I just finished reading a beautiful meditation on mollusks. Gastropods in particular. The snail to be exact. An ordinary garden snail sustained the spirit of Elizabeth Tova Bailey for one year among many of a mysterious illness, and she wrote about it in her lovely book, The Sound of a Wild Snail Eating. Her friend had lifted the snail from the floor of the woods near her home, laid it under a wild violet uplifted from that same woods and planted in a pot, and gave it to her as a bedside gift.
By day, Bailey felt comaraderie with the nocturnal snail who also lay motionless while the sun shone and the rest of the world hurried about. By night, sleep was difficult and she felt comfort in listening to the sound of the snail chewing wilted leaves and mushrooms with its 80 rows of 2,640 teeth and in knowing he was roaming about while the rest of the world slept.
"Everything about a snail is cryptic, and it was precisely this air of mystery that first captured my interest. My own life, I realized, was becoming just as cryptic. From the severe onset of my illness and through its innumerable relapses, my place in the world has been documented more by my absence than by my presence....Yet it wasn’t that I had truly vanished; I was simply homebound, like a snail pulled into its shell. But being homebound in the human world is a sort of vanishing."
The book’s 208 pages, which includes penciled drawings of snails, gives me new respect for the complex anatomy and physiology of, and surprising historical literary attention to, the common snail. In fact, it made me feel guilty for so intensely disliking the slimy slugs, gastropodal cousin to the snail, that invaded a garden I once had and on which I blamed the garden’s lack of growth. Every night I put out jar lids full of beer to entice them away from my plants, but these efforts of eviction did no good. Still, I remind myself, those slugs didn’t carry the snail's graceful shell with the Fibonacci spiral that speaks of elegance and mystery.
A commercial has been on television lately advertising the perks program of a certain drug, and it compels me to put on my medical writing hat. With every box of this drug that you buy there’s a perk inside that apparently makes the drug worth buying in case you had any doubt about buying it for its ability to alleviate the troubling condition from which you sought relief in the first place. I know the power of perk programs. I recently succumbed to the pull of one for another type of product, a nonpharmaceutical, and admit its effect is to make me choose that product preferentially rather than others in its genre when I run out and need to restock.
The problem with the commercial’s advertisement of this specific drug’s perk program is that this drug should never be taken for more than 14 days or more often than every four months. Mr. or Ms Consumer should not be going back and back to the drugstore, this time trying for the steak dinner with a purchase, and two weeks later trying for a free spa appointment. If the condition that this drug addresses doesn’t go away in 14 days, you are supposed to stop taking it and see your clinician. Reading the box will tell you this but it’s not what the commercial or even the existence of a perk program implies.
Your clinician and pharmacist should tell you the full story of any drug you’re taking or considering taking; in addition or alternatively, as in all areas of life, you can educate yourself to a large degree. Everything about how and why a drug is supposed to be taken is included in the drug’s product “label” (also called prescribing or product information). It’s not really a label, like one that is glued to a box or bottle, but a multi-page document that details everything about the drug, including its chemical makeup, relevant clinical trial data, dosing instructions, known and potential side effects, and more. (For over-the-counter drugs, the label is not as detailed.) Every word in the label is carefully controlled and must be approved by the Food and Drug Administration. As an addendum to the label, there is often a patient medication guide that reiterates what consumers most need to know in easy-to-understand terms.
Anyone can access these drug labels; you don’t have to be a healthcare professional. Go to this advertising-free site operated by the National Library of Medicine: DailyMed. Enter the generic or trade name of the drug in question in the search box and go from there.
Believe it or not, the junior/senior high school that my sons went to graded on “sense of wonder.” Realistically, no one expects a seventh-grade boy to score too high in this regard, but by ninth grade the expectation is that this sense should be observable and growing, and by senior year, it had better be a palpable driving force. The theory behind taking the temperature of each young man and woman’s growing sense of educated wonder is that it is wonder that will keep him or her learning and discovering when teachers and transcripts no longer require it. Wonder will keep them pushing back the boundaries of what has been done or known by themselves or others, to go further and deeper, to uncover yet more in every realm.
