Tuesday, November 30, 2010

World Aids Day: December 1st 2010

With the arrival of World Aids Day in 2010, there is some good news and a renewed sense of hope on the horizon.  The 2010 Global Update by UNAIDS shows that in 2009 the pace of new infections has declined by almost 20% compared to 1999. Unfortunately, new infections still outpace treatment success by two to one. There remains much to be accomplished in BOTH access to treatment and the promotion of preventive measures.

For official information from the World Aids Campaign and for a nice interview on World Aids Day from NPR, follow the hyperlinks.

The Virginia Commonwealth University School of Medicine will be having a World Aids Day event on December 1st, 2010. Although I will not be formally participating this year, my thoughts and perspectives from last year’s speech are largely the same.

Huge in Honduras:

I am frequently asked by friends and acquaintances if I see and treat strange or exotic infectious diseases on my medical relief trips to Honduras. Common illnesses and afflictions tend to be the daily fare.

I recently co-authored a paper (Medical Relief Services in Rural Honduras: An Assessment of Healthcare Needs and Delivery with a Comparison of Two Neighboring Communities), with collaborators Rachel Whitney and Dr. Mike Stevens, highlighting the common diagnoses encountered. In brief we see a predominance of common musculoskeletal, gastrointestinal and dermatologic complaints. The prevalence of obesity in our clinical sample was indeed striking, with 60% of the patients in one community being either overweight or obese. Now, these patients are by no means a representative sample of Hondurans, however, it does highlight the impact of sociodemographic predictors of health. Although both communities were indigent, the more urbanized community was likely associated with declining physical activity and increased consumption of calorie rich, nutrient poor food. Obesity in Latin America has been increasing in the last 10-15 years. Notably, obesity is most prevalent in urbanized areas of countries rising from poverty. This has been previously reported.

So it appears that future medical relief missions to these Honduran communities should adequately prepare themselves to manage conditions associated with an expanding obesity epidemic. 

Thursday, November 25, 2010

The Pope and Public Health

In a recent publication titled Light of the World: The Pope, The Church and The Signs Of The Times,” the Pope stated that there are rare cases when condom use can be justified. His views are neatly summarized in this article. Although he did not endorse condom use for contraception, the pope did suggest  that  there may be a basis in the case of some individuals, as perhaps when a male prostitute uses a condom, where this can be a first step in the direction of a moralization, a first assumption of responsibility.”
As I am an infectious diseases physician and epidemiologist, one can easily guess my stance on condoms, particularly as a public health intervention.  It seems like ‘justification’ of condom use is subject to interpretation. This reminded me of a clever condom commercial that makes a persuasive argument.

Wednesday, November 24, 2010

Gen Y vs. MTV Generation

This past weekend I read an interesting article in the New York Times (Growing Up Digital, Wired for Distraction) on Generation Y and their obsession with wireless gadgets. Apparently, the availability and incessant use of text messaging, Facebook, Twitter etc. is distractive and prevents youngsters from focusing in class and completing homework.

As the director of 3rd and 4th year medical student Internal Medicine training at the Virginia Commonwealth University, I have noticed students furtively glancing at their mobile phones and sending messages during patient rounds. This is not to imply that our students are not all extremely bright, motivated and dedicated. It seems, however, that the disruptive effect of mobile gadgetry extends beyond that of traditional classrooms.

My parents must have had it easy. In the 1980’s I was distracted by MTV, as were millions of other teenagers. No cool smart phones, iPods, Twitter, Facebook and YouTube. How lame. However, as a proud member of the MTV Generation, I did get to watch the initial airing of Michal Jackson’s Thriller video. That’s no small consolation.

