Frugal Fig Flatbread

Say that five times fast. Then take a bite of the most delicious appetizer I think I have ever served.

The recipe is adapted from The Frugal Foodie Cookbook, written by Alanna Kaufman and Alex Small, aka the bloggers Two Fat Als. I met Alex and Alanna at the Union Square Farmer Farmer’s Market a few weeks ago, where they were selling their book and cooking up Eggplant Pasta. Once I learned that Alex is a med student at Mt Sinai School of Medicine in New York City, I knew I had to buy his book. (Even though I passed up the pasta – Y’all know my feelings on eggplant…) I was so excited – another medical food blogger! And with a book deal!

Alex and Alanna, a law student at Columbia University, met while undergrads at the University of Pennsylvania, and created all their recipes in their book while living on a student budget. Each recipe in the book has a little story attached and a cost breakdown per serving. Most of the recipes appear to be originals. The book’s introductory chapter (much too short, in my opinion) reveals the Als’ secrets for saving money while eating well – like making their own stock and breadcrumbs, using leftovers wisely, freezing herbs and making their own bread.

Of course, frugality (and regular bread making) is best accomplished by those with little financial resources but lots of free time. Students fall nicely into that category. It’s much harder being frugal while working 10-12 hour days, and even harder once you start taking night call. So it will be interesting to see how Alex and Alanna adapt their frugal lifestyles once the demands of residency and the law firm begin to take their toll. Hopefully by then, they will have the resources they need to enjoy being foodies without the luxury of free time.

Fig and Fontina Flatbread with Rosemary

The Fat Als use this Mark Bittman pizza dough recipe for their wonderful appetizer. That particular dough recipe calls for instant yeast. Since I only had active dry yeast, my recipe calls for proofing the yeast first. I’ve also adapted the original recipe by adding fresh rosemary and a generous sprinkle of salt and black pepper. Although The Als’ recipe calls for half figs, I’ve found that it is better to use fig slices, so that the juices find their way onto the bread while it is cooking. Next time I’ll use even more rosemary.

The recipe below makes two large cookie sheet size breads with a slightly puffy crust. If you like your crusts thin, as we do, you can split the dough into thirds and roll it out thinner, making three smaller breads from the same batch of dough. You’ll need to watch it more closely as the ends will cook quickly.

This bread goes great with a cold beer.

For the dough –

1 package active dry yeast
1/4 cup hot water (100 degrees – very hot tap water will do)
A pinch of sugar
3 cups all-purpose flour (I used King Arthur’s bread flour); more as needed
2 tablespoons olive oil, plus a little more
2 teaspoons coarse kosher or sea salt
3/4 cup water

For the topping-
1 cup shredded Fontina cheese
1 cup shredded Parmesan cheese
1/2 lb. black mission figs
Fresh rosemary
Salt and pepper

Pour 1/4 cup hot water into a small bowl. Sprinkle the yeast on top along with a pinch of sugar. Give a quick stir and let sit till bubbles rise. Combine flour, salt, olive oil and activated yeast in a food processor. Begin processing and add 3/4 cup water through feed tube. Process, adding a little more water if necessary, until mixture forms a slightly sticky ball.

Turn dough onto a floured work surface, and knead to form a smooth, round ball. Put dough ball in a bowl, and cover with a clean damp towel. Let rise until dough doubles in size, 1-2 hours.

Just before the dough is done rising, preheat your oven to 400 degrees fahrenheit. Slice the figs by cutting them in half lengthwise (de-stem the ends with the knife if needed), then trimming the backsides flat, so you end up with nice thick slices with skins just around the edges. Divide dough in half and roll it onto lightly oil-greased baking sheets. Rub a little olive oil over the doughs, and divide cheese and figs among them. Sprinkle generously with fresh rosemary, salt and freshly ground pepper. Bake in the oven on the top shelf for 8-10 minutes, until golden. Cut into squares using a pizza cutter and serve.

Chocolate Chip Birthday Cake

Happy Birthday, Mr TBTAM.

