By the fourth sentence of the preface to The Silent World of Doctor and Patient, Jay Katz has quietly issued a startling challenge to a fundamental principle of the doctor-patient relationship. He writes:--Michael Millenson at the Health Affairs Blog. Times obituary of Jay Katz here.
It took time before I appreciated fully the oddity of physicians’ insistence that patients follow doctors’ orders. During my socialization as a physician I had been taught to accept the idea of doctors’ Aesculapian authority over patients. When I began to doubt this authority, that was the moment when the book began to take shape in my mind.
“The oddity of physicians’ insistence that patients follow doctors’ orders” – the phrase brings you to an abrupt halt. Jay Katz, who wrote those words in his landmark book published nearly a quarter of a century ago, died in late November at the age of 86.
But I can't help myself. Why is Yiddish a "venerable tongue" in the headline? Surely the language is no older than English? And why is it called "the 1,000-year-old amalgam of Hebrew, German and assorted European dialects that was once the lingua franca of Europe’s Jews"?
Amalgam? (You mean, perhaps "language"?) Assorted European dialects? (Maybe "languages"?) Lingua franca? (Rather, "first language"?)
It's almost as if the reporter knew nothing about the topic she was writing on!
"Iz er a yid?" (Is he Jewish?)
"Avade iz er a yid." (Of course he's Jewish.)
What was next said, as I first heard it:
"Er kikt oys vi a narisher." (He looks like an idiot.)
I said "Vos?" (What?)
"Ir kikt oys vi an arisher." (You look like an Aryan[?].)
"Vi an arisher!"
Oh! I get it. Like an "ayrisher" ("Irisher" in non-"YIVO" Yiddish, Irlender in standard Yiddish), in the speaker's pronunciation - "arisher."
Thus was I saved from getting in a fight with two older men on the Lower East Side (probably avoiding a beating in the process).
Ultimately, because of vast historical and social forces, physicians by and large remain oriented towards an unattainable and inappropriate positivist ideal, and thereby severely compromise the deeper values of their own moral agenda. This choice—encouraged by the professionalization process—largely explains why medical ethics serves such a minor role in medical education; why complaints of medicine’s dehumanization are rampant; and why myriad studies, surveys, and testimonies attest to the lack of physician empathy. Indeed, if medicine aspires to an objective ideal at the expense of its unique value-laden agenda, the profession will be hounded by complaints that it has forsaken its ancient calling for a Faustian pact.--Alfred I. Tauber, Medicine and the Call for a Moral Epistemology, Part II: Constructing a Synthesis of Values. Perspectives in Biology & Medicine Summer 2008; 51(3).
A self-conscious moral epistemology—an epistemology that remains aware of its ongoing negotiation of competing values and construction of its interpretative knowledge—provides a philosophy of medicine for the doctor’s diverse roles and activities. On this view, a philosophy for medicine must acknowledge the multidimensional character of medical thinking that utilizes values spanning the ideals of laboratory science to the empathetic response of humane care. But more, this philosophy must recognize a fundamental difference between the scientist’s search for the real and the physician’s pursuit of the therapeutic.
Medicine requires more than “true” outcomes (as in scientific truth-seeking); physicians embrace “best” results for the care of their patients. While seeking the “true,” patients and their caregivers are often satisfied with something else (for example, the effective intervention may be a sham treatment or a placebo). “Truth” directs clinical science, and clinical science directs itself to good outcomes, but in the hierarchy of medicine’s philosophy, it is ethics of care that directs the physician’s science and ultimately determines clinical choices.
Surgical residents may someday soon have to prepare themselves to halt an operation and announce that it's nap time.Solomont doesn't know that surgeons often must hand off care during a long procedure (colectomies can last forever)?
The Royal College of Surgeons (one of the organizations named by Solomont as opposing stricter work-hour regulations) provides a summary of their recommendations regarding training modifications. After a thorough review of work patterns in the context of impending regulations (or after they had already been instituted; it's not clear to me), the following findings became (magically?) apparent:
- a significant reduction in the need for acute surgical intervention (except for life- or limb-threatening conditions) between 22.00 and 08.00
- the majority of work undertaken by surgical staff during this period relates to the management of medical co-morbidities
The report also mentions a number of possible solutions. Leaving off for a snooze during the middle of a heart bypass is not mentioned, but scheduling innovations are.
Surgery and medicine training programs are naturally going to squawk at work hour regulations, and it's a tradeoff between continuity of care and well-rested residents. But it's also a myth that every hour of time spent at the hospital means another hour spent in quality medical education. Hiring physician extenders doesn't mean depriving housestaff of the opportunity to see interesting patients and learn necessary procedures. Often just the opposite is the case.
