Mars Chocolate Company Advertises With Broccoli


MARS chocolate ad

The other day, over lunch, I was reading the Sept 2011 issue of the Atlantic and came upon this image on p. 37. According to the not-so-fine print, this full-page broccoli fix is sponsored by MARS chocolate, North America, website listed:

www.marshealthyliving.com

So we can find out about nutrition from the company that manufactures M&M’s, Snickers, Twix, MilkyWay and 3Musketeers.

Part of a trend –

The New Yorker recently ran a profile of PepsiCo CEO Indra Nooyi that almost persuaded me the super-sized soda-based conglomerate does the right thing in the healthy living department.

Kinda like Shell, Exxon and BP doing good work for the environment.

Got it?

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Reducing Cancer Care Costs: The Value of Physicians’ Cognitive Work

We’ve reached what may be my favorite of the proposed ways to reduce cancer care costs, published in the NEJM by Drs. Smith and Hillner. Idea Number 8 is to realign compensation to value cognitive services, rather than chemotherapy, more highly.

What the authors are saying is that we’d save money if oncologists were paid more for thinking and communicating, relative to their compensation for giving chemotherapy. They write:

Medicare data have clearly shown that some oncologists choose chemotherapy in order to maximize income for their practice.<46,47> A system in which over half the profits in oncology are from drug sales is unsustainable.

They suggest that physicians’ compensation should go up, relatively, for time spent

  • referring patients for participation in clinical trials;
  • discussing orders for life-sustaining treatments;
  • considering advance medical directives;
  • talking about prognosis in family conferences.

I couldn’t agree more.

Take the clinical trials example. In my experience enrolling patients in clinical trials, it was a lot of work if you (the oncologist) wanted to do it properly: You’d have to read through the entire protocol; identify any potential conflicts of interest, look up any other protocols for which the patient might be eligible and (ideally) offer that as well, take the time to explain that it’s fine for the patient to not enroll – that there’s “no pressure” (subject of a future post: when patients feel that they should enroll in their doctor’s trial), answer all of the patient’s and a family member or friend’s questions about it, process the paperwork carefully…

And I’d add to the authors’ suggestions for compensation-worthy time spent:

  • going over pathology results, carefully and with an appropriate expert (a pathologist), and discussing the findings with the patient or designated proxy;
  • reviewing radiology images with appropriate specialists (x-rays, CTs, MRIs… comparing each with the previous studies) and sharing the results, as above;
  • checking blood work; abnormalities can be subtle; trends not obvious if results aren’t charted over time;
  • discussing the patient’s condition, periodically, with other doctors such as the internist (or pediatrician), cardiologist, pulmonologist, surgeon, etc.
  • researching relevant published studies and case reports for puzzling clinical situations (using Google, Medline, a real library, maybe calling an expert at another medical center…)
  • communicating with patient about the condition, more generally (not only about end-of-life issues) – such as explaining  a tumor’s known or unknown causes, treatment options, genetic and other implications of a cancer diagnosis.

Bottom line:

When oncologists earn more money by prescribing treatments like chemotherapy, there’s a conflict of interest and a tendency to give more treatment. If oncologists’ salaries were set based on a case load, or time spent taking care of patients that includes cognitive services – thinking and communicating – patients would get better care and less unwanted treatment.

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On Deaths in the New York City Triathlon, and Pushing Ourselves to Limits

Yesterday some 3900 people swam, biked and ran in New York City’s 11th annual triathlon in what might be a celebratory event of human strength and perseverance.

According to this morning’s paper, a 40-year-old woman suffered a heart attack during the 1500 meter swim in the Hudson. She was hospitalized and said to be in stable condition. A man, aged 64, became unconscious mid-way through the swim and was pronounced dead. The man’s death was the second in the history of NYC’s triathlon; three years ago someone else didn’t make it through the water segment.

In March, 2009, the LA Times ran a piece on Death by Triathlon. Most who died in triathlons were men between the ages of 35 and 55 years. Most of the deaths occurred during the swimming portion of the race.

Triathlon (Wikimedia Commons image)

At the pool where I swim, I see people training for the triathlon, and I admire them.

