August 31, 2007 - Another Risk Factor for Cancer

Today's New York Times contains an article reporting on a dramatic change of strategy for the American Cancer Society. They've decided to dedicate $15 million – their entire advertising budget for next year – to a series of ads dramatizing the plight of the uninsured.

Some are charging that this strategy is too political – although the Society's leadership is quick to point out that the ads are non-partisan, and don't call for any single solution to the crisis of the uninsured (such as universal health care coverage). They are, however, going to be spending heavily for ads in states with early Presidential primaries, in an effort to influence the direction of the debate.

I can see why the Society would want to do this. They spend millions every year encouraging people to get early-screening tests for cancer. These tests save lives, no doubt about it. Yet, the uninsured are much less likely to go for these tests. Who's going to go out and get a colonoscopy for routine cancer screening, if it means paying the full cost of $3,000 or more out of pocket? People without medical insurance are highly unlikely to have this kind of money just sitting in a bank account somewhere (if they did, they would probably have used it to buy insurance).

"I believe, if we don't fix the health care system, that lack of access will be a bigger cancer killer than tobacco," says John R. Seffrin, chief executive of the Cancer Society. "The ultimate control of cancer is as much a public policy issue as it is a medical and scientific issue."

Here are some eye-opening statistics from the article:

• According to the U.S. Census, the number and percentage of people in the United States without health insurance is on the rise. Last year, 47 million people – 15.8 percent of the population – lacked medical insurance. That's one in seven people who are at a higher risk for cancer, because they probably won't be going for screenings.

• One out of every 10 cancer patients is uninsured. I can't imagine trying to pursue the costly treatments for lymphoma without insurance. It's hard enough affording them with insurance! It's also hard enough managing the paperwork, keeping track of appointments, and all the rest. If I had to do that as a charity-care patient – filling out endless forms for financial assistance, and having to endure long waits for scarce appointments – obtaining treatment would seem like a full-time job in itself.

• One out of every four families affected by cancer will be impoverished as a result of the disease – including one out of every five who do have medical insurance.

• Uninsured breast cancer patients are more than twice as likely to have their cancer diagnosed in late stages as those with private insurance. The same is true of those suffering from cancers of the larynx and mouth.

• This advertising expense, large as it is, is just a drop in the bucket, compared to commercial advertisers. The American Cancer Society's planned expenditure of $15 million on this campaign in the next year is just a quarter of what just one auto-insurance company, Geico, is spending on its "caveman" series of ads.


People are literally dying because they lack health insurance. When is the nation going to wake up and realize that – voting only for politicians who have a concrete plan for doing something about it?

August 29, 2007 - My Friendly Neighborhood Case Manager

Today I speak by telephone with Kim, an R.N. who's employed by Care Allies (formerly Intracorp) – a company contracted by my medical insurer, the Presbyterian Church (U.S.A.) Board of Pensions (or perhaps by their contracted insurance company, Highmark Blue Cross/Blue Shield), to do case management for cancer patients. I've spoken with Kim a couple of times before, as she introduced herself to me and explained that she'll be available as a resource person, as I make treatment decisions. She works for Care Allies' Comprehensive Oncology Program.

Kim is helpful and professional, and seems very knowledgeable indeed about NHL and its treatment. She explains that, until recently, she worked for the CIGNA insurance company, managing care for stem-cell transplant patients (CIGNA evidently owns Care Allies, and contracts out their case-management services to other insurance companies – so, she still works indirectly for CIGNA). I'm favorably impressed with Kim. She has a warm and friendly way about her, and seems genuinely interested in me as a person – but, I'm under no illusions as to what her job is. It's the insurance company that writes her paycheck. They want her to become personally familiar with my treatment plan, so she can head off any costly treatments that may be less than medically necessary.

Kim and I are going to be traveling together through the gray area of medical insurance coverage – that gray area that has to do with the phrase "medically necessary." If Dr. Lerner, Dr. Portlock, or some other cancer specialist recommends a particular treatment, from now on the insurance company is going to subject that plan to a greater level of scrutiny. The insurance company has been doing that all along, to some extent – but now they have flagged my case as one requiring the dedicated, personal attention of one of their employees. With regard to my case, Kim is the insurance company's human face (or, I should say, their human voice – I've never met her in person). She and I are allies – up to a point. I sense, from her demeanor, that she'd genuinely like to see me get better – but, at the end of the day, her job is going to be to recommend more affordable alternatives, if such are available.


