Matt Moore’s iconographic representation of the digital habits of the wired physician, drawn for Wired Magazine’s App Guide.
… I was hired by Wired to illustrate 20 visual narratives for this special issue focusing on smart phone and tablet apps, and the people who use them… Hopefully my abstracted icon narratives get your imagination wandering in the right direction.
I like it.
A well-written and balanced article on mammography from USA Today may help move the conversation about this screening test away from hype and a bit closer to reality. The title – “Mammogram is ‘terribly imperfect’, though recommended.”
For women in their 40s, mammograms reduce the risk of dying from breast cancer by about 15%… But mammograms miss some cancers and raise false alarms about others, causing women to go through unnecessary follow-up tests… “We’re saying, ‘Mammography is a terribly imperfect test, but we’re recommending women get it,'” Brawley says. “The task force was saying, ‘Mammography is a terribly imperfect test, and women have to make a decision about whether to get it in their 40s.'”
I encourage all women to read and share this article.
What I love about the article is how clearly written, non-inflammatory and concise it is, proving that the mainstream media can get it right when it comes to health information. The article also includes a fabulous summary graph that is simple to interpret and very clearly conveys just what it is mammograms can and cannot do when it comes to preventing deaths from breast cancer.
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More reading on mammograms from TBTAM and elsewhere
Kudos and a huge thanks to Melissa Clark at the NY times for this wonderful recipe, now in the running to replace Mr TBTAM’s signature recipe as our family classic clam sauce. (I now realize I have never posted Mt TBTAM’s clam sauce recipe, but promise to do so – I actually have a video of him making it.)
This meal was one of several that came from a Saturday morning bike trip to the Union Square Farmer’s Market (I’ll post that too), where we found gorgeous cherry tomatoes and fresh garlic. The herbs came from our own container garden. Gradually, we’re shifting away from stocking the fridge at the supermarket to getting fresh things at the farmers market when we can, and tailoring our week’s dinners around that. It makes for a more empty fridge throughout the week as we work our way through what’s there while it’s still fresh. I like it.
Linguine with Littleneck Clams, Roasted Tomatoes and Garlic
The recipe I’m posting here is Melissa’s recipe with a few modifications – Mr TBTAM doctored it up at his mother Irene’s suggestion, she having made it herself the week before. Their changes were to add a can of clams (to get more clam-flavored broth), increase the garlic from 14 to 20 cloves (it’s roasted, so don’t worry, it’s not too much) and adding fresh basil and parsley instead of mint.
You may want to make the original recipe instead of our version. Either way, be sure to read and the accompanying article explaining the traditional Italian method of saucing pasta and why it’s done that way. I think there may be a way to shorten the recipe a bit and keep to tradition, what with all the taking of things out of and back into the pasta pot. Suggestions in this vein are welcome.
We served the dish with a side of sauteed kale, a salad and warm loaf of crusty bread for dipping in the wonderful sauce.
20 garlic cloves
2 pints cherry tomatoes
1/4 cup chopped basil
6 tablespoons olive oil, plus more for drizzling
1/4 teaspoon kosher salt
1 teaspoon fresh ground black pepper
Salt to taste
1 pound dry linguine
1 teaspoon crushed red pepper flakes or 1-2 small dried red peppers
1/2 cup dry white wine
4 dozen littleneck clams, scrubbed
1 can minced clams
1/4 cup chopped parsley (plus more for garnish)
Heat the oven to 450 degrees. Smash and peel 12 garlic cloves; peel and finely chop the remaining 8. Toss the smashed garlic with the tomatoes, basil, 2 tablespoons oil, salt,and 1/4 teaspoon black pepper. Spread out in a layer in one or two baking pans (make sure they aren’t too crowded, so they don’t steam) and roast the tomatoes, tossing occasionally, until they split open, 15 to 20 minutes.
Cook the pasta in a large pot of salted water until it is 2 minutes from being done to taste. Drain.
Return the pasta pot to medium-high heat. Warm 4 tablespoons oil in the pot. Add the chopped garlic and red pepper flakes; cook for 30 seconds. Add the wine and let simmer 2 minutes. Stir in the roasted tomatoes and garlic. Add the clams. Cover the pot and cook until the clams open, 5 to 10 minutes. Use tongs to transfer open clams to a bowl; discard any that do not open.
