Monthly Archives: August 2010

The pleasures and complexities of taste

Preparing food at homeThis week I discovered a wonderful new cooking and recipe blog, More Thyme Than Dough. It was started last February in response to these economically difficult times. More people are eating at home and need to prepare low-cost meals.

The website offers insights into food, delicious recipes with a detailed cost analysis, and beautiful, step-by-step photographs of the cooking process.

The physiology, evolutionary significance, and pleasure of taste

Back in March and April of 2009 I wrote a long series of posts on taste. I got interested in the subject when I came across the idea of supertasters – individuals who are overly sensitive to bitter tastes and, as a result, have their own peculiar food preferences. The percentage of people who are supertasters varies by nationality and ethnicity, but in the US it’s about 25%.

When More Thyme Than Dough contacted me about quoting one of my posts on taste (see the result at I Am not a Picky Eater!), I decided to resurrect them and present them here as a series. Read more


Knowing when you’ll die: Tony Judt’s last interview

Tony Judt on Charlie RoseTony Judt died on August 6. He had been diagnosed with ALS (Lou Gehrig’s disease) in September of 2008. Over the years he had been both guest and guest host on the Charlie Rose show. Rose interviewed Judt just eight days before he died. As you can see from the video, Rose was visibly moved as he introduced the interview – Judt’s last, as it turned out.

Contemplating death

Death is a huge uncertainty in anyone’s life. A friend once told me of a woman with leukemia who said “At least now I know what I’m going to die from.” For some, this knowledge brings relief.

What I find fascinating about the shared experiences of those with a limited time to live is the uniqueness of each response. What I find valuable is the opportunity to contemplate my own life and death.

Here is Judt’s answer to a question on his thoughts on dying and any insights into living.

I’m better on living than I am on dying because, until you die, you know nothing about it, but by then it’s too late. But I can tell you a little bit about the peculiarity of knowing you’re going to die and knowing when – roughly speaking.

Most of us, most of the time, have absolutely no idea where we’ll be in five years – you, me, anyone — anything could happen to a normal person. But we’re pretty clear where we’ll be next month: doing the same thing we’re doing this month.

My situation is exactly the reverse. I have no idea where I’ll be next month. I could be silent. I could be dead. I could be exactly like this. I could be in a variety of stages. But I know, absolutely with certainty – within reason – that I’ll be dead in five years. And that reversal of consciousness means that I am very focused upon life in the next two weeks.

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Teens benefit from later school start time

Teen asleep on library floorAn excellent, extended overview in the LA Times on studies that indicate a later school start time is better for teen health.

The medical reasons:

As kids approach puberty, scientists now know, there is a two-hour shift in when their bodies release melatonin, the hormone that causes sleepiness. As a result, teens and preteens find it impossible to fall asleep until about 11 p.m., even if they try to go to bed earlier. Yet teenagers still need an average of 9.25 hours of slumber each night.

On top of the shift in natural sleeping and waking times, … there is also a delay in when a severe dip in alertness occurs during the early morning hours. In adults, this low point hits between 3 a.m. and 5 a.m.; in adolescents, it falls between about 5 a.m. and 7 a.m. That means that, while their alarm clocks are telling teens to get out of bed and demanding that their brains perform, their bodies are screaming at them to keep sleeping.

The melatonin shift may happen as early as age 10 or 11.

Here are the health issues of early start times:

Overtired kids, studies suggest, struggle with depression. … In addition to the mood, behavior and learning issues, scientists are starting to uncover more subtle ways that such chronic sleep loss can hurt kids. Some studies, for example, show that sleep deprivation compromises the immune system. Others suggest that, with too little sleep, the body releases higher levels of hormones that induce hunger, possibly contributing to growing rates of obesity.

Tired teens may also be more vulnerable to falling asleep at the wheel. … To stay awake, young people often turn to coffee, soda, energy drinks and other caffeinated beverages.

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Palliative care: Lost and recovered

Victorian deathbedHere’s an excerpt from the third and last part of the interview with me by Dr. Lisa Marcucci at Inside Surgery. The question asked for a little known fact from the history of medicine.

