THE PARTY OF WORK

David Brooks (The Party of Work, NYTimes Nov 8) correctly points out important reasons why Republican emphasis on individualism failed to attract voters. Hard working Asians and Hispanics don’t buy into rugged individualism, a concept as old as the Mayflower. They recognize the benefit of having some security through government.

What Brooks left out, as everyone is afraid to include, is the role of fundamental Christian beliefs in Republicans losing the election. It is Christian beliefs that hijack the education of our children away from science, reduce their future competitiveness and obstruct medical innovations such as stem cell research. It is Christianity (as well as orthodox Judaism and fundamentalist Islam) that supports male-dominant societies that treat women as property or conduits for progeny and strive to remove their having any control over their own bodies. Christian beliefs are usually the main justification for resisting civil rights of gays. The list goes on. It’s all in the Bible, sometimes between the lines, and it was rejected by voters last Tuesday.

Brooks also omits a more insidious force in Republican camps: classism, which runs deep in old money. The rich wish to preserve class differences as long as they can. They couch it in terms of job creation or trickle down benefits if taxes are kept low, but it really is class warfare. They don’t want expanding middle classes or waves of immigrants to upset their own apple carts. Other people’s poverty doesn’t seem to bother them much. It’s a story as old as the Bible. It’s what caused the French revolution.

But back to individualism. In early U.S. history, the least functional of these libertarian types just moved further into the frontier, as Brooks pointed out. Now, we’ve run out of frontier. And sadly, there are no far-off lands toward which Karl Rove, Rush Limbaugh and several tall blond rabid Republican women commentators might set sail. Looks like they’ll just have to learn how to get along.

The Republican loss is a move in the right direction. Who knows, maybe in a decade or two the country can take on hand guns, or eliminate the teaching of Creationism in public schools.

November 10, 2012

https://www.jameschanningshaw.com

ROOM FOR EXAMINATION

For all of James's blogposts, books, and more, visit https://www.jameschanningshaw.com

My blog has been rather silent for a while. I'm sure you've been heartbroken. The reason is that I've been working on my new book, the title shown below. It finally went live on Kindle this week and is available through the Kindle store. If you do not own a Kindle, the Kindle app is free for ipads and iphones, possibly other computers.

This is an account of my career as doctor and dermatologist; the training, the patients, doctors, the practice in both private and academic settings. 

Here's an excerpt from the first chapter:

One Friday, Mrs. Berenson, a woman in her late fifties, was hospitalized for severe psoriasis. Hers was much worse than most. I took a history and examined her. We ordered some standard treatments and I left for the weekend. Over the years she had become familiar with the hospitalization routine.

When I arrived Monday morning, Dr. Raugi broke the terrible news. Early Saturday morning Mrs. Berenson climbed out her tenth floor window without being noticed by nurses, and jumped to her death.

        As soon as I could, I went alone to her room. It smelled of disinfectant. I closed the door, muffling the voices that came from the corridor. What had we missed? We must have missed something. This wasn't the psych ward; this was dermatology. I could hear a siren in the distance. I put my head against the glass to look down at the flat roof of the service entrance ten floors below. A shiver crossed my shoulders. Dermatology patients don't commit suicide. Had there been clues? Morning sun shimmered on the river and bridges below in the city. Admittedly, her diagnosis was a severe form of psoriasis, the pustular type of psoriasis, the von Zumbusch type that covers the entire body, and she had struggled with it for years. I pulled open the window, letting in traffic noise, and pushed it closed again. There had been prior hospitalizations. Maybe Mrs. Berenson had had enough of the repeated admissions and poor results. Did we make the mistake of directing all our attention to her skin disease while overlooking a profoundly depressed, suicidal woman? I looked around the room. Housekeeping had already made up her bed. More likely, we missed something much larger. We, Medicine, the profession of medicine, had failed her.

I hope you get a chance to read the book!

James Channing Shaw 

GNOCCHI in creamy tomato sauce: 

           Prep time: 10 minutes

           Cooking time: 30-40 minutes

           Serves 2 to 4

Gnocchi must be one of the ultimate comfort foods of all time: soft, sexy little bite-sized potato puff dumplings, firm enough to resist in your mouth, bland enough to absorb whatever sauce you put with them. Gnocchi are wonderful as a starter, side dish or main entrée.

