Schwing!

The Vancouver Olympics end today after the men’s ice hockey finals this afternoon between Canada and the US. It’s been a wonderful two weeks for me with TV coverage on three different networks that I recorded on DVR, scanned at super fast forward and either viewed or erased. No ads, minimal fluff, no 10,000 K cross country skiing, but some amazing individual and team performances. To the credit of NBC, they kept the jingoism down, and though they are probably obliged to highlight the accomplishments of the US athletes, they gave plenty of time and credit to the host nation, Canada. There were two bits of fluff that I actually liked. The first told the story of Gander, the small town in Newfoundland that on 9/11/2001 took in all of the passengers from US bound flights that were diverted to eastern Canada when US airspace was closed down. The 10,000 citizens of Gander took in 7,000 passengers and crew, housed them, fed them, gave them emotional support and accepted no money in return.

The second was a piece on Canada’s many outstanding comedians. There’s Mike Myers, John Candy, Jim Carrey, the first for me; Dan Aykroyd, and loads more. Some say that the long Canadian winters induce a form of insanity that produces comedians. Others theorize that it’s the authoritative society that creates rebels that fight back with humor. I don’t buy that one. How many really funny people come out of Switzerland? Part of the answer, at least since 1977, is Lorne Michaels, the founder and producer of Saturday Night Live. He is from Toronto and no doubt sought to promote the careers of fellow Canadians. He didn’t make Rick Moranis and Eugene Levy funny but he did give them a forum for the development and broadcasting of their talents.

Despite the Olympics and all the hype surrounding it, the biggest sports story for me in the past two weeks came right out of New Haven, CT. The US collegiate team squash finals took place in a match between Trinity College and Yale. Trinity, the number 1 team in the US for the past 12 years, was led by senior, Baset Chaudhry, a 6’5’’ player from Lahore, Pakistan. Yale’s top player was a 5’8” freshman from Singapore, Kenneth Chan. Chaudhry has been the best player in the US for the past three years. He was undefeated this year and beat Chan handily in their previous meeting. According to his coach, he is an excellent student and a popular figure on campus. His parents came from Pakistan and were in New Haven to see his last team match. At the end of the match, which Chaudhry won in straight sets, he had a Serena-esque meltdown in which he physically confronted and verbally attacked his defeated opponent. The outburst was caught on tape and featured on ESPN’s Sports Center:

http://sports.espn.go.com/ncaa/news/story?id=4949438

The ESPN piece was presented by Merril Hoge, an ex-NFL running back, cancer survivor and motivational speaker. Hoge presented the frightening incident with a smirk and joked about the towering Chaudhry’s intimidation of Chan. As his co-commentators chuckled in the background, he quickly and condescendingly explained away the game of squash, and then went on to talk about buttocks seals and verbal spraying. The only reason the sport of squash received any national coverage was because one of its top players acted badly, one might say like a football player. Whereas antisocial behaviors such as fighting and trash talking are condoned or encouraged in many sports, they are not a part of squash which actually has Ethics Guidelines. To his credit, Chaudhry, once past the heat of battle, apologized to every team and coach in collegiate squash and ultimately punished himself by withdrawing from the national individual tournament, giving up his last chance to defend his two time championship. ESPN did not report this in follow-up.

Merril Hoge may see himself as a motivator who can help us “Find a Way” in life, but he and ESPN missed the boat on this one. We need to decide as a nation if the way to success includes behaviors that injure others and whether such behaviors such as drug use, bullying, trash talking, robbery, rape and murder are excusable in those who have achieved great success. Maybe we should just be a bit Canadian, include good deeds in our definition of success and learn to tell a good joke. Schwing!

