Blog, MD

Musings of a pediatric hematologist-oncologist.

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My Daughter Endorses a Candidate for President!

September 21st, 2008 · 48 Comments

Popularity: 69% [?]

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Google Triplet Redux

April 9th, 2008 · 21 Comments

The damndest thing happened to me last week … somewhere I heard a repeat of an NPR story about Google Twins - people who share your name but who you have nothing else in common with.  It reminded me of a piece that I wrote on this blog a while back about being a “Google Triplet” and how I’ve enjoyed “bumping into” the other Sam Blackman’s out there on the ‘net.

You can imagine, then, my utter surprise when a reporter from the New York Times dropped me an e-mail and asked to interview me for a story on this very subject.  She apparently came across my blog entry.

The story runs tomorrow in the National News section.  I should send the other Sam Blackman’s a note …

Popularity: 75% [?]

→ 21 CommentsTags: Internet · Media

‘Tis the season!

December 17th, 2007 · 25 Comments

It’s a late night in the Blog, MD household. Mrs. Blog, MD (or Ms. Blog, CRNA to be specific) is laid up with either a really nasty cold, the flu (despite an influenza vaccination), or some other horrible respiratory pathogen. Between her coughs, I caught myself wondering where we stood in terms of our favorite respiratory viruses this year. Plus, this year’s ‘killer RSV’ story has finally popped up (on CNN.com, of course), so I suppose it’s time to check.

Where does one turn for the latest in respiratory and enteric pathogen tracking, you might ask?

Well, the best place to go is the CDC NREVSS, of course. That’s the CDC National Respiratory and Enteric Virus Surveillance System, in case you weren’t hip to the acronym. It turns out that the CDC collects surveillance data from collaborating university and community hospital laboratories, selected state and county public health laboratories, and commercial laboratories all across the country.  They track all of the pediatrician’s best friends:

  • respiratory syncytial virus (RSV)
  • human parainfluenza viruses (HPIV)
  • respiratory and enteric adenoviruses
  • rotavirus
  • rhinovirus
  • enterovirus
  • human metapneumovirus

The latter, human metapneumovirus, is a favorite of mine.  It’s a recently identified Paramyxovirus that was first isolated from hospitalized kids with non-RSV acute respiratory tract infections.  It turns out that at the time of its discovery (2001), the only virus remotely similar was an avian pneumovirus.  The symptoms of human metapneumovirus are similar to RSV: ranging from upper respiratory tract disease, to severe bronchiolitis, to pneumonia.  A Dutch group, in their initial description of this virus, also provided proof that this was not an emerging infection, rather one that appears to be fairly ubiquitous, with serologic evidence of its existance dating back for at least 50 years.  It’s likely that metapneumovirus could be the cause of many of those wonderful non-RSV bronciolotis cases that I spent the better part of my residency admitting in the middle of the night. 

In any case, NREVSS tracks hMPV as well as all of the other bad actors by collecting data from various reporting sites, and then posting 3-week running averages, by state, region and for national averages.  As you can see for yourself, nationally, we’re on our way to RSV season:

We’re also starting to see a good number of bona fide influenza cases (courtsey of CDC’s wonderfully-named FluView):

So, perhaps Mrs. Blog,MD does have the flu after all. Even though she got her shot, we know that the flu vaccine is only 70-90% effective against laboratory confirmed influenza (courtesy of the CDCs wonderful FAQ on influenza immunization). For influenza-like infections (ILIs), the vaccine is only minimally effective.

Take home message: wash your hands, get your flu shots (or FluMist), know your disease trends, and hope for the best this season!

Popularity: 78% [?]

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‘Tis the season?

December 16th, 2007 · 46 Comments

Very interesting article in American Medical News (Nov. 26, 2007) on the recent introduction of a health care gift card.  It’s no secret that gift cards are a wonderful way for retailers to siphon more money from consumers using a variety of methods.  First and foremost, is the fact that only about 90% of gift cards are actually redeemed.  Considering that gift cards are an $80 billon-a-year industry, we’re talking about $8 billion given to retailers without any merchandise being delivered.  Quite a gift.

Second, a variety of less scrupulous gift card vendors assess various fees, especially cards issued by malls and credit card companies.  They’re basically charging a fee to spend money.  Third, once people enter stores to redeem the gift cards, they’re prey to the expert marketing efforts at work, meaning that often times they spend more than the value of the gift card.  Finally, some gift cards expire, meaning that the retail establishments get to keep the money free and clear.

