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By Elaine Schattner, MD, on January 2nd, 2012
The December issue of Wired Magazine profiles David Kirchhoff, CEO of Weight Watchers, in a story on new ways to measure calories and food. It’s an interesting piece, with several points worth contemplating at the start of the year.
Kirchhoff, who gained some 70 pounds in his years after high school, writes a blog about the ups and downs of his physical self. When he first came to Weight Watchers, it was a regular points-minded participant. Now, as a fit CEO, he’s changed the plan. In December 2010, the company adjusted its algorithm for counting points. Among the revisions, a banana and other fibrous fruits are relatively encouraged relative to other, less nutritious foods with similar amounts of calories.
The two main points I took away from the Wired story by Jeffrey O’Brien, supplemented by reading of his and sources are these:
1. The effectiveness of Weight Watchers derives largely from its method of peer-to-peer support.
Earlier this
See more A Healthy New Year’s Resolution with a Social Twist
By Elaine Schattner, MD, on December 14th, 2011
 One theme of this blog is how confusing can be on-line information. Last Monday I posted that I’m searching for a good Personal Health Record. I braced for spam, and got it in spades. (Thanks for that!)
But an intriguing, clearly ML-directed email led me to a curious, fake EHR company’s website: Extormity.com.
“…offering highly proprietary, difficult to customize and prohibitively expensive healthcare IT solutions. Our flagship product, the Extormity EMR Software Suite, was recently voted “Most Complex” by readers of a leading healthcare industry publication” – the site mock-boasts. A few clicks led me to its probably-true inventor, but I think I should let my readers’ fingers do the walking on this one.
Please do visit Extormity, for kicks. Some of the tabbed details are hilarious as things go in health IT.
For now I’ve decided to follow @Extormity on Twitter, for no reason.
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See more Email Leads the Author to Extormity, a Mock EHR Provider
By Elaine Schattner, MD, on December 7th, 2011
A hit in the women’s breast cancer Twitter league came my way from the Breast Cancer Sisterhood®. Brenda Coffee, a survivor and founder of the Survivorship Media Network, offers a serious post on What Your Oncologist Doesn’t Tell You About Sex.
There’s a music video, Don’t Touch Me that’s annoying but depressingly right on how some women feel in menopause — a frequent and under-discussed aspect of chemo or hormonal therapy for BC, followed by a grounded and unusually frank discussion about what happens to women after cancer treatment, menopause and sex.
Brenda’s right; none of this was included in my med school curriculum or oncology fellowship. Although, in fairness and quite seriously, this was a subject on mine and some other oncologists’ radar long ago. Cancer treatments can have lasting effects on sexuality in men and women.
Worth checking out Brenda’s network and her candid post. You can follow her @BCSisterhood on Twitter.
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Related Posts:Boobstagram
See more The BC Sisterhood Takes on Sex After Cancer and What Oncologists Don’t Say
By Elaine Schattner, MD, on December 2nd, 2011
 For the weekend -
A tweet led me to a fantastically inventive kind of music. The Radioactive Orchestra comprises 3175 radioisotopes. From the website: “Melodies are created by simulating what happens in the atomic nucleus when it decays from its excited nuclear state…Every isotope has a unique set of possible excited states and decay patterns…”
image from the Radioactive Orchestra project
The project, sponsored by a Swedish nuclear safety organization, KSU, encourages visitors to select among the graphed isotopes, listen and learn. You can try composing music on your own, or you can check out a production by DJ Alex Boman on YouTube:
Super-cool.
h/t: Maria Popova, @brainpicker, who picked up on this last August at Brainpickings. And to @JohnNosta, who sent yesterday’s tweet.
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See more New Music from an Orchestra of Radioactive Isotopes
By Elaine Schattner, MD, on November 21st, 2011
A short note on Cutting for Stone, a novel I’ve just read by Dr. Abraham Verghese. He’s an expert clinician and professor at Stanford. The author uses rich language to detail aspects of Ethiopian history, medicine and quirks of human nature. The book’s a bit long but a page-turner, like some lives, taking a strange and sometimes unexpected course.
For today I thought I’d mention one passage that haunts me. It appears early on, when the protagonist, a man in middle age reflects on his life and why he became a physician:
My intent wasn’t to save the world as much as to heal myself. Few doctors will admit this, certainly not young ones, but subconsciously, in entering the profession, we must believe that ministering to others will heal our woundedness. And it can. But it can also deepen the wound.
