May 13, 2008
What's lost in the war against illegal immigrants
Meet Dr. Alfredo Quiñones-Hinojosa (above).
This Johns Hopkins neurosurgeon got his start in 1987 when as a 19-year old he realized that selling hot dogs on the corner in Mexicali, Mexico was not a promising career path.
He climbed a border fence, made his way north and now, 21 years later, finds himself removing brain tumors for a living.
Here's Claudia Dreifus's Q.&A. with him, from today's New York Times.
- A Surgeon’s Path From Migrant Fields to Operating Room
At the Johns Hopkins School of Medicine, Alfredo Quiñones-Hinojosa has four positions. He is a neurosurgeon who teaches oncology and neurosurgery, directs a neurosurgery clinic and heads a laboratory studying brain tumors. He also performs nearly 250 brain operations a year. Twenty years ago, Dr. Quiñones-Hinojosa, now 40, was an illegal immigrant working in the vegetable fields of the Central Valley in California. He became a citizen in 1997 while at Harvard.
Q. Where did you grow up?
A. Mexicali. My father had a small gas station. The family’s stability vanished when there was a devaluation of the Mexican peso in the 1980s. My father lost the gas station, and we had no money for food. For a while, I sold hot dogs on the corner to help.
As the economic crisis deepened, there seemed no possibility for any future in Mexico. I had big dreams and I wanted more education. So in 1987, when I was 19, I went up to the border between Mexicali and the United States and hopped the fence.
Some years later, I was sitting at a lunch table with colleagues at Harvard Medical School. Someone asked how I’d come to Harvard. “I hopped the fence,” I said. Everyone laughed. They thought I was joking.
Q. After you crossed the border, what kind of work did you find?
A. I was a farm laborer in the San Joaquin Valley, seven days a week, sunup to sundown. I lived in this little trailer I paid $300 a month for. It didn’t take long to see that farm work was a dead end.
After a year of it, I moved to Stockton, where I found a job loading sulfur and fish lard onto railroad freight cars. My eyes burned from the sulfur, and my clothes smelled from fish lard, but it paid me enough so that I was able to go to night classes at San Joaquin Delta Community College. There, I met this wonderful human being, Norm Nichols, the speech and debate coach. He took me into his family and mentored me. Norm helped me apply for and get accepted to the University of California, Berkeley.
Once at Berkeley, I took a lot of math and science classes to up my G.P.A. Science and math are their own language. You didn’t need to write in perfect English to do well in them. I pulled straight A’s in science. In my senior year, someone told me to go see this guy, Hugo Mora, who helped Hispanics with science talent. I brought him my transcript and he said: “Wow! With grades like these, you should be at Harvard Medical School.” That’s how I got to Harvard. All along, I had much luck with mentors.
Q. Did you find Harvard tough?
A. Not really. Compared to working in the fields, it was easy. The question was what kind of doctor should I become? For a while, I thought I’d be a pediatric oncologist, because I wanted to help children. But then I thought, I’m good with my hands. Maybe I should do surgery.
One day, I was walking through Brigham and Women’s Hospital and I saw Dr. Peter Black, the chairman of neurosurgery. I introduced myself, and he invited me that day to come to watch him do an operation. As it happened, he was doing an “awake” surgery, where the patient’s brain is exposed and the patient is awake so that the surgeon can ask questions. As I watched that, I fell in love with brain surgery.
Q. What about it spoke to you?
A. Imagine, the most beautiful organ of our body, the one that we know least about, the one that makes us who we are, and it was in Dr. Black’s hand. It was in front of me. It was pulsating! I realized I could work with my hands and touch this incredible organ, which is what I do now. I cannot conceive of a much more intimate relationship than that. A patient grants you the gift of trusting you with their lives, and there is no room for mistakes.
Dr. Peter Black, he was a very humble person. And he took me under his wing. So here again, I was very fortunate with mentorship.
Q. I'm told that you do something that not all surgeons do: you spend a lot of time with patients before an operation. Why?
