What I’m Reading

The Whiskey Rebels was a great read. Now I’m back to the present era, but in a different country. My father, also a mystery reader, has lent me his Kindle so I can partake of the newest from Donna Leon, About Face.

This book features Commissario Guido Brunetti, a detective in the Venetian police. The series involves regular murders and crimes, not serial killers leaving trails of tortured victims. Brunetti has a boss who is more politician than crime-fighter, but the secretary to the boss, Signorina Elettra, is a beautiful, stylish, and idealistic computer nerd who can find almost any information needed to solve a crime. She can also work the Vice-Questore to get what she and her comrades need to solve each crime.

The books paint a beautiful, yet disturbing, portrait of life in Venice. Brunetti is married to the daughter of a wealthy count; of course, she is a communist who teaches literature and loves Henry James. They have two children who have grown up through the series. Leon details daily life in Venice, from morning espresso to after-dinner grappa. The disturbing part involves the corruption of Italian society and government. Bribery and abuse of power seem to figure in many stories, and may prevent the truth from surfacing.

I am only a couple of chapters into the present book, but the detailed characters have already drawn me back into the Commissario’s world. Once again, I will post an after-read review on my LinkedIn reading list. In the meantime, I highly recommend this series to anyone who likes mysteries.

Ears vs. Eyes: Learning to Love Podcasts

I am a visual person. I remember faces and I remember names, but I can’t always put them together again. I often find the very act of making a list allows me to remember what I need, even though the list gets left in the car. I can still see what I have written in my mind.

The popularity of audio books escapes me. I read fast, and I process things so much easier by seeing them than by hearing them. A multi-chapter book would require a recap at the start of each commuter session (or a long enough trip to listen to the whole book in one session).

A couple of years ago, I won an Ipod Nano. I quickly transferred a bunch of CDs and set up my Itunes account. I am not fond of listening through headphones, but my new car has a Ipod jack. The podcast, however, has only recently gotten my attention.

Other faculty have been creating podcasts that physicians can download to answer specific questions. I didn’t get it, because I wouldn’t remember what I listened to long enough to benefit (see first two paragraphs). I far prefer to access an online “written” reference, especially if its presentation is friendly for my BlackBerry screen. Other physicians began downloading these short updates, though, and they still seem to be popular.

Now I have become a podcast personality. ASN Kidney News, the magazine I edit, started producing these with the May issue. I chat with the author(s) of something in the magazine, and we post it on the ASN web site and in Itunes. I was thrilled when the first one was downloaded more than 700 times. After all, kidneys are a niche audience. We just posted the second Kidney News podcast; in 10 days it has received >4,000 unique visits and >12,000 total visits!

I have also wandered around the Itunes store to see what other podcasts are out there. I am especially delighted to find my favorite NPR shows. I often miss Fresh Air on my local station; now I subscribe and listen the next morning at work (or on my way home in the car, if I have to do something away from my desk)! For the past year, I have planned Saturday morning rounds so I could hear as much of Wait, Wait, Don’t Tell Me as possible. If you haven’t tried this one, you do not know what you are missing; it is roll-on-the-floor, pee-your-pants funny. While this level of humor has, on occasion, proved problematic while driving, it is always appreciated. Now my patients don’t have to “wait, wait” while I laugh!

I still don’t remember as much of what I hear as what I read or see. I do appreciate what podcasts can do for the world, though.

By the way, I am a member of KIOS, the Omaha NPR station. Have you joined your local NPR affiliate?

Questioning a Paradigm

Mostly I post my personal musings on science, healthcare, and other nonsense that catches my eye. Today I am going to post about a medical study that was just published in the July 2 issue of New England Journal of Medicine.

The first author is Michael Mauer, a pediatric nephrologist at the University of Minnesota and my research mentor during my fellowship (consider this my disclaimer of potential bias). The study examines changes in kidney function and structure over 5 years in patients with type 1 diabetes, the type most common in young children. This study examined primary prevention of diabetic kidney disease; patients without albuminuria (thought to be the earliest manifestation of the problem) or hypertension (high blood pressure), and with normal kidney function (glomerular filtration rate) were assigned to receive enalapril (which inhibits angiotensin converting enzyme), losartan (which blocks the angiotensin II receptor), or placebo. They not only examined all of these functional studies before and after 5 years of treatment, but also performed kidney biopsies with morphometric studies for the lesions seen in diabetic nephropathy (primarily expansion of the mesangium of the glomerulus).

Drugs that block the renin-angiotensin system, like enalapril and losartan, have been shown to benefit patients with advanced kidney disease from diabetes (shown in photo) and other causes. They also seem to benefit patients with early type 2 diabetes (the type seen more commonly in adults and associated with obesity). It has been hoped that they would prevent kidney disease entirely, although smaller, shorter studies have failed to demonstrate this phenomenon. Thus, the hope that this study would answer the question: should all patients with type 1 diabetes be put on these drugs at the time of diagnosis of diabetes?

The answer seems to be no for now. Neither drug showed a clear benefit over placebo in any parameter measured. The study is not perfect; a number of questions arise with careful reading of the article and the supplementary material. Like most studies, the results will breed discussion, more questions, and more experiments.

