Say Aaah and Get Thin!

"The EndoBarrier™ is a gastrointestinal liner that acts as an impermeable barrier to prevent food from coming in contact with the wall of the intestine. This may have an effect on the patient's uptake of both nutrients and calories. It may also have a metabolic effect that is similar to Roux-en-Y gastric bypass surgery, which produces significant weight loss and resolution of type 2 diabetes."

Product statement courtesy of GI Technologies

One of the truly inspired new technologies to come along for weight loss is a product called an EndoBarrier. Inserted endoscopically, this plastic tube provides a barrier to nutrient absorbtion by shunting the food through the small intestine along the inside of a flexible plastic tube. The food does not get absorbed through the wall of the small intestine because of this plastic barrier. Fewer nutrients absorbed translates into fewer calories absorbed and this promotes weight loss. A recent article in New Scientist describes how, in experimental rats, this device enabled significant weight loss and even reversed type 2 diabetes. We may be entering into a time when a simple, safe and reversible procedure can save the lives of hundreds of thousands of our patients who struggle with obesity.

Jamaican Dirty Dancing

The Jamaican Broadcasting Commission has banned all explicit references to sex and violence in songs and videos aired on radio or television. "Dancehall" style music and videos that show "daggering' the grinding, pelvic-thrusting dance that is popular with the young Jamaicans has been banned on the island. This means that there is effectively a ban on American hip-hop and Trinidadian soca music. A recent article published in the Jamaica Gleaner states that "dancehall is being used as a convenient scapegoat for underage sex and juvenile delinquency."

Quoted from: The Week, March 6, 2009.

In her recently published book 'Pleaures and Perils' (Rutgers Press, 2009), Debra Curtis, Ph.D explores the complex relationships between music, videos and commodities such as cell phones in the sexual attitudes of teenagers on the Caribbean island of Nevis. This move by the Jamaican government may have wider implications for teens and it will be interesting to see how restricting access to the music and policing a dance style will go over in Jamaica.

Egyptian Movies

I once saw an Egyptian movie many years ago. The film was peculiar in that the camera was fixed and seemed never to move either to follow the actors or to pan the scene. Of course this was many years ago but this film technique and use of script, scenery and plot development to tell the story made the film about the film technique and not about the story. This movie reminded me of a soap opera with no one manning the camera. It was as though the camera was operated by one of the actors. He would turn on the camera and then run into the frame to deliver his lines before running out at the end of the scene to turn off the camera again.

When George Lucas made the first Star Wars movie he did something that was considered quite extraordinary for the time. He built elaborate and expensive sets, used them for one or two scenes and then either blew up the sets or moved on to the next expensive and elaborate scene. To make his characters and alien planets believable and to tell the story in a compelling manner he had to create a whole universe for the characters to inhabit. If you look at, what was considered to be the standard for science fiction storytelling prior to this you would watch re runs of Star Trek. If you compare Star Trek to Star Wars you will find that Star Trek is scripted and filmed very similarly to the Egyptian film technique.

George Lucas understood storytelling. He created a technique that is still considered groundbreaking today because he focused on the result and did not make his films about the process. Whether we are raising children, learning to ski, going to work or having a quiet dinner with the family, if you keep your focus on the whole experience and do not get caught up in the minor, sometimes irritating events of the day then your results will shine in spite of the process you went through to accomplish them.

Roll the Ugliness

"Roll the ugliness." is Steve Martin's response to a Latin American padre who has come to show him a videotape of illegal 'cat juggling' in an attempt to secure a donation of money from the wealthy character of Navin Johnson. Some things in life are just plain wrong! Cat juggling is one of them.

Fortunately, thanks to Mr. Johnson's generous donation, cat juggling has been virtually eliminated in almost all western countries. There are a few remote areas in the third world where it is still allowed however, and local activists are working hard to put a stop to this travesty.

'Hampster bowling' and 'ferret twirling' are on the rise however so be alert for any signs of these illegal activities in your neighborhood. Although these are clearly within the jurisdiction of The Bureau of Rodent Offenses (TBRO) and not the responsibility of the Mammal Trauma Unit (MTU) as is the case with cat juggling, any offense toward any pet or animal is unforgivable.

On a serious note, former Falcon's quarterback, Michael Vick has been sentenced to house arrest recently (although he rightfully belongs behind bars) for his cruel treatment of dogs. The inhumane treatment of animals is everyone's business and is of moral significance for the human race as the protectors of and advocates for our pets.

Office Cultural Legacy

Almost everyone we meet who impacts our lives in any meaningful way will have, inherent in their personality, certain biases and, in social interactions will exhibit some evidence of the life they have lived prior to the time when we met them. Some people refer to this as 'baggage' which is a derogatory term but the same could be said for the good traits that develop in all of us resulting from our families, jobs, school experiences and relationships.