Try this easy recipe. You won’t be sorry. It’s pronounced approximately: “Nyoki”

MUSIC: Listen to the song Calgary from the Bon Iver album called BON IVER, and then listen to the rest of the album. Gorgeous. It’s pronounced approximately French: ‘Bone Yverre’.

HERE’S ALL YOU NEED:

           

•             Gnocchi: one package 500g, vacuum packed or fresh
•             Shallots or yellow onion, finely chopped, ¼ Cup
•             Garlic, ½ to 1 medium clove, finely chopped
•             Grape or cherry tomatoes: approx 300 grams (10 oz) or about 30 tomatoes
•             White wine: (vermouth, dry white, or sweet white), 1/3 to ½   Cup
•             Heavy cream (from 18% to 35% fat), ½ Cup to 1 Cup
•             Salt, pepper
•             Pinch of sugar
•             Olive oil: 3 TBSP
•             Thyme (optional) small pinch
•             Slivered basil leaves for garnish
•             Parmesan cheese, grated, for garnish

HERE’S WHAT TO DO:

·        sautee tomatoes in olive oil for five minutes in a covered shallow sauce pan

·        add shallots, garlic, salt, thyme, pepper, sugar and cook, covered, stirring occasionally, until tomatoes are soft or broken and release some liquid.

·        While tomatoes cook, bring pot of water to boil for the gnocchi

·        Add wine to tomatoes and reduce, uncovered, to about 1/3 liquid

·        Salt the pot of water and add gnocchi: stir occasionally to prevent sticking on the bottom. Gnocchi are done when they float, about 2 to 5 minutes

·        Add cream to tomato mixture and bring to a medium boil.

·        Add more salt and pepper to taste

·        When gnocchi are done ladle them into the tomato mixture through a slotted spoon and reheat.

·        Mix gently and serve

·        Garnish with slivered fresh basil and parmesan cheese.

 

WINE: This dish goes well with a red or white. White Burgundy, Chablis or Chardonnay, or a Chianti or Rioja would do nicely. Avoid a really heavy red like a Shiraz. I would accept a nice red Bordeaux, especially if the gnocchi are served with an accent of rare rib eye on the side.

            

GUM CHEWING: the ugly side

                                    by James Channing Shaw

            Try this experiment. Walk up Broadway in New York or any big city street. Watch people chewing gum. Do you think they look good? Sexy, manly, feminine, smart, whatever? If so, I probably can't help you. 

NEW YORK CITY

            Now try this: Look down at the sidewalk in New York or any city of five million or more. For miles and miles, each and every concrete slab of sidewalk is polka-dotted with hundreds of splats of stepped-on gum, mostly black, no matter how pink or sparkly or blue they started out. And—talk about disgusting—try stepping on a soft wad that sticks to your heel in a really long string and gets picked up by the wind and wraps around your pants. But I don’t care that much about your pants, or the polka-dot sidewalks. It’s the chewing that gets me. 

PARIS

            My guess is that the majority of people who regularly chew gum do it more for the image than the taste. For those who are about image, I wish you luck. For those who chew gum for the taste, or your breath, there still is hope for you.

            

Here’s the concept: Quietness is a great beautifier.^* Picture the inside of Notre Dame Cathedral in Paris at closing time; a grove of giant Sequoias at dusk with rays of sun peeking through; an empty stage with a nine-foot grand piano. Quietness beautifies your face as well. Rippling jaw muscles are off-putting, tense. Blow bubbles and you have just labeled yourself a junior high school punk or a Valley Girl from the eighties. Chew with an open mouth and you become a caricature of a gangster, a pimp, or some other low life form. Yeah, you're tough all right. Just need a few tattoos.

            Let’s face it. Gum chewing and charm are as incongruous as oysters with chocolate sauce, or a Republican with a social conscience. They simply don’t go together.

            I can accept it when it’s a celebrity doing the chewing, especially when it serves a purpose. John Lennon, I admit, looks pretty good chewing gum in the studio recording of “All You Need Is Love”, but he has to keep the saliva flowing. He has a job to do. Or the final scene of Last Tango in Paris in which wounded Marlon Brando slows his jaw, furrows his brow, takes the gum out of his mouth and sticks it to the underside of the balcony railing before he collapses, dead. It is hard to deny that gum chewing carries with it some cachet in the arts. At least for Brando and Lennon.

