My old boss gave me the ultimate in compliments last year. And I quote, “Graham, you’d make a good argument for human cloning.” Nothing has really come close, until I found Vivian’s note about me on her blog:

bq. 23 year old graham blogs about med school. my question for you: would you marry him? like, right now. would you? like i would marry jon stewart and ed helmes right now if either asked me (i put in some serious thought just then when i was thinking of who i’d marry). and you should know that i take questions seriously, my mec interviews take forever because i think hard.

I’m seriously flattered. But I’m sorry, long-distance just won’t work for me. What a tangled web we weave.

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Hmmm. I just don’t feel like the ad goes with the page topic. Maybe it’s just me.

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They’re such tiny little creatures. Innocent. Unaware. Confused. Scared. Absolutely helpless.

Billy was born this morning–and due today. Less than 12 hours ago. I’m probably the 10th, maybe 15th person his little eyes have seen. And as our preceptor explained the physical exam to us, he was both completely human and completely foreign at the same time. The body, the face, the hair. The eyes. The fingers and toes and the belly. All human. I’m watching her push down into his tiny little abdomen to feel for masses, and I’m picturing how tiny and fragile and *new* everything must be inside. Comparing it to my old, wrinkled, fat cadaver. Comparing it to myself. She’s pushing down harder than I expect, and I begin to worry that she’s hurting him. This new little person who wasn’t here yesterday. Who’s got this insanely unique life ahead, who has a name, and a family, and a whole world around him. He didn’t know it was there, and we didn’t know he was here, either.

But he’s so mechanical, it’s almost as if he’s still without a personality. Like his body’s on autopilot. Input: cold. Output: cry! Input: touch on palm. Output: close palm! Input: hear another baby crying. Output: cry!

I can only begin to imagine what the actual maternal instinct must feel like after spending 15 minutes with a newborn. In Mexico, giving birth is dar la luz –to give light. I couldn’t find a more fitting term if I tried.

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Trans fats are very bad . McDonald’s still uses trans fats for their fries. Do your part, send a message to McDonald’s telling them them keep their promise from last year to switch to a trans-fat free cooking oil. And now, your local news , Bob.

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An old post from a previous incarnation. A quick primer on cholesterol and trans fats.

You know those “Comments” hotlines on food packages where you can tell the manufacturers what you think? Well, I called one today.

Ever since this Metafilter thread , where dejah420 educated me about the dangers of trans fats, I’ve been on another of my personal health rampages against them. (I do this about once or twice a year, cutting something nasty from my diet. A year and a half ago, it was fast food and beef, a year ago, it was my sugar binges… I’m back to eating sugar, but still off the beef.) But I digress. These trans fats are bad news, but they’re about as omnipresent in our foods as a god is supposed to be in the world. You’d be amazed where you find this stuff–cereals, bagels–even Rice-a-Roni packages.

So, I called up the fine people at Rice-A-Roni , and told them, “I’m sorry, but I can’t eat your food anymore. It has trans fats in it.” The guy on the end of the line gave some pre-written speech about the FDA not making any specific comments on trans fats (even though the Institute of Medicine’s report recommends consumption “be as low as possible.”)

I’m happy to say that the FDA is expected to force food producers to list the amount of trans fats in their products, just like saturated fats are listed today. So the guy suing to take Oreos off the shelves succeeded (even after acknowledging the lawsuit was frivolous). A victory for the little guy.

(For the time being, anything “hydrogenated” or “partially hydrogenated” most likely contains trans fats.)

And if you’re curious what the problem is, here’s some background:

You’ve got several types of cholesterol-carrying molecules in your body: the main ones are HDL cholesterol (high-density lipoprotein) and LDL cholesterol (low-density lipoprotein). HDL is “good cholesterol.” It’s a molecule that absorbs excess cholesterol from the blood, takes it to the liver, where the liver removes it from your bloodstream. LDL is “bad cholesterol.” It can build up on arterial walls (it’s then called “plaque”) and shrink the passageway for blood. This is a major cause of heart attacks, strokes, TIAs, leg clots, etc.

H DL (you want it H igh) and L DL (you want it L ow)

By fat-type:

• Unsaturated fats: that’s things like fatty fish and oils, like olive oil, INCREASE your HDL (this is good) and DECREASE your LDL (this is good)
• Saturated fats: animal fats (fatty meats besides fish), butter, and tropical oils, INCREASE your HDL (this is good) but INCREASE your LDL (this is bad)
• Trans fats: think Crisco, as well as partially and fully hydrogenated plant oils, DECREASE your HDL (this is bad) and INCREASE your LDL (this is bad).

  Get it? Got it? Good.

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I’ve been spending 2 evenings a week at the Ravenswood Family Health Center, a community clinic in East Palo Alto, developing a patient assistance program (PAP) for them. It’s a slow process, introducing a new program to an already-running institution; difficult to get buy-in from the providers and staff, difficult to figure out the logistics, and difficult to manage all the paperwork. But I absolutely love it there. The staff are incredibly friendly and fun, as well as the providers–you really get such an amazing sense of the team effort that they’re creating to help each other out. And they’re not just doing it because it’s their job; they’re doing it because they enjoy it. It’s an outstanding clinic. They do education in the community, homeless outreach, and benefits analysis to help people get some–or any–health insurance.

