The Bluebird
by Charles Villiers Stanford.
The lake lay blue below the hill
The lake lay blue below the hill, below the hill
As I looked, there flew across the waters cold and still
A bird whose wings were palest blue
The sky above was blue at last
The sky beneath me blue in blue, was blue in blue
A moment ere the bird had passed
It called, as if in a trance he flew
The lake lay blue below the hill
The cost of preventing preterm labor with 17 alpha-hydroxy progesterone caproate, a very cheap compounded progestin, is about to skyrocket, according to an editorial in this week’s NEJM.
Why? Because this cheap, generic, compounded drug, proven to prevent preterm birth by well-done research funded by the federal government, is now available in an identical but FDA-approved patented formulation called Makena.
In a move that is pure and shameless profiteering, K-V pharmaceuticals has decided that FDA-approval of Makena means they get to charge $29,000 for a treatment that until now cost at most $300 per pregnancy.
The advantages of an FDA-approved formulation are obvious – consistency of product, reassurance of safe compounding practices and widespread availability. But at this cost?
Aetna takes on K-V
The NEJM editorial highlighting the problem with Makena’s cost was written by Joanne Armstrong, MD, a physician with the Women’s Health Division of AETNA, who makes well-reasoned case for FDA intervention on the price of Makena.
Rather than representing a good investment of increasingly scarce health care resources, Makena will force patients, physicians, and those responsible for financing care to make hard choices. K-V Pharmaceutical has announced a copayment-assistance program, but no program providing short-term financial assistance to some patients will mitigate the harm that this new cost will cause to publicly funded programs, including Medicaid, and the women who rely on them. Nor will it mitigate the cost to employers and individuals who purchase insurance coverage and therefore directly bear all increases in health care costs. This tremendous cost increase and the likely decrease in access to an effective medicine are sizable unintended consequences of the FDA approval of 17OHP. They demand reconsideration and corrective action.
It’s a Big Insurer vs Big Pharma smackdown.
Kudos to Armstrong and Aetna for publicly taking on Big Pharma. This is one case where the interests of the insurer are clearly aligned with that of women and their families.
I for one feel like David sitting watching two Goliaths fight it out.
And this post is just me joining in the battle with my little slingshot…
Note – this post went out on the feed before I had finished editing it. Don’t use the feed recipe, it’s got errors. Use this one.
Having friends over for dinner who are both Kosher and vegetarian can be a challenge, and I love a good challenge. What makes it a fun challenge is that these friends are always up for trying something new, and appreciate the efforts we make to accomodate their dietary preferences. Even better is the fact that our kids are older, which means we’ve moved on beyond just pasta.
Mutual college spring breaks for our daughters was last night’s reason for getting together. It was also the first day in weeks when I did not have to be anywhere but home, having been overwhelmed with work, life and family issues. I actually had time to cook!
Turning to one of my favorite cookbooks, Regional Italian Cuisine, for inspiration, I found it on pages 156-157, where there were photos and recipes for four gorgeous Tuscan vegetable dishes.
Fagioli all/accelletto (White Beans w/ Sage)“Let’s make them all!” I called to Mr TBTAM, who agreed that they looked so beautiful together in the book, they’d make a perfect dinner. We figured we’d round out the meal with mesclun salad with a lemon vinaigrette and a warm baguette.
So we rode our bikes to Fairway for provisions, doing a Central Park Loop on the way there and back. (My first ride of the season, I can’t wait for more warm weather!)
Believe it or not, preparing these four dishes was not very difficult, and Mr TBTAM and I only spent a total of about 2 hours in the kitchen, including time for making some fresh breadcrumbs. We started with the beans, which we allowed to stew on the stovetop for about an hour, while we made the rest of the dishes. The breadcrumbs and the Fennel were next, and while that baked, I made the spinach. Last was the most amazing – the mushrooms. All the cooked dishes kept nicely while we sat around drinking wine and munching on appetizers for over an hour, and reheated beautifully just before mealtime.
The best part is that we now have four tried and true side dishes for future dinners, vegetarian or not.
And so do you.
I’m starting with the prettiest first, and will post the others over the next few days. Enjoy!