Speaking of naps, many sleepless surgeons have already taken a few - but in the OR, browning out over the field, not at home. Which would Solomont prefer?
Greed vs. Greens, or In Which Righteous Quasitarian Anger is Cooled by Spicy-Hot Chili Sauce on Falafel
View Larger Map
A pity that Google Maps' streetview is not festooned with the For Rent banners I saw today on the building at 34 Union Square East. I didn't take a photo, since I was stunned simultaneously with grief, schadenfreude, schaden-anger [Schadenzorn?], and...
...the happy thought that Maoz Vegetarian is just down the block.
View Larger Map
Yummy, and much cheaper than Zen Palate Usq ever was. Maybe I'm not so mad after all.
Define quality for me. Then show me a system in which there won't be as many winners as losers--how else do you save 30%? Then I will show you a real health care policy debate and we will see how much consensus we have.Wellness? Wellness programs today look an awful lot like the voluntary education oriented wellness programs we were selling in 1988 and things are far worse. Prevention? Most of the commonsense steps in prevention were available to us years ago.We have been avoiding the heavy lifting in health care reform for 16 years. For me, all of these new ideas aren't so much new ideas as one more "Ground Hog day" in the long-running health care debate.
Among Cubans, “intoxicado” is kind of an all encompassing word that means there’s something wrong with you because of something you ate or drank. I ate something and now I have hives or an allergic reaction to the food or I’m nauseous. On the day Willie’s intracerebellar bleed began, he had lunch at a fast food restaurant, the newly opened Wendy’s. His mother and his girlfriend’s mother assumed that the severe headache he experienced that night was related to eating a bad hamburger at Wendy’s - that Willie was “intoxicado.”More at the Health Affairs Blog about a terrible linguistic misunderstanding. "Neither the ER doctor nor the family requested a professional medical interpreter because each side believed they were communicating adequately."
- a discussion by Matt DeCamp of intellectual property rights and distributive justice, and their interdependence
- Lee Jennings' study of osteoporosis treatment in the hospital (per guidelines: calcium, vitamin D, and anti-resorptive/bone-forming agents). Two percent of patients got recommended treatment in-house!
- a sobering fact about residents' physical examinations of women (Rosette Chakkalakal): they don't listen to the heart like they should (is it because they respect too much their patients' modesty? or they're uncomfortable with moving their breast out of the way?)
- a study by Nitin Kapur of interpartner violence and sexually transmitted infections among Indian women (with a 1-month prevalence of IPV of around 20%, if I remember correctly; related link)
- Last but not least, my study about factors associated with patients' failure to fill new asthma prescriptions [Google version above not yet re-edited to account for Power Point - Google incompatibility].
Baucus talks a lot about pay for performance plans but never really describes which he prefers, how the current stakeholders will be assuaged, or whether P4P is meant to be the basis for a new payment model - not just a worthy experiment. He also doesn't mention that outcomes improvement via P4P isn't supported by the literature. Then again I didn't expect him to say that. (But maybe he doesn't know that? Senator, a Dr. Berger on the line.)
We need to train more primary care doctors. I heard only 2 percent of last year's doctors were primary care, because the money wasn't there. We need more medical homes, a more holistic approach to care. There must be a greater role for primary care then there is in America today, and this bill has incentives to do that.
The Google, please:
I suppose it makes more sense to analyze the word as following normal Israeli Hebrew phonetics, than as a foreign word which needs to be spelled with another alef.
(a corrective to reports like this one)
1. We knew statins helped lower the risk of heart disease anyway.
2. Now we have an industry-funded study to tell us that statins help in people with high CRP.
3. They cut the risk of cardiovascular events from 1.8% (per year) to 0.9%. Yes - a relative risk reduction of 0.5. But 1.8% and 0.9% are both low numbers. Do you have patients who would think this difference meaningful?
4. The study excluded basically everyone we meet in the real world: folks with high cholesterol, diabetes, and kidney disease.
5. We still don't know if CRP risk stratification helps improve outcomes.
6. We're not buying it.
a talk in English by Zackary Sholem Berger, co-publisher at Yiddish House
Thursday, December 4th, 2008, 9:30am
Stern Judaic Studies Seminar Room, Room 302, Hagerty Library
33rd and Market Streets, Philadelphia, PA (map)
All Yiddish House books (including our new Eyn Fish Tsvey Fish) will be available for purchase and signing.
Sponsored by the Judaic Studies Program of Drexel University, Dr. Rakhmiel Peltz, Director.
