The literary myth of hyacinth: the thing to come in our garden

While visiting Phipps Garden on March 17, I noticed our hyacinths are growing at the same pace with that of Phipps.  The one with a sign of Garden Hyacinth is from Phipps, the rest are all from our garden.

Last year I wrote “They call me hyacinth girl” ( http://doctorjytsai.blogspot.com/2011/04/they-called-me-hyacinth-girla-trip-to.html ) to insinuate homosexuality of T.S. Eliot.  In his The Waste Land we read,

You gave me hyacinths first a year ago;
The call me the hyacinth girl.

Hyacinth was a beautiful boy and lover of the god Appollo and the wind god, Zephyr in Greek mythology.  One day Apollo and Hyacinth took turn throwing the discus; the jealous wind god blew the wind causing the discus off course, hitting and killing Hyacinth.  Apollo made a flower, the hyacinth, from Hyacinth’s spilled blood.

Knowing this literary myth and the origin of the name of hyacinth, one will better understand why the two lines in his The Waste Land leads to such a speculation.  I wrote “Threes company” in which I also touched this subject.

http://doctorjytsai.blogspot.com/2011/01/threes-company-ts-eliot-vivienne-eliot.html     

 

Happy St. Patrick’s Day from Phipps Garden

After having a lunch with our friends, we visited Phipps Garden to see what it can offer; we’re not disappointed.  Even though this was the very first day of the Spring Flower Show and many of the flowers are not in their glory yet; the colors were already there, these photos can attest to it.

We attired in green to send out Happy St. Patrick’s Day greetings from the most beautiful place in Pittsburgh—Phipps Garden.  I got my “100 years of Excellence” T shirt to celebrate Dr. Greenlee’s (our neighbor) 100^th birthday some years ago.

  

Caesar, Lincoln and Shakespeare

Today (March 15) in 44 B.C., Roman dictator  Julius Caesar was assassinated by a group of noble conspirators led by Marcus Brutus and Caius Cassius.

When John Wilkes Booth shot Lincoln and yelled sic semper tyrannis (Latin for “Thus always to tyrants”), some attributed it to what Marcus Brutus uttered when he stabbed Caesar, given the fact that Booth was a Shakespearean actor; he and his brother (Edwin Booth, an even more famous Shakespearean actor in his days) acted in Shakespeare’s Julius Caesar in 1864 (see photo)—the year before Lincoln’s assassination.  In Shakespeare’s Julius Caesar, we read “Liberty! Freedom! Tyranny is dead!” uttered by Cinna (another conspirator) the moment when Caesar was dead.

Caesar was assassinated in Act 3 Scene 1 and there are two famous speeches at Caesar’s funeral by Brutus and Antony in Scene 2.  “Not that I loved Caesar less, but that I loved Rome more” is basically Brutus’s defense.  One will fall in love with Shakespeare if one reads Antony’s lengthy speech (soliloquy).

Marcus Brutus also had another soliloquy in his orchard before he assassinated Caesar.

I always think Shakespeare must have put a lot of thought and time in his numerous soliloquies.  But then again it might not be so, as Alfred Whitehead said of the Bard, “I don’t believe Shakespeare ever had to grope for a word.  Can you imagine him chewing the end of his quill pen until he could think of the right one?  There is such exuberance in him that I believe once he had clearly imagined a scene, the words came of themselves, in a rush.”

Q: How was the winter? A: What winter?

While working in the garden today, I overheard the newly emerged tulip was whispering to Chinese leaf mustard (小芥菜), “How was the winter?” Having survived a mild winter in our garden, the Chinese leaf mustard (小芥菜) responded, “What winter?”  The children we raised tend to have the attitude we have; this also applied to the “children” in our garden.

Spring fever—winter never came and spring has arrived

Winter never came and spring has arrived.  Spring fever makes one itch to work in the garden and we did today.  Rows of tulips announced beautiful days will be here again.  If you look carefully you’ll see the hyacinths are not far behind.  Katy even transplanted the snow peas from “greenhouse” to the garden.  If snow comes again, let’s hope they are not betrayed by their name.

Football: The modern American gladiator

The last paragraph of this letter-to-the-editor in WSJ is amusing.

Reading Samuel Johnson’s Dictionary: never a dull moment

These four words (butterfly, chicken, dickens and dull) are taken from Samuel Johnson’s Dictionary (published in 1755).

butterfly

A beautiful insect, so named because it first appears at the beginning of the season for butter.

I always wonder what’s butter got to do with butterfly.  Never did I know there was a season for butter.

chicken

(3) a term for a young girl.

It is apparent that chicken [‘chick’ is used more often nowadays] was a slang for young girl back to Samuel Johnson’s time.  It is best to avoid using ‘chick’ as it tends to belittle women.  But, then again, they call themselves “Dixie Chicks” (from Texas).

