simple, committed by doctors practicing medicine according to the standards of the Pope rather than the profession to which they belong and the country in which they are licensed to practice.

It is tragedy and an abomination.

Were these doctors practicing out of fear and ignorance of the laws, or out of their own religious beliefs?  Did they think they had no legal recourse but to ignore clear medical standards, or did they deliberately ignore them?

We will need to await the results of the investigation into this tragic case to learn the answers to these questions, but one thing is clear.

When the Pope plays doctor, women die.

My First Curry

I think I’ve just found a new weekly dinner staple for this family.

Curry.

Fast, delicious, comforting and spicy. Adaptable to almost anything you’ve got in your larder without a trip to the store. In this case, we always have a bag of shrimp and a box of peas in the freezer, a few onions and carrots in the drawer and a can of tomatoes on the shelf. (A potato or yam would not have been out of place added to this mix…) And while the coconut milk is delicious, it’s not essential to a great curry.

I do realize that I will have to start keeping cilantro around more routinely. I think I’ll add it to my herb garden in the spring.

Shrimp Coconut Curry

This is not an authentic Indian curry recipe. It started out as this recipe, but I forgot to use the open can of coconut milk in the rice, so I decided to add it to the curry instead. I also added garlic and a few more spices –  it just seemed like the right thing to do.

What I ended up with was not far from authentic. This curry is similar to those originating in the Kerala region of India. It’s pretty mild as curries go, and not bad for my first try at this genre of meals.

Coincidentally, a patient today dropped off a big bag of spices she brought back from the Kerala region of India, so be prepared for even more authentic curries to come.

Ingredients

  • 2 tbsp canola oil
  • 1 lb shrimp, peeled and deveined
  • Salt and pepper
  • 1 large sweet onion, diced
  • 2 medium carrots, diced
  • 3 large cloves garlic, minced
  • 1 large fresh tomato, diced (or a 14 oz can of diced tomatoes)
  • 1 cup frozen peas
  • 1 1/2 tbsp curry powder
  • 1 tbsp coarse grain mustard (or mustard seeds if you have them)
  • 1/2 tsp ground cinnamon
  • 1/2 tsp ground ginger (better yet, use fresh ginger if you have it)
  • 1/2 tsp turmeric
  • 1/2 tsp cumin
  • 1/8 tsp ground red pepper
  • 1 can coconut milk
  • Chopped cilantro for garnish
  • Cooked basmati rice

Directions

Start your rice cooking.

Toss shrimp with some salt and pepper. Heat 1 tbsp oil in a Dutch oven over medium-high heat. Add shrimp to pan; cook 2 minutes until just pink. Remove from pan.

Heat remaning tbsp oil in the pan. Add onion and cook 2 minutes, stirring constantly. Add garlic and cook another minute. Add spices and cook one more minute, stirring constantly. Add coconut milk, peas, carrots and tomatoes – bring to a boil. Cover and reduce heat to medium-low; simmer till carrots are soft, about 5-10 mins. Return shrimp to pan to heat for a minute.

Serve immediately over rice with cilantro garnish.

Chili – A Spicy Meal for A Bittersweet Season’s End

It’s always bittersweet, closing our Endless Mountain cottage for the season. We don’t get there enough even in season as far as I’m concerned, so this quick hello and goodbye is almost painful.

Our busy schedule in the city means we do not arrive till after dark on Saturday. Only one other house in our little enclave has lights on, and it feels strange and deserted – so different from summer.

The season is farther along here on the mountain – The trees are already bare and the back porch is awash in 3 inches of leaves. We can see our breath even in the house, and the olive oil on the kitchen shelf is thick and cloudy. Fortunately, the water is still flowing freely through the pipes. We start a roaring fire in the fireplace and set to work making a pot of chili for dinner.

A few minutes after Mr TBTAM heads off down the mountain for a few last minute ingredients, the power goes off, leaving me in darkness. I manage to quickly reset the circuit breakers in the electric panel on the front porch and then, feeling a bit unsettled, call my older brother Al on FaceTime to keep me company while I cook until Mr TBTAM returns. This was probably not a good idea, because every few minutes Al interrupts the conversation to ask me “What’s that face at your kitchen window?” (Big brothers never change…)

Finally Mr TBTAM returns. We forgo the frigid dining room and eat our chili from bowls while sitting together on the love seat that we have pulled over in front of the fireplace. It’s too cold to move much farther from the fire, so we just spend the rest of the evening on the love seat, reading. A few more electrical resets later (the blower attachment on the fireplace insert was the culprit) the baseboard heaters are finally cranking up and we retire, gratefully, to a warm bedroom.

