let's agree to disagree, because I don't believe you

The intersection between open information access and public understanding is an interesting one in healthcare. The NYT published two articles recently that encapsulate this well. The more recent of the two articles covers the current war brewing between parents and medical authorities over vaccines.

The article caught my eye because I have two friends who are on opposing sides of the divide on this particle issue. One of my friends is a new parent, who has firmly declared his intention to prevent his son from being immunized for as long as he possibly can. He has been reading up and what he has been reading has convinced him that vaccines pose a threat to his infant son, including putting him at increased risk of developing autism. In fact, the last time I mentioned the wonder of the polio vaccine to him, it set him off on a tirade about SV40. SV40 was a viral contaminant found in early versions of the polio vaccine. While it has been found in certain human types of cancers, there is not conclusive evidence that SV40 has a causal relationship to cancer. The government has long since regulated that any vaccines manufactured after 1961 must be free of SV40. However, my friend is still convinced that companies and the government cannot be trusted, and that some vaccines still could have SV40 contamination.

But getting back to autism, the claim against vaccines here has to do with mercury contamination. It is true that there are microscopic levels of mercury present in vaccines. The preservative thimerosal used to be employed routinely in vaccine preparations, and the preservative does contain a derivative of mercury. Still-

"By 2001, no vaccine routinely administered to children in the United States had more than half of a microgram of mercury - about what is found in an infant's daily supply of breast milk."

If anything though, this requirement seemed to heighten parents' concern that thimerosal may have been connected to their childrens' autism. Leading the charge is Dr. Mark Geier, something of a renegade researcher, to whom the NYT attribute the following:

"Dr. Geier said in an interview that the link between thimerosal and autism was clear." & "Public health officials, he said, are 'just trying to cover it up.'"

So now it might look like there's a whistleblower at work here, someone who has crossed the picket line and is advocating for truth. Except that those of us with a science background cannot help but be swayed by this criticism:

"Scientists say that the Geiers' studies are tainted by faulty methodology.

'The problem with the Geiers' research is that they start with the answers and work backwards,' said Dr. Steven Black, director of the Kaiser Permanente Vaccine Study Center in Oakland, Calif. 'They are doing voodoo science.'"

Anyone who has tried to do experiments this way knows the flaws here all too well. It is far too easy to bias your results if you have already decided what your conclusion has to be.

My friend SP is the other friend, the non-parent that is also a physician who happens to work in infectious diseases. To her, there is nothing more dangerous than my parent-friend's thinking. She tells me that parents are quite commonly now citing herd immunity as a rationale for foregoing immunizations. She also says that the internet is the enemy of many a physician for exactly these types of occurrences.

As usual, I sit on the fence, taking it all in. My innate scientific bearings tempt me to side with SP. At the same time, I am not a parent. If I were a parent, I imagine, as a scientist, I would be reading voraciously about maintaining the wellbeing of a child. Furthermore, if there was even the slightest doubt that studies were inconclusive, or there was the slightest possibility of risk, I can't be certain that I would bravely suck it up and follow my physician's lead. I have to assume that reading up, educating oneself on medicine and its dangers is a positive thing. But all of this patient access to information must lead to physician frustration as evidenced by the second NYT article, rather aptly titled Doctors do know some things patients don't know.

When my grandfather had some health complications recently, I remember feeling this urge to fly to where he was. This urge was not grounded in a need to make sure he was going to be okay. Rather, I wanted to sit down with his physician and interrogate him about my grandfather's condition. I wanted every fact, and what I was getting from my parents, uncles, and aunts was not cutting the mustard. I wanted to understand as much as the physician did about what had happened, what the treatment paradigm was, what the long-term outcomes were. In the absence of that Spanish inquisition, I started reading up on the diagnosis my grandfather received. This only served to further alarm and discomfort me. What I was reading did not match with how he was being treated. I started to get suspicious. I was making everyone around me nervous, until I (albeit unwillingly) let go of all my doubts. At some point, I had to give in that my grandfather's physician probably had experience, understanding and training that trumped all my misgivings. And in this particular case, it was true and my grandfather was fine. But it doesn't always turn out that way.

