Friday, May 27, 2011

Re: Expert help on Lifehacker (or why not to volunteer to be an expert)

Hey [name removed to protect the innocent] -

Sorry for taking a while to get back to you.

I'm afraid there's no correct answer. Particularly for men - men can wipe however they want without any consequences other than social ill will from smelling bad. It's alleged that women should wipe front-to-back to avoid urinary tract infection. This certainly seems reasonable as it makes sense that keeping feces away from the female urethra would keep the area sterile (urine itself is sterile, after all). Unfortunately, there are no randomized, placebo-controlled studies looking into this that I am aware of.

In researching your question, I did come across some interesting facts about the history of toilet paper (there's a Wikipedia entry). Also, I enjoyed the humorous website in researching this piece. It almost looks like something from, but it's not.

Anyway, hope this helps. As a gastroenterologist, believe it or not, it's a question that no patient has ever, ever asked me.

commander flatus

On Fri, May 20, 2011 at 6:49 PM, [removed] <[removed]> wrote:
Hi [commander flatus],

Thanks for emailing in to volunteer your expertise. We're starting up a section next week called "Am I Doing This Right" (title not yet finalized), that takes basic stuff that you and I and everyone else does on a daily basis, and asks an expert if we are, in fact, doing it correctly.

Here's the question/activity I'm concentrating on first: wiping your butt. Silly topic, but one that's pretty interesting. How many people are doing it the "wrong" way? We'll find out.

So my question to you, as a medical professional, what is the "correct" way of wiping? Front to back, or back to front? And what are the medical reasons why and why not?

Feel free to write as much as you like, giving opinions, examples or even previous cases where you've encountered this. (No names necessary.)

Thanks for helping out Lifehacker! Don't forget to include any websites or links or info you'd like us to credit you under.

[removed contact info]

Saturday, May 21, 2011

Abbott's HUMIRA® (Adalimumab) Meets Primary Endpoints In Phase III Ulcerative Colitis Study

Abbott's HUMIRA® (Adalimumab) Meets Primary Endpoints In Phase III Ulcerative Colitis Study

There are a couple of things that strike me about this study:

  • Their placebo response rate is really, really low compared to other UC (and IBD) studies.
  • Their aggregate response rate of 16-17% is really pathetic, even compared to other studies of anti-TNF drugs.
  • I ain't writing adalimumab for UC based on this data.
Disclosure: I'm on their speaker's bureau and have given promotional talks for them. It's a good drug for Crohn's disease, but these data (which I suspect will lead to an FDA approved indication for ulcerative colitis) are very underwhelming. If I were the FDA, I would request another Phase III study.

Why I quit Wordpress

I used to run my blog on Wordpress and hosted my site at Dreamhost (I would recommend Dreamhost without reservation, BTW). But I found I was spending lots of time doing updates and I really don't have time for that. I also frequently noticed that my posts would get spam inserted into them to manipulate search engines via SQL injection hacks. Annoying.

So I closed up my Wordpress install over there and came to Blogger (who I can bitch about, but they're free). I've also used Google Webmaster Tools (also free) and I have used the webmaster tools since back in the Wordpress days. I liked Wordpress, it was fun. Learned some CSS skills. I liked Gallery for sharing images too (but now I use Picasa).

Anyway, upon setting up my blog on blogger, I noticed that my traffic logs had some strange guests (Ukraine and Russia? see below - click to zoom):

Weird, right? So doing some digging I checked the webmaster tools site for evidence of stupidity and there it was under my crawl errors (again, click to zoom):

Some script kiddie website had figured out a way to insert their serialz in my Gallery. WTF?

I love free software, I've licensed stuff under the GPL that I've written. The problems are: difficulty of necessary upgrades being performed regularly by casual users and the lack of commercial impetus to make a proper product.

I'm sticking with big names and commercial software for the foreseeable future.