            But what famous role models have chewed gum over the years? Queen Elizabeth? Winston Churchill? Fred Astaire? Audrey Hepburn? Jacqueline Kennedy Onassis? The President of the United States?  Of course not. None of them. In public, at least. The gum-chewers would be the Donald Trumps of the world, televangelists, professional wrestlers, the Charlie Sheens of the world, low-level politicians, maybe ex-governors of Alaska. You get the gist. In what career could it possibly be advantageous to interview for a job with gum in your mouth? Induction into the Mafia, perhaps.

            There is one major exception to all this:  professional baseball players. To their credit, they figured out that the manly wad of tobacco they used to squirrel into the sides of their cheeks caused mouth cancer, so now it's a gooshy wad of pink bubblegum. It looks so juvenile, so demeaning, compared with the tobacco, but they deserve a break. And they have important work to do, as do soldiers, whom I would totally forgive for chewing gum. Maybe, though, the ball players could consider not blowing bubbles during televised games, at least while at bat.

 * quote from Robertson Davies

There is something about Paris.

At the intersection of Rue de Seine and Rue Jacques-Callot in the 6^th arrondissement sits one of the most pleasant cafes in the entire world. The name of the place is La Palette. Last week, just after Halloween, having walked past this cafe several times with its tangle of blooming pink rose vines above the entrance, we finally got the chance to sit and have a drink on our way home from art gallery browsing. When we arrived, every outside seat on the terrace was taken except two lonely tables with ‘reserved’ signs. We eventually squeezed through the double front door to a small room with  two empty tables open to the air, also reserved. The maître-d’ intercepted us, and before we could explain our intentions, he opened his arms to the reserved tables. Easy. Lucky.

La Palette has none of the affectations that a 2011 food writer might rave about in, say, The Globe and Mail or The New York Times. There is no meat market feel: people, mostly young, all wearing scarves around their necks, come here to talk and sip on an aperitif, some stay on into dinner. There is no throbbing hip-hop with a subwoofer that throws out your sacro-iliac joint. In fact, there is no music at all—one listens instead to the friendly sound of the occasional clink of a wine glass, intermittent “bonsoir” or “merci” between patrons and bustling, black-vested, long white-aproned servers; strangely, one conducts a conversation here without even raising one’s voice. There is no television, no neon: the venerable café is paneled with warm old wood walls and covered with paint-smeared palettes from not-so-famous painters, perhaps famous ones as well, since Picasso and Cezanne, among others, were known to frequent the place. Outside, in fading light, a crowd enjoys the soft air of an Indian Summer. Inside, a long zinc or copper bar with the same warm wood plus marble paneling extends along one entire wall, clearly the command center of the café. We had time for one beer, a delicious Belgian Grimbergen, then back into the balmy Paris night.

There definitely is something special about Paris. This particular bar/café is merely one small taste. At La Palette, we carved out a few minutes of that special je ne sais quoi, that unique brand of social networking that does not require a computer, a culture of civilized intercourse that is found nowhere in the world but Paris. 

SUN PROTECTION: Myths and truths

SUN PROTECTION: Myths and truths

                   

             Summer is here, and despite growing familiarity with the concept of sun protection over recent years, misconceptions abound concerning sun safety and how best to protect yourself from the damaging effects of the sun. The causative role of the sun is indisputable in skin cancer and premature aging of the skin. Even melanoma, the most rapidly increasing cancer in white populations, is strongly associated with intermittent sun exposure.

            Here are six of the most commonly held myths surrounding sun protection.

            Myth #1: All skin types require sunscreens.

            The truth: Individuals with very fair skin (red hair, freckles, sunburn always) and fair skin (blue to hazel eyes, light skin, sunburn easily) benefit most from regular use of sunscreens. Natural pigment (i.e. melanin in the skin) is by far the most effective sunscreen. The darker a person’s skin, the greater the innate protection. Individuals with olive-colored (tan easily, rarely burn) or darker skin (never burn) have very little risk of developing the types of skin cancer that arise on sun-damaged skin. Sunscreens can help prevent further darkening after exposure to the sun, but skin cancer prevention and photo-aging is much less of an issue for individuals of color.