As the employer, I have to make decisions about hiring my staff and part of that process is to decide if that person will 'fit' in with my ideas, my expectations and work well within the office culture that I have created with the existing staff. There are objective ways to evaluate people such as the 'Big 5 Inventory Test' or the 'Stanford Shopping Mall Test' (see blog entry; The Happiness Scale) or, as the prospective employer I can look over their resume and see where they have worked before and try to draw conclusions based on what I know of the offices they have worked at previously. I can learn a bit about them based on their office cultural legacy.

Employees who come from very dysfunctional offices may require more time and patience than those who have been with a stable office for many years. A person will have embedded some of the attitudes and expectations of the previous management system and heirarchy and feel that that should be the norm in my new office. I recall hiring one woman a few years ago and going over with her in detail the typical day and what would be expected of her. She lasted only one day on the job because, (she later told me on the phone) she expected to have all day to talk with her co workers, to socialize and then expected to go out to lunch with her new office girlfriends every day as she had at her previous job.

As an employer, it is very gratifying to watch the office culture take on a life and an energy all it's own which is a direct reflection of the staff. Their energy, dedication and goal oriented approach to meaningful work as well as their friendship for each other makes our office a pleasant and enjoyable environment.

Cartoon Credit: Lawrence Gilson

Cognitive Dissonance

When William Butler Yeats got married in 1917, his father wrote him a warm letter of congratulations. "No one really knows human nature, men as well as women who have not lived in marriage, the enforced study of a fellow creature."

Quoted from; Mistakes Were Made (but not by me), Tavris and Aronson

When someone I met recently called off an imminent wedding, I asked him why. He replied that it was because his fiance had expressed distain for something that he considered fundamental to his identity and feelings of self worth. Sociologists have pointed out in studies of couples that the expression of distain and disrespect is one of the surest ways to spot a troubled relationship. When one partner rolls their eyes or blows out their cheeks, looks at the ceiling or otherwise shows that they do not respect the views of their partner, these are telltale signs that the pair should find others to build relationships with that can be based on mutual respect.

One of the older couples I know arrive at my office hand in hand. Married for probably fifty years, the most striking thing about them is the fact that they will listen eagerly and respectfully to each other. She will sit in rapture and listen to an account of a war story that happened in World War II as though she is listening to it for the first time. Even I know the stories because this pleasant man tells them to me so often. When he starts to tell the same story I always glance over at his wife and witness true love and respect in her demeanor. Each time the old war story starts she is transported. There she sits with wide eyes, clinging to her purse, hanging on his every word and when the story is over she relaxes and nods appreciatively. The memory has been retold once more for posterity and all is right with the world.

When you are looking for a new partner, keep an eye out for when her eyes start to roll. Just to be sure she is the right person for you I recommend telling the same story every day at least once to see how she reacts. If she shows you she is bored and thinks you are an dern'ed fool then get rid of her and find another one. Who knows how she'll react if you are fortunate enough to grow old together.

Websters Dictionary def.

cognitive dissonance : psychological conflict resulting from incongruous beliefs and attitudes held simultaneously

Squirrels and Nuts

A recent newspaper article detailed an attempt by pop star, Amy Winehouse to recover from alcohol addiction while vacationing on the Caribbean island of St. Lucia. She was sent to a resort on the island presumably to sober up and get herself well before returning to her recording career in London and the resort staff were put on notice that Ms. Winehouse was not to be served any alcohol while she was a guest.

Like many addicts, Amy found a creative and alarming way to acquire alcohol during her restricted stay to thwart her would be guardians. She would simply approach other guests sitting at the bar or in a resteraunt enjoying their drinks and ask them for a light for her cigarette. When the unsuspecting guest reached for a light and looked away for a split second, Amy would simply pick up their drink and walk away. One astonished guest commented to the reporter that she acted "just like a squirrel with a nut!"

This is an interesting example of how we as caregivers, family members and loved ones of drug and alcohol addicts struggle with the complex and unexplainable behaviors they exhibit. As we are reminded repeatedly in support groups and from our counsellors and therapists, people who are addicted to substances exhibit relentless loyalty to the substance even in the face of public ridicule, loss of career and family, disease and even death.

As Amy Winehouse scampers off to drink down other patrons alcohol we can only thank our lucky stars that we are not cursed with this disease and try again to be tolerant and patient with those who are dying from it.

The 99 Cent Phenomenon

A recent article in the New York Times examined the phenomenon of the 99 cent item. The article cites Robert Schindler, a professor of marketing at the Rutgers School of Business as stating that consumers "percieve a 9-ending price as a round number price with a small amount given back." Steve Jobs, the founder of Apple computer which developed the iPod has leveraged this idea into the sales and downloads of his digital music empire and has, in the process "saved the music industry from oblivion."

