Fighting Malaria – The Time is Now

World Malaria Map

This week’s issue of JAMA is devoted to malaria – a disease that affects over 300 million people each year and takes one million lives annually, most of them small children in Africa. In pregnant women, malarial infection can lead to preterm delivery, low birthweight and anemia.

The combination of increased attention, new drugs and new approaches to this serious global problem has created a window of opportunity that must be grasped now if we are to eradicate malaria from the earth. But it will take a concerted effort from governments, industry and the private sector if it is to work

Weapons in the Fight Against Malaria

  • Treatment: Artemisinin-based combination therapy (ACT) is the treatment of choice. Artemesin is a derivative of the plant artemisia annua, a Chinese herb that has been used for many years to treat fever. As is the case with many herbs, its mode of action isn’t entirely understood and it is non-patented. Research is ongoing to find new combinations and delivery systems for ACT’s. Both Novartis and Sanofi-Aventis sell ACT to endemic countries at a reduced, no-profit cost, but cost remains high in many areas and counterfeiting of unregulated product is an increasing problem. There is also increasing concern that resistance will develop.

  • Insecticide-Treated Nets (ITN’s): This is one of the easiest and cheapest strategies for preventing malaria. Sleeping under an ITN can reduce the risk of malaria by almost 50% and dramatically reduce perinatal disease and child mortality. A single bed net costs between 4 and 6 US dollars, family nets about $10.

  • Indoor Residual Spraying (IRS): Insecticide use remains one of the more controversial but highly effective approaches to eradicating malaria. Opponents are concerned about the environmental and health effects of insecticides. Proponents argue that in malaria endemic areas, until better alternatives are available, the benefits far outweigh the risks. I side with the proponents.

  • Prophylaxis in Pregnancy: In endemic areas where prenatal care exists, giving pregnant women sulfadoxine-pyrimethamine (SP) in the latter part of pregnancy can reduce anemia-related deaths and low birthweight.

What Works Best?

That’s a subject of much debate. Probably a combination of all of the above.

What Our Government is Doing

George Bush launched the President’s Malaria Fighting Initiative in 2005, possibly one of the few positive legacies of his presidency. He pledged to increase U.S. malaria funding by more than $1.2 billion over five years and challenged other donor countries, private foundations, and corporations to match his pledge. Of course, if even one quarter of the Iraq war budget were spent on malaria….

What Bill Gates is Doing

A little bit of everything, really, but one interesting thing is investing in One World Health , a non-profit pharmaceutical company that seeks to discover, develop and distribute drugs against malaria (and other diseases in the third world). He’s also donating to Medicines for Malaria, a public/private partnership between existing pharmaceutical companies and the public sector, which seeks to do the same thing.

What You Can Do

You can join the fight against malaria by donating to any one of the causes listed at the end of this blog post. Or just Google “malaria”. In an amazing show of how the internet can be a power for good, this will find you over a dozen organizations that are helping the cause.

I’m sending my dollars to Veto the Squito, a campaign launched by the Love, Hallie Foundation to buy ITN’s for kids in Africa.

Why Love, Hallie? Well, I have a bit of a personal connection. Love, Hallie was founded by my friend Sofia and her husband Ted in memory of their amazing daughter Hallie. Raising money to buy ITN’s is exactly what Hallie would have done, so that’s what I and my girls are going to do.

You do what seems right for you. But do something. Because the time is now.
_________________________________________________________________
Organizations that are Leading the Fight Against Malaria

Malaria Foundation International – $ 5 per net, 100% of your donation buys nets. Or set up a fundraiser. Or raise money via your website.

Veto the Squito: Kids helping other kids

CDC – Bed Nets for Children

Malaria No More – If you’re a soccer fan, this is your organization. Beckam is their spokesperson. His motto? “We need nets”. This is where American Idol gave part of their Give Back donations.

Nothing But Nets – Buy a net. Save a life.

AMREF (African Medical & Research Foundation) – They have projects in Tanzania, Ethiopia, Kenya and Uganda.

Sweat for Nets – Children helping children in partnership with the CDC.

Grand Rounds 3: 35

ImpactEDnurse is hosting this week.

Bloggers were asked to submit a post they are particularly proud of. It’s a smaller selection that usual (only 26 posts), but each is a gem. Truly the best of the best.

