Most recipes for corn pudding get published in the fall, evoking images of the Indians and the Pilgrims gathered around the Thanksgiving table. These recipes are a great reason to use the leftover corn you had put in the freezer in July and then forgot you had until you found it while cleaning out the freezer in November.
Here’s what I say – forget the frozen corn. Make the corn pudding in July using sweet corn fresh off the ear. And don’t waste the recipe on leftover corn – buy the corn special just for this recipe. It’s worth it. Serve it with reheated ribs and barbecue sauce that you had found in the freezer. Add green beans, and if the weather is right, it can become your first rooftop dinner of the season.
Oh and did I mention I didn’t actually make this? Mr TBTAM did! But I helped reheat the ribs and set the table.
Corn Pudding (Modified from Fonda San Miguel: Thirty Years of Food and Art, by Tom Gilliland, Miguel Ravago, and Virginia B. Wood, in Epicurious)
If you make this, I recommend cutting the peppers in a large dice rather than strips above, because the strips make it hard to cut the pudding onto squares, which is why it sort of just looks like a delciious clump on the plate…
2 pounds fresh corn kernels
Whole milk as needed (up to a cup)
6 eggs, separated
1/4 cup sugar
6 tablespoons butter, softened
3/4 cup all-purpose flour (substitute corn flour for a gluten free option)
1 teaspoon kosher salt
cayenne pepper to taste (about a pinch or more to taste)
1 teaspoon baking powder
1 cup (4 ounces) shredded Cheddar cheese
1 poblano chile, roasted, peeled, seeded, and cut into 1/4-inch strips
Half of a red bell pepper, cut into strips
Preheat oven to 350 degrees. Lightly grease a 13-by-9-inch baking dish with butter or oil. Puree the corn in the food processor with just enough milk to make a smooth puree (we used a little over a half cup). With the machine running, add egg yolks, one at a time, and process 30 seconds after each addition. Keeping machin running, add the sugar a little at a time and process until mixture is lighter in color and sugar is dissolved, about 3 minutes. Add butter and process until smooth. Transfer to a large bowl. In a separate bowl, combine flour, salt, and baking powder; fold into corn mixture. Beat egg whites until soft peaks form and fold into corn mixture, alternating with the shredded cheese. Pour into baking dish and top with strips of chile and red bell pepper. Bake in preheated oven for 45 minutes, or until golden brown. Serve warm or at room temperature.
An Even Easier and Less Fattening Corn Pudding
We got the whole idea of making corn pudding from my mother in law Irene, who made this much simpler and just as delicious recipe, also from Epicurious. I’m making Irene’s version next time – it’s also less calories..
I wish you could smell these gardenias, whose aroma is a truly one of nature’s gifts.
These gorgeous blossoms were brought to me by one of my Greek patients, who grows them on her terrace in Astoria. Every June she brings cuttings for me when she comes for her annual exam.
This year, she tells me one of her gardenia pots broke and rather than her having to replant the bush, do I want it for my garden?
I am so there.
Stay tuned in a week or so for some shots of her terrace garden, which I cannot wait to see. I am confident that it will put mine to shame.
Spuyten Duyvil Creek, separating the top of Manhattan from the Bronx, spanned by the Hentry Hudson Bridge and viewed from Inwood Park just before opening curtain of Moose Hall Theater Company’s excellent outdoor production of Othello.
The Supreme Court has sided with Big Pharma in their challenge to the Vermont Law limiting the pharmaceutical Industry’s access to physician prescribing information.
The nation’s high court handed down a verdict Thursday in the Sorrell v. IMS Health case, striking down by a 6-3 vote a 2007 Vermont law that that bans the practice of data mining — the sale and use of prescriber-identifiable information for marketing or promoting a drug, including drug detailing — unless a physician specifically gives his or her permission to use the information.
Apparently, Big Pharma’s right to “free speech” trumps my right to privacy. How getting access to my prescribing information has anything to do with free speech is beyond me. In the twisted logic of the pro-business, anti-citizen Supreme Court –
Speech in aid of pharmaceutical marketing… is a form of expression protected by the Free Speech Clause of the First Amendment.
