NPO until AMA

Breast Cancer: Deja Vu

Wed, 18 Nov 2009 14:40:26 GMT

I think I should copy and paste the below article, change the dates, and submit it to JAMA as original research.

(Emphasis mine)

News Media Coverage of Screening Mammography for Women in Their 40s and Tamoxifen for Primary Prevention of Breast Cancer

Lisa M. Schwartz, MD, MS; Steven Woloshin, MD, MS
JAMA. 2002;287:3136-3142.
Context In the late 1990s, 3 events pertaining to breastcancer prevention received considerable attention in the USnews media: a National Institutes of Health (NIH) consensuspanel recommended against routine screening mammography forwomen in their 40s (January 1997), the National Cancer Institute(NCI) subsequently reversed the recommendation (March 1997),and an NCI-sponsored study demonstrated the efficacy of tamoxifenin the primary prevention of breast cancer (April 1998).
Objective To examine how the major US news media coveredthe potential benefits and harms of 2 breast cancer preventivestrategies.
Design and Setting Content analysis of US news storiesreporting on the breast cancer prevention events. We used Lexis-Nexisto search for print news stories in the 10 highest-circulationUS newspapers and requested transcripts from 3 major televisionnetworks to obtain all relevant news coverage in the 2 weeksfollowing each event.
Main Outcome Measures Attitude toward preventive strategy(encourage, neutral, discourage); level of uncertainty aboutbenefit and how benefits and harms were presented.
Results Twenty-seven stories about the NIH consensus panel,24 about the NCI reversal, and 34 about tamoxifen appeared inhigh-profile news media within 2 weeks of each event. Sixty-sevenpercent of NIH consensus panel stories left the impression thatthere was a lot of uncertainty about whether women aged 40 to49 years should undergo screening, but 59% suggested that womenshould probably or definitely be screened. Only 4 stories suggestedthat women faced a genuine decision about what to do. The levelof uncertainty reported was substantially lower following theNCI reversal (21% suggested a lot of uncertainty), and moststories (96%) suggested that women should be screened. In contrast,tamoxifen stories highlighted uncertainty about what women athigh risk should do (62% suggested there was a lot of uncertainty),and none left the impression that women should definitely takethe drug (24% suggested they probably should). Sixty-five percentof these stories suggested that women faced a genuine choiceand would have to weigh the risks and benefits themselves.
Conclusions Most news stories favored routine use of screeningmammography and urged caution about using tamoxifen. Almostall noted the potential harms of each preventive strategy; however,the negative aspects of tamoxifen received greater emphasis.Whereas taking tamoxifen was presented as a difficult decision,having a mammogram was presented as something women ought todo.

Vaccinated!

Sun, 11 Oct 2009 17:09:07 GMT

The Clark County Health Department (the county where I work), was giving out free swine flu vaccines to health care professionals yesterday.
So I took the MAX to the Expo Center, and then rode my bike over the Columbia into Vancouver.

It seems they were expecting a bigger turnout than they got. There were about 20 volunteers, but only 3 people getting vaccines. I got the squirt up the nose and rode on back. (after getting lost at the Jantzen Beach Supercenter for half an hour)

So, my nasal passages are full of live attenuated H1N1 viruses!

Space

Thu, 01 Oct 2009 04:31:39 GMT

Why does the phrase "a wingless, blunt-body manned vehicle that would reenter on a ballistic path" take me back to my childhood in Huntsville?

Who's Afraid of the Flu?

Sun, 20 Sep 2009 05:14:41 GMT

The best article on the swine flu that I've seen yet.

But H1N1 has also homed in on the weaknesses in our heads — hovering in the blind spots where our risk analyses break down, just beyond the view of our mind's eye. What is the defense for the mind games of a virus?

...

Whether it (the vaccine program) works will depend partly on science and partly on our ability to navigate the shadowy negotiations going on inside our heads.

People's reaction to influenza has always intrigued and frustrated me. Some view vaccines as sinister poison foisted on them by a paternalistic government. Others view vaccines as foolproof magic bullets that will protect them against respiratory illness of any kind. Often the latter become cynical when they get a cold during flu season, and see the flu shot as a waste of time.

Vova and Dima 4eva

Sat, 19 Sep 2009 20:31:32 GMT

OMG, Putin and Medvedev are the slashiest world leaders evar.

Product Plug

Tue, 15 Sep 2009 00:50:18 GMT

Tillamook Extra Sharp Cheddar Cheese
Made in Oregon, aged 2 years. Good stuff.

