In the News: Serevent-related deaths and CT scans as a cause of cancer

Some FDA panel members recommend Serevent be taken off the market

Serevent, which is a part of the asthma blockbuster drug Advair, has been linked to sudden death in children. GSK claims there is no increased risk of hospitalization and mortality with Advair.

Serevent (salmeterol) is a long-acting beta2-adrenergic receptor agonist (LABA) which is used for treatment of asthma and COPD. The FDA will look into the safety profile of all LABAs at a future meeting.

Long acting beta-adrenoceptor agonists include salmeterol, formoterol (part of Symbicort) and bambuterol.

Note: The photo on the right shows a Seretide-labeled metered-dose inhaler (MDI). Seretide is the trademark for salmeterol in Europe.

CT scan may increase cancer risk

According to a NEJM review quoted in the NYTimes, in a few decades, 2 percent of cancers in the United States may be due to radiation from CT scans given now.

The average American’s total radiation exposure has doubled since 1980, largely because of CT scans. About 62 million of them were done in the U.S. in 2006 (up from three million in 1980) and studies suggest that a third of CT scans are unnecessary.

References:
Stronger Warnings Advised on Asthma Drug. NYTimes.
Report Links Increased Cancer Risk to CT Scans. NYTimes.
Current Concepts: Computed Tomography — An Increasing Source of Radiation Exposure. D. J. Brenner and E. J. Hall. NEJM.
Image source: Wikipedia, GNU Free Documentation License and public domain.

Motherhood is interfering with my reading

My husband use to think that I was sending videos of him to Matt & Trey because each week Cartman would say something that he said a few weeks earlier. Now I think someone's spying on me (not very hard since I blog so damn much!). Amanda Eyre Ward's article at Babble.com is so me.

Lots of mothers I spoke to found that they had no attention span after childbirth. Marritt Ingram, author of Inconsolable, says, "I read young adult fiction for a while. I think the first book I finished was Hatchet." Hatchet, it must be noted, is the story of a boy who, following a plane crash in the Canadian wilderness, must learn to survive with only a hatchet and his own wits. Sounds like a metaphor for motherhood to me, though my own experience might more aptly be called Chardonnay.

I know I was reading after my daughter was born, but I can't really recall what I read. I'm pretty sure one was by Ariel Gore - motherhood books are good for new moms. But I know I did read because she was one of those babies who HATED to be put down. Seriously. There was a time when I slept upright so she can sleep on my chest. So when I was home for my leave I'd arrange it so that she napped on my comfy chest while I had a book in hand. That said, I doubt much really sunk in.

I knew my life was going to change, but seriously my reading habits were not on that list. Thankfully four years later I can say I'm pretty much recovered. I still have trouble focusing, but I'm better at being able to put a book down and going back to it a few days later. Ward also notes that:

A friend had another scientific take: "I read somewhere a long time ago that babies get their brains from their mothers. I've decided that's why some of us are complete dingbats while pregnant. The baby is sucking all our smarts out!"

Ain't that the goddess darn truth! Again, I knew my bones were being sucked of what little calcium they held, but my brains too? And when you get to know my daughter, you know she sucked most of my brains out. Miss Smartypants she is.

Technorati tags: books, motherhood, Amanda Eyre Ward

A doctor asks which portable computer/PDA/smartphone to choose

A colleague of mine recently asked me which gadget he should choose to replace his HP iPAQ hx 4700 PDA which suddenly stopped working. For those who do not know, iPAQ hx 4700 was a great PDA with the largest screen on the market, Bluetooth and WiFi, and was the top of the line HP model in 2005. He used his PDA for to-do lists, calendars and UpToDate (installed).

What are my friend's options for replacing his PDA? My answer is below. Disclaimer: This information is not comprehensive by any means, please double check the technical specifications and prices yourself.

Regarding the choice of PDA, those type of gadgets seem to be going out of fashion nowadays in favor of smart phones/mini-PCs. Dell stopped making their PDAs and HP reduced their product line to just 2-3 models.

There are several choices on the market right now and I will try to list the pros and cons of 2 of them below:

1. Apple iPhone, price $400.


Pros: easy-to-use, large fonts, zoom-in feature, always-on Internet.

Cons: requires AT&T subscription with data plan ($ 60), programs cannot be installed, small 8 GB hard drive.

2. OQO portable computer, price $ 1,200.


Pros: True Windows computer in the size of PDA, synchronization is very easy, all Windows program can be installed and work seamlessly, 30 GB hard drive.

Cons: relatively expensive, portable Internet requires Verizon or Sprint high-speed data plan ($ 70-80 per month).

Both are excellent options. If I were you, I would go to an Apple store and just see if iPhone works for you. BlackBerry is another alternative but I do not like their tiny screens. Ultra-mobile PCs (formerly known as Origami project) may work for some but they use a TabletPC OS rather than the regular Windows XP or Vista.

OQO seems to be the best option but is also the most expensive one.


Epocrates & iPhone. Link via Doctor Anonymous.

Related:
The New Pocket PCs, PC Magazine, 05/2008.

Updated: 05/12/2008

Do All Girls High Schools Create Stronger Women?

This question is in the top 10 that I get asked when I tell someone I work in education equity. Some assume that I must support all girls high schools as the answer for increasing women in non-traditional fields for a variety of reasons including that girls won't be distracted by the boys, without boys there is no harassment (obviously stated by a man or a woman who forgot what high school was like!), or whipping out the old adage that girls just do better in math & science (my bread & butter) in an all girls classroom.

Simply put, no. I don't.

There are valid reasons to send your child to a single-sex school and I admit to daydreaming about having gone to Smith. But that is more about Smith not the all women thing. A few weeks ago on the DC Metro Moms Blog (sister to the Chicago Moms Blog where I contribute), KC mused about what she would be like if she had gone to an all-girls school and wonders if the only way her daughter will come out strong is to send her to an all-girls school. As fate would have it an email popped into my inbox a few days later about a new study out. On single sex schools! The Goddess does love me.

KC is correct when she notes that:

Some studies have shown that girls attending all-girls schools do develop more confidence in themselves as students and are more likely to continue on in fields like math and science. They seem to do better on standardized exams across the board, independent on baseline level of achievement and socioeconomic status. When observing co-ed classrooms, boys often dominate discussion while girls are at times victims of subtle sexism. While both boys and girls seem to do better academically in same-sex schools, this difference is greatest for girls.