Still, you have to wonder, do people not know their own limits? Or do they choose to ignore them?

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About this Week

Dear Readers,

It’s a quiet, warm and breezeless day here in Manhattan.

I’ve been at the hospital for much of the time lately, visiting with my Dad. Being there brings back all kinds of memories. I could write an essay about it, in a flash, but I don’t feel like doing so, so I won’t.

Not an easy week.

All for today,

ES

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Live Every Week Like It’s Shark Week, Again!

Tonight the Discovery Channel will begin its annual Shark Week festival on TV. “Show me your teeth,” dares a singing woman, repeatedly, in the preview.

Show Me Your Teeth

I’m reminded of my thoughts on the advice – if you can call it that; it holds as a puzzle with me – from the recently-troubled Tracy Morgan as Tracy Jordan on NBC’s 30 Rock. Here’s a rerun, from last year’s ML on the same:

Dialog from Jack the Writer (Season 1, Episode 4, 2006):

Tracy Jordan: But I want you to know some­thing… You and me, it’s not gonna be a one-way street. Cos I don’t believe in one-way streets. Not between people, and not while I’m driving.

Kenneth: Oh, okay.

Tracy Jordan: So here’s some advice I wish I would have got when I was your age… Live every week, like it’s shark week.

—-

Now, five years later, I still don’t watch the Discovery Channel by choice. And I’m afraid of sharks when I’m in the water in places where they might be near. Last season, I watched 30 Rock less regularly than before, not just because of Tracy’s frequent absence, but  mainly for lack of time. Still, what I enjoy most on that show is watching Alec Baldwin, who continues to set a fabulous example of how a talented and handsome man can pick himself up after a rough patch.

Just yesterday I was swimming in the pool next to people in scuba gear practicing for the real deal. I wondered if they watch Shark Week, or live by it, somehow.

How have Tracy’s words influenced me?

Well, I’m determined to get my book done, to take care of my mind and body, and to enjoy part of every single day. No deep insight, really. But true, at least for today. Maybe next year, I’ll have a more interesting thought on the subject of Shark Week. I might even watch the program.

Now, back to the real thing (what matters now: my book, my health, my family).

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Reducing Cancer Care Costs: Oncologists Need to Get a Grip on Reality, and Talk about Dying

We’ve reached the second half of our discussion on Bending the Cost Curve in Cancer Care. The authors of the NEJM paper, Drs. T. Smith and B. Hillner, go on to consider how doctors’ behavior influences costs in Changing Attitudes and Practice. Today’s point on the list: “Oncologists need to recognize that the costs of care are driven by what we do and what we do not do.”

In other words (theirs): “The first step is a frank acknowledgment that changes are needed.” A bit AA-ish, but fair enough –

The authors talk about needed, frank discussions between doctors and patients. They emphasize that oncologists/docs drive up costs and provide poorer care by failing to talk with patients about the possibility of death, end-of-life care, and transitions in the focus of care from curative intent to palliation.

They review published findings on the topic:

In a study at our institution of 75 hospitalized patients with cancer, the oncologist had initiated a discussion of advance directives with only 2 patients.31 In a prospective, multicenter study of 360 patients, only 37% of the patients and their families could recall having a discussion about impending death with the physician.32 Such a discussion is a prerequisite to good planning. Oncologists wait until symptoms appear or until they believe that nothing more can be done.33 In one study, at 2 months before their death, half the patients with metastatic lung cancer had not had a discussion with their doctors about hospice.34 This may explain why in a recent series the average length of stay in hospice for patients with lung cancer was 4 days.35

Although I have questions about the specific methods for some of these references, the bottom line is clear: Oncologists wait too long to talk with their patients about palliative or hospice care.

What they’re saying is that doctors need to get a grip on the problem (to overcome their denial and inability to talk about death), if they want to help patients come to terms with the inevitable. Doing so would save billions each year in the US, and would also spare patients from futile treatments and needless suffering.

I couldn’t agree more. It’s a potential win/win, if physicians think realistically about the situation and possible outcomes, and speak openly – and gently, no matter what, with their patients.

