Adventures in Dehydrating: getting my feet wet (:

January 15th, 2013

Last week I got my personal Christmas present to myself- an Excalibur 9 tray dehydrator.

I’ve been eyeing these babies for quite awhile. I think it’s a natural curiosity when one on tries to resolve the need for portable, refrigerator-less food with the reality of an always-on-the-go-no-breaks-not-even-bathrooms culture of the hospital. I mean, there are only so many granola bars a girl can eat!

Many days I better have something in my work bag, or I’m eating nothing. More often I’m eating whatever is handy, hence the need for intelligent, healthy solutions.

I was giddy when it arrived. Visions of dried sugar plums danced in my head! Well, ok, maybe not sugar plums but more like peppers, greens, …

This weekend I opened it up. I plugged it in and promptly blew the circuits in my kitchen outlet. I think it had something to do with me freaking out it was shipped in the ‘on’ position and I didn’t know how to turn it off so I pulled the plug, which literally pulled the plug.

No matter. Several small appliance/ outlet tests and a circuit breaker later, I figured it out.

First up: 4 hr kale chips. Awesome, as are all kale chips.

Second: eight hour living raw arugala chips. Let me clarify: I hate arugala. OK, maybe hate is a strong word. I sincerely dislike arugala. Earlier, I had made a mistake buying two huge bunches of arugula at the store, thinking it was spinach. What a green rookie mistake.

I really didn’t know what to do, because I was out of the things to make an arugala and pear salad, but I did have part of a pear left.

I took some balsamic vinegar and puréed the pear, coating the arugula with the purée. It seemed like a good idea the time.

Needless to say, the dehydrated arugala is just as un-appetizing as normal arugula. So I ground it all into a powder and mixed it into a butternut squash soup. That worked really well, but it took forever to clean the trays, because I failed to have the foresight to purchase nonstick liners.

Today I went to the store to get some more appetizing veggies. I got eggplant, green beans, and colored peppers. Now this I’m really excited about!

Tonight I made a dry curry rub and coated the green beans. They are dehydrating as we speak. Wish me luck!

New (Hopefully) Series: Lonely #greensmoothie Breakfast (#lonelybfast)

January 10th, 2013

You may have noticed my earlier post on my foray into green smoothie land. This is an attempt to meet a personal health goal: eat more vegetables.

I love veggies, and I have no trouble eating them. I do have trouble finding prep time.

So, I’m trying this. It is also a way for me to connect with people who come to me asking about these new fads and trends in nutrition: I say don’t knock it until you’ve tried it. And researched it. Green smoothies is my first trendy nutrition habit to try.

Since I started trying to do this regularly, I have been pretty good about it. I don’t do it everyday, but 3-5 days out of the week I’ve successfully made this breakfast.

I’m going to try to tweet my smoothie recipes and my taste rating under the ‘Lonely’ bfast heading (#lonelybfast) I started writing about my ‘lonely’ meals when I lived apart from my husband and was dining solo. I’m usually eating workday breakfast solo, so it fits.

I can say my experiment is going pretty well so far, and I have been satiated until lunch. That makes me very happy, because I was really worried about getting ravenous in a few hours. I am also drinking 12-16 ounces of coffee, so that may play a role.

Unfortunately it hasn’t worked for my husband, just because he leaves the house so early, he never eats breakfast. To my vast amazement and delight, he actually likes the ones I’ve made for him. He can even tolerate ones that are more savory than I can. I think I’ll have to switch him to a ‘dinner and a smoothie’ plan to get him all the veggies he needs. We already try to have veggies for 1 or 2 side dishes at night, but he ONLY eats veggies at night, and that makes it hard to get his daily servings in.

How should I rate the taste? That’s an interesting question because I know that I may think something tastes really good but someone else (like oh, let’s say my dad) who is used to highly processed fatty/sugary foods will think it sucks. Anyone reading my recipes and ratings should take them with a grain of salt: my 5 stars may not be YOUR 5 stars.

So today I did the following:
1 1/2 cups kale
1/2 cup dandelion greens
1/8 large avocado
1 orange
1 acai/acerola purée smoothie packet (freezer section at Whole Foods)
3/4 cup unsweetened coconut milk beverage
2 tbs dried unsweetened shredded coconut

To be frank, this didn’t taste great. I’d give it 2 stars. I wasn’t looking forward to drinking it. I think it was the dandelions (stronger taste than the red kale), the avocado (I’m developing an aversion to using it in smoothies, not sure why but it’s too creamy I think), the acai/acerola (can’t taste it; frozen blueberries are better) and orange (too citrus, clashed with the avocado).

