Lawrence Niles, et. al., Life Along the Delaware Bay. Cape May, Gateway To a Million Shorebirds. Rutgers U.P., New Brunswick NJ., 2012. Pp.153.
What we have here is a handsome coffee table book, beautifully illustrated with more pictures than text, about the importance of the Delaware Bay as a stop-over place for a number of shorebirds, among which the threatened Red Knot receives most attention. Larry Niles is well known for his work on the Knot and is the author of several previous publications (see the post The modest birder # 18).
After a quick glance at the town of Cape May and its Hawk Watching platform, a brief mention of the NJ Audubon's counting of the Fall migration of raptors and song birds, the authors (their individual contributions are not clearly identified) jump into media res with the following chapters on the importance of the horseshoe crab whose eggs make the Bay "the most important [shorebird] stopover in the Western Hemisphere" before giving a chapter each to the Knot, the Ruddy Turnstone and Sanderlings. The remaining shorebirds are lumped together in a chapter on "mud birds," among which the Semi-palmated Sandpiper is (as in the overall numbers) the most numerous. A separate chapter deals with gulls, the great competitors for the crab eggs; it is followed by a chapter on the Bay's marshes and a final chapter discusses the threats to its ecology.
It should be clear that this is a book for more than an occasional visitor to Cape May. On the other hand, even a casual nature lover will find much of interest while the non-specialist birder cannot easily find so much interesting and important information. I particularly like the several maps and graphs as well as the pictures (pp. 33ff., 45 and elsewhere) showing the actual work of the many volunteers who capture the birds, note their vital statistics before placing the, sometimes several, bands on their legs before releasing them.
A world map on p. 44 shows the location and migration routes of the nominate species (Calidris canutus canutus) and the five subspecies of Knots, two of which, the C.c. Rufa and the C.c. Roselaari) occur in North America and of these the Eastern species, the Red Knot, accounts for the smallest population. By the numbers, Knots are actually mostly European birds. Although the fate of the Red Knot (and the horseshoe crab) is the focus of Niles' research, the graph on p. 37, shows that the Rufa Knot only accounts for 9% of all the shorebirds using the Bay during their Spring migration (during the Southward migration the Bay is unimportant), Semi-palmated Sandpipers and Dunlin together making up 66% (in the fall they are the majority also). But the apparently declining population of the Red Knot is a significant indicator of the health of its various habitats, the Arctic where it breeds, the coasts of South America and in particular Southern Argentina where it winters and perhaps of greatest significance the Delaware Bay where it refuels on the way north with enough energy reserves for successful procreation.
From remarks while discussing other species it becomes clear that shorebird populations globally face declines and this is true of all the Knot groups, independent of the decline of the horseshoe crabs. The causes of these declines are rarely as clear as in the case of the Red Knot with its temporary but all important dependence on one food. Such birds as the Sanderling, which is only an opportunistic feeder of crab eggs and more numerous on sandy beaches anywhere than in the Bay seems to be holding its own better than other species as for ex. the Semi-palmated Sandpiper (one of the book's "mud-birds" and also only an opportunistic feeder of the eggs (the crabs preferring sandy beaches rather than mudflats as is clearly evident in such places as Bombay Hook in Delaware). Such drastic declines as that of the Phalaropes in the Bay of Fundy, far from metropolitan polluting areas, remains a puzzle. And while the horseshoe crab-Red Knot relationship provides a clear ecological model, the factors discussed in the last chapter on such environmental threats as rising sea levels should be studied with as much immediacy.
Yet, while we must applaud Niles and his collaborators for their contributions to our knowledge, the book has a few problems. For ex. the Google map (p. 46) of the Western Hemisphere showing the migration route of one known Rufa, gives the distances in kilometers while the explanation uses miles, which would be ok if the arithmetic were correct: the flight north from Uruguay is given on the map as 8000km in 6 days but described as 3,000 miles, while it is more likely 5,000 miles, one mile being approx. 1.6 km (the distance being easily obtainable for Google). And while we are talking about Uruguay, there was a (still unexplained?) kill of some 2,000 Knots about a decade ago on their stopover place there. Meanwhile there is some encouraging news: At the end of Sept. 2013 the Fish and Wildlife Service proposed "endangered species" status for the Red Knot and since 2012 there's a managements plan that ties the horseshoe crab fishery explicitly to the Knot's recovery.
A, to me, more significant problem, for which we probably must blame the Rutgers University Press are the book's misleading titles that reveal an advertising mentality aiming at the "hype" rather than at accurate information. As a "bird book" it provides only a small, if significant, slice of "life" along the Delaware Bay. The subtitle clearly exploits the fame of Cape May as a resort and a remarkable birding spot, though among the birds, shorebird migration in the number of 1,000,000 strikes me, a 30+ year birder in southern Jersey as a gross misstatement. And, as results from the authors' own data, half a million in the month of May when there is the greatest concentration, is a better "ballpark figure." And considering the importance of the Delaware side of the Bay, it could with better justification, have been called "Lewis, the Gateway, etc." But why, Cape May having been put forward, is there such slight mention of important birding at other times of the year when "Life along the shore" is often as exciting s the month of May. Or why is the work of the Cape May Bird Observatory passed over by a slimple reference to the counting of Fall migration done by NJ Audubon.
Which brings me to a rather unrelated fact though it seems worth mentioning. Most of the documentary photography is by Jan van der Kam, a fellow Dutchman, with whose jealous making work, I have long been familiar, most recently through his work in a Dutch coffee table book simply called Shorebirds (whose scientific standards are a model). Van der Kam, a professional who seems to do nothing but shorebirds in their habitats, I am still pretty amazed by the occasionally artistic, rather than merely documentary shots that are included also in this book. Yet, through the CMBO blog "View from the Field," I have come to realize the possibilities of what a person with a sense of photographic "view" (and a knowledge of bird behavior) can do with modern equipment.
Tuesday, September 17, 2013
Wednesday, July 10, 2013
on wine (9) throwbacks in Maine
Calvin Trillin tends to refer to the less sophisticated foodies of the past as the "beef Stroganov types." When it comes to wine I think back to the "Matteus days" of the 1960s when the flat bottles made very good candle holders. But Colette and I were recently reminded that there then were other choices, her former husband preferring California jug wines and several of our friends drinking Almaden because the bottles could do long service as wine carafes. The occasion occurred on our birding trip to Maine at the end of last May and I was reminded of our poor to middling eating experiences when I checked my diary for the precise date of seeing the Spruce grouse (which for me was a "lifer").
I hesitate to name the restaurant, at the entrance to a former Down East sardine harbor, because the owner who served us was a kindhearted elderly woman who told us with some pride that she and her husband, the cook, had started the restaurant in their 20s when an uncle gave them a loan (actually a gift as it turned out). Anyway, the menu and (unfortunately) the cooking apparently had remained the same all these years. Colette had a boiled lobster which can't be easily spoiled unless it's overcooked, which it was. Maybe it had something to do with the time it took to prepare my frozen (and thin) pork cutlets. The veggies come from cans or frozen packages. Even the blueberry pie wasn't made from scratch, which we find (after decades of Maine summers) a rare find. The wine "list" had "red, rose, white from 3 California growers in 2 "carafe" sizes. One of these growers was Almaden and the "carafe was a recycled Almaden bottle. On the whole it was a typical 1960s "family restaurant" experience. The only other eating out event was at a Chinese place that turned out to be equally behind the times, but fortunately they had bottled beer.
We decided to have all our other meals in our rooms with food from the local Hannefords. What has surprised us about that chain, even those in upscale tourist places, is their very large selection of California and other US wines and there relatively poor selection of French and Italian wines. But at least they have usually something drinkable. And we have found the occasional boutique delicatessen with a fine wine selection. This trip was no exception and Colette discovered a wine boutique when we were rained out in Machias and in need of something uplifting. It was also the 33d anniversary of our "non-marriage." Among the choices available the owner, a retired "gentleman" whose hobby was wine and that he now maintained to supplement his investment income, were several unfamiliar Champagnes of which one in particular was his own favorite. Colette brought if back, and a good choice it turned out to be. The notes in my diary read: "A remarkable non-vintage from Jean Vesselle in Bouzy. A Brut that was light, effervescent & without yeast. A "trouvaille, a donna nubile." At $44 it was better than any non-vintage in that range we occasional buy to celebrate. The bottle turned out the highlight of our trip even though we had a truly outstanding dinner at "Joseph by the Sea" in Old Orchard beach (which is otherwise a remarkably honky-tong place). We had Colette's favorite white, a Sancerre from the Chateau de Sancerre, a 2011 that turned out to be a very good year in several places in France. This bottle got marked in my diary, with the entire meal, as "up there with the best of our experiences."
Actually, when we returned for our customary "August in Maine" (on Southport Island) we found that some of the better (and expensive) restaurants had significantly improved their menu, including the preparation and well as presentation and their wine list. Thus the "Thistle Inn" in Boothbay Harbor featured several whites and reds from France and Italy (as well as better American ones), that included even a Cotes de Provence rose which Colette, with her Provencal background, appreciated.
The Inn is comparable to "Joseph by the Sea," but it lacks the view.
2011 was also a good year in Beaujolais and the Savoie (an area from which I have seen few, or any wines in the USA). But, as one of the hazards of the Pennsylvania Liquor Control Board's choices, our local outlet featured as a "Manager's Choice" a "Savoie" 2011 from Aspremont. It's a light golden wine, which I used to buy from the local grower in St. Jean d'Arvey, above Chambery, when I lived there one summer when I was 21 or 2. I actually tended some vines for the old lady whose garden I kept and whose goats I retrieved every night before milking them. I first bought one bottle for old times' sake, but not only the memories made me go back to the store and by the remaining bottles (7).
What a pleasant drink it had remained and the stuff that the grower drank (see On Wine(8). By the way, our birding trip in Maine, netted, in spite of the persistent lousy weather, 129 species with 27 "first of year" birds and 4 "lifers." Good enough to overlook to forgettable meals.
I hesitate to name the restaurant, at the entrance to a former Down East sardine harbor, because the owner who served us was a kindhearted elderly woman who told us with some pride that she and her husband, the cook, had started the restaurant in their 20s when an uncle gave them a loan (actually a gift as it turned out). Anyway, the menu and (unfortunately) the cooking apparently had remained the same all these years. Colette had a boiled lobster which can't be easily spoiled unless it's overcooked, which it was. Maybe it had something to do with the time it took to prepare my frozen (and thin) pork cutlets. The veggies come from cans or frozen packages. Even the blueberry pie wasn't made from scratch, which we find (after decades of Maine summers) a rare find. The wine "list" had "red, rose, white from 3 California growers in 2 "carafe" sizes. One of these growers was Almaden and the "carafe was a recycled Almaden bottle. On the whole it was a typical 1960s "family restaurant" experience. The only other eating out event was at a Chinese place that turned out to be equally behind the times, but fortunately they had bottled beer.
We decided to have all our other meals in our rooms with food from the local Hannefords. What has surprised us about that chain, even those in upscale tourist places, is their very large selection of California and other US wines and there relatively poor selection of French and Italian wines. But at least they have usually something drinkable. And we have found the occasional boutique delicatessen with a fine wine selection. This trip was no exception and Colette discovered a wine boutique when we were rained out in Machias and in need of something uplifting. It was also the 33d anniversary of our "non-marriage." Among the choices available the owner, a retired "gentleman" whose hobby was wine and that he now maintained to supplement his investment income, were several unfamiliar Champagnes of which one in particular was his own favorite. Colette brought if back, and a good choice it turned out to be. The notes in my diary read: "A remarkable non-vintage from Jean Vesselle in Bouzy. A Brut that was light, effervescent & without yeast. A "trouvaille, a donna nubile." At $44 it was better than any non-vintage in that range we occasional buy to celebrate. The bottle turned out the highlight of our trip even though we had a truly outstanding dinner at "Joseph by the Sea" in Old Orchard beach (which is otherwise a remarkably honky-tong place). We had Colette's favorite white, a Sancerre from the Chateau de Sancerre, a 2011 that turned out to be a very good year in several places in France. This bottle got marked in my diary, with the entire meal, as "up there with the best of our experiences."
Actually, when we returned for our customary "August in Maine" (on Southport Island) we found that some of the better (and expensive) restaurants had significantly improved their menu, including the preparation and well as presentation and their wine list. Thus the "Thistle Inn" in Boothbay Harbor featured several whites and reds from France and Italy (as well as better American ones), that included even a Cotes de Provence rose which Colette, with her Provencal background, appreciated.