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New Fairway Delivers Fresh Produce to My Neighborhood

On the local, national and nutritional fronts:

How refreshing, in this heat, that Fairway opened a new store on East 86th Street yesterday. Coincidently, Michelle Obama’s push to eliminate “food deserts” – places where it’s hard to find affordable fresh produce and other healthy foods – was highlighted this week when several big retailers signed on to the initiative.

PHOTO CREDIT: DNAinfo/Amy Zimmer (Manhattan Local News)

There was a carnival-like atmosphere on the sidewalk outside the new store, which occupies a large, multilevel space where there used to be a Circuit City (bankrupt, closed) and a Barnes & Noble (moved). Inside, I made a rough tally of unpackaged (6 varieties), nectarines (4), plums (3), string beans (4, including a yellow variant I’ve never seen before), potatoes (11 non-sweet, +  yams and “yellow yams”), onions (7), mushrooms (5), not counting the pre-packaged kinds), peppers (11), tomatoes (9) and beets (3).

You get the picture: if you’re looking for a fresh ingredient and it’s available anywhere New York, chances are you can find it here. Downstairs, there’s fresh fish, meat, coffees, baked goods, and tons of regular and organic grocery items. I counted 22 types of pure honey, not including differently-sized items of the same brand and flavor, and then stopped. Upstairs, there’s a limited selection of prepared foods, a competitively-priced smoked fish counter, a wide cheese selection, dried fruits, nuts and more.

I spent a while meandering through, and heard only positive comments. The shoppers seemed happy; the employees registered glee. A woman next to me on a briskly-moving line summed up the consensus: “This is the best thing that’s happened to the neighborhood in years.”

We should all be so lucky –

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Looking Back on ‘The Normal Heart,’ and Patients’ Activisim

A few weeks ago I saw The Normal Heart, a play about the early, unfolding AIDS epidemic in NYC and founding of the Gay Men’s Health Crisis. The semi-autobiographical and now essentially historical work by Larry Kramer first opened at the Public Theater in 1985.

Cover of the paperback, published by “Plume,” from Wikipedia

The story takes on the perspective of a young man who’s seeing the death of too many of his friends and neighbors from a strange and previously-unknown disease. As much as the situation is disturbing, and frightening, and shattering of the gay men’s barely decade-old freedom to behave as they choose, most of the protagonist’s associates just can’t deal with it. Nor can other, potentially sympathetic officials like Mayor Koch, health officials at the CDC and NIH.

Among the men who form GMHC, in this drama, there’s a mixed crew. Some say they’re  embarrassed by the attention the illness drew to some gay men’s behavior. Many stay fully or half-closeted, understandably insecure in their jobs. They worry about discrimination and rejection by families, landlords and even doctors, some who were reluctant to take on patients with this disease. Some of the affected men and their friends, straightforwardly, fear death; others are in plain denial about what’s going on in their community.

The scenes unfold between 1981 and 1984, more or less the time when I moved to Manhattan, lived downtown, applied and matriculated at NYU’s medical school. Many of the first clinical cases, i.e. patients, I saw, were young men with HIV and Kaposi’s sarcoma, one of the first conditions associated with the outbreak and that’s featured in the play – the appearance of maroon or violet-colored, usually but not always flat, often elongate, spots on the skin. The AIDS patients tended to have anemia, either from immune blood disorders or, more often, infection in the bone marrow. As a hematologist-to-be, I was intrigued.

Then and now, looking back, it’s hard not to respect those men’s activism, especially those who, with Kramer, created the AIDS Coalition to Unleash Power (ACT UP). They were impatient with the pace of research and physicians’ protocols, and spoke out so emphatically about their needs: for more research; for prevention and treatment; for easier access to new drugs; and, simply, for good medical care.

The play closes soon in New York;  its producers are said to be planning a tour and a London production of the work. Patients and their advocates, of all backgrounds and particular concerns, might take notes.

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Taking Care of Yourself When Someone You Love is Ill

This week a close relative was hospitalized and turns out to have a serious condition.  He’s not a blog-lover, so I’ll keep this abstract:

When a loved one gets sick, you have to take care of yourself. It’s hard to do your work, and to be there 24/7 for the rest of your family, and to eat nutritious, non-hospital cafeteria-type meals, and to find time to run or swim or whatever it is you do to take care of the one life you have.

