I love Hillary, but this is just too funny….
Thanks, Lou!
Garbage In, Garbage Out
Two of our finest docs were recently down-graded from premium status by a major insurer for providing sub-par care. Specifically, the insurer claimed that not enough patients seen by these docs got routine screenings with pap smears and mammograms.
I was asked to help review the data that led to this down-grade in designation for these docs. Here’s what we found –
Of the 209 instances where the insurer claims that patients did not receive either paps or mammograms according to recommended screening guidelines –
This, my friends, is how insurers measure quality.
TBTAM’s Recommends – An Equal Music by Vikram Seth
The best novel I’ve read this year is An Equal Music by Vikram Seth. It is the story of a violinist in a string quartet who reunites with his one true love, a gifted pianist with a tragic secret, 10 years after their relationship ended. The violinist wrestles with his own inner demons even as he tries to reclaim his love, hold onto his violin, make a living and stay united with his quartet.
This one of those books you want to read slowly, savoring every word. It is a journey into the inner world of music and the mind of the musician, narrated by one who is passionate about every note he plays. It was all I could do to keep myself from jumping up and heading to the music store to find a recording, any recording of the pieces descibed.
“This book needs a soundtrack” I told my husband when I was about halfway through the book. “I’m dying to hear this music.” Then I looked on Amazon – There is a soundtrack!
Buy this book. Buy the soundtrack. Read, listen and enjoy.
jUST A sUGGESTION
dEAR mR gATES AND mR jOBS –
i LIKE YOUR COMPUTERS A LOT. bUT i HAVE ONE SMALL SUGGESTION.
nEXT TIME YOU DESIGN THE KEYBOARD – cOULD YOU MAYBE PUT THE caps lock KEY SOMEWHERE FARTHER AWAY? mAYBE AT THE TOP OR SOMETHING? oR NEXT TO SOME LETTER i DON’T USE SO MUCH? mAYBE NEAR THE Q?
bECAUSE WHERE IT IS, i MUST HIT IT AT LEAST 50 TIMES A DAY. aND i CAN’T THINK OF THE LAST TIME i NEEDED CAPS LOCK, CAN YOU?
tHANK YOU FOR YOUR ATTENTION.
sINCERELY,
tbtam
Kiddush Quiche (say that 5 times fast….)
The Hebrew word Kiddush means a prayer recited at the beginning of the Sabbath or holiday, but can also refer to a reception held just after services, often in conjunction with a Bar Mitzvah. Food at a Kiddush tends to be light or sweet fare – salads, fish, bagels, wine, cakes.
We hosted a Kiddush at our home last month for our friend’s son on the night before his Bar Mitzvah. In this process I discovered that hosting a friend’s party is much less stressful that hosting your own, especially when they bring most of the food, which in this case included a varity of cakes and fruit, the most amazing of which was the chocolate flourless cake from the Silver Moon Bakery. Because the timing of services made me worried that some of the guests may not have eaten dinner, I added cheese to the menu of sweets and decided to make a quiche.
It was a good decision – the group pretty much devoured everything. And what a great group it was – the kids all got along well, and we adults re-connected with old friends and made some new friends, too.
Thanks to our dear friends for allowing us to play such a special part in this important event.
Leek, Red Pepper and (chicken) Sausage Quiche
I modified a recipe for leek quiche I found in the Professional Chef, and used my own pie crust recipe. Obviously, our friends are not Kosher, but if you are, skip the meat in this quiche.
1 recipe Pate Brisee
2 large leeks or 4 small ones, thinly sliced
1 red pepper
1 clove garlic
butter or oil
salt
cayenne pepper
1 1/4 cup half and half
3 eggs
4 oz grated cheese (I used Fontina, you could also use Jarlsberg)
2 tbsp fresh thyme, chopped
2 sausages (I used Applegate Farms organic pre-cooked chicken-apple sausages), diced
Prepare the crust
Make the Pate Brisee dough, roll it out and fit into a 10-inch tart pan. Partially cook it by either lining it with foil and adding pie weights, or setting a slightly smaller pie pan inside it. Bake at 425 degrees Fahrenheit for about 15 minutes till set. Then remove the foil and weights or smaller pie pan, prick the bottom with a fork and and bake another 5 minutes. Take out and let cool before filling
Make the Filling
Heat a small amount butter or oil in a saute pan. Add sausages and saute quickly over high heat to brown. Remove from pan to paper towels to drain. Lower heat to medium high and saute leeks, peppers and 1 tbsp thyme until leeks start to soften. Add garlic and saute a few minutes more. Season with salt, pepper and a pinch of cayenne. Remove from heat to cool.
