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November 1, 2011, 4:01 pm

A Few Drinks a Week Raises Breast Cancer Risk

Even a moderate amount of alcohol consumption may increase breast cancer risk.Tony Cenicola/The New York TimesEven a moderate amount of alcohol consumption may increase breast cancer risk.

Some women who drink to their health may want to reconsider. A new study shows that women who routinely have even small amounts of alcohol, as few as three drinks a week, have an elevated risk of breast cancer.

The research, which looked at the habits of more than 100,000 women over 30 years, adds to a long line of studies linking alcohol consumption of any kind — whether beer, wine or spirits — to an increased risk of breast cancer. But until now the bulk of the research largely focused on higher levels of alcohol intake. The latest study is among the first to assess the effect of relatively small amounts of alcohol over long periods of time, drawing on a large population of women to provide new detail about the breast cancer risks associated with different patterns of drinking.

The rise in cancer risk from three to six drinks a week, though, was modest, and for many women may not be enough to outweigh the heart-healthy benefits of drinking in moderation. Read more…


November 1, 2011, 12:01 am

A Thanksgiving Feast, No Turkeys Allowed

"This year, skip the turkey and fill your table with vegetarian fare."Getty ImagesThis year, skip the turkey and fill your table with vegetarian fare.

Are you ready to reimagine Thanksgiving without the turkey?

Every fall, the Well blog goes vegetarian for Thanksgiving, taking the meaty bird off the table to make room for a spectacular array of vegetarian soups, sides, main courses, salads and desserts. While a turkey-free Thanksgiving might sound like heresy to traditionalists, we’ve discovered that focusing on the bounty of the fall harvest, rather than the bird, can alter your eating habits and inspire your cooking year round.

Each day for the next three weeks, the Well blog will feature a new vegetarian or vegan option for your holiday table. All of this year’s recipes will be updated daily in our interactive recipe collection. Even if you’re not a vegetarian, you’ll discover mouthwatering new dishes created by an all-star lineup of chefs, cookbook authors and television food personalities. So get ready to save a turkey and savor the flavors of your most creative Thanksgiving ever.

To kick off Well’s Third Annual Vegetarian Thanksgiving, we teamed up with the popular vegan chef Nava Atlas, whose new book, “Vegan Holiday Kitchen: More than 200 Delicious, Festive Recipes for Special Occasions,” hits bookstore shelves today.

Ms. Atlas offers a starter of coconut butternut squash soup; a side dish of black rice, corn and cranberries; a colorful kale salad; and a hearty vegetable couscous suitable for serving as a main course.

Coconut butternut squash soup.Susan VoisinCoconut Butternut Squash Soup

Vegan Holiday Kitchen’s
Coconut Butternut Squash Soup

Once you’ve got the squash baked, this soup comes together quickly. The mellow flavors of squash, kale and red onions synergize delectably and look gorgeous together as well.

1 large butternut squash (about 1 1/2 pounds)
2 tablespoons olive oil or other vegetable oil
1 large yellow or sweet white onion, chopped
1 medium apple, any variety, peeled and diced
2 cups prepared vegetable broth, or 2 cups water with 1 vegetable bouillon cube
2 teaspoons good-quality curry powder
2 teaspoons grated fresh or jarred ginger, or more, to taste
Pinch of ground nutmeg or allspice
1 14-ounce can light coconut milk
Salt and freshly ground pepper to taste

Garnish
2 medium red onions, quartered and thinly sliced
1 good-size bunch kale (about 10 to 12 ounces)

1. To bake the squash, preheat oven to 375 degrees. Cut in half and place halves, cut side up, in a foil-lined shallow baking dish and cover tightly with more foil. Bake for 30 to 50 minutes, until you can easily pierce the flesh with a knife. Scoop out and set aside.

2. Heat about half the oil in a soup pot. Add the onion and sauté over medium-low heat until golden, about 8 to 10 minutes.

3. Add the apple, squash, broth and spices. Bring to a steady simmer, then cover and simmer gently until the apples are tender, about 10 minutes.

4. Transfer the solids to a food processor with a slotted spoon, in batches if need be, and process until smoothly puréed, then transfer back to the soup pot. Or better yet, simply insert an immersion blender into the pot and process until smoothly puréed.

5. Stir in the coconut milk and return the soup to a gentle simmer. Cook over low heat for 5 to 10 minutes, until well heated through. Season with salt and pepper. If time allows, let the soup stand off the heat for an hour or two, then heat through as needed before serving.