I’ll Bring the Kleenex

I hope you readers took the time to view the last YouTube clip in my “What a Dog” blog. It showed the ingénue, Cameron Diaz, in the role of a nightclub performer who dropped men’s jaws and induced howls and whistles. An actress only gets to be an ingénue once, and Cameron made the most of it. I tried to divert your attention from her clinging, shimmering gold sequined dress to the sexily dubbed singing voice, but once she let her fingers play down the right side of that dress, who could notice the voice? Perhaps ingénue is not the correct word as it implies naiveté and innocence more than newness to acting. Lauren Bacall, 50 years earlier, was a similarly sultry ingénue in her first role as Slim in “To Have and Have Not”. She even taught her man, Humphrey Bogart, how to whistle:

You know you don't have to act with me, Steve. You don't have to say anything, and you don't have to do anything. Not a thing. Oh, maybe just whistle. You know how to whistle, don't you, Steve? You just put your lips together and... blow.

Diaz and Miss Bacall had similar beginnings. Cameron left the beaches of Southern California at the age of 16, signed on with an agency and spent the next five years as an international model. Bacall began modeling in New York City at the age of 17. She appeared on the cover of Harper’s Bazaar, was noticed by director Howard Hawk’s wife Nancy, was invited to Hollywood for a screen test and the rest is history. Nancy Hawk helped her develop her style in clothes and her trademark seductively low voice. Miss Bacall lured Humphrey Bogart from his wife all on her own.

Cameron went from temptress in The Mask to angel in the Charlie’s Angels movies. She played a ditzy blond on screen and began to play the potty mouthed bad girl off screen and in the Tabloids. I’m sure for her it seemed the right move, but can a woman who used Ben Stiller’s semen as hair mousse (Something About Mary) ever be taken as a serious actress? To her credit, when she doesn’t have to appear in a film, she does a great job. She is a perfect Princess Fiona in the Shrek movies. Sweetness with an edge, and a tolerance for us donkeys.

In my house, Cameron Diaz is best known for one of her lines from Charlie’s Angels, “I love tickets”, which she delivered in response to a potential suitor’s line, “I’ll get tickets”. Though endlessly repeating movie lines is a decidedly male annoyance, even the women in my family will almost smile when I respond, “I love tickets”. And I do, both repeat the line and love tickets. Have you noticed that many of my blogs make references to movies?

Some of my love of the movies is genetic. My father grew up in the pre-TV era and would spend all afternoon Saturdays at the movies for a quarter. The Brooklyn theaters would have serials, Flash Gordon and the like, newsreels, a double feature and contests with prizes for the kids. My maternal grandfather, Julius Davis, loved movies and would laugh and weep audibly, a strange sight for a ten year old me to witness in a public Manhattan theater. My grandmother Florence, who was a very controlling and in control woman, explained that he cried because he had strong emotions that just came out at the movies. Their's was an old world marriage. He practiced medicine, sat in his chair and read newspapers and journals. She managed the home, help, children, social calendar, vacations…basically everything and everyone else. She was always very protective of him. We had to be quiet during his daily nap. We couldn’t sit in his chair. My aunt Dorothy wouldn’t eat lox because my grandparents threatened to put locks on the door if she kept going into my grandfather’s office. After his second heart attack Florence stayed home with him for three months. When she finally thought he was well enough to be home without her, she went out to join her sisters for their weekly card game. He was not home when she returned. A panic followed. The police found him that night in a city hospital morgue. He had been found dead in the back row of a Broadway movie theater. We’ll never know the whole story. No doubt he took advantage of my grandmother’s afternoon out to take a walk on a beautiful summer day. One possible scenario: he developed chest pain and ducked into an air conditioned movie theater to sit down and rest. A second scenario: he liked movies but the one he chose was too much for his weak heart. Either way, he died in a place where his feelings could be freely and openly expressed. I express mine there too. Join me sometime. You can buy the popcorn. I’ll bring the Kleenex.

What a Dog

Have I mentioned that I like to sing in the shower? Perhaps not. It’s not something I tell everyone. It used to embarrass my kids. They’d insist that there be at least 3 closed doors between my shower and their ears. A lot of good that did—they both know my whole repertoire, down to the third verses. Shower acoustics make all of our voices echo with a resonance that most of us can’t create with our limited breath support and vocal skills. The humidity helps too, along with the hot water that relaxes tense muscles, and the privacy and nudity that disinhibit and free us to experiment and let loose. So what, you say. We all sing in the shower. Granted, but you don’t sing what I sing, and I’d like to share some of that music with you. Relax; I am not extending 6:30 AM invites to anyone. You don’t have to listen to me either. Just take some time to check out the real singers on YouTube using the links below. Smiles and surprises, I promise.