. . . as if it were Hebrew, you get this:
More in Clinical Correlations.
Our exposure to health care policy - as part of our primary care curriculum - ran the gamut recently.
Last week we went to Washington to advocate for increased support for the primary care workforce. (In brief: we need more primary care health care providers. There aren't going to be enough of them, especially if we start covering the uninsured. We need to create incentives to help people choose to go into primary care rather than the oversubscribed and overpaid subspecialties.) We spoke to young, fresh-faced, intelligent, and hyperinformed health care staffers of some of the Capitol's most influential senators - they were genuinely friendly and happy to see us.
One senator's office is working on a creative idea left over (so they said) from Hillarycare, a "foundation" to ensure a funding stream for primary care education, training, and loan repayment, paid for by a tax on insurance companies. Of course, no one in the room disagreed with that. Everyone realizes that primary care training needs to be dissociated from the current system, private insurance companies and hospitals included. (Our very friendly lobbyist, paid for by NYU Medical Center and along with us to make sure we didn't say anything stupid, was not very excited to hear about this idea.)
This week (thanks to a colleague of mine, whose father is a fundraiser for the senator in question) we went to the office of the junior senator from New York. We spoke to her for fifteen minutes about the necessity to improve funding for the primary care workforce - she was impressively informed, realistic about the political obstacles, and . . . oh, who am I kidding? We were giddy. We got a picture, too!
On Friday, we visited Jack Resnick, an internist (let's say it: a primary care doctor!) with a practice on Roosevelt Island. "[In Washington,] they're talking about payment reform, which is . . . pffphpht! You have to tear out the guts!" By which he means - you have to alter the incentives so as to drastically reduce hospitalization. It's an open secret that hospitals are not the best places for sick people. They breed infections, deconditioning, delirium, psychosis. Resnick's approach (and the approach of this organization) is to closely monitor the chronically ill patients in his practice, keeping the hospitals at bay by providing patients sophisticated but sensitive care at home. It's more feasible for Resnick because (a) he lives on an island; (b) he's ready to devote himself nearly 24-7 to his patients. But this, he says, is the wave of the future - money saving, intensive, personal primary care for the elderly and chronically ill, taking away money from hospitals where it's not usefully spent (or, rather, uselessly overspent).
Resnick, and the AAHCP (see the link above), are behind the Independence at Home Act, a bill introduced in September which would experiment with cash rewards for house-call physicians that trim Medicare outlays for high-cost patients with multiple chronic conditions.
[revised per comments]
But what's this hanging from the ceiling? A red and gold plastic ribbon with a golden bell?
In the heimische sukkah, a heimische Christmas decoration!
More in the Forward, where I interview Putnam about his new book, Jewish Philosophy as a Guide to Life.
ZSB: Is there a risk of the religious life?Hilary Putnam: There’s always the risk of fanaticism. I spend part of every year in Israel at Tel Aviv University. There, the conflicts of certainties are appalling; that’s beginning to be the case in the U.S.
Solutions received by Monday at 7pm will get a free piece of apple-and-honey.
1.The lack of affordable and accessible health care for all Americans.
2. The need to develop methods to decide when to pay for emerging modalities and pharmaceuticals.
3. The need to move resources into prevention and public health.
4. The need to move resources into primary care.
5. How do we care for an aging population?
6. How do we expand physicians' use of evidence-based treatment approaches?
7. Great disparities across ethnic and income groups.
9. Dental care.
10. The lack of health-care professionals.
*Okay, he didn't say "crises," he said "topics." But "crises" is more fun.
Often, I think, people use that phrase as a retelling of the widespread myth that psychopathologies can't be diagnosed through testing. ("Anxiety is a diagnosis of exclusion.") Or a claim that only laboratory tests or imaging matter, not the history or physical. ("Hepatorenal syndrome is a diagnosis of exclusion.")
The next time someone calls a diagnosis a D of E, by gum, I'm going to ask them just what they mean.
Since I have a lot of money, people are always sending me their crazy ideas. And I have to take them home on the train. I fall asleep and dream . . . dream of long vacations, plush terry-cloth robes, little bars of soap you always steal and then feel obscurely guilty about (unless you steal from the minibar, in which case you dream about credit-card bills in the mail and some meaty guy stomping through your front door with a large stick). When I wake up from my dream, I'm at the last station stop and the janitor has to sweep me out of the car with his broom. I wander outside and can't find the bus stop. Scared, I take a taxi.