A. I meet them several times, and their families. They don’t know if they are going to wake up after the operation. Not all the time am I successful. I do about 230 to 240 brain tumor operations a year. The majority make it. Some have complications. And some — 2 to 3 percent — it takes awhile for the patients to wake up. I need to meet everyone so that they know the risks. But getting to know these patients, it’s the most painful part.
I was at a funeral yesterday. This was a 21-year-old man with a young wife, pregnant. Three surgeries, and the tumor kept growing and growing. And he told me, “There’s no possible way I’ll give up.” He fought so hard. He trusted me with his life. Not once, several times. I owed him my presence.
Q. How do you handle such losses?
A. One of the ways I work it out is through research, the laboratory. I’m trying to learn about the causes of these recurring tumors. The patients, they can donate tissue, which we will examine.
My hypothesis is — and there are quite a few scientists who believe this — there are within these brain tumors a small subset of cells that can keep growing, even when you think you’ve taken them all out. We call them brain stem cells. They can keep making themselves, and they can make “daughter cells” that can become anything else in the brain. They have the ability to go to sleep for a little bit and then wake up and do it again. So we’re trying to identify this small subset of cells we may be leaving behind when we make these beautiful surgeries.
Q. Have you actually found them?
A. Yes, but only in the laboratory. When we’ve found them, they may be a product of the experimental conditions of the laboratory. We haven’t found them yet in live patients. The next challenge is to see if they truly exist in the human brain while the patient is alive.
Q. When you hear anti-immigrant expressions on talk radio and cable television, how do you feel?
A. It bothers me. Because I know what it was that drove me to jump the fence. It was poverty and frustration with a system that would have never allowed me to be who I am today.
As long as there is poverty in the rest of the world and we export our culture through movies and television, people who are hungry are going to come here. There’s no way to stop it.
brellas.wordpress.com — Just five days old and already a star
I figured I better feature this website immediately, what with its having premiered only last Thursday, May 8, with the following introduction: "I’m not exactly sure what’s going to occur here. There will be umbrellas. That is all."
The photo up top is the site's "Umbrella image of the week."
I like the cheekiness, what with the site being only five days old today.
Enter the Rumbler
Long story short: It's a souped-up, tricked-out new police siren with an amplifier and two sub-woofers augmenting the standard sound palette.
According to today's Associated Press story, it works by "... creating a lower-pitched sound that should cut through pretty much any traffic din and that can create vibrations that might get the attention of otherwised soundproofed motorists or pedestrians."
Hear it in action above and below.
Tell you what: It won't do much to alert the increasingly frequent drivers wearing closed headphones and listening to music I'm seeing in Charlottesville.
I can't imagine it's not happening everywhere.
Here's the AP article as it appears in today's Wall Street Journal.
- Police Test Souped-Up Siren
The town of Vienna, Va., isn't big, but anyone who has tried to navigate its main streets at peak times knows it can be crowded and noisy. And that can hamper a police cruiser trying to get somewhere quickly.
Enter the Rumbler.
Vienna police are testing the Rumbler, a device that augments the standard siren with an amplifier and two subwoofers, creating a lower-pitched sound that should cut through pretty much any traffic din and that can create vibrations that might get the attention of otherwise soundproofed motorists or pedestrians.
Police hope drivers or walkers "will start looking around, and hopefully they'll find the emergency vehicle" and clear the way, said Officer W.G. Murray of the Vienna Police Department. Vienna, which has 11 patrol cars to cover its 4.4 square miles, will rotate officers into the single car outfitted with the Rumbler, to give most officers a chance to gauge its effectiveness.
The Rumbler consists of two speakers, mounted inside the front bumper, that emit a lower-pitched siren that seems to slice through ambient noise more effectively. The device even creates a small but noticeable vibration inside a car, much like when a passing car is playing a thunderous hip-hop song. Police, fire and ambulance drivers often express frustration when traffic doesn't clear for an emergency vehicle, and the situation can be potentially fatal if cars unknowingly drive across the path of a speeding firetruck or police car.
"I had times, when I was on patrol, where I knew people didn't hear" the siren, said Vienna Detective James K. Sheeran as he watched the Rumbler being demonstrated. "I know they didn't hear it, because they didn't know why I walked up to their cars" when they did pull over, the detective said.