Head on over.

Thoughts on Medical Blogging

In this week that has seen the departure of three of my favorite medical bloggers from the public blogosphere (Fat Doctor, Flea, and now today, Dr Dork), it’s reassuring to learn DB’s Medical Rants is five years old today. (via Kevin, MD.) What’s even more reassuring to me is that Dr Bob is not anonymous and that his blog seems not to have led to any problems with his job as an academic physician.

Which leads me to comment on the doomsaying going around the medical blogosphere. I for one do not think that the medical blog is an endangered species. Sure, we’ve had a rough week. But we’re just getting started, folks. Because we are so new (except, it seems, Dr Bob), we’re having some growing pains. Painful as they may be, this is what it feels like to be on the forefront of something new.

And so we are all learning as we go. Because of the nature of what we are doing, the entire learning process is public. Which is not so good for the bloggers who’ve been hurt, but good for the rest of us.

Here are just some of the things I’ve learned these past few months from my fellow blogger’s experiences.

Employee Blogging

Blogging about one’s workplace or one’s colleagues is risky business, whether we are doctors, Google employees or bookstore clerks. Just because we are doctors does not mean we are immune to censure by our employers. I’ve thought a lot about this.

I do think, however, that being doctors gives us more protection than most employees from being fired for our blogs, don’t you?

Patient Privacy

Concerns about patient privacy are very, very real. And the disclaimers we put on our blogs may not be enough to reassure the public that they will not see themselves discussed on a blog someday. I don’t know the answer to this one, except that I find I am uncomfortable blogging about a specific patient without asking her permission. I’ve talked about this before, too.

Self-editing

Because we do not have editors, we must rely on ourselves to self-edit. Remember the old adage “count to ten”? Perhaps we need something similar. Like “Save it as a draft for 24 hours, and if you still feel the same tomorrow, post it.”

Maybe we should take advantage of our relationships with one another and ask for a little peer review once in awhile. If you’re worried something may be over the line, send it on to a fellow blogger you respect and ask their opinion before you post it. I for one would be happy to peer-review anything you’all want to send me, if only for the joy of getting to read it before everyone else does…

Shop talk

We are also learning that our rants can be interpreted by some as disrespectful to patients. And that “shop talk” commonly heard in the doctor’s lounge may not be appropriate when blasted throughout the blogosphere.

This is where private blogs may provide the “doctors only” locker room forum that we all need occasionally. Therefore I am hoping to get an invitation from Dr Dork to read his private blog and to visit Fat Doctor at her new invitation-only blog whenever she decides to re-enter the blogosphere…

The sad thing is that these private blogs will deprive the rest of the world of the opportunity to get to know these incredible individuals. And that is a damned shame.

Mean commenters

Some people out there who choose to comment in our blogs can be mean-spirited, foul mouthed and cruel. Just take a peek at the comments section over at Dr Wes’s blog after I asked him a simple question about a new test that my brother has been asking me if he should have. (I’m sorry, Dr Wes, to have stirred up so much annoyance for you…) This sort of cruelty led Dr A to take a blogging hiatus recently, although I am pleased that he is back. And now Neonatal Doc is on a blog-break for similar reasons.

I don’t have an answer for this one except to say “Neonatal Doc – come on back already!”

Anonymous or not?

This, of course, is the question that plagues me the most. Anonymity brings a certain freedom, doesn’t it? But I am beginning to believe that freedom is really just a false sense of security. After all, it is not freedom to say whatever we want without repercussions. It is not freedom to talk about others in public without them ever finding out. It is not freedom to say the first thing that comes to our heads without stopping to ask ourselves “Will I be sorry for this later?”

I’m beginning to side with Dr Rob that we should be willing to name ourselves. (His recent post “I am a blogger. I am a doctor” is a must-read for any new medical blogger.)

Revealing my identity makes it harder for me to fall into the “chat room” mentality that uses anonymity as a springboard for behavior that would never happen if my name was known. What I say, I stand behind. If I say something offensive, they have the right to challenge me. If I am wrong, I will say so and make the correction and/or apologize.

My partners know I blog. My staff knows I blog. My wife and my Mom know I blog. If my patients ask, I give them the URL of my blog. I am me on my blog – faults and all. Some people out there seem to think that medical professionals aren’t just normal people. Thanks to the “professionally offended,” we are losing voices of real people doing hard jobs.