Here's what the Care Allies website says about the role of the case manager ("you," in this case, refers to the insurance company contracting for their services, rather than to the patient):

"How it works for you.

Our case managers reach out to the patient to provide assistance and help providers deliver positive results. Through personal interaction, our case managers can address the patient's needs, care environment and available alternatives to help optimize outcomes. With years of experience and knowledge, we can apply an integrated approach across the entire continuum of care.

Empowering your employees through health advocacy.

When employees know they have an advocate to help them deal with a difficult health condition and assist with navigating the complexities of the health care system, we believe they're likely to be more satisfied with their benefits program – and get well faster. CareAllies offers services administered by Intracorp that have been awarded accreditation from URAC, an independent organization whose mission is to help ensure consistent quality care for payors and consumers.

We Make a Difference.

As our customers fight the pressures of health care inflation, CareAllies' Case management services can continue to add value through experience, expertise and efficiency. We are uniquely equipped to link case management with its other health and productivity management services. The result is appropriate actions that can help ensure early intervention, and positive health outcomes for employees, and increased savings for employers."

"Positive health outcomes" – we all want to see more of those. But, positive for whom? For me? For the Presbyterian Church (U.S.A.)? For the insurance company? Suddenly, as I drive further down the treatment highway, more and more people seem to be showing up in the car.

I'm sure there are ways Kim will be genuinely helpful, in guiding me through the bureaucratic maze of insurance review and approvals. She's already starting to do that, offering to check for me on whether Hackensack University Medical Center – where I'm going on September 10th, for a consultation with Dr. Michele Donato about testing for a possible future stem-cell transplant – is inside or outside the insurance company's network. If I'm going to get a "no" from the insurance company regarding some future treatment, I suppose it would be more congenial to hear it personally from a specialist who knows my case, than by pulling some computer-printed letter out of a window envelope. Yet, a "no" is a no – even if it's the more congenial variety. I'm hoping I won't be hearing that word, from Kim or from anyone else. But, time will tell.

An image comes to mind: of Humphrey Bogart, Walter Huston and Tim Holt in the classic Western, Treasure of the Sierra Madre. Those three grizzled prospectors find themselves thrown together as traveling companions, each of them owning a partial share of a gold mine. On the surface, they're friends and allies – but always there's a certain tension underneath, because of the gold. Will they protect one another's interests? Or, will one of them betray the others, to gain a larger share of the gold?


In the movie, their partnership does not end well. I hope Kim, my doctors and I will do much better.

Sign Petition or Call to Help Needy Children

My August 21 blog entry, "The Least Among Us," focused on an action by the executive branch of our government to adjust family income qualifications, so fewer children would qualify for free medical insurance provided by the various states.

Members of the clergy who are so inclined can sign an electronic petition to Congress and President Bush, addressing the President's threatened veto of renewed funding for this program. You can do so by clicking HERE.

Those who are not members of the clergy can visit www.coverallchildren.org, where you'll find information about a toll-free phone number (1-866-633-6432) that you can call, to send a message to your congressional representatives on this issue.

I received this from an organization called Faithful America, which is affiliated with the National Council of Churches.

Here's a description of the purpose behind the petition:

"As people of faith we have a sacred obligation to protect our children, including making sure they have health coverage. The State Children's Health Insurance Program (known as SCHIP) has been a blessing to millions of children who would otherwise be uninsured. But SCHIP ends on September 30 and President Bush has threatened to veto legislation to renew the program. PICO invites clergy to add their names to a petition to Congress and President Bush calling for SCHIP to be renewed with adequate funding to reach five million uninsured low-income children. Please also encourage members of your congregation to call PICO's toll free Cover all Children Legislative Hotline at 1-866-633-6432 to make their voices heard on this critical issue for the faith community. For more information visit www.coverallchildren.org."

Thank you.

(08.26.07) Recommends:

Kitchen Clam Bake!

What better way to get the taste out of my mouth from yesterday's unmitigated disaster then to have a tasty dinner. The Food Network has been hyping the Clam Bake lately, so we turned to everybody's favorite secret crush, Rachael Ray, for a recipe. We modified things a bit here and there, but still hope we did Ra Ra proud.