The point is, a physician may be immersed in his work in a manner that he is, in
See more ‘Cutting For Stone,’ and Considering the Experience of Practicing Medicine
By Elaine Schattner, MD, on November 17th, 2011
Today’s ML comes straight from the Oval Office. President Obama talks about smoking, and how hard it is to stop, and what can be done to reduce the use and long-term health consequences of tobacco.
What I like about this Presidential health advisory:
He credits the ACS, which is sponsoring a smokeout today.
He’s clear about the problem’s scope: “Today 46 million Americans are still hooked, and tobacco remains the leading cause of preventable, early deaths in this country.”
He doesn’t deny his own history. His experience lends credibility to his words; he understands how hard it is to stop smoking once you’ve begun.
He considers a solution: “We also know that the best way to prevent the health problems that come from smoking is to keep young people from starting in the first place.”
He reflects on the power of tobacco companies, which are fighting requirements for candid warning labels on their
See more President Obama Talks About Smoking and Tobacco
By Elaine Schattner, MD, on November 16th, 2011
Yours truly, the author of Medical Lessons, is listening to music while she writes. A live version of the Stones’ “Silver Train” has just come on, and she’s happily reminded of something that happened 30 years ago. Distracting? Yes. Calming? Yes. Paradoxically helps to keep me on track? Yes.
My iPod keeps my mind from wandering further. And it lifts my mood.
And so here, on my blog, which is not peer-reviewed or anything like that, I put forth the medical concept of “iPod therapy.”
“When you’re weary, feeling small…” Music can help.
Today’s news reports that 1 in 5 Americans take drugs for psychiatric conditions. That sounds like a lot to me, but I’m no pharmaceutical surveyor. Of course many people need and benefit from medical help for depression and other mental illnesses.
But, in all seriousness, I wonder how many people might use music like a drug to keep them relaxed, happy, alert…
Why not prescribe music? It
See more iPod Therapy — Why Not Prescribe It?
By Elaine Schattner, MD, on November 9th, 2011
 Last week Forbes ran a photo-feature on the 7 most powerful ‘foodies’ in the world, according to author Michael Pollen.
Michael Pollen, Forbes, Nov 2011
So who made it onto the short list?* with annotation by ML:
1. Michelle Obama (First Lady, mother, organic farmer-in-chief and Let’s Move! fitness enthusiast)
2. Marion Nestle, Professor, New York University (a neighbor, I’d like to meet!)
3. Josh Viertel, President, Slow Food USA (need to learn more)
4. Will Allen, Urban Farmer (ditto)
5. Jack Sinclair, Head of Grocery, Wal-Mart (who knew they’re the largest vendor of bananas in the US? I did! by listening to the Brian Lehrer show, some time ago.)
6. Ken Cook, Executive Director, Environmental Working Group (sounds reasonable)
7. Mark Bittman, Columnist, The New York Times (he’s on Twitter).
It seems to this homemaker/mom/physician that this group may indeed influence how, where and what we eat. The public health implications of their work may prove unmeasurable, but be large and very real, nonetheless.
I recommend
See more Seven Powerful ‘Foodies’ on Forbes, Influence on Public Health?
By Elaine Schattner, MD, on November 7th, 2011
On Friday I visited the Scar Project exhibit at Openhouse, on Mulberry Street just south of Spring. Photographer David Jay offers penetrating, large, wall-mounted images of young people with breast cancer.
The photos reveal women who’ve have had surgery, radiation, reconstruction or partial reconstruction of the breasts. Some are strikingly beautiful. Some appear confused, others confident. Some look right at you, defiant or maybe proud. Some, post-mastectomy, adopt frankly or strangely sexual postures. Others hide a breast, or turn away from the lens.
This collection is not for everyone. The photos of ravaged bodies of women with cancer might be upsetting, if not frankly disturbing, to some who look at them. Not everyone chooses to do so.
The women’s scars and expressions are telling. Though not representative, these images reflect wounds not often-shown in medical journals, or elsewhere.
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By Elaine Schattner, MD, on November 3rd, 2011
 I began reading August Farewell on the seventh day of that summer month. The date coincides with the beginning of David Hallman’s narrative of his lover’s death two years prior, and memory of their decades-long relationship.
A book by a gay Canadian Christian man might seem remote to a woman like me, who’s married, Jewish and lives in New York City. But Hallman connects, effectively; his story sticks and might influence the near-death arrangements of any person living in our modern world.
Hallman recounts the death of a man, his partner William (Bill) Conklin, who’d lived for years with multiple sclerosis and its debilitating effects. In August, 2009 Conklin learned he had advanced pancreatic cancer. The story works through the author’s 16 daily notes on meetings with doctors, nurses and palliative care specialists, and visits with old friends and family.