Miss Peggy Lee was born in 1920 in North Dakota. From small town radio to Hollywood clubs, she made it to Benny Goodman’s big band as his featured vocalist. She acted, wrote music and lyrics and continued to perform into her 70s. She has been compared to The Great Gatsby’s Daily Buchanan; “she brings others close to her with the softness of her voice. There’s a creamy warmth to the tone of her voice that gives it a sensually conspiratorial quality”. (Discovering Great Singers of Classic Pop By Roy Hemming and David Hajdu; Newmarket Press, 1991). For me, her voice is cream, honey and sex. Everyone has covered her seminal Fever, including me in the shower. I like to deliver the line, “Julie, baby, you’re my flame”, in a voice that’s a mix of Charlie the Tuna and Andrew Dyce Clay. He’s a Tramp from Disney’s Lady and the Tramp is another of my Peggy Lee songs. She wrote the lyrics and was the voice of that bushy tailed junkyard vixen who made all the male dogs howl (don’t miss the link below). I change “He’s” to She’s and “rover” to big tease. It works for me. She also wrote the Siamese Cat song and was the voice of both cats. I don’t do that one. I’m more of a dog guy.

Another Peggy Lee classic that I don’t do is Why Don't You Do Right (see link). As a guy, there are some songs that just don’t cross over, unless you’re willing to go Outrageous! (classic flick) and do the drag thing. I admit, I do sing Johnny Mathis’ When Sunny Gets Blue and Misty, but I still prefer Jessica Rabbit’s shape to Roger’s. Jessica, by the way, covered Why Don’t You Do Right (see link) vamping to a gape-jawed Bob Hoskins. My jaw dropped too when I discovered who gave Jessica her voice. Believe it or not, it was Amy Irving. She was, you may remember, the girl in Carrie, Yentyl, and Crossing Delancy. She also happened to be married to Steven Spielberg in 1988 when Who Framed Roger Rabbit was released. Spielberg founded Amblin Entertainment. Amblin made Roger Rabbit. I don’t think it was a coincidence that she got the job. And I am absolutely sure that Amy Irving sang in the shower. Not good enough, though. They divorced in 1989.

The last link is for those of you who prefer the real thing to cartoon characters. Cameron Diaz knocked everyone’s socks off in her film debut, The Mask. The body and moves are hers, but the voice belongs to Susan Boyd, a journeywoman singer and actor who you can see in reruns of Happy Days. The wolf in the audience is Jim Carrey who is a cartoon character with or without the celluloid.

Enough words. It’s time for you to get a taste of the Indomitable Miss Peggy Lee and Jessica/Amy/Cameron/Susan doing their thing. Then, if you really want to laugh, picture yours truly singing Miss Lee in the shower. “Fever ‘till you sizzle. What a lovely way to burn”.

http://www.youtube.com/watch?v=cO3hrVaVzP0&feature=related

http://www.youtube.com/watch?v=jdqvX-n25gs

http://www.youtube.com/watch?v=yy5THitqPBw&feature=related

http://www.youtube.com/watch?v=WfjuZVG4wGM&feature=related

With A Capital T

I volunteered to give a Grand Rounds talk to the Stamford Hospital Medical Staff on a topic that is hot in Gastroenterology and has been bugging every GI doc in the US for the past year. The topic is the use of anti-acid Proton Pump Inhibitor medications (Prilosec, Nexium, Protonix, etc.) along with Plavix, a blood thinner that is used, among other things, to prevent clotting of coronary artery stents. Last year a French study said that PPIs could interfere with the anti-platelet effect of Plavix and possibly cause coronary stents to clot off leading to heart attacks and death. That single study, which was done in test tubes, not lab animals or people, was publicized by the news media, embraced by cardiologists and pharmacists, and has caused many doctors to have their patients stop taking PPIs. It has also caused many patients to stop taking PPIs on their own or at least question their Internist, Cardiologist and/or Gastroenterologist. Last November the FDA got into the act and now recommends against the use of both Prilosec and Nexium with Plavix.

