Sunday, November 8, 2009
Sunday, October 25, 2009
Since the letter was published, there has been some discussion regarding the implications of this meta-analysis for those of us using Avastin. At the current time the feeling is that this data cannot be extrapolated to Avastin, in part because Avastin is a larger molecule (the entire globulin, vs. the immune arms as with ranibizumab). This molecular characteristic is felt to result in less egress of Avastin into the systemic circulation, and it is to this characteristic that the longer-acting effect of Avastin has been attributed. There is currently an NIH sponsored head-to-head clinical trial comparing Lucentis and Avastin underway. The results are due in 2012. The study is ongoing, and the fact that it has not been stopped is some solace to those of us who prefer Avastin that the study has not to date shown that Avastin is either hugely inferior or has significantly higher side-effects that Lucentis.
Monday, September 14, 2009
A close friend of mine recently said to me, "You know David, most people really don't know what the Baha'i Faith is all about." I was a bit surprised to hear this, but I knew it was true. After all, when I mention to people that I am a Baha'i, there is often a puzzled look on their faces. Most people seem to have the impression that the Baha'is are a good bunch of people, working in some way toward peace. But beyond that, most people don't have an understanding of the basic principles of the Baha'i Faith. This realization was a bit surprising to me because the Encyclopedia Britannica lists the Baha'i Faith as the second most widespread religion after Christianity. And The LA Times noted that the Baha'i Faith is among the top two fastest growing religions in the world. So I thought it would be useful to explain the fundamentals of the Baha'i Faith. It is likely something that you will encounter more and more in the coming years.
Baha’u’llah – The Promised One
When someone asks me, "What is the Baha'i Faith?" The brief explanation that I give goes to something like this: The Baha'i Faith is a world religion whose purpose is to unite all peoples and races. Baha'is are the followers of Baha'u'llah, whom they believe is the Promised One of all ages. The traditions of almost every people include the promise of a future time when peace and harmony will be established and humankind will live in prosperity. Baha'is believe that the promised hour has come and that Baha'u'llah is the great personage whose teachings will enable humanity to build a new world.
This brief explanation raises a few key points. First, the Baha'i Faith is an independent world religion. It is not an offshoot, sect or denomination of another Faith. Second, its purpose is to establish unity among the peoples and races of the world. Third, the Baha'i Faith accepts Baha'u'llah as the one whose teachings will establish the long-awaited peace on earth. It's a large claim for sure, and most people are rightfully skeptical at first. But millions of people find it a claim worth looking into.
God is Unknowable
Baha'u'llah teaches that there is a source of creation that we call "God." Yet God is unknowable in his essence. Our finite minds cannot fully grasp God and we should not make images of God in our mind, thinking of him, for example, as a man. God created all things out of love: "O Son of Man! I loved thy creation, hence I created thee. Wherefore, do thou love me, that I may name thy name and fill thy soul with the spirit of life."
The Manifestations of God
Baha’u’llah teaches that throughout the course of history, God has given humanity guidance. This guidance comes to humanity through the Manifestations of God -- those special beings who revealed (or “manifest”) to humanity the word and the will of God. History knows them as the founders of the world's great religions: Krishna, Buddha, Moses, Christ, Muhammad, and Baha'u'llah. This idea that a single God has sent these various Manifestations of himself to humanity is a fundamental teaching of the Baha'i Faith. Baha'is accept the divinity of all of these individuals, that they all speak with the same authority, and that they have progressively revealed the will of God to humanity. Referring to these Manifestations of God, Baha’u’llah has written, “If thou wilt observe with discriminating eyes, thou wilt behold them all abiding in the same tabernacle, soaring in the same heaven, seated upon the same throne, uttering the same speech, and proclaiming the same Faith.”
