WHEN I see birches bend to left and right
Across the lines of straighter darker trees,
I like to think some boy’s been swinging them.
But swinging doesn’t bend them down to stay.
Ice-storms do that. Often you must have seen them
Loaded with ice a sunny winter morning
After a rain. They click upon themselves
As the breeze rises, and turn many-colored
As the stir cracks and crazes their enamel.
Soon the sun’s warmth makes them shed crystal shells
Shattering and avalanching on the snow-crust—
Such heaps of broken glass to sweep away
You’d think the inner dome of heaven had fallen.
They are dragged to the withered bracken by the load,
And they seem not to break; though once they are bowed
So low for long, they never right themselves:
You may see their trunks arching in the woods
Years afterwards, trailing their leaves on the ground
Like girls on hands and knees that throw their hair
Before them over their heads to dry in the sun.
But I was going to say when Truth broke in
With all her matter-of-fact about the ice-storm
(Now am I free to be poetical?)
I should prefer to have some boy bend them
As he went out and in to fetch the cows—
Some boy too far from town to learn baseball,
Whose only play was what he found himself,
Summer or winter, and could play alone.
One by one he subdued his father’s trees
By riding them down over and over again
Until he took the stiffness out of them,
And not one but hung limp, not one was left
For him to conquer. He learned all there was
To learn about not launching out too soon
And so not carrying the tree away
Clear to the ground. He always kept his poise
To the top branches, climbing carefully
With the same pains you use to fill a cup
Up to the brim, and even above the brim.
Then he flung outward, feet first, with a swish,
Kicking his way down through the air to the ground.
So was I once myself a swinger of birches.
And so I dream of going back to be.
It’s when I’m weary of considerations,
And life is too much like a pathless wood
Where your face burns and tickles with the cobwebs
Broken across it, and one eye is weeping
From a twig’s having lashed across it open.
I’d like to get away from earth awhile
And then come back to it and begin over.
May no fate willfully misunderstand me
And half grant what I wish and snatch me away
Not to return. Earth’s the right place for love:
I don’t know where it’s likely to go better.
I’d like to go by climbing a birch tree,
And climb black branches up a snow-white trunk
Toward heaven, till the tree could bear no more,
But dipped its top and set me down again.
That would be good both going and coming back.
One could do worse than be a swinger of birches.
Fortune's Son: The New York Times has a lengthy examination of John Edwards' trial work that reveals a good deal about the man's motivation, and that of most personal injury lawyers:
An examination of Mr. Edwards's legal career also opens a window onto the world of personal injury litigation. In building his career, Mr. Edwards underbid other lawyers to win promising clients, sifted through several dozen expert witnesses to find one who would attest to his claims, and opposed state legislation that would have helped all families with brain-damaged children and not just those few who win big malpractice awards. (emphasis mine)
Edwards rarely accepted cases in which a baby died during delivery (which, according to the article only bring in around $500,000 a case), preferring instead to concentrate on the multi-million-dollar-yiedling cerebral palsy cases.
We can say good-bye to what the Times refers to as "what they call tort reform" if Edwards is elected, that's for sure:
Mr. Edwards's former colleagues in the plaintiffs' bar certainly support his candidacy. His campaign is disproportionately financed by lawyers and people associated with them, according to the Center for Responsive Politics, which calculates that about half of the $15 million he has raised comes from lawyers. People associated with Baron & Budd, a Dallas law firm noted for its work on behalf of plaintiffs in asbestos cases, contributed $77,250, the largest amount, the center found.
Mr. Edwards has declined to discuss his fees as a lawyer or the size of his personal fortune. Senate disclosure forms suggest that he is worth anywhere from $12 million to $60 million.
That one of the country's biggest asbestos litigation firms - an area of litigation that abuses the legal system for profit even more than birth injury litigation - is his top donor should give anyone with an interest in truth and justice pause.
Despite widespread use of fetal heart rate monitors and increasing reliance on Cesarean sections to avoid complications, the rates of cerebral palsy have remained the same. It's a condition whose origin lies in multiple factors, many of which happen in utero long before delivery. Which is why those who are truly motivated by altruism rather than profit want to set up a fund for all children with brain injuries:
Some say that the biggest losers in litigation over brain-damaged babies are the parents of children whose cases are rejected by lawyers.
