Monday Medical Madness #1

Medical Madness:

I am genuinely surprised by the large amount of vitriol and misinformation spouted about healthcare by the average American.  Sometimes I write reasoned, personal responses to these people.  I’ve decided to post them here to reach a wider audience.

 

Monday Medical Madness #1:

Today we have the Facebook post of Mark, a 30-something, college-educated New Yorker, working for a financial publication, whose sibling is a critical care physician and whom I do know personally.


Mark on Facebook:

Finally with the hospital I’m getting some answers about my sick friend. He is apparently very dehydrated–drink your water my friends. But a doctor telling me I have to talk to a nurse or admin instead of him. Uh what? Are they deaf, are they stupid?

…And those so-called ‘doctors’ better answer my questions.

RoseBioMed:


Mark, the physician spoke with you briefly and then directed you to the appropriate resources to give you the appropriate (and very basic) updates about your detoxing friend. This is a fully correct approach. No physician is stupid or deaf in this scenario. Medicine is best served by a team approach. NB: Beware of the trite tale of the VIP patient who demands that only the Attending physician draw his blood. This patient is only shooting himself in the foot. The best person to draw that blood is a phlebotomist if the hospital has one; next an experienced nurse.



My little affirmation: Szymborska’s “A Big Number” in Medicine




Polish poet Wislawa Szymborska was awarded the Nobel Prize in 1996.  A couple of lines I find I often recall from View with a Grain of Sand: Selected Poems,published in the US in 1995:


Four billion people on earth,
  
but my imagination doesn’t cope well with large numbers.

It’s still moved by singularity.

from "Wielka liczba" (A Big Number), 1976
In medical practice, we are treating individual patients, yet our interventions are guided by evidenced-based medicine, ideally the results of large, randomized, prospective trials.  (But we don’t deny these studies are difficult, “proof” is difficult; see “Why Most Published Research Studies Are Wrong” by John P. A. Ioannidis.)
 
Using Szymborska’s words (my translation of them), we aim always to have our finger on both “large numbers” and “singularity.”  A very enjoyable way to build up knowledge of the former in oncology is the Chemotherapy Foundation Symposium, held every year in November (Saturday too) in New York.  Personally, I am very moved by individual patients and their families; my goal is to be the oncologist I’d want to be treating someone close to me.  The big numbers are fascinating too; another way to watch the progress of the biomedical marketplace over our entire careers.  This fall, I’m looking forward to beginning some additional formal training in clinical research.


Arcadia by Tom Stoppard in New York


at the Ethel Barrymore Theater through June 19, 2011

I just got my ticket and am looking forward to seeing Tom Stoppard‘s Arcadia in New York at the end of the month.  The first three reviewers on Amazon do a superb job of describing the play, so I’ll just link: 

Arcadia: A Play

Arcadia delves into the nature of truth through math, philosophy, love, literature (Lord Byron), and art with two compelling sets of characters in the 19th and 20th centuries.

For example:

1809:  13-year-old Thomasina and her teacher Septimus are sitting in the schoolroom.  Thomasina tells Septimus that his equations are only for commonplace manufactured forms.  Thomasina wants to create the kind of equations that make nature, such as an equation to make a flower rather than a circle, cone, or square.

1993:  Hannah is reading from Thomasina’s portfolio.  The pages are filled with iterated equations (the solution of one equation is the input for the next equation).  Valentine, a graduate student in math,  is surprised that Thomasina would be doing this because iteration has only been practiced since the 1970s.

This scene served to remind me of my 2009 weekend visit to Barcelona and seeing some Gaudí.

Sagrada Familia, Barcelona

We greatly appreciated the exhibit that deconstructed the nature shapes Gaudí used:

Especially fond of mosaics and dark blue, this reptile at Park Guell was a favorite of mine:

These are not quite the equations for flowers that Stoppard’s character Thomasina wanted, but this math art, made by a trained economist I know, would have pleased her, I think:

Euler’s Formula
pronounced “oiler” I learned

Algebraic Polynomials

A few Arcadia quotes:

Thomasina, age 13, to her tutor in Act 1 Scene 1:

“When you stir your rice pudding, Septimus, the spoonful of jam spreads
itself round making red trails like the picture of a meteor in my
astronomical atlas. But if you stir backwards, the jam will not come
together again. Indeed, the pudding does not notice and continues to
turn pink just as before. Do you think this is odd?”

“If you could stop every atom in its position and direction, and if your
mind could comprehend all the actions thus suspended, then if you were
really, really good at algebra you could write the formula for all the
future; and although nobody can be so cleaver to do it, the formula must
exist just as if one could.”

Thomasina:  Septimus, what is carnal embrace?

Septimus:  Carnal embrace is the practice of throwing one’s arms around a side of beef.