 

I have been “outing” myself almost daily these days to patients who want to know more about what I may think on a certain issue. I’ve been holding back from telling colleagues, more so because most are not as into the internet as I am and probably don’t even know (or care) what a blog is.

To be honest, the main reason I haven’t made my blog public is that I hate my photo on our medical center’s website, and figure that if I reveal who I am, someone will google me and see that horrible picture…

Are there any Agreed Upon Standards for Medical blogs?

Thanks to Walter at Highlight Health for pointing out the existence of the Health on the Net Foundations “Code of Conduct” for medical websites. Bloggers that meet HON’s standards can apply for their accreditation. (Anonymity runs counter to the code).

Final thoughts

I want to personally thank Barbados Butterfly, Fat Doctor, Flea, Dr Dork and Neonatal Doc for the opportunity to read their amazing blogs. Their departure has left a gaping hole in the fabric of our blogging community. I hope that together we can re-weave it, but this time with threads that are strengthened from their experiences.

I also hope those who have chosen to leave the blogosphere will consider returning after they have had time to recover and reassess. Because we need their voice.

Roasted Cauliflower

Once you’ve eaten it, you’ll never want cauliflower any other way… Recipe from Cook’s Illustrated Magazine Jan 2007. (Thanks, Nancy!)

Roasted Cauliflower

1 head cauliflower
extra virgin olive oil
Kosher salt and fresh coursely ground black pepper

Preheat oven to 475. Trim outer leaves of cauliflower and cut stem short. Slice into flat slices, keeping the florets attached as much as possible. Place cauliflower slices on a foil lined baking sheet. Drizzle with oil and sprinkle with salt and pepper. Flip cauliflower gently over using a spatula and drizzle with more oil and season with more salt and pepper.

Cover baking sheet tightly with foil and place on lowest rack of the oven. Cook 10-15 minutes. Remove foil and continue to cook until bottoms of cauliflower are golden, 8-12 minutes. Carefully flip the cauliflower and bake another 8-12 minutes.

Serve hot with olive oil to drizzle if needed.

Declining Breast Cancer Rates – The Plot Thickens…

Breast Cancer Rates (From NEJM 2007. 356 (16): 1670)
The decline in breast cancer rates that begain in mid-2002 appears to have been sustained through 2004, according to a recent paper in the New England Journal of Medicine. This unprecedented drop in new breast cancer cases occured just after the publication of the results of the Women’s Health Initiative, when millions of American women stopped taking hormone replacement.

The coincidence in timing between the drop in HRT use and the decline in breast cancer rates is postulated as additional evidence for the link between post-menopausal hormone use and breast cancer.

But a paper being published in the June 15 issue of Cancer suggests another possible explanation for the drop in breast cancer rates – a decline in mammogram screening. According to researchers at the National Cancer Institute, mammogram screening rates declined by 4% between 2000 and 2005.

Mammogram Screening Rates (Breen et al. Cancer. Online 14 May 2007)

If this is the case, then the decline in breast cancer incidence is not good news, but rather a harbinger of not-so-good things to come – namely, an increase in later stage cancers.

I suspect that the drop in breast cancer rates will ultimately be found to be due to a mixture of both effects – a decline in HRT use and a decline in mammography. But it’s going to be sometime before all of this is sorted out.

Rates of Confusion about HRT and Breast Cancer

In the meantime, I would not recommend using this new data as carte-blanche to restart HRT, nor am I changing my Rules for Prescribing HRT.

And ladies, please get your mammograms.

Another One Bites the Dust…

Our dear friend Fat Doctor has closed her blog after being “outed” by a co-worker. Good to know that at least her job is safe.

We’ll miss you, FD. We’ll miss you a lot. Take care of yourself. And stay in touch – there are still comments, you know…

It’s a jungle out there, dear blogging friends, and we all need to be careful.

Heaven

Central Park on a sunny Saturday afternoon in early spring, watching your kid play softball. It doesn’t get any better than this….

Grand Rounds, Volume 3, No 33

Welcome to Grand Rounds, a carnival of posts submitted by medical bloggers every week. It’s the best of the medical blogosphere, and I am privileged to host this week.