"For the one or two who got a substantial jury verdict," said George W. Miller Jr., a former state representative in North Carolina who practices law in Durham, "there were 99 that did not get anything, either because they were not able to finance litigation or their claim was questionable."
"The real issue," Mr. Miller added, "is who knows what causes these kinds of medical problems?"
He said he planned to bring up the issue of compensation with a state commission that is studying medical malpractice. One approach would be to limit awards and create a fund to be shared by all families with similarly afflicted children.
This is not the first time Mr. Miller has championed the idea. In 1991, his legislation to create such a fund was defeated, in large part by the state's trial lawyers. Among those who spoke out against the bill was Mr. Edwards, who called it a baby tax.
Odd that a Democratic politician would be opposed to a tax, especially one designed to help the weak and downtrodden.
Blood Sucking Parasites: Poor South Carolina. Not only are they being invaded by politicians in the upcoming primary, they're also plagued with bed bugs. According to this article, the resurgence is a national one, and one that's due to the decline of DDT use, rail travel, downtown hotels, and general-purpose insecticides:
After World War II, bedbugs subsided. Jones believes the widespread use of the pesticide DDT -- even to treat the clothing and possessions of returning solders -- was a factor. So were increased regulations on the sale of used furniture, she suspects, as well as the increased preference for single-family homes over shared housing such as apartment buildings, which give bedbugs easy access to a smorgasbord of food sources.
The type of pesticides that were used then and the way they were applied also reduced the bedbug population, Mannes said. General-purpose insecticides used to be applied in an untargeted, broadcast method for all sorts of pest problems, and those insecticides killed many more types of insects than the ones that were targeted, she explained. If a homeowner had his home treated for cockroaches, for example, the insecticide would kill bedbugs and other insects as well.
Snetsinger suspects even the shift from rail to motor travel, and the accompanying move away from old downtown hotels near railroad stations to newer motels, played a role in the bedbugs' subsidence.
Come to think of it, I have had several people come in with small, scattered bites recently. You can learn more about the little critters, including what they look like, here and here.
Medicare Solution: Scrappleface has a solution for the cost of the Medicare drug benefit. The senators will pay for it:
'Like any other business, when you make a mistake you have to eat it,' said an unnamed aide to Senate Majority Leader Bill Frist, R-TN. 'We can't go to the taxpayers and say 'Oops! We said we needed $400 billion of your money, but it's really $530 billion.' posted by sydney on
1/30/2004 09:32:00 PM
Job Satisfaction: A survey of NHS workers in London found that patients aren't a factor in physician job satisfaction:
Like most employees, doctors rated their work colleagues as a key factor in job satisfaction. Sixty one per cent of doctor and dentist respondents rated their colleagues as the most important factor in their job. By comparison, only 50% of nursing staff rated colleagues as the most important factor. But, whereas 20% of healthcare assistants rated their patients as one of the five most important factors in their work, patients were not ranked in the top five at all by doctors and dentists.
Most of the time, being with my patients is the best part of my work. But after this week, I have to agree with the NHS doctors. I began it with a hospital patient who complained incessantly that "doctors just aren't as dedicated as they used to be," because another doctor made rounds in my place last weekend. And this, after I got up at 5:00 AM, drove ten miles on icy roads and nearly slid off said roads twice just for the privilege of seeing him on Monday morning.
And it ended with a new patient whose husband has taken control of her medical management. I know this, because he told me up front that he has. He credits himself with saving her life twice from incompetent doctors. (I'm just the latest in a long line.) At any rate he was explaining to me what tests I should do to investigate a recent episode of medial rectus palsy. He's convinced that it was caused by the same condition he has.
Husband: Surely, you've heard of PTO.
Me: Ummm. No, I haven't.
Husband: Unbelievable. It's very common medical terminology. (Then, very slowly, as if talking to a person of limited intelligence or limited English) It. Stands. For. Patent. Foramen. Ovale.
