Vaccines (long)

I was going to write this as a response in the comments to my last post, but then it just got too long, so now it's its own post. (Ooh, look at that command of the English language! Two variations of the letters i-t-s, each used correctly, in sequence!)

PCJ writes:
I have to admit that looking at the vaccine schedule, and looking at my tiny, tiny (well, less tiny every day) baby, makes me nervous.

It sometimes feels so counterintuitive, [admittedly as a result of living in a society pretty much free of rampant infectious disease] to load up an infant who seems perfect as she is with chemicals I don't know a lot about. So I honestly can understand how this anti-vax movement is growing. I feel like vaccinating is the right decision, but I would be lying if I said that it was a no brainer, or that I don't occasionally have moments where I get scared and think, "I wonder if 50 years from now we will learn that there are problems caused by vaccinating so much and so early in infancy."

PCJ also expresses concern that she could never find good resources for telling her what the supposed controversies were and how/why they had been refuted. As for that last part, I'm happy to pull some references for you and point you in the right direction. If you have access to a college library system, it makes things easier (the local community college may even have access to medical search engines like PubMed? I'll put together a list of good places to look next week.)

Now, for the first part. First, let’s have an immunology lesson. Antibodies are protein molecules that your body makes that have specific recognition sites for antigens. An antigen is any foreign substance, be it a bacterium or peanut, that your body recognizes as foreign (if you have an autoimmune disease, it means you have abnormal antibodies that recognize your own cells as foreign). You also have a pretty strong barrier system before your antibodies need to swing into action: your skin, nose hair, and snot are all designed to keep foreign objects out. If, however, something gets through, your antibodies will most likely be called into action (OK, there’s another part to the immune system, too, but I’m trying not to write a book here).

You are, at birth, already equipped with all of the antibodies you will ever have. What’s more, you are born with antibodies against every single antigen you will ever encounter, before you encounter it. In fact, you have antibodies against substances that do not even exist on Earth today. If, 20 years from now, someone created a new bacterial species, or aliens landed on the planet and sneezed on us, we – at this very moment – already posses the antibodies that match up to those bacteria and the alien snot. (If you would like an explanation of how/why this happens, just ask.) Therefore, the idea that infants do not have immune systems as strong as those of older children/adults is a misconception. In fact, if you think about it, even if mom doesn’t have something nasty like herpes or syphilis, the “birth canal,” as it is euphemistically called, is still pretty dirty and nasty and germ-filled, and Baby has to have the ability take care of those exposures right away. So that’s how I explain away the idea that it would be better to wait until a child is older to begin vaccinating – aside from the fact that some of those vaccines are for diseases that only pose a risk to infants. More below.

Now, let’s consider the idea that infants get “so many” vaccinations. Here is the CDC schedule of recommended vaccines for infants and children. Take a look at the two-month pediatrician visit. Your average two-month-old who is receiving his or her second dose of Hep B at the two-month visit will receive 6 shots, one of which actually contains 3 vaccines. So that’s 8 immunizations. Eight sounds like a lot compared to none or one – that’s a lot of “stress” on the baby’s immune system, right? Wrong. Remember that everything around you is an antigen. Your body has to “cope” with the “stress” of being bombarded with millions of molecules each day: viruses, bacteria, parasites, fungi, dirt, dust, cat dander, bed bugs… the list is endless. Even someone else’s dead skin cells floating around the air are antigens. Your body – and your baby’s – are able to handle those, so eight more exposures won’t hurt. I promise. Besides which, if any of those eight diseases were as prevalent today as they were 50 years ago, it’s just as likely that your baby would be exposed to all of them at the same time and still make it out OK. So there’s no “stress” involved with exposing a baby to eight vaccines/antigens at once. (There is, however, a very real problem with giving a baby six injections, which is pain. That’s why some vaccines are given in one preparation, like diphtheria, tetanus, and pertussis (DTaP), or the MMR (measles, mumps, rubella), or the new ProQuad (MMR plus varicella). When people do studies, there is a significant health care cost decrease and health effect of combining vaccines into fewer injections.)