Add the pasta and 3/4 teaspoon black pepper to the sauce in the pot. Cook, tossing, until pasta is just cooked through. Return the clams to the pot and toss with the pasta and parsley. Divide mixture among serving bowls. Garnish with a little more parsley if you want and drizzle with more oil.
Just spent an hour or so at my IMac in my own personal memorial to Steve Jobs, reading everything I could get my mouse on about him. Thought I’d share a bit of what I found, the best of which is his commencement speech at Stanford in 2005, something I’ve watched several times before but can’t listen to enough. When I get up the guts to really follow his advice, I’ll let you know.
A truly great man. A truly great loss.
“Jean Georges Dinner”, reads the message title in my in-box. That’s enough to get my attention, spam or no. I open the email. It’s a contest at Bloomspot for a seasonal wine tasting and pairing for two at Jean Georges.
That’s a no-brainer. I click the link embedded in the email, fill in my email, zip code and city, and click Enter. Jean Georges here I come! Wait, what’s this?…
Increase your chances. INVITE FRIENDS.
Get a bonus sweepstakes entry for each friend who enters.
Hmmm… “Increase your chances” Chances of what? I notice they did not say “increase your chances OF WINNING”.
Now I’m not dumb. I know that increasing the contestant pool is not a good thing when it comes to improving one’s odds of winning a contest.
But they are giving me additional contest entries. Doesn’t each additional entry effectively double the odds in my favor? Hmmm…This may not be as simple as it looks.
Time to do some math.
(I know, I know…I have much better things I should be doing with my time. But I just saw Moneyball, and am re-enamored with statistics. And you know me, ADD-girl, I just head where my brain takes me… )
It’s interesting when you do the numbers. Those extra contest entries you get for sharing on Facebook initially do increase your absolute odds of winning. But those odds only stay increased if the pool of contestants doesn’t grow or move more than a level or two beyond the initial share. Because once it does, the whole thing actually starts to work against you and everyone else, and your absolute odds of winning become really, really low. At which point, having more shares actually increases your relative odds of winning over having less shares.
Let me show you…
Bottom Line
Sharing contest invitations on Facebook is fun, but the more everyone shares, the lower the odds of winning for everyone. (So stop sharing everyone, will you?…) Once a contest gets big, sharing can increase your minuscule odds of winning to slightly less minuscule, so you might as well go for the big share and enjoy the ride. Understand you are sharing your email address, effectively building up a mailing list for the contest sponsor, which was probably the whole point of the contest in the first place.
If you really want to win something, stick to your church raffle. The odds are much better.
And if you want to keep your odds up in a contest, definitely do not blog about it, since now you’ve told everyone, and you didn’t even get a single extra sweepstakes entry.
Where the Metro North Railroad line ends in Wassaic, New York
is where the Harlem Valley Rail Trail begins.
From there, its 10.7 miles of paved riding past farms
fields,
and wetlands,
through forests,
and along stretches of Rte 20 and then narrow country lanes
to Millerton, NY.
There you can stop for a tea tasting or a bite at the Harvey & Sons Tea Factory Shop,
visit Gilmor Glass Works,
or shop for books, antiques or bicycle gear,
before heading back the way you came, to the train station at Wassaic and then home.
Of course, if you wanted to bring along a picnic lunch, you could have picked up provisions at Cousins Market just down the road from the train station in Wassaic,
where they make great sandwiches using homemade roasted peppers.
Which is what we did.
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The entire Harlem Valley Rail Trail, when it is finished, will run 46 miles from Wassiac to Chatham, NY. Much of the trail north of Millerton is still under development, though the stretch from Under Mountain Road to Copake Falls Station is complete. One can put together a longer ride than ours (We did a total of about 22 miles round trip) if you are willing to head off the trail onto nearby (hilly) roads.
Just yesterday, I put up a post about the recent birth control pill recall. This recall is a big deal – millions of women are potentially impacted, and the adverse effect – an unplanned pregnancy – is very significant.