Chocolate Chip Birthday Cake

This is a tried-and-true family birthday cake favorite. From Irene, of course. For the grated chocolate, we use chocolate chips, ground in the food processor till it is about a 60/40 mix of finely ground and tiny pieces. I screwed up this one by forgetting to add the chocolate on top till after it was baked – no problem, just sprinkle it on while it’s still hot and no one will know the difference. Serve with tall glasses of milk.

½ lb. butter
1 ¾ c. sugar
1 tsp. vanilla
4 large eggs, separated
1 cup milk
2 2/3 cups self-rising flour
½ c. grated semisweet chocolate (inside)
½ c. grated semisweet chocolate (topping)
Powdered sugar for the top

Have all ingredients at room temperature. Cream butter and sugar till light. Add egg yolks one at a time. Beat until smooth. Add vanilla. Beat in flour and milk alternately, starting with flour and ending with milk, adding about a third of each at a time and working quickly. Beat egg whites until stiff and fold into batter with ½ cup grated chocolate. Pour into greased and floured pan. Sprinkle remaining chocolate on top.

Bake at 350°: 9 x 13 baking pan 45 minutes or large tube pan 55 minutes, or 2- 9 inch layer pans 40 minutes, or 2 loaf pans 45 minutes. Cool, sprinkle top with powdered sugar.

Roasted Baby Eggplant

Hello, little darlings! How CUTE are you??? And those little onions cozied up next to you? Just begging me to take them home and roast them…

Wait. I can’t do this.

I can’t write that “Aren’t these adorable little eggplants I found at the Union Square Farmers Market and look at the wonderful dish I made using them!” blog post I was planning to write.

It would be a lie.

Not because I didn’t buy these little babies, or roast them up with garlic and lemon and olive oil and mint to serve alongside roast lamb chops at a dinner party to a bunch of friends who ate them up so quickly that we wished we’d made more. I actually did all those things.

It’s because the one thing I did not do was eat these adorable little eggplants. Because I don’t like eggplant.

Really. I swear, I am not kidding. I can’t stand eggplant.

I know, I know. You like eggplant. You are not alone on this, trust me. Everyone loves eggplant. Everyone, of course, but me.

I know what you’re thinking – How could anyone not love eggplant?

If you really want to know, I’ll tell you. But I’m a little worried that when I tell you, you won’t like eggplant anymore either. Then you’ll hate me for making you hate eggplant and I’ll feel guilty for ruining every future eggplant experience you might have had. So if you’re easily influenced, or worried on this particular issue or wavering even the slightest bit on the whole eggplant thing, then you might just want to stop reading right now and skip down to the recipe at the bottom, which was really very good according to your eggplant-loving compatriots who ate it.

But if you’re still reading, I’ll tell you why I hate eggplant.

It’s the texture. That sort of rubbery soft sensation that feels like you’re eating something you’re really not supposed to be eating. Like…maybe… Oh, I don’t know.. a cooked alien? Seriously, I think if we were to grill up ET and serve him, he would taste just like an eggplant. And if you leave the skins on – well, now to top it all off, you’ve just made my teeth squeak.

You asked…

It took me years to convince Mr TBTAM that I am not an eggplant lover. He’d cook it up and offer it to me, over and over again, as if he’d never heard what I told him last time he’d made it, which was “I don’t like eggplant”. Or we’d be shopping for something to cook for dinner, and he’d say “How about eggplant?” or “Don’t these eggplants look delicious?” and I would remind him, yet again, that I DON”T LIKE EGGPLANT. Each time would be a new disappointment for him, and he’d look at me as if he had just realized that I was not the person he’d hoped he married.

Of course, being married 24 years, he’s gotten the point by now, and has taken to broiling his own eggplant when he wants it, then ignoring me while he eats it, or ordering Chinese eggplant when we are out, but then of course I can’t share it, even though he’s gotten half of my pan fried noodles. Fine.