Tour De Lab

Mon, 14 Sep 2009 05:10:38 GMT

Missy and I did a fairly grueling pub tour today. It was the Tour De Lab, and stopped at the three Lucky Labrador Pub locations. It was a benefit for a local animal shelter/hospital.

We went up the highest hills I've ever tackled on my single bike, and we've never done anything like this on our tandem.

I'm pretty happy with how we did. We only had to walk the bike once, on the very last hill. It came up by surprise, right as we turned from a stoplight, after we thought we were done with hills. The tandem's actually a pretty good hill-climber. I figured we'd be the slowest people on the road, but we passed quite a few people.

This was one of the most exhausting things I've done. We had a problems at the end, that I was almost two weak to restart the bike at a green light, and I was having trouble keeping the bike (and Missy) vertical when stopped. But we think we're doing pretty well, after 5 months of tandeming, we've not fallen over. We have the bike pretty well customized with new saddles and handlebars. As tired as I was, my knees, back, elbows and wrists feel absolutely fine. That probably means it fits me pretty well. I think Missy needs some small adjustments.

We were having a lot of problems with shifting down into the smallest chainring. I'll have to look into that in the near future.

The ride was more of an accomplishment than actual fun. We'll probably stick to flatter stuff in the near future.
We're really happy with getting the tandem for our anniversary. It's much more versatile, efficient, and useful than 2 bikes, and is tons of fun. And kids always like it when we ride by.

Health insurance is an oxymoron

Fri, 11 Sep 2009 01:40:01 GMT

From ZDnet

There are three layers in what you call “health insurance.”

Certainty
Likelihood
Remote chance

Insurance brokers are bookies, not bankers. They deal with chance. They don’t deal with certainty.

...

The question is not who to tax, or whether to tax. The question is how to tax — publicly, privately through forced savings, or as we do it now, through bookies?

Orwell Diaries

Fri, 28 Aug 2009 15:57:01 GMT

For the last year or two, I have had the Orwell Diaries on my LJ friends page. Basically, it's a publication of George Orwell's personal diary in blog form, with a 40-year time shift.

Mostly it's been semi-interesting stuff about some travels in Morocco and quaintly boring stuff about his chickens and vegetable garden. But in the last few months, pressure has been building as Germany's military buildup has quickened. His charting of the political mood in the UK is fascinating. I also didn't realize that Germany and the USSR were allies at the start. The British were scared witless by this (and rightly so). I don't even want to imagine how the war would have went with the Soviets on the Axis side. But I guess in 1939, it was all the Brits could think about.

Yesterday's post was quite dramatic, with threatening moves toward Poland. This got me thinking, when did Germany invade Poland? Holy Crap! In four days.

Apparently they had Soviet help. Why didn't I know this?

Here's the LJ feed, if you want Orwell on your friends page.

Last Train to Clarksville

Wed, 26 Aug 2009 14:38:37 GMT

The Monkees' "Last Train to Clarksville" refers to Clarksville, TN (adjacent to Fort Campbell, home of the 101st Airborne) and is about being drafted. As many times as I've driven through Clarksville, I kind of feel like an idiot for not picking up on this.

Buckaroo!

Mon, 20 Jul 2009 17:20:06 GMT

To cheer ya'll up on a Monday morning, I give you this:

(The end credits to my favorite movie about a physicist-neurosurgeon-rock star-samurai-astronaut-superhero)

Health Care Rationing

Mon, 13 Jul 2009 21:19:17 GMT

"Rationing" has become a big negative buzzword in the current health care debate. As in, "we don't want any rationing of our medical services." We already have horrible rationing, and anyone who thinks we don't isn't paying attention.

Repeatedly I've heard tales of the rationing present in the Canadian system. Often I've heard the specific exam

Customize

ple of long waiting lists for joint replacements, or patients being denied knee replacements because of factors like age.

I have had plenty of real-life patients with bad knees and demanding jobs. The following case is an amalgamation of 3 or 4 cases I've seen.

Two patients both have jobs in the housing industry, and both of them need to go up and down ladders. These bad knees make it really hard to go up the ladders. Both have been hit by the lagging construction industry, sharply reduced demand for new homes, and have had to cut back on hours. We'll call them Bob the Builder, and Chris the Constructor.

Bob works for a large company, and has standard private insurance. He got a knee replacement pretty quickly. After recovery, he feels much better. He can't go up the ladders like he used to, but because of the reduced hours, he's working OK at the moment.