The Rumbler is about two years old, but it has been picked up by about 200 police and sheriff's agencies throughout the country, according to its manufacturer, Federal Signal Corp. of Oak Brook, Ill. District of Columbia police equipped about four dozen cars with the Rumbler in the fall and plan to expand it to all 767 of the department's marked patrol cars.
At a cost of about $350 a unit, "it's definitely not cost-prohibitive," Mr. Murray said.
I'd like to see this technology crammed into a travel alarm clock — I'd buy one in a New York yoctosecond.
Half Brolly — Episode 2: Will this appease Flautist?
When last we visited the half brolly in Episode 1 last week — on Thursday, May 8, 2008 at 3:01 p.m., to be precise — its appearance was greeted with a fusillade of derision from down Atlanta way.
bookofjoe's very own Georgia peach commented, "Four hundred dollars for a half-(assed) umbrella and base, just for some shade???? My Tweety & Sylvester parasol would keep you in the dark with style and flair — $10.00. Or... garbage bag stretched over an old TV roof antenna: $2.50."
That stung just a wee bit.
But we're resilient here, me and Shawn Lea and her mighty crack research team, so we went on an all out search for a version that might better suit the sensibilities of our musically inclined friend.
And I do believe (pending Flautist's weighing in here, of course) we may very well have succeeded.
Without further ado, then, the second, far cheaper — $139 v $400 — coming of the half brolly.
From the website:
Even a small patio has room for this half umbrella.
Now you can enjoy shade where a full-size umbrella just won’t fit!
This half umbrella fits up against the wall and only needs half the space.
Even use it as an instant awning for a window.
Because the pole fits up against a wall you can use this umbrella with or without a table.
There’s even room to stand under it because it’s almost 8' high.
Use to shade a small table on a narrow balcony, or place in front of a window where it can do double duty as an awning.
Sturdy steel pole, easy-up crank handle, and mildew-, fade- and weather-resistant polyester canopy.
• Plastic ring, metal clip, steel base pole and hardware included
• Decorative floral designed cast iron base [below] included
• Canopy measures approx. 7'6"W x 3'9"D x 7'10"H
• Base measures approx. 19"W x 12¼"D x 1"H
• Steel umbrella pole with crank handle
Hey, Flautist, don't get your knickers in an even bigger twist — "crank" handle is their copy, not mine.
Beige or Green.
$139 (cast iron base included — can you believe it?).
BehindTheMedspeak: Would you pay extra to have your dental anesthetic wear off in half the time?
Novalar Pharmaceuticals is betting lots of people will be happy to add $25-$50 to their bill to cut the time it takes full sensation to return to their lips by 75–85 minutes, in about half the time it would normally take after receiving an injection of local anesthetic prior to undergoing dental work.
Me, I'm old school so I'll pass but I can't see the harm in opting for the additional reversing shot.
Here's Andrew Pollack's article from yesterday's New York Times with the details.
- Drug Promises to Restore Sensation After Dental Visit
For those who don’t like to drool, slur their speech or unknowingly bite their tongue after a visit to the dentist, help might be at hand.
A small drug company said it won approval Friday from the Food and Drug Administration to market the first drug meant to undo the effects of local dental anesthesia.
In clinical trials, the drug cut the median time it took for full sensation to return to the lips by about 75 to 85 minutes, or by more than half.
The drug, called OraVerse, was developed by Novalar Pharmaceuticals, a privately held company in San Diego. The company said it would begin selling the drug to dentists late this year for $12.50 an injection.
After a dentist finished a filling or some other procedure, he or she would inject OraVerse into the same spot where the anesthetic had been injected.
Is a drug really needed for what seems like a trivial use? Novalar and some dentists who advise the company said it might be useful for children, who can injure themselves by biting their lip or tongue without knowing it.
“Kids tend to chew on their tongue when it’s numb,” said Dr. Athena Papas, a professor at the Tufts University School of Dental Medicine. The drug, however, is not approved for children younger than 6 or weighing less than 33 pounds.