That's my dream. To some people, it's trivial, stupid, a little cheap. But then I give them some money, and the word "cheap" is never mentioned again. The word "dream" is thrown around a lot, mostly by me. The prophets of Israel, I read, used to dream. Their dreams are full of sprouting sticks, rattling bones with ill-fitting skin heaving themselves reluctantly to their resurrected feet, women eating their newborns. Not Elul stuff at all.
When I think how far I have come, and how much money I have, I thank whatever gods may be for my dreams. I might write them down in a book someday. Dreams do come true!
So when will the OU withdraw certification entirely from Rubashkin's? When the case goes to court? When a conviction is handed down? When the sentence is served? How many "weeks" will this take? 1? 2? 6? 12? 52?
And why does there need to be a change in management? After all, these are just goyish legal structures we're talking about (ערכאות של גוים). "The law of the land is the law" is just Conservative liberal halachah, right?
Maybe there needs to be another trip to Iowa, company-paid. Make sure one of the rabbis involved "knows some Spanish." Look, the cafeteria is awful clean!
* * *
You know what's useful? Reading political news.
From here to there
New Yiddish fish are everywhere!
Eyn Fish Tsvey Fish Royter Fish Bloyer Fish
One Fish Two Fish Red Fish Blue Fish by Dr. Seuss
Yiddish translation by Sholem Berger
$15 + shipping (and tax in NY State)
Di Kats der Payats, The Cat in the Hat by Dr. Seuss, in Yiddish--$15
George der Naygeriker, Curious George by H. A. Rey, in Yiddish--$18
Colorful alef-beys poster by Stephen Cohen--$12
Remind me not to get involved in them again ... when I have a choice in the matter.
Join JFREJ, the AJWS-AVODAH Partnership, and Uri L'Tzedek for a salon-style, interactive program: learn about the complex intersections of immigrant rights, labor rights, and Jewish law - from the Lower East Side's kosher meat boycott of 1903 to the AgriProcessors boycott of 2008.
Featuring Professor Hasia Diner, NYU, and Organizers from the United Food and Commercial Workers Union, Uri L'Tzedek, and Hekhsher Tzedek. Presented through Jews for Racial and Economic Justice (JFREJ) and American Jewish World Service and AVODAH: The Jewish Service Corps.
This event is co-sponsored by Hazon, the Workmen's Circle / Arbeter Ring, and Jewish Labor Committee/United Hebrew Trades. For more information or to RSVP click here or call 212-647-8966 ext 10.
We confirm the amazing achievements of Yiddish without any negation at all of the importance of Modern Hebrew, Ladino, Zionism, secular Judaism, Jewish culture as a whole (yiddishkeit) or any other intimate, creative, and authentic Jewish entity and conviction. In addition, we are not all just Yiddishists, of the sort who are committed to Yiddish and only to Yiddish. Just the opposite. We are of various Jewish ideologies. "Whatever we are, we speak Yiddish" - Yiddish is our common property and an integral part of our anchoredness in a part of our identity, our past, and in a part of our future.--Joshua Fishman, from אַ באַגריסונג־וואָרט לכּבֿוד דעם 100סטן יובֿל פֿון דער טשערנאָוויצער שפּראַך־קאָנפֿערענץ an article in the Yiddish Forward commemorating the 100th anniversary of the Yiddish Language Conference. Translation mine.
It'd be asking too much to eliminate pharm-phunded contributors from ostensibly nonpartisan guides which reflect the best available consensus of our profession (that would be...legitimate!). Nor do I think it's likely that their contributions will be vetted by a pharm-free referee (that would be...adequate!). In the absence of these strategies, it would be nice - paradoxically - if those medications mentioned in the text could be listed on first appearance by brand name and manufacturer. Otherwise how are we to know which contributor is putting a golden shine on the clinical evidence?
We wait frozen in angry day
for night with its moon,
for moon's tenderness.
We wait terrified in angry night
for day with its sun,
for sun's clemency.
Day and night -
They think we're big,
they make free use of us.
We're small, quite small -
fear pulls us to the ground,
as if we're his, as if he owns us.
So small, what should we
do with ourselves?
Our pain, what should we do
with our pain?
Day and night -
They think we're big,
they make free use of us.
--Leib Kvitko (Oct. 15, 1890-August 12, 1952)
(my translation; original here)
1. One assumption made by opponents of work-hour regulations is that these regulations are only justified if there is a proven connection between longer work hours and more medical errors. But why is the burden of proof on those who want to change the established order? Why must we assume that the more hours doctors work, the better? Do we know that 120-hour work weeks make better doctors than 80-hour weeks, or do older doctors - who tend to be most vocal in their opposition to work-hour regulations - merely harbor nostalgia for their training days?