It would be nice if there were some way to titrate, to determine whether a physician is talking out the wrong orifice, or whether a parent/family member/patient is getting excessively paranoid. As luck would have it, I happen to know a little bit about science, and therefore, I have slightly better instincts about whether an uh-oh feeling is warranted or not. I know what I don't know at the very least. But I still can't blame people who question a physician's diagnosis, or patient advocacy groups who browbeat physician groups about new therapies, etc. It feels chaotic, but everyone is just trying to respond to the deluge of information out there, a difficult task given that there is not always a good way to rank the information based on scientific merit.

Well... I just gave myself a headache thinking about all of this. But I guess it was better than thinking about my life, and my crazy newly hatched plan. Don't worry, none of it involves Scientology.

should I stay or should I go now?

Apparently, I am the textbook definition of bad indian daughter. I do not go home to visit my parents nearly as often as I am asked. Furthermore, as my grandfather pointed out to me yesterday, his youngest brother has great grandchildren, while my grandfather has not even been granted the favor of a marriage amongst his grandchildren. Guess who is the oldest in that mix? And then, of course, the icing on the cake, the coup d'etat- my mother wanted to buy me a pair of diamond earrings and I declined. I don't believe in diamonds for various reasons that are not even worth belaboring at the moment. Worse yet, I don't wear an appreciable amount of jewelry. Let's just say, if there had been any doubt in my mind (which there never really was), my mother favors my brother over me now for all of eternity.

All of this must sound ungrateful though, I know. A few months ago, my grandfather had quite a health scare, and that was really the impetus for this quick sprint to the land of humidity and granite. He was in good spirits. I can tell when my grandfather is feeling well, because he goes on campaigns, he wages war. His latest battle is with Medicare. Just from talking to him this weekend, my disgust with our current healthcare system compounded. Apparently, the new Medicare prescription coverage program does cover medicines; the problem is it only covers three prescriptions per month. My grandfather has ten different meds he has to take right now. Interestingly, some of the doctors and pharmacists have found loopholes so that my grandfather does not spend his social security check on prescriptions; for example, they fill 3 months worth of tablets at once. Others are not so flexible. My grandfather is covered by Medicare in one state, but he's visiting my parents right now. In my parents' state, while he can get prescriptions filled, he has a $10 additional charge he has to pay for each prescription. The $10 charge was the last straw for my grandfather. He started writing letters, calling the various insurers and doctors. I have seen my grandfather do this over the years, and usually, his perserverance beats the bureaucracy. But I can see how the machine has become unstoppable now; the bureaucracy is such that his attempts at arguing his case are simply tossed aside as part of a standard operating procedure.

Being at home has always been difficult for me, for as long as I can remember. But it started me thinking about the strange things that happen when you exert stress on a system. I think about those bacteria that grow under anaerobic conditions. This weekend, I felt that X-men-esque potential, that possibility that evolution might be uncharacteristically leaping forward. Amidst the chaos and failed expectations that always come with a visit home, a plan was hatched in my head. The seed germinated, the sprout finally poked its head above the dirt. Now I have to decide if I truly want and whether it's worth the risk to leap.

gotta rush away, she said

day in, day out, accumulating

When I reached the Sun Gate on the Inca Trail, the whole morning, the whole four days, the entire trip squeezed into a tight ball of sharp clarity. All morning, I wondered where the energy came from, what force was keeping me upright and mobile. In our particular trek, the third day was the most strenuous, passing through three mountain passes, one of which reached a dizzying 4210 meters. That it was named Dead Woman's Pass did not help morale any.

By the last morning, every muscle in my leg felt overexerted. The high altitudes and cold nights and hard ground had contributed to sleep deprivation. The little energy that remained, I used to avoid twisting my ankles. Even on that last day, there were downhill descents over uneven rock that required special concentration. Or at least it felt special after three days of hiking.

But on that last day, there is no weariness. It is the classic point in a journey. Well past the half way mark, it is clear that the path must be followed. No weariness, but no elation. Just the knowledge of what is inevitable, of what must be done. I can trace back the inspiration for braving the mountain passes of the third day, for keeping my chin up on the second day, but I still can not pinpoint where the source of energy sprang that brought me to Macchu Picchu on that last day.