I knew women taking these pills would be very worried, and wanted very much to do more than just spit out the press release from the FDA. I wanted to both reassure women and give them information that they could use other than just a link and a phone number. I also needed to figure out how I would be handing the recall in my own practice. So I combined the two and posted what I’ll be telling my patients to do if they find that they are taking a recalled pill pack.
As soon as the post went up, I got worried.
What if the advice I was giving my patients was not what other docs might do for their patients? What if patients misconstrued it, or had an individual situation that warranted some other approach ? (I couldn’t figure out what that might be, but that’s why it’s called individual.) What were the pharmacies and the pill manufacturers telling these women to do?
I knew that the advice I would be giving my patients was reasonable. The two weeks I was telling them to use backup contraception was double that recommended for women starting pills more than 3 days after their menses. The additional pregnancy tests I recommended were more than ample for detecting a pregnancy as early as possible, without leaving the chance that it was too early to be detected. This is bread and butter gynecology, folks. It’s what I do every day, and I can do it in my sleep. It’s no different than me telling women what they should do if they miss a pill in pack. (Repeat after me -Take two the next day.)
But this just felt different. Probably because it is a unique situation for which there is no published consensus or package labeling. And because the whole scenario is ripe for lawsuits. It’s a birth control pill recall, for god’s sake.
I debated taking out the information about what I’ll be doing in my practice. But I’d be damned if this blog was going to turn into nothing more than a newsfeed. Where’s the value added that my readers get from me being a doctor? No. I was going to keep the post as it was. With one small change.
I made it very clear in the post that this was advice I was giving to my patients, not advice I was giving to my readers. And I told the readers to talk to their own doctor about what to do.
Most importantly, I finally did what every medical blogger should do, and what I should have done years ago on this blog. I wrote a disclaimer, and linked to it prominently, both in my navigation bar and on my “About” page.
Suddenly, I feel better.
If you’re a blogger, and don’t yet have a disclaimer, it’s time to write and post one. Here are a few links I found helpful in writing mine –
CLICK HERE FOR INFORMATION ON THE FEB 1, 2012 PFIZER BIRTH CONTROL PILL RECALL.
A recall has been issued for certain brands of generic birth control pills. The pills have been recalled because they were packaged incorrectly, which could lead to unplanned pregnancies. Essentially, the pills were packaged upside down. This could lead women to take an extra week of placebos at the beginning, rather than the end of the pack, leaving them unprotected against pregnancy.
Brands affected are –
What should you do if you’re taking a recalled pack?
If you’re taking one of these brands, don’t panic. First check to see if you are taking an affected lot by going to http://www.qualitestrx.com/pdf/OCRecall.pdf. Your pill’s lot number should be on your pill card or pack. A tip off that you have an affected pack is that the seven days of placebos, which are a week of different colored pills than the rest of the pack, are at the beginning of the pack. Pill users can call 1-877-300-6153 between 8 a.m. and 5 p.m. CT for further information. You can also head to your pharmacist for help.
Talk to your doctor about what you should do if you are taking a recalled pack.
Here’s what I’ll be telling my affected patients. (Disclaimer – what follows is information about advice I will be giving my patients. What your doctor may want you to do could differ. Talk to your doctor if you are taking an affected lot of pills )
I expect a message from my EMR very soon giving me a list of those patients known to be taking these brands so I can contact them personally. But most of the time, I have no idea which generics my patients have been given until they come back next year for their annual or call for a refill. But the pharmacy and their insurer know which pills my patients are taking. Hopefully their databases are kicking into gear to rapidly identify and contact affected pill users. The lawyers are probably kicking into gear even faster…
“Let me never be confounded”
Ben Goldacre does a great job explaining why you can’t always take a headline about a research study at face value. Readers need to understand the concept of something called “confounding variables” – not always so obvious factors that can explain away associations that looks causal but in fact are nothing more than coincidence.
Why does he care? Because the media still keeps reporting unadjusted findings in headlines, only to use the last sentence in their article to say “Never mind – there’s a whole ‘nother reason why what we said in the headline really isn’t true”.