My usual response is that a lot of the effects of an all-girls classroom is from the smaller class size. In "University Students from Single-Sex and Coeducational High Schools," Karpiak et. al, surveyed current students at the University of Scranton about their majors, high school experience, and attitudes towards gender roles. They also looked at historical data on students from both groups (SSHS & CoEdHS) about their declared major freshman year and their actual degree major.

The results?

In sum, students from single-sex high schools entered college less concentrated in majors traditional for their gender and more likely to have declared a gender-neutral major than those from coeducational high schools. However, by graduation, the advantage for women from single-sex high schools had disappeared. In contrast, men from single-sex high schools were significantly more likely than those from coeducational schools to hold gender-neutral majors at graduation.

Further:

Secondary school is time-limited. In order to translate into differences in the college experience and the labor market, the single-sex high school's moratorium from gender socialization must result in changes that can withstand the social realities of a world populated by both women and men.

Thus in order for the real increase in strength girls obtain in their all-girls high schools, society as a whole must also change or else they slide backwards. Of course by society we also mean that the men of the world must become more egalitarian. But what if they are off in all-boys high schools? Are they becoming more egalitarian as one might assume from their higher rates of enrolling in non-traditional male majors?

It appears that something about the single-sex setting—perhaps direct sexism (Lee el all., 1994), exacerbation of "macho male cultures" in schools (Jackson, 2002), and/or lack of daily exposure to competent female peers in the high school classroom—corresponds with less egalitarian attitudes in males. Our results suggest that, at least for men, holding more flexible ideas about possible careers for one's gender does not necessarily translate into broader notions of egalitarianism.

So while our girls are off getting all Buffy-ified, knowing who Alice Paul is, and finding their voice, our boys might be off learning that Harriet Nelson is the ideal mate. When the two meet in college or even later in the workforce, I doubt this will lead to ideal dating situations much less work environments. It really is sad to think that any benefits that girls gain in not having boys in the classroom is lost because the boys don't have girls in their classrooms. Even when we're making boys more egalitarian, we're kinda losing!

Of course the study team acknowledges that this study needs to be done with a much larger and more diverse sample, but it really is one of the first to look at the lasting effects of going to a single-sex high school. And in the end do we want our daughters to enter as engineering majors or become engineers?

To KC I say, there are many strong women who have emerged from co-ed public schools. Your daughter can be one of them. But that is a decision for her and the family to make. Heck, those of us who went to a co-ed school might be stronger because we survived.

Crossposted at Chicago Moms Blog


CITATION: UNIVERSITY STUDENTS FROM SINGLE-SEX AND COEDUCATIONAL HIGH SCHOOLS: DIFFERENCES IN MAJORS AND ATTITUDES AT A CATHOLIC UNIVERSITY
Psychology of Women Quarterly 31 (3), 282–289.


Technorati tags: feminism, single sex schools, high school, girls, education, Psychology of Women Quarterly, Karpiak, University of Scranton

Dr. RW Shares His Impression of 4th annual Mayo Clinic Update in Hospital Medicine

Notes from Dr. RW is one of the hospitalist blogs I subscribe to. The posts listed below are definitely worth-reading if you organize a CME course or you think of attending one:

Thoughts and impressions on hospital medicine CME

Alternative medicine promoted to hospitalists attending CME course

Fondaparinux and HIT---the bubble has burst

Random observations from the hospital medicine CME conference

More clinical pearls from the hospital medicine CME conference

Hospital medicine CME conference: final reflections

References:
A List of Hospitalist Blogs
Using Web Services to Enhance a Medical Education Course

Dora the Explorer of Eating Disorders

My heart literally sank when I saw this post about the latest Dora dolls. What happened to my daughter's best doll friend? Just the other day she was a happy-go-lucky exploradora and now she looks like she needs a few tamales! I may need to order "Yum! Mmmm! Que Rico!" for Dora for Christmas. Come on Fisher Price, you're killing us here!

Here's a few reasons why I love Dora:

1. She's Latina: How many Latinas can a Latina watch on TV nowadays? I keep our cartoon watching to Noogin, so outside of Dora & Diego's sister, Alicia, that brings us to zero.
   
2. She's adventurous: She's not afraid of a challenge. Find baby blue bird's mommy? No problem. Take Santa his gift? A snap.
3. She shows that when you need help, you ask for it: Map, Backpack, & Boots are her constant side-kicks aka helpers. Dora's not afraid to ask for help when she needs it and that is an invaluable lesson. Especially for the daughter of two perfectionists with her own perfectionist tendencies.
   

When Dora was princess-ified, I was ticked. NOT because I hate princesses - I eat my Almond Vanilla Special K every morning from a Little Mermaid bowl. Honest. Well, unless I grab the Tigger bowl. I was ticked because Dora was the princess alternative. She flew through trees, climbed mountains, and flew in Tico's plane all without a thought to her hair or how dirty her white sneakers would get. I came to be ok with the princess thing only because Dora kept going on adventures.

Are these dolls FP's way of trying to keep the ever growing (in years) Dora fans interested in their early childhood friend? Do the dolls come with the tagline, "Vamanos! Let's hit the rest room together so we can hold each other's hair back as we puke!" Because seriously, Dora looks like she needs to eat something. She goes from looking like a child to looking like the Latina Jon Benet. UGH! Can you tell how ticked I am at this?

After reading the blog post, I sent an email off to my family reaffirming my wishes for a toy-less Christmas* AND a plea that if they do buy my daughter a toy, please do NOT buy her the new Dora dolls. We have plenty of Dora dolls in the house, Dora can very easily wear frilly things without having to lose so much weight.

I've written before about the sexualization of our daughters and I fear that the new Dora toys are playing right into this. It really is quite sad for me. The one cartoon (I count Diego in there too) that I felt was safe to go crazy with has turned on my daughter. What does it say to a 4-year-old who would get a new skinnier Dora doll? Don't they know that kids play with all their dolls together? "Hi chubby Dora, want to go to the mall?" Of course they do, but FP doesn't care. If they did, they wouldn't be putting out this doll. Gawd, this is worse that "I hate math" Barbie.

This post will be cross-posted to my Chicago Parent blog, The Red Thread.