Teachings for a Global Age
According to Baha’u’llah, the Manifestation of God returns from the same source from age to age, as people stray away from the teachings of the previous Manifestation of God, and as society changes. “This is the changeless faith of God, eternal in the past, eternal in the future.” The Manifestations of God all have the same purpose -- to bring God’s guidance to humanity. Their spiritual teachings remain the same: develop your virtues -- love, kindness, justice, compassion. However, their social teachings – those that guide the complexities of society -- are not the same. The social teachings change in accordance to the circumstances of the times: one says you can divorce, another says you can’t. Eat pork; eat what you want. Have four wives; don’t have four wives. These differences exist not because of intrinsic differences between the Manifestations or of their source. The differences in the social teachings exist only because of the changing circumstances of humanity at a particular time and place in history. Math in one grade is different from math in another grade, not because the teachers are in conflict, but because the students are different. The religions are not really different religions. They are stages of one common faith, like the chapters in the same book.
The spiritual teachings of long ago are still valid today. This is the reason millions of people continue to find sustenance in faiths that are thousands of years old. However, people are increasingly disillusioned by their religions (or any religion) because they do not appear to address the needs of the age, they do not appear to be relevant to life in the 21st century.
When Baha’u’llah appeared in the mid 1800’s, he claimed to bring God’s message that humanity would soon be moving into a global age, and that new teachings were required to govern a global society. Of course, at the time, these teachings were considered insane. How could anyone speak of “global” society, when the fastest way to travel was by horse? When communication required a message be carried by hand from place to place? But he spoke of the need to recognize the oneness of humanity, the oneness of God, and the oneness of religion. Those who accept his claims do not think of him as an enlightened or prescient man, but regard him as the most recent of the Manifestations of God, who has come to usher in the universal age of peace and unity.
I hope that these basic teachings of the Bahá’í Faith help make it less of a mystery to you. If you want to learn more, information is available at www.bahai.org.
Thursday, June 11, 2009
I recently had the opportunity to read President Barak Obama’s letter on Health Care Reform, dated June 3, 2009. There is one paragraph in particular that jumped out at me, because it seeks to identify the “root cause” of rising health care costs. Here it is:
“At this historic juncture, we share the goal of quality, affordable health care for all Americans. But I want to stress that reform cannot mean focusing on expanded coverage alone. Indeed, without a serious, sustained effort to reduce the growth rate of health care costs, affordable health care coverage will remain out of reach. So we must attack the root causes of the inflation in health care. That means promoting the best practices, not simply the most expensive.… That's how we can achieve reform that preserves and strengthens what's best about our health care system, while fixing what is broken.”
First, let me say, that I agree with the gist of the statement. Rising health care costs are killing our economy (well, that and a few other things), and medical care can definitely be improved so that it is more cost effective.
But here’s the truth. The single best way to reduce the cost of healthcare is to reduce the need for healthcare. We are a sick bunch of people, and for the most part, it’s because of our own behavior – we’re all “patients gone wild.” The majority of us are sick, not because we’re out doing healthy things and suddenly get struck down by some horrific disease. No, we’re sick because we eat too much, sit around too much, eat the wrong foods, smoke, consume alcohol, and generally ignore the things that lead to good health. We’re sick because of the wild and crazy choices we make. The vast majority of healthcare costs in America and the CNMI are tied to chronic “lifestyle” diseases. The top ten causes of death in the US include heart disease, stroke, diabetes, and cancer. And every single one of these has been incontrovertibly linked to how we live our lives – whether it’s what we eat, what we do, what we drink or what we inhale.
To a large extent, we’re digging our graves with our spoons and forks. Last year, we spent over $20 billion dollars on cholesterol lowering drugs. That’s billion, with a “B”. If you had $20 billion dollars, and decided to burn a million dollars a day, every single day, it would take you 55 years to spend $20 billion! Why is our cholesterol high and why does it need to be lowered at a tune of $20 billion a year? High cholesterol is a major risk factor for heart disease and stroke. Our bodies produce some cholesterol, but most of the problem comes from what we eat. Only animals have cholesterol in them. Vegetables have no cholesterol at all. We’ve known for decades that the most effective way (and the cheapest way) to lower cholesterol is to lower our consumption of animal products – animal flesh, animal milk, animal cheese, animal crackers, etc. But you know what? We’d rather not make that kind of change. We’d rather pop a pill and keep eating whatever we want to eat. And that’s $20 billion dollars we spend so we can do what we want to do, which is to eat lots of animals.