Probably the most important point I can make here is that

paradigms are meant to be shifted.

We cannot prove anything merely by arguing its logic or making observations from other situations. Logic and other situations suggest that these drugs would work!

 We must do the appropriate experiment if we really want to answer the question.

Diabetes is the most common cause of kidney failure in the United States, although most patients have type 2 diabetes. Drugs like enalapril and losartan still play an important role in the management of this disorder, especially in patients with type 2 disease and more advanced kidney problems. For now, though, we will not be starting these drugs along with insulin in newly diagnosed type 1 patients. And we must keep looking for treatments and cures.

Click below to link to the abstract:

Why I Take Time To Blog

Isis over at ScienceBlogs posted yesterday about blogging and one’s career. Her post first discusses Alex Coturnix and his rules for blogging: (1) A blog post is not a scientific publication; (2) It doesn't count if you publish your data in a blog post; and (3) Your blog usually doesn't generate novel data.

These are important points to keep in mind. While I am a physician-scientist (see photo for proof) I do not discuss my data in Golden Thoughts. If you want to know about my science, you can pull my papers. Or email me, cause I will talk about my hypotheses till the cows come home. Given the frustrations of obtaining funding and running the reviewer mill, no one does science for kicks. Science is a labor of love.

I have on occasion done the “lay science” thing when a topic grabs my attention, and I present it for a different, more general audience. Some folks do this regularly and well (see Uremic Frost for a fine example in Nephrology).

Ultimately, a blog is a personal thing. I love to write. Here I can tell tales or expound on the injustice of the world without annoying anyone (my drinking buddies are quick to point out that my bar stories are waaaay too long). Readers can just click away from my page when they get annoyed. My blog gives voice to thoughts in my head that get in the way of everything else. In a way, it helps me get focused by letting that other stuff out.

I don’t blog everyday because I wish to remain employed. I have stuff to do if I want to be clothed and if I want to eat. But I can’t imagine life without Golden Thoughts anymore.

What I’m Reading

I encountered David Liss through his novel A Conspiracy of Paper. It brought the economic bubble collapse of the East India Trading Company in 1700s London to life. I have tried to read all of his subsequent novels with their rich, well-researched historical backgrounds.

His latest moves to the infant United States and the presidency of George Washington. Two of his government, Jefferson and Hamilton, are jockeying for power. Others are finding ways to make fortunes, legally and not-so-legally.

The story is told from the perspective of two characters, a patriot spy and a frontier woman. The woman hopes to write an American novel, and draws from her experiences just west of Pittsburgh where her husband helps develop a novel whiskey. Whiskey is the coin of the frontier (which was Pittsburgh), and the only way to transport crops through the roadless wilderness back to sell on the coast.

I’m not quite halfway through this book, and it is already wonderful. In addition to painting a deep tonal portrait of another time, David Liss always brings strong female characters to his work. I have always wondered how women such as myself existed in these periods, so this factor appeals to me.

When I finish, I will update my thoughts on my LInkedIn reading list.

Holidays in the Hospital

University of Nebraska considers July 3 a holiday. The city of Omaha does as well.

Unfortunately, my patients missed the memo.

So I’m at my desk. I have just finished rounding on the patients at one hospital. The new admission has finally gotten to the other one, so I can head on over there and finish rounds.

There are a lot of people working on holidays, and not just doctors. Waiters, retail clerks, and others are all out there plugging away.

If you go to a restaurant or drop by a store this weekend, think about saying thanks to the people working through the holiday.

And have a happy Independence Day – even if you only see the fireworks through a plate glass window or on TV!

Photo courtesy of Photoexpress.com.

A Woman of a Certain Age

Earlier today I was lusting over the shoes de jour at the blog of Isis when this ad showed up alongside her words of wisdom:

So we have a woman with gray hair writing on the chalkboard (how old school!) touting online educational opportunities (how… inexplicable).

And then you look to see which programs are being highlighted: Education, Nursing, Health Management, General Studies, and Financial Planning. How… traditional!

Now I grew up in Missouri and got my degrees (BA & MD) from one of the MU campuses (Kansas City). I suspect “women of a certain age” are a growth industry for universities, especially for online education. I suspect these may be popular programs amenable to online learning as well, but I can’t help noticing that they are very traditional pink collar fields.

The whole thing just made me feel, well, weird. I would have shown the potential student at a kitchen table, NOT in an obvious classroom situation. That is sort of the whole point of online education… it’s NOT in the classroom. The tiger tracks are cool, but surely the student could have been standing by a desk at home, perhaps in house slippers.

I also would have liked to see the “mature woman” looking a little nicer. The sweatshirt and jeans with runners is so “Early-bird special at Country Kitchen.” Surely a woman improving her mind and working toward an advanced degree would look a little more put together. Jeans, ballet flats, and a nice fitted jacket?

As a 48-year-old woman whose nest will be empty in a couple of years, I am near the age group this ad targets. I would think one that projects the desired image of an older, professional woman would be more successful.

But what do I know: I’m a doctor, not an advertising guru.