Michael Chaplin is hosting this week's Grand Rounds, the best posts of the medical blogosphere. It's chock full of quotes, and a discerning description of yours truly. Go check it out! He's got doctoring in his blood (or at least, that's my translation of Iatremia.)

Next week's host is Dr. Sanity!

Our Place in the Sun

I took my med school's course on nutrition back in the 90's, when Vitamin E was all the rage. If I recall those heady days, the only question about E was whether we should slather it on our skin, eat it, or freebase it.

Times change. Now, E is out and D is in, in a big way. You may know that Vitamin D is the vitamin we make, by sitting in the sun's UV rays (technically, since we produce it, can't be a vitamin, but I digress).

Some oncologists and dermatologists currently believe D is so important in fighting cancer, it's actually worth running the risks associated with increased sun exposure (namely, cancer. And wrinkles. But mostly cancer). Needless to say, this is controversial:

...Dr. Edward Giovannucci, a Harvard University professor of medicine and nutrition ... laid out his case in a keynote lecture at a recent American Association for Cancer Research meeting in Anaheim, Calif.

His research suggests that vitamin D might help prevent 30 deaths for each one caused by skin cancer.

“I would challenge anyone to find an area or nutrient or any factor that has such consistent anti-cancer benefits as vitamin D,” Giovannucci told the cancer scientists. “The data are really quite remarkable.”

It gets juicier:
“I am advocating common sense,” not prolonged sunbathing or tanning salons, Holick said.

Skin cancer is rarely fatal, he notes. The most deadly form, melanoma, accounts for only 7,770 of the 570,280 cancer deaths expected to occur in the United States this year.

More than 1 million milder forms of skin cancer will occur, and these are the ones tied to chronic or prolonged suntanning.

Repeated sunburns — especially in childhood and among redheads and very fair-skinned people — have been linked to melanoma, but there is no credible scientific evidence that moderate sun exposure causes it, Holick contends.

“The problem has been that the American Academy of Dermatology has been unchallenged for 20 years,” he says. “They have brainwashed the public at every level.”

This guy, Dr. Michael Holick, helped discover how Vitamin D works. But when he published his book about the benefits of UV and the dermatology brainwashing, he was stripped of his professorship (which no doubt led to more ... exposure)

Via metafilter, who reminds us that Baz Luhrman's advice about sunscreen, and life, is suddenly suspect.

Red Scare

Here's some provocative, if underpowered, research findings (via the guy at Scared Monkeys, whose name is actually... Red):

"Across a range of sports, we find that wearing red is consistently associated with a higher probability of winning," report Russell A. Hill and Robert A. Barton of the University of Durham in England. Their findings are in Thursday's issue of the journal Nature.

Red coloration is associated with aggression in many animals. Often it is sexually selected so that scarlet markings signal male dominance.

Just think of the red stripes on the scowling face of the male Mandrill, Africa's largest monkey species. But red is not exclusively a male trait. It's the female black widow spider that is venomous and displays a menacing red dot on her abdomen.

Similarly, the color's effect also may subconsciously intimidate opponents in athletic contests, especially when the athletes are equal in skill and strength, the researchers suggest.

One's thoughts immediately turn to the Red Sox, who didn't wear much red until the past few years. In their previous world series appearances, they've lost to teams like the 1949 Cardinals and... 1975 Reds... But you can't overlook the fact that the most dominant team last century wore blue pinstripes. Also, in NFL football, the dynasties of the Patriots, Cowboys, Steelers, Packers, Bears... not a red shirt or helmet in the bunch (The Patriots in particular have done much better since moving away from red).

There ought to be a more innovative way to study this, a la Steven Leavitt's Freakonomics, where looked at the statistics behind Sumo matches and found it's likely some important status-determining matches are thrown. The current red study just doesn't seem to have a lot of data behind it, especially the team sport analysis. I'm not sure how they can do better, though, short of having the same teams play each other dozens of times, switching uniforms halfway through.

Besides, even if there is a visceral reaction to the color red, it's hard to say whether it would always be negative. If red arouses the fight-or-flight response, it seems just as likely that opponents would fight harder, rather than be intimidated. I think bulls would agree with me.

And if this turns out to be true, it may go a ways toward explaining the "Red Shirt phenomenon" of classic Star Trek, in which hostile aliens would always spare Kirk, Spock, and McCoy but kill the random crewman with the red shirt.

AMA, Premium

While I was away, my colleagues at went beyond our usual pithy medical device commentary and actually took on the AMA:
We have reported earlier about the proliferation of free, open-source, online medical journals. When it comes to the spread of information, the American Medical Association (AMA), however, is moving in the opposite direction.

