Wednesday, February 10, 2016

Finding Encouragement In The Doctor’s Office

Book Review
Compassionate Medicine: There is healing power in words; if you have been on the receiving end of encouraging words, when needed, you will understand their meaning and power to both soothe and heal. Dr. Bomback writes in Los Angeles Review of Books: “In The Lost Art of Healing, Lown recalls the simple advice he received from a Siberian physician — ‘Every time a doctor sees a patient, the patient should feel better as a result’ — and spends most of his book trying to convince his readers that physician-patient dialogue is the only reliable way to ensure a positive medical outcome.”
Photo Credit & Source: LARB

Never underestimate the healing power of compassionate words, and all the more so when they are part of the traditional physician-patient dialogue taking place daily in the doctor’s office. How a doctor conveys medical news can affect a patient’s well-being and health. Such is the essential point of a book review article, by Andrew Bomback, in the Los Angeles Review of Books.

In “Don’t Let Me Be Lonely, Doctor: On Epigenetics, Placebos, and ‘The Lost Art of Healing’ ” (February 4, 2016), Bomback, a medical doctor practicing in New York, writes:
This year marks the 20th anniversary of Bernard Lown’s The Lost Art of Healing. Lown, now 94 years old, is a retired cardiologist best known for developing the direct current defibrillator used to resuscitate victims of cardiac arrests. He also accepted the Nobel Peace Prize in 1985 on behalf of International Physicians for the Prevention of Nuclear War, an organization he co-founded with a Russian cardiologist. Lown’s 1996 memoir, though, will also be one of his lasting legacies. The book is still distributed to first-year medical students around the world, part pleasure-reading gift and part instruction manual for the career they’ve chosen.
In The Lost Art of Healing, Lown recalls the simple advice he received from a Siberian physician — “Every time a doctor sees a patient, the patient should feel better as a result” — and spends most of his book trying to convince his readers that physician-patient dialogue is the only reliable way to ensure a positive medical outcome. “I know of few remedies more powerful than a carefully chosen word,” writes Lown. “Patients crave caring, which is dispensed largely with words.”
I took care of Lillian before reading The Lost Art of Healing. When I read Lown’s memoir a few years later, her case kept popping into my head. My colleagues and I published the largest case series of fibrillary glomerulonephritis patients treated with rituximab to date, and Lillian is the clear outlier, the only patient with advanced kidney failure who responded to the drug. We had no explanation for her success. Lown probably would argue that my optimistic words were a key player. “I attempt to discover a silver lining in the cloudiest situation,” he writes. “This has little to do with truth or falsehood. It flows from the deepest intent of doctoring, to help a patient cope when a condition is hopeless and to recover whenever it is remotely possible.”
True enough; and truer words have never been spoken on the beneficial effects of compassion. Can it be that a good part of the illnesses that are present in our society are due to lack of compassion? This human emotion, an action on behalf of the other, can help not only in the prevention of some illnesses, but also improve the outcomes of individuals who are suffering illnesses. Again, compassion is part of what I would call complementary medicine. As the placebo effect shows, it is a powerful anodyne. As are healing thoughts.  (Rationalists beware. Optimists fare better when faced with a life-threatening medical diagnosis.)

We do not understand why this is so from a scientific point of view, but we do feel emotional satisfaction and find it a benefit to our being when in the presence of someone who cares. As is the emotional connection made, when someone shows a personal interest, especially if that person is a medical doctor who has specialized knowledge. How this works is less important than why it works, or, more to the point, that it works. This is not a warm. fuzzy feeling; it is bettering emotional health, which has an important place in modern medicine.

Alienation and loneliness are often seen as social ills, as abnormal behaviours, when in fact they are normal responses to modern life today. Such “negative” feelings are accentuated in times of change and crisis. Many times people feel very alone in the doctor's office, afraid of the news. When doctor’s act as a patient’s advocate, working together, to get a positive outcome, I suspect that the results are significantly better. As are acts of kindness.

I was fortunate to have found an excellent and compassionate family physician (Dr. G.) before I began chemotherapy. (Our family had recently moved to Toronto.) Dr. G. was encouraging and also used soothing words. I still can remember this time in my life; and I believe that I will carry this memory forever, such is its importance.

Kindness does not have to be the enemy of science or of reality.