The patient chose to die at home and his partner, Hallman, honored
See more August Farewell: A Short Tale of a Peaceful Ending of Life
By Elaine Schattner, MD, on October 28th, 2011
I read Your Medical Mind in hard cover, the old-fashioned way.
This book, on how patients think, offers a penetrable, informed and anecdote-riddled discussion of how people make health-related decisions. It’s co-authored by a husband and wife, Drs. Jerome Groopman and Pamela Hartzband.
The two are experienced physicians: Groopman’s an oncologist and familiar author; Hartzband’s an endocrinologist. He says he’s a “believer” in modern medicine, although his faith’s been challenged since suffering untoward effects of back surgery. She’s a “doubter” and tends to wonder about other doctors’ directives. One thing I like about the book is its dual authorship; underlying its course lie communication, mutual respect and, in all likelihood, some compromises.
The book resembles a travel narrative of sorts, starting with an overview of the planned medical decisions “tour.” The pair sets out to interview “scores of patients of different ages, in different parts of the country, of different economic status, with different
See more Two Minds on Medical Thinking
By Elaine Schattner, MD, on October 24th, 2011
An article appeared in yesterday’s NYT Magazine on the hazards of over-confidence. The Israeli-born psychologist (and epistemologist, I’d dare say), Nobel laureate and author Daniel Kahneman considers how people make decisions based on bits of information that don’t provide an adequate representation of the subject at hand. He recounts how poorly, and firmly, army officers evaluate new recruits’ leadership potential and how brash, rash or naive traders maintain investors’ trust while weighing stocks to buy or sell.
The point, as I understand it, is that individuals, including influential and powerful people, routinely make recommendations without having adequate knowledge to support their decisions. And they do so comfortably.
Men are afflicted by overconfidence more than women, he suggests, although I’m not sure he’s right on this point. In the article, he uses reckless investors who rack up stock losses as an example: Guys are more likely to lose lots of money than are
See more Reading About Thinking (on D. Kahneman’s Ideas on Perceptions of Knowledge)
By Elaine Schattner, MD, on October 10th, 2011
 More, a magazine “for women of style & substance,” has an unusually thorough, now-available article by Nancy F. Smith in its September issue on A Breast Cancer You May Not Need to Treat.
Ductal Carcinoma in Situ (DCIS) in the breast, histopathology w/ hematoxylin & eosin stain, Wiki-Commons image
The article’s subject is DCIS (Ductal Carcinoma in Situ). This non-invasive, “Stage O” malignancy of the breast has shot up in reported incidence over the past two decades. It’s one of the so-called slow-growing tumors detected by mammography; a woman can have DCIS without a mass or invasive breast cancer.
While some people with this diagnosis choose to have surgery, radiation or hormonal treatments, others opt for a watchful waiting strategy. The article quotes several physicians, including oncologists, who consider the surveillance approach favorably and otherwise.
In 2009 the NCI sponsored a conference on diagnosis and management of DCIS. The participants issued a helpful, albeit technical, consensus statement.
The
See more More on DCIS
By Elaine Schattner, MD, on October 5th, 2011
Last week a video came my way via ZDoggMD, a popular blog by doctors who are not me.
The Office Med School Edition
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The clip is a parody of The Office about Problem Based Learning (PBL).
In a typical PBL, the students meet regularly in small groups. On Monday they begin with clinical aspects of a case. The process involves finding information and researching relevant topics to “solve” the diagnosis and /or a treatment dilemma. Over the course of each week the students move forward, working through a hypothetical patient’s history, physical exam and lab studies to the nitty-gritty of molecules, genes and cells implicated in a disease process.
It’s a lot of fun, usually.
The video was uploaded in February, 2007. It’s attributed to a group of med students at the University of Pittsburgh, class of 2009.
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By Elaine Schattner, MD, on October 3rd, 2011
 Today’s New Yorker has a story, Personal Best, by Atul Gawande. It’s about coaching, and the seemingly novel idea that doctors might engage coaches – individuals with relevant expertise and experience — to help them improve their usual work, i.e. how they practice medicine.
Dr. Gawande is a surgeon, now of eight years according to his article. His specialty is endocrine surgery – when he operates it’s most often on problematic glands like the thyroid, parathyroid or appendix. Results, and complications, are tracked. For a while after he completed his training he got better and better, in comparison to nation stats, by his accounting. And then things leveled off.
