What is the Internet Hiding?

Eli Pariser talks at TED about how we’re losing the internet to algorithmic gatekeepers at Google, Yahoo, Facebook and even our news sites, which tailor search results to what they think we want to see. Which is why I often start exploring my search results on page 10 instead of page 1. But what if some search results don’t even make it onto my queue?

The side by side comparison of two different users’ internet search on the term “Egypt” during the crisis there is a stunning example of how computerized gatekeepers choose for us what we see (and don’t see) when we log on.

You can’t have a functioning democracy if citizens don’t have a free flow of information.

I encourage you to watch the entire video, and hope the big mahoffs of the internet sitting in the TED audience heard Pariser when he told them this  –

We really need for you to make sure that these algorthms have encoded into them a sense of the public life, a sense of civic responsibility. We need you to make sure that they’re transparent enough that we can see what the rules are that determines what gets through our filters. And we need you to give us some controls so that we can decide what gets through and what doesn’t.

Because I think we really need the internet to be that thing that brings us all together. We need it to introduce us to new things, and new ideas, new people and different perspectives.

And it’s not going to do that if it leaves us all isolated in a web of one.

In the meantime, Pariser tells us ten things you can do now to get back onto the internet you fell in love with.  Here is his list of what to do – head to his site to learn how.

1. Burn your cookies.

2. Erase your web history.

3. Tell Facebook to keep your data private.

4. It’s your birthday, and you can hide it if you want to.

5. Turn off targeted ads, and tell the stalking sneakers to buzz off.

6. Go incognito.

7. Or better yet, go anonymous.

8. Depersonalize your browser.

9. Tell Google and Facebook to make it easier to see and control your filters.

10. Tell Congress you care.

Birth Control and Sexual Attraction – Why We are Not Lemurs

In an article filled with speculation, misinformation and broad sweeping generalizations, the Wall Street Journal does its damned best to make the birth control pill seem to be the worst thing to have happened to modern civilization, implying that by interfering with ovulation, the pill impairs our natural ability to choose a mate, causes women to choose less masculine partners and then stray from them, and makes us pick genetically similar rather than dissimilar mates.

Women on the pill no longer experience a greater desire for traditionally masculine men during ovulation….Researchers speculate that women with less-masculine partners may become less interested in their partner when they come off birth control, contributing to relationship dissatisfaction…That could prompt some women to stray, research suggests. Psychologist Steven Gangestad and his team at the University of New Mexico showed in a 2010 study that women with less-masculine partners reported an increased attraction for other men during their fertile phase.

“Less masculine” men. What the heck does that mean? Less hairy? Less into sports? Less violent? Not into Nascar or big trucks?

How about more likely to engage in conversation? More likely to care about their partner’s satisfaction in bed than their own? More likely to accept a woman having a career?

One could use the data to argue that the pill may be the best thing that ever happened to relationships as far as the female partner is concerned.

And where is the data from real life human relationships supporting these laboratory results? Are women on the pill actually making bad partner choices or straying more? Are men actually choosing non-pill users as their partners over pill users ?

Sorry, no data.  Just speculation and innuendo.

Oh, yeah, and the big new study. A study on lemurs.

The findings, published in the journal Proceedings of the Royal Society, Biological Sciences this year, showed that the injection of Depo-Provera, a long-lasting contraceptive that is approved for use in humans, dramatically altered the chemicals that female lemurs give off to indicate their identity and how genetically healthy they are.

Lemurs, in case you didn’t know, are the only primates who have female dominant societies, so I guess we should just extrapolate this data to humans, who as far as I can see have a male dominant society.  A  common social construct among lemurs is for the women to live with the kids and the males to migrate without them, so much for the nuclear family, huh? Oh, and one more thing – Lemurs have very poor vision, so without their sense of smell telling them a female is receptive, the males would miss their one shot a year to procreate, since female lemurs are only sexually receptive one day a year, another common trait with humans…

So, yeah, we should just extrapolate that lemur data to human societies and relationships. And while we’re at it, lets use it to frighten women and men away from the hormonal birth control.

Nice reporting job, WSJ. Can I send you the women who stop their hormonal birth control and have an unplanned pregnancy after reading your article so you can explain it further to them?

Shaved Asparagus Salad at La Pasta Eataly

OMG. So delicious. Alone worth the trip to Eataly.

I assume they used Batali’s recipe – it is, after all, his place. So I tried it myself. Pretty darned good. Try it.

If you haven’t been to Eataly, add it to your must-do list for NYC. (Thanks, Rachel for turning us on to it..) It’s a huge Italian market, food court, restaurant and people scene rolled into one. Think Reading Terminal Market meets the Italian Market meets Dean & DeLuca meets Whole Foods.  Go after hours to avoid the pressing crowds (they’re open daily till 11 pm), but know that the freshly made gnocci may be gone by then.