6. Just before serving, heat the remaining oil in a large skillet. Add the red onions and sauté over low heat until golden and soft.

7. Meanwhile, strip the kale leaves off the stems and cut into thin shreds. Stir together with the onions in the skillet, adding just enough water to moisten the surface. Cover and cook over medium heat, stirring occasionally, until the kale is bright green and just tender, about 5 minutes.

8. To serve, ladle soup into each bowl, then place a small mound of kale and onion mixture in the center.

Yield: 8 servings.

Black rice.Susan VoisinBlack Rice, Corn and Cranberries

Vegan Holiday Kitchen’s
Black Rice, Corn and Cranberries

The first time I came up with this recipe, I thought I’d better cut the recipe in half so my family of four wouldn’t be eating it for the rest of the week. What a mistake — we tore through it in no time. While it’s a festive eyeful, it’s too good to save for only special occasions, and too simple not to make for everyday meals.

1 cup black rice or wild rice
3 tablespoons olive oil or other vegetable oil
3 to 4 cloves garlic, minced
3 to 4 scallions, green and white parts, thinly sliced
2 cups thawed frozen corn kernels
1/4 cup lemon or lime juice, or to taste
1/4 to 1/2 cup chopped cilantro leaves, to taste
2 teaspoons ground cumin
1/2 teaspoon dried oregano
1/4 teaspoon dried thyme
1/2 cup dried cranberries
Salt and freshly ground pepper to taste
1/4 cup toasted pumpkin seeds for topping

1. If using black rice, combine in a saucepan with 2 cups water. Bring to a rapid simmer, then lower the heat, cover and simmer gently until the water is absorbed, about 30 minutes. If you’d like a more tender grain, add 1/2 cup additional water and cook until absorbed. If using wild rice, combine with 3 cups of water and cook as directed above.

2. Just before the rice is done, heat half the oil in a large skillet. Add the garlic and sauté over low heat until golden. Add the scallions and corn kernels and sauté just until warmed through.

3. Transfer the cooked rice to the skillet. Turn the heat up to medium-high, then add the lime juice, cilantro, cumin, oregano, thyme, cranberries and remaining oil. Gently stir the mixture, then season to taste with salt and pepper.

4. To serve, transfer to an attractive serving platter and sprinkle the pumpkin seeds over the top.

Yield: 8 servings.

Massaged kale salad.Massaged Kale Salad With Cranberries and Cashews

Vegan Holiday Kitchen’s
Massaged Kale Salad With Cranberries and Cashews

There are so many ways to vary this salad: You can toss in some slivered baby carrots, add diced pears or apples, substitute another kind of nut, or add a bit of thinly shredded red cabbage for extra color or sliced celery or bok choy for extra crunch. Even in its simple form, as presented here, it’s luscious and festive.

1 good-size bunch kale, washed and dried
Olive oil or other vegetable oil, as needed
2/3 cup dried cranberries
1/2 cup crushed toasted cashews, or pumpkin seeds
1/2 cup vegan mayonnaise
1 to 2 tablespoons lemon juice, to taste

1. Strip the kale leaves off the stems. Cut into ribbons and place in a large bowl.

2. With a little olive oil rubbed into your palms, massage the kale for a minute or so, until it becomes bright green and softens a bit.

3. Stir in the remaining ingredients and serve at room temperature.

Yield: 6 to 8 servings.

Vegan Holiday Kitchen’s
Seven-Vegetable Couscous

Seven vegetable couscous.Susan VoisinSeven-Vegetable Couscous.

Seven-vegetable couscous is a well-known offering at Sephardic Jewish New Year celebrations, but since it’s a bountiful, colorful tribute to the harvest, it makes a great meat-free main dish for Thanksgiving as well. Despite the long ingredient list, it’s as easy as can be to make.