The Inn is comparable to "Joseph by the Sea," but it lacks the view.
2011 was also a good year in Beaujolais and the Savoie (an area from which I have seen few, or any wines in the USA). But, as one of the hazards of the Pennsylvania Liquor Control Board's choices, our local outlet featured as a "Manager's Choice" a "Savoie" 2011 from Aspremont. It's a light golden wine, which I used to buy from the local grower in St. Jean d'Arvey, above Chambery, when I lived there one summer when I was 21 or 2. I actually tended some vines for the old lady whose garden I kept and whose goats I retrieved every night before milking them. I first bought one bottle for old times' sake, but not only the memories made me go back to the store and by the remaining bottles (7).
What a pleasant drink it had remained and the stuff that the grower drank (see On Wine(8). By the way, our birding trip in Maine, netted, in spite of the persistent lousy weather, 129 species with 27 "first of year" birds and 4 "lifers." Good enough to overlook to forgettable meals.
Saturday, June 8, 2013
healthcare (14); The New York Times does a colonoscopy
In my last healthcare post (# 13) I praised Jane Brody and the Times for their regular reporting on problems in the healthcare industry. Industry is the right term as can be concluded from a front page article on Sunday, June 2, 2013 (with 2 follow up pages and graphs) which compares the cost of frequent medical intervention in the USA with that of many other advanced countries. American readers may take issue with the inclusion of Spain and others as advanced countries, whose per capita income is significant lower than that of the USA or even other European nations. Or they can point out that a procedure done in a physician's office, regardless of the actually good result, cannot be of the same high quality, and thus obviously cheaper, than the same procedure in an American hospital with its hordes of personnel and high technological equipment.
I have some experience with procedures done in a physician's office. When I was about ten years old and still suffering from terrible ear aches our family doctor sent me to a nose ear and throat specialist. This was during WW II and transportation was strictly limited. My mother and I walked to the specialist's home (where he had his consultation room), a distance of 4 km. It was winter. After an examination he ordered a tonsillectomy which he would perform in his consulting room. A month later we made the same trip. He put me out, operated and after I came to, sent us home. As we walked I held an old towel in front of my mouth that had to be changed every so often as it became sodden with blood. Eventually we had to borrow some from people along the road who obviously observed out progress. Anyway after some time I was pronounced healed by the family doctor and have not had an ear ache since. There were other benefits. Once the weather was less inclement, my mother sent me to return the borrowed towels which became a sort of congratulatory walk with lots of concern, chocolate (although it was rationed) and cookies. Two years later I took the same road to my high school and each time it rained or snowed I was invited in to dry and warm myself. Other times, other mores, but the point of the story vindicates that what looks like "primitive" medicine under warlike circumstances, had no negative effects on my subsequent health. Yet, it's not a an experience that I can recommend. Colette, my partner, recounted a similar unpleasant (even without the 4km walks) experience of having an endoscopy done in a doctor's office when she was a teenager in France, also without ill effects.
Fast forward to my sixties when I shipped on a hilly golf course and developed a painful condition in my right knee. I went to the College's orthopedic specialist. He had eight consulting rooms in an annex to the hospital and I could observe him flitting from one room to the other. When he had more than two minutes he handed me several brochures on what operations were available and ended up by ordering x-rays which was done in the hospital. He hung them up during the next visit and said he could not see anything mechanically wrong other than what he called a lack of cushioning material and some unwanted deposits but nothing to require surgical intervention. He prescribed painkillers and icepacks in case of swelling. At a later visit he suggested an MRI to be done at a brand new clinic not connected with the hospital. The clinic charged my insurance, at that time one without any co-pay, 3200 dollars. It revealed nothing new. Later I found out that the doctor was a co-investor in the MRI clinic. Still later our women's hockey coach developed also a knee problem. She went to another doctor at another hospital and was operated on with great results. Eventually I also consulted a different doctor; he too prescribed pain killers. As his practice did not take my insurance, I consulted yet another doctor and eventually, after more x-rays and another MRI, I had my knee replaced. That was after 4 years of frequent painful periods. Now, after 13 years with my "bionic" knee, I'm not very agile (perhaps also because I am 82) but do not use painkillers. Meanwhile my eye doctor, who removed cataracts from each eye, suggested that a regimen of some of the painkillers had encouraged their growth.
A major point of the NYT article is that the too frequent, often automatic ordering of x-ray, MRI exams and scans, that may not be necessary, may lead to unnecessary and risky interventions and often done by clinics in which the ordering physician has a financial interest, are a major cause for the rise in the cost of healthcare. This point has been made in previous NYT articles, specifically with colonoscopies as example. The present article can be seen as a similar examination into the illness of the healthcare system in the USA. In a follow up Editorial (June 9) the paper suggests a way out by pointing out how the Affordable Care Act ("Obama-care") already began to work towards fixed costs. Fixed cost systems are not something new and are in place in dealer operated car maintenance programs (more expensive than the - alas rapidly disappearing - "corner store" mechanic) and obviously are designed for a reasonable profit.
As a patient I do, of course, not know whether tests or scans are necessary. Three years ago I had repeated and painful infections in my right ear and problems in my right sinus. After doses of prednisone did not work, I was prescribed a scan which "indicated possible problems." When the pain returned a year later and new doses of prednisone did not work, I had another scan, with the same result. By then I lost my hearing in that ear. The local nose and ear man suggested I see one of several specialists in Philadelphia, who would most likely perform the necessary operation. After consulting with my primary physician, I went to the Un. of Penna, where the specialist examined my ear with a fancy microscope that projected a large picture on a television screen. He did not read the cd of the last scan. He took out a polyp, removed the tube that the local doctor had inserted to help drainage, prescribed two types of eardrops, made me come back for four check ups and the infections have not returned (the hearing in the right ear did, however, not return. The insurance paid for the two scans that apparently were of no use other than suggesting an operation would solve the problem, a conclusion rejected by the specialist's specialist. The sinus problems still exist but are no longer painful, and most likely were not painful before the ear infections. But subsequently, after more pain that I described in healthcare post #12, MRI' s and spinal injections+ phys. therapy the treating physicians concluded that my head problems were most likely caused by a seriously pinched nerve in my neck. So while modern technology eventually solved the problem, it was mostly a process of "if this doesn't work, let's try something else."
The NYT article also delves into the great variation in the charges for the same procedures in various parts of this country and even within some cities. This too had been reported on in recent articles. It would seem to me that there cannot be any reasonable explanation for that variation other than the fact that medicine is a private enterprise and the charges a based on the maxim "what the traffic will bear," i.e. GREED, which is fed not by the need of doctors to meet the varying expenses of the actual cost of living but on competitive life style expectations. (I guess, I can't escape having written my Ph.D. Thesis on Thorstein Veblen, the author best known for his devastating crtitique of the Leisure Class" "football stands in relation to athletics as the pigskin to agriculture"). In another of their occasional in depth investigations, Sunday Aug. 4, 2013, the NYT exposes specific differences in the cost of joint replacement, focusing on the coast of hip replacement with a 2007 US estimate of $73.000 which the patient had done in Brussels for 13,660 (incl. travel costs).
Both Colette and I grew up in countries (France and the Netherlands) that now have national health systems (which contrary to American propaganda, deliver the required healthcare readily and well). The comparative costs in European countries with high standards of living for a procedure is not only significantly less than in the United States, but the same throughout a particular country. Colette's brother is a physician and can afford a time share for the family ski vacations as well as vacations throughout the year in such exotic places as Thailand or the Caribbean. Colette sister in law is a trained geriatric social worker employed in the national social care system. Colette and her bother own the former second home of their parents in the Provence and if she so desires he'll buy her out. His three sons, having completed the required secondary (national) education went on to specialized private education (2 of them taking a year in the United States). It doesn't sound like his standard of living is lower by the same percentage as the cost of the medical care he delivers in comparison to an American colleague. I have 2 nephews (by non-marriage) one of which ran a blood laboratory and the other a dentist, the latter living in what we call a "gentleman's house" and drives a fancy BMW. The difference is that not only is there a national health system, but also a national education system as well as a national pensions system, all of these systems paid for out of the general revenue based on a graduated tax code. For those who so desire and are able (and willing) to pay there are also private institutions.
Obviously, as is made abundantly clear by the opponents of "Obama-care" (a very imperfect hybrid between a national health system and private enterprise), so-called "socialized" medicine is undesirable on principle. Which is too damn bad! After all, the members of Congress, most teachers (in my case it's included in the tuition of private education) and other civil servants or unionized workers have socialized medicine paid for out of tax revenues or added to the cost of the product made by the union workers.
Somewhat less anecdotal than Colette and my experiences is an article on p. 6 of the June 16th NYT's business section about the healthcare system in Sweden, unfortunately a country that in the USA has a "socialist" reputation. It also has a very high standard of living and a thriving free enterprise economy. Yet, the GREED factor has been eliminated from the general healthcare system which is government run, efficient and about half as expensive as the American one. And, as in the Netherlands and France, for the rich and those with high-cost health plans there are "boutique" hospitals as well.
My niece, an exec. in a firm checking possible healthcare fraud in the Netherlands, wrote me that the gov't was going to economize (i.e. no longer free healthcare), but she included an American item making fun of the shortcomings of US healthcare for the elderly, saying that it would not be as bad as that. The item shows an elderly lady with a revolver who is encouraged to shoot 4 congressmen so she can get all the health care she might need for free in prison and also would no longer have to pay income tax.
If it seems that there is no end to this BlogSpot it is because there's no apparent end to the NYT's discovery of more gauging medical practices. This time, in a front page+ on Oct. 12. 2013, it deals with the exorbitant costs of medicines, for ex. for asthma patients: one steroid inhaler retails for $175 in the US while pharmacies in Britain (with that much maligned - mostly by US opponents to a national program - healthcare system!) pay $20 and dispense it free; a nasal spray sold in Oakland for $250 a month but costs only $7 in Europe where it is available over the counter. An on it goes.
Addendum: As I was rereading some Dutch mysteries I came across Blond Baboon by J. van de Wetering. It dates from the 1970s and in it there's a subplot in which a neurosurgeon with financial interests in scanning devices habitually scares patients into undergoing more than one tests, all of which were paid for by the insurance. It appears that there's nothing new on the western medical front.
I have some experience with procedures done in a physician's office. When I was about ten years old and still suffering from terrible ear aches our family doctor sent me to a nose ear and throat specialist. This was during WW II and transportation was strictly limited. My mother and I walked to the specialist's home (where he had his consultation room), a distance of 4 km. It was winter. After an examination he ordered a tonsillectomy which he would perform in his consulting room. A month later we made the same trip. He put me out, operated and after I came to, sent us home. As we walked I held an old towel in front of my mouth that had to be changed every so often as it became sodden with blood. Eventually we had to borrow some from people along the road who obviously observed out progress. Anyway after some time I was pronounced healed by the family doctor and have not had an ear ache since. There were other benefits. Once the weather was less inclement, my mother sent me to return the borrowed towels which became a sort of congratulatory walk with lots of concern, chocolate (although it was rationed) and cookies. Two years later I took the same road to my high school and each time it rained or snowed I was invited in to dry and warm myself. Other times, other mores, but the point of the story vindicates that what looks like "primitive" medicine under warlike circumstances, had no negative effects on my subsequent health. Yet, it's not a an experience that I can recommend. Colette, my partner, recounted a similar unpleasant (even without the 4km walks) experience of having an endoscopy done in a doctor's office when she was a teenager in France, also without ill effects.
Fast forward to my sixties when I shipped on a hilly golf course and developed a painful condition in my right knee. I went to the College's orthopedic specialist. He had eight consulting rooms in an annex to the hospital and I could observe him flitting from one room to the other. When he had more than two minutes he handed me several brochures on what operations were available and ended up by ordering x-rays which was done in the hospital. He hung them up during the next visit and said he could not see anything mechanically wrong other than what he called a lack of cushioning material and some unwanted deposits but nothing to require surgical intervention. He prescribed painkillers and icepacks in case of swelling. At a later visit he suggested an MRI to be done at a brand new clinic not connected with the hospital. The clinic charged my insurance, at that time one without any co-pay, 3200 dollars. It revealed nothing new. Later I found out that the doctor was a co-investor in the MRI clinic. Still later our women's hockey coach developed also a knee problem. She went to another doctor at another hospital and was operated on with great results. Eventually I also consulted a different doctor; he too prescribed pain killers. As his practice did not take my insurance, I consulted yet another doctor and eventually, after more x-rays and another MRI, I had my knee replaced. That was after 4 years of frequent painful periods. Now, after 13 years with my "bionic" knee, I'm not very agile (perhaps also because I am 82) but do not use painkillers. Meanwhile my eye doctor, who removed cataracts from each eye, suggested that a regimen of some of the painkillers had encouraged their growth.