I am in the process of deciding how to approach my talk and hope to use you, my readers and friends, as a sounding board to help me focus and organize my thoughts. Let me jump to the bottom line first. Although some PPIs do interfere with the activation of Plavix in the test tube, in real life prospective studies published in the past year, done on people, there has been no increase in heart attacks or death in those co-treated with PPIs and Plavix. The only increase in morbidity (bad stuff happening short of death) or mortality has been secondary to GI bleeding from stopping the PPI. PPIs have been proven to heal ulcers and protect against GI bleeding. If someone has an ulcer or some other GI lesion that could bleed, drugs like Plavix make the bleeding much more severe and difficult to stop. America’s foremost Cardiologist, Eugene Braunwald, the Harvard guy who writes the foremost Cardiology textbook, wrote a paper saying that we should not stop PPIs in our patients who are taking Plavix but rather get back to thinking about preventing GI bleeding. Still, I get calls daily about my patients being taken off PPIs because they have been told the whole class of drugs will cause them to have a stroke, heart attack or die.

Am I the only doctor reading the literature? No, I’m not. I’m going to try not to let my anger or frustration get in the way during my talk. The studies are out there and I’ll present them. That, however, is not enough for me. I’d like to open a discussion on how we doctors do or should respond to new medical studies, all of which these days appear in newspapers, TV news, talk shows and the like. Do we give in to mass hysteria? Do we wait for corroboration or expert opinion? Do we act based on how it affects our income?

Last spring I gave another Grand Rounds, along with a panel that included a cardiologist and hematologist, on the use of blood thinners in patients having GI endoscopic procedures. The PPI/Plavix issue had just started and I was asked for my opinion. What I said was that more study of the topic was needed, as in fact was recommended by the original study’s authors. In the interim, because of the serious question of stents clotting off, heart attacks and death, I said that it would be prudent to use another anti-acid medication if possible and to make sure if a PPI was to be used along with Plavix, that it was being used for a strong indication. Now, a year later I’d like to practice evidence based medicine and tell my patients not to stop their PPI even if they get a new stent and are put on Plavix. Unfortunately, with Cardiologists and Pharmacists, not to mention the FDA, still saying to stop the PPI, I can’t, without creating discord and setting myself up for potential litigation if a bad outcome would occur. I’m facing a tail wags the dog situation where the established untruth trumps evidence and expert opinion. That’s what I’d really like to talk about.

There are billions of healthcare dollars being spent on unproven procedures and treatments. Even when expert guidelines and recommendations exist (remember my mammography blog?), public opinion and inertia and fear and greed rule. I wonder how popular a theme that would be for grand rounds? Better, I guess, to be a team player, give the public what they want and let me and my colleagues keep selling you stuff you don’t understand and can't use—to use a Music Man analogy, expensive musical instruments that you teach yourselves to play by concentrating, Professor Harold Hill’s think system. Friends, we got trouble right here in River City. That’s Trouble with a capital T that rhymes with P and that stands for PPIs and Plavix.

Harold Hill: A man can't turn tail and run just because a little personal risk is involved. What did Shakespeare say? "Cowards die a thousand deaths, the brave man... only 500"?

http://www.youtube.com/watch?v=s60hOgqLFGg

2010, Looking Up

“The best way to have a good idea is to have a lot of ideas.” This Linus Pauling quote was the solution to a recent New York Times Sunday crossword puzzle. I knew when I read it that it would be the inspiration for a blog, I just didn’t know what the blog would be about. As I set out now to write, I still am not entirely sure. You see, I am no genius. For whatever reason, I just don’t have as many ideas as Pauling, a Nobel Prize winner for Chemistry and Peace. Albert Einstein agreed with Pauling. He was passionate about imagination and said it was more important than knowledge. It was his ability to be persistent, and be willing to imagine and fail 99 times that allowed him to be recognized as a genius when, on his hundredth attempt, he succeeded. The more you read about Einstein, the more you’ve got to like him. My joke about sex at 60 is that I’m for it, but you should at least pull over to the side of the road first. Einstein said the same thing in a different way: “Any man who can drive safely while kissing a pretty girl is simply not giving the kiss the attention it deserves”. I wonder what the first 99 girls were thinking.