When I added a half packet of Truvia, it got a lot better, enough to make it a 3.

Tomorrow I probably won’t get to it (7am conference), so we’ll see what my next one will be.

Green Smoothies-OK, I’m curious

December 15th, 2012

I know the wonders of veggies, and I strive to eat as much as I can. Just like the rest of America, I struggle with the time it takes to prepare them. It’s not that I have difficulty with veggies in particular- I have difficulty with preparing my own food period. When you have a 70-80 hour a week job, when are you supposed to find time to cook for yourself?

I worry about my husband in particular. I have to force-feed him veggies. It’s a real struggle.

So I’ve been racking my brains trying to figure out how to incorporate more vegetables into our routine.

One potential answer? Green smoothies. Now before you start laughing, please note I am not a ‘nutrition freak’. I may be the Medical Director of Clinical Nutrition at my hospital, but I’m a Standard American, just like other Standard Americans (to play off the phrase SAD, or Standard American Diet). I eat crap just like the rest of you.

But I am trying very hard to keep my family’s eating habits in line, so as a generally curious person, I was intrigued by the idea of getting all my daily fruits and veggies served straight up in one convenient 16 ounce to-go package that reportedly tastes great.

I’m not a fan of the fact it’s a liquid (liquids generally produce less satiety because they empty out of your stomach more quickly), but I am a fan of how much great green goodness can be packed into just one green smoothie.

I mean, you people have NO CLUE the kinds of faces my husband makes when I serve Kale. It’s painful for both of us.

So, I frantically searched for a place near me that made green smoothies, just so I could give it a try. I do intend to try it at home, but the convenience factor of having someone else make it for me is huge for me right now while I’m drowning in work.

Thank heaven I found a place- awesome organic nursery with a REAL juice bar- these people ROCK! Good Earth Greenhouse and Cafe in River Forest, IL has an unbelievable list of fruit and veggie smoothies.

So, drum roll—–

My first green smoothie!

Brass Monkey with Kale (kale banana hazelnut milk almond butter raw cacao dates)

It’s AWESOME!!

I decided to go all-in and get the Rock Me Amadeus too
Cucumber celery spinach romaine kale arugula cilantro jalapeno parsley

Yeah. I said it. ALL IN.

It’s not exactly awesome, but it’s the real deal green smoothie, and I’m proud of myself for going for it. It’s not bad, it’s just that I, as a card-carrying SAD eater, am not used to savory juices. It has such awesome stuff in it, though, I’ll learn to like it.

I hope to write more about my Green Smoothie experiences.

What’s not so great- this place opens at 9 and closes at 5 which essentially makes it impossible for me to get my daily green smoothie fix.

It’s also 7-8 bucks a smoothie. Wowie that’s pricey but if it is your entire meal then it’s not far off fast food prices for a full meal.

20121215-113829.jpg

20121215-113904.jpg

20121215-113930.jpg

Quick Blog #DDW12-Benefit to live tweeting?

May 20th, 2012

I had a question.  Does live-tweeting help improve comprehension of a lecture?

I asked this question because I think it does.  I have to focus and process VERY quickly to live tweet.

I was curious to know if it had been studied formally.  I’m currently sitting in a DDW lecture (not listening b/c I”m not interested in this particular abstract).  So I’ll google it briefly

Search string: “does live tweeting improve comprehension”

Limiting to 2 google results pages (hey I’m at a conference here, no boos to my thoroughness)

Page 1:

Blog saying it’s distracting

http://commetrics.com/articles/forrester-conference-and-twitter-does-live-tweeting-help-engage-conference-delegates/

One article about lessons to learn before doing it

Everything else is unrelated

Page 2:

AHA!

http://theactiveclass.com/tag/mobile-technology/

The effect of Twitter on college student engagement and grades

  1. R. Junco1,*,
  2. G. Heiberger2,
  3. E. Loken3

Article first published online: 12 NOV 2010

http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2729.2010.00387.x/abstract

Journal of Computer Assisted Learning

Volume 27, Issue 2, pages 119–132, April 2011

 