Standing at the Sun Gate, realizing the booty was all but in hand, I took in the view, and then peered closer. If you do too, you will see the extensive winding road, snaking its way through the green, making its climb to the ruins. I looked at my watch. It was nearly 10 in the morning. From that view, from that distance, the ruins still looked untouched.

An hour later, after the brief gratuituous collapse, I came upon a different world altogether. After four days of near solitude, of listening to wind, tree branches, and the gentle trudge of footsteps, I found myself thrust into throngs of people. People who were well-dressed, clean, rested, and not particularly quiet. I would love to launch a diatribe about their sense of entitlement, their lack of awe, but I know that the real problem was one of shock.

Since I have been back home, it's been some of the same. I could bemoan the bad luck that's befallen me upon my return, but it seems unwise to do so right now. I know my Peru-colored glasses are slanting everything. Instead, I'm going to give myself a double dose of culture shock, by going to visit my family this weekend in EBF. This time of year, the contrast of the heat and humidity alone should turn me into a raving lunatic.

what's it all about, they scream and then they shout

If you need more than my word that Lima is the armpit of Mi Lindo Peru (sorry, but I seem to see dozens of restaurants that go by that name- it seems to be the equivalent of Bombay Palace or some such), consider the first song I heard there: Girl you know it's true. Would you like to know the second? Too bad- Blame it on the rain. Folks, avoid this city at all costs.

I recollected this because my radio happened to be on KMEL today on the way to work. Supposedly, the station is celebrating black music month in June. And yet, what found its way onto the airwaves? I'll give you a clue: if there was a problem, yo, I'll solve it, check out the hook while the DJ revolves it. You know I'm not clever enough to make this up.

find a friend in a film

Note to self: you will never be one of those dancers in the iPod commercials, so you may want to rethink the whole convulsing around in your apartment by yourself to your iPod mini thing. Then again, it's not really your fault- Galang and The Jurassic Five back to back are difficult to resist.

Before my apartment turned into Dance Party USA, I noticed that the AFI was doing a special on the top 100 film quotes of all time. Blech. There was no need for televising this, especially since VH1 was not involved, enlisting such hipsters as Michael Ian Black to make sardonic remarks. Instead, you have mostly self-involved actors/directors remarking on the brilliance of these quotes. Puh-leeze. What's really brilliant is not the movies, or even the dialogue, but the audience, and how the audience chooses to latch onto words that most writers/actors/directors can't predict for the life of them. J will be very disappointed that there were no Old School quotes- that just shows what the AFI knows. Here are the ones that were mentioned that find their way into conversations I have with people all the time:

#3- "I coulda been a contender" from On the Waterfront. I use this all of the time, mostly because I am constantly falling flat on my face.
#4- "...we're not in Kansas anymore" from The Wizard of Oz, although my friend R and I use it more in reference to Swingers.
#8- "May the force be with you", mostly for commenting on Abhi's blog. My brother also feels the need to say "May the Schwarz be with you" all. the. time. I feel it's important to note here that the Star Wars quote I favor most ("I know") was noticeably absent.
#9- "Fasten your seatbelt. It's going to be a bumpy night." from All About Eve, when I've been drinking. Gets a lot of funny glances.
#10- "You talking to me?" from Taxi Driver. Duh- I lived quite close to NYC for 5 years.
#11- "What we've got here is a failure to communicate." from Cool Hand Luke. I found it very disheartening that most people thought I was referring to a Guns'N'Roses song whenever I quoted this in the 90s. Also, young Paul Newman was the sexy... I'm just saying.
#12- "I love the smell of napalm in the morning" from Apocalypse Now. My brother, not me. Yes, he's a sociopath.
#19- "I'm mad as hell, and I'm not going to take it anymore!" from Network, because I often feel like that nutcase in my current place of employment. Also gets a lot of funny glances.
#29- "You can't handle the truth!" from Mr. Jumpsalotoncouches. Thanks to my friend A, that film gets a lot of quoting.
#37- "I'll be back" from Terminator, another one used frequently by psycho-bro. He would be frothing at the unfortunate fact that no Kindergarten Cop quotes made the list.
#45- "Stella! Hey Stella!" from A Streetcar named Desire. It's fun to yell out non-sequiturs like this, even if the reaction is sometimes less than optimal.
#54- "There's no crying in baseball!" from A League of their own. Now, I hate Tom Hanks as much as the next person, but this quote is great and multi-purpose if you remove baseball, and replace it with any other thing under the sun. And believe me, I do.
#61- "Say 'hello' to my little friend" from Scarface. One of my friends in college had the bad luck of getting introduced to everyone with this opening line. By me.
#69- "They're here" from Poltergeist. Fun to say (in a creepy, Poltergeisty voice) when you're expecting people for dinner or a party. Really livens up the mood.
#79- "I am serious, and don't call me Shirley" from Airplane. My cousin D used this one on me when I was fifteen, I didn't get it, which prompted him to sit me down and watch the movie as if it was required summer reading. I owe him one.
#80- "Yo, Adrian!" See #45 for an explanation.
#85- "My precious" from LOTR. Used by my buddy W. Regarding just about anything.
#94- "I feel the need, the need for speed" also by Mr. Jumpsalotoncouches. My friend R used this on me, just yesterday in fact. I told him that I don't keep recreational drugs in my office.
#96- "Snap out of it!" from Moonstruck, although most of the time, people don't think I'm actually quoting anything when I use it.
#98- "Nobody puts Baby in a corner" from Dirty Dancing. The sheer brilliance of this one when it's well-placed can result in much hilarity.