The Vermont Law Did Not Go Far Enough
By limiting its restrictions on data sharing to Pharma marketing, Vermont set itself up for the SOCTUS decision by making it appear that they were unfairly singling out marketing uses from other uses of prescribing data. In my opinion, I don’t think anyone should have my prescribing data without my permission.
The AMA’s Role in Releasing Physician Prescribing Information
The Vermont Law would not have been necessary were the AMA not selling physician information (the so called AMA Physician Masterfile) to the data mining companies, who then merge the files with pharmacy data and sell it to Big Pharma so they can use it to track physician prescribing patterns and target their marketing messages. Lucky docs don’t even have to be an AMA member for them to sell their data.
Now, the AMA is coming in like the White Knight, supporting physicians’ right to restrict access to their data –
While the AMA supports the appropriate disclosure of prescriber data, the AMA firmly believes that every physician has the unequivocal right to decide whether his or her individual prescribing data is shielded from pharmaceutical detailers. To help physicians exercise that right, the AMA created the Physician Data Restriction Program (PDRP), which enables physicians to “opt out” of such disclosure quickly and easily, while still allowing their data to be available for academic and governmental research.
“The PDRP is available to all U.S. physicians – both AMA members and nonmembers. Since its launch in 2006, nearly 28,000 physicians have used the PDRP to restrict their data….Interested physicians can register online or by calling (800) 621-8335.
Please. They’re the ones selling our data in the first place.
Looks like the wrong lawsuit was filed in the first place. It’s docs who need to be suing the AMA.
The theme is summer at this week’s Grand Rounds, being held today at Shrink Rap. Some great posts there in this round up of the best of this week’s medical blogosphere.
How much fun am I having this weekend? I get to sing in the orchestra pit with the band, accompanying the dancers of the National Dance Institute in the 2011 Event of the Year – A Sense of Wonder. My kids danced with NDI when they were in middle school, and now I’ve been drawn back into this wonderful world through singing. (Thanks, Gary, for the invite!)
NDI, founded by NYC ballet dancer Jaques D’Ambois in 1976, brings dance and music to public school students in NYC, across the US and around the world. The high standards Jacque and his artistic team of professional choreographers and musicians demand from their dancers, along with the professional sets (one year they were designed by Red Grooms!) means that the Annual Event is like no children’s school performance you’ve ever seen. This is not ballet, or modern dance – it’s NDI dance, a unique blend of fun and movement that any kid who loves to move can learn and excel doing.
This year’s NDI Event theme is Science, and the kids dance marvelously as they celebrate frackals, the immune system, DNA replication, robots and the miracle of the sun.
For me, the best part is getting to be one of the girl back up singers in She Blinded Me With Science. Our version is a bit tamer than the orginal but just as much fun.
If you’re looking for a great show for yourself and your family, come on by – we’ve still got two more shows to go. And if you do, be sure to stop down to the pit afterwards and say hi!
I swear, that Twitter is ruining your mind. You’re lost the ability to read anything more than 130 characters. You’re chatting and @tting and #ing, but are you…
Hey! Are you reading me, or have I lost you already?
I mean it! Close that damned thing and read a blog!
You don’t know what to read?
Here, let me help you. Read this week’s Grand Rounds over at HealthBusiness Blog. It’s the best of this week’s medical blogosphere. Go on. Read it. Follow every one of those links and learn something besides a Wiener joke.
Talk about eliminating the middle man. Pfizer is now conducting research on their bladder-drug Detrol directly with patients via the internet. (via Pharmalot and the WSJ)
Study participants are being recruited through Internet advertisements and directed to the study’s website, which explains the study and allows enrollment.
Patients who enroll in the study will be required to have blood drawn at a local clinic or during a home visit. Medications will be mailed to participants, something that’s rarely, if ever done in clinical trials. Patients will keep diaries using a mobile phone that has an application specifically designed to track symptoms of overactive bladder. Patients will fill out assessments on a secure website four times throughout the study.