Now let’s consider the typical course of an infection and why vaccines work. An immune defense is normally mounted in the following way: an antigen makes its way into your system, past your barrier defenses (skin, nose hair, snot, etc). It floats around, and lots of antibody-producing cells come into contact with it. It will probably infect its target cells first, which is what will make you clinically sick. Eventually, one of those antibody cells that bumps into the antigen sees that it's a match, and starts churning out clones of its antibody. Some of the antibodies help your body fight the current infection, and others hang around for life, primed and waiting for a second exposure to the antigen so they're ready to fight it. When you get exposed to the antigen again, those antibodies are ready, so there’s no lag time for an immune response to be mounted. So that's why you only get chicken pox once. The first time, you get sick. The second, third, fourth, and hundredth times you get exposed, your antibodies attack and neutralize the virus before it can get the disease process underway. The “natural” way to gain immunity, then, is to be exposed to antigens, and that’s how humans lived for many, many years. If you succumbed to the infection, well, too bad; if you survived measles, mumps, chicken pox, smallpox, diphtheria, tetanus, pertussis, meningitis, pneumonia, polio, and rotavirus, then congratulations, you got to live and reproduce.

The miracle of modern medicine (and indeed, the CDC has called it one of the 10 greatest public health achievements of the 20^th century) is that we are able to mimic having an initial exposure to these antigens without the morbidity and mortality of the associated clinical illnesses. You can give everyone smallpox and congratulate those who survive (about 65%) on never having to worry about contracting it again, or you can engineer a way to expose your immune system to the virus the first time so it can build that antibody army and be ready for the smallpox particles waiting to attack – and no one dies (well, at least not anywhere near as many). So vaccination serves as the first exposure to these antigens. Kill the polio virus so it can’t replicate in your cells and give it to people. Engineer a viral shell that looks just like the shell of the human papillomavirus but doesn’t have any DNA inside of it, and give that to people so that when the real thing comes around it will be neutralized very quickly. (How quickly? Take allergies, for example. Allergies are an example of an immune reaction gone haywire. Someone who is genetically susceptible to bee stings can be stung once and be fine – probably some breathing difficulties, maybe a little more swelling than a non-allergic person, but nothing too bad. But as soon as they are stung a second time, within minutes, if not seconds, they will break out with hives and wheezing, and are likely to die if they do not receive immediate medical care. Seconds-to-minutes is the small amount of time it takes for your body to recognize the intruder and respond.)

The important ingredient in vaccines is the inactivated form of whatever bacterial or viral infection it prevents. These are either the real agents, just killed/inactivated (literally, it can be killed bacteria), or they are engineered particles that will still trigger the intended immune response. Take the HPV vaccine, for example. Researchers were able to figure out the genetic code for the viral shell and grow shell-only replicas of the virus, without its enclosed DNA that would infect human cells using yeast (the yeast is the factory that provides the machinery for the viral particles to grow). That shell is still a protein, just like the actual viral shell is. There aren’t any manmade chemicals there. We have just figured out how to utilize various systems to grow bits and pieces of naturally occurring substances. Vaccines also contain solutions to make them stable for transfer, storage, and injection. For Gardasil, the HPV vaccine, Merck states on the package insert that “Each 0.5-mL dose of the vaccine contains approximately 225 mcg of aluminum (as amorphous aluminum hydroxyphosphate sulfate adjuvant), 9.56 mg of sodium chloride, 0.78 mg of L-histidine, 50 mcg of polysorbate 80, 35 mcg of sodium borate, and water for injection. The product does not contain a preservative or antibiotics.” Yes, there are some chemicals there: aluminum (which you ingest from other sources naturally anyway), sodium chloride (table salt), L-histidine (a naturally occurring amino acid you get from meat and other protein sources), polysorbate (an oily liquid used as an emulsifier), sodium borate (another salt, containing sodium and boron, probably for a buffer), and water to make the whole thing liquidy. There are no preservatives (so it has a limited shelf life), and no antibiotics (no reason it should, since you don’t use it to fight bacterial infections). Nothing harmful, at least not any more so than the ingredients you can’t pronounce on a bag of potato chips.