At the beginning of the Iraq War (2003), the lead vocalist of Dixie Chicks said in London that they’re “ashamed that the President of the United States is from Texas.” I recall the statement offended many “patriotic” Americans, leading to the cancellations of the American tours that year.  It turns out they are the “chicks” with foresight and courage.

dickens

a kind of adverbial exclamation, importing, as it seems, much the same way with the devil, but I know not whence derived.

Some years ago, I made round on an elderly black lady in the hospital and asked her how was her night, she responded “slept like a dickens”.

I once asked Janice where the “dickens” came from (Samuel Johnson didn’t know), she said it was not referred to Charles Dickens, that much we know now.  Even Shakespeare used it in his Merry Wives of Windsor (Act 3 Scene 2)—written before 1600.

Ford:  Where had you this pretty weathercock?

Mrs. Page:  I cannot tell what the dickens his name is my husband had him of.          

So basically ‘dickens’ is used euphemistically for ‘devil’

dull

(8) Not exhilarating; not delightful; as, to make dictionaries is dull work.

Dr. Samuel Johnson said “to make dictionaries is dull work”; but there is no dull moment reading his dictionary.    

Images in Clinical Medicine: Volvulus in National Cheng-Kung University (台南國立成功大學醫學院), Tainan, Taiwan

There is an “Image in Clinical Medicine” on each issue of New England Journal of Medicine (N.E.J.M.) It didn’t escape my notice that there were two images of volvulus within the past few years and both came from the same hospital: National Cheng-Kung University (台南國立成功大學醫學院), Tainan, Taiwan.

I took the liberty to put these images in my blog to convey my heartfelt congratulations.  These four doctors deserve much recognition as it is not easy to get the image published in the prestigious and venerable N.E.J.M., which is celebrating its 200^th anniversary this year. (MGH had its bicentennial celebration last year).

Volvulus is the torsion (twisting) of a segment of intestine, which often leads to bowel obstruction or even gangrene because of circulatory compromise in severe case.  The most common sites are sigmoid or cecum, as reported by Ping-Hsien Chen, M.D. and Chiao-Hsiung Chuang, M.D.  It can also happen in the small intestine as reported by Ming-Yuan Hong, M.D. and Chih-Hsien Chi, M.D.

The Images published also come with a short case report and description of the images.  These doctors did it splendidly; the followings are their images and descriptions.

The above CT image shows a distended sigmoid colon that was looped in an inverted U (Panel A, arrows).  The coronal view reveals dilated loops of colon with a central whirl sign (Panel B, arrow), [which is characteristic of the volvulus.  This was caused by the dilated sigmoid colon around its mesocolon (the peritoneal fold that attaches to the sigmoid)].

The above abdominal computed tomography with intravenous contrast material revealed twisting of mesenteric pedicles (arrows), with the superior mesenteric artery encircled by the superior mesenteric vein in a 360-degree clockwise rotation. This radiologic finding is known as the “whirl sign,” which occurs when bowel loops rotate around a fixed point of obstruction, suggesting intestinal volvulus.    

Harry Hopkins – the man one should know and appreciate

Churchill, Hopkins, his daughter (1/1941)

I always lament Harry Hopkins is not more well known and appreciated.  There is no argument that the intimate friendship and collaboration between FDR and Churchill contributed greatly to the final victory, especially in the European theater.  And Harry Hopkins made it possible.

Joseph Kennedy (JFK’s father, then American Ambassador to Britain) sent FDR depressing reports at the end of 1940, saying the Blitz had cause great damage both to the buildings and morale and the defeat is unavoidable.  FDR sent his own emissary, Harry Hopkins, to England to meet with Churchill on Jan. 10, 1941 during the height of the Blitz (nearly one year before the Pearl Harbor attack).

(The photo shows Hopkins' daughter, Diana, had an eye on FDR's Scotch terrier, Fala, and was oblivious to Churchill being around.)

Churchill wrote in his The Second World War that Hopkins told him on their first meeting that “The President is determined that we shall win the war together.  Make no mistake about it.” and “He has sent me here to tell you that at all costs and by all means he will carry you through, no matter what happens to him--there is nothing that he will not do so far as he has human power.” Of course, this was not a public knowledge then.

Hopkins was the man without a public office and yet he was involved in making decisions of the highest consequence during the war.  He was living in the White House for a while.

We read a Churchill’s telegraph to FDR on 7/25/42, saying he “doubted if success would have been achieved without Hopkins’ invaluable aid.” to which FDR expressed his own happiness at “the successful meeting of minds”.