I do have some ideas. Usually, they come to me at 4 AM. To those of you who have been faithful to PinpointAnalysis, you may remember my Naybob Bobblehead doll. Now that was a great idea. Can’t you imagine how many parents would buy one with their face on it for their kids in college. I’m sure it would be a big seller, especially if it contained an audio chip with a recording of the parent’s voice, “No, no, no!” I’d follow it up with one for the college freshman to balance out the parental advice with some that spoke more to the id. For the guys, there’d be the YeaMeg doll. It’s head would bob in the yes direction only and the recorded voice would be Meg Ryan’s from the Deli scene in “When Harry Met Sally” (see link below).   An orgasmic yes, yes, yes, yes would do it for me. For the ladies I’m still not sure. It would have to be a multidirectional bobblehead, one that could be pushed in any direction. I think I’d leave the audio chip out, you know, keep him strong and silent, or just plain dumb. There would have to be a changeable face option, Antonio Banderas one day, Brad Pitt the next. The problem is that it might be nice to leave out the face altogether, a la Xaviera Hollander’s zipless sexual encounter. I haven’t yet figured out how to make a bobblehead with no face and a tight ass.

Another idea of mine is the Backapplicator. This invention is a long rectangular shammy towel designed to allow sunbathers to apply suntan lotion to their own backs. Utilitarian and feels good too! Imagine kiosks at the beach where you could either buy a Backapplicator or lie down on a massage table and be lathered up like a shoe getting buffed. I’d start this one out in California.

With the New Year approaching some of us reflect on the year, or decade, that is ending. Others look forward to the year to come and make resolutions of all sorts. Einstein said that our main problem is that we have perfected our means to get things done but are confused in our aims. For those of you who are reflectors, I think you’d have to agree. I’m more of a look forwarder. This coming year I’m going to follow the advice of two great Americans, Satchel Paige and Pat Paulsen. Baseball legend Paige said, “Work like you don't need the money. Love like you've never been hurt. Dance like nobody's watching”. Paulsen never won a US presidential election despite trying six times. Still, I’ll aspire to follow his campaign slogan, “I've upped my standards. Now, up yours”.  A very happy and healthy New Year to you all.

http://www.youtube.com/watch?v=F-bsf2x-aeE&feature=PlayList&p=0C96102F6BAD11D0&index=0&playnext=1

Falling Out Of Bed

This blogging gets tougher as the days get shorter. The news media do not have the luxury of a warm den, a leather chair and a hi-def TV with cable and DVR to wallow in (like I do) as the season takes its toll on their affects. They must produce copy to meet their deadlines, deadlines that in the age beyond CNN no longer wait until five PM, but rather exist in real time, ever ready to shake, jolt and revolt us. I have no such constraints and I readily admit, my readers, that it has been two weeks since my last blog-fession.

We are in the midst of Tiger frenzy. A friend asked me to comment in my blog. Pinpoint Analysis is what he may have hoped for, but I’m thinking, these days that, like my brother Bill joked, my postings tends to be not at all analytic, a bit obtuse and written (who said it?) by a pinhead. What, me worry? Heck no. Here goes…