It has come to our attention that the AMA, has quietly announced that it will make the contents of its AMNews online edition (website) available for AMA members only. Bylined as the "The Newspaper for America's Physicians", the AMNews was the last AMA publication with current content available online for free (for your information, JAMA, which publishes research that is mostly funded by the U.S. taxpayer, has never been available to the general public.)

It reminds me of the this year's Homestar Runner April Fool's Day subscription plan, called Pay Plus!, which was pitched as "Same content! New annual fees! Just Pennies per Pixel!"

The Medgadget call to action got the attention of the AMNews editor, who responded by saying, essentially, that membership has its privileges. However, as GruntDoc suggests, it's actions like this that guarantee AMA membership will become more irrelevant as time goes on.

In case you're worried, Blogborygmi will continue to remain free, as the administration costs are almost entirely supported by revenue from Storeborygmi, the online shopping experience.


After two weeks of seeing extended family in Greece, I was returning home in a mood to start writing again. I had some layover time in the Milan airport before the second leg of my trip, and had prepped a few posts. But nothing was quite as blogworthy as what happened on the flight home.

Even so, the first seven hours of yesterday's Alitalia flight 618 were uneventful. I was too sleepy to appreciate the movie, too hungry to mind the airline food, and not pleased with the International Herald-Tribune crossword. I settled into a light sleep about halfway through, with occasional wakeups for snacks and drinks.

I woke up with a start, for instance, when the captain announced we’d begun our descent into Boston. He said the weather was partly cloudy. The elderly Greek woman seated next to me noted the temperature – 12 C – would be a big change from what we’d enjoyed in Athens.

As we past through the cloud layer, I peered through my window seat to look for landmarks. I didn’t see any, but was pleased that things looked I lot greener than when I left in April. We got closer to the ground and I fretted that I couldn’t spot the Boston skyline –- or even the ocean. What approach was this? As we touched down, the passengers applauded, but I was growing alarmed: this didn't look like Logan. I saw a fleet of gray military cargo planes outside a hangar. There were no passenger planes from my view, just wet tarmac and an overcast sky. Where were we?

The Greek lady remarked she’d made this flight twenty times, and had never seen this part of Logan. The woman behind me suggested, “It might be that new runway they’re talking about.” The cockpit told us nothing. Some passengers had unfastened their belts and began to retrieve carry-on bags. I thought about turning on my GPS receiver. The Greek lady checked her watch and announced that, wherever we were, we landed a half-hour early.

After about a minute of growing unease, the captain announced (in Italian first, then English) that we were in Bangor, Maine, and under what he termed “police control.” As I was translating this to the Greek woman next to me, the plane was boarded. Four men in black uniforms, along with a plainclothed man with a large ID badge, walked past us to an aisle seat about eight rows behind me. They surrounded a man who calmly stood up, and then they all quietly walked out. The whole thing took less than a minute. I got a good look at the deposed passenger (but was afraid to reach for my camera): he was tall, maybe 6’, with light brown skin, a curly beard, no mustache, and short black hair.

The captain told us we were still under police control, and the passenger who was removed was wanted by US authorities. We would stay in Bangor until they identified and removed the man's luggage, a process they estimated would take 30-45 minutes.

We were allowed to circulate during the luggage search, so I got up and interviewed the man nearest to the deposed passenger (note: I am not a journalist). Here's how the interview transpired:

Me: Hey, wow, was he, like, sitting right there?
Nearby passenger: Yeah! They just came right in and took him! They didn’t even ask his name.
Me: Is that his jacket?
Him: He just got up and left. Didn’t take any carry-on with him, either.
Me: Was he doing anything weird during the flight?
Him: No, nothing I could see.
Me: Um... So, what did you think of the movie?

Another passenger remarked, “He didn’t seem surprised at all. It’s like he knew they’d be coming for him.” I wouldn’t ascribe so much to that brief encounter, but then again, we didn’t have a lot to work with.

That’s when Mom called. She and Dad were supposed to pick me up at Logan. She was really worried about how the Arrivals board switched from “On Time” to “Delayed” so late in the flight. The group of reporters massing at Logan alarmed her, too, until Channel 5’s Kelly Tuthill explained to her that we had a suspected terrorist aboard, and had landed safely in Maine.

“How did all these reporters know so fast?” Mom wondered. Tuthill revealed: The network told them.

When I explained that the luggage search, refueling, and flying home would take at least another hour, Mom asked what we were still doing on this plane. It’s a good question: if this man is wanted by the US, and dangerous enough to prompt a landing at the first available international airport on US soil, why not evacuate the plane during the luggage search? Wasn’t it possible we were sitting on a ticking bomb?

As if on cue, the cockpit requested we take our seats but keep our belts unfastened (“the better to evacuate us,” I suspected.) Flight attendants positioned themselves by the exits, and for the first time since we were boarded, I got nervous. But soon after, the luggage was found and we were told we’d be underway again soon.