Goldacre uses the theoretical example of how drinking is linked to higher rates of lung cancer – until one takes into account the fact that drinkers tend to smoke more. Then – Voila! The association between drinking and cancer disappears and the real troublemaker – nicotine – is unearthed.
Required reading for science writers and lay readers alike.
And that video up there?
It just may probably be the best choral song ever written, and the most fun I have ever sung – In Thee Have I Trusted, from Handel’s Dettingen Te Deum. (If you don’t have time to listen to it all, start around 2:40 – the end is the best part…)
It has just two lines –
Oh Lord in Thee I trusted
Let me never be confounded.
“Let me never be counfounded.” Best song line ever. It is my mantra.
The idea that heart disease mortality rises dramatically at menopause has been one of the truisms of medicine that spawned a generation of hormone use by women and led to the rise and subsequent fall of Prempro in the Women’s Health Initiative, the end-all-be-all study that failed to prove the truism. The truism is still so strongly believed that research to prove it right continues, using different hormone formulations and different cohorts of women, in the hopes that the hormonal fountain of youth was just misbranded and given to the wrong aged cohort.
Now comes a landmark study that suggests that what we’ve thought all along about heart disease and menopause may actually be wrong.
Dhananjay Vaidya and colleagues at Johns Hopkins and the University of Alabama have re-analyzed mortality data on men and women in the UK and US and concluded that, contrary to popular belief, heart disease rates and mortality do not increase dramatically with menopause, but rather rise more gradually as a function of age in both men and women.
“Our data show there is no big shift toward higher fatal heart attack rates after menopause,” said study leader Dhananjay Vaidya, an assistant professor of medicine at the Johns Hopkins University School of Medicine. “What we believe is going on is that the cells of the heart and arteries are aging like every other tissue in the body, and that is why we see more and more heart attacks every year as women age. Aging itself is an adequate explanation, and the arrival of menopause with its altered hormonal impact does not seem to play a role.”
Statistical mumbo-jumbo
(I am no statistician, so what follows is my own interpretation of what I read in the paper. )
The researchers use of logarithmic instead of linear graphing of statistical data, and state that it is a better way to measure associations such as heart disease with age. What I think they are saying is that it is better to describe mortality at a given point in time as a proportion of previous mortality than to graph absolute mortality rates at different points in time. They state that their way of looking at the data aligns more with heart disease being a function of aging and loss of repair mechanisms with time, as opposed to some dramatic external force changing the curve at a given time. By restricting the analysis to various ageing cohorts over time, they also can compensate somewhat for improvements in prevention(such as statins) that can affect heart disease rates in a younger populations compared to, say, their parents.
A Very Compelling Argument
I have to say after reading the paper that that Vaidya and colleagues make a very compelling argument for rethinking the old truisms that have had us looking to estrogen as the holy grail of heart disease prevention in women.
However compelling, the study does not change anything at the moment in my clinical practice, since I do not prescribe hormones for heart disease prevention. I will continue to offer HRT as one of several treatment options for women suffering from menopausal symptoms, so long as they understand its risks as well as benefits. (See my 10 Rules for Prescribing HRT)
The Breast Cancer Mortality Data is Even More Interesting
Even more interesting was the researchers’ finding that breast cancer mortality, in contrast to breast cancer incidence, decreases dramatically at menopause.
This would argue strongly against the routine use of hormone replacement in menopause. It also would argue that the bang for the buck in mammogram screening may be better spent on younger than older women, something that flies in the face of the recent USPSTF recommendations to back off on one-size fits all routine mammograms in younger women.
Wow.
This is really fascinating stuff. It really turns the so-called window hypothesis on its head. (The window hypothesis says that there is a small window of time around menopause in which to start HRT to get it’s cardiac benefits, and that starting it too late, as was done in the WHI, actually can be harmful.)
The study also hammers the biggest nail yet into the coffin of HRT as the anti-aging cure for all women.
I can’t wait to hear this study discussed at the upcoming Menopause Society Meetings in Washington. So glad I am going – this is sure to be one interesting meeting. Stay tuned…
New York City may be densely populated with people, but the cricket density is pretty darned low – like maybe one cricket in the whole darned city – and guess where it is? Yep – it’s on my rooftop.