Work limits have troubling consequences [...] including interruption of
resident learning, fracturing of traditional hospital teams, and the creation of
a kind of shift-work clock-watching mentality among young doctors.
"A clock-watching mentality among young doctors" links to a sidebar referencing not a study or review but . . . a conversation the author appears to have had with some young doctors who don't like work-hour regulations. But my colleagues - conscientious, hard-working, caring doctors - like and accept these regulations as a rule. They "watch the clock" only in the sense that every shift worker respects their own commitments whether at work or outside. Martyrdom is not our measure of compassionate, effective care or of professional devotion.
Intercessory prayer for the alleviation of ill health.
Roberts L, Ahmed I, Hall S.
Hertford College, Cattle Street, Oxford, UK, OX1 3BW. leannerobert_uk at yahoo dot co dot uk
Cochrane Systematic Reviews 2007.
BACKGROUND: Prayer is an ancient and widely used intervention for alleviating illness and promoting good health. Whilst the outcomes of trials of prayer cannot be interpreted as 'proof/disproof' of God's response to those praying, there may be an effect of prayer not dependent on divine intervention. This may be quantifiable; which makes this investigation of a widely used health care intervention both possible and important.
OBJECTIVES: To review the effectiveness of intercessory prayer as an additional intervention for those with health problems already receiving standard medical care.
SEARCH STRATEGY: We systematically searched ten databases (June 2005).
SELECTION CRITERIA: We included any randomised trial of personal, focused, committed and organised intercessory prayer with those interceding holding some belief that they are praying to a God. This prayer should be offered on behalf of anyone with health problems.
DATA COLLECTION AND ANALYSIS: We extracted data independently and analysed on an intention to treat basis calculating, for binary data, the fixed effect relative risk (RR), their 95% confidence intervals (CI), and the number needed to treat or harm (NNT or NNH).
MAIN RESULTS: Ten studies are now included (n=7646). We found a slight difference between groups, favouring prayer for death (6 RCTs, N=6782, RR 0.88 CI 0.80 to 0.97, NNT 42 CI 25 to 167, I(2 )83%) but no differences between groups for clinical state, complications or leaving the study early. Individual studies did find some effects. One trial separated death data into 'high' and 'low' risk and found prayer had a positive effect on those at 'high' risk of death (1 RCT, N=445, RR 0.3 CI 0.2 to 0.46, NNT 8 CI 7 to 11). A second study found a positive effect of prayer on women undergoing IVF treatment with significantly more successful implantations in the prayer group compared with standard care (1 RCT, n=169, RR 0.68 CI 0.53 to 0.86, NNT 5 CI 3 to 10). A larger study assessed the effect of awareness of prayer and found those aware of receiving prayer had significantly more post operative complications than those not receiving prayer (1 RCT, n=1198, RR 1.15 CI 1.04 to 1.28, NNH 14 CI 8 to 50) and those uncertain if they were receiving prayer (1 RCT, n=1205, RR 1.12 CI 1.01 to 1.24, NNH 17 CI 9 to 201)
AUTHORS' CONCLUSIONS: It is not sensible to interpret any of the interesting results with great confidence. However, for women hoping for successful IVF treatment there are some data suggesting a favourable outcome of prayer but these data are derived from only one of the smaller trials. On the other hand, one of the larger studies suggests that those undergoing operations may not wish to know of the prayer that is being offered on their behalf. Most data are equivocal. The evidence presented so far is interesting enough to justify further study into the human aspects of the effects of prayer. However it is impossible to prove or disprove in trials any supposed benefit that derives from God's response to prayer.
has gotten ever sicker the past two years,
his body has slowly shrunk
as if he were hiding himself from the world
and somewhere, with trembling hands,
holding onto a concealed
center of life.
And then one day
he entrusted me
with his apartment keys.
He had to go into the hospital
for an operation
and he asked me
to take care of his two vases
in the window.
"I can bring them to my place,"
"No, no," he stammered.
"The piano has to live with somebody."
He hung his head
and added as if embarrassed,
"If you have time, it would be good
if once a week, in the evening,
you could just sit for a moment
by the piano."
(from Der Finfter Zman, CYCO Farlag, 2008. Original Yiddish here. Translation mine.)
do not nourish
as parents do children.
Like the eucalyptus,
they make the soil
beneath them barren.
Standing in a
grove of them
(from Say Uncle, Grove Press, 2000)
What explains the large variation in health care costs across the country? You would expect that the regions with the highest health care expenditures have the sickest patients, or have the highest prevalence of chronic health conditions.But you would be wrong. Health care expenditures are highest where health care supply is the highest. As the number of hospital beds, doctors, and medical technologies (”supply-limited health care”) increases, the use of these goods increases as well.