Thomasina:  I hope you are ashamed.

Septimus:  I, my lady?

Thomasina:  If you do not teach me the true meaning of things, who will?

Septimus:  Ah.  Yes, I am ashamed.  Carnal embrace is sexual congress, which is the insertion of the male genital organ into the female genital organ for purposes of procreation and pleasure.  Fermat’s last theorem, by contrast, asserts that when x, y, and z are whole numbers each raised to the power of n, the sum of the first two can never equal the third when n is greater than 2.

(Pause)  Thomasina:  Eurghhh!

Septimus:  Nevertheless, that is the theorem.

Thomasina:  It is disgusting and incomprehensible.  Now when I am grown to practise it myself I shall never do so without thinking of you.

Act 2 Scene 7:
Thomasina: No marks?!  Did you not like my rabbit equation?

Septimus: I saw no resemblance to a rabbit.

Thomasina: It eats its own progeny.

Septimus: (Pause) I did not see that.

20th century scholar Hannah in Act 2:

“It’s the wanting to know that makes us matter.”

Polish Sausage

A couple of facts about Beth McGregor:  she performs stand up (in 2009 charmingly PG-rated yet funny, especially in comparison to the sexually explicit lesbians with whom I saw her perform; in 2010 no longer PG yet still funny and skilled) and created a web show, teaches at an all-boys elementary school in Manhattan, and is the lovely younger sister of a college friend of mine.  I’m reposting her cute anecdote:

[A] student said this today, as he bounded down the stairs: “This Polish sausage has errands to do!”

Understanding Autism 1 Question Survey

In 2013 the clinical diagnoses of Asperger Syndrome and Autism will be merged into Autism Spectrum Disorder. I plan to write about this and part of my explanation would involve the results of the single question survey below. Unscientific though it is, it’d be great if you could enter your answer for me. Thank you! Results in a couple of weeks.

Create your free online surveys with SurveyMonkey, the world’s leading questionnaire tool.

Healthy Christmas Eve Dinner

I have a hypothesis that for many people focusing on eating in a
“positive”
manner, consuming health-promoting ingredients and tasting the colorful flavors of food in simple preparations, could
be an effective psychological perspective to adopt.  Now, the one time I mentioned my innocent hypothesis was at a celebratory engagement dinner for 13 when the  entire table was talking about weight-loss drugs (in my view, another deserved part of the armamentarium), and a 60-ish socialite-type, a very proper-appearing woman, with both a father and a husband who were physicians, unleashed a bizarre barrage of shrieking illogical attempted personal insults on me in response.  Now that I have mentioned my little hypothesis here, I’d hope for reasonable, analytical responses.

I was fourteen when I started eating about one pound/450g of (usually frozen) broccoli, cauliflower or asparagus daily, just steamed and seasoned with spices or a little soy sauce, for health-promoting reasons.  I realize this is rather unusual.  But, I’ve read a lot of nutrition information over the years and have been confided in by numerous people with food and/or health issues.  The recently popular The China Study: The Most Comprehensive Study of Nutrition Ever Conducted and the Startling Implications for Diet, Weight Loss and Long-term Health has inspired  a lot of people to eat more vegetables, but one thing I take issue with is Campbell’s extrapolation of casein (a milk protein) condemnation to all animal proteins.  Last week’s NEJM has a study, Body-Mass Index and Mortality among 1.46 Million White Adults, that again shows a J-curve regarding BMI and life expectancy (and this has been shown before in cancer survival in particular).  BMI from 20.0-24.9 is associated with the lowest mortality. This is not most of America, but a particular socialite-type New York feature that continues to surprise me is the number of middle-aged female patients who confide in me and apologize to me for not being about 20 pounds lighter.  I actually always feel better about an average middle-aged patient who is stable at 140 pounds at 5’5″ (BMI=23.3) than a 115 pound (BMI=19.1) one. 

I’m an enthusiastic cheerleader for people interested in positive changes; most commonly:  being active, getting the heart pumping, and selecting healthy foods and portions.  Of course I’d like to see fewer people struggling with these issues.  Perhaps a focus on “health-promoting” ingredients and actions rather than on “denying oneself” could lessen the struggle for some.

Below I’ve included some dishes fit for convivial
holiday socializing  that contain a majority of health-promoting
ingredients, e.g. for those who like sweets the baklava-like dessert
I’ve included contains canola oil (omega-3s) rather than butter.  Perhaps enjoy with pinot noir (resveratrol)!  With the exception of the Red
Velvet Cake, all of these recipes are uncomplicated, not very
time-consuming in both preparation and clean up, and create great
leftovers, e.g. a stuffed portobello mushroom makes a good small lunch.