I think I’ve now addressed all of PCJ’s concerns; at least, all the ones in that particular comment. Let’s recap: infant immune systems are just as strong as adult ones, and we are exposed to bazillions of antigens every day, so purposefully exposing a baby to eight more doesn’t do any harm. There are very few chemicals in vaccines, especially these days. There is no harm in vaccinating children, only benefit.

Now let’s ask, “why do we time our vaccines the way we do?” Great question. Take a look at the two-month-old vaccine schedule. Hepatitis B, rotavirus, DTaP, Hib, PCV, IPV. Oh wait, I have to tell you something else first. During development in the uterus, a fetus receives antibodies from its mother. These antibodies will provide extra protection to the infant until it is about 6 months old, at which point they wane.

-Let’s start with Hib. Fifteen years ago, Hib was the #1 cause of meningitis in infants, and everyone who got it did so around 6 months of age. Why? Mom’s antibodies protected them before then, but as soon as they disappeared, Hib was waiting. Hib killed babies; that is a fact. So a baby gets its first dose of Hib at 2 months of age, and it’s a special formulation of the Hib bacterium that evades Mom’s antibodies while stimulating Baby’s. That way, when Mom’s antibodies disappear around 6 months, Baby’s antibodies are ready to go. If unvaccinated older children and adults get Hib, they don’t suffer from as much morbidity (read: don’t get as sick) as infants do, so if you were born prior to the Hib vaccine era, no one’s going to do a catchup immunization on you.

-Rotavirus is also started early, because the only people who die of rotavirus infection are infants, whose bodies can’t handle the intense electrolyte imbalance caused by massive diarrhea as well as adults can. Adults get rotavirus (a guy in my class caught it working at the kids’ hospital this summer and was sick as a dog), but they don’t die from it, so again, we don’t immunize them.

-PCV has the same sort of logic as Hib, but it causes pneumonia. This one also protects against adult disease, because pneumococcus is the #1 cause of pneumonia in adults.

-I can’t give you a good rationale for IPV right now, but the bottom line is that kids get polio, and no one wants polio. Just ask that woman who just turned 60 who’s been living in an iron lung her whole life. Same with diphtheria, tetanus, and pertussis. If you want to know what you’re protecting your child from with the pertussis vaccine, just watch these videos. Just watching the videos makes me sick to my stomach. Breathe, children, breathe!

-Now Hep B is an interesting story. The rationale behind giving Hep B immunizations so early is not that infants are likely to be sharing dirty needles to fuel their heroin addictions. It’s because there are a lot of people infected with Hep B who don’t know it, and they may get pregnant. It's cheaper and easier to vaccinate all babies at birth for Hep B than it is to test every mother and then decide whether to vaccinate. So yes, if you are known to be Hep B negative, you can defer the Hep B shot until your kid is older. (The CDC even says so right on the vaccine schedule.) But why do it? Your immune system is no stronger at age 10 than it is at age 1 month. It just isn't. And as for whether someone can avoid exposure to Hep B their whole life, even given that they never engage in risky sex or use dirty needles, well, that's a matter for debate. One bad blood transfusion, one visit to a foreign country (or an underdeveloped part of the U.S.) with unclean sanitation... that's a pretty big risk.

-Most of the other vaccinations you get as a child have a similar rationale. Rubella (the “R” of MMR) is kind of interesting, on the other hand, in that it actually doesn’t cause any sort of big-deal childhood illness. You get a mild rash with a fever and you’re fine (it’s also called German measles). The problem is that if women get rubella for the first time while they’re pregnant, their babies end up blind and deaf with mental retardation. So we vaccinate girls so they’ll never be sick with rubella while they’re pregnant. And in fact, to completely eradicate the disease, we vaccinate boys, too. Damn carriers.