A major point of the NYT article is that the too frequent, often automatic ordering of x-ray, MRI exams and scans, that may not be necessary, may lead to unnecessary and risky interventions and often done by clinics in which the ordering physician has a financial interest, are a major cause for the rise in the cost of healthcare. This point has been made in previous NYT articles, specifically with colonoscopies as example. The present article can be seen as a similar examination into the illness of the healthcare system in the USA. In a follow up Editorial (June 9) the paper suggests a way out by pointing out how the Affordable Care Act ("Obama-care") already began to work towards fixed costs. Fixed cost systems are not something new and are in place in dealer operated car maintenance programs (more expensive than the - alas rapidly disappearing - "corner store" mechanic) and obviously are designed for a reasonable profit.
As a patient I do, of course, not know whether tests or scans are necessary. Three years ago I had repeated and painful infections in my right ear and problems in my right sinus. After doses of prednisone did not work, I was prescribed a scan which "indicated possible problems." When the pain returned a year later and new doses of prednisone did not work, I had another scan, with the same result. By then I lost my hearing in that ear. The local nose and ear man suggested I see one of several specialists in Philadelphia, who would most likely perform the necessary operation. After consulting with my primary physician, I went to the Un. of Penna, where the specialist examined my ear with a fancy microscope that projected a large picture on a television screen. He did not read the cd of the last scan. He took out a polyp, removed the tube that the local doctor had inserted to help drainage, prescribed two types of eardrops, made me come back for four check ups and the infections have not returned (the hearing in the right ear did, however, not return. The insurance paid for the two scans that apparently were of no use other than suggesting an operation would solve the problem, a conclusion rejected by the specialist's specialist. The sinus problems still exist but are no longer painful, and most likely were not painful before the ear infections. But subsequently, after more pain that I described in healthcare post #12, MRI' s and spinal injections+ phys. therapy the treating physicians concluded that my head problems were most likely caused by a seriously pinched nerve in my neck. So while modern technology eventually solved the problem, it was mostly a process of "if this doesn't work, let's try something else."
The NYT article also delves into the great variation in the charges for the same procedures in various parts of this country and even within some cities. This too had been reported on in recent articles. It would seem to me that there cannot be any reasonable explanation for that variation other than the fact that medicine is a private enterprise and the charges a based on the maxim "what the traffic will bear," i.e. GREED, which is fed not by the need of doctors to meet the varying expenses of the actual cost of living but on competitive life style expectations. (I guess, I can't escape having written my Ph.D. Thesis on Thorstein Veblen, the author best known for his devastating crtitique of the Leisure Class" "football stands in relation to athletics as the pigskin to agriculture"). In another of their occasional in depth investigations, Sunday Aug. 4, 2013, the NYT exposes specific differences in the cost of joint replacement, focusing on the coast of hip replacement with a 2007 US estimate of $73.000 which the patient had done in Brussels for 13,660 (incl. travel costs).
Both Colette and I grew up in countries (France and the Netherlands) that now have national health systems (which contrary to American propaganda, deliver the required healthcare readily and well). The comparative costs in European countries with high standards of living for a procedure is not only significantly less than in the United States, but the same throughout a particular country. Colette's brother is a physician and can afford a time share for the family ski vacations as well as vacations throughout the year in such exotic places as Thailand or the Caribbean. Colette sister in law is a trained geriatric social worker employed in the national social care system. Colette and her bother own the former second home of their parents in the Provence and if she so desires he'll buy her out. His three sons, having completed the required secondary (national) education went on to specialized private education (2 of them taking a year in the United States). It doesn't sound like his standard of living is lower by the same percentage as the cost of the medical care he delivers in comparison to an American colleague. I have 2 nephews (by non-marriage) one of which ran a blood laboratory and the other a dentist, the latter living in what we call a "gentleman's house" and drives a fancy BMW. The difference is that not only is there a national health system, but also a national education system as well as a national pensions system, all of these systems paid for out of the general revenue based on a graduated tax code. For those who so desire and are able (and willing) to pay there are also private institutions.
Obviously, as is made abundantly clear by the opponents of "Obama-care" (a very imperfect hybrid between a national health system and private enterprise), so-called "socialized" medicine is undesirable on principle. Which is too damn bad! After all, the members of Congress, most teachers (in my case it's included in the tuition of private education) and other civil servants or unionized workers have socialized medicine paid for out of tax revenues or added to the cost of the product made by the union workers.
Somewhat less anecdotal than Colette and my experiences is an article on p. 6 of the June 16th NYT's business section about the healthcare system in Sweden, unfortunately a country that in the USA has a "socialist" reputation. It also has a very high standard of living and a thriving free enterprise economy. Yet, the GREED factor has been eliminated from the general healthcare system which is government run, efficient and about half as expensive as the American one. And, as in the Netherlands and France, for the rich and those with high-cost health plans there are "boutique" hospitals as well.
My niece, an exec. in a firm checking possible healthcare fraud in the Netherlands, wrote me that the gov't was going to economize (i.e. no longer free healthcare), but she included an American item making fun of the shortcomings of US healthcare for the elderly, saying that it would not be as bad as that. The item shows an elderly lady with a revolver who is encouraged to shoot 4 congressmen so she can get all the health care she might need for free in prison and also would no longer have to pay income tax.
If it seems that there is no end to this BlogSpot it is because there's no apparent end to the NYT's discovery of more gauging medical practices. This time, in a front page+ on Oct. 12. 2013, it deals with the exorbitant costs of medicines, for ex. for asthma patients: one steroid inhaler retails for $175 in the US while pharmacies in Britain (with that much maligned - mostly by US opponents to a national program - healthcare system!) pay $20 and dispense it free; a nasal spray sold in Oakland for $250 a month but costs only $7 in Europe where it is available over the counter. An on it goes.
Addendum: As I was rereading some Dutch mysteries I came across Blond Baboon by J. van de Wetering. It dates from the 1970s and in it there's a subplot in which a neurosurgeon with financial interests in scanning devices habitually scares patients into undergoing more than one tests, all of which were paid for by the insurance. It appears that there's nothing new on the western medical front.
Monday, April 29, 2013
politics (17) DC is getting nuttier
In 1925 Congress established The Federal Helium Program to stockpile helium in case of dirigible warfare. One would have thought that after the disaster of the Hindenburg in New Jersey in May of 1937, which effectively ended the "airship" program, while the regular aircraft industry was expanding, would also have reduced if not eliminated the US program. The Germans indeed redirected their effort and the airship materials to building up the Luftwaffe. It is true that at the beginning of the German air campaign against London the English tried to protect the city with a ring of stationary balloons, the heavily laden German bombers being limited to low altitudes. But it did not work as the planes "jumped" over the balloons and within a short time higher altitude planes were developed to reduce losses to anti-aircraft artillery.
I am bringing this up because Congress voted, before going on recess on 4/27/13 to extend the program (which Repr. Barney Frank thought ended in 1996!), with only 1 vote against in the House. This when Republicans promote spending cuts and the idea that private enterprise can do a better job anyway, while the Democrats generally oppose the Republican spending cuts; but in this instance they all voted for a truly non-essential spending bill. In the total Federal budget the savings from letting the Helium program die would not save the Nation, but as a matter of principle it would have looked good if this near unanimity had produced ANY savings.
The helium bill came at the same time as the bipartisan vote to give the FAA the flexibility of deciding where to apply the sequester cuts instead of applying them across the board as required which had led to furloughing air controllers etc. thus creating delays at airports. As the politicians wanted to get home for their recess this vote would have been a no brainer if the members of Congress were in the habit of using their brains. Undoubtedly a similar vote will become expedient when it comes to the defense department. But why not to all government departments as a principle?
But some programs like Meals on Wheels, etc. probably have not much flexibility (but its recipients are among Romney's famous 47% and usually do not live in the gerrymandered districts of Rep. House members). It would be better to get rid of the sequester altogether, while maintaining the idea of savings. For example, all members of congress could reduce their staff by 1, committees could reduce their staff proportionally, etc. For one thing there is a lot of overlap between a congress member's staff and the staffs of the committees on which a member serves. And it would not just be a saving of salaries but also of the office expenses etc. the "work" of a staff member entails, much of which, I'm sure serves to show that the person is productive. But then, lest we forget, Congress exempted itself from the sequester. But would that not make the staff savings more symbolic of the congressional will to reduce public expenditures?
Republicans used to say: Well, where is Obama's leadership? As if they would be led in Obama's direction. Media types blame him for failure to reach out and have turned this failure into a character defect. But Obama did reach out and mostly in vain in 2009 or, for example, playing golf with John Boehner. Someone suggested: "have a drink with Mitch McConnell." But why shouldn't the Senate Minority leader reach out? After all he is still the Minority leader after 4 years of trying to prevent Obama's re-election and of becoming the Majority leader. What happened to the famed southern graciouness and hospitality? And why do columnists like Ms Dowd insist on blaming Obama for not reaching out. It's clear that O. can show the donkeys where the water is, but he can't maken them drink. Even when the Republican Senator Toomy proposes a compromise on "background checks he has to admit that it failed because some fellow Repuclicans woould not want it to look as if Obama had a victory, REGARDLESS OF THE 85% OF REPUBLICANS NATIONWIDE ARE IN FAVOR
OF THESE CHECKS.
I hate to suggest it, but it maybe racism after all. In 2008, one could blame W. for the victory of a Democratic candidate, even if a black one (during the nationwide gun control debate someone said: Why should a Jewish big city major tell us wat to do). But no such excuse existed in 2012, unless the Reps must blame themselves for putting up the inept Romney. Would the antagonism to the president have been as strong it it had been Ms Clinton? After all there was a lot of antagonism to Mr. Clinton and even with all his "social" problems, the Republicans worked with him even while they were trying to impeach him. Nothing that Obama has put forward in the budget and debt ceiling debates is way off center, yet it nearly all gets rejected without real consideration. And that even in cases where "private enterprise" has no ideological opposition.
I am bringing this up because Congress voted, before going on recess on 4/27/13 to extend the program (which Repr. Barney Frank thought ended in 1996!), with only 1 vote against in the House. This when Republicans promote spending cuts and the idea that private enterprise can do a better job anyway, while the Democrats generally oppose the Republican spending cuts; but in this instance they all voted for a truly non-essential spending bill. In the total Federal budget the savings from letting the Helium program die would not save the Nation, but as a matter of principle it would have looked good if this near unanimity had produced ANY savings.
The helium bill came at the same time as the bipartisan vote to give the FAA the flexibility of deciding where to apply the sequester cuts instead of applying them across the board as required which had led to furloughing air controllers etc. thus creating delays at airports. As the politicians wanted to get home for their recess this vote would have been a no brainer if the members of Congress were in the habit of using their brains. Undoubtedly a similar vote will become expedient when it comes to the defense department. But why not to all government departments as a principle?
But some programs like Meals on Wheels, etc. probably have not much flexibility (but its recipients are among Romney's famous 47% and usually do not live in the gerrymandered districts of Rep. House members). It would be better to get rid of the sequester altogether, while maintaining the idea of savings. For example, all members of congress could reduce their staff by 1, committees could reduce their staff proportionally, etc. For one thing there is a lot of overlap between a congress member's staff and the staffs of the committees on which a member serves. And it would not just be a saving of salaries but also of the office expenses etc. the "work" of a staff member entails, much of which, I'm sure serves to show that the person is productive. But then, lest we forget, Congress exempted itself from the sequester. But would that not make the staff savings more symbolic of the congressional will to reduce public expenditures?
Republicans used to say: Well, where is Obama's leadership? As if they would be led in Obama's direction. Media types blame him for failure to reach out and have turned this failure into a character defect. But Obama did reach out and mostly in vain in 2009 or, for example, playing golf with John Boehner. Someone suggested: "have a drink with Mitch McConnell." But why shouldn't the Senate Minority leader reach out? After all he is still the Minority leader after 4 years of trying to prevent Obama's re-election and of becoming the Majority leader. What happened to the famed southern graciouness and hospitality? And why do columnists like Ms Dowd insist on blaming Obama for not reaching out. It's clear that O. can show the donkeys where the water is, but he can't maken them drink. Even when the Republican Senator Toomy proposes a compromise on "background checks he has to admit that it failed because some fellow Repuclicans woould not want it to look as if Obama had a victory, REGARDLESS OF THE 85% OF REPUBLICANS NATIONWIDE ARE IN FAVOR
OF THESE CHECKS.
