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.

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…
____________________________________________________

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.

Was it Defensive Medicine or a Necessary Test?

Hemorrhagic Ovarian Cyst

Here are the facts as CBS presented them last night-

A young college student presents to the ER with abdominal pain. She gets a CT scan. The CT scan shows an ovarian cyst. Dad, who is an MD, gets the bill for over $8,000, most of which is for the CT. Dad goes on CBS says his daughter should have had an ultrasound because it was cheaper. He says it is because the ER docs were practicing defensive medicine.

What we do not know is anything else. What was the history of pain? Sudden onset or gradual onset? Lower or upper abdominal? Associated nausea and vomiting? Fever? New sexual partner? Urinary symptoms?

We also are not told what the young woman’s exam showed. Did she fever? Was the pain right or left sided? Rebound and guarding? Absent or hyperactive bowel sounds? CVA tenderness? What did her pelvic exam show? Cervical motion tenderness? Cervical discharge?

What about her lab findings – UA, Hemoccult, CBC, Pregnancy test?

So many little details that would have informed the discussion. But we were not told any of them. The poor ER doc barely got a word in edgewise.

There are three possibilities as I see them –

1. The ER docs did everything right. Based on the history, physical and lab studies, they were worried about an appendix, and decided she needed a CT. An ultrasound could show an ovarian cyst, but ovarian cysts are incredibly common and not necessarily painful. They can certainly co-exist with an inflamed appendix.

In this case, if the patient had had an appy, and a delay to diagnosis had led to rupture because she had a sono and then the CT, CBS’s story would be about how Dad is accusing the ER for failing to diagnose daughter’s appendicitis in a timely fashion.

2. The patient presented with signs and symptoms typical for an ovarian cyst (sudden onset of pain mid cycle, no fever or elevation in white count, negative pregnancy test, pain improving as she waited in the ER), and the doctors either didn’t get a full history or misinterpreted the clinical scenario. In that case, Dad is right, not because the ER docs were practicing defensive medicine but because they did not use clinical judgement.

3. The ER docs order a CT on every patient with abdominal pain because they are practicing defensive medicine. That’s what the news story implied.

Unfortunately, we’ll never know what really happened, and so we cannot have an informed debate about the topic. And that’s a shame, because it is an important topic. Maybe Kevin, MD knows what really happened, since he was interviewed for the spot. (Congrats, Kevin!)

Of course, in the days before CT, this young woman would more than likely have ended up in the OR with an appendectomy and removal of her ovarian cyst. Now that would have been a big bill….

UPDATE

The Dad-Doc in the story has weighed in on the discussion in the comments section below (Thanks, Dr Bob!). Here’s what he said –

I am the Dad-Doctor in the CBS piece. Here is more clarification:

1. No fever
2. Cursory hx and exam by PA
3. No pelvic exam

In my experience, today’s ER’s have become CT Triage Centers

Autumn Cookies

Maria is asking me for an easy, fast recipe for a special autumn treat to give out to her friends to celebrate this wonderful season. Here ya’ go, Maria…

Assuming you have a food processor, these cookies are both easy and fast. You can make a batch in a single sheet pan, so no problems with your small oven. I can put together a batch in about 25-30 minutes, which is also the cooking time. So, if you do back-to-back batches, you can crank out quite a few cookies in an evening. Plus, they store well either in an airtight container or in the freezer. Put wax paper between layers in a rubbermaid or tupperware box.

KRUNCHIES

This is Irene’s recipe, I’m not sure where she got it. I used a combo of walnuts and pecans in this batch, and made them in a 9 1/2 by 12 inch cookie pan, but they were a little too thick for my taste. You should make them as directed below in a 13 x 18 inch cookie sheet – you’ll get more cookies, and they’ll be thinner and crisper.

2 cups flour
¼ tsp. salt
1 cup sugar
½ tsp. cinnamon
2 sticks cold butter
1 egg, separated
1 tsp. vanilla extract
1 cup finely chopped nuts (pecans, filberts, almonds, pistachios, in any combination)

In food processor mix flour, salt, sugar and cinnamon. Pulse several times to mix. Cut each stick of butter into 8 pieces and add to flour mixture. Pulse until crumbly. Add egg yolk and vanilla and process until dough forms a ball.

Pat thin on large (13 x 18 in) cookie sheet with sides. Smear surface of dough with unbeaten egg white. Pour off excess egg white. Sprinkle evenly with chopped nuts.

Bake in pre-heated 350 degree oven for 20 to 25 minutes till lightly browned. Check at 15 minutes to keep from burning.

Remove from oven and cut in squares while they are hot (I use a pizza cutter), then place the cookie sheet on a rack to cool. When cooled, carefully lift the cookies out using a narrow spatula to avoid breaking them.

Pate Brisee

Pate Brise (from Pleasures of Cooking)
You won’t find an easier crust to make or work with than this. This recipe is for a partially cooked pie crust to be used with a quiche type tart. If using for pies or fruit tarts, don’t pre-bake. Just roll out into pan and fill.

1 2/3 cups unbleached, all-purpose flour
1 tbsp. sugar
1/8 tsp. salt
12 tbsps. unsalted butter
4 ½ tbsps. ice water

Process the flour, sugar, salt, and butter to the consistency of coarse meal, about 10 seconds.
Pour ice water through feed tube while processing. Stop motor as soon as dough begins to form a ball.

Turn out onto a lightly floured surface and shape into a disc about 1 inch thick.

Roll dough into a 15 inch circle and fit it into an 11 inch tart pan with removable bottom. Prick all over with a fork and refrigerate about 25 minutes or until ready to bake.