-One of the newer vaccines available is varicella, which causes chicken pox. Now I know that every one of you reading this is going, “Huh? What’s the problem with chicken pox? We all got chicken pox and we’re fine.” Well, the fact is that infants die of chicken pox. Fetal exposure is a really serious deal – it causes massive morbidity, if the fetus survives to birth. Infants who get chicken pox can die, too. And even if you survive, the course of the illness has a huge effect on the indirect costs of healthcare. (Quick financing primer: direct cost of an illness includes the money it takes to go to the doctor and buy the medicines. The indirect cost includes money lost from parents staying home from work.) When your kid gets sick for two weeks with chicken pox and you need to use up all your vacation days or hire a babysitter (and what babysitter in their right mind wants to care for a sick kid?), you’ll wish your kid didn’t have chicken pox.

So that’s that, people. Vaccinate your children. To me it IS a no-brainer. Still want more information? Here are some reliable sources available to everyone: Wikipedia (medical people use it all the time, and you can usually double-check anything strange you find here from other places on the Internet); MedlinePlus from the National Institutes of Health; the Centers for Disease Control and Prevention; and any of the medical specialty academies (like the American Academy of Pediatrics). Want to find the package insert for a vaccine or drug? Google the name of the product and “package insert” and you should be able to find a pdf of the file. Any more questions? Please, ask!

Quoted in the paper!

Renowned public health professional quoted in the newspaper.

OK, maybe not. Yet. But I did get quoted! It was perhaps the driest of the things I said to her, but probably the safest, too, as I looked back on my conversation with nervousness last night. Is it dumb that I wish there were a way for me to be referenced as a public health person, rather than a medical student? "Medical student" is not a title that garners respect. But I was sort of boxed in; she knew I had an MPH, but when she asked what I DID I didn't have much else to say other than "medical student."

What else did I tell her?
-That I was surprised (albeit pleasantly) to hear that the bill had passed the House, because my impression before coming to KY, and even since coming to KY from Kentuckians, is that this state is behind the times, especially when it comes to public health (heck, there was a bill last week trying to legalize unpasteurized milk in the state, for goodness sake!), and this measure would help show that Kentucky knows what it needs to do to ensure the health of its residents. (When I told Eric I had said this, he said, "Uh oh. Now you're anti-Kentucky." I freaked out, because even though I ended by saying this was a good thing, one might infer that I don't have high expectations. Especially as a carpetbagger. Except really, that IS how the rest of the country views Kentucky, and how Louisville views the rest of the state. Everyone at school also reacted with surprise to hear the bill had passed.)

-That my reference to "parts of the state where people don't have access to regular screening" refers to both the eastern and western ends of the state (although, in reality, 2/3 of KY's counties are medically underserved) where physicians are few and far between, and residents are either uninsured or underinsured -- all of which act as barriers to receiving preventive care.

-That if it were up to me, no required immunizations would have opt-out clauses, but I understand that the tradition in this country is to allow people to make their own choices. That said, I am disappointed in the fact that the opt-out clause included in this bill makes opting out of the HPV vaccine much easier than for any of the other required vaccines, and that at the very least, this vaccine should be treated the same way as all others. (The beginning of that statement was pretty sketchy, as I allowed my Holly-the-Healthcare-Dictator opinions to slip out, but I thought I ended strong.)

How did she end up calling me?
The day before, they ran this story, which said that more people in Kentucky oppose mandatory HPV vaccination than support it. It included this paragraph:

She [a poll respondent named Marie Mazzotta with an 11-year-old daughter] said Gardasil is unlike many other vaccines required for school attendance because it doesn't target a disease that can easily be spread in the classroom. Instead, it protects against strains of human papillomavirus that cause 70 percent of all cervical cancer cases and are only transmitted through sexual contact.

I emailed the reporter to say that I was critical of the fact that while the graf above and below that one were direct quotes from Mazzotta (crazy quotes, I might add), this one appeared without quotation marks, leading readers to the assumption that her statements are factual. In fact, they are not. Hepatitis B is a mandatory vaccine, doesn't target a disease that can be easily spread in the classroom (unless classrooms these days are full of drug-sharing addicts), and also protects against cancer (hepatocellular carcinoma). So instead of presenting Mazzotta's beliefs as facts, the story should have presented actual facts to dispute her beliefs. I actually have no problem with the paper quoting the crazies and their crazy talk, as long as their lies are refuted.