Abstract

Despite the widespread use of social media by students and its increased use by instructors, very little empirical evidence is available concerning the impact of social media use on student learning and engagement. This paper describes our semester-long experimental study to determine if using Twitter – the microblogging and social networking platform most amenable to ongoing, public dialogue – for educationally relevant purposes can impact college student engagement and grades. A total of 125 students taking a first year seminar course for pre-health professional majors participated in this study (70 in the experimental group and 55 in the control group). With the experimental group, Twitter was used for various types of academic and co-curricular discussions. Engagement was quantified by using a 19-item scale based on the National Survey of Student Engagement. To assess differences in engagement and grades, we used mixed effects analysis of variance (ANOVA) models, with class sections nested within treatment groups. We also conducted content analyses of samples of Twitter exchanges. The ANOVA results showed that the experimental group had a significantly greater increase in engagement than the control group, as well as higher semester grade point averages. Analyses of Twitter communications showed that students and faculty were both highly engaged in the learning process in ways that transcended traditional classroom activities. This study provides experimental evidence that Twitter can be used as an educational tool to help engage students and to mobilize faculty into a more active and participatory role.

 

So at least one study supports my theory.  No time to do a more thorough review–back to the twitter stream . . .

 

Doctors, quality guides, and unnecessary tests: Don’t tell me what to do!

April 28th, 2012

Wow.  We REALLY do not like being told what to do.

As a background, quality improvement is a major professional goal of mine.  I have had formal QI training, I’ve taken a lot of classes that explore the issues of quality in medicine, and a significant proportion of my time is spent thinking about how to improve and streamline our delivery of high quality care.

We should all want that, right?  Shouldn’t we all want to improve?

Yeah, you’d think.

Maybe not.  Or at least not in a way that feels like homework/grades/slaps on wrists/cookbooks/“The Man”/you can’t tell me what to do damnit!

An alarmingly large proportion of physicians in the Medscape 2012 annual physician compensation report seemed durn determined to do whatever they ~individually~ feel is best for their patient, ignoring the guidelines that their own professional societies created.  They seem to feel justified, though by stating they don’t think the guidelines are going to do any good/aren’t in their patient’s best interest.

Let’s look at a couple of slides (annotation is mine: locate source URL by clicking on the Medscape link above):

 

I know the challenges to implementing changes that can actually drive improvement.  These challenges plague each step of the process: What is quality of care?  How to you define it? How do you measure it?  How to you balance quality for the patient with quality for the physician and quality for our nation?  How do you pay for it?  How do you convince people less medicine is quality care?

I also know why doctors dislike guidelines: they want to make the decisions for themselves at the bedside, and they don’t want to deny interventions to patients when they think there’s a possible chance it could help.  Evidence-based medicine looks at things on a big scale, and docs want the freedom to think, “what if my patient in front of me really is the one that an Umpteenth Emergency Department CT abdomen Scan shows the as-yet-to-be-diagnosed cancer that caused the last 5 years of his/her abdominal pain?” (Yes I’m being facetious, OK, I’m trying to make a point).

I belong to several professional GI societies, and one of those societies, the American Gastroenterological Association (AGA) has recently joined many other professional societies in the Choosing Wisely campaign [see a JAMA viewpoint article here].  Together they are trying to come up with medical interventions that are IN GENERAL  unnecessary: tests or therapies that add very little to making people better.

For years the AGA, American College of Gastroenterology (ACG), and the American Society for Gastrointestinal Endoscopy (ASGE) have published guidelines that seek to provide the best possible evidence for what has been shown to help people.  DOCTORS WROTE THESE GUIDELINES, along with many other people (and sometimes laypeople).

They are also actively partnering with national non-profit organizations to create and promote better quality in healthcare.

Not that I didn’t know that a lot of doctors don’t like guidelines, or at least don’t like being forced to conform to guidelines.  No American likes being told what to do: patients, physicians alike.  I get it, but C’MON PEOPLE.  You/we are not perfect.  There are truly some things we need to do to get our butts in gear and accept we don’t always provide high quality care, and guidelines can be very helpful tools (when applied correctly) to get better at what we do.

There is still a huge amount of autonomy in the American practice of medicine.  Probably too much autonomy as physicians and patients have been allowed to willy-nilly demand pointless interventions that satisfy our guts (no pun intended) but do little to actually improve health.  We will pass the exhorbitant costs of this wasteful care onto our children who will eventually face a crisis of debt and widespread health disparities.

That is, if we don’t take the bull by the horns and do something about it.