Thursday, May 19, 2011

commander flatus' laws of internal medicine

commander flatus' laws of internal medicine:

  1. beer (and sometimes steroids) makes everything better
  2. when faced with a consultation that you don't know what to do about, blame another organ/subspecialty with which you're not involved/responsible for
  3. nausea and vomiting is (almost) never a good reason to call a gastroenterologist
  4. some people just can't handle a tummy ache
  5. (dr.) commander flatus' sign: a patient who presents with magic marker drawing on their body parts to illustrate where their pain is may need a psychiatry consultation in addition to a workup for their pain
  6. when commander flatus leaves town, his patients will simultaneously crump. the likelihood of this occuring increases logarithmically as the purpose of the trip increases from cme to vacation.
(and now google's adsense will populate my blog with ads for medical malpractice attorneys)

    Monday, May 16, 2011

    The false economies of web reviews

    Ever wonder why you never really read a negative review of a product on websites? I used to. In fact, I fell victim to purchasing a few less-than-spectacular products based on reviews posted on websites I trusted.

    Take, for example (because this is really easy), any of the books by Timothy Ferriss. In particular, the book "The 4-Hour Body" is notable given the large amount of online hype it generated, particularly on high-traffic websites like gizmodo, and (where it got a full week of excerpts and glowing reviews). Unfortunately, most serious book critics - like the NYT - considered the book to be nothing more than a laughable bad joke. Why, then, the disparity?

    First of all, we should acknowledge that in addition to being a confirmed narcissist (based on his own writing), and a likely sociopath, Timothy Ferriss has been called the greatest self-promoter in the world by Wired Magazine in 2008. The guy clearly has a forcible personality which, coupled with nearly delusional lifehacking writings can sell lotsa books.

    The bigger issue here is how advertising on the web is structured, particularly as it relates to product reviews. See that link to Amazon to purchase "The 4-Hour Body" (please don't click it). If you were foolish enough to actually buy this book, I would get a cut of the sale. Big websites like gizmodo and lifehacker make gobs of money this way, so tend to put out positive reviews of products so that people reading will click the linky-link and buy the product.

    This is why I wanted to review this book here briefly: don't buy it, it's shit. And also to point out that you can't trust online reviews, even from great sources - they're all tainted by the almighty dollar.

    Review: Yeast by Zainasheff and White

    I bought this book because I wanted to (maybe) start doing some yeast ranching over at my place. See, I really love this Wyeast/Rogue Pacman yeast, but it's got very limited availability (special edition/once a year/blahblahblah). So I was hoping that this book would be a good one for the homebrewer that wants to get into yeast ranching to read.
    Unfortunately, it's not. That's not to say it's not a great book (it is). Jamil Zainasheff has risen to the height of homebrewing royalty and is clearly a really smart guy. Chris White is the founder of White Labs, provider of pure liquid yeast cultures for homebrewers and commercial brewers. These guys are both experts in beer and brewing and the book is full of great information for beer geeks who really want a better understanding of yeast and fermentation. I would recommend it for the advanced homebrewer or commercial brewer. However, if you want resources on simple, reproducible yeast ranching, I would recommend the following (free) links instead and save your money for some other book or yeast ranching equipment.

    Here you go:

    The free information in those articles is much more practical and usable than the book. You will need a pressure canner like the one of the left here. I looked around at Wal-Mart and they don't really have anything suitable. I usually like to buy this kind of stuff at wally world because it's so ridiculously cheap.

    The book is available here (Amazon).

    Saturday, May 14, 2011

    The Great Blogger Outage of 2011

    Seems to have eaten two of my greatest posts ever. I am nagging them about getting me back up.

    Friday, May 6, 2011

    Eye-Fi Connect x2 Card

    I recently purchased a second one of these - they're relatively inexpensive now. I really liked the one I got for a point-and-shoot camera, and wanted to try on in my Nikon D80.

    Setup is pretty easy, though I thought setting up the direct mode access with the new Android and iPhone/iPad apps was a little confusing. The software is OK, could be a bit better - the EyeFi helper app keeps crashing on me. My D80 also seems to be unable to complete and upload of a large batch of photos (about 100 JPG high resolution). I've even set the power settings as their support pages suggest. Sometimes, you just have to plug the card into a computer.

    The are where it really shines, though, is the ability to instantly put pics on Picasa or other sites to share with other family members.

    Find it here at Amazon, about $40 as of this writing. Size is pretty unimportant since the card has a feature that deletes pics off the card after uploading once you've hit a user-specified capacity. That's pretty cool.

    Overall I'd give it a reserved recommendation. The software needs some improvement.