For more, go to [LARB]

Tuesday, February 9, 2016

A Mid-Winter View (2016)

Half-Way Points

We are now a few days into the second half of the winter season of 2016; midwinter officially took place here in the northern hemisphere on Thursday, February 4th at 6:21 p.m. Eastern Time. This photo (unedited), as many of my posted photos are, is taken from my sixth-floor apartment (on the afternoon of February 4th); but this time the view is from my kitchen window—facing northeast. Another perspective of the park, which we can view from all of our windows. If you do not notice any evidence of snow, it is because we have received so little of it this winter. This is a new experience for me, where in February the grass is visible and not covered in snow. (Although the forecast is for a for some snow today; an inch or two.) We have had a number of mild unwintery days, unseasonable for this part of Canada. As a notable example of this, it was 16°C (61°F) on February 3rd. Winter began on December 22, 2015, and will end on March 20, 2016, with the arrival of spring.
Photo Credit: ©Perry J. Greenbaum, February 2016

Monday, February 8, 2016

Jewish Humor: A Subversive Force For Social Change

Book Review

Humor can be funny, but it can also be serious and a force for social change, which is what essentially describes the aims of  political satire, namely, a targeted attempt to offend those in power who have committed some wrong, moral ethical or otherwise. Depending on whom one offends, this can be career-damaging for comedians, which is not generally the case today in the United States, but was so during the McCarthy era. Prof. George Jochnowitz writes: “As noted above, humor is a subversive force. This led to the persecution of some comedians who were viewed as dangerous during the era of McCarthyism. One of the victims was Philip Loeb, who was blacklisted and lost his job as Molly Goldberg’s husband on The Goldbergs. (There were also attempts at blacklisting coming from the left, as in a January 1949 article in Jewish Life, the predecessor of Jewish Currents, in which Sam Levenson, who had distanced himself from communist activity, was denounced by Louis Harap, a former editorial board member, ‘for being like a Nazi stormtrooper.’ ”)


by George Jochnowitz

Kvetching and Shpritzing: Jewish Humor in American Popular Culture
by Joseph Dorinson,
Foreword by Joseph Boskin.
McFarland & Company, Inc., 2015, 248 pages.

When I first saw the title of Joseph Dorinson’s book, I was a bit puzzled. I know that Yiddish kvetshn means “to squeeze” and can be used figuratively to mean “to complain.” Complaining goes well with humor. As for shpritsn, I only knew the meaning “to spray.” I looked it up in Uriel Weinreich’s Modern English-Yiddish Yiddish-English Dictionary, but all I found were synonyms: splash, sprinkle, spurt, squirt. Dorinson, however, explains it all: As a term of comedy, shpritzing means spitting all over your objects of scorn, “dogmas, institutions, celebrities, and enemies,” by bubbling up and spilling over like a shaken bottle of seltzer. And Jewish humor, adds Dorinson, “does not even spare God.”

Why, indeed, should God be spared getting wet? Dorinson cites Woody Allen as saying that “Jews celebrate Yom Kippur to honor a God who broke all of His promises to His people.” So true: After the Israelites left Egypt, they wandered in the desert for forty years. A generation died there and never saw the Promised Land. Eventually, the Israelites built an army and fought their way in — a process that took centuries.

“The Bible,” Dorinson writes, “is allegedly devoid of humor,” but his cautious use of “allegedly” indicates that he has doubts about this statement, as indeed he should. The Hebrew Bible is generally not funny, but there are some great and subtle wits at work in the text. When David flees to escape from King Saul, he is captured by the servants of King Achish of Gath. David then pretends to be insane, leading the king to ask this ironic question: “Have I need of mad men, that ye have brought this fellow to play the mad man in my presence?” (1 Samuel 21:15). After Job is struck with catastrophe after catastrophe, the comforters come to him and ask, “If we assay to commune with thee, wilt thou be grieved? But who can withhold himself from speaking?” (Job 4:2). And when the Prophet Isaiah speaks about the daughters of Zion, he describes the day when “my Lord will strip off the finery of the anklets, the fillets, and the crescents; of the eardrops, the bracelets, and the veils; the turbans, the armlets, and the sashes; of the talismans and theamultets; the signet rings and the nose rings; the festive robes, the mantles, and the shawls; the purses, the lace gowns, and the linen vests; and the kerchiefs and the capes” (Isaiah 3:18-23). This Rabelaisian list was clearly meant to be sarcastic.