The surgeon-writer considered how coaches can help individuals get better at whatever they do, like playing a sport or singing. He writes:
The coaching model is different from the traditional conception of pedagogy, where there’s a presumption that, after a certain point, the student no longer
See more Do Doctors Need Coaches? Atul Gawande Considers How Physicians Keep On Learning
By Elaine Schattner, MD, on September 28th, 2011
Last night Showtime aired the second season’s finale of the Big C. As usual, there was no detail whatsoever about Cathy’s advanced melanoma or treatment.
I didn’t think the show could get worse, in the reality-of-having-cancer sense, but it did. Cathy, who still looks great and complains of no physical problems, determinately runs, walks and trudges through a New Year’s marathon. OK, that might happen, but it shouldn’t.
Biggest mistake ever in this series so far: In a scene near the end, Cathy’s first oncologist shows up at the race to see her meet the finish line. While they’re waiting, he and Cathy’s teenage son Adam go to a diner. Adam asks the doctor about his mom’s prognosis, and the oncologist answers.
It’s a blatant, medical ethics 101 no-no — talking to a patient’s family member without her permission. And to a minor, no less.
I just read the program has been renewed for a 3rd Season.
See more End of the Big C Season 2, ML Coverage Stops
By Elaine Schattner, MD, on September 27th, 2011
 I finally caught Contagion, a week or so after the movie spread to theaters throughout the country. After so much talk about the film’s scientific grounding, or not, I wasn’t sure what to expect of a film on such a scary and medically intense subject. And with so many star actors, and being directed by Steven Soderbergh, the work was bound to disappoint this doctor-writer-viewer.
The imaginary scare, grounded in science, offers little pleasure. I didn’t enjoy watching it much.
Still, there’s value in disseminating information on how germs spread. Other, expert writers have already covered ID aspects of the film, like details on a hybrid bat-pig virus infecting humans.
I might complain about the absurd blogger-villain, but let’s just say he’s not worth it.
My favorite scene is contained within the official movie’s trailer. In it, we see Matt Damon portraying the husband of a woman (Gwyneth Paltrow) who’s just returned from a business trip in Hong Kong with a cough and lethal virus.
See more In Shock, and Not Hearing What the Doctor Says in ‘Contagion’
By Elaine Schattner, MD, on September 21st, 2011
Dr. Anne Marie Cunningham is a GP who lectures at the University in Cardiff and practices in South Wales. She’s been blogging on Wishful Thinking in Medical Education since October, 2008.
We connected on-line a while back, likely a function of shared interests, but it took me a while to examine her work. It’s rich with ideas on ethics, technology and teaching modern medicine.
The UK’s Telegraph picked up on a recent, excellent post, Social media, black humor and professionals…
There’s a lot I might learn by following ‘Wishful Thinking…,’ and will.
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Addendum 10/3/11: links corrected.
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By Elaine Schattner, MD, on September 20th, 2011
I stayed up last night watching the Big C. The latest episode, The Darkest Day, takes place on Dec 21 at the end of the show’s pseudo-fall second season.
Here, two things happen of above-average interest to this doctor-patient-viewer:
First, the characters’ usual and crude shenanigans are interrupted by Cathy’s visit to a class of future cancer doctors. (Can we say “oncologists”? No, it’s too big a word for this program.)
Second, Cathy aborts her family’s planned vacation to stay with her friend Lee, who’s dying. Her decision to stay with Lee is perhaps the most interesting, and controversial, decision she’s made so far, but I won’t harp on this, because how can anyone judge what she’s doing?
The lecture scene:
Dr. Sherman (Alan Alda) “presents” Cathy (Laura Linney) to his class, a group of diverse young people most of whom are taking notes on (Apple – another story) laptops in a small lecture style room. The
See more Cathy Tells Future Cancer Docs to Shut their Laptops and Speak Plainly
By Elaine Schattner, MD, on September 15th, 2011
Watching the Big C feels like a chore lately.
It reminds me of the feeling I used to get when I had to see and examine a patient in the hospital, under my care for some administrative non-reason, who didn’t need to be in the hospital IMO, and whose hospital presence took time my time away from patients who needed my attention. But because I was responsible, I’d go and see her every day just the same, and listen and examine, make notes and occasional suggestions.
The show is terrible. There, I said it on the Internet.
In the most recent episode, Cathy (the melanoma patient who’s said to be responding to a treatment about which viewers know nothing) runs into her oncologist at the pool where she symptom-freely coaches a swim team. The doctor, portrayed by Alan Alda, has a young wife who talks openly about sex with her husband and invites Cathy to a meal in their home.
See more ‘The Big C’ is Failing
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