The same is true for diabetes, which is devastating our community, and growing at an alarming rate. We know that for most of us, the adult onset variety can be controlled, or at least hugely improved, with diet and exercise. Yet we choose not to make these difficult changes. We choose to eat what we want, and take pills and go on dialysis and lose our vision and our feet and our erections. And we spend untold billions on the cost of care for diabetes and its related problems.
A diet high in animal fat is also linked to a slew of cancers. Pass the processed meat that starts with “S” and ends in “M” and rhymes with “PAM”. Or just pass a burger or wiener or any other chunk of meat. Alcohol consumption is linked to many cancers. Pass a Bud (better make that a Bud Lite). Tobacco is irrefutably linked to cancer. But we can’t seem to manage to pass legislation to ban smoking in public spaces. Pass the votes.
I admire efforts to improve the cost-effectiveness of the healthcare we deliver, but I know that the “root cause” of the mess includes our culture of indiscretion, of consumption, of sitting around. Any serious effort to fix the healthcare mess must include a change in our culture – what we eat, what we do, what we drink and what we inhale. These changes won’t solve all the problems, but they’ll make a huge dent in the demand for and the cost of healthcare. A major portion of the responsibility to “reform” belongs on our shoulders -- those who end up needing healthcare. Reduce the need, and you reduce the cost. It’s simple. But it’s not easy. We humans typically don’t like change. Yet failure to change our behavior will result in more and more people needing healthcare every year, rising costs, and eventually, not enough doctors, hospitals or other resources to take care of so many sick people. We’re experiencing the fallout right now, right here in the CNMI.
Addressing our behavior needs move to the front and center in the public policy discussion on healthcare reform. It’s a nut we must crack.
David Khorram, MD is the co-founder and medical director of Marianas Eye Institute. He is the author of the book, World Peace, a Blind Wife, and Gecko Tails, which is available on Amazon.com and at Marianas Eye Institute. Dr. Khorram can be emailed by visiting www.MarianasEye.com, or by phone at 670-235-9090. © David Khorram, 2009.
Saturday, May 2, 2009
Friday, May 1, 2009
I am getting more than 8 Swine Flu "Updates" per hour. Good grief. This is a true epidemic, likely soon to be a global pandemic. My guess is that we'll be in Phase 6 next week. But the relatively minor human toll (low morbidity and low mortality) does not yet justify the resource allocation, nor the media attention that we have all seen.
We need to insure that we have a "measured response" that is commensurate with the real, not the perceived, threat. And responding appropriately, in the face of media hype and patient worry and governmental involvement, is a real art. I am hoping to hear your opinions on this.
In the past six weeks, Swine Flu has killed between 20 and 80 people. More than 2000 have had clinically significant infections. In the same time period, more than 40,000 people have died from routine influenza. Millions were infected. More than 40,000 died from TB just last week. 40,000 more died from malaria last week.
Friday, March 13, 2009
Thursday, March 12, 2009
Saturday, February 28, 2009
Sunday, February 22, 2009
Saturday, January 31, 2009
This is a weird growth that some people are born with. It's called a dermoid. It can enlarge over time, as this one has. (This guy walked in this week is in his 20's. Time to remove it, don't ya think?) You can see it has hair growing on it. Sometimes there's bone and teeth and cartilage and other Frankensteinian components in them. Growths like this that consist of tissue not normally found at the site are called "choristomas". One choristoma made it to the big screen in the movie, "My Big Fat Greek Wedding," where the Aunt is telling the fiance of the lump that was removed from her back that had teeth and hair in it, and that it was the remnants of her twin that was never born. It was a great scene, and a proud day for choristomas everywhere.