I was recently appointed to the AGA Institute Clinical Practice & Quality Management committee, and I was thrilled to be able to help shape these issues for our field and truly help bring GI into a higher standard of care.

Well, I guess I have my work cut out for me.  I’m going to become “The Man”, so to speak, the “Bad Guidelines Guy”, or umm “Gal”.

So, I guess my challenges in quality improvement are:

  • To try to move that needle on those surveys and convince physicians that being mindful of evidence based medicine can improve population health and individual health
  • To try to understand why so many doctors dismiss the guidelines they created
  • Find out what they think really will help improve patient care
  • To fight with insurance companies, government, and local administrators who apply these guidelines inappropriately (and just fuel those doubting doctor’s fears)
  • To determine what really makes a difference in improving care and decreasing the economic burden of healthcare for my future children

Good luck to us all.

Cancer Phobe-A Doc faces her Breast Health Fears

April 2nd, 2012

Today is my second vacation day of the year.  No, i’m not in Bermuda ):

I’m taking two days to do the kind of stuff every human needs to do.  I’m organizing my life and checking off my personal “punch list”.

First on my list is making my yearly trips to the doctor.  Usually I see the dentist twice a year, but since I moved last year I’ve yet to re-establish care in ANYTHING.  Time to take control.

So, first thing this morning (after cereal and coffee of course) I called my own hospital’s scheduling line to find me some new doctors.

Since I plan to have children in the next few years, I’m going to keep my primary care with a generalist OB/Gyn.  I need a pap smear/pelvic and some general pre-(very VERY pre) natal counseling. CHECK! Got it with someone who has clinic on my research day so I can schedule follow ups conveniently.

I also scheduled my dental cleaning.  I hate it, but my teeth are now quite valuable if you count the thousands of dollars in braces, bionators, and veneers that have graced my pearly whites over the years.

Next I faced something I’ve been meaning to do for a few years–a cancer risk assessment clinic.

Let me just say I am a HUGE cancer phobe.  When I was in my fourth year of med school, I sat down in the MICU one day and rubbed my sore neck muscles–only to find a “larger than the upper limit of normal” lymph node.  I had a few in other areas as well, so like a good med student I flipped out and convinced myself I was going to die from lymphoma.  Ten-thousand dollars later (yes m’aam, 10K smackeroos before my co-pay), I had a lymph node biopsy to tell me I was OK.

Years before, I had had another cancer scare.  One that hit a little closer to home.  When I was 17, I found a lump in my breast in the shower.  Of course, I flipped out then as well.  I went to see a surgeon who did a breast ultrasound.  I had the lump removed and was reassured it was benign–a fibroadenoma.  Pretty common, I know now.

It hit close to home because breast cancer is prevalent in my paternal grandmother’s family.  She had a sister who died of it in her thirties, and a niece who developed it in her 40′s.  A few years later, she herself would get breast cancer.

Now, my grandmother was in her 70′s, and it was metastatic mostly because she never went to see doctors and ignored her cancer until it grew to the size of a baseball.

She ignored it probably because she was scared and knew it was cancer. 

Can I blame her?  No, I can’t.  I can’t without being a hypocrite.  I am terrified of breast cancer, and I don’t do breast self exams for that very reason.  As an anxious person anyway, I know I’m going to feel funny lumps and bumps and convince myself it’s cancer.  Again, just like the prior two times.

I’m not without some justification–screening brings a lot of anxiety and false positives.  There was even one large randomized controlled trial of breast self exams in China that didn’t show a benefit of mortality reduction and did show an increase in the diagnosis of benign breast lesions in those who perform BSE’s (“Randomized trial of breast self-examination in Shanghai: Final results,”Journal of the National Cancer Institute, Oct. 2 (vol. 94, issue 19) 2002).

 

But I can’t ignore some facts:  I’m over 30 and childless (increases chances).  My age at menarche also gets me a couple of notches.  The fibroadenoma as a teen moves me up even farther.  Finally there’s my paternal grandmother and her breast cancer clan.   Thank goodness neither of her two daughters, my aunts, have had any problems, and they are approaching their 60′s.

So, I’ve decided to go talk to someone.  I filled out my family tree at family history.hhs.org.  I was unhappy i couldn’t add to my grandmother’s side, though, so I’ll have to hand-write it onto the tree.  I’m sure there are other family history apps that could help out with this.

What I’m hoping to get is an opinion on whether I should begin screening with mammography at the recommended age of 40, or if I should start sooner with a different modality such as ultrasound or MRI.

