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By Elaine Schattner, MD, on March 31st, 2011
An article in the March 24 NEJM called Specialization, Subspecialization, and Subsubspecialization in Internal Medicine might have some heads shaking: Isn’t there a shortage of primary care physicians? The sounding-board piece considers the recent decision of the American Board of Internal Medicine to issue certificates in two new fields: (1) hospice and palliative care and (2) advanced heart failure and plans in-the-works for official credentialing in other, relatively narrow fields like addiction and obesity.
The essay caught my attention because I do think it’s true that we need more well-trained specialists
See more In Defense of Primary Care, and of Sub-Sub-Sub-Specialists
By Elaine Schattner, MD, on March 30th, 2011
 a poem for Wednesday:
I was touched by this headline in yesterday’s news: Japan nuclear crisis may have a silver lining for radiation health research. Yeah, and cancer is a gift.
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The wasabi is too hot,
NPR shared yesterday, and I agree.
This radiation story has a long half-life, whether we write on it or not.
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Sketch of a wasabi (Japanese horseradish) plant, from an 1828 in botanical encyclopedia, by Iwasaki Kanen (Wiki Commons)
Related Posts:Considering the Coverage of the Earthquake, Tsunami and Nuclear Reactor BreakdownsSearching for Information in Case of a Nuclear DisasterContemplating the List of NamesNews on an Unusual Cancer Treatment by Heat in Surgery (Hipec)Dietary News Update
By Elaine Schattner, MD, on March 29th, 2011
This clip has had me wondering:
The DNA Dance
The video shows kids dancing on a college campus. They’re wearing tee shirts in any of four colors (representing nucleotides?) and lining up and zip-splitting in a semi-coordinated fashion, and having fun.
That’s fine, but let’s face facts: the exercise has little to do with DNA or understanding genetics at a meaningful level. From the Times Learning Network:
The idea was to connect science with the arts and to facilitate student understanding of the role genetic information plays in our lives. It also works on a metaphorical level, as an allegory for the student-faculty relationship and the college experience.
My initial reaction was puzzlement, then concern about higher education in the U.S. mixed with fear for the next generation of scientists: Where are the nucleosomes? Is the bicyclist like a helicase? What happens if there’s a double-strand break? All these things we should know.
Am I being too harsh?
See more Where Are the Nucleosomes?
By Elaine Schattner, MD, on March 28th, 2011
 Unfortunately things are not obviously getting better in Japan. The water, air and food are affected. A few radiation workers are sick.
This morning I came upon a 5-min YouTube clip of Dr. Norman Coleman, a senior radiation oncologist at the NIH’s Center for Cancer Research, via a @NCIBulletin on Twitter. He’s speaking at the U.S. Embassy in Tokyo:
Dr. Norman Coleman, speaking March 25 in Tokyo
I think CNN, ABC, NBC, CBS, PBS, NPR and even Fox should track down Dr. Coleman and use him as an expert when he’s not busy helping resolve this emergency, because it seems he is knowledgeable, reasonable and cautious, besides appropriately tired having traveled and pondered such a complex situation that affects the public’s health.
Then again, it’s always a good idea to hear from a variety of sources -
A recent, perfectly-titled Dot Earth post by Andrew Revkin threads Nancy Grace, a meteorologist, CJR, Jon Stewart and a magician. Read it and watch:
See more An NCI Radiation Oncologist Considers the Situation in Japan, on YouTube (with a link to Nancy Grace)
By Elaine Schattner, MD, on March 27th, 2011
 Like many New Yorkers, feminists?, hematologists and other people, I was saddened to learn yesterday of Geraldine Ferraro’s death. The Depression-era born mother, attorney, criminal prosecutor, Congresswoman, 1984 Democratic VP-candidate and part-time neighbor to yours truly, succumbed to complications of multiple myeloma at the age of 75.
Abnormal plasma cells in a bone marrow sample said to be from a patient with myeloma (Wikimedia Commons). Plasma cells have nearly-round, eccentric nuclei and abundant cytoplasm (ES).
Myeloma is a cancer of plasma cells — specialized white blood cells (mature B lymphocytes) that make antibodies. Plasma cells normally develop in the bone marrow; they can exit into the bloodstream, which is why this condition is often called a tumor of the bone marrow or, occasionally, sometimes, as a leukemia. The term myeloma comes from Greek roots – muelo (which can refer to the bone marrow) and –oma, which in medical parlance has come to stand for a tumor and may
See more Thoughts on Geraldine Ferraro, and Myeloma
By Elaine Schattner, MD, on March 25th, 2011
 This week’s New Yorker cover pretty well sums up my thoughts lately. It’s a bleak, semi-natural image that blends art and science, offers brightness amidst darkness, and reminds us of how little most of us know about physics, nuclear energy and radioactivity.
