Doctors and obesity

Got a request from Ted to talk about this story:
http://www.washingtonpost.com/wp-dyn/content/article/2008/01/25/AR2008012502926.html?referrer=emailarticle

Basically, it's about obese people's experiences getting poor medical care due to MDs' stigmatization.

I guess my first thought is that patients get stigmatized for addictions of all kinds and eating addiction (which I would argue is the root of most obesity) on average probably gets MORE sympathetic treatment than other addictions. But of course, that doesn't justify prejudging people and compromising their medical care.

The issue of behavior influencing medical conditions is a huge one for physicians. We want patients to follow our instructions and be flawless. REalisitically, I don't think we can get rid of this desire; the best we can do is be aware of these expectations and supress negative transference of our judgments. The bottom line is, the patient pays us for a service and being disrespectful, judgmental and dismissive is not good service. Education, of course, and acknowleding the patient's ambivalence towards making change probably goes a lot further.

And this is not to say I don't struggle with being judgmental of my patients.

I am curious to know what 'medical condition' is predisposing people to obesity (see the article). I have a feeling the 'experts' may be referring to metabolic syndrome which of course is more of an effect, rather than cause of obesity.

Juno

I braved considerable odds -- no date, no car, no clean clothes, no washed hair, no absence of beer in font coat pocket -- to check out my first Oscar-nominated film of the season.

I have to say, it started out a little rough; the dialogue seemed contrived and precious but things quickly veered away from Chasing Amy-ville to lead to an enjoyable movie. I might've wanted fewer improbably witty and/or enlightened exchanges between any number of characters but the bottom line is I was entertained, moved and kept in suspense so what the heck. And, man, can you believe Jennifer Garner's facial structure?

For a likely entirely different take on teenish pregnancy, keep your eyes peeled for 4 months, 3 weeks and 2 days.

http://www.metacritic.com/film/titles/4months3weeksand2days

This and that...

VH1 is doing their 'top 40 greatest internet superstars'

http://www.vh1.com/shows/dyn/the_greatest/115766/episode_about.jhtml

To tell you how compelling this show is, I was watching it over some woman's shoulder at the gym, without sound, and still was riveted. They had that dude who made his own Tron costume and lives in Tron world 24/7...

http://www.tronguy.net/

Next, in honor of Yale Internal Med Primary Care Second Look/Alumni Reunion tonight, it's time to acknowledge that Jane Hunter was separated at birth from Samantha Bee. This picture doesn't quite capture it but if you watched last night's Daily Show, you would have no doubt:

Lastly, the great basement adventure started last night. I hacked off the old parge that's on top of the brick going down the stairs with a hammer. I got it all without a chisel. Probably not too wise. I may try to repoint just this part myself and leave it as exposed brick. I'm going to get O to help me tonight, safety goggles and dust mask included of course. Speaking of O, here's a great pic from last June's graduation (from pre-K with grandma Liz and random paparazzi):

Arctic Tale

Owen has now watched this National Geographic documentary twice in back-to-back nights. Many thanks to Michelle who sent a really cool set of Nat'l Geo books (and video) that Owen loves. He said tonight that wet polar bears look like 'white female lions' so we may have a budding Marty Stouffer on our hands. He also asked what 'fiesty,' 'hasty,' and 'timid' meant so this might be a good one for other young readers out there. There's a couple animal deaths but no attack scenes and good 'circle of life' type explanations (but real circle of life, not disney's version where everyone fits into an ecological niche except hyenas who are facists/nazis). There's a global warming argument/message built in as well. I imagine there are probably not too many doubters of this phenomenon among the six people who might read this blog entry, but just in case:
http://www.washingtonpost.com/wp-dyn/articles/A35233-2004Nov8.html

Celluloid Heroes

http://www.nytimes.com/2008/01/23/movies/awardsseason/23oscarscnd.html?_r=1&8dpc&oref=slogin

Oscar nominations are out and I have seen none of the nominations for best picture. That's an all-time low for those of you scoring at home. I may start with Juno so I can join the conversations about it.

This is as good a time as any to remind you all that I spotted Philip Seymour Hoffman at a yankers game, timed my exit exactly with his, shook his hand and said 'I loved you in Happiness.' **WRITER'S EMBELLISHMENT**Then I said 'Don't you have anything better to do than root for this disgusting franchise? Get back to the studio and make Oscar your b#$&^.' He has since renounced the yankers and become an Academy favorite....

Record Time

The Bianchi express got me and O to school in about 4 minutes this morning. There's a bike lane on 22nd street so we could cruise w/o worrying about the extra side-to-side wobble caused by the trailer bike. The other safety feature is that the traffic on 22nd moves slowly or not at all; those poor SOBs are in line for the expressway so they can sit some more. He was loving it and I think pedaling a lot too.

So close....