            Myth #2: If you use appropriate sunscreens, sun exposure is safe.

            The truth: Sunscreens mostly protect against burning rays (ultraviolet B, or UVB). Deep penetrating tanning rays (UVA) still get through to the dermis where they contribute to aging and skin cancer. The absence of sunburn with sunscreen gives a false sense of security and often translates to spending more time in direct sun. This is a potentially harmful practice, one that explains, in part, the increased incidence of melanoma that has been reported in sunscreen users.

            The correct approach, then, for preventing skin cancer and photo-damage is to use sunscreens regularly as one part of a lifestyle of sun avoidance behavior (hats, long sleeves, long pants, shade). Daily sunscreens are especially important on the face, ears, neck and hands where coverage with clothing is difficult. If your goal is getting a tan or a dose of Vitamin D, it is safer to spend short amounts of time in the sun without sunscreen, then cover up or seek an umbrella.

            Myth #3: If SPF-30 is good, SPF-60 must be twice as good.

            False. Two points are crucial here. First, SPF-4 or SPF-8 sunscreens deliver inadequate protection, but once you get to SPF-15, you achieve more than ninety-two percent protection. Increasing to SPF-30 or SPF-60 merely takes it to ninety-four or ninety-five percent. The amount and frequency of application become the important issues, as long as you are using SPF-15 or higher.

            Second, SPF grades only UVB protection (the burning rays). There is no equivalent grading system for UVA protection. One must rely on the ‘broad spectrum’ labeling to indicate UVA protection, and it is often inaccurate. The best UVA blockers are zinc oxide and titanium dioxide.

            Myth #4: You don’t need sunscreens on a cloudy day.

            The truth: Ultraviolet light intensity is not reduced on cloudy days. The rays get jumbled in the clouds, but the intensity hitting a person’s skin at ground level is the same as on a clear day. Cooler temperatures with clouds give a false sense of security which often means that people spend more time exposed without protection. Also, with ultraviolet intensity being greatest on June 21^st every year in the Northern hemisphere, UV intensity in May can be the same as July, April can be the same as August, and March the same as September. Sunscreens should be used at least from March through September.

            Myth #5: Sunscreens must be applied thirty minutes before going in the sun.

            The truth: This is totally false. The chemicals and blocking agents in sunscreens are fully effective right out of the tube. In fact, the sun-blocking effects of sunscreens have been shown to be the strongest immediately after applying to the skin, and gradually fall off in strength over several hours.

            Myth #6: Only specialty clothing provides good sun protection.

            The truth: All types of clothing, when dry, protect from the skin from both UVB and UVA radiation. Of course, the tighter the weave, the better the protection. Specialty clothing manufacturers have designed excellent sun-protective clothing and have confirmed high SPF equivalency values, but the real benefits lie more in the comfort and lightness of their fabrics, not the sun protection per se.

            The exception to this rule happens when fabrics get wet. Most standard clothes, t-shirts for instance, become worthless as sun barriers when they get wet. Specialty sun-protective garments maintain their SPF when wet, and highly protective swimwear is available for children and others spending hours in the water.

            

Vitamin E and THE SKIN, PART II: Anti-Oxidant effects

Does supplemental Vitamin E (orally or topically on the skin) deliver real health benefits?

Go to: It's Your Skin: treat it well!

http://itsyourskintreatitwell.blogspot.com/ 

https://www.jameschanningshaw.com

PORTIFICATION© of red wine


Red wine lovers! Try these two unconventional approaches to preserving your wine. Purists, don't scoff just yet. These methods, I admit, are heretical. But your palate does not lie. If you detect good flavors where once there were bad ones, that’s the name of the game.

1. Portification. How many times have you opened a not-so-inexpensive bottle of red and been disappointed? You wouldn’t serve it to guests, but are reluctant to pour it down the drain. And how many times have you wished you could resurrect a two-day-old bottle of Bordeaux that has lost its mojo?

There is hope. PORTIFY© your wine. Add Port to a glass of wine, about ¼ Port, ¾ wine. It makes all the difference in the world. Cheap $10 Port is fine for the job. Ruby Port is better than Tawny Port. Works best with Cabernet Sauvignon, Merlot, Shiraz, Malbec and Italian wines, and less well with Pinot Noir.