Chris is a self-employed small business owner. He used to have 1-3 part time employees, but he doesn't have work for them. I think he used to have insurance, but he had to drop it, because his business is not making any money. He doesn't qualify for Medicaid because of his assets. He's not getting a knee replacement anytime soon. Potentially he could sell his business, and get a job for a company, tough it out on the ladders until he gets insurance, and then get the surgery, but nobody's hiring. It's possible the economy could recover before he is unable to work, and he could get insurance or pay cash for the surgery. Best-case scenario, he gets a knee replacement in a year or two. Worst-case scenario, he never gets the knee replacement, blows through all his assets, ends up on state support with Social Security Disability, Medicare, and Medicaid and (maybe) gets his knee replacement in 2-4 years. By that time, he will probably never re-enter the work-force. Or maybe the worst-case scenario is that he ends up homeless on the street. That happens too.

This is how health care is rationed in this country. In Canada, both Chris and Bob would get knee replacements in say, 3-6 months. I don't want us to end up with an exact copy of the Canadian system. We spend about 16-18% of our GDP on health care, and Canada spends 9-10%. So we should get something better, because we pay more.

I think it's actually reasonable, at a level of 17% of our GDP, that we could pay for all necessary health care for all Americans. That's a lot of money, and it should go a long way. If an American pays twice as much per capita than a Briton, it stands to reason our product should be twice as good. But health care in the US is currently so inefficient, fails to cover 12% of our citizens. There need to be major changes in the entire delivery system before we can get the maximum bang for our buck. I suspect this would probably be with a single-payer system,
similar to Canada's. Or we could end up with something closer to Germany's. (It seems to be the country closest to the Democrats' model) That's going to take a concerted effort, and probably a decade or two.

But in the short term I doubt we can provide health care for everybody without some form of rationing. Currently we ration on factors (employment status, size of employer, student status, parental employment status) that make no sense.

P.S.
Most of the current debate is on the "public option." In Germany, 87.5% of people choose the public option. The private insurance companies seem afraid to compete with the U.S. Government, and for good reason: they suck. I can't think of another industry with worse customer service. Large portions of their business model consist of denying or delaying reimbursement for services paid for by their customers. If the Government offered a viable alternative, people would run from the private insurers in droves, and they know it.

P.P.S.
All this assumes that you (like most bloggers and talking heads) consider short waiting lists to be a major health indicator, rather than infant mortality and life expectancy (like most public health experts).

Post in Outline Form

Tue, 30 Jun 2009 04:08:11 GMT

2005 Ford Focus Wagon
- I love driving it
- I've become a station wagon partisan
- I hope it will be a long lasting car
- Putting a tandem rack on top will be expensive
Speaking of the tandem
- It's in the shop with brake problems
- Getting a tune-up too
- We'll probably get a new stoker handlebar
I'm re-reading the Baroque Cycle
- It makes more sense the second time around
- Not all irony is comic
- Spoilers are no fun
- Is it more entertaining than LOTR?
- Government in those days was stupid
  - Divine right of kings?
  - Choosing leaders by inbreeding rather than elections?
  - Carlos the Sufferer?
    - Seriously, look at his family "tree"

The word of the day is Focus

Sat, 20 Jun 2009 01:38:37 GMT

We got a new (used) car today. A 2005 Ford Focus Station Wagon. I'm not sure if I mentioned this, but I managed to total the Sonata in an 8mph fender bender.

We settled on the Focus because it is surprisingly comfortable for someone 6'4". The seat scoots all the way back, it has a telescoping steering wheel, adjustable seat height, and my knees don't hit the console. We got the station wagon because we're in Portland, and if don't have roof racks full of bikes, snowboards, and kayaks, you're doing it wrong. We think we're going to be able to do a lot of adventures on the tandem once we can get it mounted on the car.

The color is white, we may have pictures up soon.

Starlight Parade Photos

Mon, 01 Jun 2009 06:12:11 GMT

I've posted some photos from the Starlight Parade to Flickr. I'm sorry that the quality is so low, but they were taken on my phone. But at least it gives an idea of some of the things we saw.

Starlight Flickr Set!

Lost: The Island Power Play

Fri, 15 May 2009 13:25:45 GMT

My thoughts on the season finale:

With the introduction of Jacob, and his subsequent killing, the show has taken a twist into American Gods territory. In the intro, we are introduced to Jacob as the "good" god, and a second "trickster god" who wants to kill him. But this is against "the rules." (From the Wikipedia entry: The trickster deity breaks the rules of the gods or nature, sometimes maliciously (for example, Loki) but usually, albeit unintentionally, with ultimately positive effects.) Because of some rule we don't know the details of, this trickster can't kill Jacob.