1 1/2 cups couscous, uncooked
1 tablespoon vegan margarine
1 teaspoon turmeric
1 teaspoon salt
2 tablespoons extra-virgin olive oil
2 medium onions, chopped
1 cup finely shredded white cabbage
1 medium turnip, peeled and diced
1 medium yellow summer squash, halved lengthwise and thinly sliced
1 medium zucchini, halved lengthwise and thinly sliced
1 15- to 16-ounce can chickpeas, drained and rinsed
1 1/2 cups diced ripe tomatoes
2 teaspoons grated fresh or jarred ginger, or more, to taste
1 teaspoon ground cumin
1/2 teaspoon ground coriander
Dried hot red pepper flakes, to taste, optional
Salt and freshly ground pepper, to taste
1/2 cup golden raisins (for garnish)
1/3 cup minced fresh parsley (for garnish)
Sliced or slivered toasted almonds (for garnish)

1. Combine the couscous and 3 cups boiling water in a heatproof bowl. Cover and let stand until the water is absorbed, about 15 minutes. Fluff with a fork, then stir in the margarine, turmeric and salt. Cover and set aside.

2. For the vegetable stew, heat the oil in a large saucepan or soup pot. Add the onions and sauté over medium heat until translucent. Stir in cabbage and sauté until it and the onion are lightly golden.

3. Add the remaining stew ingredients. Bring to a simmer, then cover and reduce the heat to medium-low. Cook, stirring occasionally, for 15 to 20 minutes. Add water as needed to produce a moist, but not soupy, consistency. The vegetables should be just tender, but still firm.

4. To serve, arrange the couscous on the outer edge of a large serving platter and make a well in the center. Pour the vegetable mixture in the center, then sprinkle with the garnishes, topping with sliced or slivered toasted almonds. Let each guest place a mound of couscous on his or her dinner plate and top it with the vegetable mixture.

Yield: 8 servings.


October 31, 2011, 5:47 pm

Lessons From a Halloween Costume

Boo was dressed as Daphne from Scooby Doo for Halloween.Last year, Sarah Manley’s son dressed as Daphne from Scooby Doo for Halloween.

A year ago I made the seemingly mundane choice to let my son choose his costume for Halloween. He chose Daphne from Scooby Doo. A few parents at his preschool disapproved, I wrote a blog post about it, and in the blink of an eye, the post set off a national discussion about gender identity, bullying and a parent’s role in both issues.

It seemed everywhere I turned someone was reposting my article or writing a commentary on my parenting. CNN called for an interview. Even the Well blog wrote a piece on the subject. My original article still gets a couple of hundred views each day and has about 47,000 comments. Isn’t that insane? I had no idea it would strike such a chord.

A year later, looking back on the events before and after Halloween, I still struggle to understand what all the fuss was about. The silly thing is that everybody else put far more thought into the costume than my son did. He loved Scooby Doo the cartoon, but he had already dressed as Scooby Doo, the dog, for a past Halloween. He looks just like the Scooby Doo character Fred in real life, so he didn’t see a lot of costume potential there. The obvious choice, to him at least, was Daphne — orange wig, purple outfit — can’t get much more fun than that.

But the rest of the world, starting with some of the mothers at his preschool, saw things differently. Read more…


October 31, 2011, 5:14 pm

Steve Jobs’s Cancer Choices

CANCER VICTIM Adhesive notes made Steve Jobs's face on the Apple Store in Munich.Christof Stache/Agence France-Presse — Getty ImagesCANCER VICTIM Adhesive notes made Steve Jobs’s face on the Apple Store in Munich.

Did Steve Jobs doom himself by delaying conventional medical treatment?

When doctors first discovered a cancerous tumor on his pancreas in 2003, Mr. Jobs was urged to undergo an operation to remove it. But he chose instead to try alternative treatments, experimenting with herbs, acupuncture and other remedies for nine months before agreeing to surgery. As Denise Grady points out in a story in today’s New York Times, by then, the cancer had spread to his liver, leading many to speculate that putting off surgery may have done more harm than good.

But there is no way in this life to know what might have been — not in politics, baseball, romance or the stock market, and certainly not in sickness and health. Mr. Jobs’s wish to avoid or delay surgery was not unusual. And given the type of tumor he had and the way it was found, his decision to wait may not have been as ill considered as it seems at first blush ….

Dr. Edward M. Wolin, co-director of the carcinoid and neuroendocrine tumor program at Cedars-Sinai Medical Center in Los Angeles, said that among patients with the kind of cancer Mr. Jobs had, “when they are first found on a scan, about 60 percent of the time it’s already metastasized to the liver.” Another expert, Dr. Steven K. Libutti, director of the Montefiore Einstein Center for Cancer Care in New York, said that based on his reading of the new biography, it seemed likely that Mr. Jobs’s tumor had spread by the time it was found, and the delay in surgery probably did no harm.