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More on Eataly

More Shaved Asparagus Salads

Another Death from Cancer

Our Fran died last week.

We had weeks – months, really – to prepare ourselves for my sister’s passing. I myself had been steeling for this moment for two years, since her diagnosis of stage IV cancer, knowing full well where we were going, just not sure when we would get there or how hard it would be along the way.  Grabbing at the occasional story of miraculous survival encountered through the internet, even meeting one or two of those courageous and lucky folks still alive and kicking years after a similar diagnosis, hoping against hope that Fran would join their ranks, always pulling back when I remembered the look on her surgeon’s face when he told us his uncertainty about whether or not they had in fact “got it all”, knowing now that his prediction of where she would recur, if she recurred, was spot on.

But nothing prepares you for a death from cancer. Nothing.

Chemo was hell. The anxiety was worse. The pain unimaginable.

This disease eats away at bodies, and nerves, and hope, and joy. It tears strong families down like muscle being pulled from bone, shredding our loved ones away in small painful pieces, day after day until in the end they are gone and there is just the pain. Pain that somehow manages to co-exist with a blue cloudless sky, the smell of lilacs and cacophony of bird song on a May morning.

Thankfully, and almost surprisingly  soon, now that she is gone, the good memories of Fran are starting to return, seeping in ever so slowly through a small hole in the wall of pain. The lounge act she performed for us in our living rooms, singing “It’s almost like being in Love” with an abandon and finger-snapping rhythm no tacky lounge singer in a smoke filled velvet walled room could ever match. Fran doing Cher better than Cher. Or performing the Spanish duck act that made us laugh till we cried.

On the flip side we’ll remember the “I’m an angry woman” persona that fueled her patient advocacy and sometimes (well, a lot of times…) drove us a little crazy. Her straight on approach to life that pulled no punches, always spoke to authority and saw through the grey straight to the black and white of any situation.

We’ll remember her generosity of time, money and energy, giving to anyone and everyone she knew or did not know with no questions asked. Having a baby? She crocheted you a blanket. Like those earrings she was wearing? She made you a pair. Have a cause? She’d donate. Again and again. Even as she was dying, Fran was making one last gift for each of her sibs, decorating the 8 clay pots in which she had sub-divided the Jerry Jade (Jerry Garcia’s jade plant – that’s another story..), wanting to leave us all a final gift.

She never finished the pots.

But we will, all of her girls gathering together in her craft room one last time, fueled by wine and memories and laughter. Laughter for our Fran, who made us laugh as no one ever will again.

God, I miss her.

Terrace Herb Garden 2011 – Beginnings

It amazes me every spring to look out at what I assume is a dead herb garden and find the chives overwintered and blossoming. I planted that one pot of chives over 10 years ago, and it just won’t quit! At some point I think I’m supposed to move it to a larger pot, but I’m so afraid to disturb what I assume is a perfect container ecosystem.

The sage and oregano also made it though the season, though the sage is mostly wood with a few tiny leaves. We picked up new basil, parsley, thyme, lavendar and mint plants at the Union Square Farmer’s Market yesterday, along with a single hot pepper plant and some red lettuce and mesclun mix that I think I may have packed too tightly into one pot and will probably re-do tomorrow.

The pansies that I picked up for a song one weekend last month in Massachusetts are overflowing the window boxes, and I’ve added a few to the herb garden for color in this early part of the season.

The chocolate vine we planted at the end of last season has taken off, and will need a bit of taming to the trellis.

Unfortunately the ornamental grasses did not survive, so we will be heading to the nursery to get more for this season. I am toying with the idea of turning the grass box into a regular vegetable garden, but really need the height of the grasses to soften the brick corner and give me something to look out at from the kitchen window.

I also plan on getting more basil and really going big on the pesto-making this summer. We had to resort to store bought pesto this past winter, and that’s just wrong.Our freezer may not be big enough to hold what I plan to make, so I think I’ll do some in jars this season.

Am debating about using the rest of the Miracle Gro I have or trying something else to feed the garden this year. Any suggestions in this regard are most welcome..

Unfortunately, one of our favorite nurseries, Liberty Sunset in Brooklyn, has closed. I plan to check out the new Urban Garden Center, run by the same family that ran Dimitri’s, to see what we can find there. What’s your fave place for plants in NYC?

Next project – the roof.

Bialy – My New Bagel

My coffee guy now has bialys and I’m loving them!

A bialy is like a bagel, but smaller, is baked rather than boiled and instead of a hole, has a depression filled with a little mixture of fresh soft onions. Bialys have less calories than bagels – 240 vs 300 calories according to the H&H website, though some websites say the calorie count is even lower. Bialys don’t need cream cheese, so there’s another calorie saving. (Unless of course, you add a very tiny pat of butter, which is what my coffee guy does for me…)

I mostly love that Bialys are from Bialystok, Poland.* This reminds me of Max Bialystock in the Producers, which reminds me of his whacky secretary Ulla who answers the phone “Bialystock and Bloom, got dag pa dig!”, so everytime I get a bialy that’s what I say to myself.