This means that while you folks in rural America are being serenaded to sleep by a soft background hum of millions of crickets –
here’s what I have to listen to –
Any suggestions on how I’m supposed to get to sleep tonight? How long do crickets live, anyway?
It’s not like I and my fellow authors will be heading on a book tour or be invited onto Oprah anytime soon (especially since she’s off the air, but you get my point…), but I am so proud to announce that the American Academy of Pediatrics Textbook of Adolescent Healthcare has finally been published!
I wrote the chapter on contraception, but it’s just a teeny-tiny piece of this amazingly comprehensive text, available either in hardcopy or as an e-book from the AAP Bookstore.
Congratulations and thanks to the hard-working editors, especially Elizabeth Alderman, MD at Montefiore, and to Diane Lundquist at AAP, for their long and hard work on this wonderful project.
I’m honored to be a part of so esteemed an academic community as the physicians who have written and edited this textbook.
That’s the opinion of television’s The Doctors, a syndicated TV Show that appears to be giving Dr Oz a run for his money, in USA Today. In fact, that’s the headline – IUDs: The Best Contraceptive Option.
What you know about birth control: Nearly half of all U.S. pregnancies are unintended; abstinence is the only sure-fire way to prevent pregnancy (and protect you from STDs); smoking while on the Pill may increase your risk of heart attack or stroke; as long as you are still getting a period, you can get pregnant during menopause. But here’s something you may not know:
We think IUDs work best.
This is contraceptive education at its worst. Highlighting the rare side effects of other methods and dismissing the ones of the method you are touting. (Almost made me wonder if there’s advertising money coming from the IUD manufacturers to the show, but I could find nothing on the show’s website to support this…)
IUDs are a great method, but they’re not for everyone. Pills are also a great method, and they’re not for everyone. Ditto for condoms, diaphragms, sterilization, Essure, the Ring, the Sponge and the Patch.
All these methods are great, and none is perfect. They all have benefits. They all have side effects. And every woman has a unique body, health history and personal concerns that determine what birth control is “best” for her. Which may be entirely different than what’s “best ” for someone else.
Contraceptive choice is not a horse race. There is no “best”. There’s only what’s right for you.
Don’t let a headline drive your choice. Make your own decision with the help of your own doctor.
Not some TV Doctor wearing blue scrubs on a sound stage in Beverly Hills.
Long time blog TBTAM readers know that many of the great recipes I share on this blog come from my mother-in-law Irene, the world’s greatest home cook. So it should come as no surprise to learn that this weekend’s hurricane, which shares my mother-in-law’s name, brought me the best bread recipe I have ever made, and the best bread I have ever eaten.
I’ve been wanting to try Jim Leahy’s No-Knead Bread ever since Mark Bittman first revealed it to the world in 2006 – a simple yet elegant method of making bread that has found an almost cult-like following on the web and around the world. But the 12-18 hour rise always stopped me dead in my tracks whenever I considered making the bread, since I rarely, if ever, plan anything that far in advance. But once I realized on Saturday morning that Hurricane Irene would essentially confine me to my apartment till at least Sunday afternoon, I knew the time had finally arrived for me to drink the No-Knead Kool Aid.
And am I ever glad I did. This bread will change you life. I mean it. It is the easiest and best bread you will ever make. The crust is hard and golden, while the crumb is porous, soft and almost spongy with a sourdough type taste and consistency that rivals anything from the best bakeries. Hot from the oven it is heaven. Toasted with a little butter and jam it is divine. Use it for sandwiches. Eat it with cheese. Or just eat it plain.
You’ll never want any other bread again.
Thank you, Irene!
No-Knead Bread
From Jim Lahey via Mark Bittman in the NY Times. I strongly encourage you to watch the accompanying video before making this bread.
As pointed out by baking maven Rose Levy Beranbaum, the water amounts in the recipe (1 5/8 cups) varies from that in the the video (1 1/2 cups), as do the rise times. (The video says nothing about the second 2 hour rise.) I decided to use 1 1/2 cups, and did not realize there was a second rise since I based my recipe on the video. I also used rapid rise instead of instant yeast. (With the MTA shut down, I could not get to a store that carried it.) As a result, my dough had completed its rise by about 4 hours, and by morning it actually had dropped a bit. Next time I will use the right stuff, do the second rise and expect my bread will be even lighter. I should also point out that I accidentally put my bread in seam side down, so I did not get the nice folds that Leahy got in the video.