I hate to suggest it, but it maybe racism after all. In 2008, one could blame W. for the victory of a Democratic candidate, even if a black one (during the nationwide gun control debate someone said: Why should a Jewish big city major tell us wat to do). But no such excuse existed in 2012, unless the Reps must blame themselves for putting up the inept Romney. Would the antagonism to the president have been as strong it it had been Ms Clinton? After all there was a lot of antagonism to Mr. Clinton and even with all his "social" problems, the Republicans worked with him even while they were trying to impeach him. Nothing that Obama has put forward in the budget and debt ceiling debates is way off center, yet it nearly all gets rejected without real consideration. And that even in cases where "private enterprise" has no ideological opposition.
Thursday, February 14, 2013
irreconcilable loyalties (6) Awlaki and Obama (2)
The last two weeks brought a strong reminder of the "drone program" that has become the most important anti-terrorist (=Al Qaeda) weapon. The question of American citizenship and death without due process raised by the killing of Al Awlaki and even more so by that of his innocent 16 year old son, was raised repeatedly in the Senate confirmation hearing of John Brennan as Director of the CIA by both Republicans and Democrats, including Senator Rockefeller, a former head of the Committee. Brennan presented the Administrations argument that since Al Qaeda is at war with us, any American who joins A-Q surrenders the protections guaranteed American citizens.
Because the son was also killed that position was not accepted, but also in the mind of some Senators was the constitutional separation of powers and Senator King stated his doubts about the president acting as prosecutor, judge and jury and executor. There emerged a consensus that drone strikes ought to be reviewed beforehand by a secret anti-terrorist court.
All of this was preceded by a "leaked" White Paper the Administration had prepared for the leaders of the Congressional Committees that oversee the National Security activities who had been asking for the secret memos the Justice Department had prepared for the White House. For several days the media went on a feeding frenzy. When some Senators, lead most vocally by Sen. Wyden, a Democrat, threatened to hold up the Brennan nomination, Obama called him late at night to say he would release some of the memos.
The New York Times, which had kept the killing of Awlaki before the American people in occasional articles and had tried to obtain the secret justification memos published a strong "Public Editor" column in its Sunday edition censoring the government once again. It also published a letter from Archbishop Tu-Tu asking whether the lives of non-Americans were valued less than that of Americans.
Because Brennan is a long-time CIA operative and was a higher up when "enhanced interrogation" and "rendition" were instituted by the Bush-Cheney team, he was asked about torture as well and stated that waterbording was "reprehensible" and should not be done by Americans. This brought up the question of Guantanomo and the general impression of non-legal foundations for retention of its inmates.
All of these developments left me uncomfortable because the question of irreconcilable loyalty remains. It reminds me of the medieval double contract theory that was also used as the foundation of 16th century resistance theory. viz. every person has a contract with civic authority as well as the covenant with God, the latter superseding the former in case of conflict between the demands of the two contracts. Obedience thus becomes a matter of conscience as it was assumed that the civic authority, whose persons also were bound by the divine covenant, should act in accordance with God's law. Already in the 1578 Vindication against Tyrants, a secularized justification of resistance was developed which figured in the arguments for the English Glorious Revolution and from there informed Jefferson's Declaration of Independence. The American Constitution, to prevent another resistance against a tyrannical government, guarantees the non-violent resistance against governmental misconduct. As it guarantees freedom of religion, the question of religious conscience becomes moot, especially as there are legal exceptions for conscientious objectors. Al Walaki could thus have remained in the US and by leaving it and associating himself with Al Qaeda and its violent anti-American actions, he rejected the American constitutional system even if he remained "endowed with the right to life and liberty. It therefore seems to me, as it does to the NYT and some Senators that the Constitution binds Obama (as it should have Cheney-Bush) to its provisions as well as to the Declaration's "inalienable right to life and liberty." Obama's loyalty to the Constitution is not obviated by Awlaki's giving up his loyalty nor can it be reconciled with the Drone program nor for that matter with some aspects of "covert action" as currently practiced. (In fact, I think, that the covert action of "neutralizing with extreme prejudice" is at the origin of the Drone program).
After the nomination of Brennan cleared the Committee, Sen. Paul of Kentucky undertook a lengthy filibuster that focused on the constituionality of the President's prerogative for the use drones and in particular whether drones would ever be used to kill American citizens on American soil. In response to the latter hypothetical question the Attorney General answered by letter "NO."
Also as a result of the Brennan hearings the Administration finally made the Justice Department's memos to the President available and on Sunday March 10, 2013 the NYT had a 2 page article, beginnin on p. 1, that revealed the background as well as the actual operation of the Awlaki killing. It seems to me that the legal justification is rather "iffy." It incidentally also clarified the killing of Awlaki's son which occurred during a separate strike that was based on erroneous information and is recorded as a fiasco. Awlaki's son was not a target, but in the "wrong place, at a wrong time." So much for the media big heads lumping the two killings together.
Because the son was also killed that position was not accepted, but also in the mind of some Senators was the constitutional separation of powers and Senator King stated his doubts about the president acting as prosecutor, judge and jury and executor. There emerged a consensus that drone strikes ought to be reviewed beforehand by a secret anti-terrorist court.
All of this was preceded by a "leaked" White Paper the Administration had prepared for the leaders of the Congressional Committees that oversee the National Security activities who had been asking for the secret memos the Justice Department had prepared for the White House. For several days the media went on a feeding frenzy. When some Senators, lead most vocally by Sen. Wyden, a Democrat, threatened to hold up the Brennan nomination, Obama called him late at night to say he would release some of the memos.
The New York Times, which had kept the killing of Awlaki before the American people in occasional articles and had tried to obtain the secret justification memos published a strong "Public Editor" column in its Sunday edition censoring the government once again. It also published a letter from Archbishop Tu-Tu asking whether the lives of non-Americans were valued less than that of Americans.
Because Brennan is a long-time CIA operative and was a higher up when "enhanced interrogation" and "rendition" were instituted by the Bush-Cheney team, he was asked about torture as well and stated that waterbording was "reprehensible" and should not be done by Americans. This brought up the question of Guantanomo and the general impression of non-legal foundations for retention of its inmates.
All of these developments left me uncomfortable because the question of irreconcilable loyalty remains. It reminds me of the medieval double contract theory that was also used as the foundation of 16th century resistance theory. viz. every person has a contract with civic authority as well as the covenant with God, the latter superseding the former in case of conflict between the demands of the two contracts. Obedience thus becomes a matter of conscience as it was assumed that the civic authority, whose persons also were bound by the divine covenant, should act in accordance with God's law. Already in the 1578 Vindication against Tyrants, a secularized justification of resistance was developed which figured in the arguments for the English Glorious Revolution and from there informed Jefferson's Declaration of Independence. The American Constitution, to prevent another resistance against a tyrannical government, guarantees the non-violent resistance against governmental misconduct. As it guarantees freedom of religion, the question of religious conscience becomes moot, especially as there are legal exceptions for conscientious objectors. Al Walaki could thus have remained in the US and by leaving it and associating himself with Al Qaeda and its violent anti-American actions, he rejected the American constitutional system even if he remained "endowed with the right to life and liberty. It therefore seems to me, as it does to the NYT and some Senators that the Constitution binds Obama (as it should have Cheney-Bush) to its provisions as well as to the Declaration's "inalienable right to life and liberty." Obama's loyalty to the Constitution is not obviated by Awlaki's giving up his loyalty nor can it be reconciled with the Drone program nor for that matter with some aspects of "covert action" as currently practiced. (In fact, I think, that the covert action of "neutralizing with extreme prejudice" is at the origin of the Drone program).
After the nomination of Brennan cleared the Committee, Sen. Paul of Kentucky undertook a lengthy filibuster that focused on the constituionality of the President's prerogative for the use drones and in particular whether drones would ever be used to kill American citizens on American soil. In response to the latter hypothetical question the Attorney General answered by letter "NO."
Also as a result of the Brennan hearings the Administration finally made the Justice Department's memos to the President available and on Sunday March 10, 2013 the NYT had a 2 page article, beginnin on p. 1, that revealed the background as well as the actual operation of the Awlaki killing. It seems to me that the legal justification is rather "iffy." It incidentally also clarified the killing of Awlaki's son which occurred during a separate strike that was based on erroneous information and is recorded as a fiasco. Awlaki's son was not a target, but in the "wrong place, at a wrong time." So much for the media big heads lumping the two killings together.
Tuesday, July 31, 2012
healthcare (13) Long live Jane Brody and the NYT
Apart from the several physicians I have seen in recent years, most of my health related info comes from Sanjay Gupta's program on CNN, the New York Times reporting on medical malfeasance and especially from Jane E. Brody's Tuesday columns in the Science Section of the NYT. Hers is great public service as she presents her research without hype (the sober evidence is often bad enough). They are examples of "you can trust what you read" in this newspaper at least. It seems to me that much of the recent "medical reporting" results from the passage of the Affordable Care Act (Obama Care) that continues to fuel the political debates; a good deal of it, incl. in NYT Editorials, aims at reducing the coasts of healthcare, e.g. her column of May 28, 2012 on trimming the "Bloated Health Care System."
In April 2012 I began to collect NYT articles and pretty soon I got the impression that for the health profession April was "the cruelest of months." But I was wrong, once my curiosity was awakened I ended up with frontpage items as well as pages from the Business Section. I started this blogpost in September, but as becomes clear, the bad news endures.
Then there is also the scarifying arrogance of the drug industry's warning pages that accompany their advertising, some of which I already dealt with in earlier posts. (An interesting change in vocabulary, no doubt reflecting the difficulty of getting in touch with one's physician, is the recurrent advice to "consult" or "notify your HEALTH CARE PROVIDER" or "PROFESSIONAL" i.p.o. "your doctor." Apparently they now assume practical nurses and qualified pharmacists are safe enough.) I call their warnings, meant more to forestall legal action than to inform (their nomenclature being generally too confusing for the lay person) "arrogant," for under the guise of advising the patient, drug companies reveal that their medicines often do not work and are frequently harmful, yet still ask your doctor prescribe them. One may be amused by the advise to Viagra victims to call their doctor who can't be reached because he's enjoying the sunset with his partner in separate bath tubs after having taken Cialis. But there is nothing humorous about an ad that recommends ABILIFY, an anti-depressant prescribed as an add-on treatment when a weaker antidepressant alone is not enough; the first warning is that "elderly patients with dementia-related psychosis (eg. an inability to perform daily tasks due to increased memory loss) cannot take it because of an increased risk of "death or stroke," Is this because of the ingredients or because the elderly may take more than the prescribed dose by mistake? One may develop "neuroleptic malignant syndrome" (NMS) as well as tardive dyskinesia (TD) - which may happen also AFTER you consulted your doctor and were advised to "stop taking Abilify." In sounds like Abilify may be incapacitating.
It turns out that Abilify, described as a "powerful anti- psychotic" is the 5th best selling drug in the US (NYT, p.D6). The prescriptions for such drugs have risen though the rate of serious psychiatric disorders remained the same. These drugs were developed for use in cases of schizophrenia and bipolar disorders but drug companies tested them for use against depression and anxiety disorders, thus increasing their sales but means of t.v. and magazine ads that cause the (self-diagnosed) Patient to pressure the doctor to prescribe the medicine even in case of insomnia or every day, situational anxiety. But, as the article also points out, these stronger drugs are not more effective than the first generation of anti-psychotics.
[Febr. 3 2013 addendum: In a frontpage and front section article of nearly 3 full pages, the NYT chronicles the medical history of a young man who became addicted to Adderal, an attention deficit/ hyper activity drug, who resorted to faking the sumptons to get more prescriptions. In one of his actual psychotic conditions he was also prescibed Abilify. While this patient abused the system, experts feel that alarm bells should have been ringing, espec. when the parents began to demand that his Adderall treatment be stopped as they feared "it would kill him." It's a truly sad story.]
Abilify is a drug to be used as an ad-on, perhaps for all those anti-depressants currently listed in tv ads by a law firm organizing a class-action suit. Those drugs were once recommended "at the drop of a hat," almost like "take some liquid and 2 aspirins and call me in the morning." But then aspirins, as well as other pain remedies turned out to have bad side-effects and Tylenol became the safer remedy. Until this year and another law firm is advertising for victims of Tylenol and a set of other drugs in which the Tylenol ingredient is used.