Me: Isn't that PFO?
He didn't miss a beat, but launched into a condescending explanation of the physiology of patent foramen ovale. Who does he think he is? I'm the doctor. I'm supposed to play the role of the arrogant ass who doesn't listen. posted by sydney on
1/30/2004 09:03:00 PM
Great Expectations: Researchers confirm what experience tells us. Cancer patients who enroll in clinical trials don't do any better than those who opt for traditional care:
Scientists from Boston's Dana-Farber Cancer Institute and the Harvard School of Public Health found little convincing evidence that patients who had enrolled in clinical trials lived longer or suffered fewer recurrences or progressions of disease than did their counterparts who received standard treatment outside a trial.
The study wasn't a great one. It looked at other studies that dealt with outcomes of various clinical trials and found them wanting. But, that's been my experience with patients who enroll in clinical trials. They travel great distances at great expense to participate but end up dying with the same frequency as my patients who opt for local care. Which is why it's important, when a patient asks about clinical trials, to make it clear that if they want to do it for the good of others, then by all means do it, but if their expectation is that they'll be cured, they should give it a hard second look:
'Clinical trials are critical to the advancement of cancer care,' said lead author Jeffrey M. Peppercorn, whose study appears in the Jan 24 issue of the British journal The Lancet, 'but it is important that people who enroll in a study understand that their participation is intended primarily to benefit future patients.'
For many patients and families considering a clinical trial, however, the primary motive is not altruism but self-interest, a distinction that oncologists acknowledge is sometimes blurred by doctors seeking to recruit patients to their research studies or by those who believe care in trials is superior. posted by sydney on
1/30/2004 08:26:00 AM
Screening the Chaff: A reader comments on prenatal screening:
Most patients have absolutely no clue what is up with the triple screen, and their overworked doctors do not take the time to explain the real utility of this test. Cut away all the talk of risk, percentages and thresholds, and what you have at the end of the day is this- the decision is to abort or not. It is helpful to know about a handicap in advance, but we're kidding ourselves to think that the test was designed to improve prenatal care and planning. With the anxiety of an abnormal test result often hanging over their heads for days to weeks, most of the time due to false-positives, it's hard to say it reduces the anxiety of the patient population overall. Not to mention the incalculable anguish of losing a chromosomally normal child from amniocentesis complications.
Once I explain the test in this light- that the triple screen, amniocentesis, and CVS check for conditions about which WE CAN DO NOTHING except offer termination, most of my patients look at me like I'm nuts, and refuse the test. I do encourage AFP-only testing, as it really does help to know about NTD in advance given the improvements in fetal outcomes with prenatal surgery and scheduled C/S.
I have an even bigger problem with CF testing [cystic fibrosis - ed.]- a nonfatal disease with which many people live for decades- with their mind and soul quite intact, thank you. While I would never wish the condition on anyone, I certainly wouldn't wish away those who have it. It goes without saying that the Cystic Fibrosis Foundation is mute (literally- I ran a search on their website using "prenatal testing" and found 0 entries) on the topic. I was stunned that ACOG recommended this test be offered to all caucasian couples. What's next? Soon, we'll be able to test for every genetic defect, and patients will be given a checklist of what they want to have tested prenatally. Brave New World, indeed. posted by sydney on
1/30/2004 07:54:00 AM
Alternative Healthcare: The Wall Street Journal'sOpinionJournal calls for change in the healthcare system, and has examples of companies that have made things like health savings accounts work. It also has this breakdown of healthcare spending:
Hospital care 31%
Physician and clinical services 22%
Other spending* 22%
Prescription drugs 11%
Nursing-home care 7%
Program administration 7%
*Includes dental services, home health care, durable medical products, over-the-counter medicines, public health, research and construction.
Taken together, outpatient services and prescription drugs account for the majority of spending. These both also happen to be the most sensitive to consumer demand. And injecting some patient (and doctor) responsibility in paying for them would do a world of good when it comes to cutting costs. posted by sydney on
1/30/2004 07:52:00 AM
Thursday, January 29, 2004
All in the Spin: Do medical and dental xrays do more harm or good? Depends on your bias. From the first link:
Radiation from X-rays in dentist surgeries and hospitals causes 700 people in Britain to develop cancer each year, researchers say today.