More in Clinical Correlations, the blog of NYU Internal Medicine.
Judging articles in the medical literature based on whether the authors have cool names.
Project LIFE-Learning to Improve Fitness and Function in Elders: Methods, design, and baseline characteristics of randomized trial.Good paper:
Enck P, Zimmermann K, Menke G, Müller-Lissner S, Martens U, Klosterhalfen S.A mixture of Escherichia coli (DSM 17252) and Enterococcus faecalis (DSM 16440) for treatment of the irritable bowel syndrome - A randomized controlled trial with primary care physicians.
Adeoye AO, Omotoye OJ.Eye disease in Wesley Guild Hospital, Ilesa, Nigeria.Afr J Med Med Sci. 2007 Dec;36(4):377-80.
Thyroid hormone transport and metabolism by OATP1C1 and consequences of genetic variation.
van der Deure WM, Hansen PS, Peeters RP, Kyvik KO, Friesema EC, Hegedus L, Visser TJ.
I did get some nice stuff today, and I hope the upshot here will tend more towards the second motivation than the first:
גימטריקון (Gimatrikon), i.e. a gematria dictionary
Rats, Lice, and History
How We Die
The Poems of Gerard Manley Hopkins
The Courtier and the Heretic: Leibniz, Spinoza, and the Fate of God in the Modern World
The Examined Life: Philosophical Meditations
Consider the newly posted review (at the Seforim blog) by Rabbi Aryeh Frimer of Rabbi Daniel Sperber's Darka shel Halakha. The majority of his explicit argument is (a) Sperber misunderstands the original Talmudic statement about women and aliyot; (b) Sperber misconstrues the scope of kavod-haberiyot - it can only temporarily nullify a rabbinic decree; and (c) Sperber misapplies kavod-haberiyot to the matter of women reading Torah.
Two side comments, however, throw as much light on Frimer's argument as do the more bibliographic portions:
[I]n the case of aliyyot, no act of shame has been performed to all
those not called to the Torah (both men and women); they are simply not honored.
This is incorrect. As R. Frimer surely knows, reading from the Torah at fixed times is one of the basic requirements which a Jewish community must fulfill (not, as far as I am aware, an individual requirement, as he seems to assume). In the case of a man, not being called for an aliyah at one occasion means "simply" that he must wait for another occasion. But the possibility remains that he may someday be called. For an Orthodox woman, she will never be honored. Thus "both men and women" is a misleading formulation, and "simply not honored" is rhetorical sleight-of-hand: if one can never be honored - never participate in a basic community ritual - I think shame is something to be careful of.
The second group of misstatements is more revealing.
This view [of many rabbis] explicitly rejects subjective standards - in which what is embarrassing results from the idiosyncrasies or hypersensitivities of an individual or small group. The vast majority of religiously committed women are not offended when they do not receive an aliyya. Indeed, they understand and accept the halakhic given, although some might clearly have preferred it to be otherwise.
"Idiosyncrasies" and "hypersensitivities" are strange terms to be applied to the spiritual strivings of half of all Jews - to which Frimer begins his essay with an avowal of respect.
And then - how does R. Frimer know that "the vast majority of religiously committed women are not offended when they do not receive an aliyya"? Has he talked to them? Or are "religiously committed women" defined as those who do not think about receiving aliyot? In any case, the formulation "...when they do not receive an aliyya" is again misleading, implying as it does that we are considering an individual aliyah, one of many, which Leah or Sarah happens not to be called for at a particular moment. Rather, as I pointed out, we are talking here about the wholesale exclusion of a very large group (half of all Jews!) from a basic community obligation.
More importantly, does it make halakhic sense that if a group of women – nay, any group, says: “this Rabbinic halakha offends me” – be it mehitsa, tsni’ut, kashrut, stam yeynam, many aspects of taharat ha-mishpahah, who counts for a minyan, and who can serve as a hazzan - then we should have a carte blanche to go about abrogating it. Such a position is untenable, if not unthinkable.
More rhetorical sleight-of-hand! The premise in this paragraph is not being advocated by any party to this dispute (or indeed any observant Jewish feminist!). I very much doubt that R. Sperber is indicating that any group which thinks itself offended by a given Rabbinic edict "should have a carte blanche to go about abrogating it" (whatever that means). It is true that when a Rabbinic edict does lead to the wholesale exclusion of women, the circumstances of the legislation (whether or not they apply, and when) should be very carefully examined. No slippery slope here, merely R. Sperber's derekh-haTorah.