Historiocally, the invention of the cash register by a Dayton bar owner allowed merchants to "thwart pilfering clerks by charging a penny less than the full dollar amount, thereby forcing cashiers to open the register to give change to the customer."

The chain of '99 Cents Only' stores went public in 1996 and today has 282 outlets and is worth more than half a billion dollars. The last quarter sales were up 8 percent and profits were up 31 percent. Hmmmm.

A Distant Ship Smoke

"Britain is failing its children, the pursuit of private advantage has impinged directly on our children" British children are the unhappiest of any in the world's developed countries only American kids came close to our level of alienation and discontent. Part of the reason is the breakdown of the nuclear family. Children raised by single parents have lower self esteem and poorer academic achievement than those in traditional homes. But much of the problem lies with the British ethos that places a low priority on children. A culture of "excessive individualism" encourages parents to put themselves first.'

Quoted from Richard Layard -co author of 'A Good Childhood: Searching for Values in a Competitive Age'

If Thomas Merton Played Football

"The biggest human temptation is to settle for too little."

Thomas Merton quoted in The Buffalo News

I was watching the last hour of 'Rudy' with my daughters tonight and reflecting on how religion, passion and personal vision can be such powerful forces in our lives. This, of course is the message of the film and story of the unlikely hero of the Notre Dame football team. You remember the plot; steel mill workers son overcomes all obstacles to join the mighty football team and ultimately triumphs by being such an unselfish inspiration to those around him that, in the end he is carried off the field by his team mates and into the storied history books of one of the most tradition bound football teams in the land.

Thomas Merton was a monk, philosopher, prolific writer and scholar. His messages of self fulfillment, inner peace and worship are not exactly in line with those of the hero of 'Rudy' but a thin line could be drawn between them...especially in a blog. One could speculate that Thomas Merton, had God on his mind when he strolled and thought deep thoughts. Rudy had God on his mind too as he was eyeing the opposing offense from his position as a defensive lineman and thinking about how he would like to tackle the crap out of the other teams quarterback. God is a mysterious force and how we see God and incorporate God into our daily goals, trials and tribulations is ultimately a personal journey.

I do not know if Thomas Merton ever watched a Notre Dame football game. Probably not.

Audio Crawl

Al Franken created one of the funniest bits ever for his radio show, 'Air America'. The 'audio crawl' was the radio version of a technique used on television all the time. A 'crawl' is television jargon for the stream of words you see on the bottom of your screen as the image appears above. The crawl details breaking news, public announcements such as school closings or weather storm warnings. On the financial television channels, the crawl shows the different stocks prices throughout the trading day streaking across the bottom of the screen.

In the 'audio crawl' segment on his radio show, Al and his female co host devise a plan to implement an audio version of the crawl for their listeners so that they can deliver the main story and still give additional information to the audience at the same time. The female co host begins to read the news with professional enthusiasm and suddenly we are aware of a low pitched mumbling sound heard along with the lead story; Al has begun reading his prepared text! The funny part is that the 'audio crawl' requires that the listener discern the main story from the subtext at the same time by listening to both at once. What follows is a confusing soup of intonations and animated narrative. Trying to listen to Al's 'crawl' means that we have to focus on the mumbling and ignore the more interesting voice of the main announcer. We have to concentrate to understand the words instead of absorbing the story.

Needless to say, the experiment known as 'audio crawl' was abandoned after about 25 seconds as being both too stupid and too distracting for anyone to follow. But it was very funny.

Cartoon Credit: Lawrence Gilson

The Deaf Social

One of the most inspiring parties I have ever attended was at a gathering of about 150 deaf people. I was invited by my sign language teacher when I was in college several years ago. The whole class was invited but I was the only one to make the trip on the bus out to the hall where the event was to take place. The gathering was called a 'Deaf Social' and believe me when one of these things is arranged, you had better come ready to party! Deaf people love to dance, are intensely social and love really LOUD music. The music is so loud because they obviously have to feel the rhythm to dance. Their conversation is uninterrupted by the music because they communicate with ASL (American Sign Language) so they can be sharing an intimate joke while standing right next to gi-normous music speaker.

One of the interesting thing about standing and watching many deaf people sign together is that you can view multiple conversations at the same time without leaving your chair. I'm sure that there is a certain code for secrecy and a way for people who use visual forms of communication to 'whisper' to each other but I saw none of that at this event.

If you are ever an invited guest to a deaf social, I encourage you to go. The people I met that evening were among the most interesting and amusing people I have ever met anywhere. The jokes are funnier, the camaraderie is more intense, the people are so animated that hearing people seem like store window manniquins in comparison. Take my word for it, you will be amazed.