Although medical X-rays help diagnose disease, they have long been known to cause a small increase in the risk of cancer because of the radiation they emit.
...Researchers from Oxford University and Cancer Research UK estimated the size of the risk based on the number of X-rays carried out in Britain and in 14 other countries. According to their findings, published in the medical journal The Lancet, the results showed that X-rays accounted for six out of every 1,000 cases of cancer up to the age of 75, equivalent to 700 out of the 124,000 cases of cancer diagnosed each year.
From the second link:
Around 700 cancer cases a year are caused by X-ray examinations, a study shows.
But that works out at just 0.6 per cent of the 124,000 patients a year who are diagnosed with the disease.
....Dr Amy Berrington de Gonzalez, who led the study, said: ''The possibility we have over-estimated risks cannot be ruled out, but it seems unlikely we have underestimated them substantially."
Amazing how the same numbers can be used so differently.
UPDATE: A reader with radiology experience writes:
Your small blurb about the effects of medical radiation struck a chord as a radiologist. Statisitically, when you attempt to predict at the low end of the dose effect curve as these people do, you become very unpredictable and inaccurate, however, there is no question that when the studies are reviewed, that even low dose radiation is carcinogenic and will be responsible for causing some cases of cancer in the population at large. How many, is really another question, as I said.
That said, every physician who orders or interprets xrays needs to be mindful of these effects when they use them, especially as our need and use of medical diagnostic or therapeutic radiation is increasing dramatically. Many of our present diagnostic studies, particularly, the most used, diagnostic CT, is not as low dose as people may think. We are obtaining more and thinner cuts, dramatically increasing the amount of information we can obtain and the tasks we can perform with this modality, but at a tremendous radiation expense. It has been quoted, how accurate I don't know, that as much as 70% of the medical radiation dose to the American population is from diagnostic CT! When, for example, you see the dramatic increase in number in the use of say Chest CT's for the exclusion of pulmonary embolism, this is believable and quite frankly staggering. Our typical patient for this study from the ER, is an under 50 woman, with vague respiratory symptoms. This study has become so easy to order and fast to do, that no corroborating studies are obtained prior to getting the study. No blood gases, no d-dimers, no chest xrays. We have patients returning to the ER frequently, who get these studies, all negative, sometimes as frequently as 6 times in 6 weeks. This would also apply to the use of abdominal CT. This is distressing. When you directly see the tremendous overuse of this modality, you start to realize, that applied to the population as a whole, this is going to have a price to pay and radiation induced malignancy is it.
Hmmm. We do use CT scans of the chest a lot, and the abdomen, too. And then, when the radiologist sees something that's not quite normal, but not quite abnormal, either, he usually recommends a follow-up CT scan in a few months. And then, they see something else in the follow-up CT scan and recommend yet another. I have a couple of patients who are on their third or fourth follow-up CT for uncertain findings that, truth be told, are done more for our own protection than theirs. Yet another way our litigation culture is influencing healthcare - and health.
Small Things Considered: Watch out for those rubber ducks (requires subscription). They may look innocent, but they have as many germs as an Asian bird:
It is widely documented that toys, particularly shared toys (such as those in day-care centers and doctors' waiting rooms), can be reservoirs of infection. It is also well established that polluted water is an important reservoir of infection of many kinds. A neighbor of mine, a toddler, had diarrhea due to giardia infection, and one of the antecedent events was the swallowing of several gulps of stagnant water squeezed from a bath toy in an outdoor wading pool.
Before Dr. Marx, a doctor might or might not have given sedation or pain relief in childbirth, said Dr. Paul L. Goldiner, chairman of the anesthesiology department at the Mount Sinai School of Medicine in Manhattan. 'She single-handedly pushed the development of obstetric anesthesiology as a specialty.'
Understanding SARS: Looks like one reason the SARS virus had such a variety of patient responses was that it evolved over the course of the outbreak:
In the first people infected it was virtually identical to viruses taken from civets, weasel-like animals valued for their meat and sold in markets in southern China.