My eggplant dislike is well-known in my husband’s family. I think it may have been a bigger issue for his mother than me not being Jewish, which actually, never seemed to be an issue. Of course, in that family, food is like politics, and we all know where every one stands. Peggy hates eggplant. My brother-in-law doesn’t like fish, but loves milk. Irene used to hate cilantro, but now she likes it in small quantities, but she still doesn’t like goat cheese. Mr TBTAM’s sister doesn’t like sugar in her whipped cream, should we make two separate batches or not? His other sister actually swore off garlic, which in my family would be sort of like me leaving the Catholic church, but worse.

Of course, in my family no one cares what food you like or dislike. They’re too busy eating.

The single exception to my “I don’t eat eggplant” rule was Augergines in Spicy Honey Sauce, which actually looks like a cooked alien but tastes wondrous. Maybe it was because the eggplant is called an “Aubergine”, which distracted me long enough to actually taste the eggplant. But I think it was the honey. I’ll pretty much eat anything if it’s sweet. Which is not to say that if I am coming over for dinner, you should go looking for a great honey Aubergine recipe to serve me, because really, I can pretty much promise you I won’t like it.

But I can promise you that you will love this recipe for roasted baby eggplant. After all, how could you not? Those little things really are adorable.

Just like ET.
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Roasted Baby Eggplant

I modified a recipe I found on the Real Simple website. We added in a bunch of those tiny baby onions up there in the photo. Those I ate.

12 baby eggplant
1 lemon
2 cloves garlic, thinly sliced
fresh mint leaves
1 teaspoon kosher salt
1/2 teaspoon freshly ground black pepper
3/4 cup olive oil

Heat oven to 450°F. Slice each eggplant in half lengthwise, leaving the eggplant halves attached at the top. Arrange the eggplants in a baking dish.

Cut the lemon in half. Thinly slice on of the halves into 12 slices, then cut each slice in half crosswise. Insert the lemon slices into the slit in each eggplant, then press some garlic and mint into each slit. Season with the salt and pepper. Squeeze the juice from the other lemon half and drizzle over the eggplants with the oil. Cover with foil and roast, basting frequently with the juices in the dish, until the eggplants are very soft, about 40 minutes.

Remove foil and roast for 5 more minutes. Transfer to individual plates and serve.

Back in the High Life Again

Okay, I’m over myself. Enough wallowing and worrying. It’s time to revel again in the joys of daily life in this marvelous city I call home.

Like having an hour and a half to kill with Mr TBTAM after dropping my daughter off at Pier 40 to see “Confidence Man“, a play stage-managed by her fave Middle School Social Studies teacher. Not enough time for a movie, so what were we to do? Go see the sunset from the High Line, thats what!

What’s the High Line, you ask?

Only the hippest and most wonderful new park in New York City, built along the old abandoned elevated freight rail line that runs near the Hudson River from the meatpacking district all the way up to 34th st and 11th Avenue. The High Line is testimony to what concerned citizens can accomplish when they come together with a purpose – in this case, to save the rail line from destruction by resurrecting it as an urban oasis.

The High Line’s design was inspired by the natural landscape that evolved over the years on the abandoned rail bed, and the design works. The place feels less a park and more like found nature in the middle of an urban cityscape.

Sunset is when the High Line is at it’s best. The setting sun and city lights add a magical glow, and the crowds have thinned enough that you can get a prime Hudson viewing spot on one of the broad lounges that line the lower half of the park.

But don’t just sit – stroll the entire park from bottom to top, going through and under buildings, past galleries, apartment buildings and warehouses. My fave part was walking the narrow Chelsea Grasslands, which brought back memories of summer days spent on the freight train tracks as a kid.

Don’t worry – the High Line is safe after sunset. A Parks Ranger told me there have been no incidents other than the occasional drunk. We saw lots of young professionals and couples, a few small parties, and even ran into my buddy Kathleen and her family in from Minnesota. Unfortunately, the Renegade Cabaret – one woman’s response to the instant audience created when the High Line opened within view of her fire escape – was quiet the night we visited.