One would ask, then, why not just give/use cash?  Frankly, I don’t have a good answer for this particular question.  It certainly seems easier.  I remember the days when I’d get a Hanukkah card from my grandmother with $25 in it and consider it a king’s sum.  I could only spend up to $25 and I could spend it in increments, all at once, or not at all, without fear of it losing any significant value.  No muss, no fuss.  Of course today I’d ask my grandmother for Euros, but that’s another story.

So what possible role could gift cards play in the current health care system?  The company advancing this idea is Highmark - a health care conglomerate that includes a Blue Cross/Blue Shield carrier, a dental insurance company, a provider of managed care vision benefits, an eyeglass frame designer (fancy that!), and a processor of Medicare claims, amongst other businesses.  According to the AMNews article, Highmark believes that these healthcare gift cards can be used for everyday health expenses.  Naturally there’s a fee ($4.95) for the privilege of loading the card, and it can be used for things as small as co-pays to things as large as medical equipment or gym memberships.  Naturally, Visa has a hand in it as well, meaning that there are additional fees.  In this case, a $1.50-per-month fee if the card isn’t used for more than nine months. 

Clearly it’s a gimmick, and one that will surely enhance the bottom line of two large companies by sucking additional health care dollars out of the pockets of consumers.  Heaven forbid those dollars should actually go to the physicians and nurses who make a living out of delivering medical care, right?  After all, Visa and Highmark executives need to be paid for their innovation and leadership.  Besides, the $3.2 million that Kenneth R. Melani, Highmark’s president and CEO makes hasn’t put him into the billionaire range, and that’s clearly not acceptable.

Jennifer Offenberg, PhD, an assistant professor of economics at Loyola Marymount University in LA says, it best: “It’s a little mysterious why they [the patients] would bay $105 for $100.  I don’t understand it.”

Neither do I. 

Popularity: 82% [?]

→ 46 CommentsTags: Rant

Not dead yet.

December 15th, 2007 · 16 Comments

So … how’ve you been?I’ve been doing well, thanks.  It’s been a long time.  Some people have written me (or my blog) off for dead.   I suppose that’s fair.  It has been a while since I’ve written anything here, plus there have been a couple of false starts.It turns out that I have, in fact, been happily blogging way for the past several months, but on an entirely different project.  I’m not sure yet if I’m going to link that project to this page or not.  I’ll probably think about it over the next few weeks.  If I end up getting back into the groove with Blog, MD, then maybe I’ll link the other project here and see what people think.I’m also not going to make any grand announcement of a return.  I was never a top tier medblogger, and so I doubt that many people noticed my going dark for the past 6 months or so.  Plus, I don’t want to set an expectation for something that I might not keep up with.  So, we’ll see how things go over the next few weeks and if I really get up and going, then I’ll try to get back into the mix vis a vis grand rounds submissions, asking to be linked to blogrolls, etc. 

Popularity: 78% [?]

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Ride For Them 2007 !!

July 12th, 2007 · 17 Comments

Hi all,

Despite the “I’m Back” post from a couple of months ago, I seem to have fallen off of the blogwagon pretty hard. It’s certainly not for lack of material. Rather, it’s for lack of time. I’ve been working hard in the lab, working hard in the clinic, and more recently, working hard on the bike.

Once again, I’ll be riding in the Pan-Massachusetts Challenge, a 192-mile ride from Sturbridge, MA to Provincetown, MA. All of the money raised by the Pan-Mass Challenge goes to support the Dana-Farber Cancer Institute. I’m very luck in that all of the money that I raise is held in a specific account that my teammates and I can use to directly fund programs to support pediatric oncology patients and their families. Last year I raised over $80,000 and our team raised a total of $135,000. This year we’ve expanded the team and hope to break $150,000.

So for now, I’ll be blogging very sporadically and cycling more regularly. If you could please visit my PMC website, www.rideforthem.com, I’d appreciate it. There you can read the stories of the children that I ride in honor and in memory of. If you are interested in making a gift to this important effort, please click here. Finally, if you have a blog or other website, would you consider posting a little blurb about my effort, and perhaps a link to the Ride For Them website ? I think it would be absolutely terrific if the physician- and nurse-blogging community could help me make a concerted effort this year to spread the word! I appreciate the kind words and the link provided by Kim over at Emergiblog.