Funghi alla Toscana
Garlic, tomato paste, lemon and mint combine to give these mushrooms a most wonderful flavor. My recipe uses more mushrooms and a tad less olive oil than the original, (17 ounces and 5 tbsp, respectively, in the original recipe).
- 1 1/2 lbs small to medium sized fresh mixed mushrooms (I used bella, white and chanterelles)
- 4 cloves garlic, thinly sliced
- 4 tbsp olive oil
- Salt + pepper to taste
- 2 tbsp tomato paste
- Juice of 1 lemon
- 1 tbsp butter
- 2-4 tbsp chopped fresh mint for garnish
Preheat oven to 400 degrees Fahrenheit. Clean and thinly slice mushrooms, tossing them with 1/2 the lemon juice. Heat olive oil in a cast iron skillet. Add mushrooms and saute over medium high heat – how long? The original recipe does not say. I figured until they just barely give up their water, or about 5 minutes. While the mushrooms are cooking, melt butter in a sauce pan. Saute garlic in the butter until golden, about 1-2 minutes, then add the rest of lemon juice and the tomato paste and season with salt and pepper. Add to the mushrooms, season again with salt and pepper and pop the skillet into the oven for 10 minutes. Top with mint and serve hot in the skillet.
Should you look at a disaster?
Anesthesia Oboist tells us why we must watch the images of the Tsunami in Japan –
What turns my stomach is the image of a bunch of safe, comfortable Americans / British people / Europeans WHINING from their comfy homes about how “tough” it is to look at other’s pain and suffering. THEY WON’T EVEN LOOK, they REFUSE TO SEE the faces of their brothers and sisters suffering across the world – and thus, to my mind, in a way deny or refuse to affirm the reality of that suffering.
At the same time, she offers us a link to an amazing post that contrasts our Western disaster porn with the Japanese media, which has been a beacon of calm.
When news broke of the radiation leakage and the explosion at the Fukushima Daiichi nuclear power plant, I expected the televisions to be splashed with infographics of the potential fallout, showing kill zones and decay zones. But nothing happened. Instead, a Japanese official held up a diagram of the reactor’s coolant system, explained how it was failing, and what they were doing to allay the damage.
…Creating a national sense of fear and panic won’t make the tsunami stop, and won’t keep the nuclear plant from a meltdown. So these people have decided their role is to keep Japan moving, to keep the national spirit up, to wait for news rather than manufacture it themselves.
Do follow the links and read both eloquent posts arguing why we must look, but not look too much.
I have to admit that I’ve been a bit addicted to tsunami news – in fact, I was up past 1 am last night trolling the net for Tsunami videos. Call it morbid curiousity, but I just needed to see. To understand the enormity of what had happened. To wrap my head around this horrific reality. Shamefully I have to admit that before this, I really did not understand the power of the tsunami. I thought it just destroyed things near the beach, not miles inland.
But that video up there set me straight. And finally showed me everything I needed to see. So I’m posting it for those, like me, who want/need to look.
But now I’m going to turn off CNN, delete “Tsunami” from my search engine, send a check to Red Cross and get back to living. Because in the end, that’s really all I can do.
Dr Pullen hosts this week’s Grand Rounds with an Olympic medal theme. Yours truly netted an honorable mention.
But every post is a winner at this weekly compilation of the best of the medical blogosphere.
A Pasedena family has created a homestead on 1/5 acre in Los Angeles – complete with a year-round garden producing a 6,000 lb annual harvest, chickens, small farm animals and bees. In addition, they use solar powered, hand-powered kitchen appliances and run their cars using homemade biodiesel.
Their dream? A community of like-minded homesteaders living what they call the Path to Freedom. (That dream,unfortunately, may be on hold, as they’ve raised the ire of their own community by patenting the term “Urban Homestead”…)
I don’t know about you, but I find the idea of urban homesteading inspiring. I wish there were more than 24 hours in a day so I could create a similar existence for my family here in NYC. (This darned day job just keeps getting in the way…)
I may just make a small start this year and see if I can build me a raised bed on the roof. I’ve not had great success to date growing much other than herbs in containers, and my apple trees are becoming more and more challenged by their containers every year. But a raised bed might be worth a try. I’m on the lookout for a reasonably priced plan for building a moderate sized bed that won’t leach dirt onto the roof and will drain well. While the subsoil irrigation systems look interesting, I’m afraid I’ll blow it if I try something that complicated on the first go round.