Here is how I would have conducted the interview with Mazzotta:
Me: Why don't you approve of the HPV vaccine?
Mazzotta: Because it doesn't target a disease that can be easily spread in classrooms, like measles. It targets a disease that can only be spread by having sex, and having sex is wrong!
Me: But didn't you vaccinate your daughter against hepatitis B at birth? Don't you know that the only way people get hepatitis B is by sharing dirty needles and having sex? Did you think that vaccinating your 1-day-old against a sexually transmitted disease would give her implicit permission to start sleeping around?
Mazzotta: Uh... duh... Sex is bad!

And that's what I would have printed. And that's why I don't work for newspapers anymore.

Oh, right -- the point of my story. So I emailed Laura Ungar yesterday to air my grievances, though in a much more professional manner, and she thanked me for my thoughts. Later in the day, when the story broke about the bill being passed, she emailed me to see if she could get my thoughts on the issue, so we had a nice phone chat around 6 pm. And thus history was made.

Note: Yesterday's story about the poll was written by the C-J medical reporter, Laura Ungar. She is who I emailed and who I spoke with last night. Deborah Yetter, who has the byline for today's story, is the government reporter. Ungar is given credit in the tagline of today's story.

Note 2: I was quoted in USA Today around this time last year regarding a visit by President Bush to Louisville. Maybe this is going to be my yearly event.

Cat bloggers

I've been discovered. A few weeks ago, I got an email from cat-bloggers.com saying they had noticed I blog about cats and asking if I would like to be part of their network. I still haven't responded. It's sort of a weird site -- badly laid out and hard to navigate, and some of the blogs are dedicated to cat-type things while others are like mine, a mix of life and cats (and life with cats). So I haven't decided. On the one hand, I don't want to be associated with anything weird that might damage my reputation. On the other hand, it might bring me more readers. Thoughts?