Thanks for considering this! I’ll leave you today with a local cable news piece supporting my ride last year. If you go to the Ride For Them website I have a few other interesting videos regarding my ride and the PMC.

Popularity: 86% [?]

→ 17 CommentsTags: Medicine

I’m back.

May 6th, 2007 · 117 Comments


As one can tell from scrolling through the sparse entries over the past 6 weeks, I’ve been laying low. It’s actually been a nice little holiday - I find that a break every now and again helps gets the creative juices flowing again. Plus I’ve been working on a couple of other projects, one that I hope to reveal in the next 3-6 months.

Given that it is relatively late, and that I’ve had something of the emotional day, I’m going to keep this entry short. Before long, I’m sure that I’ll get back into the swing of things. There are grand rounds to write for and to host. Flea did me the favor of tagging me with the ‘Why Do You Blog?‘ meme (which I’m hoping to respond to). And the lovely Dr. Signout tagged me with the ‘Thinking Blog‘ meme.

And since blog memes are always a cheap and easy way to fill blog space, I think that I’ll start one percolating around and see how far it goes. I’m calling it the “$456 billion meme” (which should be pretty easy to track in Technorati).

This meme is inspired by something from my hometown paper, the Boston Globe. They posted a pictorial feature called, “What does $456 billion buy?“:

While there is some disagreement on the idea of troop deadlines for US soldiers in Iraq, all sides seem to be on board with the amount included in the bill to fund the war.

Including the $124.2 billion bill, the total cost of the Iraq war may reach $456 billion in September, according to the National Priorities Project, an organization that tracks public spending.

The amount got us wondering: What would $456 billion buy?

The Globe did a great job of listing some of the obvious places where this money could go: education, environment, global poverty. They also really (in my opinion) stepped in it with this one:

US drivers consume approximately 384.7 million gallons of gasoline a day. Retail prices averaged $2.64 a gallon in 2006. Breaking it down, $456 billion could buy gasoline for everybody in the United States, for about 449 days.

Please. Could that be any more infuriating? And appalling?

Here’s my suggestion: $456 billion could probably buy a cure for cancer. Given that we fund the National Cancer Institute to the tune of about $4.8 billion, and the entire NIH for about $28.85 billion, we could fund the work of the NCI about 100 times over for the money we’ve pissed away in/on Iraq. And the 3376 American soliders killed? We could send all of them to college and graduate school and staff 10 or 20 brand new cancer centers. And pay for the laboratories.

So this is the meme: where would you have spent the $456 billion spent on this miltary action? I hereby tag Flea, Signout, Clark, GruntDoc and Dr. Rob. For those not tagged who have an suggestion, feel free to comment here. Or at the Globe’s website. Or both!

Popularity: 100% [?]

→ 117 CommentsTags: Government · Medicine · Oncology · Politics · Rant

Grab your tissues. This is what Pulitzer Prizes are for.

April 18th, 2007 · 41 Comments

It’s coming up on 3 years for me as a pediatric oncology fellow. As I’ve discussed earlier in this blog, it take an increasing amount to generate an overt emotional response. I’ve come to the conclusion that this is due to the fact that my emotional range has been severely re-calibrated as a result of my experiences.

Therefore, it is a testament to the power and beauty of the photographs that earned Renee Byer, of The Sacramento Bee the 2007 Pulitzer Prize for Feature reporting that tears welled up in my eyes as I scrolled through the twenty photographs documenting Derek Maden, and his mother Cyndie French, during his 11-month battle against neuroblastoma. I’m certain that you will find these photographs as compelling and heartbreaking as I did. Their honesty and intimacy blew me away. They are by far the most accurate a portrayal of childhood cancer as I have seen in the lay press, and triggered flashbacks of the children that I’ve seen whither away as a result of their disease.

I hope that these photos will motivate you to consider joining the fight against childhood cancer - either by writing your federal representatives to argue for more support for cancer research - or more directly, by making a donation to my 2007 Pan-Mass Challenge effort. A good part of the money that I raise goes directly to helping support children and families during their cancer treatment.

A small donation, no matter what the amount, will help. Please visit my website - Ride For Them - read the stories of the children that I take care of, and consider helping me in this important effort.

Thanks.

[NB: Thanks to Mark Hemingway at MetaFilter for bringing this to my attention.]