.
canola flower (aka rapeseed)


Other health-promoting ingredients include:

                       turmeric                      –              anti-Alzheimer’s and anti-MS in vitro
             cinnamon                   –              insulin modulator
                  
             garlic, ginger              –              antioxidants
                  
             chili powder               –              anti-inflammatory

             sweet potato              –               carotinoids

             asparagus, cabbage  –                thiocyanates
                  
             beets                         –                betanins are antioxidants

              cherries                     –                anthocyanins are antioxidants

              lettuce                      –                 folate

              onion                       –                 quercetin                 

              tomatoes                 –                  lycopene

              chick peas,              –                  fiber
               black beans
                  
              walnuts, fish            –                  omega-3s

              cashews                  –                  proanthocyanadins

              salmon                   –                   selenium
               

              shrimp, scallops      –                   lean proteins;                                                                              shrimp cholesterol being                                                                  health negative is
                                                                 controversial


Healthful Holiday Dinner
Appetizers

 1.  Kim Chi

 2.  Shrimp Dumplings

 3.  Asparagus

steam until bright green, sprinkle with soy sauce and lemon juice

Soups

 3.  Cream of Mushroom Soup (without cream)

 4.  Cream of Beet Soup (without cream)

in Roasted Acorn Squash

with Avocado

Polish Beet Soup with Mushroom Dumplings (barszcz z uszkami)


Vegetables

 5.  Sweet Potato Salad

 6.  Chickpeas in Star Anise and Date Masala

 7.  Stuffed Portobello Mushrooms  

Fish


 8Fish Wrapped in Romaine Leaves  

 9.  Miso Salmon

10.  Sri Lankan Shrimp  


Dessert


11.  Baklava Cake  

12.  Red Velvet Cake (American Cancer Society winner) 


My Red Velvet Cake looks nothing like this.

In Polish tradition Christmas Eve is without meat and there are 12 dishes (like 12 apostles), so I included 12 (eclectic) dishes here.  Other Polish traditions include eating the Christmas Eve meal (Wigilia)
only after the first star is seen in the sky and always having an extra
place-setting for an unexpected guest

Magforce’s Nanotherm for Glioblastoma Multiforme

Jason Chew at Biopharma Report posts about Nanotherm, an iron oxide nanoparticle treatment for solid tumors approved for glioblastoma in the EU in June 2010:  MagForce– Revolutionizing Cancer Treatment with NanotechnologyMagforce will launch the product in Germany in Q1 2011.

This is a new modality for Hyperthermia in Cancer Treatment .  The amino silane coating results in the particle being taken up preferentially in cancer cells while the  magnetic properties of iron oxide allows for a type of treatment through hyperthermia .  Application of an external magnet to injected particles produces a temperature increase that kills some cells and further sensitizes others to radiotheraphy and/or chemotherapy.


An Amino Silane

NB:  It goes without saying that I have no personal, professional, or financial connections to Magforce.

Thanksgiving: An AIDS Journal

The huge article in the Nov. 30, 2010 New England Journal of Medicine is Preexposure Chemoprophylaxis for HIV Prevention in Men Who Have Sex with Men
(free full text).  A lot has been and will be written about this
controversial study.  Just after Thanksgiving weekend I want to
set the stage with my little memory of a singular narrative of 1980s AIDS.

The first popular narrative medical non-fiction I recall ever reading is 

THE STORY OF GABRIELLE,

a slim volume written in the 1930s by the mother of a pediatric cancer patient, Gabrielle, who was about eight-years-old in the book.   I was about the same age when I read it.  In fifth grade we read Sadako and the Thousand Paper Cranes (PMC) (Puffin Modern Classics)

in school and I learned for the first time about radiation and leukemia.  In sixth grade I read Death Be Not Proud (P.S.)

from my family’s home library.  Clearly I valued these books, recalling them today even though I have not re-read them since elementary school.  Not an overly serious child, I recall that my favorite book that I read in sixth grade was actually Mrs. Frisby and the Rats of Nimh (Aladdin Fantasy).

The first popular narrative medical non-fiction I recall reading that made me cry is 
Thanksgiving: An AIDS Journal, which I found in an English used bookstore in Prague and finished on an overnight train from Prague to Krakow the summer I was seventeen.

Elizabeth Cox was a mother to two-year-old Luke when she helped her composer husband, Keith Avedon, overdose on morphine at the end of his short struggle with AIDS in 1987 (the year AZT was approved, just 25 months after showing efficacy in vitro).  Just a few years before, Elizabeth was an undergraduate student and flutist who exalted in writing term papers in her underwear at the apartment of slightly older Keith as they planned their future together.  Keith had never mentioned his earlier intimate relationships with men; Elizabeth and Luke were not infected.

(NB:  Like all of the linked books in my blog, if you click and buy
the book at Amazon, 4% of the price you pay goes to me rather than to
Amazon.)