Replacing drugs with safer ones sounds like a good thing. But it begins to sound like trading in one side effect for another. Thus fluoriquinolones, the chemical in the strong antibiotics Cipro and Levaquin, replaced aminoglycosides and chloramphenicol that had potentially life threatening complications. Wow, one says, the pharmaceutical industry really looks out for our health. But then there is Jane Brody (9-11-12) who headlines her column "A Cure That Can Be Worse Than the Illness." She points out that these drugs are often wrongly prescribed for minor infections rather than only in such serious life-threatening cases as life "hospital-acquired pneumonia." Among possible side effects are blinding retinal detachment and acute kidney failure. The culprits here appear to be physicians who do not inform the patients of the FDA warnings carried by these drugs and i wonder whether they actually read them carefully; after all didn't they take the oath: First do not do harm!"? Meanwhile several of these drugs have been removed from the market. There are also some 2,000 lawsuits.
That physicians often fail to exercise the proper caution when prescribing medicines is a constant refrain in the medical pages of the NYT Sciences sections. On 2-28-12 I found the headline "A Cocktail of Drugs May Cloud the Brain," which addresses that cumulative effect of anticholinergetics found in pain killers like prednisone, Tylenol, Advil PM, antihistamines like Benadryl, etc. These anticholinergetics can block the action of a neurotransmitter that is needed in various functions including the cognitive one and memory production. Elderly patients, like me, are more at risk and that brings me to Jane Brody's column of 4-17-2012 entitled "Too Much Medicine, and Too Few Checks," which opens with a reference to her 92-year old aunt as "a walking pharmacy." She was taking 6 prescription medicines and several over the counter ones as well as a multivitamin, vitamin C and vitamin D. In the hospital a neurologist prescribed one medicine and a cardiologist another. As she was being discharged she collapsed. After that, still in the hospital she developed double pneumonia. Fortunately she responded to antibiotics and began to recover. Brody then goes on to describe the knowledge available to prevent similar crises including that of a team of experts that listed 53 potentially inappropriate medications or classes of medication. About one third of the column deals with "The Patient's Responsibility" including downloading a Drug Diary from the Foundation for Health in Aging, which should be shown to one's physician.
Unfortunately the problem may originate before a physician administers a medicine. Not only have pharmaceutical companies skipped tests or not revealed "negative results" but researchers may have published fraudulent papers that even if retracted may already have found their way into the literature, the retractions coming much later and/or having escaped the relevant database. A very recent and truly abysmal case concerns Yoshitaka Fujii who falsified data in no less than 172 papers (NYT 10-2-12, p. D3). And then there's the revelation of the existence of pharmacies that have in fact become drug companies but which as pharmacies escape to the FDA's scrutiny. One of these, New England Compounding (what's in a name!) Center, sold the drug methylprednisolone that was used in spinal injections and which was contaminated with a fungus that caused the death of 11 patients (by 10-10-12) and hospitalized others. A NYT front page article (10-7-12) documents the widespread use of medicines produced by numerous compounding "pharmacies" either because there is a shortage, they are less costly or because the salesperson has been seductive. This particular scandal remains in the news as more patients are coming forward and dying. Several Representatives have started an official inquiry and meanwhile it became known that medicine from that Compounding Center have also been used in open heart and other surgery. The NYT on 10-16-12 had a front page follow up and its Science Section 2 more articles, and on 12/24 it detailed some longstanding problems, incl. lax inspections and poor sterilization practices at NECC, whose family ownership also is involved in two more compounding firms, one of which had very dismal hygienic conditions according to a NYT article of 11-13-12, p. A13). In view of all the problems plaguing the health services, I find it incomprehensible that compounding pharmacies have escaped close supervision and that their use has become widespread. The NYT reports (11-14-12, p. A16) that "friends in Congress" thought it ok for the Compounders to be regulated by the individual states. But it's also one more "serious lapse of judgment" on the part of physicians.
Sales practices "may be colored by the financial interests of the producers" suspects a letter from the Senate Finance Committee to various pharmaceutical companies. The senators focused on the overuse of narcotic painkillers (NYT. 5-9-12, p.B7). Lo and behold, the NYT Business Section of July 3, 2012, continues a frontpage article about GlaxoSmithKline admitting, after years of being sued, criminal fraud in its sales practices and settled for 3 BILLION dollars. These practices included not only trips to the Caribbean but also helping to publish a medical journal article that misreported data from a clinical trial. Three billion sounds like a lot, but several of the drugs in question brought about 28 billion in sales for the years covered by the settlement. In this case whistleblowers provided important information.
Such fines occasion a bit of wistful thinking: Can they help reduce the national deficit? On 4-11-12 Johnson and Johnson and a subsidiary were fined $ 1.2 billion for its marketing practices of Risperdal; and the NYT article summarizes some more penalties:in January a Texas judged levies a fine of $158 million, in 2011 a Sth Carolina judge levied $327,000,000 and in 2010 a Louisiana jury settled on $258,000,000 (it's fun to type all those zeros!), and an Arkansas judge issued a penalty of $1.19 billion for nearly 240.000 violations of the state's Medicaid law. The article recalls other cases, eg. Pfizer's $2.3 billion in 2009, Eli Lily's $1.4 billion. There's more: The NYT reported on 5-8-2012 that Abbot agreed to pay $1.6 billion in connection with its anti-seizure drug Depakote. Some of these marketing practices involve selling the drugs for conditions not approved by the FDA. It must be that the pharmaceutical industry has decided that fines are part of the cost of doing business and calculated them into the price of the medicine so that the patient is actually paying them.
Among all the newspaper clippings I found a scribbled note on Pradaxa, an anti-bloodclotting drug that had been haled in 2009 as a wonder drug that would replace Warfarin, the rat poison. That's what I had to take when I had my knee operation. At the time I was amused for I had used the poison, successfully, against rats and mice. It turned out that the FDA was too quick in its approval of Pradaxa, and when I googled Pradaxa I was suprised to find so many websites, several of which by law firms (the Internet has replaced "ambulance chasing"). Pradaxa is made by Boehringer Ingelheim, a family owned company in Germany. My undated note quotes Boehringer saying in Nov. 2011 that 50 deaths were within a "reasonable order of magnitude," but later admitted of knowing 260 deaths. This was when lawsuits had begun. The company's total sales amounted to 12.7 billion in 2009 and more than 1 billion in Pradaxa sales in 2011. The problem with the drug is that it can cause severe bleeding and even when you could get to a health professional it would be in vain for there is NO REVERSAL AGENT. Interestingly enough the official company's website provides a link "Talking to Your Doctor" that allows you to "create a personalized doctor discussion guide." Even more interesting was the fact that when I printed the entire website I got the good news and the coda, but the intervening material with all the possible side effects came out blank.
Whistleblowers are important but rarely welcome. This was made clear once again by the reports in July 2012 of the FDA spying on and monitoring the e-mails of its own experts and their contacts with members of Congress and the media, even though the Insp. Genl. had refused to give permission. The issue here was the FDA's alleged failure to adequately review medical devices, especially those used in breast cancer screenings.
The next month Jane E. Brody produced a column, NYT 8-21-12 "Medical radiation Soars, With Risks Often Neglected." She reproduced a table showing the amount of background and direct radiation of various procedures. Medical radiation "can be used to treat and sometimes cause certain cancers." But doses are high and have downsides, eg. they can damage DNA and cause cancers later. She quotes one expert's warning that there is "widespread overuse". Then there are untested procedure of ct-scans for detecting calcium in coronary arteries as well as the great variation in amounts of radiation from the same procedure even at the same institution at different times.Reasons for the increased use include paying for the equipment of doctors in private practice or in hospitals that duplicate nearby hospital equipment.
It's abundantly clear that there's something rotten in state of medicine. And now we have first hand testimony by Sanjay Gupta, himself a brain surgeon. The NYT on 8-1-12 carried his Op-ed with the title "More Treatment, More Mistakes." But, while telling the reader about some abhorrent errors he also reports on the lessons learned and subsequent preventive protocols that were put in place (some of which seem to me so common sensible that I wonder why it took serious errors for them to be decreed. On 9-25-12, the Times enumerated a number of mistakes under the headline "No Sponge Left Behind" that illustrates my point). The cases Gupta described were necessary interventions, but in line with the "widespread overuse" of medical radiation reported by Brody, there is also an apparently widespread overuse of unneeded cardiac treatment.
The NYT of Aug. 7, 2012 published a long investigative report on the HCA chain of for profit hospitals, after a nurse alerted the chief ethics officer, engaged an outside reviewer who found "excessive and risky cardiac work . . ." This drove up costs (mostly reimbursed by Medicare) but also increased profits. Some doctors made misleading statements to show treatments were needed. Photos of doctors involved show them all to be of S.E.Asian origin and one wonders whether their status as foreigners allowed them to be more easily influenced to produce more profits from unneeded procedures. One of them was named "most profitable" and in spite of the review he's still on the staff of his hospital. Moreover, unnecessary treatments had already been investigated by HCA in 2003. It's a sordid story of a company unable (Unwilling?) to clean house. To make matters still more horrendous, the Times published another investigative report of two full pages concerning the financial shenanigans at HCA over the last decade that makes on think consolidation of hospitals into a giant network and leveraged buyouts to increase the bottomline of equity firms forces people, including doctors who are supposed to "do not harm," to tolerate and probably promote the mistreatment of defenseless human beings.
Any more of this and I'd be ready to ask: Anyone ready to call the PROFESSIONAL CAREGIVER? At least my own, as well as those of Colette, my long time partner, is among the reliable ones.
In April 2012 I began to collect NYT articles and pretty soon I got the impression that for the health profession April was "the cruelest of months." But I was wrong, once my curiosity was awakened I ended up with frontpage items as well as pages from the Business Section. I started this blogpost in September, but as becomes clear, the bad news endures.
Then there is also the scarifying arrogance of the drug industry's warning pages that accompany their advertising, some of which I already dealt with in earlier posts. (An interesting change in vocabulary, no doubt reflecting the difficulty of getting in touch with one's physician, is the recurrent advice to "consult" or "notify your HEALTH CARE PROVIDER" or "PROFESSIONAL" i.p.o. "your doctor." Apparently they now assume practical nurses and qualified pharmacists are safe enough.) I call their warnings, meant more to forestall legal action than to inform (their nomenclature being generally too confusing for the lay person) "arrogant," for under the guise of advising the patient, drug companies reveal that their medicines often do not work and are frequently harmful, yet still ask your doctor prescribe them. One may be amused by the advise to Viagra victims to call their doctor who can't be reached because he's enjoying the sunset with his partner in separate bath tubs after having taken Cialis. But there is nothing humorous about an ad that recommends ABILIFY, an anti-depressant prescribed as an add-on treatment when a weaker antidepressant alone is not enough; the first warning is that "elderly patients with dementia-related psychosis (eg. an inability to perform daily tasks due to increased memory loss) cannot take it because of an increased risk of "death or stroke," Is this because of the ingredients or because the elderly may take more than the prescribed dose by mistake? One may develop "neuroleptic malignant syndrome" (NMS) as well as tardive dyskinesia (TD) - which may happen also AFTER you consulted your doctor and were advised to "stop taking Abilify." In sounds like Abilify may be incapacitating.
It turns out that Abilify, described as a "powerful anti- psychotic" is the 5th best selling drug in the US (NYT, p.D6). The prescriptions for such drugs have risen though the rate of serious psychiatric disorders remained the same. These drugs were developed for use in cases of schizophrenia and bipolar disorders but drug companies tested them for use against depression and anxiety disorders, thus increasing their sales but means of t.v. and magazine ads that cause the (self-diagnosed) Patient to pressure the doctor to prescribe the medicine even in case of insomnia or every day, situational anxiety. But, as the article also points out, these stronger drugs are not more effective than the first generation of anti-psychotics.
[Febr. 3 2013 addendum: In a frontpage and front section article of nearly 3 full pages, the NYT chronicles the medical history of a young man who became addicted to Adderal, an attention deficit/ hyper activity drug, who resorted to faking the sumptons to get more prescriptions. In one of his actual psychotic conditions he was also prescibed Abilify. While this patient abused the system, experts feel that alarm bells should have been ringing, espec. when the parents began to demand that his Adderall treatment be stopped as they feared "it would kill him." It's a truly sad story.]
Abilify is a drug to be used as an ad-on, perhaps for all those anti-depressants currently listed in tv ads by a law firm organizing a class-action suit. Those drugs were once recommended "at the drop of a hat," almost like "take some liquid and 2 aspirins and call me in the morning." But then aspirins, as well as other pain remedies turned out to have bad side-effects and Tylenol became the safer remedy. Until this year and another law firm is advertising for victims of Tylenol and a set of other drugs in which the Tylenol ingredient is used.