For all of you out there who fear cancer, you are not alone.  Even us doctors can be illogical about cancer.  Don’t let your fear control you, though.  Take charge, take a deep breath, and talk to your doctor.

Sigh, I just remembered another fear–skin cancer (I have tons of moles).  Time to call Loyola again. This time for the dermatologist . . .

Naps-not just for trainees

March 7th, 2012

During my internal medicine residency, I was one of the “subjects” in my then-attending Vinny Aurora’s (@futuredocs) experiments of residents and sleep.  I wore a little black watch looking thingy for about a month that tracked when (or not) I was sleeping.

I don’t sleep much.  Life is too full for sleep!  I get about 4.5-6 hours during the week.  I make up for it on the weekend; I like to get 8-10 then.

I am chronically sleep deprived.  I know it.  I feel it.  I fade most afternoons.  I usually don’t indulge in the p.m. coffee run, but most days it would be nice (like right now).

One thing I have found, though, is that a quick nap during my mid-week research day is OH, SO, NICE …..

On Wednesdays we have a 7 a.m. conference.  I get up at 5:20 to make it on time.  I usually go to bed between 11 and 12:30 the night before.  I barely stay awake for it, but waiting for me after that hour of knowledge building is a cozy, warm, quiet office.  Very Very Nice.  Very Very sleep inducing.

I know I shouldn’t sleep “on the job”, but isn’t that what some recent studies of work hours are suggesting?  I find my 20-40 minute naps (don’t ask me exactly where/how I take said nap) are excellent revivers.  I feel so much better afterwards, and I truly think it improves my focus and concentration.  It doesn’t impact how long I work, since “work” takes me well past 6 p.m. most nights.

I’m all for naps.  When I had to take them, I didn’t appreciate it.  Now, though, there are days in clinic when I long for a quick trip to my warm, quiet office . . .

Is BPA Bad? Lets find out Part 1

November 30th, 2011

The JAMA article about the large increase in urinary Bisphenol A (BPA) levels after eating canned soup caught my eye because my husband and I eat a lot of canned soup.

[JAMA. 2011 Nov 23;306(20):2218-20. Canned soup consumption and urinary bisphenol A: a randomized crossover trial. Carwile JL, Ye X, Zhou X, Calafat AM, Michels KB. Source: Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA.]

Naturally I was concerned, but my epidemiology background makes me a hearty skeptic when it comes to chemical/toxin “scares” from food.

My motto is “Show Me the Data”.  It is SO DURN HARD to perform a really good study of the isolated effects of isolated chemicals from isolated foods ON HUMANS NOT RATS that I rarely alter my normal food intake to avoid specific compounds unless a strong body of evidence suggests there’s really something to it.

I also know just how easy it is to get a really crappy epidemiologic study published (ahem, Andrew Wakefield?).

So, here’s my project: look into this BPA thing.  People take teams of researchers and spend months doing this.  This is time I do not have. So, I’ll do this in parts. Part I is literature search.

SO PUBMED, SHOW ME THE DATA:

1. Search string #1: BPA w/o limits = Results 2807 

2807 isn’t a manageable #.  I knew it wouldn’t be, but I was curious.  So, I need to refine my search.

2. Search string #2: BPA or Bisphenol A, limits: humans, english, search title only = Results 537

This still isn’t manageable for 1 person, unfortunately.  I.E. it would take about 9 hours to screen all these abstracts.  But, if I refine the search further, my search becomes more specific and less sensitive.  I might miss an important article.  So I’ll limit to full text only next, then screen the titles.

3. Search string #3: Search string #2 but with full text limit = Results 498

That isn’t too helpful.  Limiting to free full text would be very helpful (i.e. 154), but then I know I’ll miss some important things.  Ok, so let’s see how long it will take me to screen titles.

4. Screening titles, using timer to measure time to screen one screen of titles = Results Page 1 = 2 min, Page 2 = 1.30 Page 3 = 1.20 Page 4 = 1 min

So, I can guesstimate that it would take me about 34 minutes at 80 seconds a page to screen the titles. Out of the first 80 I screened, I chose 30 titles to review.  If that is a steady ratio, I’ll pick 187 abstracts.

