Just a quick rundown.
Praxis #4, a surprisingly interesting carnival about academic life, is up at Martin’s place.
Grand Rounds is up at Distractible Mind
Tangled Bank is up at Ames’s place.
And Skeptics’ Circle No. 100 is coming soon to Orac’s place! Stay tuned!
On the weekends, my four-year old daughter comes to work with me. There isn’t much for her to do. She certainly isn’t allowed in patient rooms. She doesn’t help me make medical decisions. But we spend twenty minutes each way in the car laughing. We walk around the hospital, everyone greeting her, everyone her friend. One time, when she was actually admitted to the hospital, she wasn’t scared at all because, “all my friends are there.”
Friday night, we went to services. My mother-in-law was singing, and she asked us to come. Normally, I’m not one for formal religious observances—it’s just not my thing. So rather than contemplating the nature of the universe, I watched my family. My daughter ran around saying “hi” to all of her friends (that’s everyone), cuddled her grandfather, sat on her pre-school teacher’s lap, played with her cousin. It was about family.
When she is having one of her tantrums, and my wife can’t possibly take another minute of it, we trade places. When it’s all over, we all climb in bed together and cuddle and laugh. It’s family.
I was watching Dan Savage and and some Family Research Council talking head on Anderson Cooper the other night. The were talking about the Prop 8 debacle in California, and it finally hit me for the first time—the “family values” groups have no idea what family is, not even a clue.
If you read their websites, James Dobson and others are always talking about things like “Three Lies About Sex Before Marriage”, “Pornography”, and “The Gay Revisionist Agenda”.
Last week’s New England Journal of Medicine gave us some remarkable news, via the JUPITER Trial, adding additional evidence to the pile of articles on the cardioprotective effects of statins. This article is getting lots of press, which is great, but I’d hate to see this week’s edition of the Journal get lost. Specifically, there’s a huge population-based study on obesity and mortality. We’ve explored previously the dangers of obesity, and we’ve been fought the whole way by various denialists.
Earlier studies have shown associations between excess body weight (as measured by body mass index (BMI)) and death, but this study did a few things differently. The latest study in the Journal, titled “General and Abdominal Adiposity and Risk of Death in Europe”, takes a look at a larger data set, and takes a closer look at different measures of obesity.
NB: Believe it or not, I actually had to close comments, the first time I’ve ever had to do it. They had become so offensive without any useful content that it’s no longer worthwhile to keep it going. Sorry.
I have repeatedly vowed to stay away from this topic, but in defense of my colleague, I must speak out. Harriet Hall, from sciencebasedmedicine.com wrote a brief piece examining the medical literature regarding male circumcision. As part of the discussion, she mentioned having performed many of these procedures during an earlier part of her career. In response to her interesting post, she received comments such as this one:
Dr. Hall needs to confess her guilt for the intentional injury of scores of infant males and reexamine her motives in writing this document.
We’ve talked quite a bit about ethics in this space, especially medical ethics and “blog ethics”. Today, though, we will specifically examine the nature of medical ethics as they apply to so-called alternative medicine.
First, and perhaps most important, I am not an ethicist. I do not have the depth of reading, the knowledge of terminology, or the specific education to lead a formal discussion on ethics. What I am is a practicing internist, who must make ethical decisions on a daily basis. Most of these decisions are of necessity made “from the heart”, but it is not infrequent that I must evaluate a situation more formally and fall back on some of the ethical principles of my profession.
Ethics are not static. They are not a divine gift bestowed on each of us as we don our white coats. They are a living part of our specific cultures, and of the profession we serve. Some of the modern principles of medical ethics are newer than others. Beneficence, non-maleficence, and confidentiality are ancient principles of medical ethics, which continue to be relevant today. Patient autonomy is a more recent value, reflecting a shift in how society views the relationship between patient and physician. These ethics must be mutable, as the profession itself is ever-changing. Despite this fluidity, there is an identifiable line of “doctor-hood” that has existed for at least the last century, and the members of this guild have always tried to adhere to some type of code of behavior.
Alternative medicine poses real challenges to the principle of medical ethics. First, we’ll discuss who, in fact, is bound by these principles, then the way in which alternative medicine is or is not compatible with medical ethics.
I have a love-hate relationship with credit and charge cards. They’re incredibly convenient, but my few puritan instincts tell me that they’re the spawn of satan.
And the fees! The fees! No, not the ones for paying your bill late, or for paying your bill on time over the phone, balance transfer fees, application fees, balance transfer fees, overlimit fees, or even annual fees. (Did you know that banks make more money from fees now than from investments?) I’m talking about the fees that the card networks charge to merchants. Jane Birnbaum explains in Thursday’s Times:
A typical merchant card payment has two parts: an “interchange fee,” which includes an average 1.7 percent of the sale price and a flat per-transaction fee, and a separate fee that goes to the merchant’s bank. Take, for example, a driver who pays for a $1,000 car repair with a credit card. The bank that issued the consumer’s card receives an interchange fee of $17.10 (including a 10-cent flat fee), while the repair shop’s bank gets $4, or four-tenths of 1 percent of the total sale. The repair shop pockets $978.90.
On a large, $1,000 sale, one could just consider this a cost of doing business. Who is going to walk around with $1,000 in cash in their pocket anyway? Checks are dowdy and raise unmanageable fraud risks (a subject for another post). So, the card is most excellent in that situation.
On small transactions, these fees can have a large impact; they cause merchants to lose money on a sale. Because credit cards are used more than cash now in the US, the fees add up to an enormous tax on consumers. Birnbaum continues:
In 2007, merchants paid $61.56 billion in electronic payment fees, up from $48.58 billion in 2005, according to the Nilson Report, a payment systems industry newsletter…
Obviously, this is passed onto the consumer. But instead of passing it onto just the plastics, merchants spread the costs among all customers, even those who use cash or checks. This is because under the guise of consumer protection, California and other states have laws that prohibit businesses from charging customers more when they use plastic (however, merchants can advertise “cash discounts”). Agreements between credit card networks and merchants prohibit policies setting a minimum amount for credit transactions.
Straight outta Locash!
So, next time you’re in line at the 7-11 behind the 18 year old using plastic for a $2.32 purchase, remember that you are paying for it with both your wasted time and money!
I am enjoying the news post election, because what was once news media “liberal bias” about Sarah Palin is now simply common sense.
Even more fun is the frank conversation about the conservative movement. Today’s Journal has a must read by Mark Lilla on how the very conservatives who valued intellectualism and elites were corrupted by “populist chic.” Lilla recalls Jane Mayer’s recent article on Palin, noting how conservative intellectuals chose Palin as a candidate that was appealing to the masses. But in so doing, conservative intellectuals mirrored their liberal rivals. Lilla explains:
Back in the ’70s, conservative intellectuals loved to talk about “radical chic,” the well-known tendency of educated, often wealthy liberals to project their political fantasies onto brutal revolutionaries and street thugs, and romanticize their “struggles.” But “populist chic” is just the inversion of “radical chic,” and is no less absurd, comical or ominous. Traditional conservatives were always suspicious of populism, and they were right to be. They saw elites as a fact of political life, even of democratic life. What matters in democracy is that those elites acquire their positions through talent and experience, and that they be educated to serve the public good. But it also matters that they own up to their elite status and defend the need for elites. They must be friends of democracy while protecting it, and themselves, from the leveling and vulgarization all democracy tends toward.
He concludes:
…As for political judgment, the promotion of Sarah Palin as a possible world leader speaks for itself. The Republican Party and the political right will survive, but the conservative intellectual tradition is already dead. And all of us, even liberals like myself, are poorer for it.