In a medium sized bowl, whisk eggs and cream together. Stir in the grated cheese and the second tbsp thyme, season with salt, pepper and cayenne.
Assemble and Bake
Spoon the filling mixture into the tart crust. Add the egg mixture gradually, stirring carefully with a fork to distribute the filling ingredients evenly.
Set the quiche on a sheet pan and bake in preheated oven at 350 degrees Fahrenheit for 40-45 minutes until set ( a knife blade inserted into the center comes out clean) and lightly browned.
Serve warm or at room temp.
Misconception
“When two people are in a relationship, things sometimes get out of hand.”
Misconception is a fabulously quirky little film about the consequences of teen intimacy, produced for Apple’s Insomnia Film Festival by Cohlie Brocato, a student at Brooklyn College.
The Insomnia Festival is open to high school or college students, who have 24 hours to make and post a film to Festival’s Website. Viewers rate the films, the top 25 films get screened by industry bigwigs, and the top prize winner gets the tech tools needed to jump start their film career.
So head on over to the Festival Website to see this glimpse of the next Woody Allen in the making, and while you’re there, drop a vote for the film before Nov 9 (requires a brief registration).
Good Luck, Cohlie!
They Can’t Ban the Banned
What fun is a run without tunes?
Organizers of the NYC marathon seem not to have considered this question. Citing safety concerns, they’ve forbidden the use of headphones during this year’s race, forcing marathoners to leave their IPODs and MP3 players at home and run what may be the race of their lifetime without the motivating power of music.
That is, at least, until the runners cross the Queensboro Bridge into Manhattan and reach the corner of 63rd and 1st.
There they can hear the music of My Brothers Banned, a musical group whose sole purpose today is to play the tunes that will motivate runners to cross that finish line. It’s fun to watch as the runners legs all begin to move in time to the beat of the music, and even the screaming fans along the sidewalks are bouncing along to the music. When the music slows down and softens to instrumental jazz, Lyle Puente, the Banned’s lead singer, calls out encouragement over the microphone to individual runners.
The Banned, an eclectic, ever-changing group of musicians from Mohegan Colony, NY, has been coming down to play this spot in the marathon every year for the past 5 years. The group gets its name from founding brothers Lyle and Eric Puente, although only Lyle remains in the band today.
Today, the boys will play the marathon until the bitter end, their energy remaining high even as the last stragglers weave among the street cleaners and garbage trucks towards the finish line in Central Park. Then they will pack it up and head back home till next year’s race.
Their motto? “We bend with the wind and fall down laughing.”
Running to the Music of My Brothers Banned
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This is eighth in a series about NYC street life called I Get it on the Streets.
Deliciously Ugly Aubergines
“Is that a placenta or food?” asks my sister when she sees what I have made.
Very funny, sis. This stuff happens to be de-lish, despite it’s off-putting appearances. Making it perfect for my entry in the Ugliest Gourmet Contest being hosted by Not Eating Out in New York. And the first eggplant recipe that I actually like (I have a thing about the texture).
So shut up, close your eyes and eat it. You’ll thank me when you’re done.
Augergines in Spicy Honey Sauce
Modified from Tamarind and Saffron, by Claudia Roden, via BBC Food. Aubergines is what they call eggplant outside the United States. I like saying “aubergines”. It makes me feel so, well…European.
2 medium to large aubergines
Olive oil
Kosher salt
3 garlic cloves, crushed
2in fresh root ginger, grated or finely chopped
1 cinammon stick
1 1/2 tbsp cumin
A pinch of cayenne, to taste
6 tbsp honey
1 lemon or lime, juiced
1/2 cup water
1. Peel the aubergines and cut into rounds about 1/3 in thick. Dip them in olive oil, turning them over, and sprinkle with salt.
2. Cook on a griddle pan or under the grill, turning them over once, until they are lightly browned. They do not need to be very soft, as they will cook further in the sauce.
3. In a wide saucepan or frying pan, fry the garlic in 2 tbsp of the oil for seconds only, stirring, then take off the heat. Add the ginger, cinammon or cumin, cayenne, honey, cinammon stick, lemon juice and water.
4. Put in the aubergine slices and cook over a low heat, either in batches so that they are in one layer, or together – rearranging them so that each slice gets some time in the sauce – for about 10 minutes or until the slices are soft and have absorbed the sauce. Add a little more water if necessary. Serve hot.
Financial Conflicts – Show Us the Money
As terms of their settlement with the FDA over kickbacks to doctors, five hip implant device makers have posted payment amounts to consultant docs on their company websites, according to the Wall Street Journal Health Blog.
I went to the websites (links are in the blog article), and was shocked to see that some docs were earning upwards of a million dollars a year as consultants to the firms who manufacture the implants they use in their hip surgeries. In addition, it’s clear that academic medical centers are also reaping the rewards of their relationships with this industry.