And it’s a strange, unsettling start for the Spring.
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Related Posts:Considering the Coverage of the Earthquake, Tsunami and Nuclear Reactor BreakdownsNew Music from an Orchestra of Radioactive IsotopesChange the Channel?Still Thinking About the Earthquake in Japan, and How to HelpLive-Blogging a Book, and the Earthquake
By Elaine Schattner, MD, on March 24th, 2011
 The Times ran an intriguing experiment on its Well blog yesterday: a medical problem-solving contest. The challenge, based on the story of a real girl who lives near Philadelphia, drew 1379 posted comments and closed this morning with publication of the answer.
Dr. Lisa Sanders, who moderated the piece, says today that the first submitted correct response came from a California physician; the second came from a Minnesota woman who is not a physician. Evidently she recognized the condition’s manifestations from her experience working with people who have it.
The public contest – and even the concept of using the word “contest” – to solve a real person’s medical condition interests me a lot. This kind of puzzle is, as far as I know, unprecedented apart from the somewhat removed domains of doctors’ journals and on-line platforms intended for physicians, medical school problem-based learning cases, clinical pathological conferences (CPC’s) and fictional TV shows.
In this example, the patient’s diagnosis
See more Crowd-Sourcing a Medical Puzzle
By Elaine Schattner, MD, on March 23rd, 2011
 If you’re thinking of participating in a clinical trial for cancer or any other medical condition, a good place to find out about the research is ClinicalTrials.gov.
The site, sponsored by the NIH, NLM and FDA, is one outcome of the FDA Modernization Act (FDAMA) of 1997. The database aims to provide information on clinical trials to patients and physicians, and to generally increase transparency on study funding, design and availability of other trials evaluating the same condition or drug.
A mouthful of jargon, as you’ll find regarding pretty much any trial. But better that it’s public -
In recent years, some medical journals have required that clinical investigators seeking to publish study results register their trials, from the start, with the Clinical Trials database. Since 2007, when Congress passed the Food and Drug Administration Amendments Act of that year (US Public Law 110–85) researchers must register and report results for most
See more A Good Place to Find Information on Clinical Trials
By Elaine Schattner, MD, on March 22nd, 2011
This morning health business mavens are chirping with bright results for ipilimumab, a monoclonal antibody that can extend life in people with metastatic melanoma. If the new data – which I haven’t seen — are true, it’s good news for patients.
In 2010, melanoma affected 68,000 people in the U.S. and led to death in approximately 8,700. The WHO estimates that over 50,000 people die of this disease worldwide annually. For patients with metastatic disease, median survival is less than one year.
Last August, investigators reported in the NEJM that ipilimumab prolonged overall survival in patients with metastatic melanoma from approximately 6 to 10 months. Those findings were based on a randomized, multicenter Phase III study funded by Bristol-Myers Squibb, the drug’s manufacturer. In that trial, the most common serious toxicity of the drug was deemed to be immune-based diarrhea. Now, the drug is up for FDA approval and Bristol-Myers is saying that another
See more Bristol-Meyers Says Ipilimumab Prolongs Survival in Metastatic Melanoma
By Elaine Schattner, MD, on March 21st, 2011
 I first heard about quinoa a few years ago, when food-sellers started marketing the stuff as a cereal-like, cholesterol-lowering nutritious substance.
Chenopodium Quinoa (Wiki Commons)
It’s from the Andes, I knew, and comes in some varieties. If you purchase the raw stuff or receive a gift, say, from a Peruvian person who knows her quinoa, you’ll find quickly that you have to rinse it a few times with water before cooking it with whatever seasoning you choose, such as cilantro or just a pinch of salt, or with some olive oil and ground pepper, cinnamon or curry, because the starch has to be rinsed of its saponin (soapy) coating.
What I learned yesterday, beginning with an informative feature in the Times, is that quinoa is not a grain but a seed. According to that article and Wikispecies (a fabulous web-find, in itself), quinoa belongs to the chenopod family or subfamily of plants which includes the likes of beets
See more A Nutritional Tidbit, on Quinoa
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