Hiding Tiger, Revealed Transgressions is nothing more than an ancient Greek tragedy. How the mighty have fallen and all of that. It’s Oedipus with his eyes out or the Emperor with no clothes. We elevate our modern heroes up on 90 million per year endorsement pedestals and delight in their falls. For some of America Tiger was more than a king or hero, he was a god. There was a website tigerisgod.com. Forgive me, but I can’t go on without playing the race card. Tiger was revenge. He beat the white guys at their game. He proved yet again, the physical superiority of blacks. He took the white guys' trophies, prize money, endorsement contracts and even their blond Viking goddess. For white America, he made us feel less racist. Corporate America showed us how colorblind they could be… when there’s profit to be made. They turned him into a billion dollar brand. No matter what bad consequences may come as a result of Tiger’s infidelity, if rich blacks, Asians, Jews and women can now be members in formerly white only clubs, I’d say Tiger did good. Without Tiger (and Oprah) there’s no way Obama would be President. They showed America’s power brokers that a black product could be packaged, sold, return a profit and inspire along the way. A shake up like this forces us to face the wide racial divide that still exists in America, and that is good too. Amid comparisons between Tiger and OJ, SNL skits and all of ESPN’s self-righteous pundits telling Tiger how to live his life, my favorite quote was from a black 20 something, who when interviewed on the street, said that he would never have voted for Obama if Obama had not been married to a black woman. That thought had never occurred to me. Of course not, I’m white.

For Tiger and his family, I wish them the best. No one really wants to be, or live with a god. For the rest of us, there’s still a lot of work to be done as a country, and as we all must admit, behind our own closed doors too; as husbands, wives, children, parents and friends. Before the year is over please, someone, get me up out of this leather chair. There’s some holidays and a new year coming. If there’s work to be done , let’s do it together.

Tigger: There's no difference between plunging 10,000 feet to the jagged rocks below and falling out of bed.

Piglet: Oh, really?

Tigger: Sure, haha! Except for the splat at the end they're practically similar.

NEJM -- On Mammography -- More Agreement Than Disagreement

NEJM -- On Mammography -- More Agreement Than Disagreement   


This week’s blog is serious. Please take a few minutes and click on the link above to read the New England Journal article on mammography in women between 40 and 50. Before you start reading, take a moment to recognize and acknowledge your biases. After you have read the article I’d like to discuss some of these issues with you. The issues that come to mind for me are breast cancer, cancer screening, women’s health, health care rationing, the health care crisis, the government’s role in health care decision making, technology and its limitations….there’s a lot to talk about.

In order for an online discussion to take place, you have to use the comments area at the bottom of the blog. You can use your name or be anonymous. If this format works, we can use it to discuss other issues in upcoming weeks. If not, it was worth a try.

Some food for thought:

• In 2009, some 192,370 American women will be diagnosed with breast cancer, accounting for more than one in four cancers diagnosed.

• In 2009, an estimated 40,170 women will die from breast cancer; only lung cancer kills more women. This corresponds to 25 deaths per 100,000 women, down from 35 in 1989.

• Data from 2006 -- the most recent statistics available -- showed that about 2.5 million American women have a history of breast cancer. Most of these women were cancer-free. Others were still undergoing treatment.

• From 2002 to 2003, there was sharp decline in breast cancer rates, particularly for women aged 50 to 69. This reflects the drop in hormone replacement therapy by menopausal and postmenopausal women that began in 2002. Breast cancer rates have remained about the same since 2003.

• Since 1990, breast cancer death rates have dropped steadily. The decline has been greater among women under 50 (3.2 percent per year) than among women over 50 (2 percent per year).

• From 1997 to 2006, breast cancer deaths dropped by 1.9 percent a year among white and Hispanic women, 1.6 percent a year among black women, and 0.6 percent annually among Asian-American and Pacific Islander women. Death rates have stayed the same for American Indians and Alaska Natives.

“The choice is not between health care rationing and some undefined alternative, since there is no alternative. Rather, the choice concerns what principles we will use to ration health care. In the United States, we have traditionally rationed health care in the same way we ration expensive cars: those who can afford to pay for them are those who can have them. The alternative currently being considered in health care reform would involve a shift to other principles, such as those rooted in considerations of fairness, efficiency, and efficacy.” Robert D. Truog, M.D. From the same NEJM issue as the article above.

17% of Congress are women.

The Republican National Committee’s health plan covered abortion for its employees beginning in 1991. When feminists pointed this out this year, the Committee Chairman withdrew the coverage.

Among uninsured women, only 30 percent had a mammogram during the past two years, compared with about 70 percent of insured women.



I am interested in what you have to say!