To reframe the question R. Frimer is asking (but without the stacked deck): does it make halachic sense that a community which values the spiritual striving of women should consider whether its own honor is sensitive to their wholesale exclusion? The question answers itself.
By analogy, medical schools should do what they're best at. Different medical schools are (I speculate) better at educating different types of doctors: NYU might be better at training primary care physicians, while Columbia (to pluck a name out of the air) might be better at training future cardiologists.
So why can't medical schools specialize? Why not telescope the long and tiresome haul of medical school-residency-fellowship into a single training program?
We know "physician" is a variegated profession. Why must all doctors be trained the same? Wouldn't it make sense for a medical school to be able to choose an area of specialty, rather than trying (fruitlessly) to be all things to all possible future doctors?
(He was a guest on this very blog some time ago.)
The Truth About Maimonides Medical CenterInside is a 15 (!)-page article about the hospital, its detractors, and its defenders.
Community leaders and dozens of former patients complain to Zeitshrift about negative treatment in the Borough Park hospital - Some leaders say that other hospitals aren't any better - What can we do to improve the situation?
Even if doctors are reluctant to quote such possibilities, maybe they still practice according to them? The literature on medical decision-making gets broader every day, and I fear to tread where I am ignorant. I know enough though to say that it strongly depends on the specialty. Sometimes subspecialties of medicine differ so much from each other it's as if they are different professions altogether. The emergency-room doctor and the critical-care physician deal in life and death every day, while the outpatient practitioner has influence in the gradual development of healing or disease - these are broad generalizations, of course.
I would understand if the findings of the study were a slam dunk, but they aren't: verbal IQ was the only category with a statistically significant difference (performance and total were not statistically significant), and the IQ difference is probably not behaviorally significant in any case (what's five or seven points?).
Given that the differences are small and possibly not statistically significant, it behooves those reporting the news to give a sense of potential sources of bias: factors which could skew the results in one way or another. And one way in which results can be skewed is for raters to "know" or "guess" while rating the children in one group that their IQ should be higher. We are all inherently biased creatures - blinding is the way, in modern epidemiology, to reduce bias. When small results are claimed (as they are here) a source of bias like this is quite worrisome.
The cognitive benefits of breastfeeding remain unproven.
(Of course my son is being breastfed - with formula too. But the reason he'll grow up smart, God willing, is because his mother is smart.)
(The cat and the monkey you already have, yes?)
The findings suggest that psychiatric disorders in Marines are diagnosed most frequently during the initial months of recruit training rather than after combat deployment. The disproportionate loss of psychologically unfit personnel early in training creates a "healthy warrior effect," because only those persons who have proven their resilience during training remain eligible for combat.
"Doctor, if a man had chest pain, can he walk home for two hours [on Shabbos]?"
"It depends what kind of pain."
"The doctors said it wasn't heart pain. Can he walk home? I don't think it's safe to walk home. The rabbi said he could take a car home."
[T]he question up to what level of possibility [doubt, sofek] something is considered sofek pikuach nefesh does not have an objective answer, but rather [is according to] the assessment of the community that the activity was done for the sake of saving a life [pikuach nefesh]. The situation in which such an activity is required is considered to be "sofek pikuach nefesh."
So we might as well follow the retro trend and call it patient obedience. Just like they should have termed it with all honesty in the good old days.
In our Yiddish at home we say aroplozn dos vaser; I know people have also said (op)shvenkn dem klozet. Of course, just like American Spanish, in American Yiddish nowadays 99% of people say (I bet) floshn. I use that word too, with guilty pleasure.
See my poster on the topic. When you're done looking, check out the thought-provoking companion exercises. Lastly, make yourself a cup of tea (Lapsang Souchong), sit down, take a minute, and write down your epistemology on a piece of paper. Please e-mail that epistemology to me; I'd like to start a database of such statements-of-epistemology. So far I have an N
of ... 1.
What is the effectiveness of laypersons' pediatric CPR?
What is the effectiveness of classes for laypeople about pediatric CPR?
What is the effectiveness of e-mails advertising classes for laypeople about pediatric CPR?
I wanted to go memorialize the Warsaw Ghetto uprising, but it's too close to Pesach. I suppose this should make the historical memory even sharper: in varshever geto iz itst khoydesh nisn ("in the Warsaw Ghetto it's Nisan now" -- Binem Heller).
I have a problem with "Orthodox." Not with the term itself but its use. Whenever someone is observant, or considers themselves bound by halachah, the term "Orthodox" is always put into play in the article describing them. This seems to happen most often in the Times.