This week’s grand rounds is dedicated to our favorite surgery registrar, Barbados Butterfly, whose blog was unceremoniously taken down not too long ago. I will not write here of the circumstances of her leaving the blogosphere, or posit the details thereof. I wish only to celebrate her as the quintessential medical blogger that she was.

Barb’s blog was everything a medical blog is supposed to be – well-written, thoughtful, honest, educational, entertaining, heartwarming, humorous, heart wrenching and above all, real. I only hope that I occasionally achieve what Barb did with every post of her blog. She was (and is) the best.

Barb, this one’s for you.

Best in Show (Read down the 1st letter of each section to spell out our favorite registrar’s name…)

Sid Schwab’s post War Story should be required reading for every president and every legislator before they decide to send us to war, and by every American who thinks they have an opinion about the war in which we are currently fighting. Link to it, email it, send to everyone you know.

Advice from medical bloggers

Planning on getting a full body CT? Have you thought about the radiation risks? Fortunately, Dr Wes has done all the work for you, so head on over to his post The Radiation Risk of CT Scanning and learn what you need to consider before submitting yourself to those rays…

If your patient has upper abdominal symptoms that don’t respond to medications, don’t wait two years before referring her for a scope. Dr GC George shows us why.

Looking for reliable health information on the Web? Tech Medicine take you on a tour of the search engines you can use.

Hyperlordosis. It’s not just for Pregnant Women. Jolie Bookspan tells us what causes it and how to avoid it.

Rants

#1 Dinosaur is on his soapbox this week, and who can blame him? The American Cancer Society is using patient surveys to imply that he is not doing enough to cajole his patients into routine screening. He attended the department meeting from hell and then was subjected to another hospital’s blatant advertising when all he wanted to do was buy some stationary. Head on over and give him some love, he needs it…

Grunt Doc takes on Intel’s Andy Grove Plan for Fixing Health Care. We hate it when folks with money think they know everything, and suggest that throwing their technology at a problem is all you need to fix it.

Better be careful…

Dr Enoch Choi is dealing with an outbreak of Listeriosis and a turkey recall. This is no small matter for pregnant women (or turkeys).

Privacy disclaimers are not the solution to maintaining patient privacy in email communications. But encryption may be. Read all about it over at the Haversion Canal.

Interested Participant tells us that they are considering banning plastic containers in Dubai. Do they know something we don’t?

Art (and Autism)

Artist Koen Hauser’s amazing photos merging anatomic details and human models are on display over at Unbounded Medicine.

Where are all the adults with Autism? As Kristina Chew tells us, “they are living among us”.

Diabetes

Kim at Emergiblog wonders and worries about how the young man she treated with newly diagnosed diabetes is doing. After reading her post, I’m worried about him too…

I wish we could somehow introduce him to Kerri from Six Until Me, who has learned to accept a lifetime spent with her diabetes by viewing it as Gromit to her Wallace. This wonderful post about how acceptance does not mean defeat is a must read for all diabetics (as is her blog). Also check out Kerri’s recent trip to the Big Apple, including an amazingly gorgeous photo of the tulips in Union Square.

The consequences of starting insulin therapy extend far beyond glucose control, especially if your patient is a truck driver, as Dr Hebert knows all too well. An excellent post that illustrates the delicate balancing act doctors and patients must play within the US healthcare system.

Is it time for a dating service for diabetics? Maybe located at Diabetes Mine? Looks like Amy’s considering it…

Obstetrics

Midwife with a Knife delivers Twins! Breech! Stat! (Great photos…)

Searching for Patients

Join the chase, as Universal Health searches for a lost demented patient in the halls of an old relic of a hospital in my home town.

It’s the last day of the month, and Psyched Out plays Bounty Hunter to try to find all her patients who have been MIA. God bless you, Psyche, for all that you do!

Business of Healthcare

Jay the insurance shopper is trying to pay as little as possible to get his lipoma removed. It leads him to consider how consumer directed health plans, like HSAs, could help control a lot of this country’s health care costs.

Generic Biologics – Could they reduce prices or are they just a bad idea? David Williams at Health Business Blog reviews a recent paper on the topic and weighs in on the question.