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Lost was OK tonight. I don't think that sheriff woman was speaking Chinese when she read Jack's tattoo. At most it was a non-Mandarin Chinese dialect badly spoken, but I suspect it was Thai. And that makes sense, but then why say it was translated from Chinese? There's not actually much to say about the episode, since nothing concrete happened. All we know is that the tailies survived and think they're OK. It looks like next week's episode will have more action.

~~~~~~~
For dinner tonight I made chicken scallopini with lemons and capers and a white wine reduction sauce. It turned out beautifully. What made it super-easy was a package of thin-sliced chicken breasts on clearance at the grocery store yesterday. It was on clearance because the sell-by date was today. It had a sticker on it that said, "Perfect for scallopini!" so I took its advice. I don't think I'd have the patience to take a regular chicken breast and pound it thin on top of everything else. The next time I make it, I'll make more of the sauce and serve it with angel hair pasta. Yum.

The American Community--Asians: 2004

The Census Bureau on Feb. 15 released a report of the Asian subset of the U.S. population in 2004. It, along with a report on the black and Hispanic populations, is "a portrait of racial and ethnic population groups in the United States based on data from the 2004 American Community Survey," according to the UCLA Asian American Studies Center, which is "an official U.S. Census Information Center in partnership with the National Coalition for Asian Pacific Community Development." The report can be found here: The American Community -- Asians: 2004.

Some highlights:
-There are about 13.5 million Asians in the United States.
-I am one of 881,813 Asian-and-White people in the U.S. (emphasis not mine).
-More than 50% of the Asian population lives in California, New York, and Texas. About 75% of the Asian population lives in those three states plus New Jersey, Hawaii, Illinois, Washington, Florida, Virginia, and Massachusetts.
-About 1/3 of the Asian population consists of U.S. citizens by birth, about 1/3 are U.S. citizens by naturalization, and about 1/3 are foreign-born residents.
-About 48% of all Asians hold at least a bachelor's degree, compared with 30% of non-Hispanic whites.
-About 45% of all Asians work in "management, professional, and related occupations," compared with 38% of non-Hispanic whites.
-The median yearly income of Asian households is $55,850, compared with $48,784 among whites.
-The median value of owner-occupied homes among Asians is $300,000, almost double the value among whites ($154,000).

I'm glad to see data on the API community in the U.S. Now if only the CDC would consistently collect data on Asians when they do health statistics reports, it would be easier for community and public health programs to do they work they need to do.

Pics

Mojo and Moxie in their respective cat cubes, with their ball-in-a-track out in front. This was a weird moment; I've not seen them do anything so coordinated and cute as this in a long, long time.


Eric and I with a baby that is not our own. I hear they're good for bringing asking prices on houses down... we might have to borrow one at some point...

Happy New Year!

Oh yeah, Happy New Year to you, too. It's the Year of the Boar, which means my brother must be turning 24 this year, which is even more bizarre to me than the fact that I just turned 26. I didn't eat noodles or dumplings or fish or anything Chinese this weekend. In fact, Eric and I left Virginia just a couple of hours before the rest of the Campbells had Chinese food for dinner, which I've never seen them do ever, so even they celebrated more than I did. I did, however, participate in a healthy debate on the LouisvilleHotBytes.com forum regarding the proper pronunciation of "gong hei fat choi," the traditional New Year's greeting, in Cantonese. You can marvel at my academic knowledge of Chinese here. Too bad I suck at speaking or understanding it these days.

I also suck at Medical Spanish, which I just finished today after 8 miserable weeks. My theory was that if someone would just teach me some basic grammar and sentence structure, drill into my head how to conjugate a few basic verbs (to be, to have) and some regular verbs, I could look up medical terminology on my own. The professor did just the opposite. On the first day, he announced that he would not teach any grammar, and we would only learn medical terminology. So for the last 8 weeks I've learned only a handful of Spanish words and wouldn't be able to use them with a patient anyway. The only good thing was that he didn't care about attendance, the final quiz was a joke, and he said he'd given everyone honors (vs. pass). The H is nice for 1 credit, but it was still a waste of my life.

Also, I realized that when I wrote my TV synopsis yesterday, I forgot about Lost. I like the 16-episodes-in-a-row format, although I agree with some analyses that say fans are getting annoyed by all the storylines running at this point. I'd like at least one thing to wrap up, please. Especially with rumors that Lost might not last very long since viewership is down, and my recent loss of Studio 60, I'm worried that Lost might end at some point without telling me what the hell happened to all those people on that plane! As for last week, I'm intrigued by Desmond's storyline. Did he really enter an alternate time to try to propose to Penny but get sucked back to the island? I'm willing to believe it; it's not the most bizarre thing that's happened on this show by far.