A single study site medical team at UCSF will monitor the trial, which will replicate the original trial done for the drug, which is already FDA-approved
I could not find a copy of the study protocol or informed consent, so what follows is just my take from the study website…
From what I can tell, there will be no face to face contact with study subjects prior to enrollment, and I suppose, no physical examinations, except for subjects in California. I wonder how much work is going to be required of the patient’s own physician – release of records, physical exam, review of the study and approval of patient’s enrollment? And isn’t sending study drug to patients sort of like prescribing medication over the internet without the benefit of a doctor-patient relationship? Just asking – I’m no lawyer, but in general we tend to frown on this sort of thing in the medical circles I travel in…
Head on over to the study website yourself and check it out. The study info video is more like a sales pitch than anything else, with a little cash registers ca-chinking noise every time a study survey is completed, and lots of fun cartoony things explaining the study logistics, making the whole thing look like a real blast and a fun way to make a little extra cash. Only at the very end of the three minute video do they tell you that you may end up getting placebo, and there is nothing of course, about the DRUG you’ll be taking, or it’s possible risks. To get that info, you’ll have to register, and live in a state where the study is being conducted. (I know because I tried to get a look at it, but apparently the study is not being done in New York State).
My Take as As an IRB member
I don’t think I would have approved that recruitment video. Too happy and cutesy, with statements like “You’re probably here because you have symptoms of overactive bladder syndrome, and you want to do something about it” – implying treatment rather than research.
The study intro page states the study is about testing the efficacy of Detrol for reducing incontinence, but the video really has little about actually taking a drug, and more about the fun stuff that will happen over the internet. There isn’t even a picture of a person actually taking a drug – everyone seems to be “receiving” a drug, but not “taking” anything. I swear, by the time I finished watching the video, the medication was the last thing I was thinking about.
Other statements that bothered me – “Lucky you – you’ll be getting three packages!” – implying that participating in the study will make you lucky, as opposed to having an adverse effect of the drug being studied (which would be unlucky…).
Then there is the introduction of the concept of informed consent – “Sound intimidating? Don’t worry – it’s easier than it sounds!”. “They’ll be pop quiz at the end” and a cute pic of a teacher and an apple, as if signing the consent is being a good student, while not signing it means you’ve failed. Informed consent is the cornerstone of clinical research, even when it’s a study of a drug that is already FDA-approved. Let’s treat it with the seriousness it deserves.
The video does do a nice job explaining double-blinding, but not randomization, saying “there is a chance you’ll receive either study drug or a sugar pill”, but that’s not a chance, that’s the study. They also leave randomization to the end – I would have put it earlier on in the video, since for many subjects, the chance of getting a placebo is a game changer.
I like that subjects have access to their study results, and, I assume, lab results along the way. Most studies allow this, but not with the kind of ease the internet provides.
Is this the End of the Multi-center Clinical Trial?
Centralizing the study team will no doubt save tons of money, move things along faster without having to clear dozens of institutions’ IRB and contracts offices, and give much desired consistency and control of the study’s conduct. I do find it hard to imagine some of the clinical trials out there being conducted without a local study doc to handle complications, physical exams, etc. So I expect that this model won’t translate very far in its entirely. But I do see this internet-based approach being used to substitute for a lot of what local study coordinators do, freeing up the study doc up to worry about what’s important – the patient.
I do worry, thought, that all this centralization could give too much control of research to a single site. In the case of this study, that site is located at a University which just partnered with Pfizer to the tune of $85 million. I’m not trying to imply anything about this study in particular, just using it as an example to note the potential for conflicts as the relationships between Pharma and Academic Medicine become cozier and cozier. (Pretty much every big center is partnering in a big way with Pharma these days…) Pfizer’s press release states that two institutions IRB’s approved the study, and that made me happy. Given the amounts of money changing hands now between Pharma and Academic Medical Centers, the use of independent IRB’s may become more important over time to avoid any concerns over conflicts in research.
Will Internet-based Research Expand Study Subject Populations?