In his post Life, Liberty and Free Health Care, Bob Vineyard at InsureBlog exercises his first amendment rights and presents a counterpoint to every point made in what appears to have been a heated panel discussion about universal health care.

Personalized medicine and genomic health care – Eye on DNA interviews the CEO of Genomic Healthcare Strategies, and gives us a glimpse at a possible future. I was fine till I read the list of new stakeholders in this area, and realized just how much of the trend in health care is to take it out of the hands of physicians and put in anywhere else it will make money in a direct-to-consumer market. I wonder where the ethics in this brave new world will come from?

Unsung heroes – Let’s sing about them here

Val Jones tells the true story of a young girl who was given a second chance at life by a US plastic surgeon. She is planning to “pay it forward” by becoming a nurse.

Vitum Medicinus, a Canadian first-year medical student, tells of the incredible acts of a 14-year-old boy: including battling cancer, overcoming three recurrences, and his latest: writing a children’s book to inspire anybody battling adversity.

Trying to make things better

The folks over at Anxiety, Addictions and Treatments are encouraged by recent legislative action to create Health Centers of Excellence to respond to the mental health needs of returning Iraq and Afghanistan war veterans.

After all these years, racial and economic disparities persist in health care. Christopher Cornue explores this topic in the first of a series about this complex topic.

Touchy Topics

Teens and cybersex? Nancy Brown of Teen Health 411 tackles yet another touchy subject. As she puts it “Another reason to keep computers in public places.”

Dr Emer examines the reasons why patients might trust or not trust their doctors, including a discussion on how doctor-big Pharma relationships are viewed in the Phillipines, in his blog Parallel Universes.

ER Stories (and ethanol…)

Get out your Kleenex before you read this wonderfully sad story “Goodbye, from Poland” over at NY Emergency Medicine.

ERnursey shows us just how serious pneumococcal pneumonia can be. Scary…

Had a few too many Cosmopolitans? Head on over to Girlvet’s blog Tales of an Emergency Room Nurse, where you can join every drunk in the city sleeping it off in her ER

Reviews

Chronic Babe interviews film maker Daneen Akers about her film Living with Fibromyalgia. Daneen’s mother was diagnosed with fibromyalgia, and Daneen and her husband made this film to educate others about the condition.

Paul Auerbach, MD reviews a book called New Medicine: Complete Family Health Guide – How to use Complementary and Conventional Medicine for Safe and Effective Treatment. He seems to like it…

Family Stories

JC Jones, RN at Healthline has written a beautiful post about the intersection of a movie she loves (The Barbarian Invasions) and the death of her dad from prostate cancer.

Timing is everything, as Laurie Edwards tell us in her post about her Dad’s recent visit to the cath lab as she explores the what-ifs that could have led to a different outcome.

Susan Palwick posts in real time as she waits for the paramedics to respond to the 911 call she made after her mother slurred her speech and then stopped talking during their long-distance telephone conversation.

Life of a doctor

The life of a doctor is a series of choices between career and self. I hope Dr Brokeback makes the right one for herself.

Ali Tabatabaey at The Differential realizes just how important the “regular” little joys of daily life can be, especially when they are taken from us. A lovely little post.

So is being a doctor as glamorous as they say? TSCD of the blog Sunlight Follows Me (how much do I love that blog title?..) explores just what glamorous means in the real life of a doctor.

Yes, its May!

If May is better sleep month, then why am I up after midnight? Oh right, this Grand Rounds thing…

May is also Mental Health Awareness Month – and the theme in Canada is Work-life balance. I followed the links and took a quiz to discover I am a bit out of balance. Maybe I’m spending too much time blogging….

And finally, one last post – a beautiful tribute to our friend Barb, written as only Dr Michael Hebert can write it. So Long, Barb. We miss you and wish you all the best!

Next week’s Grand Rounds host will be will be Daniel Goldberg at Medical Humanities Blog. And thanks again to Nick Genes at Blogborygmi for creating and organizing Grand Rounds. You can check out Nick’s Web site for an updated list of past and upcoming Grand Rounds. Thanks for visiting!

HPV Mandatory Vaccination – "Private wealth should never trump public health"

Lawrence Gostin, JD and Catherine DeAngelis, MD have co-authored an extremely well-written editorial outlining the arguments against mandatory HPV vaccination in the May 2, 2007 issue of JAMA. The editorial can be accessed for free from the JAMA website.