So I’ll go to the gym today, just for half an hour. I’ll gor for a swim tomorrow, even if it’s just for half my usual laps: 30 minutes is better than no time in the water; 20 minutes is OK too, far better than not going at all. My intention is to keep up my routine, albeit reduced and adjusted, through what will hopefully be a long haul.

And I’ll write when I can.

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Give Doctors a Break

In a heartless op-ed in yesterday’s paper, an anesthesiologist argues that medicine shouldn’t be a part-time endeavor. Dr. Sibert makes a firm introduction: “I’m a doctor and a mother of four, and I’ve always practiced medicine full time,” she boasts. “When I took my board exams in 1987, female doctors were still uncommon, and we were determined to work as hard as any of the men.”

Her premise:

With a growing shortage of doctors in America, we can no longer afford to continue training doctors who don’t spend their careers in the full-time practice of medicine.

She’s half-right, I think; the costs of medical education are too great for doctors to be pulling back on normal work hours or quitting their work entirely, willy-nilly. Besides, perhaps a tougher or more persevering group of would-be physicians might have used their coveted med school slots to better end and, ultimately, helped greater numbers of people.

The problem is this: What happens when a doctor gets sick? Or her child? Or partner or spouse? Most of us who’ve gone to med school, men and women both, do or should plan for coping with the inevitable decline of our parents and older family members. But there are some unfortunate circumstances that can make full-time work a challenge for months or even years.

I suspect the author has been fortunate in her career and health.

When a doctor or a dependent becomes seriously ill, she needs a supportive environment. She needs a workplace that allows her to take time off completely, or to work part-time for a while and possibly for a period of years, in a way that doesn’t engender resentment among her colleagues.

In a system without slack, doctors may feel pressured to work under too much duress, when they themselves are facing serious health or family problems. As things stand, I’ve witnessed doctors who’ve abused alcohol, been unkind to colleagues and disrespectful toward patients, and cut clinical corners as ways of coping with too much work, too little free time, and too little sleep.

Sometimes, the reasons why a doctor needs to cut back on her hours or work may not be evident to her colleagues. She may keep her good reasons to herself. With patients, explaining the details of one’s own illness, or a child’s, seems unprofessional, in general, although I do think that when a doctor becomes so fragile that she may not be able to return to work, her patients have the right to know that much, if they depend on her.

As for me, what I’ll say here is this: The day I stopped practicing medicine, nearly five years ago, was one of the saddest days of my life.

Medicine still is a macho field, as Dr. Sibert reveals in her op-ed. This is a shame, because the physicians’ shortage is real. In the long run, the system – which amounts to doctors in supervisory positions, like division and department chiefs – should soften up.

A flexible, more realistic system would allow doctors, in whom the system has invested so much, and who have invested so much of themselves, to take time off when they need it, and flexibility in their schedules, so they can continue in their careers after prolonged illness.

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A Recipe for Fresh, Low-Fat Blueberry Muffins

This morning I noticed we had too many blueberries in the fridge. So while my husband went out for a run, I opened the windows wide (to cool the apartment), turned on the oven and made some fresh breakfast food.

fresh muffins, Sunday morning

It had been two decades or so since I’d baked anything like these. My recollection, mainly from my suburban childhood, was that muffins involved a fair amount of work; we used to pull out a mix-master with beaters, a flour-sifter, and all sorts of stuff that then had to be cleaned. That was far too much work for me this morning.

So I simplified and halved an old recipe I’d hand-written sometime back in my Moosewood years. And I adjusted it so there’d be less sugar, and swapped whole milk for skim.

Preparation time: 8 – 15 minutes, depending on your proficiency in the kitchen; Baking time: 30 minutes

Ingredients (for 8 small muffins):

1/4 cup softened butter (vegetable oil is OK, too; some people say that improves the texture and taste of the baked goods, but I’m not convinced and try to minimize chemicals in my cooking.)

