29 April 2006

Holy Wars

    Holy detonation, Batman!

In Chios, Greece, on Greek Orthodox Easter, this is how parishoners of two churches celebrate:

To mark the resurrection of Christ, the two congregations fire thousands of
handmade rockets at midnight across a valley at each other's churches.

Story and video here. Their goal is to hit the bell tower. No major injuries were reported this year. However, they are not uncommon (ya think?).

26 April 2006

More recycling challenges

    But, anyway, Signor Sollozzo, my no is final, and I wish to congratulate you on your new business, and I know you'll do very well; and good luck to you - as best as your interests don't conflict with my interests.
      The Godfather

A significant challenge of recycling waste seems to be finding someone's back yard to do it in. Awhile back I posted about a fight between Eastern Organic Resources, the DEP, and local governments. The last I heard about Eastern Organic was that the DEP revoked their license.

According to this Asbury Park Press article, a new controversy with a similar ring to it is brewing in Dover Township. Washington, D.C.-based Fuel Frontiers Inc. wants to build a new facility to manufacture ethanol from waste material. The ethanol would be blended with gasoline as a motor fuel.

Just like Eastern Organic, Fuel Frontiers idea sounds great on paper. Recycle waste and reduce oil dependency all at once. Unfortunately, local reaction is also similar. The article reports that:

Potential environmental problems are a concern in Dover Township, where the former Ciba-Geigy Corp. plant is now a Superfund site, and dumping of hazardous waste at the former Reich Farm led to contamination of wells in United Water Toms River's Parkway well field. Talk of any kind of fuel plant makes officials uneasy.

Well, who can blame them. Hopefully Fuel Frontiers can address Dover's concerns. The article reports that the two sides are talking:

"We recognize the issue here. We want the town to feel like they know what's going on," [Fuel Frontiers, Inc. President Jack] Young said. "We care about how we look, if we smell, and how we operate."

[Dover Councilman Michael J.] Fiure said he has been pleased that Fuel Frontiers has shown a willingness to work with the council. He said council members hope to schedule a public presentation of the company's plans at a future council meeting.

"I am very encouraged that they are going to meet with us and that we will be able to ask them questions," Fiure said.

In my Eastern Organic post, I said that this is technology we need. Let's hope things go better in this endeavor.

Thanks to Sharon for sending me the story.

More on Advair

    The doorstep to the temple of wisdom is a knowledge of our own ignorance.
      Benjamin Franklin

Of late this blog is a ghosttown, but apparently someone's reading. I got a great comment to my Advair post that actually explains some of the problems with Advair. Forbes would have done better to ask this person to write their article.

11 April 2006

Clearing in the east, finally

    The smell of hospitals in winter
    And the feeling that it's all a lot of oysters, but no pearls
      Counting Crows

Several people asked me about the "darker weather" comment in this post. Sorry I left that hanging. I figured I'd have more to say when things settled down a bit, but it's taken a lot longer for that to happen. I'll cut to the chase - everyone is fine. Here are the details:

The comment came from news that a "spot" showed up on my father's chest X-ray. Also, blood tests showed certain elevated levels that can indicate cancer. He would be having a CT scan the next day. It took four more days to get results. To everyone's relief, the scan showed no signs of cancer - the best possible outcome. They'll keep watching, but the news could have been much worse.

A day later, my mom called me. She was in the car, my dad was driving her to the ER with chest pains and elevated blood pressure. She made me promise I wouldn't drive too fast on the way to the hospital, and I didn't. We spent the next several hours there while they ran tests, monitored her vitals, and gave her medication to lower the blood pressure. She was admitted, and they kept her two days under observation in a telemetry unit where they constantly monitor her heart. They did an echocardiogram and a stress test. All came back fine.

She did have a sky-high fasting blood sugar, so she's on drugs for diabetes. It's looking like she doesn't need insulin, though, so some good news there. She's back home now. She was still in the car when she called, enjoying the fresh air. I'm sure she feels better just being out of the hospital. Just being there makes you feel sick, I think.

It's been one thing after another these last few weeks. I'm knocking on wood as I say that maybe things are finally settling down.