There were a lot of quotes missing that disappointed me, but I really couldn't believe the cheesefest that is "You survive, you stay alive! I will find you!" didn't make the cut. Anyway, I'm a collector of useful movie quotes because I have no talent for articulating anything with originality, so if you've got one (that's not from Old School or Pulp Fiction), let me know.

Just to keep in the theme of lists and the tangential mention yesterday, and since I am too blue about being here to recollect Peru right now, here are my favorite summer songs:

• "Beautiful!" by Snoop & Pharrell. I can't actually listen to this song if it's cloudy.
  
• "Summertime" by The Sundays. Have I read too much fiction or is this how it happens?
  
• "Summertime" by DJ Jazzy Jeff & The Fresh Prince. I explained this yesterday.
  
• "Girl" by Beck. It works.
  
• "Doin' Time" by Sublime, despite the fact that it features this cringeworthy gem: the tension is getting harder, I'd like to put her head under water.
  
• "Summer Breeze" by Seals & Croft. Because I am a relic.
  
• "Summer Wind" by Frank Sinatra. Sort of more for a Sunday in the summer. At the geriatric home. But I still lurve it.
  
• "Summer Breeze" by Emiliana Torrini, which is like a sip of lemonade in the country.

Maybe more will come to me later.

In another news, I am now fodder for flaming, I suppose, because I am both a) over 30 and b) on Friendster. If that's not enough to earn some wrath, check this- I'm such a techtard that I'm really not certain how the whole thing is supposed to work. Once again, I rule.

a voice inside you says there's no time for looking down

nobody's fault but my own

While tsunami warnings and earthquakes were creating panic amongst Northern Californians (and my mom, who doesn't quite grasp that there are hundreds of miles north of the Bay Area that are still considered California), I was miles away, staring at this. B*tches, now that's a fault line. Earthquakes have severely shook much of the Colca Canyon at various times in its history. Earthquakes originating here have damaged whole portions of the ctiy of Arequipa, a solid 2.5 hour drive from the photographed fault. You try to keep this out of your mind as a rickety bus winds you around narrow roads, as you take a harrowing trip around the face of a canyon. You try not to look down into the canyon, because it's a deep chasm, drops off suddenly and without warning. Just like you suspect the ground beneath your feet might do should the plates decide to shift again.

And yet I feel more unsteady here, back. The plates seem more poised to separate, the ground seems more apt to swallow me up. Had the Richter scale tipped, had I fallen victim to the wrath of the Colca Canyon, nature would have spoken. With nature, there can be no argument. But these little earthquakes, the internal ones that rend me, the ones that pose unanswerable questions and cause infinite loops of confusion, they are far more cruel. After all, they're self-imposed, ought to be controllable. They are the search for meaning where meaning may not exist, or may never definitively be established.