2/3 cup sugar

1 large beaten egg

1/4 cup skim milk

1/4 teaspoon salt

1 teaspoon baking powder

1 cup flour (I used organic, which I happened to have, and didn’t bother sifting it)

optional: cinnamon, ~ 1/4 teaspoon

ripe blueberries, about 2 cups, washed

—-

Preparation:

1. Preheat the oven to 375 degrees (F)

2. Use a fork to smash the butter at the base of a deep, medium-sized bowl;

3. Add the beaten egg and mush everything together;

4. Add in the sugar, stir with a fork or large spoon;

5. Add the milk, swirl everything together with the spoon;

6. Add the salt and baking powder, mix thoroughly at this point to evenly distribute the salt and powder;

7. Add the flour, and mix again.

(This step completes a basic muffin batter.)

8. Now, add the fruit.* For blueberries: With extra-clean hands, grab a fistful of washed blueberries and squeeze them into the batter for flavoring. Then add in the remaining whole berries and mix those around, gently.

9. Insert paper cupcake holders into the holes of an oven-proof muffin tray. Drop about 1/3 cup of batter into each cup, not overfilling.

10. Bake for 30 minutes at 375 degrees in the center of the oven.

11. Remove from the oven. (If you’re compulsive, as I am: insert and withdraw a toothpick with a quick in-out stroke; if the muffins are cooked, raw batter won’t stick. If batter does stick to the toothpick, put the muffins back in the oven for 5 minutes or longer, until they’re done.)

—–

If you follow these instructions, you can make fresh muffins with minimal equipment and little to clean up. You can freeze and store the muffins, no problem, once they’ve cooled.

*There are countless fruit variations and other add-ins you might use. This morning I prepared half of the batter using a ripe, diced banana and a fistful of cut-up walnuts.

Considerations:

Not everything I cook is nutritious. And while I don’t advise eating muffins regularly, as these are essentially confections, I figure if you’re going to serve these to your family, it’s better that they be prepared with fresh ingredients and a minimum of chemicals, sugar, salt and fats. These have some relative advantages over similar breakfast treats:

These lack preservatives;

They’re roughly half the size of typical store-bought muffins (countering the super-sized effect);

They’re made with skim milk instead of whole milk;

They have approximately 2/3 the usual amount of sugar.

Besides, they came out great!

Of course, dear readers, I’d like to know what are the true nutritional benefits in blueberries, and what happens to their putative anti-oxidant properties once they’ve been baked for 1/2 an hour. But I don’t think anyone knows, for sure.

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A New E. Coli Outbreak, Hemolytic-Uremic Syndrome, and Eating In or Out

There’s a newly-identified E. coli strain that’s causing a serious illness called hemolytic uremic syndrome (HUS). The recent cases, mainly in northern Europe, have been attributed to eating raw vegetables like cucumbers, lettuce and tomato. So far, authorities aren’t sure of the exact source.

Like any stomach bug, these bacteria can cause diarrhea, fever and other symptoms related to the gut. When people develop HUS, the kidneys fail and they may need dialysis. (Uremic Syndrome refers to uremia, when toxins normally cleared by the kidneys circulate in the bloodstream and cause problems in other body parts.)

blood smear reveals fragmented red blood cells (schistocytes), image from Wikimedia Commons

The “H” in HUS is for hemolytic, which describes how red blood cells are destroyed in the bloodstream. This occurs sometimes from effects of a bacterial toxin, such as might happen upon ingestion of a toxic strain of E. coli bacteria. This condition results in jaundice – a visible yellowing of the eyes and skin, and anemia – a paucity of red blood cells.

According to NatureNews, the culprit’s genome has been sequenced. It encodes broad-spectrum beta-lactamases. This means these toxic E. coli will, in general, resist antibiotics that exert their antiseptic powers by means of beta-lactam rings.

What’s my take-home message, as a home-maker and mom?

If I were traveling in areas affected now, I wouldn’t panic or change my plans. But I would avoid eating salad and any raw fruits or vegetables that can’t be peeled. I’d be mindful of foods like guacamole and salsa with fresh cilantro or other imperfectly-washed ingredients. Better to order cooked food, especially in restaurants where you don’t know who’s rinsing the greens.

The same rules apply at home, except that I’ll eat salad and fresh vegetables that I’ve prepared diligently.