06 April 2006

Advair scare

    Get the widow on the set, we need dirty laundry.
      Don Henley

Thursday morning on the Today Show, Katie Couric spoke with Forbes managing editor Dennis Kneale (see the clip here). Kneale was discussing this article in Forbes magazine about the GlaxoSmithkline Asthma drug Advair, and concerns about its safety. The overall question is an important one, worth consideration: what do you do when a drug helps millions, yet can be harmful or fatal to a small percentage. I have a real problem with the way this article, and Kneale's comments on the Today Show, frame the issue.

When I first heard about possible dangers of Advair, I consulted with a friend who is both an MD and asthma sufferer. Advair actually contains two drugs. One is a steroid, the same steroid found in the GlaxoSmithkline's Flovent, which eases inflamation of the airways. The second, a bronchodilator that expands constricted airways, is the same drug found in the GlaxoSmithkline product Serevent. It belongs to a class of drug called beta agonists. All bronchodilators I know of are beta agonists, and some people have adverse reactions to them. The problem with Serevent is that it lasts longer (12 hours instead of 4-6), so an adverse reaction will go on longer before symptoms subside.

The article opens with two stories of people suffering reactions to Advair. One person said that, despite complaints of ill effects, his doctor said to keep taking it (sounds like the doctor's fault to me). The second was another story of someone suffering ill effects who continued to take the drug, an includes visual that is gratuitously repeated throughout the article: dying while still clutching the inhaler.

The the article highlights Advair's popularity, noting the advertising dollars spent. I can't argue with that; I am against prescription drug advertising. I didn't like the way the discussed Advair's "nifty delivery system," which they called a "purple plastic puck." Kneale also uses the purple puck term in the interview, telling Katie how "doctors love gadgets." His tone suggests that it's some kind of unecessay gimmick product, the asthma equivalent of the Swiffer.

In fact, the Advair Diskus (as it's called) is a vastly superior delivery method. Aerosol inhalers required the user to inhale at the moment as the push the cannister down. If you're off (as I was from time to time), you end up spraying most of the drug on the back of your throat instead of inhaling it. Further, unless you kept careful count of uses, you didn't know quite when the inhaler was empty. Finally, you needed between 2 and 4 inhalations, 60 second apart, each time you take it. Advair has a little number that decreases with each use. It turns red when you're under ten doses left. When you inhale, the force of your breath draws out the drug, so you always inhale it properly. Finally, you only need to inhale once each time. That's as much of a gimmick as anti-lock brakes.

Another issue they highlight is overprescribing. One of the people in the openning paragraph also had a persistent cough and wheeze, but was not diagnosed with asthma. Kneale talks about how his doctor prescribed it to him for a persistent cough from bronchitis. He doesn't say if it helped or not. The article also notes that Advair is being prescribed to more than just severe asthma sufferers. I thought that was unfair. My asthma was never severe or life threatenning, but it is still very important to my long term health that it be kept well controlled.

The article and Kneale play free an loose with the numbers. The first statistic the present is a single doctor's assertion that Advair and Serevent are killing 4000-5000 people a year. Only later do the note studies that showed numbers like 12 out of 17000, still taking time to suggest that this finding was inappropriately deemed statistically insignificant. When numbers minimize the risk, the article's tone is always questioning. They never cast doubt on the 4000 deaths/year estimate.

They also mix in statistics for other bronchodilators, like in this paragraph:

But Serevent had been under suspicion from the start, and earlier beta agonists had stirred doubts for decades. In 1948 one study of 2,200 asthma patients found a fivefold-higher death rate for patients who inhaled epinephrine, a beta drug, versus those who hadn't."

First off, I checked and found that almost all bronchodilators are beta-agonists. This article doesn't mention that. Non-beta bronchodilators are not inhaled - they're taking orally, so the side effects tend to be worst. Theophylline is non-beta example I've taken, and it sucked. As for epinephrine, the article is correct about its dangers. I've taken it - it's awful stuff. What the article failes to mention is that more modern beta drugs, Serevent included, are a vast improvement. To read the Forbes article, you'd think epinephrine and Serevent are like Motrin and Advil.

The article does everything it can to hype the danger aspect of Advair. They're searching for the next big drug company scandal.The article says as much when it conjures up the spectre of Merck's Vioxx and Wyeth's Redux. I'm all for keeping the drug companies honest, mind you, but Forbes this article is heavy drama and a light cogent fact. There is next to no mention of the drugs success in controlling asthma and similar respitory ailments. In my opinion, that success is the real reason for Advair's popularity.