BUT then I have to read the abstracts to screen them (time estimate = 2 min/abstract = 6 hours), and THEN I’d have to read the actual articles.  Next would be the joy of getting the articles (some I’ll have access to through my job but I am anticipating quite a few I would have to inter-library-loan, ILL).  I don’t think that an estimate of 30%-50% needed through ILL is unreasonable based on my experience with the library so far.   Each ILL costs ~ $15-20.

Let’s recap:

  • 6 hours to read abstracts.
  • If I go on to choose 50% of those abstracts for review = 93
  • Cost to get full text articles if 30% require ILL = $558
  • Time to read 93 articles, [no clue really, big shot in the dark here] ? 10 min? = 15 hours

There’s NO WAY I can take the time or money to do this.

Luckily as I am scrolling, I can pass over the articles on how to measure BPA and the non-human studies that didn’t get weeded out by checking the “humans only” option.

But, perhaps more efficiently I can pick up other recent review articles about the human effects of BPA (and actually read the full JAMA article, which I have not done yet).  The danger in this is knowing whether the people who wrote those review articles have enough knowledge of epidemiology to accurately evaluate the quality of the studies.   Also here’s a WARNING about reading only the discussion section of journal articles: these ARE NOT SYSTEMATIC REVIEWS.  So, if you are “summarizing” the data, it is only natural to bias your summary to support your findings.  Since humans are humans, I don’t want to trust the JAMA article discussion without looking around myself.

See how difficult this can be?  It is SO much easier to glance through someone else’s review article and take their word for it that they evaluated this data objectively.

In the “good old days”, one was supposed to be able to trust the “name” or “reputation” of a journal and the authors.  Well, we know now that even the bastions of medical scientific writing (names like JAMA or NEJM) can let some data slip through that it shouldn’t. [There was an article on screening for lung cancer using CT scans that used historical controls to make comparisons, published in either JAMA or NEJM a few years ago.  While I was in grad school at UNC, one of my epidemiology journal clubs evaluated this article and we had serious issues with the strength and validity of their findings.  Sadly, I cannot find the citation within a a reasonable period of time to write this blog, so I'll have to get back to you.]

Who do you trust?  I don’t know.  I can only tell you what I do, and what I do changes depending on the time I have in which to do it.  Since I don’t intend to write up this exercise for anyone but myself and the readers of this blog, I’ll probably be less rigorous than I would like to be.

5. Search string #4″ Search string #3 with limits to free full text and limited to meta-analysis and review articles only, Results = 19!! Yay!!, kinda (see qualifications about about limiting it to this tight a search).

You know what?  Two of these articles are EXACTLY THE KIND OF STORY I was looking for.  I was amazed the first article ended up Freely Disseminated in Pub Med Central because it is written in 1st person by a mother and a scientist.

PLoS Biol. 2007 Jul;5(7):e200. Epub 2007 Jul 17. Babies, bottles, and bisphenol A: the story of a scientist-mother.  Quitmeyer A, Roberts R. S. Department of Biology, Ursinus College, Collegeville, Pennsylvania, United States of America.

In this article, an undergraduate biology student and her professor (who is also a scientist and mother) discuss the history of BPA, some of the studies of BPA effects, the legislation surrounding BPA (up to the time of publication, 2007).

“Many animal studies focus on the effect of BPA exposure during fetal development . . . A similar correlation to human development is plausible.   Indeed, BPA has been found in the bloodstream, placenta, cord blood, and fetal blood of humans at levels that are within the range studied in many of the animal models [16].”

Be very clear you understand their argument and rationale for their decisions:

  • Studies of animal exposure indicate adverse effects for animal offspring.
  • The same levels that are shown to be bad in rats (and other animals) have been found in humans.
  • Therefore, if I believe that what is bad for a rat is bad for a human, then I believe that BPA is bad for human offspring.

They also discuss the few human studies that exist:

“Of the few human epidemiological studies, one revealed a relationship between BPA exposure and repeated miscarriage [9]. Additionally, BPA causes a human breast cancer cell line to proliferate, indicating that estrogen-sensitive tissues and cells in the body may react similarly [10]“

They decide to apply the effects of animal studies to humans, incorporate the human studies they reviewed, and thus they believe that current human levels of BPA exposure are too high and can be harmful.

I think it is important not to arbitrarily apply rat studies to humans.  I think we should use animal studies to warn us of potential harmful human effects, then try to see if those effects do indeed show up in humans.  Epidemiology allows us to address these questions in humans without subjecting us to trials where we ingest a potentially toxic substance.  The caveat is that good epidemiology studies of chemicals are hard to come by–there is the potential for SO MUCH BIAS that one must be very careful when designing this type of study.  You can get completely wacko results and needlessly scare a lot of people (ahem, Andrew Wakefield?).

