Give a Laptop, Get a Laptop

One Laptop Per Child, an organization that is building and distributing laptop computers to children in the developing world, is offering a free laptop for every one you donate.

This is the first time the revolutionary XO laptop has been made available to the general public. For a donation of $399, one XO laptop will be sent to empower a child in a developing nation and one will be sent to the child in your life in recognition of your contribution. $200 of your donation is tax-deductible (your $399 donation minus the fair market value of the XO laptop you will be receiving).

It’s a great little laptop – built around a Linux operating sytem, rugged enough to resist the wilds of Africa and the dangers of your kid’s commute to school. Best part? The screen is visible in sunlight.

The Give one, Get One Offer runs till November 26. I ordered mine today. My daughter is ecstatic, and I hope some kid in Africa will be too.

Why not order yours?

Butternut Squash Soup with Fried Sage Leaves

A visit from Mr TBTAM’s sisters on a crisp fall day called for a great soup, and what could be better than butternut squash soup? Serve it with a green salad and warm bread.

Butternut Squash and Apple Soup with Fried Sage Leaves

This recipe is a modification of the pumpkin bisque recipe from the Professional Chef, with a bit of advice from Irene. The fried sage leaves as my addition.

1 large onion, diced
2 stalks celery, diced
3 cloves garlic, minced
3 tbsp butter
1 really large butternut squash (or two medium squash) , peeled, seeds removed and cut into 1 inch cubes
3 apples, peeled, cored and cut into 1 inch cubes
4 cups vegetable stock (or chicken stock)
2 oz cup white wine
1 tsp minced ginger
Salt and pepper to taste
30 fried sage leaves for garnish

Melt butter in a saute pan, and saute onion, celery and garlic.

Add squash and apples, saute a minute or so, then add vegetable stock. If needed, add a bit more stock or water so veggies are just covered.

Bring to a boil, then turn down heat and simmer, uncovered, until tender, about 30 minutes or so, stirring occasionally.

Meanwhile, bring the wine to a simmer in a small pot. Add the ginger, remove form heat and steep until cooled to room temp. Strain.

Let the soup cool slighty, then puree in batches in food processor. Return to pot, reheat and stir in the wine. Season with salt and pepper. Pour into bowls. Garnish with sage leaves.

Fried Sage Leaves

30 sage leaves
Flour (optional)
4 tbsp olive oil
Kosher salt

Rinse the sage leaves and allow to dry. Dust lightly with flour (optional) Heat the olive oil in a small pan. Add the sage leaves and fry for about 30 seconds. Remove with a slotted spoon and drain on paper towels. Salt before serving.

Cervical Cancer and Birth Control PIlls

A recent meta-analysis has confirmed that use of birth control pills slightly increases the risk of cervical cancer. But before you stop your pills, take a deep breath, relax and read further.

Because the risk is really small. How small? Well, if you live in a developed country (meaning you have access to Pap smears), use of the pill for 10 years increases your chance of having cervical cancer from 3.8 per 1,000 to 4.5 per 1,000.

Remember that the real cause of cervical cancer is not birth control pills. It’s infection with the Human Papilloma Virus (HPV).

But estrogen metabolites of the pill may make your DNA more susceptible to changes induced by the HPV virus. The pill can also make the glands of the cervix more exposed to infection by the HPV virus. The other big factor may be that women taking the pill may use condoms less frequently, thus making them more likely to get HPV.

The good news is that once you stop the pill, the increased risk of cervical cancer goes away. That means that when you get older and don’t need birth control, you won’t be paying the price for your decision to use pills when you needed them to prevent pregnancy.

Bottom line – limiting your number of sexual partners and getting pap smears regularly are the most important things you can do to prevent cervical cancer. There is also a vaccine to prevent HPV, but remember that it only protects against 2 of the 12 subtypes of HPV that cause cervical cancer, so it’s not a panacea.

And remember, the pill cuts the risk of ovarian cancer, a protective effect that lasts up to 20 years after you stop the pill. It also reduces your risks of endometrial cancer. And keeps your menstrual cycles shorter, lighter and less painful. Not to mention it prevents pregnancy.

A Gynecologist’s Perspective

I’ve been a practicing gynecologist for 20 years now. In that time, I can remember only 1 case of cervical cancer in my private practice, in a woman age 60 who was completely cured with a hysterectomy. (The cancer was so small they could not find it in the hysterectomy specimen because I had removed it all with my office biopsy.)

I recall many more cases of cervical cancer from my residency, most during my oncology rotation, and all in women who had not had pap smears in years. I remember vividly the woman who presented to the ER bleeding from a large cancer on her cervix. She had not seen a doctor since giving birth to the last of her 7 children, who was now 25 years old. I don’t think she ever took birth control pills.

On the other hand, I’ve lost count of the number of unplanned pregnancies that have occurred among my patients, and the number of my patients who have had abortions for an unwanted pregnancy.

Given this experience, I see no reason for woman to stop taking the birth control pills because of concerns about cervical cancer.

I can think of only one situation where I might tell a woman to stop the pill for this reason. That is the rare patient with recurrent cervical dysplasia and persistent HPV infection that does not clear. I had one such patient, and I changed her to the progesterone-only pill. She is doing well.

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 –

  • 191 received these services, and we had documentation to prove it.

  • 5 saw a different doc in our system, but had the services in question

  • 1 was referred for a mammogram, never went, and has not been back to the doc in 3 years.

  • 7 never saw any of our docs

  • 5 have not been back to see the doc in 2-3 years, and at their last visit, had the services.

      • 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

      _______________________________________________________

      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.

      Other Blogger Reactions: Pharmalot, Dr Wes

      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.