Dorinson observes that humor “also serves as a deeply subversive force.” Perhaps the Biblical tradition of wrestling with God (Genesis 32:28) and arguing with God (Genesis 18:22-33) are connected with Jewish involvement in revolutionary movements. Certainly kvetching constitutes an attack on the status quo and therefore has subversive potential. He points especially to Broadway theater, in which Jews have been leading creators, as playing “an important role in heightening America’s awareness of social issues.” Among the plays he discusses is the musical Finian’s Rainbow, with words written by E.Y. (Yip) Harburg, whose original name was Isidore Hochberg, about whom we read, “Though tainted, painted, and red-listed, ‘Yip’ persevered, indeed prospered.” The fact that the play was about race and sharecroppers did not prevent it from running for 725 performances after it opened in 1947.

Like Yip Harburg, Jewish comedians were often bold about their views but timid about their names. Jack Benny was originally Benny Kubelsky. Woody Allen was Allan Stewart Konigsberg. Lenny Bruce was born Leonard Alfred Schneider. Was there a fear that being funny, which is what a comedian wants, would be confused with being scorned? We can laugh with people because they are funny; we can laugh at them because they are undignified. Jewish names are often viewed as lacking ‘class.’ Was there a subconscious need to avoid a lower-class name in order to separate laughter from scorn? Be that as it may, Jewish scientists, who have also loomed large in their fields of work, are unlikely to change their names. Nobody would have expected Albert Einstein to change his name, and he didn’t, yet everybody thought it natural for Kubelsky to become Benny—and so it went, as by 1970, according to Dorinson, “Jewish practitioners represented 80 percent of the top comedians in America.”

On the other hand, Gertrude Berg, who created and played the role of Molly Goldberg on a radio program called The Goldbergs about Jewish life in New York, did not change her name. Neither did actors on the Yiddish stage who eventually played roles on the radio, like Menashe Skulnik. If you are enacting a Jewish character, you may as well have a Jewish name. The Goldbergs was one of several programs about minorities, as Dorinson reminds readers. There was also Life with Luigi, about Italian-Americans, and I Remember Mama, about Norwegian-Americans. Peggy Wood, the star of that show, was not of Norwegian descent. The radio program Amos and Andy, about African-Americans, had white actors when it was on the radio, but needed to change its cast when it appeared on television.

For much of the 20th century, there were resort hotels in the Catskill Mountains that catered to predominantly Jewish guests. Many of these hotels regularly had entertainers, and many of the entertainers were comedians. A significant percentage of the well-known comedians discussed in Dorinson’s book began their careers in the Catskills. During the same period, there were comedy shows on the radio, and variety shows on television that featured comedians. The Texaco Star Theater, starring Milton Berle, known as “Mr. Television,” was enormously popular, as was Your Show of Shows, starring Sid Caesar, who was Jewish, and Imogene Coca, who was not. I watched the program regularly, which was broadcast live, and I never saw any indication that Sid Caesar was occasionally violent, so I was surprised to learn from Dorinson that once in the Catskills, when the comedian Jackie Michaels “flung tomatoes at Caesar, drenching his new white suit, he chased the offender into the audience, where gleeful onlookers thought it was part of the act.” Equally surprising was that Caesar “also developed a destructive dependency on alcohol.”

This is just one example of the many details about comedy stars and their careers discussed in Kvetching and Shpritzing. We learn about comedian after comedian, actor after actor, writer after writer—and since the book is about comedy, we read joke after joke. Dorinson is a scholar utterly devoted to the subject of the joke.

As noted above, humor is a subversive force. This led to the persecution of some comedians who were viewed as dangerous during the era of McCarthyism. One of the victims was Philip Loeb, who was blacklisted and lost his job as Molly Goldberg’s husband on The Goldbergs. (There were also attempts at blacklisting coming from the left, as in a January 1949 article in Jewish Life, the predecessor of Jewish Currents, in which Sam Levenson, who had distanced himself from communist activity, was denounced by Louis Harap, a former editorial board member, “for being like a Nazi stormtrooper.”)