First up, a 16-quart stock pot:



Then, a little of Ra Ra's favorite magic sauce:



What goes well with a big pot and oil? If you said, "plate full of andouille and kielbasa," congratulations, you are correct:



Potatoes, in the hashed manner. This was the most questionable move of the evening, and I take full responsibility. Ra Ra (stop shaking your head out there; my use of this nickname should not make you nervous and/or sad) called for a "16-ounce bag frozen diced hash browns." But it's unclear whether this is what she had in mind:



One large onion, chopped:


Action Shot!



What form! What fingers! Have you ever seen 4 ribs celery, chopped, with such finesse? No, the answer to that question is no.



Seems like a good point to start filling up that big pot:



Stirring occasionally the potatoes, onions, celery, bay leaf, salt and pepper and:



Thyme. We've only just begun, but it's already starting to look like Grandma's Famous Slaw:



Now that you mention slaw, next up is four ears of corn, complete with caterpillar. No really, that little curled up booger you see right below the tip of the earn of corn isn't a booger after all. It is a caterpillar. Now that's organic!



Action Shot!



When I spy caterpillars in my corn I act swiftly and without mercy. No, No, I'm not a hand model. Yes, yes, I know it's a waste of god-given talent that I'm not.

How do you like me now:



Note: The next picture is probably NSFW, so scroll accordingly.

Naked shrimp:


Now all dressed up, but only one place to go:


Action Shot! with chicken stock:



Action Shot! with tomatoes:



Action Shot! with salt:


Note to self: no bearded clam jokes, no bearded clam jokes, no bearded clam jokes...



Mixing muscles and clams:


No need resorting to 16-year old humor when you've got this staring back at you:



Wait, it gets better:



Put the top on and wait about ten minutes. Take the top off, and through the fog we get...



...Jackpot! Good golly, that is a serious pot of food:


Add some hot sauce to taste:



And you're left with a bowl of nearly unbearably awesome goodness:



No need to risk playing Scrabble on an empty stomach:



14.7 seconds later:



Discarded shells in the foreground. "Goonies" in the background. How long can the good life last?



Well, through the magic of refrigeration, I'm willing to bet that the good life can last a few more days:

Cliff Details

Photo taken with K10D and DA* f/2.8 16-50mm of cliff details along beach in San Clemente. Focal Length: 28mm; Aperture: f/8.0

Last Clouds from Hurricane Dean

We had a fast moving storm come in this morning off the Pacific Ocean. It was the last disturbance from Hurricane Dean, which crossed over Mexico after hitting the Caribbean early this week. Photo shot with K10D and DA f/2.4 70mm "pancake" lens.

(08.25.07) Recommends:

Remaining Professional While Flying Your "Indie" Flag.

Okay, so I've got a rant pent up in me. I don't like to use this space to be negative as I prefer to focus on things that inspire me. But today I had a pretty horrible experience, and because I presume that I was the target audience of the event, some constructive criticism might be useful.

So. Today I headed out to the 2007 Bay Area Indie Music Festival. The gist of the festival was simple and enticing: 20 up-and-coming Bay Area bands on two stages from noon to 10pm, all for ten bucks. Sounds great, right? That's what I thought, too.

I rolled up to the venue in Martinez a little after noon. No band anywhere in sight. Like one sound dude. I thought this looked awkward, but I gave it the benefit of the doubt, after all it was a beautiful day and I was thinking I was in for a cool afternoon of music. But the minutes kept passing without a noticeable sign of getting the festival started. So I went and used the journalism skills I gained in high school. What I found out wasn't hopeful: the sound crew had apparently quit the night before, and they were also now down to just one stage. By 1pm there was still no sign of progress, so I left to explore Martinez. The highlight of the afternoon was walking around downtown Martinez in a KU shirt and running into a KU alumni and chatting for about ten minutes about Lawrence.

I arrived back at the venue at about 2:15 to hear the last few songs of the first band of the day. Now, using the word "Indie Music" in the name of your festival is a gutsy move because if the music turns out to be crap then lots of people like me will think you've used the word to try to get people like me to give you my money. And that's pretty obnoxious, right? So, this first band was completely completely cheesy. Something I would expect to see playing at a barbeque joint in Kansas City on a Thursday night. Completely cheesy rock 'n roll blues blah blah blah music.