I do accept the term when my work friends or colleagues use it to describe me, because they're not looking for a lecture on twentieth-century Jewish religious or intellectual history. But I'd rather be called Conservative, or frum-egal, or sho(y)mer mitsvo(s/t), or (halachically) observant/pious/devout/hyper-religious, or (failing all else) "that guy with the yarmulke/kippah/lid/skullcap/hat."
Today I gave a presentation about some ongoing research: (to what extent) do patients and the medical chart differently report the doctors' reason for their hospital admission?
You can attend the talk too!
With their scattered diaspora and entrepreneurial traditions, the Chinese have sometimes been called the Jews of Asia. The Fujianese, who are famous for their adventurism and business savvy, are occasionally described as the Jews of China. The people of Changle, Lin Li tells me, are the Jews of Fujian Province."Entrepreneurial traditions"! "Business savvy"! How polite of you, Patrick.
We slop around the pure dough with washed hands
pebbled with healed scars.
Mushing it around. It slops
over the edges,
this loving mix
Touching the new loaf
brings my head into alignment at last
all the more so with butter ready
and a clean knife.
Most of our interventions don't help patients. And isn't that a bitch.
More at Clinical Correlations, the NYU Internal Medicine blog. (Thanks to D.M. Esq. for a quick legal education.)
We rang the doorbell and the door was opened by a Jew of about sixty, short, with a pointy beard, in a white shirt without a tallit katan, and with a black yarmulke - but made of cloth. In other words a yekke-ish Jew. I mean, we're talking about titshers and except for a convert or a newly religious person it's really rare to see a Chasidic titsher. My nephew, as a matter of fact, has a Chasidic titsher, born and bred into holiness, who teaches the kids English - in Yiddish. If they can teach Hebrew in Yiddish, why not English? As to what they call him: Titsher Felberblum. Since he's a rebbe in the mornings what to call him is a momentous question. If they called him Rebbe Felberblum that would mean that a rebbe is teaching English to the children, something which shouldn't be seen or found. If they call him Mister Felberblum that would mean they're calling a melamed Mister - but then the people would cry out at this dishonor they stabbed our Rabbi, they knocked down our Rabbi! So then what did they do? Just calling him titsher would be fine for goyim or goyish Jews. But you can't refer to as titsher a Chasid with a gartel and shoes and long socks, someone who calls his fellow an evil name has no part in the World to Come. A compromise was hit upon: Titsher Felberblum. This incorporates both his Jewish name and his profession of secular studies. Thus the Torah doesn't God forbid come to be shamed, and the morning melamed's glory remains in its place.
But he really didn't mean to write this, did he?
However, the sheer abundance [of knowledge taught in medical school] crowds out an important—in fact, the only—skill that matters in treating a patient: how to critically appraise published clinical trials.The only skill that matters? How about:
1. talking to the patient (not trivial!)
2. eliciting the patient's wishes and preferences
3. diagnosis (including the use of diagnostic tests)
4. elucidating the treatment options and formulating a question
5. judging what the best evidence is for the particular clinical question
6. applying the best evidence to the clinical question
7. discussing treatment options with the patient
8. ensuring patient compliance/adherence/agreement/cooperation/investment
Pediatrics (the author's specialty) can't be that different!
making children sad.
The shade splinters sun
and my daughter from another room
spears me with a laugh.
I'm climbing the walls of guilt.
I feel the echoes
of your coming fury.
Every dying plant is reinherbated
growing sans boundaries:
One age, one stratum of stretching for light.
Of farting noises, ice cream cones
and springing eagerness for chocolate.
Some doggerel, if you're not getting shalekhmones from me.
If you're a rabbi, judicate
If you're a doctor, cure
If you're a heretic, be in doubt --
if scalpling, be sure.
If you're a cookie, delectate
if Esther now, don't fast
Don't gird yourself for battle
The lots are long since cast.
If sworn enemy, think it over
If you're our God, defend
This year, Esther, let your hair down
like a child, pretend.
Nice to form a part again of the jaunty ricketiness - my missed words here and there, my shaky transitions into and out of a near-perfect Torah reading (someone else read, hence the near perfection).
I always feel like Tachanun shouldn't be said during Adar either; someone always has to remind me.
It would be too easy - unfair, really - to say that some doctors who think patients are incompetent, or crazy, are unable to see why anyone might disagree with them. But I'll say it anyway.
and they love each other now.
Two sides of distress:
bloody sidewalk, topiary median.
I embrace their commotions
and have contracted them to draw,
in the dark cherry-ink of weavers,
victors standing over us.
Enveloped by perfect sight
I view the door clearly
but cannot feel for its handle.