Sunday dawns bright and unseasonably warm, and we set to work. I strip the beds, wipe down the bathrooms, empty the fridge and kitchen cabinets, scrub down and unplug the fridge, and sweep the kitchen floor. Having seen a few droppings on the kitchen shelf that morning, I decide to set a few mousetraps for our seasonal guests. Mr TBTAM runs the laundry and rakes the yard – an enormous job that takes him all morning. Then our neighbor offers me his leaf blower and I do the back deck and patio – a job that usually takes an entire afternoon –  in 30 minutes! We stop midway through our labors for another bowl of chili – this time sitting on the porch in the warm sun admiring the fruits of our labors. After that, we bring the porch furniture and bikes into the house, make one final sweep and get into the car for the long ride home.

Another season in the Endless Mountains has come to a close. Every year I fantasize about winterizing the place, but seeing (and feeling) the place so deserted has convinced me that I prefer to leave it as it is  – my little Brigadoon, disappearing in late fall and reappearing in Spring.

Basic Chili

While there are a lot more complex recipes out there, ours is a very basic chili. The recipe below is heavier on the meat than the beans, but we vary it.  You can substitute a 12 oz can of tomato sauce for the tomato paste and water. Add a second can of beans if you want to stretch it for a larger crowd.  Serve over rice to stretch it even more, and add a side salad for a complete meal. I’ve fallen in love with sheep’s milk yogurt and no longer use sour cream to top mine.

Ingredients

  • 1 tbsp olive oil
  • 1 large onion, medium dice
  • 1 large green pepper, medium dice
  • 2 cloves garlic, minced
  • 1 to 1 1/2 lb lean ground beef
  • 1-28 oz can whole tomatoes
  • 1 small can tomato paste +1  cup water, beef broth or beer
  • 1-15 oz can red kidney beans, rinsed
  • 2-4 tsp Chili powder to taste (some brands are spicier than others)
  • 1 tsp paprika
  • 1 tsp cumin (optional)
  • Kosher salt and fresh ground black pepper to taste
  • 1/2 cup sheep’s milk yogurt or sour cream
  • 1 cup shredded cheddar cheese

Cooking Directions

Heat oil in large pot and saute onions and peppers till soft (about 5 mins). Add garlic and saute another minute. Add ground beef and saute, breaking it up with a wooden spoon,  till no longer pink. Add remainder of ingredients and cook for 30 minutes over medium-low heat. Serve hot in bowls with with cheddar cheese and sour cream or yogurt topping.

You Grew On Me…

like a tumor. Tim Minchin on that malignant kind of love.

I’ve left it too late to risk an operation
There’s no chance at all of a clean amputation
The successful removal of you
Would probably kill me too

Brilliant as usual.

Report from Red Hook – Hard Hit by Sandy

Red Hook after Sandy – Image from redhookrevcovers.org

This report from my friend Jenny, who took off work yesterday to volunteer in Red Hook, a waterfront area in Brooklyn that was hit hard by Sandy.

I am very pleased I went. I was working with a community center and adjacent church to service the Red Hook Homes (Houses?) a vast public housing complex (7000 residents according to Wikipedia). Some of the complex hasn’t had heat or power for 10 days, and the parts with electricity didn’t have heat in some cases. The church and center were serving breakfast, lunch and dinner to the ambulatory, as well as giving out food and blankets and some other things. They had electric radiators, but the public housing authority (or Con Edison) told them not to give them out, because they would crash the grid for those with power. The demand for all this, including the heating of the center, appeared to be huge.

I helped set up for breakfast, then went out to deliver food with a partner to list of people who can’t get out because they can’t negotiate the stairs with the elevators out. The wisdom of the recommendation of having male-female pairs of volunteers quickly became evident – the male is useful given the probably high level of crime, and the female is useful to persuade people to open their door. There was quite a difference between the lighted and unlighted buildings – in the latter, some parts were in complete darkness even during the day (we had flashlights), and people were reluctant to open their doors. When they did though, they were so grateful for the ready-to-eat meals we had. Many of the buildings stank – the trash chutes are not being emptied. For this reason, some residents had windows open despite not having heat. Lots of the people I delivered to didn’t look very old for the state of their health. Generally, whether at home or in the center and church, people were miserable.

After finishing the list after a few hours, my time started to be used less efficiently and more volunteers showed up, so I decided to go home.