Dr. Papas, an adviser to Novalar and an investigator in its clinical trials, said she thought the drug would appeal especially to those receiving cosmetic dentistry “who like to look good when they leave the dentist’s office.”
Novalar said its surveys showed great interest in the product among consumers and among dentists, some of whom said they would mark up the price of the drug as a source of profit.
With about 300 million anesthesia injections given by dentists each year, company executives say the drug could easily achieve sales of hundreds of millions of dollars a year.
OraVerse is a formulation of a decades-old drug, phentolamine mesylate, which is used to treat severe episodes of hypertension.
When dentists administer lidocaine or another local anesthetic, they usually combine it with another drug called epinephrine, which acts to constrict the blood vessels. That keeps the blood from carrying away the anesthetic from the mouth too quickly.
OraVerse does the opposite, dilating the blood vessels and speeding up blood flow so the anesthetic can be carried away.
“We aren’t reversing the local anesthesia,” said Dr. Paul A. Moore, chairman of anesthesiology at the University of Pittsburgh School of Dental Medicine, who is an adviser to Novalar. “It is reversing the epinephrine.”
The label for the hypertension drug phentolamine contains warnings about heart attacks and occlusion of blood flow to the brain. Novalar said the label of OraVerse would also contain the warnings, but note that OraVerse is given in a different manner. In the clinical trials there were no serious side effects, Novalar said.
Novalar also said patients did not have pain because the anesthesia wore off more quickly, except for a little extra pain at the injection site. But the trials excluded people who got root canals or tooth extractions. Those patients would be expected to have lingering pain, and should not get Oraverse, Dr. Moore said.
In two trials of 484 patients in total, people were given either OraVerse or a sham injection. (Patients were blindfolded so they could not see the needle and, being numb, supposedly could not tell if the needle penetrated.)
People then tapped their lips every five minutes for five hours, feeling for sensation. Observers measured the symmetry of their smiles, checked for drool and listened to them read sentences.
About 41 percent of patients who got OraVerse reported normal lower lip sensation one hour after getting the drug, compared with 7 percent of those getting the sham injection. About 59 percent of those who got OraVerse had normal sensation in the upper lip after one hour, compared to 12 percent in the control group.
Note that though OraVerse will cost dentists $12.50 a dose when they buy it, they're free to mark it up as much as they want.
That's why I noted $25–$50 additional on your bill, two to four times what it cost the dentist.
Nice little chunk of change, that: multiplied by, say, 20 injections a week, 80 a month, around 1,000 a year — an extra $25,000 annually isn't chump change where I come from.
My nominee for Official Shoe of Burning Man.
Very "Beyond Thunderdome."
Widgets for everybody
Google calls them "Gadgets" but they're the same thing — features and add-ons you can put on a customized iGoogle home page.
I've been jealous of everyone I know who's got Tiger or Leopard, with their nifty desktops full of great things, but now even I, in my TechnoDolt™ Luddite Panther-using state, can have some fun.
I happened on this world of stuff via Virginia Heffernan's "The Medium" column in this past Sunday's New York Times magazine, in which she wrote, "For iGoogle — an extra-sharp way to curate and arrange your home page — consider taking on the handy widget called Web Definitions. In a flash, it combs through a dizzying range of lexicographical material and returns thorough definitions so efficiently you're tempted to try to stump it. Get it through "Add Stuff" [at the far right margin of the page] on iGoogle."
Sure, you're on Google as opposed to your own desktop when you access all these nifty virtual toys but who really cares (other than Google)?
From the website:
- Party Pump™
Make a batch for a bunch in this unbreakable jar — carefree entertaining with this self-serve dispenser that holds more than two gallons, so there's no need for constant replenishing.
While this big dispenser comes with a mix and recipes for margaritas, it’s perfect for any summer thirst-quencher.
Serve lemonade, sangria, fruit juice or punch to a crowd — guests can serve themselves.
A flat bottom lets you place it on a table, or put it in a cooler full of ice.
Holds almost 2½ gallons (37 8-ounce drinks).
Plastic — won’t break if knocked to the ground.
That last feature's key.
$19.95 (Flautist, yours comes pre-filled with margaritas — everyone else, you're on your own).