growing up

I went to the gym tonight for the first time in two weeks, and for the first time since my birthday. I had a moment of panic when the treadmill asked me to input my age and I realized I had to enter 26 rather than 25 :( The second moment of panic came when I had to input my weight and realized it was higher than the last time I was at the gym. Only 2 pounds higher, but still. Back on the bandwagon...

We have also received two additional pieces of mail to put on the refrigerator, adding to the already-crowded collection of announcements. We now have: 1 marriage announcement, 5 Save the Dates, 1 wedding shower invitation, 2 birth announcements, a set of new baby pictures serving as a birth announcement, and 3 Christmas card pictures. The whole freezer section of the door is full! And we're running low on magnets. Thankfully, one of the Save the Dates IS a magnet, which helps things significantly. At some point I'll have to cull the herd; things like Save the Dates and invitations have inherent expiration dates for display, but I'm not really sure how long the others should last. Christmas pictures until next Christmas? (I know a family that does this.) By analogy, baby announcements should last until the baby's first birthday and marriage announcements until the first wedding anniversary? I'm kind of happy that right now there is nothing more pressing on my mind than this.

Happy Birthday to me! I have confirmed with multiple people that 26 is still considered to be part of the mid-twenties, so I have chosen to celebrate. We had a very nice Valentine's/Birthday dinner at Primo last Wednesday, and I was pretty impressed with the place. It looks like it should be more expensive than it actually is, which is always a good thing. I'll add it to the list of special occasion places. (In reality, for most people it would probably be on the "slightly nice but not special occasion" list, but I'm not that rich.)

Last week we also drew our tracks for third year. I had a decent lottery number, in the top third, and I ended up with my first pick with my friend David. I start with OB/Gyn in June, then move on to surgery, then pediatrics to finish out the fall. In the spring semester I start with internal medicine, then psychiatry, and finish with family medicine. I think it's a pretty good track, and I shouldn't have a problem getting off for a wedding I'm in in April. However, I just found out today that we have a wedding in September to go to (Congratulations to Becky and Kevin!) and I'll be on surgery, which doesn't bode well, but hopefully I'll be able to sneak away for a weekend. Make that 6 weddings to attend in 2007...

I've also decided that when I do my rural rotation during family medicine, that I will request a location in southeastern KY, as close to the VA border and Abingdon as possible. That way I can go visit Eric's sister and her family on the weekends. There's pretty much no hope of staying near Louisville, so I figure I'll go to the next best place and get a real rural experience out of it at the same time. Plus, everyone else I know has spent a significant portion of time in Appalachia, so maybe I should as well.

Speaking of Abingdon, we just got back from a weekend trip there to help Paige and Brian move into their new place. Abingdon is a cute little town and they have a great house, and I'm happy they'll be slightly closer to us for the next couple years. Plus they have a baby, so how could that be bad?!

This weekend is the Colorado trip, for which I am not at all prepared. We need to give a report on a leadership book, and all I've managed to do is to check out a few books from the library. Haven't picked one to actually read, let alone start reading it. Oops. We'll see how fast a reader I really am by Saturday!

In other news, we noticed that NBC was promo-ing "The Black Donnellys" for the "Studio 60" spot next week, so some Googling turned up this: NBC yanks Aaron Sorkin's 'Studio 60'. Boo. Boooooooooo. Hopefully the story is correct in that they will air the rest of the shows sometime in the spring or summer. There's so much story to wrap up! I wanted to see what the outcome of the FCC fine was going to be. Boooooooooooooooooooooooo. What a disappointing end to an otherwise-good show. I shrieked when the baby's head was chopped off and again when it exploded at Jordan. Argh. I don't even know what else to say about this other than it sucks and I'm mad.

I never do this, but since I already talked about one TV show, I might as well do them all:
-Scrubs: Last week's episode brought back some of the original type of humor, which I greatly appreciated. However, they did keep pronouncing the "vaso" in "vasovagal" with a short "a," which bugged me.
-Grey's Anatomy: I really hate this triplet of episodes about the ferry crash. It's obviously supposed to be a big deal, a real tragedy, but the acting is just awful. There's no energy there at ALL. BO-RING. And it's not even exciting or nail-biting-inducing to have Meredith "die." Give me a break. In general, I'm getting tired of this bizarre hospital where time doesn't move forward (they've been interns for how many seasons now?), where the only interns in the place are surgical and therefore work EVERYWHERE, including the ER, and where Meredith-the-rexy-bobcat-bad-actor is so melodramatic and needy. Ugh. (Like my use of "rexy bobcat" there? That's Julie's affectionate term for anorexic chicks.)