I encourage you to head on over and look at the lists yourself. The experience of actually seeing these names and dollar amounts is quite different than just reading about it.
I don’t think there is anything inherently wrong with physicians having relationships with industry. But those relationships should be disclosed. Moreover, disclosing actual dollar amounts is an objective measure of the potential influence those relationships may have on health care decisions.
I for one would like to see this same kind of transparency in all physician- industry relationships.
MRSA – Great Advice from Dr Rob
Dr Rob has posted a brief, well-written Q&A on Methicillin Resistant Staph Aureus (MRSA) in his exam rooms and on his blog. Here are two of his responses to common questions about MRSA – head on over to his blog for the rest.
Q: Can MRSA be dangerous?
A: What made the news recently was a fatal case in a teenager in Virginia, so yes, it can be dangerous. Yet it is extremely rare that it would get this bad. To be dangerous, it would need to be ignored for quite a while.Q: Should I be worried?
A: Yes and no. While the big picture of antibiotic resistance is serious and must be addressed on an international level, it is not an immediate threat to your health any more than other medical problems. There are much bigger issues, like good nutrition, exercise, and immunizations that have much bigger impacts on your life than being worried about MRSA
Exactly the kind of calm, reasoned answers patients need. Thanks, Dr Rob!
Dogwood Fruit
I had no idea that dogwood trees have fruit until this fall when our new Kousa Dogwood (Cornus kousa) began growing these lovely pods.
Apparently these pretty little fruits are edible, but not very flavorful. I did find one recipe that uses them as a garnish, and suggestions of jams but no recipes. It seems the best way to eat them is to split them open and suck on the seeds (like a pomegranate)
Extracts from trees of the Cornus species are used in Chinese Herbal medicine along with other herbs in tonics. A Pub Med search revealed that these fruits contain Anthocyans, flavenoid anti-oxidants that may have anti-cancer activities. But I also read that the fruits can be slightly toxic and to avoid them in quantity.
I think I’ll play it safe and just enjoy them externally.
48 Hours in Istanbul
Well.
All I can say is if you have only 48 hours to spend in Istanbul, this is one nice way to do it. Hosted, wined, dined and entertained, not to mention meeting the most amazing people and getting to talk global health and politics. If only Mr TBTAM could have come along…
Day 1
My driver takes me on a brief tour (see previous post for more photos). From our conversation, it is clear that Istanbul is thriving. He and his family emigrated here from West Germany for work, as did most of his friends and fellow workers.
Istanbul is an intriguing mix of the new and the ancient, and mosques are everywhere. I only wish I could have seen more. But, this was a trip for business and not pleasure, so on to business…
That evening, after I had spend several hours working on my presentation, I meet my fellow conference speakers, most of whom hail from the European Society for Arts and Sciences, and from places such as Zagreb, Greece, Spain, Turkey and Qatar. We are all taken on a boat ride on the Bosphorus to a private mansion home on the Istanbul’s Asian side
where our hostess presented us with a wonderful dinner and a tour of her home’s 18th century Turkish Bath and Ottoman art collection. We were also entertained with traditional Turkish music and dancing of the whirling dervish.
There were TV cameras there, giving me a hint that this group hosting us was not an unimportant one in Turkey…
Coming back to my hotel room at the Conrad Hilton, I opened the bag of gifts from our hostess, and found a large sachet of lavender for my pillow, along with a beautiful painted plate and other mementos of Turkey. The hotel has turned down my bed, and left the slippers on the floor thus. (Can anyone tell me why they do this with the slippers?)
Day 2
Next day was the conference of the Turkish Business Women’s Association (TIKAD), held at a the restored Ciragan Palace on the Bosphorus. The Palace, once home to Sultans, was destroyed by a fire in 1910 and restored a decade ago to serve as a hotel and conference center.
The conference itself was extremely interesting, and focused on issues related to maternal health worldwide. I met some amazing amazing individuals who are personally working to reduce maternal and infant mortality in Turkey and the rest of the developing world.
The highlight of the conference was a visit from the Turkish Prime Minister Recep Tayyip Erdogan (that’s him above, and below with his wife and Bosnian artist Mersad Berber, whose work was on display at the conference).
Despite the recent threats of military action in northern Iraq, the Prime Minister repeatedly spoke the language of peace. Call me naive, but I found him believable. He stated his disappointment that Turkey, having one foot in the West and the other in the East, was not tapped to play mediator before we went into Iraq. He spoke of his commitment to continued improvement of Turkey’s infrastructure and the goal of a modern Turkey with membership in the EU.