Easing the pain of death was a common medical practice in the 19th century. The doctor’s black bag contained laudanum as early as the 1600s. The 19th century added morphine (1806), codeine (1836), and aspirin (1892), along with the anesthetics chloroform and ether. At a time when physicians had very little to offer patients by way of cures – other than the ineffective “heroic” measures of bloodletting and purges — it was palliative care that made physicians welcome at the deathbed.

In those days, easing pain at the time of death was not called palliative care, but euthanasia. The term referred to the outward death of the body, in contrast to the death of the spirit. Euthanasia literally means a good death.

In 1870 a school teacher named Samuel Williams published an essay that used the term euthanasia to mean something else: mercy killing. The essay generated considerable interest and discussion. To make a long story short, the original meaning of the term euthanasia was completely lost.

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Physician as lone practitioner

Marcus Welby in scrubsPart two of the interview with me at Inside Surgery appeared today.

There are questions on the writings of Atul Gawande, physicians who tell-all about their patients on their blogs, and how the practice of medical care has come to seem more like shift-work than the venerable profession it once was. Here’s an excerpt from that last topic.

In 20th century America, business and industry became bureaucratized and were subjected to outside control. The medical profession held out against this change for a very long time. It argued that the doctor/patient relationship was special and unique among professions and should be under the control of doctors and patients, not outside bureaucracies.

The medical profession may have also been concerned about loss of prestige and income, but the sanctity of the doctor/patient relationship was central to resisting external control. This more or less committed the practice of medicine to the model of the solo practitioner.

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The tyranny of health

Chocolate cakeSomething happened to the public perception of health and medicine in the 1970s. People began to adopt — and financial interests and the media began to profit from – “healthy lifestyles.”

This was not without consequences.

• Americans became increasingly preoccupied with diet, exercise, and health habits.

• There was a big uptick in the use of alternative “medicine” and stress reduction practices – acupuncture, chiropractic, herbalism, naturopathy, nutritional therapies, yoga, massage, biofeedback.

• The increase in news and advice columns on health and wellness made people more anxious about their health.

• The public sought medical care much more frequently for symptoms that would have been considered insignificant in the past.

Was “healthy lifestyles” a medical idea?

Health awareness and anxiety are nothing new. Throughout history people have been concerned about threats to their health. Bubonic plague killed 200 million people. The death rate for women who gave birth in the 19th century was 400 per 100,000 births, compared to 10 per 100,000 today.

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Blogging: Time to get over it

The blogging catDr. Lisa Marcucci, a trauma surgeon and Associate Professor of Surgery, recently did an interview with me for her very successful blog Inside Surgery. It was an opportunity for me to think about why I blog, among many other things. I talked much more freely about myself than I ever do on my own blog.

The interview is quite long and will be posted in three parts. Here’s an excerpt from Part 1, where Dr. Marcucci asks about the mission of my blog.

I started blogging because I wanted to understand something that changed medicine and ideas about health in the 1970s. Prior to that time, the policies of the Kennedy and Johnson administrations had assumed the state should be responsible for the health of its citizens. When political and economic thinking became more conservative in the 1970s and 1980s, governments began to promote the idea that individuals were personally responsible for their health and should practice healthy lifestyles.

A large segment of the population – mainly the educated and economically secure – welcomed these ideas. Feeling personally responsible for one’s health and practicing healthy lifestyles gives one the reassuring illusion of control. In particular, it’s a good distraction from the things that are beyond individual control, like salmonella in our peanut butter and the superbug MRSA at the gym.

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The end of privacy

The end of privacyDid you know there’s a Gmail feature – Mail Goggles – that will prompt you to solve simple math problems before you hit send? This “soft paternalism” keeps you from doing something you’d regret later. By default, it’s only active late at night on weekends, “when you’re most likely to need it.” You can adjust the settings, though.