Popularity: 100% [?]

→ 41 CommentsTags: Cancer · Fundraising · Oncology · Pediatrics

A worthy cause …

April 17th, 2007 · 11 Comments

I’ve been a huge fan of Internet radio ever since the first edition of iTunes was installed on my Mac. I’ve written before about WOXY.com. WOXY is a remarkable station that orignally was based in Oxford, OH as a terrestrial station, then lost its license, was resurrected as an Internet-only station, ran out of money, and was resurrected again after being funded by lala.com.

Despite these miraculous saves, WOXY, along with the majority of other Internet radio stations, are endangered by the never-ending greed of the RIAA and the record industry. A recent ruling by the Copyright Royalty Board will increase webcaster royalty rates between 300 and 1200 percent over the next 5 years. Before long, Internet radio will be the same worthless dreck that is broadcast over the airwaves.

SaveNetRadio is a coalition of artists, labels, listeners, and webcasters. They’ve organized a petition drive, and I’m hoping that you’ll sign on. All you need to do is click below and you can e-mail your federal representatives. Please take a minute to consider helping out with this worthy cause.

SaveNetRadio.org

Popularity: 93% [?]

→ 11 CommentsTags: Government · Music

Coup - Contrecoup

April 15th, 2007 · 10 Comments

Being from New Jersey, my ears perked up when I heard the news about Gov. John Corzine’s motor vehicle collision. On Thursday night, when the collision was first reported, the news indicated that he wasn’t serious injured. As events unfolded, it became clear that John Corzine was critically injured as a result of this automobile collision. Buried in the middle of the NY Times story on 4/13 was this line:

“Mr. Fuentes said he was unsure whether Mr. Corzine was wearing a seatbelt; he often does not.”

I couldn’t believe my eyes. The governor. In a state trooper driven vehicle. Not only not wearing his seat belt, but having a reputation for not wearing a seat belt. According to his chief of staff, despite the fact that NJ state law requires all front-seat occupants to wear seat belts, Corzine was “not always amenable to suggestion”. So much for the law applying equally to all.

As soon as I read it, I was certain that there would be a number of stories, editorials, and blog posts on this point, and sure enough, there have been quite a few over the past few days, including calls for him to be ticketed.

Frankly, I’m surprised that nobody brought up the question of whether or not Corzine’s health insurance is covered by New Jersey taxpayers, and if so, the costs incurred by his poor judgement. While I feel bad for him and his family in that he was injured, I don’t feel that he deserves to escape the scrutiny that would apply to others whose poor judgement leads to catastrophic illnesses whose costs are borne by the rest of us. This includes those who motorcycle or bicycle without a helmet, drive drunk, or those who drive recklessly (which includes driving without a seatbelt). Motor vehicle associated trauma costs approximately $90 billion per year, and makes up 22% of traumatic injuries per year in the US.

Once upon a time, I did a rotation on the Trauma Surgery service at Cook County Hospital where I had a chance to work with Dr. John Barrett, one of the giant’s in the field. It was one of the most incredible months of my education, and one that I’ll cherish for years to come. My first week, I admitted a patient injured in a motor vehicle collsion (MVC). One rounds, I stated that the patient had been injured in a “car accident” and was immediately set upon by the residents, fellows and attendings. Barrett clearly stated, and everyone chimed in in unison, “There are no accidents.” Injuries received in an auto collision are the result of a series of events. In many of these cases, the events are preventable. Governor Corzine is an unfortunate, illustrative case.

[NB: Coup-contrecoup refers to a mechanism of close head injury in which the head impacts a stationary object and the brain continues forward strinking the inner skull, then rebouds to cause damage to the opposite side of the brain.]

Popularity: 92% [?]

→ 10 CommentsTags: Medicine

Wherefore art thou, spring?

April 7th, 2007 · 8 Comments

The grey weather is starting to get on my nerves a little. Half of the Arnold Arboretum - the jewel of Jamaica Plain - is populated by leafless trees that look no different to me than they did in December. The other half (near Hemlock Hill), while green, is only so because of the high concentration of Asian evergreens.

Nonetheless, Mrs. Blog, MD and I ventured out for a stroll hoping for small signs of spring. We saw a few trees with buds and a couple of Salix gracilistyla that were starting to bloom. There were a smattering of Narcissus and some wildflowers poking up through the grass, but for the most part, nada.