Jenny

If you want to volunteer in Red Hook, as Jenny has, you can contact the Red Hook Initiative (info@rhicenter.org) or NYC council  SRelief@council.nyc.gov).

You can also find opportunities at redhook.recovers.org, a website that links those in need in Red Hook with those who can help.  This site is part of a wider effort started by sisters Caitria and Morgan O’Neill, who have created a website in a box (Recovers.org) that communities can use to organize in times of disaster. Other NYC neighborhoods using recovers.org are Astoria, The Lower East Side and Staten Island.

Caitria and Morgan are trying to spread the word so that municipalities actually set up and learn how to run a recovery in advance of trouble, as part of the infrastructure for emergency preparedness. Thanks to TED.org for spreading the word about this amazing effort.

TBTAM Earns HON Certification

If you find yourself wondering if the medical information you’re finding on the web is trustworthy and reliable, look for the Health on the net (HON) certification. HON is a non-profit group based in Geneva, and is one of the first sites designed to guide both patients and doctors to reliable health information on the web.

HON-certified sites undergo a rigorous review to assure they meet the 8 standards set by HON for trustworthy medical information.

1. Authoritative: Any medical or health advice provided and hosted on this site will only be given by medically trained and qualified professionals unless a clear statement is made that a piece of advice offered is from a non-medically qualified individual or organisation.

2. Complementarity: The information provided on this site is designed to support, not replace, the relationship that exists between a patient/site visitor and his/her existing physician.

3. Privacy; Confidentiality of data relating to individual patients and visitors to a medical/health Web site, including their identity, is respected by this Web site. The Web site owners undertake to honour or exceed the legal requirements of medical/health information privacy that apply in the country and state where the Web site and mirror sites are located.

4. Attribution: Where appropriate, information contained on this site will be supported by clear references to source data and, where possible, have specific HTML links to that data. The date when a clinical page was last modified will be clearly displayed (e.g. at the bottom of the page).

5. Justifiability: Any claims relating to the benefits/performance of a specific treatment, commercial product or service will be supported by appropriate, balanced evidence in the manner outlined above in Principle 4.

6. Transparency: The designers of this Web site will seek to provide information in the clearest possible manner and provide contact addresses for visitors that seek further information or support. The Webmaster will display his/her E-mail address clearly throughout the Web site.

7. Financial disclosure : support for this Web site will be clearly identified, including the identities of commercial and non-commercial organisations that have contributed funding, services or material for the site.

8. Advertising policy: If advertising is a source of funding it will be clearly stated. A brief description of the advertising policy adopted by the Web site owners will be displayed on the site. Advertising and other promotional material will be presented to viewers in a manner and context that facilitates differentiation between it and the original material created by the institution operating the site.

I’m proud to display my HON certificate in my sidebar, and encourage you to look for it in the sites you visit for medical information. But be careful – A lot of quackery sites may simply use the HON image and falsely claim they meet the standards. That’s why HON certificate displayed should always includes a verification link back to HON. And there are a lot of great sites out there that have not applied for HON, so its absence is not necessarily a bad thing.

I must admit that I am a bit disappointed to see that HON has certified Drugwatch.com – an ambulance chasing site put up by a bunch of lawyers looking to find clients to sue Pharma. Drugwatch shows up on the front page of almost any search for the drugs for which they are searching for litigants – Yaz, Accutane and the SSRI’s are frequent targets. I wish HON would take another look at that certification.

How to Use HON to Limit Internet Searches to Trustworthy Sites

Google is getting much, much better at preferentially displaying quality info sites at the top of medical searches, and distinguishing ads from real content. They came up with some great finds on the first page of searches I did for major terms such as HPV, herpes and Menopause.  But if you have concerns about what you are seeing in a search, you can use the HON tools to focus your results within HOn certified sites – and without ads.

HON Plugin – If you find yourself spending a lot of time separating the real info from the crap when it comes to medical info on the web, consider downloading the HON Plugin so your search results will display the HON certificate right in your search results.

HON Site Search – If you don’t want to use the toolbar, you can search directly from the HON site

HON Select – You can also use HON Select to conduct searches for medical information from MeSH® terms, authoritative scientific articles, healthcare news, Web sites and multimedia – all in one search.

Try a HON search for yourself and see what you get

Search only trustworthy HONcode health websites:

Hurricane Sandy Relief – Time to Pay it Forward

If, like me, you are feeling blessed and grateful that you made it through the storm last week unscathed, here are just a few websites to find opportunities to volunteer your time and resources to help those less who were less fortunate.

Add additional volunteer opportunities in the comments section. And pass it on.