Hand-washing after touching any part of a toilet, bathroom sink or faucet is always wise. The point is to avoid accidentally putting germs in your mouth that come from animal or human feces.

Yuck.

My next post will be on another topic, entirely.

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Good People, a New Play About Chance, Decisions and Fate

A short note on Good People, the title of a new play at the Manhattan Theatre Club starring Frances McDormand

It’s a simple story, at some level, about a middle-aged woman from south Boston who loses her job. She has a disabled, adult daughter who needs caregiving, and she needs money. She contacts some old friends, and scours the neighborhood for a job. She encounters a once-boyfriend, just for a summer at the end of her childhood, who’s become a doctor with a fancy office and a fancy house and a beautiful wife.

Frances McDorman, in a photo for the MTC

And she’s angry, angry because she’s never been able to leave her community despite, as she puts it, “being nice.” She put her daughter’s needs first and helped others when she could – or so she says, but she was too often late for work at one job and the next, because she was waiting for the daughter’s sitter, or because she couldn’t pay the bill on her car, or for some reason or other unfortunate event, as she sees it, that isn’t quite her fault.

The play’s well-executed, with firm acting and revealing details – like the wallpaper and mismatched furnishings  in the woman’s kitchen, and the spotty sportswear the women don when they go out to be sociable. Some scenes take place in a church, where the characters chat as they play “BINGO,” waiting and hoping for a lucky break.

It’s about fate, and responsibility, and assumptions people sometimes make. And it’s closing this Sunday.

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Psychology Colors and Emotions, from the Late Dr. Robert Plutchik

This morning’s med-blog Grand Rounds is up at MedGadget, where my colleague Dr. Nick Genes has put together a nice assortment of reads. One entry refers to the Plutchik Emotion Circumplex – “a wonderful graphic representation of a highly regarded emotion classification system.”

Plutchik's diagram, as featured in his book: "Emotions and Life: Perspectives From Psychology, Biology, and Evolution"

I never took psychology in college, and in med school they sent us straight onto (into?) the psychiatry wards. For whatever reason, I wasn’t familiar with the colorful schematic. Here’s what I learned today:

Dr. Robert Plutchik was an academic psychologist and author best known for his work on the nature and evolutionary aspects of emotions. He was a Brooklynite who attended City College, received a Ph.D. from Columbia University and became a professor at the Albert Einstein College of Medicine. According to an obituary in now-defunct New York Sun, after retiring he moved to Sarasota, Florida. He died in 2006, at the age of 78.

From the Sun:

He was best known for his theory, laid out in “Emotion: a Psychoevolutionary Synthesis” (1980), that there are eight primary emotions, which can to some extent be recognized in all animals. These are joy, acceptance, fear, surprise, sadness, disgust, anger, and anticipation. It was Plutchik’s insight that emotions could be laid out in a circular arrangement, much like a color wheel, and then combined into secondary emotional states. Love, for instance, was in this schema a combination of joy and acceptance. Delight was a combination of surprise and joy.

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Cooking With Leeks

A note on cooking with leeks, inspired by a NYT Well post with a list of related Recipes for Health:

I use leeks all the time, as my neighbors are probably too aware. I use leeks sautéed in olive oil as filler, mixed with an egg and flour for a tart, or to season simple pasta, or to flavor and decorate roasted potatoes.

How I prepare leeks is this:

First I cut off the base and ragged tips of 3-4 stems, slice the mainly dark-green stems lengthwise, and then cut the stalks into 1 – 3 inch sections, depending on what they’ll be used for. Because there’s often dirt from the ground deep in the lower, paler sections of the leeks, I manually expose and separate each rounded layer, and then wash everything  under briskly-running water, thoroughly rinsing at least three times.

You don’t have to dry the cut, washed leeks. What I do is heat a heavy, wide pan on the stove, add a thin layer of olive oil, and then throw on the damp (or dry) leek pieces. With the flame set low, I toss on about a half teaspoon of salt for a volume of 3-4 large stalks. Sometimes I add fresh ginger, cut into tiny pieces, into the mix.