So Locke is actually dead. The person that persuaded Ben to kill Jacob is actually the trickster in Locke's form. I can only assume that EVERY dead person on the island is the trickster. This includes Ben's daughter, who conveniently told him to obey Locke. This includes Christian Shepard, who told Locke to leave the island. I would go so far as to suggest that the trickster and the smoke monster are the same thing! They often show up together, and the monster is usually involved in memories of the dead.

So Smokey has made his power play, and is now the dominant god of the island. What does that now mean? I guess we have to wait until 2010 to find out. I also wonder about Hurley's visions. I don't feel that these are apparitions of the trickster. I think these are something different entirely

What makes us happy?

Wed, 13 May 2009 17:02:29 GMT

There is a long, but excellent article in the Atlantic about a study that has followed the physical and psychiatric health of 268 Harvard undergrads from the 1940s to the present. The research, among other things, has tried to define what makes someone happy or successful, or how you would even define that.

It's a fascinating, read and I highly recommend it.

From the article:

In 1946, for example, 34 percent of the Grant Study men who had served in World War II reported having come under enemy fire, and 25 percent said they had killed an enemy. In 1988, the first number climbed to 40 percent—and the second fell to about 14 percent. “As is well known,” Vaillant concluded, “with the passage of years, old wars become more adventurous and less dangerous.”

...

JFK is one of the study subjects, although his data is sealed until 2040.

Of course, Kennedy—the heir to ruthless, ambitious privilege; the philanderer of “Camelot”; the paragon of casual wit and physical vigor who, backstage, suffered from debilitating illness—is no one’s idea of “normal.” And that’s the point. The study began in the spirit of laying lives out on a microscope slide. But it turned out that the lives were too big, too weird, too full of subtleties and contradictions to fit any easy conception of “successful living.”

...

“Their lives were too human for science, too beautiful for numbers, too sad for diagnosis and too immortal for bound journals."

There's also a section on Anna Freud's defense mechanisms, which is an aspect of psychology that I think is the most useful and most overlooked by primary care physicians.

What have you been up to since your last HIV test?

Wed, 13 May 2009 05:54:13 GMT

The CDC e-Cards are a blast. Especially the STD ones.

I loved Star Trek

Tue, 12 May 2009 06:37:49 GMT

That was a great movie. It surpassed my expectations. Although nowhere near as campy as the original series or Doctor Who, they had just the right amount of goofiness and shameless comedy. It's a hard balance, staying true to the spirit of the original, while making the movie (new continuity?) modern and stand on its own. Somehow, JJ Abrams pulled it off. I felt the tone, visuals, and attitude were perfect.

I loved all the Original Series sendups. Like Kirk's Green Woman. Like Pike ending up in a wheelchair by the end of the movie. Heck, I was excited Pike was even in the movie. I also loved some of the goofy science. "Why aren't we at warp speed?" "We are!"
Although time-travel plots have been a bit overdone in the last few years, I think it was good to start off the re-boot with a time-travel plot. It's now a separate time-line with a new continuity. So they won't need to worry about tip-toeing around old plot points like the previous series. Heck, they could re-visit Kahn!

What I am anxious to see: Star Trek II: The Uhura-Chapel Catfight.

Although I miss the comfortable banter of Kirk, Spock, and Bones the characters didn't really know each other yet. There were little inklings of this, and hopefully their friendship will develop over future movies.

Why we live in Portland

Mon, 11 May 2009 04:30:49 GMT

The New York Times has an excellent article on vacationing in Portland

Frugal Portland

From the article:

This joyful stress would begin with the city’s most important meal: breakfast. Despite its laid-back aura, Portland is an early-rising town, and its commuting cyclists need fuel for their morning rides.

...

In its place was a dedication to the things that really matter: hearty food and drink, cultural pursuits both high and low, days in the outdoors and evenings out with friends. It’s the good life, and in Portland it still comes cheap.

...

Today, there are almost 400 carts around Portland, most of them clustered into “pods” that ring parking lots, ... As a New Yorker I was jealous; as the Frugal Traveler, overjoyed at what I could find within a single pod.

The article sums up a lot of what we love about living here. Also, check out the slideshow

13,000 die of influenza

Fri, 01 May 2009 12:25:16 GMT

There's been a strange reversal this last week. Every year, I spend considerable effort trying to convince people that influenza is a Big Deal. Some people get shots. A lot of people brush it off, making excuses, questioning the shots' effectiveness, and using that classic fallacy "the shot gave me the flu." Most people don't seem to think that influenza is something worth worrying about

Since January First, an estimated 13,000 Americans have died of regular, garden-variety flu. This was a "light" flu season. Influenza killed thousands this year, it will kill thousands next year. Most of those were elderly, who may have died a year or two before their time. Some of those were children. 83 children died in the 2007-08 season. As a doctor, I have to consider most of those deaths preventable, and look at them as a motivation to work harder on prevention next season.