Any and all advice welcome.
If ever a medical device company crossed a line with their marketing, this one has.
Essure, which makes a sterilization device for women, is trying to scare men away from vasectomy in order to drive women to use their device.
“We made men watch footage of an actual vasectomy” says the female overvoice – and then they proceed to show men’s reactions to watching a surgical procedure – “That’s frickin’ gross, man” being the most memorable quote.
The final tagline – “You can only wait so long for him to man up.”
Yeah – and to be sure he doesn’t, we’ve created this ad.
Slimy, harmful, obnoxius and just plain stupid. A couple’s decision as to which sterilization procedure to have should be one informed by real information, not stupid frat boy marketing.
How dare they?
The FDA should pull this ad. Now.
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Addendum –
I just emailed the FDA at BadAd@fda.hhs.gov. Feel free to copy my message below and send your own email –
To the FDA –
I find the following ad for Essure both inflammatory and unethical. I am incensed at the impact this ad could have on couple’s informed choices about sterilization.
http://www.youtube.com/watch?v=nPk5mtLMv94
I ask that you mandate that the company who makes Essure immediately pull this ad, both from the web and from any media outlet where it is playing.
Thank you for your attention to this matter.
If you had a gift certificate for dinner at Blue Hill, when would you go? Summer or winter? Would it be salads, corn, fresh tomatoes, summer vegetables and berries or root vegetables, greenhouse greens and autumn fruits?
I chose winter. Perhaps it’s my Irish/Slav potato-loving roots and my love of cheeses and cured meats. Or the fact that the gift certificate, given to me by a grateful patient over a year ago, was about to expire.
For those of you who may not know Blue Hill, it’s the restaurant the Obamas chose for date night in 2009, where chef Dan Barber, at the forefront of the farm-to-table movement, serves food the NY times says “you’d almost rather hug than eat”.
We took the girls to Blue Hill for a special family dinner, riding the train to West 4th St one Sunday evening in mid-January, walking through the Village and stopping along the way to browse the vinyl at Bleecker Bobs before taking a late seating at Blue Hill. We’ve never before eaten with the kids at such a high end restaurant, but they’re old enough now to appreciate it, and have a good consciousness of the issues regarding the food supply in this country and the importance of restaurants like Blue Hill in supporting local farmers.
The meal was marvelous, every bite a satisfying surprise. Since the gift certificate went only so far towards what is a very pricey meal, we decided to share the appetizers and skip the bottle of wine so we could enjoy dessert. So no one was more surprised than I to discover that, despite what might have seemed small portions in another restaurant, we were utterly satisfied by the end of our meal and elected to forgo dessert.
But that’s what real food does, doesn’t it? It truly satisfies.
Sometimes I wonder if the reason Americans are so fat is because we just keep looking to satiate our inner craving for real food, a craving that synthetic processed food will never be able to fill. Which suggests that the higher price tag for organic veggies and grass fed meats may actually bely the biggest food bargain we’ll ever get.
Blue Hill-Inspired Braised Fennel and Apples
The Blue Hill appetizer that inspired this dish was braised and roasted fennel, smoked apples and homemade pancetta. They sliced their apples so thin you could almost see through them – without a mandoline, I couldn’t come close, but still I enjoyed my own version almost as much. I based my recipe on one from Simply Recipes (nice pic there of braised fennel), used pistachios instead of pancetta, and drizzled a nice rich balsamic vinegar atop for color and a dash of flavor.
2 small fennel bulbs
Extra-virgin olive oil
Salt and freshly ground black pepper
(optional) a tiny sprig of fresh rosemary or thyme
1/2 cup chicken broth
1 tbsp balsamic vinegar
1 large Gold Rush or other tart crisp apple, thinly sliced
Roasted peeled pistachios – I get mine from a local Middle Eastern Food shopTrim the fennel, halve each bulb through the core, then cut lengthwise into 1/2-inch-thick slices.
Heat 1 tbsp olive oil in a large skillet over medium-high heat. Cook the fennel (in batches if ned be) until browned on all sides, turning carefully and seasoning with salt and pepper while browning, about 4-5 mins each.