Public health authorities, pediatricians, and infectious disease specialists, rather than political bodies, should drive mandatory vaccination decisions and policies… Since the manufacturer stands to profit from widespread vaccine administration, it is inappropriate for the company to finance efforts to persuade states and public officials to make HPV vaccinations mandatory, particularly so soon after the product was licensed. Private wealth should never trump public health.

The authors are careful to steer clear of arguments that oppose the vaccine on moral grounds. In my opinion, groups using these arguments have muddied the waters by framing this as a moral issue, when in fact, the most cogent arguments against mandatory vaccination are made from a public health perspective, and are medical, economic and scientific.

Hopefully this editorial can be used to combat the continuing attempts in states across the country to introduce mandatory HPV vaccination.

The driving force behind mandatory legislation has been Women in Government, a group of female state legislators that receives funding from HPV vaccine manufacturers for it’s “Campaign to End Cervical Cancer”. According to their map above, mandatory HPV vaccine legislation has been introduced in half the states as of March 14, 2007. To my knowledge, such bills have been vetoed in Texas and New Mexico, withdrawn in California and tabled in South Carolina, but approved in Washington DC.

What To Do If Your Cell Phone is Lost or Stolen

Not too long ago, my daughter lost her cell-phone. Like any reasonable person, she assumed that she had left it at a friend’s house, or at home or in her other purse. So she didn’t tell us for two days.

Days in which the person who found her phone racked up over $500 worth of phone calls to an island in the Caribbean.

Frantic calls to our carrier (T-Mobile) were fruitless, the policeman who accepted our report was pessimistic, and the fine print of our cellular service contract (which of course we never read) was unambiguous – we were responsible for any charges incurred up to the point at which we notified our carrier that the phone had been lost. Sorry.

Off I went to the web, and after a fair amount of searching, found nothing other than a lot of wailing and gnashing of teeth by cellphone customers like ourselves, and no advice from anyone other than to just pay the bill.

Undaunted, I scoured T-Mobile’s site and finally determined that, according to our contract, we could ask that our case go to arbitration. This request had to be in writing, of course, using the proper form letters, which were to be sent to both to theT-Mobile and the AAA (American Arbitration Association), along with a check to the AAA for for our portion of the arbitration fee ($25).

I was prepared to offer the arbitrators that we would pay the actual costs to T-Mobile for putting through those calls through, which I was sure was pennies on the dollar compared to what they were asking from us. But I felt I could effectively argue that T-Mobile should not be permitted to profit from thievery.

Mr. TBTAM sent those letters right off.

About 2 weeks later, we received a letter from T-Mobile informing us that they had recieved our letter, but that we still had to pay the charges. Still not a word from the AAA…

Then one night about two weeks later, we received a phone call from T-Mobile.

In studying our calling pattern, they said, they noted that we had never made any long distance calls on that phone before the phone was lost. (Of course, they could have figured that out when all this started…) And although I am not permitted to divulge the terms of what they offered us, let’s just say we felt entirely vindicated.

And last week, the icing on then cake – The AAA sent us our $25 check back!

So why, you ask, did T-Mobile suddenly change their mind?

The letter we received from AAA the next day answered the question. You see, it turns out that the AAA charges T-Mobile a whole lot of money for their arbitration services – in our case, $975 to be exact. Since our disputed bill was less than that, it did not pay T-Mobile to go to arbitration. Of course, T-Mobile knew that all along, but kept it to themselves, all the while continuing to demand that we pay the charges. I’m sure that most folks give up and pay the darned bill out of frustration, and T-Mobile counts on that. So they continued to stonewall until you go through the necessary steps to resolve the dispute.

According to an article I read recently, 25% of cellphones are lost or stolen every year. (I can’t find the reference, but I remember the data.) That’s millions of dollars in illegal charges for cellphone companies. While it is totally within the realm of available technology for them to intercept and confirm unusual calling patterns, it is in their financial interest not to do a thing to help stem these calls, and to do everything they can to ask us to subsidize this portion of their business.

The Bottom Line

If your phone is lost, the first and most important thing you must do it to notify your carrier. Despite this, someone may have racked up illegal usage fees on your phone prior to your notification.