*This is due to two reasons: 1) the toy recall insanity and 2) she has more toys than she can play with.

Technorati tags: Dora, Fisher Price, eating disorders, sexualization

The gifts that keep on giving!

Don't know what to get that special someone in your life for the holidays?

Are you a flaming feminist?

100% pro-choice?

Then shop at Early to Bed this holiday season!

They have some special gifts sets that will make someone's night/day/afternoon AND a portion of the purchase price goes to kick ass organizations like the Chicago Abortion Fund, Planned Parenthood, Chicago Women's Health Center, and the Prostate Cancer Foundation. Now, I didn't think there was such a thing as a perfect gift, but come on, what's not to like in these offers?

So hurry over to Early to Bed and grab yourself a gift box AND get your holiday giving done too. BAM! It just keeps getting better. Of course, it'll only gets better once the gift is opened!

Ho! Ho! Ho!
Happy Solstice!
Happy Hanukkah!
Happy Kwanzaa!


Technorati tags: Early To Bed, Planned Parenthood, Chicago Abortion Fund, Chicago Women's Health Center, Prostate Cancer Foundation

Medicine 2.0 -- A Blog Carnival About Web 2.0 and Medicine

Medicine 2.0 is a weekly blog carnival which collects the most interesting posts about Web 2.0 and Medicine. The latest edition is posted here.

This week's host used blog screenshots and Slide.com very creatively -- see the embedded slideshow above. When I hosted, I tried something similar with Google Presentations but this looks much better.

Past editions and future hosts can be found on the blog carnival index page.

References:
Medicine 2.0, Blog Carnival About Web 2.0 and Medicine, Year 1, Issue 9

Google Trends and Top Hospitals According to U.S. News and World Report

"U.S. News and World Report put 5,462 medical centers through progressively finer screens to create the 16 specialties rankings in the 2007 edition of America's Best Hospitals. Just 173 hospitals made it into the rankings, and of those, a mere 18 displayed the marked breadth of expertise, with high scores in at least six specialties, that qualified them for the Honor Roll."

Top 5 hospitals in the 2007 edition of America's Best Hospitals are:

1. Johns Hopkins Hospital, Baltimore
2. Mayo Clinic, Rochester, Minn.
3. UCLA Medical Center, Los Angeles
4. Cleveland Clinic
5. Massachusetts General Hospital, Boston

The list correlates to some extent with the number of searches in Google Trends shown below:



As a form of disclosure, I have to say I am proud to be on staff at Cleveland Clinic which has ranked among the top hospitals for many years.

References:
The Collusion between Media and Hosptials. Dr. Wes.
Cleveland Clinic Advances to Number 3 on the List of America's Best Hospitals. CasesBlog, 07/2006.
Microsoft Blogger Has as Much PR Power as CEO. What Does That Mean for Your Hospital? CasesBlog, 05/2006.

Related:
Google Trends with Numbers. Google Operating System, 06/2008.
A new flavor of Google Trends. Official Google Blog, 06/2008.

Updated: 06/17/2008

Strategic Holiday Giving

As we near the end of the year our inboxes are becoming full with requests from the organizations we have supported in the past, currently support, or just happen to be on their mailing list. What's a loving & giving mama to do on a limited budget?

No matter where you decide to give your money, please keep these items in mind:

• While giving via PayPal is easy for you, PayPal does take quite a chunk of money out from your donation. Want all of your money to go towards your charity of choice? Send a check. Even calling with your credit card may end up having the organization lose a few bucks from a transaction fee.
  
• If possible, give to a few places with larger amounts than "spreading the wealth" by sending $10 to 10 different places. If you give, as you most surely know, you get on the mailing list. That $10 won't even cover the 5 mailings you will get next year. For your benefit, the environment, and the organization's, give to fewer places to reduce the amount of mail.
  

So where to give? I work at a university, so I'd be shot on sight if I didn't say to give to your alma mater. But say you went to Harvard or another institution with a large endowment? Will your $50 do much good there? I doubt it (but willing to hear contrary). My personal choice when giving to my alma mater (which is also my place of employment) is to give to either a scholarship fund or directly to a department that meant a lot to me. I have no reason other than to give some love back to those who really helped me. I'd also be remiss if I didn't mention that I've been reading stories (sorry no links) about people who give to universities close to them and not where they went. Huh? If you went to school at Brown, but live down the street from UIC, there isn't a rule to say you can't give to Loyola.

Food pantries are in desperate need of our donations - food and money.

Although the U.S. Department of Agriculture’s annual hunger survey, which was released last week, did not show an increase in the number of hungry people in the United States since 2006, officials at food pantries are certain that more working people are seeking their assistance. At the Society of St. Vincent de Paul food pantry in Cincinnati, for example, clients now get three or four days’ worth of food instead of six or seven.

Lisa Hamler-Fugitt, executive director of the Ohio Association of Second Harvest Foodbanks, said, “I’ve been doing this for 20 years, and I can’t believe how much worse it gets month after month.”

Unless we're vacationing every month in Aruba, I think we're all hurting from the increase in energy costs, health care costs, and our salaries not keeping up with those increases. I have no idea how people making minimum wage are surviving. Some may be turning to food pantries. My daughter's pre-school is doing the traditional food drive, yet as with any food drive the request is for non-perishable food.

Through the end of August, the food bank was down almost 700,000 pounds of USDA commodities that include basic essentials such as canned fruit and vegetables and some meat _ food that is very difficulty to make up in donations, Executive Director Mark Quandt said. [link]

While I'm sure that food pantries wouldn't turn away another jar of peanut butter or mac-n-cheese, food pantries want to give out balanced meals. And that means fresh veggies & fruit. You can't get that in a food drive. That's where your cash donation might be able to go.

However you decide to give this season, please involve your children. I'm doing that with my lil one and I hope it becomes a part of her character. If you have involved your children in giving, especially during the holiday season, please share your story with us. How is it going?

X-posted at Chicago Moms Blog

Technorati tags: donations, charity, giving, food bank, food pantry, Chicago Moms Blog

Hey Chicago mama! Wanna get in shape?

Then head over to Chicago Moms Blog NOW! We have a great give-a-way for Windy City Adventure Boot Camp. Four weeks of butt kicking fitness training!

