Speaking Albanian

To Albany today with my fun-loving primary-care colleagues to advocate for streamlined consent for HIV testing - to make sure all New Yorkers get HIV diagnosis and necessary treatment as early as possible. 

Everyone was nice and I didn't trip over the furniture. 

Enjoy our position paper here. Spread the word!

In Which a Kesher Israel Member Waxes Ecumenical

Psst, Joe! Does Barry Freundel think you and Sarah Palin worship the same God?

reckless beauty
heedless joy
many
people never
panic

clamorous intoxi
cating spaces

living alone
dying embraced

Three and a Half Jewish Philosophers

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.

More in the Forward, where I interview Putnam about his new book, Jewish Philosophy as a Guide to Life.

America's Next Top Health Policy Problem

James Knickman, the unassuming and friendly health-policy analyst and CEO of the New York State Health Foundation, talked to our class of third-year primary care residents on Tuesday as part of our health policy course. Here is his list of the Top Ten Health Policy Crises.*

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.

8. Malpractice!

9. Dental care.

10. The lack of health-care professionals.

*Okay, he didn't say "crises," he said "topics." But "crises" is more fun.

"Diagnosis of exclusion"

A zillion years of medical and graduate school, and nearly three years of residency, and I still don't understand what it means when people say that such-and-such is a diagnosis of exclusion. Any diagnosis is a diagnosis of exclusion!

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.

Jewels of Elul CXVIII: A Month of Dreamers that Feels like a Year

with apologies to Craig 'N Co.

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!

Well that's all right then

Worried whether your favorite presidential candidate will defeat the other party's lying traitorous scum and save our nation this November? If you care about health policy, don't worry about it. Neither man's plan has a pig's chance at a barbecue of getting anywhere near passage.

Welcome to the hekhsher tzedek community, Orthodox Union!

Or: happy Elul!

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!

The Art of the Improbable

Today I voted for Paul Newell and Daniel Squadron. Nothing like casting your lot with the losing team! (And speaking of losing...)

* * *

You know what's useful? Reading political news.

Fresh fish for sale!

From there to here
From here to there
New Yiddish fish are everywhere!

Now available:
Eyn Fish Tsvey Fish Royter Fish Bloyer Fish
One Fish Two Fish Red Fish Blue Fish by Dr. Seuss
Yiddish translation by Sholem Berger
978-0-9726939-3-6
$15 + shipping (and tax in NY State)
yiddishcat.com

Don't forget:
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

The futile slow code

I was involved in a slow code recently. (I won't say where, or when, or with whom.) They are slippery and repugnant. Rarely can any of the parties involved say with satisfaction or complete clarity when, or by whom, the slow code was suggested or agreed to. It is a substitute for an honest discussion of options with the patient and family, and it is a legal minefield.

Remind me not to get involved in them again ... when I have a choice in the matter.

The Politics of Kashrut: Kosher Food Boycotts then and now

An event at Town and Village Synagogue. No word yet whether the refreshments will be fleischig.

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.

Without any negation

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.

Dance of the Dripping-Hand Fairies

I'm no choreographer, but it is important to be meaningful in the movements you adopt in front of the motion-detector paper-towel dispenser. I do want this paper towel! I do! Look, here I am reaching my arms underneath it!

Yiddish is still a national language of Jews

Happy 100th anniversary of the Tshernovits conference!

Studying with Big Pharma

The American Board of Internal Medicine ratifies a core of medical knowledge in which the qualified internist is supposed to demonstrate proficiency. I am using MKSAP to study - it's a series of study guides produced by the American College of Physicians. Before the table of contents, the contributors are listed, together with their disclosed involvement with (meaning: compensation by) pharmaceutical companies.

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?

Day and night

Day and night -
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?
Love?
Secrets?

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)

Poets' homework

Write a poem using only these words.

It should be a good poem.

Work-hour anecdotes battle it out head to head!

Sandeep Jauhar, writing in Slate, has an introduction to the controversy around work-hour regulation for medical residents. 

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?

Would another helping profession expect its practitioners to work more hours (consecutive or total) as proof of their seriousness? Yes there is overlap between quantity and quality, but anyone who's spent time in a residency knows that an extra hour does not necessarily mean an extra hour of learning or patient care. Sometimes - often - it means an extra hour of drawing blood, doing paperwork, transporting, finding a working EKG machine . . .

2. Jahuar writes:

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.

Notice how none of these consequences are referenced to the literature, and in fact each of them could argue, properly understood, for work-hour regulations.

For example, resident learning is "uninterrupted" by fatigue (or lack of concentration) when proper balance between work and other parts of life is ensured.

"Fracturing of traditional hospital teams": I suppose Jahuar is referring here to night-float interns or residents, people who don't work in teams. Or to "orphan" interns, coming in on the weekends when the rest of their team is off, so that someone can be around to admit patients. But how "traditional" is the intern-resident arrangement really? It can't be older (at least in the U.S.) than the teaching hospital, which itself isn't older than a hundred years or so. "Tradition" in medicine changes every few decades anyway - why shouldn't it change now?

"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.