Is there any way to know whether Mr. Jobs made the right decision? Read the full article, “Hindsight Is Kind to Steve Jobs’s Decision to Delay Surgery,” and then please join the discussion below.


October 31, 2011, 3:38 pm

Do ‘Nice’ Doctors Make Better Doctors?

In an effort to improve the doctor-patient relationship, many medical schools are now filtering out candidates who lack communication skills. Breeding nice doctors, it seems, is becoming something of a trend. But in an essay in today’s New York Times, Dr. Lisa Rosenbaum asks whether selecting future doctors based on their interpersonal skills could backfire:

How do we even measure these skills? During one of my clinical training sessions, a patient told me no physician had ever made her feel more at ease. The next cautioned that I made too much eye contact, sat too close and “invaded” her personal space. After briefly feeling like a sex offender, I realized the process, though well intentioned, was flawed.

Proponents of weeding out students who lack interpersonal skills argue that communication errors are at the root of medical mistakes. But we have no data to suggest that medical students who sit close but not too close make any fewer mistakes than their less-communicative colleagues. The awkward student in the corner who obsessively follows a checklist may make fewer procedural mistakes than his charming friend who lights up the room.

How much weight should medical schools place on communication skills? Have you had an experience where a doctor’s ability to communicate affected your treatment? Read the full essay, “Downside of Doctors Who Feel Your Pain,” and then please join the discussion below.


October 31, 2011, 1:05 pm

Really? The Claim: For a More Restful Nap, Avoid Caffeine

Christoph Niemann

THE FACTS

Late November is the start of the busiest travel season of the year, when millions of drivers hit the road for long-distance treks. Many will be sleep-deprived and looking to pull over for a nap or a dose of caffeine.

But the best idea may be to combine the two, and not in the order one might think.

Ordinarily, sleep experts advise steering clear of coffee and other stimulants before resting, since caffeine disrupts sleep. As a result, studies on drowsy drivers have generally compared the restorative benefits of pulling over and napping versus pulling over for a cup of caffeine. Researchers have found that a 15- to 30-minute nap increases alertness and driving performance, but most studies show that drinking caffeine is a slightly superior strategy.

In a series of studies, however, sleep researchers in England found that drinking a cup of coffee and then immediately taking a 15-minute nap was even more effective. The researchers tested sleep-deprived subjects in driving simulators and found that a “caffeine nap” improved driving performance and reduced sleepiness better than other commonly employed techniques, including cold air, a short nap, a break with no nap or 200 milligrams of caffeine, roughly the amount in a 10-ounce cup of strong brewed coffee.

This method is believed to work because the short power nap helps clear the brain of the sleep-inducing compound adenosine. Caffeine, meanwhile, takes about 20 minutes to have its physiological effect — kicking in just as the napper is awakening.

THE BOTTOM LINE

A cup of coffee followed by a 15-minute nap may be more restorative than either one alone.


October 28, 2011, 10:31 am

Topping a Meal With a Poached Egg

Andrew Scrivani for The New York Times

In this week’s Recipes for Health, Martha Rose Shulman explains the art of poaching an egg. She writes:

When I was a caterer I learned that you can poach eggs ahead — they’ll keep for several days in a bowl of cold water in the refrigerator. Just carefully drain and warm in a bowl of warm water. Not that they’re any trouble to poach on the spot. Here’s the very reliable method I use: Fill a frying pan with water — for one or two eggs I use my 8-inch omelet pan — and bring to a boil. Add a tablespoon of vinegar to the water. One at a time, break the eggs into a teacup, then tip from the teacup into the pan (do this in batches if necessary). Immediately turn off the heat under the pan and cover tightly. Leave large and extra-large eggs for four minutes. Smaller eggs, like the beautiful ones an urban farmer friend brought me from his henhouse the other day, will be done in three. Using a spatula or a slotted spoon, carefully transfer to a bowl of cold water. Before serving, drain on a clean dish towel.

Here are five ways to top off your meals with a poached egg.

Quinoa, Spinach and Poached Egg: As in most of the other comforting and simple dinners for one in this week’s Recipes for Health, all of the elements here can be prepared in advance of assembling this dish.

Eggs Poached in Marinara Sauce: This meal, which Italians call “eggs in purgatory,” comes together in little more time than it takes to toast some bread and warm the sauce.

Beet Greens Bruschetta With Poached Egg and Fontina: Toasted whole-grain bread forms a foundation for garlicky greens and silky poached eggs.

