an activity of the imagination

set the answer face to face
with its question.
awkward encounter
till the match fails.
who are you to set them up?


"Intoxicado" Does Not Mean "Drunk"

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."


Presenting the presenters!

I was at Hopkins last week giving a talk as a recipient of one of the GIM Housestaff Research Awards. The other awardees were impressive. I wish they were as blogorrheic as I am, so I could provide links to their life & work. In any case, among the presentations were
  • 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].



Imagine you're in the hospital and in pain. You would like some medicine to treat that pain. Ipso facto presto chango- you are looking for drugs. Hence drug seeking. Voila! A reason not to give pain meds.

The Raucous Baucus Caucus

I skimmed the Baucus policy paper, which is (like the Health Care Policy and Marketplace Blog says) a plan, not a proposal for legislation, with a whole bunch of possibilities that Baucus doesn't really distinguish among. Also, it is a zillion (or 96) pages long. A couple of observations:

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.)



Right on, Max Baucus!

From today's press conference:
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.


Spelling Hope in Hebrew

From TNR it looks like Yediot Acharonot have chosen to spell Obama with two alefs, and Maariv - with one. Which spelling wins?

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.

The Emanuels Take Over, 2

Which Emanuel brother are you? (Warning: extreme snark.)


Statins in patients with high C-Reactive Protein "cut the risk of heart disease in half"?

Shorter New England Journal on the JUPITER study
(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.

The Catholic worker against torture

Mike Benedetti continues to be idiosyncratically (& admirably) activist - going to DC as part of Witness Against Torture.


Cat and Hat Don't Rhyme in Yiddish: Translating Children's Classics into Mame-Loshn...but for Whom?

Buy our books - and hear about why we translate them - in Philadelphia!

a talk in English by Zackary Sholem Berger, co-publisher at Yiddish House
Thursday, December 4th, 2008, 9:30am
Drexel University
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.

Breaking News: Obama Cabinet Selection

Secretary of Jewish-American Literature.


The Emanuels Take Over

If Rahm is chief of staff, does that mean we get health care vouchers from his brother?


Public appearances, 1

I got an award, so I'll be giving a talk at General Internal Medicine Grand Rounds at Johns Hopkins on November 14th. Drop by.