The High Line isn’t finished yet – Phase Two will open in 2010 and will extend to 30th street, while the fate of the railyards section to 34th street is still unclear.
But don’t wait till the High Line is finished – go visit it now.
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History of the High Line – Narrated by Ethan Hawke
High Line Design Video – Cool!
Friends of the High Line – Your donation helps maintain the gardens on the High Line
The NY Times has a wonderful collection of High Line articles and images

Fallingwater

I never imagined that a building could evoke tears.

Until today, when I visited Fallingwater.

If you know me well, you are probably thinking it was something else.

Like the fact that we were on our way home from dropping my eldest off at college to start her freshman year.

Or my sister’s recent cancer diagnosis, difficult surgery and more to come chemo.

Or our family’s coming to terms with the fact that we have been unable to save my mother from her chronic pain or failing memory and must now make difficult decisions about where she will live.

But you would be wrong.

Yes, all those things have been going on lately. And while they certainly explain why I haven’t been blogging, they are not why I cried this afternoon.

I cried because this building, this home, this marvel of cantilevered concrete, steel and glass was so beautiful, so ingenious, so damned glorious that I could find no other response than tears.

How could I not cry, when the sudden downpour that began during our tour, a cascade of water from the sky that poured down around us as we walked under the covered walkway to the guesthouse so that we felt that we were actually within a water fall, turned into a radiant sun shower and then stopped just as we stepped out onto the highest terrace?

Or when I learned that Wright was 67 years old and at the low point of his career when he designed Fallingwater and at an age when most of us would be heading to retirement, he jump started the second half of his career, the half in which he created some of his most memorable designs, including the Guggenheim?

Or when I stood in the woods later, looking at that famous view of Fallingwater that we all know, and realized that man, when he does it right, can actually enhance nature rather than destroy it?

There are those who will say that Fallingwater as it was initially conceived and built was not perfect, and they would be correct. The concrete cantilevers needed steel reinforcements Wright had not planned, as did the stairs. Cracks appeared in the main level flooring almost immediately and as it continued to sag over the years, they threatened to bring the building down. But Fallingwater was saved – not by restoring the cantilever to its original position, but by stabilizing it where it had settled. As a result the building is slightly different, but stronger and just as beautiful as when it was first built.

As I write this, I feel as if I am again standing on the concrete cantilever at Fallingwater, and can feel the forces of gravity and counter tension pulling upon me.

I’ve survived my daughter’s senior summer and the move into the dorms with our relationship now settled into something different, but intact – better even, for the transition.

And as for my larger family – my eight sibs, my parents and I – we are learning that, despite our numbers, we are not invincible. Like Wright’s folded concrete cantilevers, we have sustained a crack or two. Already we are finding ourselves changed, settling into a different place than before, and will need some reinforcement and some shoring up as we go on.

But we will go on, strong and beautiful as ever.

When the Mentor Goes Rogue

A prominent Walter Reed Orthopedic surgeon is accused of inflating research data to benefit the Medtronic product that he was researching. The surgeon, who earned over $850,000 as a Medtronic consultant, also appears to have submitted copyright forms with forged signatures of his co-authors, none of them had ever seen the research paper that bore their names. One of these authors had been a resident under Kulko –

As a resident conducting research with Kuklo, Andersen said he noticed “an aberrancy in typical research” that involved “discarding inconsistent findings which did not fit his hypothesis.” Andersen said he had misgivings, but added he was a young doctor inexperienced with the intricacies of research, according to Army documents.

To conduct questionable research is on thing – to do so while mentoring residents takes the violation to a whole new level. These are the future researchers of America, the children of academic medicine. There is a responsibility to train them to conduct good, ethical research that trumps any industry contract.

We are trying to create a culture in clinical medicine, similar to that of the airline industry, that makes residents, nurses and others feel safe to question doctors when they think something may be awry. It seems to me that we need the same culture shift in academic research, particularly when the funding is coming from Big Pharma.

Go See the Brooklyn Cyclones and Fall in Love with New York

Just when you think you couldn’t love New York City any more than you already do, you go to a Brooklyn Cyclones game on Coney Island. And fall in love all over again.