I wish Erdogan had stayed to hear Denis Aribogan, the president of Bahçeşehir University, speak passionately about terrorism in the modern age. Aribogen argued persuasively that terrorism is a modern political construct that paints opposing parties as bogeymen, and uses the media to instill fear in the populace, ultimately leading to military solutions that kill more people than terrorism itself. Aribogen told me that she is speaking at the U of Virginia in March, and I encourage you to go hear her if you can.
The conference closed with another lovely dinner and a private concert by a prominent Turkish pianist and composer.
What about the food?
Of course, no post would be complete if I did not mention the food. What can I say? It was so varied, so delicious, so beautifully presented. Mr TBTAM, you will be happy to learn that I even found an eggplant dish to love – Mashed Aubergines. (Recipe to follow in another post.)
Postscript
Unfortunately, I am now forced to mention the rather bad case of gastroenteritis which presented itself to me on the plane ride home, which I am still battling today, and which I think nicely sums up my experience of modern Turkey.
Because you can better the economy, build skyscrapers, modernize the roads, grow the workforce, expand the Internet and hold glorious conferences in beautiful restored palaces.
But unfortunately, you still can’t drink the water.
Not Constantinople
That’s right, I’m in Istanbul.
Via my boss, who knows everyone everywhere in the world, I was asked to speak on Family Planning issues at the annual meeting of the Turkish Business Women Association. I have to admit I was not happy about traveling again so soon, but of course, now that I am here, I am so glad I said yes.
First Impressions (and photos)
It is so cool that one part of the city is in Europe (the left of that bridge) and the other in Asia (the right side).
I have never seen so many ships as in the Sea of Marmara. Apparently, they are all waiting for inspection and clearance to head up to the straight to the Black Sea. I’m told that the Marmara is not clean enough to swim in. And yet, I saw fisherman everywhere – along the Sea and jockeying for prime spots on the bridges. I can’t figure out how, if the water is too dirty to swim in, anyone would want to eat the fish…
I’m dying to hit the bazaars
The ancient architecture is as unbelievably gorgeous
as the modern stuff is ugly.
And the Turkish flag is EVERYWHERE. Apparently this a show of solidarity agains the Kurds in Iraq. (UPDATE – Wrong. It is because Monday is Republic Day…)
Despite the rising tensions between Turkey and Iraq, things appear quite safe here. There are toursists everywhere and everyone seems calm (though I did see a fair number of police). Then, just after I checked into my hotel, I heard a chorus of chanting voices, and a small but well-orqanized march passed down the avenue outside. I suspect these are Turks pushing for war.
That’s it for now. I have to hunker down and finish writing this talk so I can relax and enjoy myself. Tonight, a reception at a palace on the Bosphorus!
I apologize for the bad photos – I didn’t realize that my camera settings were on manual and the wrong ISO speed.
Screening Mammograms After Age 70
There are no universal recommendations for routine mammograms in women over age 70. That’s because we don’t have robust mortality data from mammogram use in this population. And so, older women are advised to make their own individual decisions about mammogram along with their doctor, based on other medical issues, life expectancy and health beliefs.
But do women have the information they really need to be deciding this question?
That’s what researchers at the University of Sydney asked when they did a study to determine what would happen if they gave women over age 70 Decision Aids (simple, visual aids) to inform their decision about having screening mammograms.
Here is an example of a decision aid. It visually represents the risk in 1,000 women over age 70 of being diagnosed with breast cancer over the next 10 years (brown boxes) if you do (right group) or don’t (left group) have a mammogram, as well as the chance you’ll have an unnecessary biopsy as a result of a false positive mammogram (dark purple boxes on the right).
The researchers found that while the women using Decision Aids made more informed decisions about having mammograms, the information did not impact the rate of mammogram use in the study population. There was an impact in that undecided women tended to get off the fence and make a choice, and women felt less anxiety and insecurity about the choice they made.
So, for most women, what Decision Aids do is make them feel better about their choices. Which says to me that most patients (and I suspect, doctors) make pre-determined decisions about mammography based on factors unrelated to the statistics of outcome, but use those statistics to support their beliefs, whichever way they decide.
Sort of like politics.
But unlike politics, those designing the decision aids are not trying to move votes, they’re trying to help you find the choce that’s right for you. If you’re undecided, or ucomfortable with your choice, a decision aid may be just the right thing for you.
Now if someone would just come up with a decision aid for the 2008 elections…
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The researchers are conducting a similar but web-based trial for younger women (over age 40). If you want to participate, or see what a decision aid is, click on the link below.
http://www.mammogram.med.usyd.edu.au/
It’s really interesting, I encourage you to do it. See if it changes your choice about mammogram or not. Or just makes you feel better about your choice.