Here’s a long article (at NYT) — by a law professor — that discusses the dangers of oversharing and the “behavioral economics of privacy” — the trade-offs we make, consciously or unconsciously, when we decide to reveal or conceal information. (emphasis added)

[A] challenge that, in big and small ways, is confronting millions of people around the globe: how best to live our lives in a world where the Internet records everything and forgets nothing — where every online photo, status update, Twitter post and blog entry by and about us can be stored forever. …

[T]here was the 16-year-old British girl who was fired from her office job for complaining on Facebook, “I’m so totally bored!!”; there was the 66-year-old Canadian psychotherapist who tried to enter the United States but was turned away at the border — and barred permanently from visiting the country — after a border guard’s Internet search found that the therapist had written an article in a philosophy journal describing his experiments 30 years ago with L.S.D. …

The fact that the Internet never seems to forget is threatening, at an almost existential level, our ability to control our identities; to preserve the option of reinventing ourselves and starting anew; to overcome our checkered pasts.

A collective identity crisis

People change. Not just from youthful indiscretion to mature adult, but – ideally – people continue to discover and pursue new interests throughout a lifetime. (emphasis added) Read more


Prescription drug abuse and the Osbournes

Legal drug abuse car crashI remember a scene from The Osbournes where son Jack, recently released from drug rehab, talks about finding a few stray particles of OxyContin dust in his pocket. He immediately consumed them as if his life depended on it. The craving was overwhelming. His description made the feeling of addiction palpable.

Some facts and statistics:

Physicans and other healthcare professionals abuse legal substances at the same rate as the general public.

• The number of emergency room visits for the abuse of legal, prescription drugs now equals the number of visits for illegal drugs. The number of visits has doubled in just five years.

• Unintentional poisoning from legal drugs is the leading cause of (unintentional) death among people between 35 and 54 years olds.

• Twenty percent of high school students have taken prescription drugs that weren’t prescribed for them. More students have used legal drugs than have used cocaine, methamphetamine, or ecstasy. They attend “pharm” parties. College students use Ritalin and Adderal to improve their grades.

• When celebrities die suddenly and unexpectedly these days, we’re treated to a laundry list of their prescriptions (Michael Jackson, Brittany Murphy, Corey Haim).

There’s no breathalyzer for DUI of legal drugs

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Tony Judt — continued

Tony JudtMore tributes to Tony Judt following his death on Friday.

Tony Judt, Historian And Author, Dies At 62 (NPR)

Focuses on the controversy over Judt’s position on Israel.

“I think he was one of the most important intellectual historians of our era,” said Rashid Khalidi, a professor of Middle East history at Columbia University and a friend of Judt’s. “He was also, I think, one of the most courageous public intellectuals of his generation.”

His 2003 essay on Israel caused a firestorm. In it, Judt called for a single, binational Jewish-Arab state in the Middle East. He lost many friends over that essay.

“I think he thought he was performing a public service,” said Khalidi. “I think he felt there is so much misinformation that it would be inevitable that he was saying things frankly and bluntly that people didn’t want to hear [and] would inevitably make him unpopular. I don’t think he cared about it.”

Tony Judt, scholar of European history, dies at 62 (Washington Post)

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I am saddened by the death of Tony Judt

Tony JudtI feel as if I’ve been on a death watch for Tony Judt all year. In his January essay, “Night,” in The New York Review of Books, he discussed his 2008 diagnosis of amyotrophic lateral sclerosis (ALS), commonly known as Lou Gehrig’s disease.

Helplessness is humiliating even in a passing crisis—imagine or recall some occasion when you have fallen down or otherwise required physical assistance from strangers. Imagine the mind’s response to the knowledge that the peculiarly humiliating helplessness of ALS is a life sentence (we speak blithely of death sentences in this connection, but actually the latter would be a relief).

Judt’s brilliant mind remained undiminished by the disease. He dictated a series of essays – autobiographical reminiscences with contemporary insights. They appeared in each new issue of the NYRB.

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Check out this medical blog

I have a post today at the blog KevinMD. Check it out.

Dr. Kevin Pho, a primary care physician in New Hampshire, has one of the most successful and popular health and medicine blogs on the web. MedGadget voted it the Best Medical Blog of 2008 and described it as:

an exemplary blog that features timely news and opinion of the latest in medicine, bringing in one of the most devoted audiences and keeping thousands of curious minds satisfied with smart and funny writing. While working on his own blog, Kevin has consistently promoted the rest of the medical blogosphere as a useful and reliable source for medical knowledge and opinion.