During their first meeting, Churchill took Hopkins to Scotland to see Lord Halifax off to the United States [as Ambassador].  We read the following from Lord Moran’s [Churchill’s doctor] diary,

“. . . I sat next to Harry Hopkins, an unkempt figure.  After a time he got up and, turning to the PM, said:

‘I suppose you wish to know what I am going to say to President Roosevelt on my return.  Well, I am going to quote you one verse from that Book of Books in the truth of which Mr. Johnston’s [Secretary of State for Scotland Johnston hosted the dinner] mother and my own Scottish mother were brought up:

“Whither thou goest, I will go; and where thou lodgest, I will lodge: thy people shall be my people, and thy God my God.”  Then he added very quietly: ‘Even to the end,'

I was surprised to find the PM in tears.  He knew what it meant.”

Martin Gilbert in his Churchill’s biography (8 huge volumes) wrote, ‘Even to us,’ the doctor added, ‘the words seemed like a rope thrown to a drowning man.’

This is how Hopkins reported to FDR, “. . . people here are amazing from Churchill down, and if courage alone can win—the result will be inevitable.  But they need our help desperately and I am sure you will permit nothing to stand in the way. . . I cannot emphasize too strongly that he is the one and only person over here with whom you need to have a full meeting of mind.”     

Churchill told Attlee, “Hopkins is a godsend” on Jan. 2, 1942.

When Churchill survived a “No Confidence” vote, Hopkins telegraphed him, “Action of the House of Commons delighted me.  These have been some of the bad days.  No doubt there will be others.  Those who run for cover with every reverse, the timid, and the faint of heart, will have no part in winning the war.”

FDR and Hopkins

The Congress passed the Lend-Lease Act in January 1941 providing $50 billion (equivalent to about $650 billion today) military aid to the countries fighting German, Italy and Japan.  Hopkins was the man behind it.  He was also the architect of the New Deal before the war.  I believe he also had a hand on Social Security Act.

Among the American marines killed while assaulting the Japanese-held Marshall Island in mid-February 1944 was Harry Hopkins’ 18-year-old son.  Churchill sent Hopkins a scroll bearing the lines from Macbeth,

Your son, my lord, has paid a soldier’s debt;

He only lived but till he was a man;

The which no sooner had his prowess confirmed

In the unshrinking station where he fought,

But like a man he died.

              Macbeth  Act 5 Scene 8             

Why insulin analog is the way to go in medicine and in business/investment

I have said “insulin is where money is”, in this post I’ll explain why insulin analog (analogue) is the way to go in medicine and in business/investment.

Insulin analog modifies the nature insulin so as to change the onset of absorption, the peak and duration of action.

Human insulin is a simple protein that is composed of 51 amino acids, having two chains (30 and 21 amino acids) connected by two S-S bonds.   

Frederick Sanger

Frederick Sanger was the one figuring this out; his 1958 Nobel Lecture is “Chemistry of Insulin”.  He figured out the sequence of amino acids in insulin.  He got another Nobel Prize in 1980 for deciphering the sequence of nucleic acids of DNA. He is truly “a man of sequence” and “a man of consequence” (重要人物)

Levemir (insulin detemir) is made by deleting the amino acid (threonine) at position 30 in B chain and adding a C14 fatty acid to it.  The end result is that it takes time to be absorbed and lasts nearly 20-24 hours mimicking the basal insulin that represents about half of our daily insulin secretion.

Levemir

Novolog (insulin aspart) is made by replacing proline (at position 28 in B chain) with an aspartic acid.  The end result is that it is absorbed rather quickly within 5 to 15 minutes of injection and lasts for 2-4 hours only, whereas the natural short-acting insulin may last 5-8 hours.

Novolog

The short-acting insulin is given before each meal to cover the surging blood sugar level as we eat.  The shorter duration of insulin analog is also advantageous as it may decrease the incidence of hypoglycemic (low blood sugar) reaction.  For example, if one has insulin analog injection before breakfast, its action will be completely gone when another injection given before lunch.  In case of short-acting insulin (not analog), the lingering effect (with 5-8 hours duration of action) of the morning injection may potentially increase the chance of hypoglycemia.

The long-acting insulin analog (Levemir or Lantus) serves as basal insulin and short-acting insulin analog to cover the blood sugar surge after meals, thus mimicking the physiological state of normal individual.     

Insulin is where money is: All eyes on Novo Nordisk

Banting and Best

I gave a talk about diabetes mellitus in the Taiwanese Bible Study last week.  In talking about the history of insulin, I said “insulin is where money is”, which is true in every sense, not trying to belittle the importance in clinical medicine.

There are three phases of making insulin.  Banting and Best discovered insulin in 1921 (Nobel Prize to Best 2 years later) and for the next 60 years (the first phase) insulin was made from bovine (牛) or porcine (豬) pancreas; the Eli Lilly got them from the slaughter houses.