Completely off-topic (and now you know I'm officially returning back to my usual form), if you claim to dislike Summertime by Big Willy Style (who I'll admit is a jacka** of cosmic proportions these days), I must conclude one of the following is true: a) you're a liar, or b) you're 190 years old and only listen to The Summer Wind by Ole Blue Eyes because that rap stuff the kids are listening to hurts your ears, or c) you've never actually experienced summer on the east coast. Yes, I said it!

just trying to get myself some gravity

I would rather starve than eat your bread

During my time in Peru, the most random things would heighten certain senses. I was in a cafe in Arequipa on one early morning. Early by Peruvian standards, that is. It was 9 am on a Sunday, a parade was clogging the Plaza de Armas, and shops were taking their time opening their doors. One of the many things that I loved about being in another country was this relaxed attitude towards time. Stores posted their hours, but they were "more guidelines, really" (TM POTC). Perhaps it would have drove me mad after a time, the lack of reliability, but during my trip, it had a calming effect.

We went into the cafe because one of my travel companions (who I took to calling el gringo numero uno during the course of the trip) has some sort of tapeworm-like condition that requires that he ingest massive amounts of food and coffee on an hourly basis. It is much like having a 185 lb. toddler roaming around the streets under your watch. The up side is that you get to explore a lot of different restaurants and cafes.

The cafe was just opening when we arrived. Casually, the women running the place brought out trays of pastries, exchanged old cakes on display for fresh ones made late the night before, setting out borrichitos and empanadas to tempt your stomach. Tray after tray, the early morning routine. A ordered a cappucino, and, with me at his side asking questions to decipher what was what, he picked pastry after pastry from the other side of the glass.

I had time then, as he chomped away on his spoils, to take it all in. Something in me stirred at the sight of a simple cake, the way it rose, the texture of its top. Something in me wanted to spend the day with these women, making pastries, kneading dough. It's not that I have romantic notions that this is a great and easy way to make living. Just the tangibility of it. I had only been travelling for a few days, but my hands felt idle. It was as though they had always been idle, but I only realized it sitting in that bakery.

Yesterday, I was at the market, and a part of me just wanted to chat with the cashier in Spanish. It's been very strange how the tables have turned back upon arriving back here. There were mangoes for sale, and I bought two even though I have never much cared for mangoes, and had no definite idea of what I would do with them. When I got home, I got to peeling and cutting them. Before I knew it, I was making ginger mango bread.

The experiment failed. The bread had neither enough of the mango flavor I had expected, nor enough of the tang that a healthy amount of ginger should imbue. But it hardly mattered. I would not have eaten it anyway. I just wanted to make mango pulp and make the concoction. I just wanted to see bread rise.

the insecurity is the thing that won't get lost

Right this moment, I'm listening to a lovely Cake and Gorillaz mashup by PartyBen. This was requisite to cure my brain of the ill recommendation I received from a coworker (one Richie Rich). He suggested I acclimate to being back in Los Estados Unidos, as I've taken to calling it now, by watching Hit me baby one more time. Now, I know this trip to Peru has changed me in some ways. But I don't think I've changed so radically that I ever might have enjoyed this piece of television basura. The worst part of the show? Amongst the scary artists that were on display (Sophie B. Hawkins, I'm looking at you, chica loca), suddenly emerges Howard Jones. Dude, Howard Jones. Don't be dissing Howard Jones- I've always lurved him. The whole foolish premise of the show is that the artist sings their most popular hit, followed by a cover of a more recent pop song. Jones intelligently chose to cover Dido's White Flag, a perfect match for his musical style. His voice is still fantastic, melodic, emotional. So what happens? Irene Cara wins the competition. Bwah. So the mashup is my musical bleach to wash away last night's waste of an hour.

On the plane ride to Peru, I read The Namesake, and I'm officially finished with Lahiri. I can't explain what it is exactly I dislike about her work. She does a better job of depicting the South Asian immigrant experience in America than most. Her descriptions of parties and such were dead-on. I can't fault her writing style. And yet there's something so hollow about the book. Something about it left me with a so what?!? feeling. What are you trying to say?!? There is never an answer to that question in her work. It's like playing a classical piece of music with perfect precision, but no feeling. I probably should have read LS' review of the book and saved myself the time. Though I usually hold on to books, treat them well, store them on my shelves, The Namesake wound up donated to a hostal in Cusco, so disenchanted was I with it. At least now I don't have to stress out about Mira Nair adapting it badly.