Despite my reservations about the recruitment video, and the logistics of handling study complications, I think the idea of using the internet to facilitate research is an interesting one, and may expand the population of folks willing to participate in clinical trials. As medicine moves out of the office into the internet and into our patient’s homes, I see no reason why research should not follow. Just so long as we proceed with caution and safeguards.
One final thing
Kelsy, the NP on the the study (see her around 0:25 on the website video), reminds me of Pam from the Office. Uncanny…Especially when she talks. She seems really nice. So does the entire study team. I wish them the best on their project.
An interesting NEJM article on the 40th anniversary of the seminal journal article on DES serves as a potent reminder of the potential effects of exposure to endocrine disruptors during critical times in development.
Beginning in the early 1960′s 1940’s, DES, a synthetic estrogen compound, was given to women in early pregnancy to prevent miscarriages. Females born from these pregnancies had an increased risk of a rare vaginal cancer during childhood, increased rates of uterine malformations that can cause infertility and premature birth, and are at a moderately higher risk for breast cancer. Use of DES in pregnant women stopped in the early 1970’s.
The lessons learned from the DES story are powerful. Endocrine disruptors may cause alterations in the reproductive tract that have severe consequences and form the basis of disease in adults decades later. Endocrine disruptors may come not only from ingested medicines, but potentially also from the environment through food. It is very difficult to recognize a teratogenic consequence of a prenatal exposure when the malformation does not manifest until 20 years later.
I’d actually never made the mental connection between DES and endocrine disruptors, and yet of course, that’s exactly how DES functioned in this case. Remarkable, how a brief drug exposure during early gestation can lead to a cancer arising over a decade later.
An important reminder, indeed, as we begin to awaken to the possible endocrine effects of chemicals such as BPA that we are using on a daily basis without really knowing how they may be affecting us in the long term.
In a large multicenter study enrolling over 70,000 women, annual screening with transvaginal pelvic ultrasound and ca125 blood testing did not reduce deaths from ovarian cancer, and in fact led to an increase in complications due to screening.
Investigators in the NCI-sponsored Prostate, Lung and Ovarian Cancer (PLCO) Screening trial randomly assigned over 78,000 women age 55-64 years of age to either annual screening with transvaginal pelvic sonograms for 4 years plus CA125 testing for 6 years or usual care at 10 study sites across the US., and followed the groups for up to 13 years. Over that time period, ovarian cancer rates in the screened group were 5.7 per 10,000 person-years vs 4.7 per 10,000 persons-years in the usual care group, with 3.1 deaths vs 2.6 deaths per 10,000 person years, respectively. Over 3000 women had false positive screening results, a third of whom had surgery and 15% of those operated on had a complications from their surgery. Deaths from other causes did not differ between the groups.
The investigators concluded that annual screening for ovarian cancer does not reduce mortality, and in fact caused harms among women with fals positive abnormal results.
This is not the first study that failed to find efficacy for ultrasound and ca125 in reducing mortality from ovarian cancer, but it is certainly among (if not ) the largest.
Whether or not more frequent sonogram screening, combining ca125 with other serum markers, or trending ca125 levels over time (rather than just looking for “abnormal” results) will prove to be effective ovarian cancer screening has yet to be determined. Studies continue to be done, although preliminary results to date on these have not been encouraging.
What I do in My Practice
I tell my asymptomatic, low-risk patients who ask me for ovarian cancer screening that annual sonograms are like kissing the Blarney Stone. It makes us all feel lucky for awhile, but actually does nothing to reduce ovarian cancer mortality.
Still, I have not refused occasional screening for anxious women (Often women who have had a friend recently diagnosed with ovarian cancer0), so long as they understand the limitations of screening, but seem to need that negative sonogram to sleep at night. I do respect their anxiety, and if that means an occasional scan in the office and a reassured patient, I don’t see much harm, and they are told up front that their insurance may not cover the scan. I also happen to refer to a great radiologist who does not overcall abnormals, so if I see anything of concern, I refer straight to him. Now that we have this data regarding adverse outcomes due to over-screening, I will share that with my patients, and may be able to stand a bit more firmly in refusing to order ineffective screening to asymptomatic but anxious women.