And then I work on other things in the kitchen – often while listening to NPR or talking to my mom on the phone – while the leeks wilt. If I’m running late, I’ll put a lid on the pan, which makes the leeks soften faster, but that’s not ideal. Every few minutes I stir them around a bit with a wooden spoon or spatula, until they’re soft and, typically, shiny with varied shades of green.

You can store cooked leeks in the refrigerator for a few days, if they’re in a sealed container. So you might, as I have, use a small amount with pasta on a Monday, and then use the remainder for a goat cheese and leek tart later in the week. There are many variations, and I’ve only started using this vegetable in the past four years or so.

This summer I intend to try making a potato-leek soup.

According to Martha Rose Shulman, writing for the Times, leeks are milder than onions but contain sulfur compounds present in onions and green garlic that some people find hard to digest. Leeks are a good source of nutrients like lutein and zeaxanthin, carotenoids – thought to be important in vision, calcium, iron, magnesium, phosphorus, potassium and vitamin K. Leeks are fiber-rich, I might add.

I should learn more about each of these elements; how they’re best cooked and absorbed. Unfortunately I’m still searching for the nutrition textbook they never assigned in med school.

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Confusing Reports On Coffee and Cancer, and What To Do About Breakfast

When I was a medical resident in the late 1980s, we treated some patients with pancreatic cancer on a regimen nick-named the coffee protocol because it included infusions of intravenous caffeine. How absurd, we thought back then, because years earlier caffeine had been linked to pancreatic cancer as a possible cause.

Now, two new studies suggest that coffee consumption reduces a woman’s risk for developing breast cancer, according to MedPage Today:

Women who drank at least five cups of coffee daily had a significantly lower risk of postmenopausal breast cancer, an analysis of two large cohort studies suggested.

…Coffee has a paradoxical relationship with breast cancer risk. The beverage’s complex mix of caffeine and polyphenols suggests a potential to confer both carcinogenic and chemopreventive characteristics, the authors noted…

I’m incredulous, still.

As with most compounds we ingest or otherwise absorb, it’s conceivable that caffeine could damage some cells or somehow factor into some tumors’ growth just as it might suppress others, and that the dose matters. The fact is that, like most dietary chemicals, we really don’t know much about its specific effects on any cancer type.

This morning, as usual, I had an early cup of joe with low-fat milk stirred in. I might have a second cup, or a cappuccino with skim milk and cinnamon, in the afternoon. And that’s about it.

When I’m not sure if something’s good or bad for me, or both, I take it in moderation, if at all, if I choose.

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On Pleasant Behavior And Being A Patient in the Hospital

Dr. Wes has a short post today, How to Optimize Your Care While Hospitalized that got me thinking. He writes:

…A lone doctor listening to some highly experienced and capable nurses, reflecting on their work:

“If the patient’s nice, it’s a lot easier to want to go back in that room with them. Their reputation travels at the nurses station. But if they’re mean, well, it’s not as easy to go back in there, so I might not stop by as often.”

“I agree, it’s easier to catch flies with honey than vinegar.”

Words to live by.

My first take: He and the nurses are right, of course: If you’re pleasant and courteous, nurses (and doctors, and physical therapists, and aides, and cleaning staff…) are more likely to spend time in your hospital room. The maxim applies in many realms.

But let’s take the conversation to the next level. What if the patient’s in pain? Sad, or maybe even crying? In that case, are the hospital staff less likely to enter? Probably so, but health care workers are a diverse bunch.

There are many nurses I’ve known who’d spend more time with an unhappy soul, or someone in pain. As a doctor, I think the same holds.

Maybe some people are grouchy because they’re uncomfortable, worried or lonely and just don’t have it in them to smile. They may lack insight or simply lack manners. They might be very upset, say, that a son or daughter hasn’t visited, or another unmentioned disappointment.

Perhaps it’s the professional’s job to see beyond the smile, or the anger.

Not an easy job  –

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Get Off My Case

In my inbox this morning, via ASCO‘s “Cancer in the News” feed:

The UK’s Telegraph (5/6, Beckford) reported that as “many as 20,000 British women could avoid developing” breast cancer “each year, if they took more exercise, drank less and ate better.” Latest figures “suggest that 47,600 women developed breast cancer in 2008,” and the World Cancer Research Fund estimates that estimates that “42 per cent of these cases…would be preventable if women developed healthier lifestyles.” The WCRF’s “10 Recommendations for Cancer Prevention include being ‘as lean as possible without becoming underweight’; keeping fit; limiting consumption of fatty, salty and sugary food and drink; eating fruit, vegetables and pulses; eating less red meat and processed meat; drinking less and choosing a balanced diet rather than vitamin supplements.”