As the virus spread more freely from person to person, it mutated slightly, apparently adapting itself better to live in humans. That was when the 'super-spreading' occurred that made the virus so frightening -- including the case of a doctor who infected several people at a Hong Kong hotel.
The virus then gradually evolved into a more stable genetic form toward the end of the outbreak, Wu's team reported. posted by sydney on
1/29/2004 08:57:00 PM
Nigeria is to test samples of the polio vaccine next month in the hope of resolving a dispute with Muslim authorities which has helped spread the crippling disease to children across Africa.
Three predominantly Muslim states in northern Nigeria stopped immunizations in November because Islamic authorities suspect the vaccines of spreading infertility -- which they believe is part of an American conspiracy to depopulate Africa's most populous nation.
From the Mail Box: A reader describes the call for universal amniocentesis as a "eugenics program masquerading as reasonable medical practice":
Thanks for your post on the little eugenics program masquerading as reasonable medical practice. I wonder if you also feel the same way about the "triple screen test." My wife is a Ph.D. in engineering with, obviously, a strong background in statistics. We looked at the stats for triple screen, and given the range of both false positives and false negatives, it seemed like all you'd actually get out of the test was an (unnecessary) recommendation to get an amnio or a false sense of security. Our Ob/Gyn for our first child (youngish woman) seemed nonplussed. Our current doc (older man) didn't bat an eye (we have a baby boy due in April).
[Also, in keeping with your themes about how insurance, etc. is making it harder to practice medicine, our first Ob/Gyn left her practice, along with the Obstetrician who delivered my daughter, to set up a practice to do laser removal of varicose veins. When two excellent Ob/Gyns in their late 30's -early 40's, with all that training and experience, decide to do cosmetic surgery instead of deliver babies, you know something is very, very wrong in the American medical system, and the problem is not with the doctors].
The triple screen is a blood test that checks for three markers of possible birth defects -human chorionic gonadotropin, estriol, and alpha-fetoprotein. The idea behind screening is to 1) help the parents and the doctor prepare for an abnormal child or 2) allow the option for an abortion if all is not normal.
I feel the same about the test as the writer, and never opted to have it done during any of my pregnancies. My last obstetrician disagreed with my decision, though. He had recently, unexpectedly, delivered a baby with a severe neural tube defect that required a lot of intensive intervention at birth and he wanted to minimize the potential for nasty surprises at the bedside. He respected my decision, but he wasn't happy about it.
On The Doctors Dean: More reader mail:
It seems to me that the Dean family comes as close to having it all as humanly possible:
- He went into politics, she's stayed in medicine.
- She didn't pretend that she had become a political junkie; he obviously didn't try to force her to. (Bravo for both of them!)
- He was the away parent, she was the close to home parent.
Obviously there's a lot of love, loyalty and flexibility in the Dean family. Both parents have allowed the other to follow their heart. That's something to celebrate, not criticize.
It was bad enough when the "little woman" was supposed to stay in the background; now, in these enlightened days, we demand that the wife make almost as many public appearance as her husband, the candidate. The wife of a candidate is still expected to fulfill a demeaning stereotype, just a different one. So much for progress.
Testy Economists: John Derbyshire noted recently that economists tend to be scathing. He's right:
I like your site, and am a regular reader, but you demean yourself when you make derogatory comments about fields of research you know nothing about. Your pompous suggestion that the entire field of econometrics (which has been around for nearly a century) amounts to "making stuff up" is absurd. If you have a problem with the specification of the model or the data used by Eric Finkelstein and his colleagues, then you should explain what exactly your objection is. If you have no credible objections, then the decent thing to do is apologize to Finkelstein et al. for baselessly denigrating their work.
I think I said they "took a wild guess", not that they "made things up." There's a difference. But, when a conclusion is based on a model rather than reality, then it's just a theory, not a fact. Especially when that model is defined this way:
An econometric model is an economic model formulated so that its parameters can be estimated if one makes the assumption that the model is correct.