All you have to do is comment and tell us why you deserve the boot camp. Yes, I entered as well. I could really use someone to kick my butt into gear over getting my body in shape.

"Eosinaphilic" esophagitis on TV

It may be difficult for some reporters to get the facts straight when covering health-related topics, for example:

- "Eosinaphilic" esophagitis is spelled correctly as "eosinophilic," the source of the word is from the cells which cause the inflammation -- eosinophils

- "Pennsylvania Boy Infected With Rare Disease." Actually, eosinophilic esophagitis is not an infection, it is an allergic disorder characterized but eosinophilc inflammation.

This condition is well described in NEJM Images: Adult-Onset Eosinophilic Esophagitis.


"Multi-ring esophagus" in eosinophilic esophagitis (left), infiltration of eosinophils (right). Source: Wikipedia.

References:
Toddler Allergic To Nearly Every Kind Of Food. NewsNet5.

Selfish headline of the year

"Adoption changes wrench American parents"

I've been watching the whole Guatemala adoption fiasco from afar, safely afar. We have discussed adopting in the past, but are no where near even starting the process. We have friends who have discussed it or are actively in the process. Thus I feel that I have compassion for the families who have been hurt by the chaos that is the Guatemala adoption system. But whom I have more compassion for are the parents of Guatemala who might had been duped into selling their children or even had their children stolen from them.

The small Central American country sent 4,135 children to the U.S. last year, making it the largest source of babies for American families after much-bigger China.

The adoptions are a $100 million a year industry for notaries.

Our government is pushing the Guatemalan government to allow the adoptions that are already in process to go on despite up to 1,000 cases where forged birth certificates or even mothers have changed their minds are documented. 1,000 children who should be with their blood families.

The women of Guatemala are not to be seen or treated as poor surrogates for the United States.

I firmly believe that if you are a real loving human being, you would want to make sure 1,000% that the baby you are about to remove from its homeland is truly up for adoption and NOT stolen. Yes, I hate the idea of children in their first few years living in homes, without someone to rock them to sleep every night, but do you really think stealing them is better? Makes you a better person? What about the mother who cries herself to sleep each night wondering what happened to her lil girl?

I really feel for all sides in this issue, but I'm on the side of the birth mothers and the children. In 20 years when your adopted son or daughter is going through some historical documents, what will you say when they ask you, "Was I stolen?"

Technorati tags: Guatemala, adoption

From zero to hero in one year: what it takes to rise to stardom in medical blogging world

Berci Mesko celebrates the one year anniversary of his medical blog ScienceRoll.com. He started with zero visitors one year ago to reach more than 1,000 page views per day.

He is generous enough to list me among his mentors but in reality I learned far more from him than the other way around. For example, I have never used my SecondLife account and Berci seems to be the medical blogger who knows most about it. I am happy to be one of his 266 FeedBurner subscribers. Currently, this blog still has about 1400 subscribers but with the speed Berci's website is ascending in the medical blogging world, it will surpass this number by its second anniversary.

Berci lists his achievements and some of them are also useful tips on how to start and maintain a popular blog:

I’ve launched two blog carnivals: Gene Genie is dedicated to human genetics and personalized medicine, while Medicine 2.0 is devoted to web 2.0 and medicine.
Tip: Start a blog carnival.

I got a special mention in Medgadget’s Weblog Awards in January.
Tip: Have your blog nominated for blog awards.

Some of my posts have been mentioned by Pharyngula, Blog Around the Clock, Medgadget, Neatorama, Mashable! and Read/Write web.
Tip: Comment on other blogs.

I enjoy the support of HONcode, Healthcare Blogger Code of Ethics and DNA Network.
Tip: Register your blog with different networks and directories.

I’ve hosted some editions of Gene Genie, Medicine 2.0, Mendel’s Garden and Grand Rounds.
Tip: Host blog carnivals.

I’ve had several behind-the-scenes interviews with famous medical bloggers and others as well.
Tip: Interview other bloggers on your website.

References:
The First Birthday of Scienceroll!
12 Important U.S. Laws Every Blogger Needs to Know. Aviva Directory, 02/2008.
A Wikipedia wizard and blogger. BMJ Career Focus, 08/2007.
Image source: BMJ Career Focus.

Updated: 02/23/2008

Turkey Additives vs. A Vegan Thanksgiving

MarketWatch describes different additives found in Thanksgiving turkeys sold on the market: sodium phosphates, modified food starch, monosodium glutamate, butylated hydroxyanisol and butylated hydroxytoluene...

The alternative is A Vegan Thanksgiving offered by a Healthcare CIO:

"Protein: Tofurky - a tofu and grain-based roast available from Turtle Island Foods . I do not typically eat meat substitutes since I enjoy the inherent food qualities of tofu, tempeh and seitan, but a Tofurky is great for family holiday entertaining."

If you haven't already subscribed to Life as a Healthcare CIO, I think you should. It is an interesting blog with a strong original voice among the more than 600 health-related blogs on the Web.

References:
Thanksgiving additives a real mouthful. Ruth Mantell, MarketWatch.
A Vegan Thanksgiving. Life as a Healthcare CIO.
T-Day! Russell Beattie’s Weblog.
Image source: OpenClipArt.org, public domain.

"Turkey/Diet" Searches Around Thanksgiving: Human Predictability Revealed by Google Trends

The blog Google Blogoscoped writes about human predictability:

"Google Trends shows an interesting search popularity graph for the queries “turkey” (as in turkey, the food) and “diet.” Searches for the traditional turkey meal peak on Thanksgiving followed by a smaller peak on Christmas. The New Year Day's resolutions bring a surge in queries for "diet" every year, over and over again:



There is an interesting correlation between depression and rain:


Searches for "allergy" peak every spring:


Immunization "shots" searches are most popular in October/November:


The blog AllergyNotes covers some other Recurrent Trends in Allergy-related Searches on Google.

References:

Google Trends Reveals People’s Predictability. Google Blogoscoped.
Microsoft Blogger Has as Much PR Power as CEO. What Does That Mean for Your Hospital?
Google Blogoscoped images under a Creative Commons license.

Kindle e-book reader by Amazon: you can have 200 (medical) books on one device

The Kindle is an electronic book reader launched by Amazon.com which uses an E Ink display and downloads content over the free Amazon Whispernet, which uses the Sprint EVDO network. The Kindle weighs 10.3 oz (292 g) and its battery lasts two days with wireless on, one week with wireless off, and charges in two hours. A computer is not required (source: Wikipedia). Read David Pogue' review in the New York Times.