If this happens, you must notify the police. Then get ready to fight with your carrier.

If they that you pay the charges, don’t give in unless you have no other recourse. Read the fine print, and do everything you can do dispute the charges, including going to arbitration. Since the arbitration charges vary depending upon the amount in dispute, I can’t promise the numbers will work out as well for you as they did for us.

But I suspect that in most cases, it won’t pay for your carrier to go to arbitration and you may very well find that you do not have to pay these illegal charges.

Good luck.

What To Do If Your Cell Phone is Lost or Stolen

Not too long ago, my daughter lost her cell-phone. Like any reasonable person, she assumed that she had left it at a friend’s house, or at home or in her other purse. So she didn’t tell us for two days.

Days in which the person who found her phone racked up over $500 worth of phone calls to an island in the Caribbean.

Frantic calls to our carrier (T-Mobile) were fruitless, the policeman who accepted our report was pessimistic, and the fine print of our cellular service contract (which of course we never read) was unambiguous – we were responsible for any charges incurred up to the point at which we notified our carrier that the phone had been lost. Sorry.

Off I went to the web, and after a fair amount of searching, found nothing other than a lot of wailing and gnashing of teeth by cellphone customers like ourselves, and no advice from anyone other than to just pay the bill.

Undaunted, I scoured T-Mobile’s site and finally determined that, according to our contract, we could ask that our case go to arbitration. This request had to be in writing, of course, using the proper form letters, which were to be sent to both to theT-Mobile and the AAA (American Arbitration Association), along with a check to the AAA for for our portion of the arbitration fee ($25).

I was prepared to offer the arbitrators that we would pay the actual costs to T-Mobile for putting through those calls through, which I was sure was pennies on the dollar compared to what they were asking from us. But I felt I could effectively argue that T-Mobile should not be permitted to profit from thievery.

Mr. TBTAM sent those letters right off.

About 2 weeks later, we received a letter from T-Mobile informing us that they had recieved our letter, but that we still had to pay the charges. Still not a word from the AAA…

Then one night about two weeks later, we received a phone call from T-Mobile.

In studying our calling pattern, they said, they noted that we had never made any long distance calls on that phone before the phone was lost. (Of course, they could have figured that out when all this started…) And although I am not permitted to divulge the terms of what they offered us, let’s just say we felt entirely vindicated.

And last week, the icing on then cake – The AAA sent us our $25 check back!

So why, you ask, did T-Mobile suddenly change their mind?

The letter we received from AAA the next day answered the question. You see, it turns out that the AAA charges T-Mobile a whole lot of money for their arbitration services – in our case, $975 to be exact. Since our disputed bill was less than that, it did not pay T-Mobile to go to arbitration. Of course, T-Mobile knew that all along, but kept it to themselves, all the while continuing to demand that we pay the charges. I’m sure that most folks give up and pay the darned bill out of frustration, and T-Mobile counts on that. So they continued to stonewall until you go through the necessary steps to resolve the dispute.

According to an article I read recently, 25% of cellphones are lost or stolen every year. (I can’t find the reference, but I remember the data.) That’s millions of dollars in illegal charges for cellphone companies. While it is totally within the realm of available technology for them to intercept and confirm unusual calling patterns, it is in their financial interest not to do a thing to help stem these calls, and to do everything they can to ask us to subsidize this portion of their business.

The Bottom Line

If your phone is lost, the first and most important thing you must do it to notify your carrier. Despite this, someone may have racked up illegal usage fees on your phone prior to your notification.

If this happens, you must notify the police. Then get ready to fight with your carrier.

If they that you pay the charges, don’t give in unless you have no other recourse. Read the fine print, and do everything you can do dispute the charges, including going to arbitration. Since the arbitration charges vary depending upon the amount in dispute, I can’t promise the numbers will work out as well for you as they did for us.

But I suspect that in most cases, it won’t pay for your carrier to go to arbitration and you may very well find that you do not have to pay these illegal charges.

Good luck.

Road Trip : Part 7 – The Road Home

Our trip back was to be a bit quicker than the one out, but we were determined to make this leg of our journey an enjoyable one. So we took a more roundabout way back up to Rt 81 via rte 26, a new highway that winds high up into the mountains. It’s the new road to Asheville, NC, where we had a pleasant 2 hour stop for lunch.

