Summer song

Grass under halogen

draped by noonish shadows.

I stroll like a lazy football player

without a ball.

This all happens at summer

when boats cut open oceans.

Hating sweat

I'm waiting for winter.

The Nightfloater's Prayer

Mincha with tallis and tefillin.

A systematic review of the effectiveness of prayer for the sick

[click the post title for the full abstract]
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.

The piano (a poem by Yonia Fain)

My neighbor, the famous pianist,
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,"
I offered.

"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.)

Kay Ryan, poet laureate

In honor of the poet laureate being someone whose books I actually own, a selection. A short selection - the shortest possible. One poem.

Great Thoughts

Great thoughts
do not nourish
small thoughts
as parents do children.

Like the eucalyptus,
they make the soil
beneath them barren.

Standing in a
grove of them
is hideous.

(from Say Uncle, Grove Press, 2000)

More health care is not better

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.

Why People Become Cannibals

There's cameraderie.

There's shared values.

They practice what they preach.

And there's always someone to have for Shabbos lunch.

[thanks to House of Gil for laying out the principles]

Best medical quote ever

“It’s incumbent on the community to dispense with the need for evidence-based medicine,” [some cardiologist] said [in the New York Times, in support of expensive, unproven "CT angiograms"].

Couples Therapy

I never lend a hand
when I can take yours
to drag our couple
across unders and overs.

What brought us together
is chicken-or-egg.
You bring and I give.
We cry and we beg.

My hobby

(with apologies to xkcd)

Judging articles in the medical literature based on whether the authors have cool names.

Boring paper:

Project LIFE-Learning to Improve Fitness and Function in Elders: Methods, design, and baseline characteristics of randomized trial.

Morey MC, Peterson MJ, Pieper CF, Sloane R, Crowley GM, Cowper P, McConnell E, Bosworth H, Ekelund C, Pearson M, Howard T.

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.

Excellent paper:

Adeoye AO, Omotoye OJ.

Eye disease in Wesley Guild Hospital, Ilesa, Nigeria.

Afr J Med Med Sci. 2007 Dec;36(4):377-80.

Note that the Dutch are usually at the top of the heap as well. How can anyone resist these authors?

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.

Passion with a purpose

I don't read a book
One moment after it stops exciting my
Curiosity or interest, and this passion
Has finally stopped my reading altogether [...]

-David Shapiro, Poems from Deal, 1969
(thanks to AS)

Today's Strand haul

This is a blogpost, so motivated by a blend of two complementary impulses: preening (look at the books I'm reading! aren't I erudite!) and the search for people to share the books with (talk to me about them! what do you think?).

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

Growth Song

Children are drinking from lukewarm brass gargoyles.
The wheel gruntingly swivels.
I stand in the field directing sprouts
mediating growth from sand to sun.
Let me be a mother-man.

Simply not honored? The "hypersensitivities" of Jewish women

Often the most interesting part of a responsum, especially a traditional responsum redolent with the assumptions of strict construction (one merely has to read the law correctly out of the proper book, and all will be truth), is not so much what is termed the "halachic analysis" (quoting sources, lists of poskim) but the interstices of the argument, in which the strict-construction myth is exploded despite itself: opinions do matter in the interpretation and creation of halachah, and in many a halachic analysis the posek's personal notions are determinative.

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.

Finally:

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.

Should we specialize medical education?

It's common wisdom that surgeries are better done at high-volume centers. Specialists should do what they're best at - this reduces errors.

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?

The Yiddish Leprechaun of Baltimore

Presenting the genial, silver-tongued, exaggeration-prone professor (and friend of mine), Marc Caplan. His life story is worth reading about.

(He was a guest on this very blog some time ago.)

Chasidim complain about Maimonides?

Last week's issue of Zeitshrift, a Yiddish magazine from Monsey, has this cover headline in red and black:

The Truth About Maimonides Medical Center
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?

Inside is a 15 (!)-page article about the hospital, its detractors, and its defenders.

GG is for pluggable

Are you looking for kids' books which are witty but not saccharine? Look no further than AA is for Aardvark, the latest creation from the unjustly unfamous Mark Shulman (a friend of mine), brimming (both author and book) with wordplay, illustrations, and double letters.

Saving a life - according to the doctors. II

If a non-rabbi could decide what sofek pikuach nefesh means, could a doctor do it? I'm not sure, because I don't think the work of a doctor has much to do with calculating mortalities - that is more fittingly the work of an actuary or an epidemiologist. If you ask a doctor, given a certain presentation of symptoms, what is the chance that a certain patient sitting (or lying) in front of them will die, they will generally say, "It depends on the patient." Doctors are notoriously reluctant to give probabilities.

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.

Not blinded in Belarus

When this study on breastfeeding and IQ was hyped in the press (MSNBC; see WebMD for a better take) why did no one mention that the pediatricians who rated the IQ of the children in question (more vs. less breastfeeding) were not blinded to which group the children were in?

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.)