Replacing drugs with safer ones sounds like a good thing. But it begins to sound like trading in one side effect for another. Thus fluoriquinolones, the chemical in the strong antibiotics Cipro and Levaquin, replaced aminoglycosides and chloramphenicol that had potentially life threatening complications. Wow, one says, the pharmaceutical industry really looks out for our health. But then there is Jane Brody (9-11-12) who headlines her column "A Cure That Can Be Worse Than the Illness." She points out that these drugs are often wrongly prescribed for minor infections rather than only in such serious life-threatening cases as life "hospital-acquired pneumonia." Among possible side effects are blinding retinal detachment and acute kidney failure. The culprits here appear to be physicians who do not inform the patients of the FDA warnings carried by these drugs and i wonder whether they actually read them carefully; after all didn't they take the oath: First do not do harm!"? Meanwhile several of these drugs have been removed from the market. There are also some 2,000 lawsuits.
That physicians often fail to exercise the proper caution when prescribing medicines is a constant refrain in the medical pages of the NYT Sciences sections. On 2-28-12 I found the headline "A Cocktail of Drugs May Cloud the Brain," which addresses that cumulative effect of anticholinergetics found in pain killers like prednisone, Tylenol, Advil PM, antihistamines like Benadryl, etc. These anticholinergetics can block the action of a neurotransmitter that is needed in various functions including the cognitive one and memory production. Elderly patients, like me, are more at risk and that brings me to Jane Brody's column of 4-17-2012 entitled "Too Much Medicine, and Too Few Checks," which opens with a reference to her 92-year old aunt as "a walking pharmacy." She was taking 6 prescription medicines and several over the counter ones as well as a multivitamin, vitamin C and vitamin D. In the hospital a neurologist prescribed one medicine and a cardiologist another. As she was being discharged she collapsed. After that, still in the hospital she developed double pneumonia. Fortunately she responded to antibiotics and began to recover. Brody then goes on to describe the knowledge available to prevent similar crises including that of a team of experts that listed 53 potentially inappropriate medications or classes of medication. About one third of the column deals with "The Patient's Responsibility" including downloading a Drug Diary from the Foundation for Health in Aging, which should be shown to one's physician.
Unfortunately the problem may originate before a physician administers a medicine. Not only have pharmaceutical companies skipped tests or not revealed "negative results" but researchers may have published fraudulent papers that even if retracted may already have found their way into the literature, the retractions coming much later and/or having escaped the relevant database. A very recent and truly abysmal case concerns Yoshitaka Fujii who falsified data in no less than 172 papers (NYT 10-2-12, p. D3). And then there's the revelation of the existence of pharmacies that have in fact become drug companies but which as pharmacies escape to the FDA's scrutiny. One of these, New England Compounding (what's in a name!) Center, sold the drug methylprednisolone that was used in spinal injections and which was contaminated with a fungus that caused the death of 11 patients (by 10-10-12) and hospitalized others. A NYT front page article (10-7-12) documents the widespread use of medicines produced by numerous compounding "pharmacies" either because there is a shortage, they are less costly or because the salesperson has been seductive. This particular scandal remains in the news as more patients are coming forward and dying. Several Representatives have started an official inquiry and meanwhile it became known that medicine from that Compounding Center have also been used in open heart and other surgery. The NYT on 10-16-12 had a front page follow up and its Science Section 2 more articles, and on 12/24 it detailed some longstanding problems, incl. lax inspections and poor sterilization practices at NECC, whose family ownership also is involved in two more compounding firms, one of which had very dismal hygienic conditions according to a NYT article of 11-13-12, p. A13). In view of all the problems plaguing the health services, I find it incomprehensible that compounding pharmacies have escaped close supervision and that their use has become widespread. The NYT reports (11-14-12, p. A16) that "friends in Congress" thought it ok for the Compounders to be regulated by the individual states. But it's also one more "serious lapse of judgment" on the part of physicians.
Sales practices "may be colored by the financial interests of the producers" suspects a letter from the Senate Finance Committee to various pharmaceutical companies. The senators focused on the overuse of narcotic painkillers (NYT. 5-9-12, p.B7). Lo and behold, the NYT Business Section of July 3, 2012, continues a frontpage article about GlaxoSmithKline admitting, after years of being sued, criminal fraud in its sales practices and settled for 3 BILLION dollars. These practices included not only trips to the Caribbean but also helping to publish a medical journal article that misreported data from a clinical trial. Three billion sounds like a lot, but several of the drugs in question brought about 28 billion in sales for the years covered by the settlement. In this case whistleblowers provided important information.
Such fines occasion a bit of wistful thinking: Can they help reduce the national deficit? On 4-11-12 Johnson and Johnson and a subsidiary were fined $ 1.2 billion for its marketing practices of Risperdal; and the NYT article summarizes some more penalties:in January a Texas judged levies a fine of $158 million, in 2011 a Sth Carolina judge levied $327,000,000 and in 2010 a Louisiana jury settled on $258,000,000 (it's fun to type all those zeros!), and an Arkansas judge issued a penalty of $1.19 billion for nearly 240.000 violations of the state's Medicaid law. The article recalls other cases, eg. Pfizer's $2.3 billion in 2009, Eli Lily's $1.4 billion. There's more: The NYT reported on 5-8-2012 that Abbot agreed to pay $1.6 billion in connection with its anti-seizure drug Depakote. Some of these marketing practices involve selling the drugs for conditions not approved by the FDA. It must be that the pharmaceutical industry has decided that fines are part of the cost of doing business and calculated them into the price of the medicine so that the patient is actually paying them.
Among all the newspaper clippings I found a scribbled note on Pradaxa, an anti-bloodclotting drug that had been haled in 2009 as a wonder drug that would replace Warfarin, the rat poison. That's what I had to take when I had my knee operation. At the time I was amused for I had used the poison, successfully, against rats and mice. It turned out that the FDA was too quick in its approval of Pradaxa, and when I googled Pradaxa I was suprised to find so many websites, several of which by law firms (the Internet has replaced "ambulance chasing"). Pradaxa is made by Boehringer Ingelheim, a family owned company in Germany. My undated note quotes Boehringer saying in Nov. 2011 that 50 deaths were within a "reasonable order of magnitude," but later admitted of knowing 260 deaths. This was when lawsuits had begun. The company's total sales amounted to 12.7 billion in 2009 and more than 1 billion in Pradaxa sales in 2011. The problem with the drug is that it can cause severe bleeding and even when you could get to a health professional it would be in vain for there is NO REVERSAL AGENT. Interestingly enough the official company's website provides a link "Talking to Your Doctor" that allows you to "create a personalized doctor discussion guide." Even more interesting was the fact that when I printed the entire website I got the good news and the coda, but the intervening material with all the possible side effects came out blank.
Whistleblowers are important but rarely welcome. This was made clear once again by the reports in July 2012 of the FDA spying on and monitoring the e-mails of its own experts and their contacts with members of Congress and the media, even though the Insp. Genl. had refused to give permission. The issue here was the FDA's alleged failure to adequately review medical devices, especially those used in breast cancer screenings.
The next month Jane E. Brody produced a column, NYT 8-21-12 "Medical radiation Soars, With Risks Often Neglected." She reproduced a table showing the amount of background and direct radiation of various procedures. Medical radiation "can be used to treat and sometimes cause certain cancers." But doses are high and have downsides, eg. they can damage DNA and cause cancers later. She quotes one expert's warning that there is "widespread overuse". Then there are untested procedure of ct-scans for detecting calcium in coronary arteries as well as the great variation in amounts of radiation from the same procedure even at the same institution at different times.Reasons for the increased use include paying for the equipment of doctors in private practice or in hospitals that duplicate nearby hospital equipment.
It's abundantly clear that there's something rotten in state of medicine. And now we have first hand testimony by Sanjay Gupta, himself a brain surgeon. The NYT on 8-1-12 carried his Op-ed with the title "More Treatment, More Mistakes." But, while telling the reader about some abhorrent errors he also reports on the lessons learned and subsequent preventive protocols that were put in place (some of which seem to me so common sensible that I wonder why it took serious errors for them to be decreed. On 9-25-12, the Times enumerated a number of mistakes under the headline "No Sponge Left Behind" that illustrates my point). The cases Gupta described were necessary interventions, but in line with the "widespread overuse" of medical radiation reported by Brody, there is also an apparently widespread overuse of unneeded cardiac treatment.
The NYT of Aug. 7, 2012 published a long investigative report on the HCA chain of for profit hospitals, after a nurse alerted the chief ethics officer, engaged an outside reviewer who found "excessive and risky cardiac work . . ." This drove up costs (mostly reimbursed by Medicare) but also increased profits. Some doctors made misleading statements to show treatments were needed. Photos of doctors involved show them all to be of S.E.Asian origin and one wonders whether their status as foreigners allowed them to be more easily influenced to produce more profits from unneeded procedures. One of them was named "most profitable" and in spite of the review he's still on the staff of his hospital. Moreover, unnecessary treatments had already been investigated by HCA in 2003. It's a sordid story of a company unable (Unwilling?) to clean house. To make matters still more horrendous, the Times published another investigative report of two full pages concerning the financial shenanigans at HCA over the last decade that makes on think consolidation of hospitals into a giant network and leveraged buyouts to increase the bottomline of equity firms forces people, including doctors who are supposed to "do not harm," to tolerate and probably promote the mistreatment of defenseless human beings.
Any more of this and I'd be ready to ask: Anyone ready to call the PROFESSIONAL CAREGIVER? At least my own, as well as those of Colette, my long time partner, is among the reliable ones.
Wednesday, July 4, 2012
the modest birder (19) birds singing, etc.
February 2, 2012, 11.05 sunny, 40s: while cleaning the feeders, I heard a "whispered", husky song and after making it clearer by pressing my hearing aid, is sounded like a subdued House finch. about 10 mins with very short intervals. About 7 Housef. of which 4 males, came to the feeder as I watched from the bench.
later saw a Redbelly drumming.
2-9-12, 12.30+ sunny, 38: It is not exactly a song but today the two Redtails that began to occupy their nest on the adjacent farm along 113 two weeks ago, were soaring above the trees in ever wider and higher intersecting courtship circles while calling their repeated high-pitched cheeeeew. (nothing of the books' 'harsh" about it).
at 3pm there were also the clear tones of a Titmouse and the double note of the Carolina Wren.
2-16-12: because some blogs report frequent singing, I have taken to watching perched finches etc. but all of them appear closed mouthed.
2-22-12: 10.30am, 48: earlier there were three male Cardinals on and near the feeders, but as I replenished them one of them was singing down the creek, across the road, sustained for several minutes.
at 2, 56 degrees, went out to see if there were more singers. Forgot my hearing aid.
Later I went down to the creek and walked zigzag up and sat on the bench, but all was silent except for a Downy calling. (The 20 or so early species crocus I brought from Super House on the campus, have multiplied to more than a hundred down the slope, some even in the stone wall).
March 7: while waiting for a stray Broadtail Hummer to appear in a yard in Cape May Point, I heard a soft warble, pretty sustained, much like a Starling as a ventriloquist, but all I could find were Robins. But then, with only one ear functioning.... But it was a Robin after all, for at home, on 3/12, 2 Robins were singing, close to each other in the same tree, in the same sort of way, though louder and they interspersed it with the shrill alarm notes. The "song" was a series of stjilps with a few warbles, each series longer than the normal song.
March 9: a Song sparrow on a fence post in Stone Harbor singing loudly and turning in all directions. A lot of effort that was also clearly visible.
March 10: a male Housef. offering a seed from the feeder to a female. 2 Kestrels copulating in a tree on the edge of Wegman pkg lot.
March 12: a Carolina Wren singing by the creek.
March 13: This time for sure: a Starling singing and not as ventriloquist but with beak wide open for the high notes; an odd collection of picked up sounds but also a nice warble. The bird in full sun on the feeder post and like a modern singer all shiny in metallics, black, purple and even green as the wings vibrated.
March 14: it's like the old recipe for rabbit stew: If you want the hear the birds singing, first be outside (with your hearing aid)! Yesterday and today we were working on the garden (resp. 74 and 69 degrees with blue skies and calm). One or two Cardinals are singing most of the morning and one, farther away, this afternoon but not very long. The Carolina Wren comes to the feeders, but sings mostly by the creek and across the road. And a Titmouse was in great form high in the trees from left to right with about 10 minutes of its four high fluted notes. Underneath, very softly a brown creeper was trying out its one toned wheez line, with interruptions, for about a minute. I actually was surprised it was a Brown Creeper as for some reason I didn't expect this inconspicuous and discreet bird to make any sound. The Red bellied Woodp. was quarking a few times and then, farther off let go with its repeated ieng notes.