Writers can be humorous, but they are not generally thought of as comedians. Sholem Aleichem was called the Jewish Mark Twain. When Mark Twain heard this, he replied, “Please tell him that I am the American Sholem Aleichem.” Philip Roth, one of the greatest novelists of our time, is often humorous. He should have won the Nobel Prize in literature. Perhaps there were already too many Jewish Nobel winners, and Roth was excluded for reasons of affirmative action.

To err is human. Fortunately, in this age of computers, we can catch our errors and have them corrected with relative ease. In future copies of the book, we can do away with slip-ups like the misspelling of Yetta Zwerling’s surname on page 60, although it is correctly spelled elsewhere on the same page. Another case of a correct and an incorrect spelling is found on page 72, where Hans Christian Andersen is referred to twice. Michiko Kakutani’s name is misspelled on page 130. Senator Joseph McCarthy is mistakenly identified as representing the state of Washington on page 110, although he is correctly described as being from Wisconsin elsewhere. There are other small slip-ups, but they can all be changed quickly and easily so that they will not distract the reader from the scholarship that went into the book. We shouldn’t be given any reason to kvetch about this fascinating work of history, scholarship, and philosophy.

George Jochnowitz was born in New York City, in 1937. He became aware of different regional pronunciations when he was six, and he could consciously switch accents as a child. He got his Ph.D. in linguistics from Columbia University and taught linguistics at the College of Staten Island, CUNY. His area of specialization was Jewish languages, in particular, Judeo-Italian dialects. As part of a faculty-exchange agreement with Hebei University in Baoding, China, he was in China during the Tiananmen Massacre. He can be reached at

Copyright ©2016. George Jochnowitz. All Rights Reserved. This article originally appeared in Jewish Currents (February 2, 2016). It is published here with the author’s permission.

Sunday, February 7, 2016

Beatrix Potter’s ‘Tale Of Kitty-In-Boots’: 100 Years Later

Children’s Books

Kitty-in-Boots: Beatrix Potter’s original illustration. Rebecca Mead writes for The New Yorker about this feline in boots: “It may have taken a century for Kitty-in-Boots to surface, but there can be no better time than today, the age of ‘Transparent,’ for a gender-binary-defying cat to materialize.”
Illustration Credit: Frederick Warne Co; The Victoria and Albert Museum
SourceThe New Yorker

An article, by Rebecca Mead in The New Yorker looks at the recovery and upcoming publication of a Beatrix Potter story, “The Tale of Kitty-in-Boots,” about a well-behaved black kitty cat who leads a double life. It was written and then abandoned a century ago.

In “The Bittersweet Announcement of a New Beatrix Potter Book” (February 1, 2016), Mead writes:
Last week, Penguin Random House announced that it will publish another “lost” Potter work about a cat: “The Tale of Kitty-in-Boots,” which she had begun and abandoned two years earlier, in 1914. Several manuscripts of the story were discovered in 2013 in the Potter archive at the Victoria and Albert Museum by Jo Hanks, a publisher at Penguin Random House; the book is being published this fall to coincide with the hundred-and-fiftieth anniversary of Potter’s birth.
According to Penguin Random House, Potter’s intention to publish the story is evident: the archive included a version that had been set in type, suggesting that its publication was once quite far along. In a letter to her publisher, Harold Warne, Potter characterized the principal character as “a well-behaved black Kitty cat, who leads rather a double life, and goes out hunting with a little gun on moonlight nights, dressed up like puss in boots.”
Linda Lear, Potter’s biographer, writes that Warne was lukewarm about the proposal, however, and suggests that this lack of enthusiasm led to Potter’s abandonment of the book after she had completed only some sketches and had begun just one color illustration. This image, the projected frontispiece, shows a black, green-eyed cat wearing a hunting jacket, britches, and boots. In one paw, she is grasping a limp, indeterminate trophy—a pheasant, perhaps—while supporting a rifle with the other.
We have a few Beatrix Potter books in our children’s library, and they are as delightful for adults to read, as they are, I am sure, for children. The book will be released for public consumption on September 1, 2016. It will have new illustrations by Quentin Blake. Beatrix Potter was born on July 28, 1866 and died on December 22, 1943. She was 77. Besides being a well-known British writer of children’s books, Potter was a natural scientist and conservationist; she was ahead of her time as a woman of science.