The second band had a lead singer who was desperately trying to look like Pete Wentz. Pete fucking Wentz? Give me a break. Consulting my show program, it looked like anywhere between 1/5 and 1/3 of the bands had lead singers desperate to look like Pete Wentz. My god. Is Fall Out Boy considered indie music? Last time I checked they were considered, er, "shitty music." That is, unless you're like a 16-year old girl. Attention Organizers of the Bay Area Indie Music Fest: are you trying to go after people like me, or 16-year old girls? Here's the thing: 16-year old girls have every right to have a music scene that they can get behind. But so many of the bands on the venue were billed as, e.g., selling out the Independent, or selling out Bottom of the Hill. These are 21+ venues, though, so it must be that you are catering to fans like me, right? So then, why all the FOB lead singers? I don't like FOB. None of my friends like FOB. Nobody with whom I've seen a show in the bay area likes FOB. So what was the point of the festival?

The organizers might say, well, if you go to so many indie shows in the bay area, then you have no doubt dealt with long delays before the headliner came on stage. And this is a valid point. But I'm not at a rock club. I'm at an amphitheater in Martinez. It's a hot Saturday. We live in the Bay Area, which means there are almost limitless opportunities to spend my day. So have the decency to get on the PA and explain to me the hold up.

Either way, if you are aiming for the teen crowd, or for me, couldn't you have been professional enough to get somebody on the PA to explain to the crowd why everything was so damn behind schedule?

So, after the second crappy band of the day I went exploring around the venue. I picked up a $5 plastic cup of Bud Lite, apparently the Official Beer of Indie Music. I tried to drown my sorrow over this experience in that 8 ounce cup of beer. Is "indie music" really this lame? Is it just "Bay Area" "indie music" that is this lame?

I consider "indie rock" to be the current musical epoch in which we find ourselves. It supplanted "alternative rock/grunge rock" which supplanted "hair metal" as the previously prevailing musical epochs. Now, the "alternative rock" epoch officially became irrelevant when bands like Stone Temple Pilots got big, because they were like knock-offs of the bands like Nirvana who defined "alternative rock." Nirvana itself knocked off a lot of music, but managed to be creative in its derivativeness. Meanwhile shitty bands like Stone Temple Pilots were just derivative without adding anything interesting to the mix.

Are we now at the tail end of the "indie rock" epoch? Because the bands I saw today were just rehashing played stuff, and it was kind of embarrassing and sad. I sat through one more band, some screamo, emocore, yadda yadda whatever stuff. By that time it was 4pm. Three bands had played by 4pm, and 20 were on the bill. Not wanting to camp out in Martinez until Wednesday afternoon, I left.

The whole ride home, I listened to my new Meiko CD, wishing I was back watching her play at the Hotel Cafe in Los Angeles. To recap this week's culture war:

Los Angeles: 1
Bay Area: 0

End Note: The festival organizers should not put on a 2nd Annual event until they (a) fully articulate the point of having this festival; and (b) are professional enough to pull off something like this.

Something's eating my tomatoes

These tomato worms do such a good job camouflaging themselves. Discovered this one upon arriving home for the weekend. Unfortunately, the 100mm macro is back in my office, so I resorted to using the SMC DA 70mm f/2.4 "pancake". Shot with K10D at minimum focus distance at f/11 in RAW. Image is full frame with no cropping.

(08.24.07) Recommends:

A Meiko Update.

So I headed down to Los Angeles earlier this week to take in two Meiko shows. I've posted about her here and here. She is in the midst of a Wednesday residency at the Hotel Cafe. And this week, she also had an early Tuesday show. Early like 6pm. And with traffic the way it is in Los Angeles, there were probably 25 people at her Tuesday show. But that didn't hold her back at all. Meiko was meant for the stage; she's a natural born rock star. She is so at ease up there. She is very warm, and funny, and tells funny stories, and comes up with funny nicknames (example: calling her trumpet player Donald Trump-et). She has such a distinct voice: she's from Georgia, and the way she plays with the Southern accent just kills.

At this point, I should also gush about the Hotel Cafe. It is one of the coolest venues I've been to. It is what I picture of a music club in LA: a totally non-nondescript front, you have to enter through a back alley, to get into the club you have to walk through heavy curtains, inside there is a front bar room, then a door that leads to a very intimate music room that comfortably fits probably 300.