Eggs Poached in Curried Tomato Sauce: A South Asian version of huevos rancheros, this dish will leave you with plenty of extra sauce to use down the road.

Endive and Quinoa Salad With Poached Egg: Long-lasting endive makes this a forgiving dish for busy cooks with unpredictable schedules.


October 27, 2011, 2:56 pm

Think Like a Doctor: The Right Test Solved!

On Wednesday, we challenged Well readers to really think like a doctor. We asked you to figure out the diagnosis for a young woman with longstanding pain and other ills and to design the testing strategy necessary to reach that diagnosis — to do, in short, what every doctor has to do in order to make a diagnosis.

The response was fantastic. Over 400 of you wrote in with suggestions of possible diagnoses as well as the medical tests needed to get there.

The correct diagnosis is …

Celiac disease, also known as gluten-sensitive enteropathy

This was a challenging case, but the right test was requested at 1:39 a.m. — just a couple of hours after the case was posted. Hats off to EGH from Arizona for asking for the key test used to help diagnose celiac disease. Several of you were interested in celiac, but it was Jan, a physician assistant from Bridgewater, N.J., who wholeheartedly put his money down on this as the diagnosis.

How the Diagnosis Was Made:

Test results started to trickle in days after Dr. Podell spoke with the patient. First the patient’s doctor in Ohio sent copies of her office visits, as well as labs, studies and consult reports from the past two years. Over that time she had seen a couple of pain specialists, a gastroenterologist and an allergist. She’d been scoped, X-rayed and CT scanned. She’d been stuck for blood and pricked for allergy tests. Most of the tests were unrevealing. But, amid all the normal tests, two stood out. In 2009, she had been tested for celiac disease: two blood tests were performed, and both were positive.

A few days later, results from tests that Dr. Podell had ordered started to arrive. Again, most were unrevealing. She didn’t have any evidence of an inflammatory muscle or joint disease; she didn’t have hepatitis B or C; there was no evidence of thyroid disease or liver disease or muscle disease. She didn’t have Lyme disease or lupus or H.I.V. infection.

What she did have were remarkably high levels of the two antibodies associated with celiac disease. Still, a positive blood test is not a diagnosis. She had also been evaluated by a gastroenterologist who had looked at her upper and lower gastrointestinal tract and found nothing. Despite that, Dr. Podell’s suspicion for celiac disease remained high. Read more…


October 27, 2011, 1:07 pm

New Rules for Childproofing a Home

If you thought childproofing was about cabinet locks and baby monitors, think again. New technology has brought new challenges for parents trying to childproof their home for babies, toddlers and small children. The latest Home & Garden report offers practical, informative advice.

These experts underlined one lesson: if you get your childproofing advice from friends, don’t trust everything you hear.

That’s because childproofing has changed in recent years, both in the products offered and in the household hazards parents face. So, families with older children are working with yesterday’s ideas.

For example, our youngest child — our fourth — is 9, so we’re not too far removed from this topic. Yet those little plastic outlet covers that seem just fine to me are apparently now ruled unwise. Likewise, a video baby monitor sounds to me like a great new safety device. But I’m wrong again.

“We started seeing strangulations about three years ago,” Mr. Mays said, alluding to the monitor cords. “In one case, the very first day the child was able to stand up in the crib, the child grabbed the cord, got tangled and died.”

And even just a few years ago, flat-screen TVs were too expensive to put on every conceivable surface in the house — especially dressers. That is no longer true, and that’s a problem.

“If a child climbs on the drawers, that TV can come crashing down,” Ms. Driscoll said. “There have been lots of injuries and deaths associated with furniture and TV tip-overs.”

Read the full story, “Childproofing: Crawling Your Way to Safety,” and then please join the discussion.


October 27, 2011, 12:02 am

Can Romance Be Reduced to Pronouns?

Behavioral scientists have long known that humans, whether in the schoolyard or in a dimly lighted bar, have a tendency to subconsciously mimic the sounds, style and movement of others. Recent research, however, shows that this mimicry also extends to how we speak and write. Even the least important words we choose can say a lot about us.