These are the little joys of my morning….

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I’m not the only one who loves bialys …

* The Bialy Eaters: the Story of a Bread and a Lost World is Mimi Sheraton’s history of the bialy and the lost community of Jews from Bialystock. It’s on my to-read list.

Sidewalk Chalk Wisdom

NYC street artist James De la Vega seems to have left a few thoughts behind on the sidewalk outside the hospital.  Glad I caught them this morning on the way to work before the rain started.

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I’m not the only one catching De La Vega’s work –

Doctors, Social Media and Patient Privacy

A Rhode Island emergency room doc has been fired for posting about a trauma patient on her facebook page. While the post did not reveal patient name or personal identifiers, it had enough clinical info that a third party was able to  recognize the patient.

I say if you’re going to write online about a patient, you had better disguise them so well they don’t even recognize themselves, and never post anywhere near the time of the event’s occurrence. Some bloggers I know change age, sex and other details, and post events long after they’ve happened, so no one one could ever know for sure who they’re talking about. Some doc bloggers go so far as to disguise themselves – preferring to remain anonymous both to protect themselves and their patients.

Some medical blogsites are rich with teaching cases, including x-rays and clinical information that, if disguised, would alter the diagnostic possibilities. As online venues begin to replace the time honored medical journal or local grand rounds, how do we keep our ability to teach one another with clinical cases and still respect patient privacy?  In the past, the limited circulation of medical journals kept these cases amongst the medical community, but now with the internet (and the lay public’s interest in medicine), the audience for such case histories is limitless.

It may be time to develop some sort of standard guidelines and release before writing about a patient on a social media site. Email and electronic signatures could streamline that process so that we don’t lose what makes the internet different than the medical journals – immediacy and accessibility. As an example, here is JAMA’s privacy policy and a link to their patient consent.

Identification of Patients in Descriptions, Photographs, Video, and Pedigrees. A signed statement of informed consent to publish (in print and online) patient descriptions, photographs, video, and pedigrees should be obtained from all persons (parents or legal guardians for minors) who can be identified (including by the patients themselves) in such written descriptions, photographs, or pedigrees and should be submitted with the manuscript and indicated in the Acknowledgment section of the manuscript. Such persons should be shown the manuscript before its submission. Omitting data or making data less specific to deidentify patients is acceptable, but changing any such data is not acceptable.

It’s a brave new world out there, folks, so be careful. For the record , I won’t post about a patient without her explicit permission, and even then I disguise her so that no one would recognize her. Which is why this blog is a bit light on patient tales. Food is a much safer topic if you ask me….

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Other posts I’ve written on this topic

Yaz and Blood Clots – Two More Studies Point to Higher Risks

Update – the FDA addresses clot risks and Yaz

Two studies published in this weeks’ British Medical Journal, one from the US and the other from the UK, report that users of drosperinone containing oral contraceptives (Yaz, Yasmin and their generics) have increased relative risks for non-fatal blood clots compared with users of pills containing levonorgestrel.

While neither study is perfect, and indeed have some very major limitations, they add to a growing body of evidence that pills containing drosperinone may impart higher risks for blood clots than older pills. Yaz is not alone in this regard – other studies have suggested that pills containing the newer progestins gestodene and desogestrel also impart slightly high clot risks than the so-called first and second generation pills containing the older progestins norethindrone and levonorgestrel.

I won’t go into the studies’ limitations here, but will say that trying to get our hands around comparative data on clot risks between various pills is an extraordinarily difficult process given that the diagnosis of blood clots is not always straightforward (or correct), pill choices are not randomized and fraught with prescribing bias, and confounding risk factors for clotting are numerous and difficult to control for. I wish folks would stop trying to answer these questions on the quick and cheap using claims and pharmacy databases without requiring chart review and strict diagnostic criteria. But that’s the way these studies are being done, and that’s the data I am being forced to contend with in my practice, so let’s talk about it.  Continue Reading

Strawberry Rhubarb Pie

Although I did not actually make this masterpiece*, if it were being published in a journal I would be last author, Mr TBTAM second, and my daughter first author. I initiated the project and sent Mr TBTAM shopping for the ingredients, but when I invited my daughter to join me in making the pie, she stated “I want to make it myself”.

And so she did.

Nice job, honey.

* The recipe is from Bon Appetit via Epicurious, although we substituted a double recipe of pate brisee from the Pleasures of Cooking for the shortening crust. I guess they get authorship too, huh? I’m think a dusting of confectioners sugar and a dollop of vanilla ice cream would be an excellent way to serve it at Easter Dinner later today.

The OBG Why Me Blues

If I ever get enough time and guts to put together a cabaret act, this is totally gonna’ be my opening number…