I wish I had pictures to share of the shows, but they requested no flash photography, and it was just too dark for me get anything worth posting.

Anyway, both shows were fantastic. If you are in or around LA this Wednesday, she has her final Wednesday date before she embarks on a month long tour across the country opening for Brett Dennen.

Finally, I've been getting a ton of hits from people looking for a "reasons to love you" mp3. I briefly thought about putting my copy of her CD up on yousendit, but I quickly realized that I couldn't do that even if I wanted to, because free music is cool and all, but making somebody else's music free isn't up to me. At any rate, Meiko is streaming her whole album (minus an awesome hidden song), at her website. So all of you looking for here stuff click here immediately.

August 23, 2007 - Wishing You Were Somehow Here Again

Yesterday evening was a moment I’ve been both joyfully anticipating – and also dreading – for many weeks. At 10:30 p.m., on a breezy, Southern California summer night, I held tightly to our daughter, Ania, bidding her farewell as she began her freshman year of college.

More than a year ago, when Ania told us she’d like to consider California colleges, it made the most sense for Claire to accompany her on the West Coast tour. It was October, and my chemotherapy was only a few months behind me. The church had been more than generous with medical leave, and I didn’t want to ask for more time. Of course, there was also the matter of airfare. I had to content myself with stories and photos.

In the spring, after the dust of the application process had settled, Chapman University in Orange, California emerged as the favored campus. We mutually agreed that I’d be the one to fly out here with Ania and help her move in.

We’ve been through this sort of leavetaking before, with Benjamin. He began his college studies at Drew University, a couple hours’ drive from home, so we knew we’d see him for the occasional weekend and for holidays. In Ania’s case, the cost of a cross-country commute – paid for by two ministers’ salaries plus some indispensable help from extended family – made it clear she’ll only be coming home for Christmas. That adds some extra angst to the farewell.

Thinking back to our leavetaking with Ben, I remember an overwhelming surge of emotion that took me quite by surprise, as we said our goodbyes in the parking lot. Sure, I’d expected a wistful moment or two. I knew I’d miss him terribly. But I figured I had the feelings under control.

So, at the end of Ben’s move-in day at Drew, I wasn’t prepared for the tears that flooded my eyes. I’m not sure how much our self-reliant firstborn was aware of what was going on inside his dad. Clearly, he (like Ania) was more than ready to strike out on his own, and felt the beckoning of the future more strongly than the drag of the past – but I just about dissolved inside during that final hug. Even so, following in the tradition of my dour Scottish and Swedish ancestors – whether or not the Swedes have a word for “dour,” they’re just as accomplished at the stiff-upper-lip routine – I kept those unexpectedly turbulent emotions under control. I turned away from him before I wiped my eyes.

This time is different: and not because I love Ania any more than Benjamin. Part of it’s the fact that Ania’s the last one to leave the nest. Part of it’s the male-female thing – the dynamic that leads families to choose that treacly “Daddy’s Little Girl” song for their daughters’ wedding receptions (something I promise you, Ania, never to do). Part of it’s the sheer distance involved, and the realization that visits will be few and far between. Part of it’s the fact that I’ve been through this once before, and am better prepared. What I was feeling last night, though, is more than the sum of all these factors. There’s also the cancer. It’s made me a softie.

Chemotherapy takes your hair, but hair grows back. It saps your energy, but that comes back, too. In a way that’s hard to describe, those drugs also dissolve some of the barriers we construct in life, that we use to hold our emotions in check. Those don’t come back so easily.

That night in December of 2005, when Claire and I sat at the kitchen table, and tried to lay out for Ben and Ania as coolly and accurately as we could the news of my diagnosis, I could feel those barriers starting to crumble. We were all feeling scared about what the future might hold. The months that followed looked like they’d be an ordeal – and they were – but we got through them, and with a favorable outcome.

In the intervening months, I haven’t felt the need to build the emotional retaining-walls back up again. What’s the point? With or without cancer, life’s too short.

Here in California, on that night fragrant with flowers, Ania and I both knew what we had to do. Throughout the past couple of days, the university’s orientation speakers had politely but firmly made it clear when was the moment for goodbyes. In the parental briefings, they warned us against being “helicopter parents”– making too-frequent visits to campus, or using the cell phone and the internet to hover over our kids, making it hard for them to break free. As we walked away from the closing ceremony, student volunteers were even holding out boxes of Kleenex. (Those Chapman people think of everything.)