How could you not?

You’re watching great baseball sitting next to the Coney Island Boardwalk overlooking the Atlantic Ocean. That’s right – you can see the ocean from your seat in the stands. And because the stadium seats only about 7500 fans, every seat feels like it’s right on the field.

There are couples on dates and families with kids and buddies drinking beers, and in the ladies’ room line an old lady with teased yellow hair who is sitting in a wheelchair and wearing a Cyclones T shirt tells you the score.

You get to sing “Take Me Out to the Ballgame” at the top of your lungs and are transported back to your childhood.

While standing in line for a Nathan’s foot long, you strike up a conversation with a big guy from Africa who’s at his first Cyclones game, and when you say it’s your first game too, the two of you look at one another and just smile.

There’s so much going on – not a second is wasted between plays. Every minute of down time on the field is a chance to shoot more t-shirts out to the crowd, to sing more songs, to watch the cheerleaders dance, to have the kids come down to the field for a pitching contest. This is baseball with A.D.D., and it’s fun!

And then there’s that great triple in the bottom of the ninth that won it for the home team.

Not to mention the Ocean sunset.

And the post game fireworks.

And the walk along the beach and the boardwalk on the way back to the subway.

And the Wonder Wheel.

The most fun I’ve ever had at a ball game.

Go.
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This is another post in a special TBTAM series “Shh! Don’t Tell the Tourists!”

Congenital Adrenal Hyperplasia – Something to Consider

Adrenal Steroid Pathways (from Wikipedia)
The New York Times this week has a very nice article about Congenital Adrenal Hyperplasia or CAH, as it is called. I thought the article was very well-written, but might be confusing for folks who don’t know the basics about CAH, and might lead some women to over-diagnose themselves with what is a rather uncommon condition. So let me see if I can give you the basics and help you put the article in perspective.

Congenital Adrenal Hyperplasia (CAH)

CAH is caused by a genetic enzyme abnormality in the adrenal gland. In women, this can lead to an over-production of testosterone, which in turn can cause irregular menses, acne, hirsutism (excess hair growth) and infertility.

Clinically, CAH is classified in decreasing order of severity as –

  • Classical salt-wasting CAH (Early onset): Presenting at birth with varying degrees of genital ambiguity in females (normal genitals in males), severe adrenal insufficiency and life-threatening salt wasting (both males and females). It is treated with lifelong steroids. Females have normal internal genital structures and with treatment can have normal menstrual cycles and normal pregnancies. Hirsutism can be problematic but is usually quite treatable. Surgery is usually done to correct the genital abnormalities.
  • Non-classical, virilizing CAH – Enough adrenal steroids are produced to prevent adrenal insufficiency and genitals are normal at birth. Elevated testosterone levels can causes early puberty and in girls, excess hair growth and clitoral enlargement.
  • Late-onset, non-classical CAH – Presents in the late teens and 20’s with menstrual irregularities, severe acne or hirsutism, and sometimes, infertility. Can also cause early puberty, though this is less common. Can have no symptoms at all.
The condition the NY Times article is addressing is late onset or non-classical CAH. So that’s what we’ll be talking about in the rest of this post.

Genetics of CAH

The gene affected in CAH is called CYP21A2, and it codes for the enzyme 21-hydroxylase. This enzyme is part of the adrenal production pathway for cortisol, and catalyzes the conversion of 17-hydroxyprogesterone to 11-deoxycortisol. (It’s the second vertical green bar on the top in the steroid production pathway up there.) If that enzyme is blocked, levels of 17 hydroxyprogesterone build up, and then steroid production tends to preferentially head down the other path towards testosterone.

Think of it as a construction delay at the Manhattan-bound Lincoln Tunnel, with cars backed up all the way to the Jersey Turnpike. Traffic is so hemmed in that you can’t get over to the right lane, and you end up on Rte 3 headed to Secaucus (testosterone) instead of Manhattan (cortisol). Not exactly where you wanted to go, was it?