In one unusual experiment, 187 men and women gathered on the Northwestern University campus to take part in several four-minute speed dates. The couples talked about their respective majors and where they grew up, but none of that interested the University of Texas at Austin psychologist James W. Pennebaker. Instead, his focus was on the barely noticed personal pronouns (I, you, me), articles (the, a), prepositions (for, of, on), conjunctions (but, and) and other small words. These commonly used so-called function words, about 180 in all, Pennebaker says, are processed rapidly and subconsciously. And our use of them can reveal, among other things, whether a romance will work out or how well two people work together.

In the speed-dating study, Pennebaker and his colleague Molly Ireland found that couples who used similar levels of personal pronouns, prepositions and even articles were three times as likely to want to date each other compared with those whose language styles didn’t match.() The metric, called language style matching (L.S.M.), was also better at predicting who didn’t make a love connection than the individuals themselves, several of whom showed interest in a partner who did not reciprocate.() “It does better than humans themselves who are in the interaction,” said Pennebaker, author of the new book “The Secret Life of Pronouns.” “Some of the most revealing words we use are the shortest and most forgettable.”

The metric has other applications. An analysis of instant-message exchanges between dating couples used L.S.M. to correctly predict who would be together after three months and who wouldn’t.() More recently, researchers also found that groups with the highest levels of language mimicry performed the best on various tasks. Pennebaker’s team even analyzed the letters and writing of famous couples, including the poets Sylvia Plath and Ted Hughes. In the final, tumultuous years of their marriage, their already-different writing styles became even less synchronized.

Synchrony, however, does not always mean that two people like each other. Analyses of arguments, like the volatile exchange several years ago between the talk-show hosts Rosie O’Donnell and Elisabeth Hasselbeck, showed that the women used astonishingly similar speech patterns when they were arguing.() To let people see for themselves, Pennebaker offers an online diagnostic in which individuals can copy and paste their own I.M. conversations. I did this with an argument I was having with a friend, and we had 88 percent L.S.M. — daytime talk show territory.() But given the volume of e-mail, texts and Facebook posts we write, synchrony opens a new frontier into our most personal thoughts. Even the 140 character variety.


“The Fine Print”
Part of a conversation between a high-matching pair (L.S.M. = 77 percent). They wanted to see each other afterward.

WOMAN: Let’s get the basics over with. What are you studying?

MAN: Uh, I’m studying econ and poli-sci. How about you?

WOMAN: I’m journalism and English literature.

MAN: O.K., cool.

WOMAN: Yeah.

MAN: All right, um, where are you from?

WOMAN: I’m from Iowa, a town of 700.

MAN: I’m from New Jersey. Uh —

WOMAN: Probably not 700.

MAN: All right, well, I mean, actually, believe it or not, where I’m from in New Jersey has a lot in common with, like, Iowa and stuff.

Neither of these students was interested in seeing the other again. (They scored 54 percent.)

WOMAN: Where are you from?

MAN: Connecticut. . . . How about you?

WOMAN: Um, I’m from Austin, Tex.

MAN: Texas? Nice, O.K.

WOMAN: When you say football, I understand football.

MAN: Oh, O.K.

WOMAN: That’s kind of like one of those things.

MAN: That’syou a U.T. fan or a

WOMAN: Um, “fan” would be the wrong word.

MAN: An understatement? Or an o —

WOMAN: No, the wrong word.

MAN: Ah, O.K.

Half of low-L.S.M. couples broke up within three months.
O’Donnell vs. Hasselbeck

Hasselbeck: I asked you a question.

O’Donnell: And you wouldn’t even answer it.

Hasselbeck: You wouldn’t even answer your own question.

O’Donnell: Oh, Elisabeth. I don’t want. . . . You know what? You really don’t understand what I’m saying?

Hasselbeck: I understand what you’re saying.

Try it yourself: secretlifeofpronouns.com/exercise/synch


October 27, 2011, 12:01 am

Teaching Doctors to Be Mindful

Doctors from across the world gather at the Chapin Mill Retreat Center in Batavia, N.Y. to bring intention, attention and reflection to clinical practice.Brett Carlsen for The New York TimesDoctors from across the world gather at the Chapin Mill Retreat Center in Batavia, N.Y., to bring intention, attention and reflection to clinical practice.

It was 6:40 in the morning and nearly all of the doctors attending the medical conference had assembled for the first session of the day. But there were no tables and chairs in sight, no lectern, no run-throughs of PowerPoint presentations. All I could make out in the early morning darkness were the unmoving forms of my colleagues, cross-legged on cushions and raised platforms, eyes closed and hands resting with palms upward in their laps.