Add the broth and bring to a boil. Simmer, covered, until tender, about 10 minutes. Using a slotted spoon, transfer to a bowl. Raise the heat to high, add 1 tbsp balsamic vinegar, and reduce the sauce until syrupy.
Arange the apples on a serving plate, then top with fennel and pistachios. Drizzle with balsamic reduction.
Po is Mario Batali’s first restaurant, except it’s not Batali’s restaurant anymore. The place is owned by Steven Crane, who opened Po with Batali over 20 years ago, but the kitchen is now manned by Lee McGrath. Which is every reason you need to eat there.
Mr TBTAM, my daughter and I had dinner at Po last Sunday evening to celebrate Restaurant Week and Valentine’s Weekend. We had a 5:15 pm reservation, since we had tickets for the 7 pm show at the Angelika theater . Although totally uncool, it was a great time to go – we had first sitting, great service, and by the time we left, the line was just starting to form at the door.
What I loved most about Po is that it is small, intimate and feels nothing like the restaurant empire that I know Batali has built since opening Po. The only scene here is the food. The decor is simple and white, but feels warm and cozy. Steve Crane the owner was there, locals kept stopping by the bar to say hi, and it just felt like what a restaurant should be, on a street that still feels like the Village has always felt. I wanted to move there. Now. After all, Murray’s Cheese shop is right at the end of the block. So is Amys’ Breads. And Faccio’s Pork Shop. And Reafettos Pasta Shop is just around the corner. What more could a person want?
Which brings me to the food (and the usual bad restaurant Iphone food photos)
My only complaint was that the cushion on the banquette needed some bolstering – we had to fight over who got “the sinking spot”. That should be easily fixed, but we forgot to tell them because we were distracted by the wonderful meal. If someone from Po is reading this, it’s the first table on the right wall as you walk in the door…
Despite the fact that we did not have the restaurant week meal, everything was very reasonably priced. Not cheap, mind you, but it did not feel like we were being gouged in return for the privilege of eating fresh, local ingredients in an intimate setting. I like the fact that Po has maintained relationships with local food purveyors since it opened, and that they get fresh food from a farm upstate. In a way they’ve been at the vanguard of the local food movement, without being all precious (and pretentious) about it.
Bottom Line
If you’re looking for a really special meal in a really special NYC location, go to Po. I’m definitely going back again. And again.
And in my next life, the one where I can afford to buy an apartment wherever I want in New York City? I’m moving to Cornelia Street.
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Mo’ Po from around the web
A pathologist uses the EMR to find out just a little more about the patient whose cerebro-spinal fluid she has under her microscope – and changes her diagnosis.
This patient had a diagnosis of plasma cell myeloma with recent acute mental status changes. So the lone plasma cell or two I was seeing, among the lymphs and monos, could indicate leptomeningeal spread of the patient’s disease process. I reversed the tech diagnosis to atypical and added a lengthy comment – unfortunately there weren’t enough cells to attempt flow cytometry to assess for clonality of the plasma cells to cinch the diagnosis. But with the information in the EMR I was able to get a more holistic picture on a couple of cells and provide better care for the patient. I cringe to wonder if I might have blown them off as lymphs without my crutch.
The much hoped-for improvement in quality due to the adoption of EMRs has been elusive to date, so anecdotal experiences like this will be important evidence to consider in judging the impact of the EMR on health care outcomes.
Kudos to pathologist Gizabeth Shyner, who writes over at Mothers in Medicine and her own blog, Methodical Madness, for “Thinking Outside the Box”.
Actually, I have no idea if the Great One even knows what a blog is. But the preface of his book Finishing the Hat contains what could be the best writing advice this blogger’s ever read.
There are only three principles necessary for a
lyric writer(blogger), all of them familiar truisms… In no particular order, and to be written in stone –Content Dictates Form
Less is More
God is in the Details
all in the service of
Clarity
without which nothing else matters.
Now go forth and write.
(Photo- Jerry Jackson, coutesy Indian U.)
Congratulations to the fabulous blogs that have won the coveted Medblog Awards this year! If you don’t read these blogs already, you’re missing out on some great blogging.
The House of Representatives will vote this week on continuing resolutions that could end funding for Title X programs and eliminate all Title X Funding going to Planned Parenthood.