It would have been much more accurate for the media had reported the finding as "Economists conjecture that obesity costs taxpayers billions of dollars," rather than stating it as an objective fact. posted by sydney on
1/28/2004 05:34:00 PM
CNN had a doctor on this morning who spoke of how physicians often prescribed antibiotics for viral infections knowing full well that it was useless at best. The stated reason for it was patient demand, and the docs didn't have time to explain that the antibiotics didn't work on viruses.
This sounded really lame to me, bordering on professional misconduct. I suppose it could be argued that there is a placebo effect, or that the patient would just go shopping for another doc, but even so.
Anyway, I thought this might be blogfodder for you. Is this self-prescription
something that you see? Don't third parties who pay for drugs say anything
about this? At one point does this become an abdication of responsibility?
Not only is this something I see, it's something I sometimes succumb to myself. There are no hard and fast symptoms or signs that distinguish a viral illness from a bacterial sinus infection. Most of the time we're guessing. And yet, there is one thing we know about respiratory infections. Most of them are viral, not bacterial. And yet we probably treat the majority of them as if they were bacterial rather than viral.
The reason we tend to do that as a profession is patient demand. Believe it or not, patient satisfaction is important to doctors. It wounds our egos when patients leave us, no matter how unjustified their reasons. It is by no means an adequate justification for prescribing needless antibiotics, but it is one of the underlying factors in the psychology of choosing whether or not to use them for upper respiratory infections. I've had plenty of patients leave me because I wouldn't give them antibiotics. Just yesterday one told me he was leaving for another, better, doctor because I wouldn't phone in an antibiotic for his cold symptoms. (Other doctors do it, don't you know?)
Insurance companies have no interest in the matter. They're even more attuned to customer satisfaction than doctors are. I once had a patient's wife report me to their insurance company because I wouldn't treat his clear nasal drainage (which he had for less than a day) with antibiotics. She told them I refused to provide him with needed medical care - and that was after I had spent time carefully explaining why it was important to avoid needless antibiotics. (I know about it only because the insurance company called me to investigate the complaint.)
The blatant misuse of antibiotics does border on the irresponsible, but I have the impression that fewer and fewer doctors are blatantly misusing them. It's just very difficult to resist the temptation to give in to demand sometimes, especially at the end of a long and trying day.
UPDATE: Here's one reader's experience with unnecessary antibiotics:
I found myself with a case of laryngitis. The last time I lost my voice it turned out to be walking pneumonia and since I have chronic asthma, I went to see my PCP. He told me that my lungs were perfectly clear and that laryngitis is almost always viral. I said OK and was ready to move along but then he offered me a prescription for antibiotics. I said, I thought you said laryngitis is usually viral. He said it is but if you want the drug for your peace of mind.... I said no thanks and found a new PCP.
I avoid antibiotics at all costs because they always give me a raging case of yeast folliculitis on my chest which makes me absolutely insane with itching and takes forever to clear up. Too bad this doesn't happen to more people because I can guarantee they would run screaming for the hills if anyone offered them unnecessary antibiotics. posted by sydney on
1/28/2004 05:28:00 PM
Belying Beauty: Hair dye may increase the risk of cancer, but bottle blondes don't have to worry:
Women who have been coloring their hair for 24 years or more have a higher risk of developing a cancer called non-Hodgkin lymphoma, U.S. researchers reported on Friday.
They said their study of 1,300 women could help explain a mysterious rise in the number of cases of the cancer that affects the lymphatic system.
Writing in the American Journal of Epidemiology, they said women who dyed their hair starting before 1980 were one-third more likely to develop non-Hodgkin lymphoma, or NHL, and those who used the darkest dyes for more than 25 years were twice as likely to develop the cancer.
....Zheng and colleagues studied 600 Connecticut women who had NHL. They were asked to specify what hair coloring products they might have used and when.
They were compared to 700 healthy women.
The Yale University researchers did not find any larger risk of cancer in women who started using hair dye in 1980 or later.
'This could reflect the change in hair dye formula contents over the past two decades, or indicate that recent users are still in their induction and latent period,' said Yawei Zhang, who also worked on the study.