I’ve gotten to know several of the providers and staff fairly well–Janet and Juan, who tease each other mercilessly (I think mostly because they know I get a kick out of it). Janet manages the front desk and manages the clinic software, and Juan manages the adult medicine clinic. I was speaking with a third-year medical student there, who told me that Juan is actually a doctor–a gastroenterologist–from Honduras. I couldn’t believe it. He takes blood pressures and does basic patient intake here, but he was a licensed physician in Honduras.

I’m almost ashamed to say it, but my respect for Juan increased dramatically after I found that out. Granted, I probably feel like I can relate to him (and him to me) better now that I know he’s gone through medical training, but there was more to it. As if Juan’s position as a clinic manager wasn’t worthy of as much respect. As if he suddenly became a more important person to me. It really bothers me. Not that I was ever looking down upon Juan, or anything. It just amazed me how much a label, an occupation, or a title can affect one’s perceptions of another person.

In related Ravenswood news, I just found out that my grant application for the summer was successful! I’m going to be spending the summer at the clinic developing a software component for the patient assistance program I’m currently running manually. Three more weeks until freedom! Hallelujah!

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Kevin, MD points to an AP story about over-the-counter cholesterol lowering drugs, and rightly argues that it’s all about money. “Savings for insurance companies, continuing profit for the drug companies.” I couldn’t agree more. Our pharm professor said there was an article in the British Medical Journal awhile back saying we should put statins in our water supply. How it would be great for the public.

So where’s the outrage? I can’t seem to find it. Physicians seem hell bent on medicating the public to death. (Maybe for good reason. Maybe they’re tired of prescribing exercise and a healthy diet and seeing 10% of patients trying?) Still, I can’t help but be bothered that we’re willing to prescribe pills for every man, woman, and child in this country at the cost of side effects and enormous increases in health care costs. We pay fast food companies to get us into this mess, and then we pay pharmaceutical companies to get us out of it. God forbid we pass some sort of law that encourages healthy eating. It works for smoking . Bad food is just as bad.

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Let’s cut to the chase: go see Super Size Me . I’ll follow with my normally over-verbose reasons, but seriously. Just go. Everyone in the US should see this movie. If not for their health, for a friend or family member’s.

I saw it last Saturday, and was totally blown away. It made me want to become a filmmaker. What a great way to reach and educate people. It does an excellent job of educating people about obesity and fast food in a fun, reality-TV type medium. Just what people want. (And if that’s not enough, Morgan Spurlock, the star, is blogging the interview circuit, too.)

The premise: a man eats McDonald’s food for a 30 days. And only McDonald’s food. If it’s not on the menu, he can’t eat it. Or drink it. He can only supersize the meal if they ask, and he has to eat one of everything from the menu by the time his month is up. He started out a pretty fit man, and got checked out by an internist, a gastroenterologist, a cardiologist, a nutritionist, and an exercise physiologist. I won’t spoil the ending for you, but he ends up putting on weight, and doing a fair amount of damage to his liver. Now, this is not 2 hours of film watching a man eat. It’s mostly education about obesity, diabetes, the fast food industry, advertising, school lunches, and American eating and exercise patterns. Did you know the McDonald’s salads with dressing have more fat that a Big Mac? Or that the large yogurt parfait with granola has more fat than the caramel sundae? Or how a Chicken McNugget is made? You will after this movie.

The movie does an excellent job of pointing out all the factors that are plotting against us; the advertisements, the lack of nutrition information, the power of industry. But it also notes that none of these things are going to change anytime soon, and if we don’t all work on them starting now, we’ll end up in a world where one out of three children born in 2000 in the US will eventually have diabetes. What a disgusting statistic.

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It’s usually a rotten apple that spoils the barrel. And I don’t think it’s any more (or less) true for lawyers. I read Overlawyered , a blog about frivolous lawsuits that highlights the need for legal reform. And while I agree that we need reform, both malpractice and otherwise, I’m always skeptical when I read it. I assume that there’s usually more background information than I’m being told. Case in point: the McDonald’s coffee lawsuit. We’ve all heard about it, probably talked about it with disgust. But when you read the facts of the case the media never presented , the black and white become shades of gray.
Lawyers aren’t all bad, either. Many (but arguably, not enough) work on important social issues protecting our rights and freedoms.
That all being said, I’m totally disgusted by this lawyer van sitting outside the ER . Had no idea they actually *did* that. Via EMedConcepts , a new ER blog.

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Just as Enoch is reporting , a mountain lion that was found in a residential neighborhood in Palo Alto was shot and killed today . The more frightening part of the article, in my opinion, is the fact that the Palo Alto squad uses AR-15 assault rifles. Yikes.

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