But it is as a writer that she is best known. Writers draw inspiration and obtain ideas for stories from what they know, and in the case of writers of children’s books, it is often that they return to the imaginings of their young minds, when ideas are inchoate and are not yet fully developed or firm. In Beatrix Potter: A Life in Nature (2006), Linda Lear writes: “Childhood forays into the countryside nurtured her imagination and inspired her art. Soon her London school room was home to an eclectic menagerie of insects, butterflies, and small animals, especially mice and rabbits all of which she drew with endless fascination.”

For more, go to [NewYorker]

Saturday, February 6, 2016

The Dual Role Of Senescent Cells

Age-Related Diseases

Mice-mates: almost two years old. The lab mouse on the right had a majority of its senescent cells cleared by a drug starting at age one, which allowed it to live 25 percent longer than the mouse who had no such treatment. And it was healthier, say the researchers. Even so, it is too early yet to say whether this will work for humans, although there is discussion about anti-aging drugs. Ewen Callaway writes in the journal Nature: “Eliminating worn-out cells extends the healthy lives of lab mice — an indication that treatments aimed at killing off these cells, or blocking their effects, might also help to combat age-related diseases in humans. As animals age, cells that are no longer able to divide — called senescent cells — accrue all over their bodies, releasing molecules that can harm nearby tissues. Senescent cells are linked to diseases of old age, such as kidney failure and type 2 diabetes. To test the cells’ role in ageing, Darren Baker and Jan van Deursen, molecular biologists at the Mayo Clinic in Rochester, Minnesota, and their colleagues engineered mice so that their senescent cells would die off when the rodents were injected with a drug.” Yet, the senescent cells containing the p16 protein also aid in wound healing and prevent tumor suppression, making it important in the prevention of cancers. Does one benefit cancel another? Perhaps medical science has not yet found the “fountain of youth,” but it is delving deeper into understanding the complex process of aging. 
Photo Credit: Jan Van Deursen
SourceNature News
More: Go to [Nature]; and to [here] for the original research article.

Friday, February 5, 2016

Questioning The Accuracy Of The LNT Model

Diagnostic Imaging

CT Scanner: The LNT model used for the last seven decades to estimate cancer risk is not accurate at low dosages common to medical imaging, say researchers at Loyola University. Catharine Paddock writes for Medical News Today: “The researchers say the model that is used to estimate the potential cancer risk of low-level radiation from medical imaging machines—such as this CT scanner—is wrong and should be abandoned.”
Photo Credit & Source: Medical News Today

An article, by Catharine Paddock, in Medical News Today says that some medical researchers are questioning the validity of a decades-old theoretical model—Linear no-threshold model (LNT)—which essentially says that there is no safe threshold when it comes to exposure to radiation. The model also says that the sum of many small exposures equals one large exposure. In other words, there is a cumulative effect on the human body.

It was John William Gofman [1918-2007], an American scientist (nuclear and physical chemistry), who first advocated for such a model to estimate actual cancer risks from exposure to low levels of radiation. The LNT model, Wikipedia notes “is considered the  foundation of the international guidelines for radiation protection.”

Yet, it ought to be thrown out, at least when it comes to establishing guidelines for medical imaging. says James Welsh of Loyola University’s Stritch School of Medicine. In “‘No evidence that CT scans, X-rays cause cancer’” (February 4, 2016), Paddock writes:
Writing in the American Journal of Clinical Oncology, the researchers describe how the linear no-threshold model (LNT)—first proposed over 70 years ago—is used to estimate cancer risks from low-dose radiation, such as medical imaging.
But—say James Welsh, a radiation oncology professor in the Stritch School of Medicine at Loyola University, Chicago, IL, and colleagues— risk estimates based on the LNT model are only theoretical, and, as yet, "have never been conclusively demonstrated by empirical evidence."
They say persistent use of the LNT model by regulators and advisory bodies leads to unfounded fears and money being wasted on unnecessary safety measures. As a result, many doctors are averse to recommending and using the most appropriate imaging procedures for their patients, and many patients are unnecessarily scared to undergo them.
This was my fear, as well; I, too, had read and been told that CT scans and x-rays have a cumulative effect on the body, increasing the risk of cancer. A recent article in Scientific American says just as much. [see here]. The article points out the benefits of using low-dose scans, where such scans deliver 75 percent less radiation than typical scans while giving sufficiently accurate results. The article also notes that physicians order too many CT scans and as a result patients receive unnecessary doses of radiation. This is a concern. Obviously, ionizing radiation (such as gamma rays) cause damage to the living cells’ integrity and ability to repair itself. It destroys DNA bonds.