For women at increased risk (family history of ovarian cancer, BRCA gene mutation carriers), I do offer vaginal sonogram and ca125 screening, but at minimum of twice a year, and urge these women to instead enroll on one of the several ovarian cancer screening trials currently in progress.
The lawyers have been advertising about it for years now, so it’s nice to see the FDA finally begin to address the issue of Yaz and blood clot risks.
The reason is the recent publication of two more studies suggesting that birth control pills containing the progestin drosperineone (Yaz and its generics) may have a higher blood clot risk than other pills.
From the FDA –
Two recent articles in the British Medical Journal have raised the question as to whether there is greater risk of DVT and PE in women taking combination oral contraceptives containing the progestin drospirenone as compared to the risk in women taking oral contraceptives containing the progestin levonorgestrel.1,2 These two new studies reported a two- to three-fold greater risk of venous thromboembolic events or VTEs (VTEs include DVTs and PEs) in women using oral contraceptives containing drospirenone rather than levonorgestrel.
Previously published studies have also addressed the risk of blood clots in women using birth control pills containing drospirenone. These studies had conflicting findings. Two were postmarketing studies required by the FDA or European regulatory agencies. These studies did not report any difference in VTE risk between drospirenone-containing products and products containing levonorgestrel or other progestins.4,5 However, two other publications from 2009 reported a 1.5- to 2-fold higher VTE risk in women who use drospirenone-containing contraceptives as compared to the risk in women who use levonorgestrel-containing contraceptives.6,7 Results of these latter four studies are described in the current labels for all the drospirenone-containing contraceptive products.
If you’re been keeping track, the score is now four studies suggesting a higher clot risk for Yaz vs two studies showing no increased risk.
That was enough to cause the European Medicines Association to issue a statement that drosperinone containing pills have a higher clot risk than levonorgestrel containing pills.
Which led our FDA to issue a statement basically saying that that they are looking into the matter, so stay tuned –
FDA is currently reviewing the two most recent studies and will be looking at all currently available information to assess whether there is a greater risk of VTE in women using oral contraceptives containing drospirenone. Data from an additional, large, FDA-funded, study on hormonal contraceptives is also being finalized and reviewed. This study includes over 800,000 US women and is designed to look at thrombotic and thromboembolic risks including VTE in a number of hormonal contraceptive products; results are expected later this summer. FDA will continue to communicate any new safety information to the public as it becomes available.
Just how high is the blood clot risk from Yaz?
It’s quite small – far, far less than a 1% chance or even a 1 in a thousand chance. According to the US Study, if 100,000 women were to use the pill for a year, clots would occur in 23 Yasmin vs 9.1 levonorgestel containing pill users. In the UK study, corresponding risks were 30.8 for drosperinone vs 12.5 for levonogrestrel-containing pills.
Remember that all estrogen-containing contraceptives carry a clot risk, on the order of a few per 10,000 women per year of use. Risks are highest in the first year of use and in women over 35 who smoke.
It’s worth noting that the Europeans are stating that the clot risks for Yaz and its generics are similar to those of pills containing desogestrol, which in the United States are marketed as Mircette, Desogen and their generics. So there’s really no reason to be singling out Yaz for blame. It’s also worth noting that norgestimate-containing pills (Ortho-Cyclens and their generics) seem to have evaded much of the scrutiny when it comes to clot risks, although the patch version of norgestimate (Ortho-Evra) did come under fire for possible higher clot risks. One study to date ranks clot risks with norgestimate pills as similar to levonorgestrel. And the Nuvaring seems to have been completely left out of the mix…
The problem, of course, with all the studies comparing clot risks between pills is that no single study included all the pills being marketed, and all to date have had both very low overall clot incidence and methodological issues that make firm conclusions difficult. I hope the study the FDA is awaiting will be more definitive. The fact that they are releasing this communication now, ahead of the results of that study, makes me wonder if they already know the outcome and are preparing us for it…
Links to studies referenced in the FDA communication
Parkin L, Sharples K, Hernandez RK, Jick SS. Risk of venous thromboembolism in users of oral contraceptives containing drospirenone or levonorgestrel: nested case-control study based on UK General Practice Research Database. BMJ 2011; 340:d2139.