CYP21A2 is a recessive gene, meaning that an individual usually has to carry two abnormal gene copies to be affected. There are several different known mutations of the gene, some leading to more severe enzyme deficiencies than other, and various combinations of these mutations in an individual can lead to varying degrees of severity of the condition. The correlation between a specific CYP21A2 mutation and clinical presentation is not always predictable, and other genes are thought to influence the phenotypic presentation.

How common is late-onset or non-classical CAH?

The Times article states that CAH is much more common than realized, and not diagnosed or treated as often as it should be.

Dr. New, who has studied the disease among New Yorkers, said she found it in 1 out of 100 people, but more often in certain ethnic groups — 1 in 27 Ashkenazi Jews, for example, and 1 in 40 Hispanics. It is the most common of the autosomal recessive diseases, in which a child inherits two copies of a recessive gene from his parents — a class that includes sickle cell anemia, Tay-Sachs and cystic fibrosis.
Remember that Dr New screens a select population of women and New Yorkers, so those numbers are not necessarily representative of the US population at large. I’ve been screening for late-onset CAH for over 20 years whenever an adolescent or adult woman presents to me with irregular menses and acne or hair growth, and I’ve diagnosed it in maybe 2 or 3 patients. It just is not very common. Be careful also not to confuse the incidence of the gene defect with the clinical condition – not all women who have the gene defect have any symptoms.

As an aside, I’ve probably seen more classic CAH patients in my career than most gynecologists, having done the pelvic exams as part of a long term study of classical CAH patients conducted by Dr New.

Screening for late-onset CAH

The screen for late-onset CAH is a simple blood test for 17 hydroxyprogesterone – that hormone builds up as a result of the mild enzyme block in the adrenals. It should be done whenever a woman presents with menstrual irregularities and signs of excess androgens such as hirsutism or severe acne. (The test has a very low yield in the absence of signs of androgen excess, but may be useful in evaluating infertility if severe menstrual irregularities are present or there is no response to standard treatments.).

Testing for 17 hydroxy-progesterone is best done fasting and in the latter part of the menstrual cycle. If the result is abnormally high, then a confirmatory test is done called an ACTH stimulation test. The patient is given a hormone that stimulates the adrenal gland to make more steroids, leading to more back up behind the enzyme block and a further rise in 17 hydroxy progesterone. (Think of the ACTH stim test as causing rush hour traffic in the analogy I gave above.)

How is CAH Treated?

Treatment of late-onset CAH depends on the desired outcome and severity of symptoms. If the menstrual cycles are fairly regular and hirsute symptoms mild, then no treatment is necessarily needed. Birth control pills are the mainstay of treatment for mild forms of the condition, especially in sexually active women who want to prevent pregnancy. More severe forms will respond to steroids with or without oral contraceptives. Women who want to conceive may be treated with steroids or not depending again on how severe the condition is and how well she responds to standard ovulation induction.

What about Genetic Testing?

Because the CYP21A2 gene is recessive, individuals who carry the gene may not be aware of it. If two carriers have a child, there is a 25% chance they will have a child with the more severe classical form of the disorder.

Which leads of course to the question – who should be screened for the CAH gene defect?

I’d recommend screening if anyone in your immediate family has CAH – you could be a gene carrier. If you are, then your husband can be screened before you get pregnant to determine if you are at risk for having a child with the classical form of CAH. Given the incidence of CAH in Ashkenazi Jews, I suspect at some point we may start offering CAH testing along with Tay Sachs and other genetic prenatal screens. Right now, however, it is not a recommended routine test in this population.

For more information on CAH

The Dinosaur Comes out of Hiding

So to speak.

Our beloved Dinosaur Doc has written a book, and with its publication, comes out of a long anonimity.

Question: What do anonymity and virginity have in common?

Answer: You can only lose them once, so make it count.

I am pleased, proud and thrilled to announce the upcoming release of my first book.