2. Refrigeration. The second approach is a no-brainer. Personally, I’ve been disappointed with the air evacuation method of preservation, but white wine can sit around in the refrigerator for days until the bottle is gone. Refrigeration slows all the oxidation processes. It turns out that red wine is the same: put leftover red wine in the fridge; when you pour a glass, microwave it for about twelve seconds and, Voila!, you are back in business with a surprisingly good reconstitution. Red wine can last for several days that way.

Enjoy.

visit Kitchen Jam at http://kitchenjam.blogspot.com/ for food and wine tips.

Vitamin E and SKIN, part one: Does Vitamin E prevent or treat SCARS?

Click here to read this referenced update in IT'S YOUR SKIN: treat it well!:  http://itsyourskintreatitwell.blogspot.com.

CHOICE: Not all it’s cracked up to be.

It’s about time for a little rant. It turns out that having lots of choice is not the end-all of freedom, as much as promoters of democracy, freedom and the American Way would like us to believe.

Take toothpaste, for example. I recently went to the drugstore to buy some toothpaste. Sounds simple, doesn’t it? I ended up walking out of the store totally frustrated.

I’ve been a loyal fan of Colgate toothpaste for easily forty-five to fifty years. I tried Crest for a while, dabbled with Tom’s, but mostly it’s been Colgate. Colgate was just fine. Simple, white, plain toothpaste with some fluoride. No problem. I’ve watched with trepidation over the years, the introduction of different looking boxes with the Colgate logo on them, but bypassed them completely, knowing where to direct my eyes on the shelf, to the red and white box of the regular brand. I think I must have loaded up last year during a sale.

Then, this year the plain red and white box with the plain white toothpaste became extinct, replaced by some twenty different varieties on the shelf. Now Colgate makes TOTAL; PROCLINICAL WHITE PASTE (in the blue box); PROCLINICAL GEL; ADVANCED WHITENING; ADVANCED CLEAN; GUM DEFENSE; ENAMEL STRENGTH; MINT STRIPE; MAX WHITE (with mini bright strips); MAX CLEAN WITH SMART FOAM [[[smart foam?]]]; MAX FRESH with mini breath strips; LUMINOUS CRYSTAL CLEAN MINT—Ahhhhhhh!!!—SENSITIVE MULTIPROTECTION; SESITIVE ENAMEL PROTECTION; SENSITIVE WHITENING; SPARKLING WHITE MINT ZING—God help us!!!!—SPARKLING WHITE CINNA MINT; TARTAR PROTECTION WHITENING CRISP MINT PASTE or CRISP MINT GEL; ULTRABRITE ADVANCED WHITENING. And those don’t include the brands for kids.

What marketing MBA did Colgate hire to come up with all those registered and trade-marked brands? Please! Let’s 'up' the lithium dose a bit. It’s like, how many different models of a VW bug do we need? Is this what the world of facebooking tweeters want?

Okay, I'm finished with the rant.

Way down that list, I discovered CAVITY PROTECTION GREAT REGULAR FLAVOR. Eureka! Might that possibly be a re-branded version of what I was hoping to find in the first place? I’ll give it a try if I can find it on the shelf, buried beneath the other varieties.

SHINGLES (Herpes Zoster): New Progress in Prevention!

see also: IT'S YOUR SKIN: Treat it Well!,  at http://www.itsyourskintreatitwell.blogspot.com/


Shingles is a household term these days. The medical term is Herpes Zoster. Take anyone older than sixty and that person likely knows someone who has had a case of Shingles. An estimated 500,000 Americans per year get Herpes Zoster, and up to one per hundred adults per year if you are older than 65. Worldwide, it's a huge problem that, while usually non-fatal, can cause terrible suffering.

The amazing development is that advances have been made in the vaccine arena that could almost make Herpes Zoster a thing of the past. See end of this posting.

In my 25-plus years in dermatology, I’ve consistently been impressed by the fact that Herpes Zoster (Shingles) is often misdiagnosed, even by dermatologists, and is often treated too late to have any benefit, which leads to protracted and debilitating pain. The pain and suffering that comes from Herpes Zoster is underappreciated by doctors and patients alike (except those who have it). Furthermore, patients with suppressed immune systems (AIDS, organ transplant patients, certain malignancies) can develop life-threatening illness from Herpes Zoster when it spreads throughout the body.