This follows numerous reports that women may develop breast cancer or suffer recurrences because they eat too much, drink too much, work too much or fret too much. (But don’t relax and put down your vacuums, girls – there’s striking evidence that household chores can reduce your risk!)

Of course it’s wise from a general medical perspective – think in terms of heart disease, osteoarthritis, type 2 diabetes and other ailments prevalent in our too-developed world – to be slender instead of fat, exercise regularly and eat a balanced diet.

I’m tired of the press trumpeting poorly-done trials that feed into a stereotypic conception of how women should behave. Yes, diet and stress could play a role in any hormone-driven disease, but so do a lot of things. As for alcohol, maybe consumption is a surrogate for wealth and living in a place like the U.S. where people drink freely, where breast cancer rates are unseemly.

We should be sure of the facts before pronouncing these fatal flaws in our ways of existence and being. Plenty of women feel badly about their tumors and disfigurement without this added layer of insult.

And what did you eat for dinner last night, big brother?

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Until Tuesday, A New Book About a Very Strong Person

A short note on a book party, fundraiser and warm celebration I attended yesterday evening. My first Facebook friend, Luis Carlos Montalván, an acquaintance from my experience at Columbia’s Journalism School, has published a wonderful book, Until Tuesday (Disney-Hyperion).

I received a copy of the book at the gallery, and couldn’t put it down. Luis, a seasoned veteran and former Captain in the U.S. Army, earned the Combat Action Badge, two Bronze Stars and a Purple Heart medal. He was severely injured during his deployment in Iraq, and came back with deep emotional and physical wounds.

His wonderful book is a tale of healing, aided by a special dog, but really it’s about human healing, and Luis’s determination to get well.

I am inspired by Luis, first that he got his book out (he beat me to it!), and also for being so brave in telling his story. It’s not an easy one, but it’s intense and will forever influence how I think about soldiers.

“Some people in the room know that every day 17 veterans commit suicide,” he mentioned to the group. I wasn’t aware, until yesterday.

For those of you who missed the party last night, you can check out this clip from CNN this morning, but of course it’s not the same as meeting Tuesday in person.

Thanks Luis, for being so forthcoming, and strong!

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New York City Reports Long Delays for Mammograms

A recent audit of nine NYC’s Health and Hospitals Corporation found City Comptroller Liu described as dangerous delays in women’s health care. It takes too long for women to get screening and diagnostic mammograms.

The 2009 audit found women at Elmhurst Hospital had the longest waits – 50 working days (that would be 10 weeks, i.e. 2.5 months) for diagnostic mammograms, on average. You can find more details here.

According to the Times’ coverage:

Ana Marengo, a spokeswoman for the city’s Health and Hospitals Corporation, which runs the public health system, said that the comptroller’s data was outdated…

At Elmhurst, she said, the wait as of December 2010 was 20 days for screening and 23 days for a general diagnostic test, as opposed to an urgent one.

Still, at Queens Hospital Center, the wait for a screening test was 56 days in December <2010>, Ms. Marengo said. “It’s due to volume and higher demand,” she said. “We only have a certain amount of resources.”

From the comptroller’s press release, a statement from Alice Yaker, Executive Director, of SHARE: Self-help for Women with Breast or Ovarian Cancer:

“While controversies about efficacy surround the screening of healthy women, there is no controversy about the need for a diagnostic mammogram in a woman who presents with a lump in her breast, for example. This requires our urgent attention, budget cuts and hospital closings notwithstanding.”

The comptroller’s message says there’s no guideline for how soon a woman with breast cancer symptoms, such as a lump, should receive a diagnostic mammogram. For screening, guidelines suggest the wait be no longer than 14 days for an appointment.

This blogger’s vote: set up a maximum wait time for diagnostic mammography: 10 working days.

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