Given all that he does – his medical practice, an extremely active blog, writing for the New York Times/USA Today/, TV appearances, social media activity – I think Dr. Pho must have a secret source of energy.

I highly recommend his blog. It deserves all the success it has achieved.


The end of the American dream?

The American DreamA thought-provoking view of America and its future from the Financial Times of London.

What, then, is the future of the American Dream? Michael Spence, a Nobel Prize-winning economist, whom the World Bank commissioned to lead a four-year study into the future of global growth, admits to a sense of foreboding. Like a growing number of economists, Spence says he sees the Great Stagnation as a profound crisis of identity for America. …

The barometer is economic. But the anger is human and increasingly political. “I have this gnawing feeling about the future of America,” says Spence. “When people lose the sense of optimism, things tend to get more volatile. The future I most fear for America is Latin American: a grossly unequal society that is prone to wild swings from populism to orthodoxy, which makes sensible government increasingly hard to imagine. Look at the Tea Party. People think it came from nowhere. While I don’t agree with their remedies, most Tea Party members are middle-class Americans who have been suffering silently for years.”

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Should I stop taking calcium?

Calcium supplement pillsI generally resist changing my behavior in response to health news. Whatever research findings are touted this week could be contradicted by next week’s latest study. But I stopped taking calcium last week after reports of a correlation between calcium supplements and an increased risk of heart attacks.

Given the millions of women who faithfully take their daily calcium pills, this news reminded me of the 2002 announcement about hormone replacement therapy (HRT). After reassurance from physicians that HRT was the way to go, turns out HRT increased the risk of breast cancer, heart attacks, and strokes. With HRT, adverse effects began to show up after five years. With calcium, it’s 3.6 years.

Both incidents were complete reversals: Take it, it’s good for you … oh, wait a minute … don’t take it, it’s bad for you. Both affect a large number of people, especially women. Both were a bit of a shock for the public, I fear.

This isn’t news

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Afghan women empowered to practice beauty

Afghan girls practice beauty careIndependently of Time’s cover story on Afghan women, the New York Times ran a feature article on Afghan women, the Taliban, and the war. Like Time, it included a photo gallery of Afghan women, including this one.

In Mahmud-e Raqi, 12 teenage girls sat around a small trunk filled with beauticians’ tools — combs, boxes of hair dye, scissors, nail polish, hair spray — and watched closely as the instructor sat one of the girls in a desk chair and demonstrated how to cut off split ends evenly.

In most places in the world this scene would hardly be a sign of women’s liberation, but in this corner of Afghanistan, it meant a great deal. The girls, ages 15 to 17, had been allowed to come from their villages to the provincial capital; they will take home a trunk of beauty goods and can earn their own money in their homes by offering beauty services to women in their village.

The girls are attending a government supported course, one that empowers them to become the Avon ladies of Afghanistan.

Beauty and self-esteem

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Bibi Aisha: Fixing what can be fixed

Bibi AishaThe young Afghan woman on the cover of Time (see last post) is beautiful, as all the photographic cues imply she should be. Except … she doesn’t have a nose. The contrast between the sumptuousness of the photo and the missing nose increases the shock value of the image.

For many in the wealthy West, what this image undoubtedly brings to mind is the thought: “She could get that fixed.”

Sure enough, Time managing editor Richard Stengel tells us:

Aisha will head to the U.S. for reconstructive surgery sponsored by the Grossman Burn Foundation, a humanitarian organization in California.

If we didn’t know the surgery had already been arranged, any number of wealthy individuals or organizations would undoubtedly have stepped forward with an offer. In fact, the organization Women for Afghan Women reports that, in response to their outreach efforts for Bibi Aisha,

the response has been tremendous. We have had several offers from doctors and medical professionals in the United States for free travel to the United States, surgery and care for Bibi Aisha. There have also been Kabul-based doctors who have offered to do her surgery for free. The generous outpouring of offers of help has been moving for all of us, particularly for Aisha.

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