Fortunately, if caught early enough, there are excellent treatments for Herpes Zoster. Diagnosing it early is not always easy. In addition to treating the ‘rash’ after it starts, there is a new vaccine that promises to prevent cases of Herpes Zoster. For us aging baby boomers, that is a real advance.

So, what is Herpes Zoster and how can it be recognized, treated, and prevented?

Herpes Zoster comes from the reactivation of the chickenpox virus, called Varicella-Zoster Virus (VZV). After childhood chickenpox, the Varicella viruses (probably millions of them) become dormant and retreat to nerves in the spinal cord where they remain for the rest of our lives. With aging, or in the setting of certain diseases, immunity against VZV weakens, and the virus can become reactivated. When it does, instead of reactivating throughout the entire body, it reactivates in one nerve ‘root’ only. This single nerve root reactivation is what causes Herpes Zoster.

Herpes Zoster blisters along the inner arm

cluster of blisters on the neck

DIAGNOSIS: Because only one nerve root is involved, the rash of Herpes Zoster happens on one side of the body along the path of a nerve, hence, one side of the face, across one side of the trunk, down one side of the arm, etc. In dermatology, we learn that with any new rash on one side of the body, we MUST consider Herpes Zoster as a possible diagnosis. Even with new-onset of pain without a rash along the path of one nerve, we have to think about early Herpes Zoster. The reverse is also true: any new skin rash involving both sides of the body or multiple limbs is probably NOT Herpes Zoster. Typically in Herpes Zoster, pain/burning/tingling usually comes first, followed in 24 to 48 hours by small red bumps and fluid-filled blisters where the nerve branches up to the skin.

TREATMENT: Early treatment limits the severity of Herpes Zoster in most cases. Once the rash of blisters and pain are established, it is too late, and treatment can only be directed toward reducing pain, not preventing it.
Three anti-viral drugs exist to treat Herpes Zoster: acyclovir, valacyclovir, and famciclovir. The latter two achieve much higher blood levels orally and are the treatments of choice. The first drug, acyclovir, has excellent anti-viral activity against the other Herpes virus called Herpes Simplex, but is less effective as an oral drug against Herpes Zoster. Patients with poor kidney function require lower doses.

The key to successful treatment is to treat early. This means patients need to seek help early and doctors need to have a high index of suspicion and institute treatment based on probability, not proof of the diagnosis. There is little to no risk to patients in treating in this manner, but delaying treatment can lead to months or even years of misery, pain, and disability. Doctors who see emergency or walk-in patients are the ones best able to help patients with evolving Herpes Zoster.
In severe or untreated cases, patients are often left with protracted pain called ‘postherpetic neuralgia’. Although it usually improves slowly over time, it can be excruciatingly painful for weeks to months, sometimes years. Treatments can be helpful, but often require sophisticated combinations of pain killers, gabapentin-like drugs, anti-depression drugs, and occasional use of nerve blocks.

disseminated VZV

In patients with suppressed immune systems for any reason, Herpes Zoster can trigger a more wide-spread illness throughout the body that can be life-threatening. Again, early diagnosis and treatment with anti-viral drugs is life-saving.

PREVENTION: Back in 2006, a live vaccine against Herpes Zoster was approved in the U.S. The vaccine, called Zostavax®, is basically a larger-than-normal dose of the Chickenpox vaccine used routinely in children. Zostavax® has been shown to reduce by 50% the risk of getting Herpes Zoster. It also reduces the risk of the protracted postherpetic neuralgia by two-thirds. Every individual age 60 or older who qualifies should request and receive Zostavax®.

The new development: Shingrix® is a new vaccine made from molecular subunits of the chickenpox virus plus an immune enhancer.  It has been shown to be safe (no accidental infection) and highly effective for up to three years (so far) of protection. Two doses are given a few months apart, and the injection into the deltoid can produce significant pain. The cost is around $300 but because it is so effective, it is likely that insurers will cover the cost, and countries with drug coverage will negotiate lower prices and cover the cost for their citizens. Cost savings will follow when fewer individuals will have need for medical care of their shingles.