Reason #45 to go veggie

This article, from last Sunday's New York Times, nicely articulates one of the main reasons I am a vegetarian. I stopped eating meat almost seven years ago, for the relatively adolescent reason that I just didn't like it anymore. It probably helped that two of my best friends were vegetarians - and their parents, also non-meat-eaters, were gourmet cooks.

Since then, the argument of distaste has been superseded by more refined ones: it's healthier to be vegetarian, and it's better for the environment. Plus, I don't miss meat at all - being a vegetarian is not a question of self-deprivation.

You can yell at me about not getting enough protein, how my muscles will disappear, blah, blah, blah - that's not what this post is about. For the record, I get plenty of protein, and when I don't, it's because I am eating like a typical med student (read: junk), not because I can't find meat-free protein sources.

Think about it: meat is basically processed food. Take raw fuel (soybeans, oats, wheat) and feed it to a machine which will require use of energy, water, and land before giving you a product - which itself will have to be processed again to be useful. This doesn't even take into account the waste produced by said machine. To be fair, I should probably stop eating processed meat substitutes like commercial veggie burgers and energy bars – but I find it hard to believe that these have anywhere near the environmental impact of commercial meat farming[1].

The following excerpt sums up the Times article's main argument:

Though some 800 million people on the planet now suffer from hunger or malnutrition, the majority of corn and soy grown in the world feeds cattle, pigs and chickens. This despite the inherent inefficiencies: about two to five times more grain is required to produce the same amount of calories through livestock as through direct grain consumption, according to Rosamond Naylor, an associate professor of economics at Stanford University. It is as much as 10 times more in the case of grain-fed beef in the United States.

The environmental impact of growing so much grain for animal feed is profound. Agriculture in the United States — much of which now serves the demand for meat — contributes to nearly three-quarters of all water-quality problems in the nation’s rivers and streams, according to the Environmental Protection Agency.

You can call me a yuppie bleeding-heart-liberal for this post, but I don't care: at least I'm consistent. I am always claiming to care about the environment, but in my everyday life I'm pretty wasteful (still use that car, dry my clothes in the dryer, etc).

Not eating meat is probably the single best thing I do for the environment. If you are trying to find ways to be more environmentally conscious, you might think about doing likewise. At the very least, you could stop buying your chicken breasts in styrofoam packages.

(Note: one day I could post the boring-but-valid Top Ten Reasons to go Vegetarian, or - this would be funnier - Most Ridiculous Things People Have Ever Said to Me about Eating / Not Eating Meat.)

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[1] At some point I'll look for data on these, or on which favorite habit of the leftist youth is actually better for the environment (recycling versus vegetarianism).

Overdosed at 2.5 years

If you listen to Sharon Brownlee[1], I am what’s wrong with the American system of health care. Not me personally – I hope – but medical students in general. There are too many of us, she says. Too many future specialists, too many future generators of bills and referrals, too many people who will wind up ordering too many expensive tests.

Although Brownlee’s opening put me on the defensive, I had to admit that the crux of her argument was basically what bothers me the most about the academic medical centers where I will do most of my training: too many cooks spoil the broth.

All the time, the doctors I work with say things like, “well, I think you have X, but I’m going to refer you to Dr. So-and-so Specialist so s/he can take care of it.” Often it is unclear to me why the referral is generated: because the doc genuinely has no idea how to proceed? Because the internist thinks s/he knows what’s going on but wants to call in the specialist for CYA[2] purposes? Because the primary doctor is already running an hour late and everyone – patients, nurses, schedulers, the doc him or herself – is too flustered to take additional time to think, research, come up with a game plan? The other day a physician admitted to me that he was referring his patients to other specialists simply because they existed at our hospital. He could have taken the time to work through the other complaints, he said, but he referred instead.

We are told by our deans and mentors that we should become specialists – mostly because of money[3]. “If you want to become an internist,” I was told in the spring of my first year by a doctor whose specialty I will not disclose, “you’d better marry rich.” At the time I was actually thinking about his specialty, but after hearing similar comments from several of his colleagues, I sort of soured.

I’ve since moved on to the blood. Part of me is drawn to hematology, or hematology-oncology (read: blood, or blood and cancer), because I am an unabashed nerd. I find the blood fascinating, and I want to work in a specialty where I might be able to help people both live well and die well. But a career in heme-onc means I’ll be working at an academic medical center forever – because the field changes so fast that I think I’d get behind in private practice.

Another part of me likes the idea of running my own show as an internist. You’ve got heart problems? Diabetes? Lung problems? I’ll deal with it. I understand that I wouldn’t be able to handle everything, but I couldn’t stand being in a specialty where I would be consulted simply out of convenience.

At one of her bioethics classes, my roommate Jenn met a Belgian doctor. I don’t recall his area of practice, but he volunteered some disparaging opinions on the US system of practice. Dermatology in particular took a beating: it did not really exist as a medical specialty in Europe the way it did in the US, he said. General internists knew dermatology – and if somebody had skin cancer he or she went to the oncologist. I suspect there was some degree of exaggeration in his answer, but at its most basic level he’s entirely right. Becoming a competent doctor is all about seeing enough of the same things over and over and over. It’s an apprenticeship during which you learn the right way to treat somebody by first seeing and then treating dozens, hundreds of similar patients. If you refer all your patients with rashes to a dermatologist, you are never ever going to do a good job diagnosing and treating skin conditions. If I were practicing without the ability to refer someone to dermatology, you can bet my loans I’d get damn good at figuring out rashes.

The worst example of the too-many-cooks principle I’ve encountered was a phone conversation I overheard while sleeping in the residents’ lounge one night. I was next to the phone, and at some early hour I heard someone trudge across the room to return a page. “This is neurology,” he announced in typical medical hyperbole. There was buzz from the other end, to which he replied, “no, you want epilepsy, beeper #WXYZ.” More buzz. “I understand,” he continued in the patient-but-annoyed tone I use with small children, “but this is neurology – you want epilepsy.” I assumed that this exchange could only concern a patient having a seizure, and, half-asleep, I was indignant on the part of the buzzing person on the other end of the line. What is wrong with the system when your patient has a seizure and the neurologist is the wrong specialist to call?

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[1] Sorry, couldn’t get the whole article since I no longer subscribe to the Atlantic, but you get the point with the first half…

[2] CYA = cover your ass. Yes, this really comes up in hospitals and doctors' offices, such that the occasional answer of a resident to an attending’s question of “why did you do that?” is, “for CYA.”

[3] Again, it is unclear to me when the money question stops being about having enough to pay back your med school loans before you retire and when it starts being about buying sports cars.