March 17: blue after a thick fog, 39 going up to 70. garden work: planting swiss chard seedlings and sowing a mix of lettuces, arugula etc. as well as Chinese peas. With birds singing: the Cardinals, but also in the jungle across the road, a White Throat, a House Finch and a Brown creeper. The forsythia is out also.
March 18: as we were reading on the front lawn in the afternoon sun (74 degrees) it sounded like spring. A Brown Creeper was whispering between examining the cracks in the oak bark in the hedgerow between us and the eastern neighbor, more than one Cardinal was singing, one of them overlaid by the flute of a Titmouse and the summer song of the Car. Wren. The more pleasant singer was the House Finch which did its three part line for about 20 minutes in the middle stories of the hickories; sitting nearly upright and in the sun it was so slender that it looked like a warbler but neither have I seen one here so far, nor did I recognize it as the song of a likely warbler: too much variation! But it moved out of the sun to show its colors.
March 19: Blue and 52 at 9.30. I was looking at BBC news with a check of the feeders. A half moulded Goldfinch was singing on top of the feeder post, its neck vibrating, beak fairly open for the high notes.
March 20: as I was working in the garden, at approx. 1-2pm (74 degrees, mostly sunny with high white clouds) a veritable concert all around (i.e. when I turned my hearing aid in any direction) there was a veritable concert. Both House and Gold finches (the latter also did their flight call while foraging on the branches); Juncos, Titmice and even a Chickadee (a first), several Cardinals, a Carolina Wren (almost "inside" my ear) and several woodpeckers with their serial calls, incl. one that sounded like a flicker, but I haven't seen one of those since last year.
March 21: 2 flickers high in an oak on a dead limb, one of them calling.
March 23: as we were leaving for a birding trip to Delaware, at 6.30am, a Robing was singing loudly an long as if it was territory announcement time. In Del. a singing Song, Field and Swamp Sparrow. We also heard three different Towhees calling.
March 25: 1st Towhee, male (on the feeder).
March 27: 1st Chipping Sparrow, 1 male only
April 1: grey and 49; the Towhee still alone, but sat on the feeder post and called.
April 3: 3 female Cardinal chasing each other thru the spruce and away while 1 male was feeding in the "covered bridge."
April 4: A male Redbelly gave a (not very sharp or high) roll and flew to a branch, soon to be followed by a female from the opposite direction. Copulation, after which the female flew to the brush by the creek and the male to the suet.
A male Cardinal peeled a seed and brought it to a female.
April 5: 2 Mourning Doves on the stone wall in a "parakeet act" before copulating
April 6: Sth jersey. On Jake's Landing Rd. 2 Yellow-throated and 1 Pine Warbler singing, but hard to locate and not only by me with my less than flexible neck. Then Marijke, my daughter, camping near the Dismal Swamp in NC sent me a picture of a Yellow-throated on a bare branch right in front of her. And she's not even Irish.
April 10: a Housefinch was singing softly while I was working in the gdn in the aft. A cool day with a chilly wind.
There were only 2 Bluejays in stead of the usual 3. They were courting and one brought something to the other.
Apparently the Redtails have abandoned their nest and they have not been around on their daily visits.
April 12: Copulating Cowbirds. Not what we need. But also a pair of the small downies, the feeding maneuver before copulation.
April 14: 5.30pm, 72, Car. Wren; Redb.wp. drumming, a flycatcher's 2 (or 3) not call, but I couldn't find it.
April 15:,33.30 pm. 82degr., Car. Wren, a Cardinal and a (Y. Runp?) Warbler. At 7.30 more singing: Towhee (sustained), 2 Cards, Titmouse, a Robin and one in constant alarm call, Redb. drumming.
April 16: 10-11am, 84 (went to 89!) Towhee, the Warbler, Cardinal, Song and Field Sp, Cowbird and a very loud que-arrk (of a Sapsucker?)
April 17: 70, like yesterday, but no que-arrk or Warbler, but songs of Car. Wren and the Redw. Blackb. that came to the feeder from time to time, was singing at the neighbors (why go the New Jersey?).
Appril 27: 60, very windy. We went to New Jersey and were on Jake's Landing Rd, by 9am. Some birds were singing, mostly intermittently, among them a White-eyed Vireo and a Warbling Vireo as well as the Yellow-throated and Pine Warblers that have been there for a while now. But even a Cardinal was singing only between foraging. At 3pm, on the way home, we drove up and down the dirt road in Belleplain in absolute silence; stopping to scan the trees, not one bird was detected though at home this is the time that they forage again and often sing.
May 1: 48-74, grey after rainy night. At 10.30 while working in the garden a real chorus of bird song: cardinal, Robin, Song Sparrow, Housefinch as well as a non-resident singer with 4-5 clear and laud melodious flutes like a Veery or a Swainson Thrush.
May 2: 50-51, some soft rain. At 9.30 a soft 2-note see-see, repeated a few times, a Black and White W.? At 10.30 a clear Housefinch; at 2.30 a clear Chipping Sparrow.
Last week the male Redb.wp. was foraging and flying off across the creek. Today both Redb. were foraging and flying off in the same direction, almost alternatively (they did so at least until May 27 when the leaves began to hide the tree trunks, but sometimes the rooted in the soil of the herb terrace).
May 3: 50-62, rain overnight. From 9.30-11, as I worked in the garden, 2 Cardinals, 2 Robins, 1 Titmouse, 3 Catbirds; 1 Yellow W. and 1 Indigo Bunting across the road where a 20+ acre field has not been mowed since 2008 and now had thick brush with some 6+ft. junipers and several 10ft bushy trees.
May 4: 52-78, grey after some rain, sun in aft., rain at night with rumbles. 9.30-11.30 same as yesterday + Chickadee, with Mocking Bird and Redwing Blb. across the road.
7-730pm: 1 Towhee, 3 Catbirds, 1 Robin, 1 Chipping Sparrow, 1 Orioles and 1 Woodthrush.
Haven't heard the Car. Wren since 4/17.
May 5: 58-70, hazy. 7.30-8am: Cardinal, Titmouse, Oriole, Robin, Towhee, Ch. Sparrow and a ventriloquist Blue Jay.
May 6: 54-68, looking like rain. 7am Robin and Red-eyed Vireo; 7 pm a Woodthrush.
May 11: 46-67, blue with high clouds, breezy. 2pm 1 Catbird and 1 Towhee singing steadily.
May 12: 52-78, blue, calm. 10am: a Scarlet Tanager, a Housefinch and a Chickadee foraging with an occasional song.
May 17: 59-74, n.breeze in Del. In the woods off rte 9, a lot of song 8.30-10.30 am and near Finis Pool and woods at noon: C.ythroat, Yellow, Prothonotary Ovenbird and La. Waterthrush; Wh. and Red-eyed Vireo, Orchard O., both Tanagers.
May 18-23: a pair of cardinals have been chasing each other. was the first nest disturbed?
a Robin feeding a single fledgling even tho there were 4 eggs; another Robin gathering nesting material.
May 20: 54-78, sunny, wile gardening, around 10am, 2 (or 3) B. orioles were dominating the song of Catbird, Cardinal and Housefinch.
May22: 56, grey, 7am, Woodthrush, Rose-br. Grossb., and a lot of different chipnotes.
May 24: 60-80, partly sunny, Belleplain dirt road etc. 6-30-10.20am, best song period 8-930; Worm-eating, Kentucky, Yellowthroated and Hooded warblers, Ovenbird, La. Waterthrush, Wh, and Red-eyed and Blue-headed Vireos, Acadian Flyc., Phoebe; a Yellow-breated Chat, a Peewee, lots of Marsh Wrens, a Va. Rail calling at Jake's Landing at noon. A Seaside Sparrow (3 songs) on Nummy Island in afternoon.
Bought a set of Birdsong Cd's, mostly to verify what I heard without seeing. It's confusing, but after repetitions, I think my memory of my birding buddy Charles' idents served me well.
May 28: 67-84, blue and humid, 4.30-530am a Robin almost continuously; 6am a Woodthrush's ee-oh-lay ending in a gurgle, while moving around; 7am Robin, Towhee, Cardinal, Rose-br. Grosbeak, 10am catbird wiht a Titmouse and Car.Wren down the creek.
May 31: 61-81, blue and calm (lots of bugs). Birding in Delaware, Odessa-Bombay Hk. Birds singing (8.30-10.30): Red and Wh.-eyed Vireos, C. Yellowthr., Yellow and Prothonotary Ws, Ovenbird, both Tanagers, Towhee, Blue Grosb., Acad. flyc., Great Cr. Flyc., Orch. O., Horned Lark, Song, Swamp, Field and Grasshopper Sparrows, Ind. Btg. Some songs on Ch.s identification.
June 3: 47-69, blue, humid. t-storm at 1.30; readbellies feeding fledglings.
June 6: 49-72, blue early, overcast by aft.noon; in mng a Robin singing continuously, oblivious to its apparent soar throat; a Goldf. singing now and then.
June 9: 59-81. sun/clouds; the "hoarse" Robin giving first 3 notes only, sounding a bit like a R.e. Vireo; 2 other Robons, a Towhee, a Goldfinch and something else far in the background, as I was fertiling the veg. herb. and containers.
June 11: 63-80, mostly overcast; at 4.30am 2 birds singing, one a Robin, the other more melodious, the Rose-br. Gr.beak probably.
June 14: 62-76, sun with high clouds. Robins, Car. Wren (only occasionally); the Towhee singing for 15 minutes at 8am in the hickory above the herb terrace.
June 15, 58-76, while working in the garden midmorning, the neighboring Mocking b. was doing its Cardinals and Robin stuff while a Card. was singing down the creek with a chewinking Towhee. Across the road a Goldf. and a Chestn. sided W. were singing while foraging and a Chipping Sp sang occasionally. One or more of the Catbirds around the house were joining in from time to time after I disturbed them.
June 21, 67-89 (after 2 days in 90s), at 5.20am a Catb. in front and a Card. in back; at 8.30 a Robin and a card. briefly. Around 10am a Catbird, a Ch.Sp., and a family of 4+? Chickadees all foraging Chickadee style; a Redb.Wp and a Nuthatch also foraging.
June 23: 62-83, from 7 to 8.30am a surprising concert: a Catb. in the bushes around me, a Towhee along the drive, a Robin nearby, a Goldf. a bit farther off, an Oriole and a Woodthrush came by pausing to sing while foraging and after that a Car. Wren around the house.
July 4, 68-92, humid in the middle of a heat wave; there has been no sustained singing and only a Catbird mumbles occasionally. The Car. Wren one time did three different songs in a row one aft. but mostly gives only its call, as does the Towhee. The Summer Silence has set in.
July 12, 59-87, blue and crisp: 6.30am the woodthrush was singing while foraging from my left in a half circle, in the brush, to my right. The eeh-oh-lay sounded a bit raspy, espec. in the "lay" that was actually a shortened slur. The last few days the Towhee has also been singing while foraging (at different times of the day); the first 2 notes clear as if it was a call and the thrill faster than in May and sometimes half inaudible or swallowed.
later saw a Redbelly drumming.
2-9-12, 12.30+ sunny, 38: It is not exactly a song but today the two Redtails that began to occupy their nest on the adjacent farm along 113 two weeks ago, were soaring above the trees in ever wider and higher intersecting courtship circles while calling their repeated high-pitched cheeeeew. (nothing of the books' 'harsh" about it).
at 3pm there were also the clear tones of a Titmouse and the double note of the Carolina Wren.
2-16-12: because some blogs report frequent singing, I have taken to watching perched finches etc. but all of them appear closed mouthed.
2-22-12: 10.30am, 48: earlier there were three male Cardinals on and near the feeders, but as I replenished them one of them was singing down the creek, across the road, sustained for several minutes.
at 2, 56 degrees, went out to see if there were more singers. Forgot my hearing aid.
Later I went down to the creek and walked zigzag up and sat on the bench, but all was silent except for a Downy calling. (The 20 or so early species crocus I brought from Super House on the campus, have multiplied to more than a hundred down the slope, some even in the stone wall).
March 7: while waiting for a stray Broadtail Hummer to appear in a yard in Cape May Point, I heard a soft warble, pretty sustained, much like a Starling as a ventriloquist, but all I could find were Robins. But then, with only one ear functioning.... But it was a Robin after all, for at home, on 3/12, 2 Robins were singing, close to each other in the same tree, in the same sort of way, though louder and they interspersed it with the shrill alarm notes. The "song" was a series of stjilps with a few warbles, each series longer than the normal song.