Since the above article is now 4 years old, I want to find some more HUMAN reviews to help me form my own opinion.

Next I will turn to an article published in Germany :

Critical evaluation of key evidence on the human health hazards of exposure to bisphenol A. JG Hengstler et al. Crit Rev Toxicol. 2011 Apr;41(4):263-91

Leibniz Research Centre for Working Environment and Human Factors (IfADo), University of Dortmund, Dortmund, Germany, Institute of Environmental Toxicology, University of Halle, Halle/Saale, Germany, Federal Institute for Occupational Safety and Health, Dortmund, German, Research and Development, Merck Serono, Darmstadt, Germany, Dr. Lilienblum Consulting Toxicology LiCoTox, Hemmingen/Han, Germany, Global Early Development, Bayer Schering Pharma AG, Berlin, Germany, Bavarian Health and Food Safety Authority, Munich, Germany, Lower Saxony Governmental Institute of Public Health, Hannover, Germany, Federal Institute for Risk Assessment (BfR), Berlin, Germany

I read the abstract for this, but I haven’t read the paper yet. Basically this was a panel in Germany that was tasked with deciding if BPA is good or bad for you, and if bad, how much is OK.  I’m going to hope that since they were a panel, and that they took dedicated time to address the same question I’m addressing, that their conclusions will be valid.  However, as pointed out in article #1, I will have to decide if politics, lobbying, and business interests play at all into this panel’s decision.

Since I have spent close to two hours on this exercise today and will now have to go back to finishing my clinic notes, working on my presentation for research conference this Friday, re-writing a paper for publication and working on my next research project, it is time to stop my BPA exploration until next time.

Stay tuned . . .

Not-So-Lonely-Dinner: Brown Butter Sage Cabbage

November 20th, 2011

I just tweeted about our current Sunday night dinner, but the hubby wasn’t as pleased with today’s offering.  He has a mental block against meat replacements (tempeh, tofu, quorn, morningstar in any form . . .)  It’s frustrating to say the least because a lot of these protein sources have a more favorable calorie-fat-protein profile.

So, I thought I’d try to remember what I did the first time that he loved so much.

Hmm, So I think I browned butter in my All-clad 4 in deep pan and then added a lot of sage.  Then I put in the cabbage and sauteed that.  At some point I added onion powder (cause I didn’t have any fresh onions), nutmeg (freshly grated), pepper, craisins, and celery seeds.  After it had sauteed for awhile, I put rice vinegar and water in until it was covered and simmering.  I let it simmer with some chicken sausage for about 30 minutes.  Most of the cabbage recipes I read simmered the cabbage for a lot longer.

The hubby loved this one.  I hope I can replicate it!

Professional Societies: The Cost of Belonging

November 16th, 2011

What does it cost to belong to professional societies?

I think it is important to belong to one’s professional societies for numerous reasons: ongoing education, networking, leadership roles, and the opportunity to have a voice in how our profession is regulated.  Collective voices (and collective pocket books) are louder than individual voices (and individual pocketbooks).

What will it cost my pocketbook, though, to join all the societies I wish to join?  Let’s see:

  • AGA = Application Fee $40; Annual Dues $395
  • ACG = Application Fee $195 (1st yr dues); Annual Dues $325
  • ASGE = Initiation Fee $100; Annual Dues $350
  • CCFA = Participating Physician $300
  • ACP = Annual Dues < 8 years post training $285
  • AMA= Annual Reg Membership, 1st year in practice $210

Whipping out my calculator, I get a bottom line of $1965.  OUCH.

(I think my application fees for ACG & AGA are waived since I was a member in fellowship.  At least one of the GI societies has a 1st year in practice discount also, I just can’t remember which one).

This is on top of my boards (pray I passed), $2165

Hmm, I think some of those are going to have to wait.

I know there are very good reasons why membership fees exist.  These organizations do a lot for our profession.  The cost of publishing the journals alone must be huge.  However,  I know MY budget and income, and for now I’ll have to pick and choose what professional societies are the most important to me this year.

Maybe next year I can add more letters to the C.V. . . .

 

    About Me

    Professional Gastroenterology Fellow

    Amateur Martha Stewart/Bob Villa/Julia Child/Collette Peters

    Search