They were learning to meditate as part of a mindful communication training conference, held last week at the Chapin Mill Retreat Center in western New York, and sponsored by the University of Rochester Medical Center.

There has been a growing awareness among doctors that being mindful, or fully present and attentive to the moment, not only improves the way they engage with patients but also mitigates the stresses of clinical practice. Read more…


October 26, 2011, 1:18 pm

Will You Give Your Son the HPV Vaccine?

A federal panel has recommended that boys be given the vaccine for human papillomavirus, or HPV. But will parents agree to it?

Gardiner Harris reports on the story in today’s New York Times:

The vaccine has been controversial because the disease it prevents results from sexual activity, and that controversy is likely to intensify with the committee’s latest recommendation since many of the cancers in men result from homosexual sex….

HPV infection is the most common sexually transmitted disease — between 75 percent and 80 percent of females and males in the United States will be infected at some point in their lives. Most will overcome the infection with no ill effects. But in some people, infections lead to cellular changes that cause warts or cancer, including cervical, vaginal and vulvar cancers in women and anal cancers in men and women. A growing body of evidence suggests that HPV also causes throat cancers in men and women as a result of oral sex.

HPV infections cause about 15,000 cancers in women and 7,000 cancers in men each year….Parents of boys face some uncomfortable realities when choosing whether to have their child vaccinated. The burden of disease in males results mostly from oral or anal sex, but vaccinating boys will also benefit female partners since cervical cancer in women results mostly from vaginal sex with infected males.

If you’re the parent of a son, we want to hear from you. Will you have your child vaccinated against HPV? Please join the discussion below.


October 26, 2011, 12:02 am

Think Like a Doctor: Ordering the Right Test

The Medical Mystery: What tests need to be ordered to help reach a diagnosis for a young woman with chronic pain that has lasted for a decade?

The Diagnosis column of The New York Times Magazine regularly asks Well readers to sift through the details of a difficult medical case and solve a diagnostic riddle. This month’s puzzle is a two-part challenge that will require you to really think like a doctor. That’s because, just like the real doctor involved in the case, you’ll need to decide what tests should be ordered based on this patient’s medical history.

Post your test request, and if the test was actually ordered, I’ll post the results in the comments section throughout the day. Follow the test results, and once you have figured out the diagnosis, post your answer. The first person with the right diagnosis gets a copy of my book “Every Patient Tells a Story,” and the satisfaction of solving a tough, tough case.

Let’s get started.


The Presenting Problem:

“Will you see my sister?” the young woman asked. Dr. David Podell’s office had told her the doctor wasn’t taking new patients, but she wondered if he would see her sister just once. “She’s so sick and has been to so many doctors, and no one knows what she has.” The woman had heard Dr. Podell described as a kinder and gentler version of Dr. House, the cantankerous television doctor who specializes in medical mysteries. Dr. Podell was a rheumatologist who specialized in odd diseases and who might, she hoped, be able to untangle the complex case presented by her older sister’s mysterious illness.

Dr. Podell listened to the woman, a colleague of a colleague, as she briefly laid out the story of her sister, now 32, who over the past 10 years had become completely disabled by strange pains and odd episodes of weakness that no one could explain. She handed Dr. Podell a letter her sister had written to him. It painted such a picture of suffering that he knew he would have to say yes.

“I am very desperate for help and I am struggling every day all day without relief,” the sister wrote.

“I have heard you are the best and if there is help out there you are the one” who will make it happen, she continued. “Please give me back my future.”

(You can read the entire letter below; click on the box in the lower left to expand in a new window.)


Dr. Podell wasn’t sure he could help, but he agreed to see her. However, she lived in Ohio, and before she traveled all the way to Middlebury, Conn., to see him, he would need to get a copy of her medical records with all the testing she’d had done, and he would need to talk with her by phone.

The Patient’s Story:

Dr. Podell called his patient-to-be that Saturday afternoon. Her voice was soft and high-pitched, making her sound younger than her 32 years. She told him that she couldn’t really remember when it all started but that her whole life had seemed one of near-constant pain. Now she was at a breaking point. It started to become unbearable when she was pregnant with her now 7-year-old daughter. She’d had to spend most of that pregnancy in bed because of terrible back pain. Her pelvis had separated prematurely, she’d been told. And her pain had slowly been getting worse ever since.