Or it could be because women who began dying their hair before 1980 are older than those who began using hair dyes more recently. (Non-Hodgkins lymphoma is more prevalent in those over 50. posted by sydney on
1/28/2004 01:59:00 PM
Events Beyond My Control: We lost our home phone line early Tuesday morning in an ice storm. Since my internet access relies on DSL, I have to try to get my blogging in at work. Not easy to do. Even worse, I can't surf the web during my downtime at home. No word when the line will be fixed. Sorry for the paucity of posts. posted by sydney on
1/28/2004 01:55:00 PM
Tuesday, January 27, 2004
Blame the Wind: If air pollution makes you sick, don't look to wind power for a solution:
Onshore wind farms are a health hazard to people living near them because of the low- frequency noise that they emit, according to new medical studies. Doctors say that the turbines - some of which are taller than Big Ben - can cause headaches and depression among residents living up to a mile away.
One survey found that all but one of 14 people living near the Bears Down wind farm at Padstow, Cornwall, where 16 turbines were put up two years ago, had experienced increased numbers of headaches, and 10 said that they had problems sleeping and suffered from anxiety.
...Dr Harry said that low-frequency noise - which was used as an instrument of torture by the Germans during the Second World War because it induced headaches and anxiety attacks - could disturb rest and sleep at even very low levels.
"It travels further than audible noise, is ground-borne and is felt through vibrations," she said. "Some people are having to leave their homes to get away from the nuisance. Yet, despite their obvious suffering, little is being done to relieve the situation and they feel that their plight is ignored."
I can see how noise could be detrimental to sleep, with the resulting insomnia causing depression, headaches, and anxiety. But, there isn't a lot of hard data in the story. Have to wonder, though, if the noise is that distressing to people, what does it do to nearby wildlife?
Devaluation: Researchers, well at least one researcher, is calling for amniocentesis for all pregnant women, regardless of age, to weed out less than perfect babies. Current practice is to offer the option of amniocentesis to women thirty-five and older because their risk of having a baby with a chromosomal abnormality (such as Down's Syndrome) was greater than the risk of having a miscarriage from the procedure. A new study says that the procedure should be offered regardless of maternal age, not because the risk of a chromosomal abnormality is the same as miscarriage with the procedure, but simply because it allays fears of having a defective child:
Statistically, the odds of a 35-year-old woman having a miscarriage following amniocentesis are 1 in 200, as is the likelihood of her having a child with Down syndrome or another chromosomal abnormality. The older a woman, the greater her risk of having a genetically abnormal child.
In a previous study, published in 2000 in the journal Obstetrics and Gynecology, the researchers discovered that for most of the women surveyed, the anxiety about having a child with Down syndrome outweighed the fear of a miscarriage.
In the new study, the researchers quantify their earlier conclusion by arguing that the provision of such amniocentesis information to pregnant women of all ages is cost-effective. Thus, from now on, doctors advising pregnant females, no matter how young, should inform them of the availability of amniocentesis as a way of determining their babies' genetic risks, said study chief Dr. Miriam Kuppermann, of the University of California at San Francisco, in a telephone interview.
'Prenatal diagnostic testing should be offered to pregnant women irrespective of maternal age or risk,' the study says."
Here's how the study decided that universal amniocentesis was cost effective:
In the USA, compared with no diagnostic testing, amniocentesis costs less than US$15 000 per quality-adjusted life year gained for women of all ages and risk levels. The results do not depend on maternal age or risk of Down's syndrome-affected birth. The cost-utility ratio for any individual woman depends on her preferences for reassurance about the chromosomal status of her fetus, and, to a lesser extent, for miscarriage.
And how do you measure "quality-adjusted life year gained"? How many "quality-adjusted life years" do you lose if your chormosomally normal baby grows up to be a juvenile delinquent? Or to develop a post-natal medical problem? How many "quality-adjusted" years do you gain if you have a child with Down's syndrome and discover that you love them and enjoy being with them? And is one "quality-adjusted life year" really worth $15,000? Seems a rather high price just for the alleviation of pregnancy jitters. posted by sydney on
1/26/2004 08:13:00 AM
Sunday, January 25, 2004
What Kind of Diet Are You? Dr. Lisa Sanders is a rare find - a thin person with empathy and compassion for the overweight and obese. She's also an internist who specializes in researching and treating obesity, the author of the New York Times Sunday Magazine column " Diagnosis", and now an author of her own diet book - The Perfect Fit Diet .