Mike Torres describes it well:

"So far, I'm really liking what I'm seeing with the Kindle. The price is still way too high (as was the price of the original iPod) but the promise of a 10 ounce device that can store 200+ books is really... well, promising.

Digital books are the future. Just like I've cleared my home of all CDs and gone 100% digital, I can't wait to do the same thing with books. It's the side of me that just hates having "stuff" everywhere. When given the option between a physical artifact or a bunch of bytes, I almost always choose bytes."

The Kindle store includes 88,000+ books including some medical titles. We will see how the new device plays on the market but if you are a medical student/resident, it would be nice to have all your favorite textbooks on one 10-once device. Russell Beattie is right that eBooks need more contrast to take off though.

The Kindle has an MP3 player and works with audio books bought from Audible.com. MS Word documents and the common photo formats are also supported via email (it costs 10 cents per file). Amazon will need to add PDF support and a text-to-speech program.

The device has a browser based on NetFront (a mobile browser) but it looks likes using the Internet beyond the Kindle store will incur extra charges according to the Amazon's terms of service.


Video: jkOnTheRun looks at the Amazon Kindle


Walt Mossberg from WSJ reviews the Kindle


References:

An E-Book Reader That Just May Catch On. NYTimes.
Amazon Kindle - a revolution? Torres Talking.
eBooks need more contrast to take off. Russell Beattie’s Weblog.
Amazon Kindle from Wikipedia, the free encyclopedia.
Mowser on Kindle. Russell Beattie’s Weblog.
Kindle, take 2. Diego's weblog.
100 Notable Books of the Year. NYTimes.
The Future of Reading. Newsweek.
Dear Jeff Bezos (one-week Kindle review). Scobleizer, 11/25/2007.
Amazon's Kindle Makes Buying E-Books Easy, Reading Them Hard. Walt Mossberg, WSJ, 11/2007.
Image source: Amazon.com.

Related:

Hack Your Kindle: 100+ Tips, Resources, and Tutorials to Get More Out of the Amazon Kindle. CollegeDegrees.com, 06/2008.
The Kindle for Medical Education. Life as a Healthcare CIO, 10/2008.
Turning Page, E-Books Start to Take Hold. NYTimes, 12/2008.
How to Read Free Books from Project Gutenberg on the Amazon Kindle http://bit.ly/jH8Hy
Investigating the art of the audiobook - Audible founder reports 40% growth in unit sales every year http://goo.gl/q1Iqh

Bitch on 'bitch'

You knew that the 'ladies' of Bitch magazine would have something to say about the McCain "how do we beat the bitch?" fiasco. JFTR - I love Bitch magazine. When I say I love it, I freakin' mean it. Last year I organized a benefit at the Hideout where I took this picture of Andi Zeisler.

Andi brings it when discussing the b-word in the WaPo, what it means to use it, who can use it, and all the good stuff:

So let's not be disingenuous. Is it a bad word? Of course it is. As a culture, we've done everything possible to make sure of that, starting with a constantly perpetuated mindset that deems powerful women to be scary, angry and, of course, unfeminine -- and sees uncompromising speech by women as anathema to a tidy, well-run world.

It's for just these reasons that when Lisa Jervis and I started the magazine in 1996, no other title was even up for consideration.

Once again, Lisa & Andi, thank you for creating Bitch.

In fact, we hoped that we could reclaim it for mouthy, smart women in much the way that "queer" had been repurposed by gay radicals. As Lisa wrote in the magazine's mission statement, "If being an outspoken woman means being a bitch, we'll take that as a compliment, thanks." I'm guessing that Hillary Clinton, though probably not a reader of our magazine, has a somewhat similar stance on the word. After all, people who don't like Clinton have been throwing the slur at her since at least 1991.

I know that many people, especially women, don't like this reclaiming thing. And it's not just a generational thing either. I've met my fair share of 20-year-olds who don't like the word in any context. But considering how it has been used to demean women with their own minds, I can't help but want to reclaim it and take that power away from it. Sadly thou, the power remains.

When these people call Clinton (or House Speaker Nancy Pelosi, or Sen. Dianne Feinstein or former vice presidential candidate Geraldine Ferraro) a bitch, or even the cutesier "rhymes-with-witch," it's an expression of pure sexism -- a hope that they can shut up not only one woman but every woman who dares to be assertive. Simply put: If you don't like Clinton's stance on, say, health care or Iraq, there are plenty of ways to say so without invoking her gender.

Thank you! I know it's hard...I find it difficult to find the correct word when I'm pissed at a woman in my life. I want to call her a bitch, but considering that I'm reclaiming that word for myself, I can't really do it, now can I? Asshole is gender neutral, isn't it?

My own definition of the term being what it is, I can confidently say that I want my next president to be a bitch, and that goes for men and women. Outspoken? Check. Commanding? Indeed. Unworried about pleasing everybody? Sure. Won't bow to pressure to be "nice"? You bet.

And guess what? I'm not even sure that person is Hillary Clinton.

I'm not sure if any politician won't bow to pressure to be nice, but I'm really starting to feel like Katha Pollitt. I feel like since rumors started that she was going to run for President I've had to defend her to almost every person in my life and it's not just her policy moves either! Now, I'm still undecided about who to vote for in the primary, but seriously folks, if all I read from here until election day is sexist crap about Hillary, I'm checking that box with her name on it!

Leonard Pitts also has some choice words to say about the word bitch and us as a society. Tell it brother!

I get that many people don't like Clinton. I don't like her much myself, and my reasons echo the consensus. She seems cold, calculated, brittle.

Here's the thing, though. I find that I can't name a single female national political figure I do like -- not respect, not agree with, but "like." Oh, I can name you many men who, their politics aside, strike me as likable: McCain, Bill Clinton, John Edwards, even cranky old Bob Dole.

But women? Not so much. Nancy Pelosi, Janet Reno, Condoleezza Rice, Madeleine Albright.... I cannot see myself -- we are speaking metaphorically here -- cuddling up to any of them. They all seem formidable, off-putting, cold.