Many will be surprised to find out that this tough, biting and sometimes foul-mouthed family doc is a girl. I myself had thought she was a he, but Lucy set me straight a few years back. (Yes, I am proud to say I was one of the privileged few who has known of her identity for some time now…) Gender mix up seems to be my specialty – I had thought NHS Blog Doctor was a girl, but he set me straight pretty quickly on that count.

I for one can’t wait to read the book. You can pre-order it on Amazon.

Congratulations, Dr Hornstein!

Alternative Medicine – It’s Not So Funny

This British comedy sketch about an Emergency Room in a Homeopathic Hospital is damed funny. (Make sure to read the signs on the corridor walls.)

But change the patient from a trauma to a cancer patient, and it’s a tragedy.

The patient still steadfastly refused all surgery, chemotherapy, and radiation. Against all evidence that the course she had chosen thus far had not resulted in the elimination of her tumor that she expected, she nonetheless insisted on continuing with various alternative medicine treatments. Against all evidence to the contrary, she continued to refuse any form of “conventional medicine.” She still believed that her ” healer” could save her life, even though she now had a large, bleeding, stinking mass in her breast stuck to her chest wall that had three years ago been a pea-sized cancer that could have easily been excised with a small surgical procedure. She was well on her way to dying in the horrific way that so many women died of this disease 100 years ago. And the cost was more than just the growth of the tumor. The woman had three small children at the time of her diagnosis.

(Hat tip to Dr Val and Orac)

Is This a News Article or an Ad for Estroven?

How to write a bad medical news article –

Lead your article on alternative treatments for menopause with an unsubstantiated anecdote by an anonymous woman who claims Estroven use led to a 20 lb weight loss without changing her eating habits. Show a photo of several brands of “natural” remedies for menopause, none of whose brand name is clearly visible except the Estroven.

Never mention in the rest of the article that there is no good data to support Estroven’s efficacy in treating any of the conditions for which it is marketed, and certainly no data that it leads to effortless weight loss.

I’m surprised – the New York Times usually does a much better job than this.

Emergency Contraception Use Does Not Adversely Affect Pregnancy Outcome

Plan B

Pregnancies conceived in a cycle when levonorgesterel emergency contraception (Plan B) was used have no increased risk of adverse outcomes.

In a prospective study, researchers compared the outcomes of over 300 pregnancies in which Plan B was used during the cycle of conception to a similar number of pregnancies in which no exposure to Plan B occurred. Outcomes were the same, with about a 10% miscarriage rate and 1% rate of major malformations in both groups.

The study outcomes are not surprising. Plan B uses levonorgestrel, a progestin component of hormonal contraceptives for many years, long ago shown to be safe if pregnancy occurs despite its use. Despite the fact that plan B uses levonorgestrel doses that are higher than in traditional oral contraceptives, no adverse impact has been reported to date on pregnancies conceived despite Plan B use. Having yet another reassuring study is always good news.

A couple of things to remember when interpreting data from studies exploring the association between exposure to a medication or chemical and pregnancy outcome –

  • The background rate of miscarriage traditionally was thought to be about 15%, but we now know can be as high as 50% if one includes very early miscarriages. Once a heartbeat is established on sonogram, that rate drops to 5% or less. So if you are studying pregnancy outcomes, how you diagnose the pregnancy will affect your miscarriage rate – will you use hcg levels or clinical diagnosis? If you enroll women in your study after 6 weeks, your miscarriage rate will be lower since the early miscarriers will not make it to your study.
  • The background rate of birth defects in the general population is 3-4% – that includes major birth defects like spina bifida and minor birth defects like an extra digit.
  • Subject recall of medication or other exposure can be skewed depending on the pregnancy outcome. If things go wrong, we tend to look back and remember everything that occurred, looking for a possible cause. If things went well, we tend to forget little things like that aspirin we took for that one-day headache. But retrospective studies are much much easier to do that prospective studies. So if you are looking for a link between an exposure and a birth defect, the first step is retrospective cohort analyses. If something comes up there, you need to confirm it in a prospective fashion (if you can).