I don't want to be back. I'm happy to be back in San Francisco, but I don't want to be back in this life, treading water. There are difficult decisions to be made, serious questions that do not have straightforward answers. I could not bear to ponder such things in Peru, but now it's all become so urgent that I have to work it all out in order to keep my head above the surface. And there are apparations and disturbing dreams that unexpectedly came to me at 3600 meters that cloud my head now and blur the edges even more so.

carved into stone on the face of earth

I'm not the kind of girl who gives up just like that

Count on me to post this as the most revealing picture of me ever on a blog, but there you have it. I'm equal parts reclusive and self-humiliating. At any rate, here you have the quintessence of my experience of arriving at Macchu Picchu after four days of trekking. Safe to say, no experience in my life thus far has compared to this.

But I find I am at a loss for words. It's as though the experience was too beyond my understanding, or moreso as though describing it would somehow detract from it. It killed me, it saved me, it was too much and not enough.

What I can outline is the feeling of being back. I'm reminded now of the Neruda lines I had scrawled in my journal before embarking on my trip:

La misma noche que hace blanquear los mismos arboles.
Nosotros, los de entonces, ya no somos los mismos.

It's the same life I have returned to now, but I am not the same. Something irreversible has inexplicably happened.

And sadly, no, it does not involve Gael Garcia Bernal.

where is my mind?

This is it. El grande. Tomorrow the trek to Machu Pichu begins. On a piece of paper, I am going to scribble a Neruda poem that is in a book I brought- an offering to the powers that be when I get to the ruinas. I had not know until after I bought it that Neruda wrote a series of poems on Machu Pichu. There is something magical about retracing these steps. Or so I like to think right now- we will see if I still feel that way after three days without a shower.

Hard to believe that so much time has passed. Yesterday I took a long walk, starting at the ruins of Tambomachay and ending at Sacsayhuaman, another set of ruins that are the most spectacular I have seen yet. The altitude is starting to feel natural, without the help of medication, but I still get winded on steps. Who am I kidding, I always get winded on steps. As we were walking around, SP made the best remark of the day- "Those Incans were no pussies." You see, poetry is everywhere.

the world I know

Several things made me swoon (besides the altitude, that is) in the last few days. A few days ago, I was at the Calera Hot Springs. There is really nothing around the hot springs- they are in the heart of Colca Canyon. Our bus arrived there late in the evening, but the stars studded the sky. I casually craned my head up to the sky, and that is when it really struck me- nothing looked familiar. Gone were the stars in the places where I am accustomed to finding them. In their place, a whole new sky.

Many other things made me swoon as well, but I arrived in Cusco today, and just finished a lovely meal in a lovely loungey bar called Los Perros. Despite its name, it was a great meal with a great atmosphere. I kept threatening to find out who owned the place and marry them, no questions asked. Clearly, the effects of the altitude are manifesting in full force.

learning to fly

I could not help myself, I had to stealthily steal myself away to attempt a post from our local internet cafe in Arequipa- at 30 cents an hour, it is a great deal. Did I mention that I am in Arequipa? The very notion still seems surreal to me.

This morning I saw Andean condors rise and soar through canyons. This afternoon, I made a wish on a pile of rocks, as is the custom at the highest point in Colca Canyon. Sadly, I was so dizzy from the 4950m altitude that I could only manage to concoct a tribute of five rocks before I had to board back on the bus.

I thought it was such a big deal to come here to Peru, and it is for me, but it's blown me away that everywhere we go, everyone else is on 2-3 month holidays, travelling to two or three countries. Have I found my people amongst these travellers, or am I just an imposter in their ranks? I can not say for sure. I can say for sure that I will be taking altitude sickness medication upon getting to Cusco. The coca leaves have not done much for me yet, and the Inca trail looms in the near future.

And thank you, thank you, thank you to all of you for your sweet comments about my trip. The one thing in my "real" life that I feel is missing right now is blogging- a million things have happened every day, and it feels so odd not to be writing to the blogosphere about it.

Now I am going to hold my breath and hope this gets posted. Internet access is good here, but not perfect (then again, the same can be said about my usual internet connection back home).