Which suggests the problem here is not so much them as me. And, if I may be so bold, we. As in, we seem unable to synthesize the idea that a woman can be smart, businesslike, demanding, capable, in charge and yet also warm.

I dunno about Pitts, but I loved Janet Reno. Yes, despite her flaws. Maybe it was my love for Will Ferrell that oozed onto our dance party Attorney General, but still, I liked how she seemed not to take shit from anyone and drove a pick-up truck. There have been times when I have loved Hillary, but then she went and lobbied for a policy that the inner feminist in her was screaming, "NOOOO!!!" at.

Which brings me to my sweetie, John Edwards. He's such a cutie and I can't help but think that's what he has going for him for me. That Kennedy-esqe way he talks about poverty, the way he talks about poverty, the way he looks so cute when he's thinking or smiling. *swoon* Maybe it's time we start voting for the bitch instead of the guy we wish would take us to the prom. Incredible idea, eh?

And BTW - I think Hillary should start selling t-shirts that say, "That's Ms. Bitch!" Or copyright, "The Bitch," and please note the capital letters. She's running for President, Senator McCain, is a Senator herself, and if people keep using it on her, let's just make it her unofficial title. Hmmm...since GWB has the Western White House can Hillary end up with a seal that says, "Bitch in Chief?"

Point of privilege...If you don't subscribe to Bitch, what are you waiting for?

Technorati tags: Bitch Magazine, Andi Ziesler, bitch, Leonard Pitts, John McCain, feminist

Checking in with the Aurora Clinic

Listen to the latest edition of RH Reality Check's podcast to hear the latest on the Planned Parenthood clinic in Aurora, Illinois. Oh, yeah...there's more great stuff in there too, but you gotta love it when you can listen to Steve chat about the clinic.

Technorati tags: RH Reality Check, Planned Parenthood Aurora, Steve Trombley, Amanda Marcotte

PLoS Medicine: How Drug Reps Make Friends and Influence Doctors

The article title is a word play on Dale Carnegie's bestseller How to Win Friends and Influence People and is co-authored by a former Eli Lilly drug rep who was featured on YouTube describing the tactics used to convince doctors to prescribe Zyprexa:

Following the Script: How Drug Reps Make Friends and Influence Doctors. Fugh-Berman A, Ahari S (2007). PLoS Med 4(4): e150.

"It's my job to figure out what a physician's price is. For some it's dinner at the finest restaurants, for others it's enough convincing data to let them prescribe confidently and for others it's my attention and friendship... but at the most basic level, everything is for sale and everything is an exchange.

During training, I was told, when you're out to dinner with a doctor, “The physician is eating with a friend. You are eating with a client.”

Table 1 in the article lists Tactics for Manipulating Physicians.

In conclusion, the authors claim that "physicians are susceptible to corporate influence because they are overworked, overwhelmed with information and paperwork, and feel underappreciated. Cheerful and charming, bearing food and gifts, drug reps provide respite and sympathy; they appreciate how hard doctor's lives are, and seem only to want to ease their burdens. But... every word, every courtesy, every gift, and every piece of information provided is carefully crafted, not to assist doctors or patients, but to increase market share for targeted drugs."

You just have to love the license of the journal:

"Everything we publish is freely available online throughout the world, for you to read, download, copy, distribute, and use (with attribution) any way you wish. No permission required. Read a detailed definition of open access."


The former pharmaceutical representative Shahram Ahari describes the tactics he was supposedly advised to use in order to convince doctors to prescribe Zyprexa (olanzapine).

References:
Following the Script: How Drug Reps Make Friends and Influence Doctors. Fugh-Berman A, Ahari S (2007). PLoS Med 4(4): e150.
How I Did It: The "Confession" of a Zyprexa Drug Representative on YouTube
Link via The Patient's Doctor.
Image source: Wikipedia

Related reading:
Lilly Considers $1 Billion Fine to Settle Case. NYTimes, 01/2008.
How to be a drug rep. Half MD.com.
Drug company official praises "smoke-and-mirrors job" by Seroquel project physician in emails. NYTimes, 02/2009.

Updated: 02/27/2009

What Happened to the Marlboro Marine?

His photo was on the front page of more than 150 newspapers and was one of the most memorable images of Iraq war. What happened next?

He was medically discharged with a "personality disorder" exactly one year after this picture made worldwide news and is currently receiving care for PTSD. The Los Angeles Times covers the story in a 2-part series:

Two lives blurred together by a photo
Rescue operation aims to save a wounded warrior
(free registration required or click here and follow the links)

References:
The Marlboro Marine: Reaching out from behind the camera. Omaha World-Herald.
Posttraumatic stress disorder from Wikipedia, the free encyclopedia.
Post-Traumatic Stress Disorder (PTSD), National Institute of Mental Health (NIMH).
Image source: The Los Angeles Times.

Still relevant after 35 years

Ms. magazine is 35 this year and is celebrating in the current issue. There's a lot of great stuff in here, but the most moving piece is an excerpt from Dr. Susan Wicklund's memoir. With permission, I'm excerpting the excerpt. I'm giving you a juicy part of the story, but I implore you, please go out and buy the current issue of Ms. to read the entire piece. This piece did not move me just because it is about abortion, reproductive justice, or feminist.

It moved me because it is a simple story of a granddaughter not wanting to disappoint her beloved Grandma. I think we all have moments like that, knowing we have to be honest, yet thinking it would break someone's heart. Fair warning...when you do pick up a copy, grab a tissue. When you're done with your copy, share it. Then buy someone a membership to Ms. for the holiday season. While you're there, do some other shopping for the men and women in your life.

I peeled myself out of the car, shed my coat and left it on the seat. It was unusually warm for February in Wisconsin. The hardwood forest was all bare sticks and hard lines. I knew it would soon be time to tap the maple trees and cook the wonderful syrup we all loved on Grandma’s Swedish pancakes.

I turned and deliberately moved up the steps to the trailer house. I was terrified of what Grandma would say, but there was no avoiding this moment. The big door was already open by the time I got to
the top step. Out peeked her welcoming smile. She was giggling.

“Hi, Grandma!”

“Oh my goodness! What a surprise! What a sweet, sweet surprise! Did I know you were coming today?”

I hugged her in the doorway, held her tight, stepped inside.