Seattle’s Green Bag Campaign

In an attempt to reduce plastic bag waste in Puget Sound, the Seattle City Council has passed an ordinance imposing a 20 cent fee on disposable shopping bags. The fee is optional – you only pay if you decide to use a disposable plastic bag instead of bringing your own reusable shopping bag to the market.

The American Chemical Council, representing plastic manufacturers, has spent almost $200,000 in a signature gathering campaign to force the tax measure onto the August 18 citywide primary ballot.

The Seattle Green Bag Campaign is fighting to get the ordinance passed on the ballot and is looking for donations and publicity to get their message out. I encourage you to spread the word and donate if you can. If you buy your reusable shopping bags at Reusablebags.com between now and August 18, they will donate 1% of their proceeds to the cause.

I think Seattle has the right approach
I’ve done a bit of my own research and agree with the Seattle City Council that taxing bags is the way to go if they want to reduce disposable bag use. That city’s move is just a small part of a national and global trend to reduce plastic bag use and waste.

  • Palo Alto, California has banned plastic bags, and will be considering a tax similar to Seattle’s later this year. San Jose already has a tax ruling up for city council ruling this summer.
  • San Francisco passed a measure in 2007 banning the use of disposable, non-recyclable plastic bags in chains grossing over $2 million yearly. But that move may have been too limited, and appears to have had little overall impact on the problem of plastic bag pollution in San Francisco.
  • Ireland passed a 22 Euro cents tax on plastic bags in 2002, and since then use of plastic bags in that country has dropped 90%. (The American Chemical Council disputes this widely touted statistic.)
  • China imposed an outright ban on free disposable plastic bags in 2008. That move has saved almost 2 million tons of oil and cut use by 40 million bags in the first year, but has been blamed for the closure of the state’s largest plastics manufacturer just about a month into the ban, a time frame that makes me wonder if there was really a cause and effect.
  • Ikea started charging for plastic bags in US stores in 2007, a move that led to a 92% reduction in use. (I myself gave in and bought several large Ikea plastic totes last time I shopped at Ikea, and find them to be a wonderful bag for many, many uses.)
  • New York City had initially taken a different tactic, requiring large retailers to collect and recycle the plastic bags they give out to shoppers. The Bloomberg administration proposed a tax on plastic bags in January 2009, but has since backed down on the issue.

Speaking as a New Yorker, I can say I had have never recycled plastic bags at the market, and would support a tax on the bags here. When I shop at Costco, a store that does not supply bags, we use old boxes to carry our goods home. At Ikea, I but their reusable tote. But when I hit Gristedes or Food Emporium or even the Farmers Markets, I take the plastic bags they give me without thinking twice. I don’t think consumer behavior in this area will change voluntarily unless it is made either too costly or too inconvenient to do otherwise.

The American Chemical Council is aggressively fighting Seattle’s and other local measures aimed at reducing plastic bag use. In Seattle, they used out of state paid workers to gather signatures against the measure. In smaller municipalities, their tactic is to threaten lawsuits that cities cannot afford to defend.

It’s another case of the big corporation using their financial and political weight to bully local governments. But with the advent of the Internet, individuals now have the resources to counter the corporate giants.

So spread the word. And start using reusable shopping bags whenever you can.
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If you want to cut back on your plastic bag use, you’ll need another bag. Here are some resources –

Joplin’s “Solace” (Mexican Serenade)


Mike Nelson’s “Solace”
After I saw the movie The Sting in Bryant Park last week, I couldn’t get Scott Joplin’s soundtrack music out of my mind. Especially the lovely Mexican Seranade ‘Solace’ that plays as Redford and Newman lay down with their respective lady loves the night before they pull off the big sting.
Determined to learn the song on the piano, I went in search of the sheet music online. And stumbled across this hauntingly beautiful guitar arrangement by Mike Nelson that beats any piano playing of the song I’ve heard to date. Certainly better than my amateur piano pickings…
I commented on Mike’s You Tube page suggesting he record it. He informed me he already has – I picked it up on ITunes.
Enjoy.