As we maneuvered onto the runway, I saw some TV trucks and photographers gathered by a fence, to film us. Of course, by now, our cameras were snapping away at them (a fellow passenger joked, “Reporters observed strange flashes of light from within the cabin...”).

Back in the air, I publicly speculated Alitalia had spare snacks on hand, for just such an occasion. But if they do, we didn't see them -- we were served only water. I took the opportunity to ask our flight attendant when they learned of the diversion. “Was it just a ruse when the cockpit said we were descending into Boston?”

“No,” he replied. We learned we were landing in Bangor right after that announcement.”

When we finally landed at Logan, I worried that we’d be subject to lengthy inspections or questioning at customs. At this point I really just wanted to go home. Other passengers were trying to catch connections. But the lines moved pretty quickly, and the only questions I was asked came from the Boston news stations.

The reporters were angling for the frustration angle – why not check the passenger lists before the flight leaves? While that sounds well and good (though is apparently technically difficult) I’m more confused about other aspects of the way this emergency was handled: The location to which we were diverted, and the apparent lack of concern after the suspect was removed.

The no-fly list is reserved for those with known or suspected links to terrorism, or other “threats to aviation.” This man was considered enough of a risk to scramble escort jets from Canada and the US, and enough of a risk to divert us to the nearest US airport available to a 767. On other occasions, however, the US has refused international planes carrying no-flyers, forcing diversions to Canada. And we were over Canada for a good long while.

I’ll try to guess what Homeland Security was thinking: since Flight 618 had made it across the Atlantic without incident, the risk of the suspect trying something between Canada and Bangor was apparently not worth bringing the plane that early, and maybe the US wanted custody of the suspect. But the risk of him flying into Boston was too great. OK, I can buy that. So the plane was diverted to Bangor, and the suspect removed. But, his carry-on and jacket are left behind for at least fifteen minutes (I didn’t see if when or if they were taken off the plane). The luggage compartment was checked for over thirty minutes to find and remove his items, while 200 or so passengers are kept on board.

Why is this man considered such a risk to Boston, but his suitcases and personal items are considered no risk to the passengers?

I don’t know. Maybe the authorities have their secret reasons, but I’m not so sure. This is the second such diversion in a week, and there’s been no announcement about improving the existing system, despite complaints from a Massachusetts congressman and hundreds of inconvenienced passengers.

What I did learn from this experience:
  • Window seats aren’t just for fun anymore, they're educational.
  • Mom is more media-savvy than I give her credit for.
  • If the in-flight movie is dull, maybe something else will enliven the trip.
  • The Smooth Retsina

    Posting will be light the next few weeks. I'm, well, globe-trotting again.

    Second Helping

    I set up a draft of this post a week ago, it's probably a little outdated by now. But I thought this news about how the CDC changed its calculation for obesity's lethality was still worth mentioning:
    According to the new calculation, obesity ranks No. 7 instead of No. 2 among the nation's leading preventable causes of death.

    The new analysis found that obesity - being extremely overweight - is indisputably lethal. But like several recent smaller studies, it found that people who are modestly overweight have a lower risk of death than those of normal weight.

    Biostatistician Mary Grace Kovar, a consultant for the University of Chicago's National Opinion Research Center in Washington, said "normal" may be set too low for today's population. Also, Americans classified as overweight are eating better, exercising more and managing their blood pressure better than they used to, she said.

    We blogged a lot about this inflated figure, last year. Whatever the statistics say, I'm traveling a country now where the figures are not so inflated, and the difference is noticable.

    And I'm particularly surprised by the data on protective effects of mild obesity. I really ought to look at the JAMA article and figure out how they're calculating this. Are they just weighing the recently deceased? Because a lot of time, you know, people lose some weight in the months before they die. Or, they take on a lot of water weight, possibly moving them into morbidly-obese classification.

    In any case, obesity is still epidemic in the US, and I think the public knows it's not healthy. It's not helpful when the CDC manufactures hysteria to try to further educate people. Because then, we risk these consequences:
    LOS ANGELES (Reuters) - A group backed by the U.S. food and restaurant industries on Monday launched an advertising campaign aimed at dismissing as hype concerns about the large number of obese Americans.

    The full-page ads in major U.S. newspapers were inspired by new government data questioning government assertions that obesity causes nearly as many deaths as smoking, according to the Center for Consumer Freedom, which paid for the ads.

    The group, based in Washington, does not disclose names of its donors, though spokesman Mike Burita said casual dining restaurant chains "are predominant sources of funding for us."

    A spokesman for Darden Restaurants Inc., the nation's largest casual dining company and owner of the Red Lobster and Olive Garden chains, could not say whether Darden was among contributors to the group.

    At the Olive Garden, they treat you like family. But, then again, so does La Casa Nostra.