-ER: Good episode. I was amused by the "save the cheerleader save the world" plug by Dubenko. I'm glad Neela did the right thing and reported the bad transplant donation, and I'm also glad that things finally got weird enough for her with Gates that she appears to have made the decision to end things with him. He's a good guy, but I don't think he's right for her. I like Neela and Ray a little better.

Now back to pharmacology.

Bardstown Fire

You probably heard about the fire Tuesday morning in Bardstown, KY, that killed 10 people, 6 of whom were children. It's the largest fire in Kentucky in many, many years, and a tragedy any way you look at it. We were actually supposed to have a lunchtime talk on forensics on Tuesday by the state's chief medical examiner, but it was called off because she was called to the scene of the fire instead.

Anyway, the fire gained even more notoriety in the last few days when it was discovered the Westboro Baptist Church planned to protest at the funeral today. You may have heard of the Westboro Baptist Church, from Topeka, Kan. -- they're the people who believe that soldiers' deaths in Iraq, and this family's deaths in Bardstown, are God's punishment for the fact that we as a nation condone homosexuality. Their behavior is quite disgusting, if you ask me.

They've protested all over the place, causing states to enact laws prohibiting "peaceful" funeral protests, but those laws were ruled by a federal judge to be un-enforceable. On Thursday, Kentucky's attorney general told the group that a Kentucky law "doesn't allow anyone to block access to a funeral, engage in violent or threatening behavior, make unreasonable noise or create a hazardous or offensive condition within 300 feet of a funeral home, memorial service or cemetery during a funeral or burial." Needless to say, the family and community were pissed.

Well, Thursday night, Mo, a DJ for the local rock radio station, WLRS, called up the group and cut a deal: He would give them an hour of airtime on his afternoon show if they agreed not to go to the funeral. They agreed. So yesterday, Mo talked to Shirley Phelps-Roper, daughter of the Westboro pastor, for one hour. Mo said he invited them on the air to "spout out their insane propaganda so the family and community in Bardstown could mourn in peace." I listened to part of the interview, but it got too revolting, so I had to stop. All I can say is, I'm EXTREMELY impressed with Mo. He kept relatively calm, considering the nonsense he was listening to, and did an amazing thing to allow the funeral to proceed in peace. VERY impressive.

Mo's interview with Shirley Phelps-Roper (scroll down a little)
C-J story about the fire
C-J story about Westboro planning to protest
C-J story about Stumbo warning the protesters
C-J story about Mo / WLRS deal

Amazon Oddities

Amazon Oddities
Check them out; they're so funny. Read the comments for the 1 gallon of Tuscan whole milk, for example. Or how about a Badonkadonk land cruiser? Only $20,000!

I ended up on this page tonight after being directed to this page, a listing of bad Valentine's Day gift ideas, by my friend's blog. I was particularly intrigued by the fresh whole rabbit. (Is it culinary? Or for your home science experiments?)

Anyway, if you have some time to kill (not that I do), check it out!

an amalgam

Test sucked, as predicted. Partying and shopping the entire weekend afterward was awesome. Superbowl was fun; I'm happy Peyton won, although I didn't realize he acted like such a crybaby on the field. I only liked him from his many endearing commercials. My favorite Superbowl commercial was the one for Emerald nuts, with Robert Goulet wreaking havoc on an office while everyone suffered through their post-prandial slump. How random! My apartment is a mess -- clothes and books are piled everywhere. I managed to do laundry last week, and Eric was nice enough to fold all my stuff for me, but now it's just sitting in a pile on the bedroom floor, waiting for me. Ugh.



This is Mojo sitting on the TV, as he has taken to doing recently, looking exactly like the bar cat in LOTR: The Fellowship of the Ring on the screen below.









Scary cats on top of the kitchen cabinets.













This is a bag of unshelled almonds I bought. I opened the bag the other day and out tumbled a walnut and a hazelnut. What?!










My mom and sister Laurel came to visit over MLK weekend, and we drove down to Fort Knox one afternoon. This is me standing in front of the house we lived in when I was born. Or else it's the house next to our house -- they all look the same and my mom couldn't remember our address. That was also the last of the unseasonably warm temperatures -- it was in the mid-50s that day, but it's been in the freezing range ever since.





This is a scary thing in a tree at home in Leonardtown, MD. Laurel found it behind the local thrift store and took a picture of it after being scared to death, reportedly. Then she posted it on her facebook site and I looked at it and was nearly scared to death as well. It's so scary looking. And random! Eric says it looks like a freaky Buddy Lee, from the jeans commercials. My favorite part is that on her facebook site, where you can type in who is pictured in the photo, Laurel just wrote, "What?"