Last month the New Statesman carried an article, “Why science needs wonder,” by Philip Ball, author of the soon-to-be published Curiosity: How Science Became Interested in Everything. I hadn’t realized that "wonder" has historically been a controversial attribute, with a past false dichotomy between the kind of wonder that makes you curious and sends you exploring and the kind that makes you awed and speechless. In elegant fashion, Ball argues that science needs poetry and not just objective inquiry.
The astronomers' claim in the documentary Nostalgia for the Light (which I wrote about here), the claim that the elemental calcium in our bones comes from the stars, intriqued me and sent me looking for more information. I found this summary report on a paper published in Nature in 2010 (Perets HB, et al. A faint type of supernova from a white dwarf with a helium-rich companion. Nature. 2010;465:322-325.) Since I don’t have a subscription to Nature and probably wouldn’t understand the paper even if I had access to it, the summary report will suffice.
This is my ever so brief summary of the report by Robert Sanders.
Astronomers have so far, at least at the time of the paper’s writing, found eight calcium-rich supernova, including supernova (SN) 2005E, discovered by a team from Berkeley and described in the paper. They calculate that when 2005E exploded half of its mass was calcium. Further calculations suggest that if this is repeated with other supernova even a couple times every 100 years, enough calcium is produced for life on earth. Two of the study authors interviewed for the report, Filippenko and Li, said that robotic telescopes are “scanning distant galaxies every night in search of new supernovae....”
Tonight I’m going to stand in my backyard, supported by a strong skeleton of calcium-rich bone, look up into the starry sky and give thanks.
Of course it pales in comparison to the holidays that bookend it, Mother’s Day and Memorial Day, but this past weekend held the first ever National Hepatitis Testing Day. How did you celebrate? Did you roll up your sleeve for a needle poke and a one-time hepatitis C test? If you are a baby boomer, specifically if you were born between 1945 through 1965, that is exactly what the Centers for Disease Control and Prevention (CDC) will soon recommend that you do.
I often work on projects related to hepatitis in my medical writing day job and have seen this recommendation coming for awhile. Several years ago the Institute of Medicine (IOM), an independent medical think tank, issued a report about the lack of awareness among the public and healthcare professionals concerning hepatitis C, as well as other types of hepatitis, leaving many infected individuals not knowing they are infected and, consequently, untreated. The problem with leaving hepatitis C untreated is that chronic infection can lead to liver disease, liver cancer, and/or death in a significant number of individuals. In response to the IOM’s report, the U.S. Department of Health and Human Services issued a report of their own, mandating, among other things, that the CDC expand and strengthen their hepatitis C screening recommendations.
Epidemiologists have long been studying the large bubble of infection in baby boomers. The CDC says 1 in 30 boomers are infected and most have no idea, despite the fact that recommendations for screening based on risk factors have been in place since 1998. Reasons for the bubble are complex, but it boils down to the fact that hepatitis C was in the blood supply for a long time before researchers figured out a) what it was, and b) a way to test for it. It wasn’t until 1992, yes recent history, that donated blood was widely tested. And of course, there were, and are, other ways to have contact with infected blood other than official transfusions.
CDC’s recommendation isn’t final yet. A public comment period is open from May 22 to June 8, 2012, after which the final guidelines will be written and published. You can read the CDC’s fact sheet here.
(photo: hepatitis C, U.S. Department of Veterans Affairs)
A new study published in the Archives of Neurology on January 23 reported a strong association between cognitive activity and beta-amyloid deposits in the brain. Beta-amyloid is the protein that destroys brain tissue in people with Alzheimer’s disease. Study researchers from the University of California in Berkley found that cognitive activity throughout a person’s early and middle life had a direct impact on the degree of beta-amyloid deposits. The more cognitive activity, the fewer deposits. The kinds of cognitive activity reported in this paper are well within the reach of everyone, such as reading, writing (including writing letters and emails), going to the library, and playing games. Although genetics certainly plays a role in the development of Alzheimer’s disease, working your brain to slow or prevent its development is an option for everyone. And it’s free!
Previous research, including the Nun Study, which I wrote about in Just Think, has demonstrated an association between cognitive activity and the prevention of Alzheimer’s disease, but this is the first study to identify a physical explanation for what is happening in the brain as a result of cognitive activity.