Asheville, NC


Asheville is a trendy little artist’s town nestled high in the mountains. It is fueled by an amazing community of artists and a real committment to providing them venues for their work. One could spend weeks seeing all the antiques, art and crafts in the Asheveille area. Some of the art space we visited was cooperative space, meaning that the artists see their own profit, rather than feeding the bankrolls of the gallery owners.

The town’s old Woolworth store has been converted into an artist superstore. If you’re lucky, you’ll meet the artist.But if not, just find your art, pick it up, and bring it to the check out counter.

Stop at the old soda fountain for lunch while you’re there.

The Asheveille area is loaded with antique stores and markets. Studio 5 Antiques on Patton St. specializes in old typewriters, and I almost bought this one home with me to use when I write my great American novel. There’s nothing like the clicking of a typewriters keys…

There’s a bit of the retro hippe feel to Asheville, and we encountered not a few street musicians who could have been plucked off the streets of Haight Ashbury in the 70’s.

Lunch was at the Bistro 1896, a moderately-priced upscale feeling restaurant with a modern side room. Ask to sit in the enclosed tiny room at the back for a special feel to your meal. I had the pork curry which was just right.

For dessert, we had amazing cupcakes from the Sisters McMullen Cupcake Corner on Patton. I don’t have a good photo of my cupcake, but it had the best white icing I have ever had. If anyone knows where I can get their icing recipe, do let me know….

All I can say is that our visit to Asheville was much too short. This is a great place to visit, and would make a great honeymoon destination. There is lots of hiking and nature as well as a little funky city with great restaurants and a good music and arts scene. I definitely want to come back and stay for a few days or even a week there, maybe this summer.

The Stonewall Jackson B&B

Harrisonburg is a largish town on Rte 81 in Northern Virginia. We had a reservation at the Marriot in town, but cancelled it thinking we would make it farther north. That left us looking for a room at 7 pm on a Saturday night inn a strange town. Fortunately, we passed a vacancy sign at the Stonewall Jackson B&B, and that’s where we spent the night. (Mr TBTAM negotiated us a good rate.)

What a sweet place! Our host Wayne and his son Roger were warm and attentive, and receommended a fine local Italian place for dinner. Our room was warm and comfortable, and had all the necessary emenities, including free wireless. Their motto is “A Night’s Delight and a Breakfast to Remember”, and it was. Thanks guys!

Home Again

Next morning we hit the road bright and early, and were back in Philly in time for Easter dinner with my family, then back to NYC. It was a great vacation, and we can’t wait to do it again next year!

Road Trip to Athens, Georgia: Part 6: Rachel’s Crabcakes

We were fed some amazing food this trip. Thanks to JB for a wonderful four course dinner, and to Joe and Rachel for the night of endless appetizers. I wanted to feature it all, but since these were the photos that came out best, we’re going with the crabcakes. Thanks, Rachel for sharing your secret recipe!

Rachel’s Crab Cakes

2 cups Crab
¼ cp. and 1 ½ cups Panko Japanese breadcrumbs
Handful of small diced red peppers (optional—sometimes I do, sometimes I don’t. I’ve also used celery, carrots, or green peppers.)
Chopped chives
1 egg beaten
2 TBSP. mayonnaise
Salt and pepper
Canola oil

Flake crab in large bowl. Add peppers, 1/4 cup of breadcrumbs, some chives, a beaten egg, the mayo and salt and pepper. Mix.

Make palm sized patties (squeezing tight). Adjust binding ingredients (mayo and egg) if the mixture is not staying together.

Put 1½ cups breadcrumbs in a flat bowl. Coat both sides of each patty with crumbs, then re-squeeze the patty and recoat it in breadcrumbs.

Heat ½ inch of oil in pan. When hot enough to sizzle a breadcrumb, put patties in oil until golden brown, then flip. Drain on paper towels.

Serve on mixed greens with lemon wedges and sauce mock roasted red pepper aioli (below).

Red Pepper Aioli

Put a roasted red pepper in the food processor and puree. Add 1 cup mayo, some squeezed lemon, and salt and pepper. Adjust seasoning and consistency. Sprinkle chives on top.

Next Up: The Trip Home (via Asheville, NC)

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