Despite the beliefs of their supporters, these resolutions will NOT reduce abortions. In fact, if they pass, abortion rates will surely increase. In addition, vital preventive health services will be cut.
Here are the lies you may have heard about Title X and Planned Parenthood, and the truth you need to know –
Lie #1 : Title X Funding pays for abortion – FALSE.
It does not, because, by law, it cannot. Here’s what Title X funded for in 2009, straight from the the HHS Website:
The majority of Title X funded clinics serve clients with incomes at or below the poverty line, and who have no other funding source for these services. In some states, Planned Parenthood is the only provider of Title X services.
Lie #2 – Planned Parenthood’s Major Business is Abortion – FALSE.
Ninety seven percent of Planned Parenthood’ services are contraception, cancer screening and STD screening and treatment. Only 3% of the almost 11 million services provided in 2008 were abortions. (Click the pie chart below for detail.)
Lie #3: We can’t afford Title X funding – FALSE.
We can’t afford not to pay for these preventive health services, all of which have been shown to be a cost effective use of federal funds. According to the Guttmacher Institute –
The contraceptive services provided at (Title-X funded) centers helped women and couples avoid 973,000 unintended pregnancies, which would have resulted in 433,000 unplanned births and 406,000 abortions.
By helping women avoid unintended pregnancies, Title X–supported family planning centers saved taxpayers $3.4 billion in 2008—or $3.74 for every $1 spent on contraceptive care.
Lie #4 . Taking Title X funds away from Planned Parenthood will prevent abortion – FALSE.
Loss of funding for contraception means more unplanned pregnancies, which means more abortions. Without restating the above argument, I’ll state the obvious –
If you want to prevent abortion, you’ll contact your representative and tell him/her to vote against any attempt to eliminate Title X funding.
Take action now. The threat to funding is real, and the need is urgent.
The weeknight warriors have done it again, this time with a delicious pasta recipe.
My role in the whole operation was limited to finding a recipe after Mr. TBTAM and I agreed over the phone on the ingredients we had in mind – shrimp, lime, pasta. I emailed him the recipe, then went back to work, strolling in the door at 7 to younger daughter having a piano lesson and Mr .TBTAM reading in the den, the table set, salad made, pasta water simmering and the ingredients for the meal prepped and waiting for the final cook after the lesson was over. I quickly made a lemon vinaigrette for the salad and started some applesauce cooking for dessert while Mr. TBTAM cooked and assembled the pasta.
But hey, I did the dishes, so it all comes out even.
Linguine with Shrimp & Cilantro-Lime Pesto
Modified from Bon Appetit, July 2010
This recipe uses Cotijo cheese, or Mexican Parmesan, an artisan cheese made from cow’s milk taken during the rainy season when the grass grows on the mountainside. Coteja is sort of a cross between a mild feta and a parmesan – salty, white, softer than parmesan, but easily crumbled – and does not melt when cooked. We found ours at Fairway, where it was very reasonably priced. You can substitute Feta if you can’t find Cotija.
I was taken aback by the final calorie count on this recipe – for 4 servings, it’s a whopping 830 calories each. Of course, one does not have to have an entire 1/4 pound of pasta per serving, but this stuff is so good it’s like crack. Next time, I’ll portion it to serve 6, cut back the olive oil to 1/4 cup, the tequila to 2 tbsp and up the lime juice to 4 tbsp total to lose some calories – I don’t think it will hurt it at all. Any other suggestions on lightening this dish without losing its oomph would be most appreciated.
Ingredients
Preparation
Blend 1 1/4 cups cilantro leaves and next 4 ingredients in processor until coarse puree forms. With machine running, gradually add 1/2 cup oil. Season with salt.
Cook linguine in large pot of boiling salted water until al dente. Drain. Meanwhile, heat remaining 1 tablespoon oil in heavy large skillet over medium-high heat. Add shrimp and cook until almost opaque in center, about 3 minutes. Remove skillet from heat; add tequila. Return skillet to heat and stir until sauce is syrupy, about 30 seconds. Add pesto; stir to coat. Remove from heat.
Add pasta to sauce in skillet; toss to coat. Season with salt and pepper. To serve, plate and sprinkle with Cotija cheese and chopped cilantro.
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I’m not the only one making this pasta.
Short and sweet. Go. Read. Enjoy.