Tuesday, November 23, 2010


I was perusing and organizing my bookshelf the other day in an attempt to avoid any domestic responsibilities and decided to reflect on a few books that I read this year. I am no literati, as such I do not aim to provide of a review of the works, simply my off the cuff comments.
So here they are, and in no particular order:
Snow by Orhan Pamuk:  beautiful book, which, as a work of fiction elegantly portrays the secular and religious tensions in modern day Turkey. The use of snow, as imagery, is beautifully done and adds to the many layers of complexity and suspense in the book.
Ghost of Belfast, by Stuart Neville: A veritable page turner. Ingenious story about an ex IRA hitman being haunted by the ghosts of those he has murdered. From my reading of Mr. Neville, the quality of the story is even more impressive given that it was his first book.
Regarding medical practice and patient safety, two time publications are Safe Patient, Smart Hospitals by Peter Pronovost andThe Checklist Manifesto, by Atul Gawande. Both point out several salient facts, not the least of which is that we as medical professionals seemingly work in the best interest of our patients, however, we value autonomy over standardization of practice. A true culture of safety will not function with ‘optionalism’ and a non-standardized, haphazard implementation of know risk reduction practices. I would recommend this for every doctor and patient.
How Doctors Think, by Jerome Groopman:  An interesting analysis of physician clinical and diagnostic reasoning suitable for professionals and laypersons alike.
The Girl who Played with Fire by Steig Larsson: Ok, so I was on vacation with my wife, and I needed a good book to read as I had essentially finished my original ‘vacation book’ on the long flight to our destination. I really enjoyed it. I am still intending to read the 1st and 3rd books of the trilogy, so as to experience them in full effect.
Imperial Bedrooms by Bret Easton Ellis: Having already read Less than Zero, Glamorama and American Psycho, how could I pass this one up? My wife was even so kind as to gift it to me on my birthday! There seems to be no limits to the depravity of the Easton Ellis’ characters. Brilliant.
Labyrinth of Terror by Richard Wenzel: Only my colleague, former boss and former Chairman of The Department of Medicine at the Virginia Commonwealth University could write an infectious diseases medical thriller which has elements of hospital epidemiology, infection control, and bioterrorism.  A proper page turner.
God is Not Great, How Religion Poisons Everything by Christopher Hitchens: Whether you are a believer or not, this book is bound to stir some emotions.
The End of Povery by Jeffrey Sachs: Sustainable growth and economic development can be aligned with social goals and lift people out of extreme poverty. I am contemplating adding this book to the reading list of my Public Health Seminar at Virginia Commonwealth University
Freefall: America, Free Markets and the Sinking of the World Economy by Joseph Stiglitz: I would recommend this book, by a Nobel laureate in economics, for a better understanding of what went wrong in our latest economic meltdown. For a vetted and scholarly book on economics, it reads with ease. You will get much more than emotional sound bites on economics.
Codex 632 by Portuguese writer Jose Rodrigues Dos Santos: Cleverly done historical fiction on the secret identity of Christopher Columbus.
Don’t be Afraid Gringo by Elvia Alvarado: Although written in the 80’s, it still provides insight into the ongoing social and gender inequalities facing Honduran peasant women. Having been in Honduras multiple times now, her comments are sadly still relevant.
The Picture of Dorian Gray, by Oscar Wilde: Now I have no idea what possessed me to re-read this book. It was worth it.
Hot, Flat and Crowded, by Thomas Friedman: The celebrated NY Times columnist and author does not disappoint as makes an argument why we need a green revolution to save the planet and to jumpstart out economic future.
Brother West: Living and Loving out Loud, a Memoir, by Cornel West: I was watching Bill Maher’s Real Time and Cornel West was a guest. His commentary was hilarious and spot on. I just had to read the book…..once again my wife gifted me another great read.
While in Honduras on a medical relief trip this past summer, in the still sweltering temperatures at night, I managed to get through several mass market thrillers, translated from the original English to Spanish. I figured I might as well read in Spanish while in Central America, no?  El Testamento Maya (Domain) by Steve Alten and  El Enigma de la Atlantida (The Atlantis Code) by Charles Brokaw.
Life, by Keith Richards: Yes, it has all of the excesses expected from a rock and roll icon, and those details do not disappoint, however, what I found most interesting was how Keith Richards developed as a guitarist, musician and song writer. Well done.
Well that is about all I can remember on write about for now.

Football for Charity

Well, I have decided to focus my first post on football (futbol, or soccer for those of you stateside). For those of you that know me well, this should come as no surprise at all. I don't really have any new accomplishments to mention, except for having just completed another season in the CVSA Premier League with Richmond City FC.... ........and at age 40 to boot (pun intended).

More importantly, Richmond City is sponsoring our 6th annual Copa Navidad this December 3rd, at SCOR. Mostly we play amateur football for personal satisfaction...however, the Copa is an opportunity for us to do something beyond ourselves. This year's charity is Richmond's very own Fan Free Clinic-  providing medical care and access to Richmond's poor and uninsured.

RCFC in the 2009 Copa Navidad: finally doing something constructive on the pitch.