“Did you somehow know I was making ginger snaps?” she teased as she set a plate full on the kitchen table. She poured me a glass of milk and I sat down on the wooden chair next to hers. I tried to bury myself in the smell of her place, a mixture of ginger cookies, Estée Lauder perfume (the one in the blue, hourglass bottle always on her dresser), and home permanents. She and Mom always gave each other perms, trying to get just the right curl in their hair. The smell never left the place.

I think she sensed that I had come to talk about something important. I started talking a few times about other, inconsequential things, then, finally, I plunged in.

“Grandma, you know I work as a doctor.”

“Of course. And we are all so proud of you.”

“Yes, but I don’t think you know the whole story. I’m a doctor who works mostly for women, helping women with pregnancy problems.”

Flower Grandma hesitated just a second, pushed back her chair, stood and held out her hand for me to follow. She went to sit in her rocker, the same one sitting in my living room today. The rocker I have sat in so many hours since. The rocker I sit in right now, writing this down and trembling as I do.

She seemed distant. I moved to the old leather hassock beside her. She took my hand and placed it on top of one of hers, then covered it with her other one. Our hands made a stack on the arm of the rocker—old skin, young skin. We sat in silence a minute. She turned to look directly at me. Her eyes, framed by gentle wrinkles, were full of some deep trouble.

After a moment, she stared straight ahead and started to speak. Slowly. Deliberately. In a very quiet voice. At the same time she began stroking my hand. It was as if the
gentle stroking was pushing her to talk.

“When I was 16 years old my best friend got pregnant,”she said. A chill went through me.

Excerpted from This Common Secret: My Journey as an Abortion Doctor, by Susan Wicklund and Alan Kesselheim, to be published in January by Public Affairs; © 2008 by the authors.


Technorati tags: Ms. magazine, Susan Wicklund, Flower Grandma

Perioperative beta-blockers and POISE trial: Updated

The post on perioperative beta-blocker use in the light of the new data from the POISE trail was updated:

POISE trial seems poised to change perioperative guidelines for beta blocker use

International Day for Tolerance is Today

The International Day for Tolerance is an annual observance declared by UNESCO in 1995 to generate public awareness of the dangers of intolerance. It is observed on November 16.

As a historic and architectural example of religious tolerance, I would point out to the capital of one of the oldest countries in Europe -- Sofia, the capital of Bulgaria, which I visited in 2007. In the very center of Sofia, there are large-scale temples of 3 major religions within 200 meters of each other: a church, one of the largest synagogues in Europe, and one of the oldest mosques in Europe (the majority of the population is associated with the Bulgarian Orthodox Church). See the pictures below:


St Nedelya Church is a cathedral of the Sofia office of the Bulgarian Patriarchate. The initial structure was built in the 10th century.


Sofia Synagogue is one of the largest in Europe.


Banya Bashi Mosque, completed in 1576, is one of the oldest mosques in Europe. It was built over natural thermal spas used since Roman times.


Google maps shows the proximity of the temples. Click to enlarge the screenshot or see the map.

References:
International Day for Tolerance. United Nations.
International Day for Tolerance from Wikipedia, the free encyclopedia.
Image source: USaid.gov.

Updated: 11/16/2009

Panic Attacks Cause Heart Attacks?

CNN's Dr. Gupta seems impressed by this new study. Dr. Wes -- not so much, to say the least. I think I am leaning on Dr. Wes' side on this one.

References:
Panic attack may lead to another kind of attack. Paging Dr. Gupta.
Panic Attacks and Risk of Incident Cardiovascular Events Among Postmenopausal Women in the Women's Health Initiative Observational Study. Arch Gen Psychiatry. 2007;64:1153-1160.

Further reading:
Panic attacks and heart disease. Notes from Dr. RW.

Updated: 11/16/2007

Clinical Case: Allergic Rhinitis and Conjunctivitis

A 35-year-old female is referred for symptoms of allergic rhinitis and conjunctivitis. She has tried over-the-counter medications with good relief of symptoms but it did not last long enough.

What is the next step?


Mind map diagram of allergic rhinitis.

Read more in Allergic Rhinitis and Conjunctivitis on AllergyCases.org.

Image source: Wikipedia, a Creative Commons Attribution ShareAlike 2.0 License.

Ti(red)

After news of the India GAP slave sweat shop broke, I drove past the GAP Kids on Lincoln and it has an ad with the girl from "Little Miss Sunshine" and this slogan. I immediately saw instead the photo of this man talking with the boys his organization helped to rescue. So I made this.

No commentary in this post...just the graphic.

Technorati tags: GAP, India, slave workers, change the world

Social Media Starfish and 6 Axes of Medical Education in Web 2.0 Style

Robert Scoble links to a Social Media Starfish created by Darren Barefoot (a Creative Commons license).

The starfish also illustrates some of what I call "6 Axes of Medical Education in Web 2.0 Style":

1. Web feeds (RSS)
2. Podcasts
3. Blogs
4. Wikis
5. Custom search engines
6. Second Life virtual world

Bertalan Mesko of ScienceRoll.com has covered some of these web tools extensively, for example:

Health loves a Second Life
Top 20 Facebook Applications in Science and Medicine

References:
How to Use Web 2.0 in Medicine?
A Presentation on Web 2.0 in Health Care by John Sharp

Related:
Web 2.0 Company Logos

Updated: 11/17/2007

The Me and Mine Meme 100

Me and Mine Meme 100 Directions:

1.) State the name of your blog, your real name or your online name, and link to your "about me" page.
Viva La Feminista
Veronica
No about page...this is what you get.

2.) Say you want to be profiled on BlogHer as a family blogger and link back to this post.
I do! I do!

3.) Tell how long you've been blogging.
Here, since the summer. Ever? Since 2000.

4.) Pass this meme on to three other bloggers that you think should be profiled/interviewed.
a. BirdieRoark
b. Marcie
c. Kim

Technorati tags: blogher, mommy blogging

Tesla Road Test on Mahalo Daily Video

The Tesla Roadster is a 100% electric sports car which accelerates from 0-60 mph (100 km/h) in 4 seconds and reaches a top speed of over 150 mph. The car is able to travel 245 miles (394 km) on a single charge and takes 3.5 hours to fully charge. This is one of the "green muscle cars" as Governor Schwarzenegger likes to call them.