Team "Britney Spears' Life Coach" came in with low expectations but finished TIED FOR SECOND last night at Fergie's Quiz-O. A ridiculously hard tie-breaker round left us with the bronze as some pack of geeks who named themselves after the server (cute but she still won't go out with you guys) were given credit for 'meat' as an answer to what an omophage eats. Props go out to Shaw "Shaco" Natan who came out of retirement to draw from his ecclectic and occasionally accurate knowledge base in some key spots.

Congress gets serious...

If you can't wait for the end of the day to hear about the MLB-Congressional hearings, Jayson Stark of espn.com has a well-informed blog going. He makes a nice point that it's a great time for posturing since "This is one of those rare issues with only one side. And Congress, shockingly, is all over that side."

http://sports.espn.go.com/espn/blog/index?entryID=3197192&name=congressional_hearings

Quick question for coffee lovers...

If this thing

ate some cherries and excreted the seeds per rectum, would you brew coffee with them?

OK, if you wouldn't do it yourself, would you pay $200/lb for the grounds if someone else did it?

http://www.baltimoresun.com/news/local/baltimore_city/bal-md.coffee14jan14,0,1896251.story

I guess as a non-lover of coffee, I may be missing the appeal.

Coca's Nuts

Go to Steve's blog for more weighty issues of geo political importance such as jobs-outsourcing, global warming and monkey sex.
www.cocanuts.blogspot.com

Visit mine for unicorns, pictures of Owen, baseball and monkey sex.

Deal imminent?

Brian Roberts to the Cubs for young pitching appears to be just around the corner. I hope Andy McPhail knows what he's doing...

The franchise is at an all-time low so trading a fan favorite could either be seen as the final death knell or perhaps perfect timing since things can't get much worse. I suppose I see the logic of trading Roberts as part of a rebuilding effort; Bedard not so much since he'll be 29 in March and true No. 1 starters are such a rarity.

Owen's in a gang....

Yes, the boy with the dollhouse is confirmed to be a member of the 'Wildcats', a group of kindergartners loosely affiliated by their interest in playing football/soccer during lunch but today threatened (as a group?) to punch one of the boys they didn't want to be a Wildcat.

Owen got a good talking-to by Mom about choices he's making and the uncool act of excluding/threatening people...(apparently, O was not leading the pack according to his teacher, but still)

Dad is quietly thrilled that O plays some kind of sport during lunch but will also send the 'everybody plays' message tomorrow.

Opioids in the ER, cont'd...

The study is by Mark Pletcher and Stefan Kertesz (among others), two stalwarts in the Gen Med/Addiction world, so it is no surprise that the multivariable analysis appropriately controlled for insurance status. Sure enough, race was independently associated with receiving opioids over the entire time period of the analysis (1993-2005) even in light of an overall increase in the proportion of encounters during which opioids were prescribed regardless of race.

So, the bottom line is, blacks are less likely to get opioids for pain in the ED even when controlling for level of pain, insurance status, gender, and pain diagnosis, among other things.

The authors delicately discuss possible explanations, listing prejudice near the top but also alluding to systemic and latent factors that are exhaustively discussed in the ever-burgeoning disparities literature.

Rocket's 'science' is not brain surgery

I have to admit, I watched Clemens on 60 minutes last night. A few reflections:

Mike Wallace is 90 years old (in May)! Unbelievable.

The 'I'd have a third arm growing out of my head or be pulling tractors with my teeth' (if I had taken all those injections) line almost made me piss my pants. The best part is that you know he rehearsed it.

I still think he's lying for all the reasons everyone else does : primarily, what's McNamee's motivation to implicate Clemens? (the defamation of character lawsuit filed by Clemens today says McNamee was offered immunity if he would implicate Clemens -- somehow MLB wanted one of its all-time greats to be brought down, along w/ the sport itself?!?!)
Also, imagine you were on national TV to defend yourself against a claim you knew in your heart of hearts was untrue. You would take Mike Wallace's hands and say 'on my mother's grave...' or you might be bemused b/c you know your innocence would be easy to prove or you might even be threatening McNamee's life or at least one heck of a lawsuit. You would NOT be squirming and talking about third arms growing out of your head.

These congressional hearings should be interesting...

Opioids in the ER

http://www.msnbc.msn.com/id/22463720/

OK, it's a lay press summary of the article but you still get the idea....

Can't wait to read the real thing to see what this disparity is ascribed to. Of course latent and not-so-latent provider prejudices about who is 'drug-seeking' play a role. But we can't ignore the fact that (probably) a disproportionate percentage of miniorities use the ER as primary care --since a disproportionate percentage lacks insurance -- and therefore perhaps more are drug-seeking. The insured whites can make an appointment and be catered to. The uninsured wait in an ER.

New Year's lethargy...

Owen stayed up til 12:10 last night AFTER his four-day trip to Omaha during which he stayed up late with Gabriel two nights in a row. He got up at 10 today but went back down for a nap at 2:30.