So far, I feel the CDC and my local health department's reactions have been sensible, level-headed and appropriate. Why have they raised the alarm? It's not because swine influenza is a scary superbug that's worthy of our panic. But the prospect of a second flu season truly is something to be concerned about. Influenza deaths are sadly routine. But by sensibly limiting international travel, closing some schools, and encouraging good hygiene, we may have the opportunity to prevent another 13,000 deaths this year. We may save the lives of 100 children.

We trifled with the Swedes, and they gave us store credit

Mon, 20 Apr 2009 01:35:11 GMT

We went to a Los Campesinos concert last week
- They might be the most enjoyable band on tour right now
  - Although I haven't seen every band in the world
- I love the stage in a band's career where they improve with subsequent shows:
  - Nickel Creek 1999-2003
  - Dresden Dolls 2004-2008
We got a new digital camera
- It is smarter than us
- The zoom is awesome
Spring is here!
- It started rather abruptly
- I hope I don't see another cloud for 6 months!
- I'm working on my ability to climb hills on my bike
Links to funny stuff on the Internet:
- The 15 stupidest game types Wii invented
- Star Wars according to a 3 year old

ETA: We were in line next to the lead singer of Everclear today. They're from Portland. Who knew?

Hooray for Sci-Fi!

Sat, 04 Apr 2009 06:10:03 GMT

Wow! Tonight's Sarah Connor Chronicles was *perfect.* I think I may remember it as one of the best moments in TV science fiction. I'm consistently amazed at how SCC is so much better than anything else in the Terminator universe. They've been methodically building up the story arcs of their two "families," it was gratifying to see them collide so powerfully tonight.

There's so much quality in the dysfunctional family drama that is SCC. I like how all the cast is so emotionally restricted - robots and humans. It leaves no room for cheap use of ACTING TALENT moments. The characters don't get to react, they just have to act. Derek's death was perfect. As the audience, we had no anticipation, no chance to take it in, no chance to mourn. Neither did the characters, they can only do the three things they can ever do, run, hide, or fight. You may get a chance to mourn later, or you may not. We, as the audience, got to mourn in the final scene as he was buried. The Connors never got that luxury.

Savannah telling John Connor about John Henry was some priceless TV. Cameron's "I only want to kill him" quip easily rivals Schwarzenegger's "He'll live" line from T2.

But what I love more than anything... We still don't know who Mrs. Weaver is, or why she came to the past. We still have absolutely what goal she is working toward. She doesn't care a whole lot about the Connors; she's never spent any energy seeking them out. Is she trying to hasten Judgement Day? Is she trying to make Skynet benevolent? Is John Henry's brother Skynet? Is she trying to pre-emptively defeat Skynet with an ethical competitor?
However it turns out, I haven't been so excited about a show since our late, great Battlestar Galactica

In other news, Dushku didn't lie about Dollhouse picking up mid-season. I'm starting to get pretty wrapped up in that show.

In crappy news, did anybody see the American Life on Mars finale? Missy showed me the last 10 minutes. What a load of crap! Did the producers even watch the original British version past the first episode? Apparently Americans
1. Don't understand the original Life on Mars
2. Don't understand the use of metaphor
3. Don't understand Bowie.

Part of me hopes that the finals scene was just a bitter "@$^& you," made by people angry about getting canceled. But I don't really think that's the case.

Police Pants

Sun, 01 Mar 2009 16:51:47 GMT

I exist in a alternate dimension somewhere between "normal-sized human" and "big and tall." My choices are generally to shrink, gain 30 more pounds, or wear ill-fitting pants.

On Consumerst.com's daily deals, they showed these undercover police pants with a free belt for $30 bucks. They have them in my size, they are cheap, they look OK, and they have 8 pockets. That could be useful for holding my phone, pens, or wearing a wire.

If I like them, I will probably order pants in all 3 colors. I just hope nobody thinks I'm a Narc.

Sell SIRI

Wed, 25 Feb 2009 06:14:58 GMT

Last night, I wasted 2 hours of my life on the phone with Sirius. I don't think there's any chance of me buying their stock.

I love the product, but the people running the company seem to have no clue about how to run a company.