There are also no anecdotal stories of people who's lives have improved thanks to Advair. So, here's one:

When doctors, insurance companies, etc. try to assess how well you are managing your asthma, they want to know how often you use your rescue inhaler. A rescue inhaler is a fast acting bronchodilater you use when you're having an attack. If you are using it often, you asthma is not well controlled, and you could be doing harm. Since I began taking Advair, I have all but stopped using my rescue inhaler. If I use it three times a month, it's a lot. I used to use it at least that many times a week. My respitory health has improved drastically thanks to this drug.

I'm one of the millions it's helped. I'd prefer a little less media hype about this one.

05 April 2006

Morning buzzkill

    The dream is always the same.
      Risky Business

I awoke on my own. I looked at the clock, and it was 10:05 AM. "We overslept!" I shouted, "It's already after 10!" My wife's groggy reply was unintelligible as rushed downstairs to grab my cell phone - I was supposed to be on a conference call for work. As I fumbled through my bag, I noticed that it was still dark out. I looked at one of the clocks downstairs. It was 3:47 AM! Relieved, I headed back to bed, reassuring my wife that we weren't late and the bedroom clock got changed somehow, maybe the cat. I pulled up the covers and settled into the pillow, looking forward to another two hours of sleep....

That was when the alarm went off, and I awoke for real.

03 April 2006

The story of John Cazale

    Every time I put my line in the water I said a Hail Mary, and every time I said a Hail Mary I caught a fish.
      Fredo Corleone
      The Godfather: Part II

Last night, we were watching the Godfather. It seems to be a fairly regular staple on cable channels like AMC and Bravo. Sharon observed that you never see the guy who played Fredo anymore. I always figured he drifted into obscurity after the Godfather movies. He didn't.

John Cazale, who played Fredo, had won numerous awards for his stage performances before his film debut in The American Way. In addition The Godfather and The Godfather: Part II, he appeared in The Conversation (also directed by Coppola) and Dog Day Afternoon (a performance that earned him a Golden Globe nomination). He was engaged to Meryl Streep, who was his co-star in The Deer Hunter.

That would be his final film, however. At the same time he was filming, he was dying of bone cancer. The studio, upon learning of his illness, wanted to remove him from the film. Streep fought to keep him, threatenning to quit. He completed the film, but died the same year.

Most of these details come from his IMDB biography.

Tough choices

    "It is our choices that show what we truly are, far more than our abilities."
      Albus Dumbledore
      Harry Potter and the Chamber of Secrets
      by J. K. Rowling

It's been awhile since I posted. I preoccupied with a pair of decisions that needed to be made.

I had to choose which job I wanted. I had pretty much come to the conclusion that it was time to move on because there was not way to stay here and continue doing what I enjoy - software development. For about a year I've been hunting. There were a few offers, but nothing worth taking. In December I interviewed at a really good place, but no offer came. In February, a new project started up here. It was completely unexpected, and it was exactly the type of stuff I wanted to do (although it's VB.NET, not C#, but I digress). Plus, they need me to get my MS certification, and they'll fund it.

It was nice. I remember telling someone that I was actually enjoying my job again. Wouldn't you know this would be when the place from December called be up with an offer? I know, people should have such problems. I understand that in this economic climate plenty of people are unemployed or under-employed. I'm damn lucky. That said, it was still a touch choice with serious implications on my future. I was back an forth a dozen times, sweating every detail. Finally I decided to stay where I am. This is the last thing I would have expected three months ago, but there it is. What changed was this: I was not longer under pressure to get out of my current job. That raised the bar on any job offer that came. I think I made the right choice. Time will tell.

The other big decision was much easier to make, but much harder to act upon. Odds are good that you've seen seen Sharon's post on the subject. Our 12 year old greyhound Toasty was suffering liver failure, and we decided to end her life quickly. That decision was clear for me. That didn't make it any easier. In reply to our e-mail about this last trip to the vet, my brother replies simply, "Sorry to hear that. Not a fun trip." He'd taken it himself only a week or two earlier. No, it wasn't.

Having weathered those storms, I got to enjoy a weekend of warm sun and gentle breezes. Yet amid the peace of bike rides and campfires, a phone call brought news of darker weather on the horizon. It's Monday now, with overcast skies.