The price of the most 2008 Tesla Roadster models is about $ 100,000 but there is no shortage of high-end buyers: the manufacturer has a 600+ person waiting list. They are developing a 5-person fully electric sedan which will be priced lower.

Mahalo Daily is a Rocketboom-type video show which is actually interesting and probably worth-subscribing to. Mahalo is the new "human-powered" search engine/web directory launched by the serial entrepreneur Jason Calacanis who made $ 30 million by selling a collection of popular blogs (Weblogs, Inc.) to AOL.

By the way, "mahalo" means "thank you" in Hawaiian and "pendulum" in Bulgarian.

One more video:


How to Play Guitar for Newbies

References:
Tesla Roadster from Wikipedia, the free encyclopedia.

Further reading:
How to Tie a Tie. Mahalo Daily.
Why I’m buying a Tesla sedan. Scoble, 06/2008.

Updated: 06/29/2008

CIO of Harvard Medical School Explains Why He Writes a Blog

John Halamka, MD, MS, is the Chief Information Officer (CIO) and Dean for Technology at Harvard Medical School, and a practicing emergency physician:

"I've found that I can answer many questions in public forums by referring to postings I've made in my blog. I've posed several questions to the community via my blog and received many helpful responses. The big question will be - it is sustainable?

People who know me well know that I am not driven by fame or fortune, I just want to make a difference. My experience running a software company in my early 20's taught me that judging the value of life by a number in a bank balance, the type of car you drive, or the size of your house is not very satisfying.

I also crave learning. I welcome suggestions on how to become a better blogger."

Dr. Halamka sleeps only 4 hours per night and has been using 30 minutes from that time since he started blogging.

References:
Blogging about Blogging. Life as a Healthcare CIO.
Image source: Life as a Healthcare CIO.

I'm running away to Wisconsin

That's right, I got accepted to the Wisconsin Go Run training at the end of the month!

What's Go Run you ask?

Go Run is a two day training dedicated to demystify the political process and inspire a richly diverse group of women to join the leadership pipeline. Go Run provides the nuts and bolts of running for political office by focusing on areas like communications, fundraising, and campaigning - skills you can use in your work and in your community today and up to the day you decide to run!

No, no...I'm not announcing my candidacy today, but who knows. After this training I just might. I'm also attending because I do want to work on more campaigns in the future, mine, someone I support, or my daughter's. There is just so much that I still need to learn about the campaign process before I even consider running.

I'm also pretty jazzed that my boss was also accepted and we're riding up together. It should be fun to hang out with her off work time and get to know each other on a different level. Not that being feminist candidates is that far off from being feminist educators.

The final cost of the training for me is $200. While that's not a lot, I am reminded that even $200 is a stretch for me and for some women who might be far better candidates than me, $200 is a closed door. So be warned...if this training is all that I hope it to be, I'll be pushing you all to support the White House Project with your birthday money.

As for me, I won't put up that PayPal button...yet. But I have another trip on the horizon that I'm starting to do some asking for in other arenas. If that falls through, the PayPal button will go up. Hey, I gotta start asking for money, right?


Technorati tags: White House Project, campaigns, politics, Go Run, feminism

POISE trial seems poised to change perioperative guidelines for beta blocker use

According to the trial, perioperative beta blockers may decrease the incidence of myocardial infarction but the survival benefits are offset by the increase in strokes.

The study principal investigator, Dr Philip J Devereaux (McMaster University, Hamilton, ON), said he was unable to determine who would be at risk and who would benefit from perioperative beta-blocker use at this stage, but added, "I certainly would not recommend it to my mother."

There was a decrease in nonfatal MI ( 3.6% versus 5.1%) but there were more strokes in the beta-blocker group ( 1.0% versus 0.5%) and a greater total mortality in the treatment arm (3.1 % versus 2.3 %).

Our current practice at Cleveland Clinic is to start long-acting beta-blockers 2-4 weeks prior to noncardiac surgery in patients with Revised Cardiac Risk Index (RCRI) score higher than 2-3 and continue for 2-4 weeks after surgery. We may need to reevaluate practice in the light of the new data from the POISE trial.

Andy Auerbach of UCSF describes how he would change his prescribing pattern regarding perioperative beta-blockers in a post on Wachter's World:

"How is my practice today different than it was before last week? I’ll continue the beta blockers for my patient who was on them previously, I’m more likely to recommend starting beta blockers a couple of weeks before surgery in high risk patients, and I’m less likely to prescribe perioperative beta blockers in the intermediate risk pre-op patient (in whom I might now perform some testing to better define the true risk). I’m also less likely to use a high dose to start, or to titrate up the beta blocker dose for tachycardia unless I am certain that I’m not treating tachycardia due to hypovolemia, bleeding, or infection first."

What other medications can be used to decrease cardiovascular risk in the perioperative period?

Statins looks promising. Researchers from Cleveland Clinic just presented an abstract on the topic at the AHA meeting where the POISE trial results were announced. The retrospective study included more than 5,200 patients who underwent coronary bypass (CABG). Treatment with statins after CABG seemed to reduces a stroke risk.

One of the co-authors of the study is Dr. Peter Zimbwa with whom I am lucky to share an office here at Cleveland Clinic. Peter is a remarkable physician and researcher, and his resume is as impressive as his titles -- he has MD, MSc, PhD, MRCP, DTM (just to name a few).

Dr. R.W. Donnell has commented on the projected benefits of statin use in the perioperative period: "look for statins to emerge as the “next beta blockers” for perioperative treatment in the coming years."

References:
POISEd to change the guidelines on perioperative use of beta blockers? The Heart.org.
AHA: Surgery with Beta-Blockers Onboard May Be Risky. MedPage Today.
Peri-operative beta-blockers- A quality indicator or a bad idea? Retired doc's thoughts.
Peri-operative Beta-blockers: Much room for evidence still exists! BMJ.
Perioperative beta blockers may not benefit patients with diabetes (if not used properly)
Case 2: Does this patient need a beta-blocker?
Continue statins as seamlessly as possible before and after vascular surgery. Notes from Dr. RW.
Perioperative beta blockers: not so fast! Notes from Dr. RW.
Three Remarkable Articles Last Week. Wachter's World, 11/2007.
Perioperative Beta Blockers, Redux. Wachter's World, 11/2007.
Image source: OpenClipArt.org, public domain.

Updated 11/16/2007