When Ania and I joined in that final embrace, we were both sobbing. She found this remarkable college on her own, surfing the internet. She lobbied us gently but effectively, until we agreed to the cross-country college tour, and, later, to allow her to accept the offer of admission. I’m more certain, now, than ever that she’s made the right choice. Last night, I told her so. On that level, I’m deeply happy – for her, if not for me. When the moment of the actual parting came, it was, as the Bard says, “such sweet sorrow.”

My eyes were streaming as I walked down the steps to the underground parking garage. This morning, I have some down time in the hotel, before driving the rental car to the Orange County airport for the long flight home.

A little while ago, I was standing in the shower, thinking over the events of the past couple of days. One of the things Ania and I did yesterday was to walk into the university library, where she checked out a book of music she needs for a vocal audition this Friday. It was a snap decision: she hadn’t realized there’s an audition for her voice lessons, so she had to quickly locate sheet music for a song she knows, to hand to the accompanist. She chose something from Andrew Lloyd Webber’s Phantom of the Opera. As I shampoo my hair, I find myself humming the tune: “Wishing You Were Somehow Here Again.”

I realize what it is I’m humming. Of all the songs she could have chosen, why did it have to be that one? The tears flow, all over again. This morning, as I awoke, I thought I was getting over this. Evidently not.

I’ll admit it. I’m a softie now. Sorry, ancestors, if that dishonors our dour Northern European traditions. I’m a cancer survivor, and I love my daughter more than words can say.

August 21, 2007 - The Least Among Us

I just read these words, that open a news article in today's New York Times:

"The Bush administration, continuing its fight to stop states from expanding the popular Children’s Health Insurance Program, has adopted new standards that would make it much more difficult for New York, California and others to extend coverage to children in middle-income families.

Administration officials outlined the new standards in a letter sent to state health officials on Friday evening, in the middle of a monthlong Congressional recess. In interviews, they said the changes were intended to return the Children’s Health Insurance Program to its original focus on low-income children and to make sure the program did not become a substitute for private health coverage."

The last part of the sentence is the ringer: "and to make sure the program did not become a substitute for private health coverage." The insurance lobby, in other words, has convinced the Administration to protect their turf, and the Administration has compliantly agreed.

I'm going to cut to the chase, here, about this recent move by the White House, without using diplomatic language: This is evil. As citizens, we need to oppose it.

Here in New Jersey, we have a well-regarded, taxpayer-funded program called New Jersey FamilyCare, that enables low-income - and even some lower-middle-income - families to get free, basic medical coverage for their children. It's funded, in large part, by Federal money, passed down to the State. I've referred many families to it.


Kids aren't expensive to insure. Most don't have high medical expenses. Yet, before FamilyCare came along, affordable, stand-alone insurance for kids was hard to find. The insurance companies weren't much interested in offering it, and many cash-strapped families tended not to buy it (even if they could find it), because they didn't like to even think of their kids getting a catastrophic illness. What we ended up with was a whole lot of bake sales and benefit spaghetti dinners, to help such-and-such a family, whose child had brain cancer or cystic fibrosis, avoid losing their home. (Believe me, you have to sell a whole lot of cupcakes to keep a family from losing their home - and, that sort of thing diverts a community's energy and resources away from other projects, like helping families that were poor to begin with get into their own home in the first place.)

Setting compassion aside for a moment, offering programs like New Jersey FamilyCare is smart for another reason, one that even the most jaded capitalist can appreciate. Widespread medical care for children means fewer long-term, disabling conditions that will only cost society in the long run, once these unfortunate kids grow up to become wards of the state.

The people who run New Jersey FamilyCare don't think much of the new guidelines:

"'We are horrified at the new federal policy,' said Ann Clemency Kohler, deputy commissioner of human services in New Jersey. 'It will cause havoc with our program and could jeopardize coverage for thousands of children.'"

The Administration has accomplished this move by fiat, without consulting Congress. The Times article says there's a chance Congress may override it. Let's hope they do.


"And the king will answer them, 'Truly I tell you, just as you did it to one of the least of these who are members of my family, you did it to me.'"

- Matthew 25:40