In an interview with Science Daily, one of the paper’s authors, William Jagust, MD, said, "There is no downside to cognitive activity. It can only be beneficial, even if for reasons other than reducing amyloid in the brain, including social stimulation and empowerment....And actually, cognitive activity late in life may well turn out to be beneficial for reducing amyloid. We just haven't found that connection yet."
The last several months I've been immersed in a six-part project on cancer therapy, a topic that is at once bleak and exciting. Targeted agents in development and genetic profiling for individualized treatment suggest a future of increasingly hopeful outcomes. Nevertheless, the million dollar question for people who receive a diagnosis of aggressive malignancy remains, How long have I got?
Clinical trials in these settings typically use median survival--overall survival or progression-free survival--as the measuring post by which to compare one treatment regimen to another or to placebo or observation. To review statistics 101, the "median" number in a series of numbers is the middle value, with half the numbers above and half the numbers below. For example, if 32 apples are distributed among 7 children, with one child receiving one apple, three children receiving four, two receiving five, and one receiving ten, the median number of apples is four. An understanding of median is important in thinking about survival data because the upper and lower range of numbers in the series doesn't change the median. If instead of 10 apples, the last child in the example above received 1,000 apples, the median would still be four. (In contrast, mean is the average of all the numbers in the series and mode is the most common). In cancer terms, if the median survival is one year, the survival for some is a few months, and for others, many years.
For Christmas 2007, my son gave me a book of essays by Harvard professor and evolutionary biologist Stephen Jay Gould called The Richness of Life (great title!). One of the essays, "The Median Is Not the Message," is about the hope inherent in statistics, contrary to popular belief. In 1982, Gould was diagnosed with abdominal mesothelioma, a particularly aggressive form of cancer with a median survival of eight months. He read everything he could about cancer, this cancer, and survival statistics. Once he realized, with relief, the extended possibility of survival beyond the median, he knew he had time to "think, plan, and fight." He flung his efforts into increasing his odds of landing at the far end of the survival range, which he succeeded in doing, living for 20 more years.
His essay explains in very understandable terms the good news he found through his analysis of statistics. It's worth a read if you have cancer, know someone with cancer, are afraid of cancer, or just want to have some practice looking at a negative situation from a positive point of view. You can find the essay in the anthology I mentioned or on numerous cancer advocacy sites, including here.
It is the day before New Year's Eve and so a more appropriate post on this day might be a hip-hooray for the fresh start ahead, or a musing on how the changing economy colors the outlook for the coming year, or even a preview of what I'll be serving guests as the clock strikes midnight. But I'll stay with this post anyway. After all, what better time to focus on the who-knows-what-is-possible streaming flare of life than hours before a new year begins.
Figure source: http://www.stat.psu.edu/online/development/stat500/lesson02/lesson02_02.html
By day I'm a freelance medical writer. After hours I do another kind of work. Creative writing, spiritual writing, essaying. This blog arises from those after hours. I write about work/vocation, meaning, hope, imagination, faith, science, creativity/writing, books, and anything else I feel the impulse to write about. I hope these short posts provide camaraderie for your own creative and spiritual life.
Over the last couple weeks I released three videos that I made related to my book Finding Livelihood. Here are the 12 steps I followed. You could also follow the steps for making a fun video of you reading a piece of poetry you love or a story your child wrote or any number of other things.
In the Celtic Prayer Book, Aidan Clarke wrote that the soul is like a bridge, "bear[ing] the weight and accept[ing] the contradictions of the two-way flow between God and the world." I like this metaphor of the soul as a bridge and have been thinking about it in relation to one's work. I’ve always thought that God wanted his people to saturate the world, all industries, all domains. Here in the pool business. Here in the advertising industry. Here at an arts center, at a hospital. God's bridges everywhere—God to world, world to God. But there's a catch to the...
For readers who are tempted to think that finding and traveling one’s path is as simple as identifying your passion on a vocational questionnaire and then never losing sight of that passion, this story may cause you to think again.
On New Year’s Day I started rereading Art & Fear: Observations On The Perils (and Rewards) of Artmaking by David Bayles and Ted Orland. I first read it the summer before last after a short writing retreat, and it seemed appropriate to start the year with a review of this book’s gems. If you do any kind of creative work, or think about doing any kind of creative work, whether or not it’s your day job, I commend this book to you.