A too large dose of radiation can be harmful, and even lethal at high enough levels of exposure, such as when one is in close proximity to a nuclear blast or the site of a nuclear accident. High-dose radiation is anything greater than 500 millisieverts (mSv). As an example, at Chernobyl (April 26, 1986), 134 plant workers and firefighters received high radiation doses (800 to 16,000 mSv), suffering acute radiation sickness: 28 persons died within the first three months.

What can turn lethal when control is lost can be beneficial when sufficient control is maintained. Such is the thinking behind safely harnessing the power of ionizing radiation as a diagnostic tool. The unanswered and debated question is determining a safe dose for medical imaging, and the most important question is determining the cumulative effects on the human body. This requires answering to everyone’s satisfaction, because a fear of over-exposure to radiation will prevent persons from having diagnostic tests that use radiation.

These tests, after all, do save lives, and CT scans are a wonderful diagnostic tool. The benefits over-all outweigh the risks, and one wonders what would happen if the use of CT scans diminished greatly. This is true in my case, where an emergency CT scan (about 10 mSv of radiation, the FDA reports) revealed I had a large tumor in my colon. I have had a half-dozen scans since this initial one a few years ago. Combined, this is well under the threshold of high-dose radiation, thus I should not be overly concerned. To be honest, I am not overly concerned, but I do want to know more. I would like more assurance, if this is at all possible.

The study’s paper reasons that low-dose radiation, which includes and is comparable to normal natural background radiation. does not contribute to cancer. (In Toronto, it is 1.6 mSv/y). The reason is that the human body, Paddock writes, “is able to repair damage caused by low-dose radiation— something that has evolved over millennia in humans and other organisms that are continually exposed to naturally occurring radiation in the environment.”

It would seem rational to think that multiple low doses over long intervals would allow the body to repair itself, something that is not possible with a single high dose. Yet, as much as there is truth in this statement, I continue to find this argument lacking in reassurance for the following reason. The dose that a human gets from a  CT scan (even of the head at 2 mSv, let alone the chest at 7 mSv) is much higher than the annual background radiation in the city in which I reside (1.6 mSv), or for that matter the average annual background radiation of any major city in the world. The Canadian annual average is 1.77 mSv; the U.S. annual average is 3.00 mSv; and in Japan it is 1.50 mSv. The worldwide annual average is 2.4 mSv. 

Again, this is noteworthy. Equally compelling, we still do not have sufficient knowledge on the cumulative effects of low-dose radiation. Although a study published in the journal Nature (June 30, 2015) suggests that even tiny doses above natural background radiation slightly elevate the risk of leukemia. The large-scale study focused on nuclear-industry workers, but the results could be extrapolated to both health-care workers and patients. For this reason and others,  I am not sure that the LNT model ought to be abandoned just yet.

I am sure, however, that this is not the end of the discussion.

For more, go to [MNT]

Thursday, February 4, 2016

Peter Frampton: Show Me The Way (1976)

Peter Frampton and band perform “Show Me the Way,” which was a huge hit in 1976. If you were around then, you noticed that it received a lot of airplay on the radio. It is the third track on Frampton Comes Alive!, a double live album. The song is prominent for the use of the talk box effect.

Show Me the Way
by Peter Frampton

I wonder how you’re feeling
There’s ringing in my ears
And no one to relate to ’cept the sea
Who can I believe in?
I'm kneeling on the floor
There has to be a force
Who do I phone?
The stars are out and shining
But all I really want to know

Oh won’t you show me the way
I want you to show me the way

Well, I can see no reason
You’re living on your nerves
When someone drops a cup and I submerge
I’m swimming in a circle
I feel I'm going down
There has to be a fool to play my part
Someone thought of healing
But all I really want to know

Oh won’t you show me the way
I want you to show me the way
I want you day after day

I wonder if I'm dreaming
I feel so unashamed
I can’t believe this is happening to me
I watch you when you’re sleeping
And then I want to take your love

Oh won't you show me the way
I want you to show me the way
I want you day after day