Jick SS, Hernandez RK. Risk of non-fatal venous thromboembolism in women using oral contraceptives containing drospirenone compared with women using oral contraceptives containing levonorgestrel: case-control study using United States claims data. BMJ 2011; 340:d2151.
Dinger JC, Heinemann LA, Kühl-Habich D. The safety of a drospirenone-containing oral contraceptive: final results from the European Active Surveillance Study on oral contraceptives based on 142,475 women-years of observation. Contraception 2007; 75:344-54.
These are no ordinary jade plants. They’re my sister Fran’s parting gift to me and each of my sisters, cuttings from the large jade plant in her foyer, potted by her husband Adam, and, when Fran died before being able to finish the pots, decorated by her dear friend Sharon.
The cool part is that the large jade in Fran’s foyer was grown from a cutting from a jade that once grew on Jerry Garcia’s deck in California. You know, this guy –
I swear it’s true. You see, some years back, my brother Joe worked as a landscaper…Wait, I’ll let Joe tell you the story….
The Jerry Jades as told by Joe
I was re-landscaping the deck area of Jerry Garcia”s home in San Anselmo, CA when his girlfriend Manasha told me to toss three potted Jades along with some other plants. I took the Jades home and kept them on my front porch on 4th Street in San Rafael. I also had about 15-20 small terracotta pots running up both sides of my steps out front that were usually planted with annuals for color, but at the time the Jerry Jades were born, the color was not in the pots and the pots just had bare soil.
When we would have wind storms in Marin, the top heavy Jades would blow off the porch ledge and pieces would break off. Jades are basically indestructable so I would just toss the broken pieces and stand the pots back up.
One morning after yet another windstorm had damaged one of the jades, my best friend Tom and I were bullshitting on the porch. Tom hates to waste or throw anything away and he is not one to sit around, so while we were talking, he was breaking the large broken jade limb apart and stuffing the plugs into the empty annual color pots. A little water and lots of neglect later, the jade plugs started sprouting arms of their own. Once in a while, we would casually mention to our friends that the jades were from the larger jade and then it would come out that they used to be on Jerry’s deck. People would get googly eyed and we would give them a cutting.
Tom and I were always more amazed that we had created a jade farm by jamming limbs in dry dirt than the fact that I was working for Jerry and Manasha. Once Jerry died, though, the jades sort took on new meaning.
I have no earthly idea who has the two mother plants at this point, but Frannie acquired one of the Jerry Jades when she mentioned the story to a surgeon friend who was a life long dead head (scary thought…). She begged me to send one for him after he learned of the story and hounded the crap out her for one. I sent her a couple of bare root jades from one of the original color pots via US Postal. Apparently her friend cried when she gave his to him. He then accidentally amputated someone’s head (Just kidding about that part..Dead head, get it?….)
Interestingly, the jades have a similar lineage story to the bootleg tapes the Dead were known for. The tapes were awesome copies, sometimes referred to as first generation sound boards (when the concert was recorded directly from the sound guy’s equipment). However, if you made a tape to tape copy of that tape, it became a “second generation soundboard,” and if you taped that tape, a third generation would be had. You see where I am going with this…
Franny’s plant are true second generation Jerry Jades since they came right from the main plant.That was 20 years ago now, pre-cell phone and pre-email and when I wrote and told my friends that I was working for Jerry (and eventually David Grisman once), I learned that some of my college friends actually thought I was “telling stories” as we now say in the South. I was always known as honest, but I guess I would have wondered about my story too since it was a pretty wild one. What a long strange trip it’s been….
Fran’s Jade plant grew over the years to a beautifully large and healthy bush that sat in her foyer, and from which she and Adam have bestowed cuttings to friends over the years hence. Spreading the Jerry love, so to speak…
I guess you could say that my plant is a 3rd generation Jerry Jade. I plan to keep it alive and growing for many, many years, and eventually, when it’s large enough for cuttings, I’ll spread the love in Fran’s memory.