On The Turning Away

"I still climb Mount Everest just as often as I used to. I play polo just as often as I used to. But to walk down to the hardware store I find a little bit more difficult."

Dr. Seuss in an interview published in The New York Times Book Review

The elderly are often the most vibrant and inciteful people in our society. They are old and wrinkled, they sometime have an odor and their speech is not often crisp and sure but wisdom still manages to sneak out through their stories and gestures. You sometimes have to really sit back and examine your own visceral reaction to appreciate the importance of a seemingly unimportant appearing older person.

Let's make a point to give the elderly a chance to speak and communicate. They are often biased and inarticulate, they make out dated references to events and people who are no longer present. But, if you take the time to hear the history and the meaning in the conversation, you will appreciate something that is difficult to appreciate in our fast paced society; depth of character.

Pleasures and Perils

This is a photo of my wife, Debra Curtis taken while we were traveling in Kenya for a month in 1986. These were the days before children, before grad school and before it came time to pay back all those student loans. Deb has always been community minded and worked for a time in a battered women's shelter where she walked to and from work while completing her master's degree. She has an undergraduate degree in political science from Keene State College, a Masters degree in Public Health from San Jose State University and a doctorate in Cultural Anthropology from Rutgers University. She is a gifted ethnographer, teacher and writer. Deb is a respected scholar and was awarded a National Science Foundation Grant for her field work in the Caribbean. Her work includes papers co authored while she was a research assistant at Stanford University, reviews of scholarly work by others in her field and she has been chosen to present her papers annually at the national anthropology association meetings for several years in a row. She is currently an associate professor of anthropology at Salve Regina University in Newport, Rhode Island.

This month, her first book, 'Pleasures and Perils: Girls' Sexuality in a Caribbean Consumer Culture' (Rutgers Press, 2009) is available on Amazon.com and will be taught in anthropology, sociology and sexuality courses in colleges all over the country. Her work in the field of girls sexuality on the island of Nevis has been enthusiastically reviewed by her respected peers.

In short, Debra Curtis is one of those wonderful people who, through hard work, force of will and steadfast perserverance has made the most of life's opportunities. The rest of us can only try to keep up and work harder even as we joyfully watch her fly on ahead.

The Art of Living

"The masters in the art of living make little distinction between their work and their play, their labor and their leisure, their minds and their bodies, their information, their recreation, their love and their religion. They hardly know which is which; they simply pursue their vision of excellence at whatever they do, leaving others to decide whether they are working or playing."

James Michener

Nickname-ification

At what point do we business owners and managers risk the breakdown of the chain of command if we fraternize with our employees? I often think about walking the line between being friendly with my staff and maintaining a distance and creating and maintaining professional boundaries. This is not an egalitarian society and my medical practice is not a democracy. There are times when it should be a 'meritocracy' and times when it should be a 'boss-ocracy'.

The managerial style I employ in our small office is often messy and slightly chaotic. The assumption is that the people I have hired to work in my practice are very capable of sorting themselves out, getting their work done and being productive without a lot of oversight. When left to themselves with a minimum of direction, the staff perform very well on the whole. If there is a personality blow out or conflict I note the nature of the dispute, see who the players are, decide if I need to intervene and then we all go back to work.

One of the best things about working with the same team is that we can all read each other's moods and be respectful of each other....most of the time.

If I do choose nicknames for my staff they are names like; 'Red Dog', 'Tex', 'Pumpernickle' and 'General Patton'. When they think of nicknames for me, the name they pick better be a cool one.

Beulah's Ship

"Finish each day and be done with it. You have done what you could."
Ralph Waldo Emerson

I am older than President Obama, television physician, Dr. Sanjay Gupta, talk show host, Stephen Colbert and Chief of Staff and former Congressman Rahm Emanuel. These people hold positions of influence and authority in the new administration and are up and are established personalities on television. Rather than focus on the ship that sailed and bemoan the bygone days and missed opportunities, the road less traveled etc. I am now a bit more interested in the careers of those who made a difference and really hit the gas after fifty.

In 1942, Beulah Hepburn Emmett took all of her inheritance and energy and, in her 60's, started the first boarding Waldorf School for high school students in the U.S. High Mowing School offered a creative alternative to traditional education. Mrs. Emmett was the daughter of a diplomat and lived abroad for most of her childhood and adult life. She acquired a hilltop farm in New Hampshire and started a small school there based on the teachings of Rudolf Steiner a German philosopher. The School has produced many artists, actors and dancers and not a few lawyers, doctors and business owners. Mrs. Emmett's school on the hill has survived her by several decades and is a powerful example of the goals that can be accomplished with dedication and vision even as some people are winding down their productive lives.