It was still a nice walk:

Julie walking down the path

I did come across a rather remarkable co-incidence. There was a twisted, gnarled treee that I spotted, and from the angle I was walking, it looked to me like a very tortured, anguished beast with two arms sticking up high:

Tortuosa

When I got up close, I was pleased to see the name of this tree:

Fagus sylvatica

How appropriate.

Popularity: 81% [?]

→ 8 CommentsTags: Boston · Photos

Did they recognize the subtext?

April 3rd, 2007 · 3 Comments

From the New York Times (4/3/2007) article on Atul Gawande, MD. Dr. Gawande does mostly thyroid surgeries, and so it is pretty funny (to me) that while waiting for biopsy results he’s playing a game of hangman (you know, where the rope goes around the neck and if you lose your man dies) on the patient’s drapes with a skin marker.

Popularity: 79% [?]

→ 3 CommentsTags: Humor · Medicine

Once bitten …

March 30th, 2007 · 13 Comments

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One blog good. Two blog better.

March 21st, 2007 · 13 Comments

Clearly I need to be spending more time in the lab. Or at least less time in front of the trusty MacBook Pro. After purusing the contents of my “Stuff for the Blog” folder on my desktop, the sheaf of torn-out journal articles that sits on my desk, and the enormous list of bookmarks, it’s clear that I need a high-throughput blog.

Inspired by a recent course that I took from the legendary Edward Tufte, I have launched a second blog that I’ve named Oculata Certitudine. It refers to a phrase from a text by Galileo (Tufte has a copy of the original text) that translates as Visible Certainty. Oculata will be in an entirely different format that this blog. It will be composed entirely of figures, tables, charts and illustrations relative to science and medicine. There may be a brief comment or two from me. Maybe a link or two of interest. The purpose is to provide snapshots and hope that every now and again it will stimulate a discussion.

It’s a different concept and it may not work, but it’s worth a try. I’m monkeying around with the format, but for now I managed to get a half-dozen entries up. If you have a minute to check it out (oculata.com), I’d enjoy hearing your thoughts.

Popularity: 77% [?]

→ 13 CommentsTags: Blogging

I’m a Google triplet

March 21st, 2007 · 16 Comments

It dawned on me recently that I’ve had access to the internet for nearly 20 years.

20 years.

In 1987, not long after starting college at the University of Chicago, I began to explore the Unix systems and quickly learned that there was an enormous interconnected world of information to be tapped into. I quickly discovered Usenet and Gopher and before long was using the internet to meet new people of similar academic interests. IRC made the world even smaller. I have one terrific story of how I, while asking for some travel advice for Portugal, I met a guy who was an English translator for a Portugese television news program. This guy and his girlfriend served as the most wonderful tour guides around Lisbon and Sintra for three days. By the time the world saw the advent of Mosaic and other browsers, in 1993, I was ready to have a T1-line plugged into my brain.

Some number of years ago, I realized that I had a “Google Twin”. Yes, another Sam Blackman, who happened to be relatively close in age. Sam 2.0* attended Brown University, and was apparently active in student government and a number of other extracurricular activities. While it made no difference to me at the time, Sam 2.0 was smart enough to buy up the samblackman.com domain. By the time I got around to buying my own web domains last year, it actually made a difference in two ways. First, I noticed that Sam 2.0 had gotten married and had dog. Second, it meant that I had to be a .org and not a .com.

I suppose this is OK. I think that I’m happier being an organizational rather than a commercial domain. In retrospect I should’ve become an educational (or, more correctly, educated) domain.

Recently I discovered that there is a Sam 3.0, who has acquired samuelblackman.com. Amusingly, Sam 3.0’s web page indicates that he’s also a cyclist and his picture in a BMX bike helmet illustrates the point nicely.

When I came across this article from the Houston Chronicle, discussing “Google Twins”, I figured it was now OK to admit my heretofore undiscussed discovery of Sam 2.0 and Sam 3.0.

*There is no particular reason why Sam 2.0 is Sam 2.0 and not Sam 1.0. The reason I assigned the version numbers with me being 1.0 is because, well, I’m clearly older, and like most 1.0 versions, probably a lot buggier.

Nota bene: Other “Google twin” musings can be found here, here, and here.

Popularity: 79% [?]

→ 16 CommentsTags: Internet · Weirdness