Dr. Sanders describes her book as a refuge for those who have been beaten and defeated by the likes of Dr. Atkins, Dr. Dean Ornish, and countless other popular diets. As a clinician, she's seen and treated the refugees from these fads. And it's this treatment approach that she shares with the rest of us in her diet book.
Her premise is a sensible one. We are all individuals, not mass-produced robots. Just as we metabolize drugs differently, we metabolize foods differently. A diet that works well for one person won't necessarily work well for another. To complicate matters even further, food is much more than a source of nutrition for the vast majority of us. There are cultural and emotional undertones, not to mention taste preferences, to our food choices that make following any given diet for the rest of our lives difficult, at best. And that's the beauty of the Perfect Fit Diet. It takes all of these factors into consideration to style a diet that accommodates individual lifestyle, psychology, medical history, and food preferences.
That also is its drawback, however. For, unlike those block-buster diet books, which give the consumer a litany of do's and don'ts, this one requires work. Hard work. First, there's the assignment of keeping a one week food diary, a strict accounting of every morsel that passes the lips - the amount, the time of day, the setting, the degree of hunger, and the motivation for eating it. Not only is this time-consuming, but it requires a willingness to confront one's weaknesses head on. Such self-examination is crucial to any successful behavior modification, but it doesn't come easy to most of us.
And it isn't just food habits that must be documented and examined. Exercise habits and their intensity and duration need to be recorded, too. And not just planned exercise, but activities like walking down the stairs or around the corner to pick up a newspaper. That's a lot of documentation.
Then, there's the data gathering. If you haven't had your blood pressure taken, or your cholesterol or blood sugar checked lately, you'll need to have that done for this diet. If you have, but you don't have the results, then you need to get them. Again, the reason is a sensible one. A diabetic, for example, wouldn't do well on a high carbohydrate diet. A person with high cholesterol would do poorly on a high fat diet. Still, it doesn't make following this diet any easier to know that you have to go to the doctor to have the testing done in order to find your perfect fit.
And then, there's the Perfect Fit Questionnaire - forty three pages of multiple choice questions about personal preferences, eating habits, exercising habits, laboratory values, and family history that, like one of those internet personality quizzes, places the reader in one of three categories - carbohydrate counter (low carb), calorie counter, or fat counter. Answers to the quiz also direct the reader to sections of the book that cover advice on how to adapt the various diets to reader taste and temperament.
And, finally, if you're unlucky enough to fall into the "carb counter" category, you have to test your urine for ketones for the first two to three months of the diet, to make sure you're not eating too many carbohydrates. (Restricting carbohydrates makes the body use up its fat stores to provide energy. Ketones are a by-product of that process.) It's an extra step that helps the carb-counter monitor their progress and adherence to the diet, but it's also one that's likely to turn a off a lot of dieters.
It is a very sensible approach, and one that is likely to work, if you're willing to put in the work. Unfortunately, when it comes to weight loss, what the public wants is a magic bullet. That's why weight-loss pills and surgery are so popular. And unfortunately, that's why Dr. Sanders, as sensible and honest and medically sound as her book is, isn't likely to garner the glory and fame of an Atkins or an Ornish. As Dr. Sanders puts it:
Albert Einstein once defined insanity as asking the same question over and over and each time expecting a different answer. If that is true, we are a nation of nuts. We go on weight-loss diets to get rid of the weight our "real diets" have put on us. Then, whether we are successful in our weight-loss diet or not, we go back to our old diet and, whad'ya know, if it made us gain weight before, it will do so again, because nothing has happened to change that diet.....You have to change the way you eat every day. And that is not easy.
There's nothing easy about the Perfect Fit Diet, either. But if you have the fortitude to examine yourself and your habits honestly and to stick with it - forever - it's much more likely to take off the pounds and keep them off than any of the other diets on the bookstore shelves.