Combine flour, yeast and salt. Add 1 1/2 cups water, and stir until blended with your hands or a wooden spoon (I used a spoon). The dough will be shaggy and sticky. Cover bowl with plastic wrap and let rise 12 to 18 hours at warm room temp (mine was about 72 degrees). The dough is ready when its surface is dotted with bubbles. Turn dough out onto a lightly floured surface. Sprinkle a bit of flour on it and your hands, and working with a very light touch, press the dough down a bit then fold it over on itself (see video for technique.) Cover loosely with plastic wrap and let rest about 15 minutes.
Sprinkle a clean smooth cotton towel with wheat bran, flour or cornmeal. Shape the dough into a ball and place seam side down on the towel. Sprinkle more bran on top and wrap the towel loosely around the dough. Let rise another 2 hours.
During the last half hour of the rise, heat a Dutch oven or other heavy baking dish in a 450 degree oven. When dough is ready, remove the pot from the oven and turn the dough into the pot (again, see video for technique – I screwed this part up…) Shake pan to center the dough in the pot .(Careful! It is hot!) Cover with lid and bake 30 minutes, then remove lid and bake another 15 to 30 minutes, until loaf is beautifully browned. Cool on a rack. Try to wait till it cools before slicing and eating, so the crust can develop a bit more.
No-Knead Links (Share your fave No-Knead links in the comments.)
I’m ready for you.
The terrace is cleared.
The roof is as secure as we can make it.
The windows and doors are closed.
The tub is filled with water.
As are all the pots, the teapot,
bowls and water pitchers.
Even the big trashcan is filled.
(You may think I’m going overboard, but when we lose power, we lose water here on the 12th floor. During the big blackout a few years back we went through every drop in the tub and pots. But we were clean.)
I’ve got two flashlights and loads of batteries.
Laptops are charged and shut off. Cell phones are charged, shut off and forwarded to the home phone. Two back up battery phone chargers are charged and ready to roll. (One even has solar recharging capacity.)
The old phone is out of the closet, hooked up and working. (It doesn’t need electricity. During the blackout, we were the only ones who had a working phone.)
Dog is walked (and not too happy given that the rain had already started when I walked her for the last time this evening…)
We are showered. (sorry,no pic…)
But most importantly…
I made cookies.
Because when a hurricane is on the march up the coast, and the subways, buses and Broadway are shut down, you do what you gotta’ do.
Bake.
Stay safe, and I’ll see you on the other side of the storm.
Jumbles
A sweet little recipe from The Rumford Complete Cookbook (copyright 1908), a little gem I picked up at an antique store upstate. (Google Books actually has the entire book online!) The actual recipe is so old that they don’t give cooking temperatures, just tell you that most baked goods require a “moderately hot oven”. I decided that meant 350 degrees fahrenheit. But on a regular cooking sheet, making the cookies using a melon baller, my first batch were too brown on the bottom and not enough on top. So I used an insulated cookie sheet, pressed the cookies down before baking and extended the cooking time from 10 minutes to 15 minutes. Perfect! If you don’t have an insulated cookie sheet, lower the heat to 325 and let me know how that worked for you. Makes 24 cookies.
- 1 cup flour
- 1/2 level tsp salt
- 1 level tsp baking powder
- 1/2 cup butter
- 1/2 cup sugar
- 1 egg, lightly beaten with a fork
- Grated rind of half a lemon
Preheat oven to 350 degrees fahrenheit. Grease an insulated cookie sheet. Sift flour, salt and baking powder together in a bowl and set aside. In a large mixing bowl, cream butter and sugar in mixing bowl; add the egg, the lemon rind, and then the dry ingredients, beating slightly after each addition. Drop onto cookie sheets using a melon baller. Flatten cookies slightly with your fingers. Bake 12-15 minutes till edges are browned. Serve immediately.