Her parents, who lived nearby, had been wonderfully supportive over the past several years. She didn’t realize how much she’d come to depend on them until they went to Germany on vacation — their first in a decade. Suddenly, without their help, she realized how limited she was and how much they had done to make her life possible. On the days when she couldn’t get out of bed, they would help her get her young daughter to and from school and help her with the shopping. With them out of town, she felt overwhelmed and helpless. She’d turned to her sister, who lived in Connecticut and could provide her with at least the emotional support she needed, and called her every day, sometimes several times a day. That’s when her sister had begun to look for a doctor who could figure out what was going on with her, and that’s how she found Dr. Podell. Read more…


October 26, 2011, 12:01 am

A New Breed of Knee Injury in Young Athletes

Richard Patterson for the New York Times
Phys Ed

Sometimes physicians will notice a medical trend well before science confirms its existence. That has been the case with injuries to the anterior cruciate ligament, the main ligament that stabilizes the knee joint, in young athletes. “Doctors who treat kids have all been saying over and over that the numbers of A.C.L. tears are going up dramatically,” says Dr. J. Todd Lawrence, an orthopedic surgeon and pediatric sports medicine specialist at the Children’s Hospital of Philadelphia. But surprisingly little firm data has confirmed that hunch.

So, for a study presented this month at the annual conference of the American Academy of Pediatrics in Boston, Dr. Lawrence and his colleagues parsed emergency room records of pre-adolescent youngsters treated at Children’s Hospital, looking for A.C.L. tears, as well as tears of the meniscus, the small pillows of cartilage that help to cushion the knee bones.

They also checked for fractures of the tibial spine, a fingerling spit of bone that extends from the tibia, or shinbone, to which the A.C.L. attaches. In prepubescent children whose skeletons are still growing, the slender tibial spine can be weaker than the tissues of the A.C.L. and break under the pressures of hard twisting or planting of the knee, even as the A.C.L. remains intact. “There was a time when the tibial spine fracture was the knee injury of childhood,” Dr. Lawrence says. “Twenty years ago, medical textbooks usually included a statement saying that kids did not tear their A.C.L., that they fractured the tibial spine instead.”

But when the researchers examined the pediatric hospital records, from 1999 through early this year, they found only 155 tibial spine fractures, while there were 914 confirmed A.C.L. tears and 996 meniscus tears. More important, while the incidence of tibial spine fractures increased at a rate of about 1 percent per year during that period, the incidence of A.C.L. tears increased by more than 11 percent per year. The difference almost certainly was not a result of better equipment leading to better diagnoses of A.C.L. tears, Dr. Lawrence says. “Even in 1999, M.R.I. technology was quite good,” so it was possible for physicians to differentiate between the injuries.

Which means that increasingly large numbers of young athletes, both boys and girls, are now suffering an injury to which doctors once thought they were almost immune. Read more…


October 24, 2011, 4:01 pm

Mammogram’s Role as Savior Is Tested

Stuart Bradford

Has the power of the mammogram been oversold?

At a time when medical experts are rethinking screening guidelines for prostate and cervical cancer, many doctors say it’s also time to set the record straight about mammography screening for breast cancer. While most agree that mammograms have a place in women’s health care, many doctors say widespread “Pink Ribbon” campaigns and patient testimonials have imbued the mammogram with a kind of magic it doesn’t have. Some patients are so committed to annual screenings they even begin to believe that regular mammograms actually prevent breast cancer, said Dr. Susan Love, a prominent women’s health advocate. And women who skip a mammogram often beat themselves up for it.

“You can’t expect from mammography what it cannot do,” said Dr. Laura Esserman, director of the breast care center at the University of California, San Francisco. “Screening is not prevention. We’re not going to screen our way to a cure.”

A new analysis published Monday in Archives of Internal Medicine offers a stark reality check about the value of mammography screening. Despite numerous testimonials from women who believe “a mammogram saved my life,” the truth is that most women who find breast cancer as a result of regular screening have not had their lives saved by the test, conclude two Dartmouth researchers, Dr. H. Gilbert Welch and Brittney A. Frankel. Read more…


About Well

Tara Parker-Pope on HealthHealthy living doesn’t happen at the doctor’s office. The road to better health is paved with the small decisions we make every day. It’s about the choices we make when we buy groceries, drive our cars and hang out with our kids. Join columnist Tara Parker-Pope as she sifts through medical research and expert opinions for practical advice to help readers take control of their health and live well every day.

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