Preheat the oven to 425 degrees. Cover the shell completely with a round of aluminum foil and fill with 2 cups uncooked rice or beans. Bake for 15 minutes. Carefully remove the foil and weights. Bake 5 minutes more, or until golden. Let cool before filling.

Family Heirloom Cookbook – Corn Chowder

It’s called the The Casserole Cookbook (© 1952). My mother-in-law Irene cut her culinary teeth on that book, learning to cook by following its simple, easy to use recipes and menus. Looks like she picked a good teacher – over half a century later, it’s listed by Saveur as one of its favorite cookbooks.

Over the years, the recipes in The Casserole Cookbook became Mr TBTAM’s family’s standards. Recipes like Shephard’s Pie, Pastistio, Veal Marenga (Irene substituted chicken livers in that one), Onion Soup, Meatballs Stockholm, Charleston Shrimp and Rice Pie, In a Hurry Baked Salmon (silly name, apparently delicious), Creamy Macaroni au Gratin (that’s Mac and Cheese to you and me), Spare Ribs, and the delicious soup I tasted last weekend – Corn Chowder.

I can’t say that I married Mr TBTAM for his mother’s cooking, but it sure sweetened the deal. And even though I have had 22 year’s worth of Irene’s cooking, I have never quite gotten over the envy I feel when I imagine the meals I missed by not growing up in that family. I don’t blame my Mom, who had to get dinner on the table every night for 9 kids, but let’s just say that Hamburger Helper was one of our family standards…

A few years ago, Mr TBTAM’s sister Nancy somehow convinced Irene to give her the Casserole Cookbook, and she’s been hoarding it ever since. If the condition of the book is any evidence, I’d say she’s been using it almost as much as Irene did. The paper cover is gone, as is the frontispiece and much of the introduction.

But who cares? What’s left is pure gold – recipe after recipe of tried and true standards, all easy to make and all delicious. Many, of course, have been tweaked and updated by Irene, and her handwritten additions and modifications make Nancy’s edition priceless.

We’ve been talking for years about how to get the recipes to all of us, but no one seems to have the time to type them all up. But today, I checked the web and there are 7 copies of the book out there – 6 on Alibris and 1 on E-Bay. Enough for Irene, myself and Mr TBTAM’s sisters, with a few leftover for my family. Now I just have to borrow Nancy’s copy so I can add in Irene’s modifications.

You see, some parents want their kids to have the education they missed, or the house they could never afford, or the freedoms they never had.

I’m just making sure my kids don’t miss out on the food.

Southern Corn Chowder (from the Casserole Cookbook)

Nancy made this in a cast iron stock pot, and it was delicious! It’s a great way to use frozen leftover corn. Of just buy frozen corn and cook it before using. If you don’t want to use the pimento, use red instead of green peppers. Add a diced carrot for even more color.

1/4 lb salt pork (It’s healthier these days to use olive oil)
1 small onion, chopped
2 tbsp chopped green pepper
2 medium potatoes, cut into cubes
3/4 cup diced celery
1 1/2 cups boiling water (I like to use chicken stock)
1 cup whole-kernel corn, cooked
1/2 tsp salt
dash of pepper
1 cup undiluted evaporated milk, hot
2 tsp butter
2 tsp flour
1 tbsp chopped pimento

Cut pork into small pieces and fry slowly until crisp in a 3 quart Paris-style casserole (I have no idea what this is – ?La Creuset) Add onion and green pepper and cook 5 minutes. Add potatoes, celery and boiling water or stock. Cover and simmer slowly until the potatoes are tender. Add corn, seasoning and evaporated milk.

Melt butter in a small pan and blend in flour. Gradually stir into the chowder, stirring and cooking slowly until thickened. Garnish with chopped pimento. Serves 4.

Common Ground in the Battle over Abortion

I posted earlier this week about the recent Guttmacher Institute study on worldwide abortion rates which showed a decline in abortions worldwide, due in large part to increasing use of effective contraception. The study also found that anti-abortion laws do not lower rates of abortion, only drive it underground. At the end of my post, I expressed hope that those of us on opposite sides of the abortion debate would find common ground in promoting the use of effective contraception.

I think this Christian blogger has met me in that common ground. If she is the voice of young pro-life Christians, then there is indeed hope that one day abortion will become as rare as we all want it to be.

Mandi, let’s keep this conversation going (and growing)..

Is Medtronics in Trouble?

I, TBTAM the Marvelous, lowly disciple of Carnac the Magnificent, did not predict this…

In the last 72 hours, my previous post outlining My Predictions for the Medtronic Implantable Defibrillator suddenly began getting a lot of visitors, most coming from a google search on the term “sue Medtronics.”

Could this be the result of Medtronics recent recall on their defibrillator leads? Is it coincidental that Medtronics also appears to have pulled its DTC campaign for cardiac defibrillators?

I wonder how bad it really is? What happens, for instance, when I google the term “Medtronics”?

Uh, Oh. Not good. Three lawyer ads right at the top. And it looks as though like the first lawsuit has already been filed.

That’s too bad for Medtronics. Hopefully their DTC campaign netted enough profit to pay their lawyers.

But TBTAM the Magnificent is disturbed that she did not predict this unforseen product recall and its consequences. It could be that the radio signals emanating from my implantable cardiac defibrillator are intercepting the flow of predictive powers which comes from the Universe through my turban.

I think it’s time to call my lawyer…
________________________________________________________________

For a much more intelligent discussion of the Medtronic product recall, and advice on what to do if you have one of the recalled leads, see Dr Wes’s Blog.