March 9: a Song sparrow on a fence post in Stone Harbor singing loudly and turning in all directions. A lot of effort that was also clearly visible.
March 10: a male Housef. offering a seed from the feeder to a female. 2 Kestrels copulating in a tree on the edge of Wegman pkg lot.
March 12: a Carolina Wren singing by the creek.
March 13: This time for sure: a Starling singing and not as ventriloquist but with beak wide open for the high notes; an odd collection of picked up sounds but also a nice warble. The bird in full sun on the feeder post and like a modern singer all shiny in metallics, black, purple and even green as the wings vibrated.
March 14: it's like the old recipe for rabbit stew: If you want the hear the birds singing, first be outside (with your hearing aid)! Yesterday and today we were working on the garden (resp. 74 and 69 degrees with blue skies and calm). One or two Cardinals are singing most of the morning and one, farther away, this afternoon but not very long. The Carolina Wren comes to the feeders, but sings mostly by the creek and across the road. And a Titmouse was in great form high in the trees from left to right with about 10 minutes of its four high fluted notes. Underneath, very softly a brown creeper was trying out its one toned wheez line, with interruptions, for about a minute. I actually was surprised it was a Brown Creeper as for some reason I didn't expect this inconspicuous and discreet bird to make any sound. The Red bellied Woodp. was quarking a few times and then, farther off let go with its repeated ieng notes.
March 17: blue after a thick fog, 39 going up to 70. garden work: planting swiss chard seedlings and sowing a mix of lettuces, arugula etc. as well as Chinese peas. With birds singing: the Cardinals, but also in the jungle across the road, a White Throat, a House Finch and a Brown creeper. The forsythia is out also.
March 18: as we were reading on the front lawn in the afternoon sun (74 degrees) it sounded like spring. A Brown Creeper was whispering between examining the cracks in the oak bark in the hedgerow between us and the eastern neighbor, more than one Cardinal was singing, one of them overlaid by the flute of a Titmouse and the summer song of the Car. Wren. The more pleasant singer was the House Finch which did its three part line for about 20 minutes in the middle stories of the hickories; sitting nearly upright and in the sun it was so slender that it looked like a warbler but neither have I seen one here so far, nor did I recognize it as the song of a likely warbler: too much variation! But it moved out of the sun to show its colors.
March 19: Blue and 52 at 9.30. I was looking at BBC news with a check of the feeders. A half moulded Goldfinch was singing on top of the feeder post, its neck vibrating, beak fairly open for the high notes.
March 20: as I was working in the garden, at approx. 1-2pm (74 degrees, mostly sunny with high white clouds) a veritable concert all around (i.e. when I turned my hearing aid in any direction) there was a veritable concert. Both House and Gold finches (the latter also did their flight call while foraging on the branches); Juncos, Titmice and even a Chickadee (a first), several Cardinals, a Carolina Wren (almost "inside" my ear) and several woodpeckers with their serial calls, incl. one that sounded like a flicker, but I haven't seen one of those since last year.
March 21: 2 flickers high in an oak on a dead limb, one of them calling.
March 23: as we were leaving for a birding trip to Delaware, at 6.30am, a Robing was singing loudly an long as if it was territory announcement time. In Del. a singing Song, Field and Swamp Sparrow. We also heard three different Towhees calling.
March 25: 1st Towhee, male (on the feeder).
March 27: 1st Chipping Sparrow, 1 male only
April 1: grey and 49; the Towhee still alone, but sat on the feeder post and called.
April 3: 3 female Cardinal chasing each other thru the spruce and away while 1 male was feeding in the "covered bridge."
April 4: A male Redbelly gave a (not very sharp or high) roll and flew to a branch, soon to be followed by a female from the opposite direction. Copulation, after which the female flew to the brush by the creek and the male to the suet.
A male Cardinal peeled a seed and brought it to a female.
April 5: 2 Mourning Doves on the stone wall in a "parakeet act" before copulating
April 6: Sth jersey. On Jake's Landing Rd. 2 Yellow-throated and 1 Pine Warbler singing, but hard to locate and not only by me with my less than flexible neck. Then Marijke, my daughter, camping near the Dismal Swamp in NC sent me a picture of a Yellow-throated on a bare branch right in front of her. And she's not even Irish.
April 10: a Housefinch was singing softly while I was working in the gdn in the aft. A cool day with a chilly wind.
There were only 2 Bluejays in stead of the usual 3. They were courting and one brought something to the other.
Apparently the Redtails have abandoned their nest and they have not been around on their daily visits.
April 12: Copulating Cowbirds. Not what we need. But also a pair of the small downies, the feeding maneuver before copulation.
April 14: 5.30pm, 72, Car. Wren; Redb.wp. drumming, a flycatcher's 2 (or 3) not call, but I couldn't find it.
April 15:,33.30 pm. 82degr., Car. Wren, a Cardinal and a (Y. Runp?) Warbler. At 7.30 more singing: Towhee (sustained), 2 Cards, Titmouse, a Robin and one in constant alarm call, Redb. drumming.
April 16: 10-11am, 84 (went to 89!) Towhee, the Warbler, Cardinal, Song and Field Sp, Cowbird and a very loud que-arrk (of a Sapsucker?)
April 17: 70, like yesterday, but no que-arrk or Warbler, but songs of Car. Wren and the Redw. Blackb. that came to the feeder from time to time, was singing at the neighbors (why go the New Jersey?).
Appril 27: 60, very windy. We went to New Jersey and were on Jake's Landing Rd, by 9am. Some birds were singing, mostly intermittently, among them a White-eyed Vireo and a Warbling Vireo as well as the Yellow-throated and Pine Warblers that have been there for a while now. But even a Cardinal was singing only between foraging. At 3pm, on the way home, we drove up and down the dirt road in Belleplain in absolute silence; stopping to scan the trees, not one bird was detected though at home this is the time that they forage again and often sing.
May 1: 48-74, grey after rainy night. At 10.30 while working in the garden a real chorus of bird song: cardinal, Robin, Song Sparrow, Housefinch as well as a non-resident singer with 4-5 clear and laud melodious flutes like a Veery or a Swainson Thrush.
May 2: 50-51, some soft rain. At 9.30 a soft 2-note see-see, repeated a few times, a Black and White W.? At 10.30 a clear Housefinch; at 2.30 a clear Chipping Sparrow.
Last week the male Redb.wp. was foraging and flying off across the creek. Today both Redb. were foraging and flying off in the same direction, almost alternatively (they did so at least until May 27 when the leaves began to hide the tree trunks, but sometimes the rooted in the soil of the herb terrace).
May 3: 50-62, rain overnight. From 9.30-11, as I worked in the garden, 2 Cardinals, 2 Robins, 1 Titmouse, 3 Catbirds; 1 Yellow W. and 1 Indigo Bunting across the road where a 20+ acre field has not been mowed since 2008 and now had thick brush with some 6+ft. junipers and several 10ft bushy trees.
May 4: 52-78, grey after some rain, sun in aft., rain at night with rumbles. 9.30-11.30 same as yesterday + Chickadee, with Mocking Bird and Redwing Blb. across the road.
7-730pm: 1 Towhee, 3 Catbirds, 1 Robin, 1 Chipping Sparrow, 1 Orioles and 1 Woodthrush.
Haven't heard the Car. Wren since 4/17.
May 5: 58-70, hazy. 7.30-8am: Cardinal, Titmouse, Oriole, Robin, Towhee, Ch. Sparrow and a ventriloquist Blue Jay.
May 6: 54-68, looking like rain. 7am Robin and Red-eyed Vireo; 7 pm a Woodthrush.
May 11: 46-67, blue with high clouds, breezy. 2pm 1 Catbird and 1 Towhee singing steadily.
May 12: 52-78, blue, calm. 10am: a Scarlet Tanager, a Housefinch and a Chickadee foraging with an occasional song.
May 17: 59-74, n.breeze in Del. In the woods off rte 9, a lot of song 8.30-10.30 am and near Finis Pool and woods at noon: C.ythroat, Yellow, Prothonotary Ovenbird and La. Waterthrush; Wh. and Red-eyed Vireo, Orchard O., both Tanagers.
May 18-23: a pair of cardinals have been chasing each other. was the first nest disturbed?
a Robin feeding a single fledgling even tho there were 4 eggs; another Robin gathering nesting material.
May 20: 54-78, sunny, wile gardening, around 10am, 2 (or 3) B. orioles were dominating the song of Catbird, Cardinal and Housefinch.
May22: 56, grey, 7am, Woodthrush, Rose-br. Grossb., and a lot of different chipnotes.
May 24: 60-80, partly sunny, Belleplain dirt road etc. 6-30-10.20am, best song period 8-930; Worm-eating, Kentucky, Yellowthroated and Hooded warblers, Ovenbird, La. Waterthrush, Wh, and Red-eyed and Blue-headed Vireos, Acadian Flyc., Phoebe; a Yellow-breated Chat, a Peewee, lots of Marsh Wrens, a Va. Rail calling at Jake's Landing at noon. A Seaside Sparrow (3 songs) on Nummy Island in afternoon.
Bought a set of Birdsong Cd's, mostly to verify what I heard without seeing. It's confusing, but after repetitions, I think my memory of my birding buddy Charles' idents served me well.
May 28: 67-84, blue and humid, 4.30-530am a Robin almost continuously; 6am a Woodthrush's ee-oh-lay ending in a gurgle, while moving around; 7am Robin, Towhee, Cardinal, Rose-br. Grosbeak, 10am catbird wiht a Titmouse and Car.Wren down the creek.
May 31: 61-81, blue and calm (lots of bugs). Birding in Delaware, Odessa-Bombay Hk. Birds singing (8.30-10.30): Red and Wh.-eyed Vireos, C. Yellowthr., Yellow and Prothonotary Ws, Ovenbird, both Tanagers, Towhee, Blue Grosb., Acad. flyc., Great Cr. Flyc., Orch. O., Horned Lark, Song, Swamp, Field and Grasshopper Sparrows, Ind. Btg. Some songs on Ch.s identification.
June 3: 47-69, blue, humid. t-storm at 1.30; readbellies feeding fledglings.
June 6: 49-72, blue early, overcast by aft.noon; in mng a Robin singing continuously, oblivious to its apparent soar throat; a Goldf. singing now and then.
June 9: 59-81. sun/clouds; the "hoarse" Robin giving first 3 notes only, sounding a bit like a R.e. Vireo; 2 other Robons, a Towhee, a Goldfinch and something else far in the background, as I was fertiling the veg. herb. and containers.
June 11: 63-80, mostly overcast; at 4.30am 2 birds singing, one a Robin, the other more melodious, the Rose-br. Gr.beak probably.
June 14: 62-76, sun with high clouds. Robins, Car. Wren (only occasionally); the Towhee singing for 15 minutes at 8am in the hickory above the herb terrace.
June 15, 58-76, while working in the garden midmorning, the neighboring Mocking b. was doing its Cardinals and Robin stuff while a Card. was singing down the creek with a chewinking Towhee. Across the road a Goldf. and a Chestn. sided W. were singing while foraging and a Chipping Sp sang occasionally. One or more of the Catbirds around the house were joining in from time to time after I disturbed them.
June 21, 67-89 (after 2 days in 90s), at 5.20am a Catb. in front and a Card. in back; at 8.30 a Robin and a card. briefly. Around 10am a Catbird, a Ch.Sp., and a family of 4+? Chickadees all foraging Chickadee style; a Redb.Wp and a Nuthatch also foraging.
June 23: 62-83, from 7 to 8.30am a surprising concert: a Catb. in the bushes around me, a Towhee along the drive, a Robin nearby, a Goldf. a bit farther off, an Oriole and a Woodthrush came by pausing to sing while foraging and after that a Car. Wren around the house.
July 4, 68-92, humid in the middle of a heat wave; there has been no sustained singing and only a Catbird mumbles occasionally. The Car. Wren one time did three different songs in a row one aft. but mostly gives only its call, as does the Towhee. The Summer Silence has set in.
July 12, 59-87, blue and crisp: 6.30am the woodthrush was singing while foraging from my left in a half circle, in the brush, to my right. The eeh-oh-lay sounded a bit raspy, espec. in the "lay" that was actually a shortened slur. The last few days the Towhee has also been singing while foraging (at different times of the day); the first 2 notes clear as if it was a call and the thrill faster than in May and sometimes half inaudible or swallowed.
Subscribe to:
Posts (Atom)