The recombinant DNA technology made the making of human insulin possible and that is the second phase.  It was a fascinating story of the race of making human insulin by Genentech and Biogen in 1970s (Genentech won the race).  The discovery of restriction enzyme (so that DNA can be ‘cut’ open) by Stanley Cohen and Herbert Boyer paved the way for Paul Berg to develop recombinant DNA technology.  Genentech was founded on the knowledge of the discovery of restriction enzyme and recombinant DNA technology.  Herbert Boyer and Robert Swanson (the venture capitalist) were the cofounders.

Somehow Stanley Cohen didn’t participate, losing the chance to make a fortune when La Roche bought Genentech for 46.8 billion in 2009.  Stanley Cohen went on to get his Nobel Prize for the discovery of growth factor in 1986; he shared with Rita Levi-Montalcini, who will be 103 years of age in April.  James Watson said the discovery of restriction enzyme should be a Nobel Prize work.

Human insulin is the first biological, which is the drug that is made by living cells.  It is made by inserting human insulin-making gene into the DNA of E-coli, which then makes human insulin dutifully.

The third phase arrived in 1990s when the insulin analog (analogue) was developed.  Insulin analog modifies the nature insulin so as to change the onset of absorption, the peak and duration of action; that is there is to it.  The insulin analogs have been outselling, and I predict, will eventually replace human insulins; the trend is inexorable.

Pay attention to Novo Nordisk (a Danish pharmaceutical giant) if one is interested in long-term investment.  It thrives on products to treat diabetes; the blockbusters abound.  The sales of the insulin analogs (Levemir and Novolog) will be around $29 billion for 2011 and that of human insulins will be around $11 billion.  Victoza (liraglutide—a GLP-1 receptor agonist) was just released last year, some analysts predict the peak sales may reach $5-6 billion a year.  Novo Nordisk is also developing degludec (an insulin analog that can have 3 times a week injection) which has a favorable report on the Phase 2 trial (photo below).  Another popular oral diabetes drug (Prandin) is also their product.

It was announced 1 out 4 of U.S. adults is diabetic (probably including prediabetes) in the 71^st American Diabetes Association meeting last year.  There are 150 million diabetics worldwide in 1980 and 347 million in 2008; it is estimated there will be 472 million in 2030.  With that many insulin analogs and Victoza under their belt; more are on the way, Novo Nordisk is well positioned to make you well and make itself a fortune.      

糖尿病 (Diabete Mellitus) is no longer a good term in describing the disease

I gave a talk about diabetes mellitus in the Taiwanese Bible Study last week, pointing out糖尿病 (the disease of having sugar in the urine) is no longer a good term.  We no longer test sugar in the urine to diagnose the disease or monitor the treatment.  Besides, a new drug under development aims to lower blood sugar (glucose) level by causing sugar loss in the urine, thus having lots of sugar in the urine is the goal of the treatment, not pathogenic of the disease.

AstraZeneca and Bristol-Myers Squibb have spent hundreds of millions in developing dapaglifozin, which is a sodium-glucose transporter-2 inhibitor.  Normally the majority of glucose filtered through the glomerulus (the basic unit of the kidney) are reabsorbed back by way of the sodium-glucose transporter, inhibition of which will prevent its reabsorption, causing the loss of glucose in the urine.

FDA rejects it on February 11 citing the concern of higher rate of breast and bladder cancer in the treatment arm.  This is not a surprise, given the FDA expert panel also didn’t recommend it in July 2011.  Like many newer agents, dapaglifozin is not a potent diabetic drug, it only lowers HbA1c by 0.5%; nevertheless, it is a novel approach; a newer class (we have 10 classes of diabetic drugs so far).  I believe this is just a temporary setback.

“Mellitus” means sweet or honey in Latin/Greek, thus Diabetes Mellitus is a better term than 糖尿病.  

Americans like to say “lick”

Today’s Blondie’s comic is not particularly comical, but I use it to illustrate that Americans like to say ‘lick’.  “One lick of work” is the signature word that Bumstead’s boss would say to him as to his work. “Lick” means the smallest effort of work.  It also means the least bit, such as “down to the last lick of paint.”

“Lick” also means defeat; William Faulkner wrote in one of his essays, “I’ll fight you.  If you lick me, you take what money I have.  If I lick you, I baptise you into my church: battered, and mauled and gouged that one into sanctity and civic virtues then . . .”  We often read in sport writing that the team was licking their wounds after an ignominious defeat.

FDR introduced Churchill to a press conference (photo right) on December 22, 1941 the day he arrived at the White House.  Churchill was asked about the Singapore situation in the Pacific theater, “How long it would take to lick these boys [Jap]?”  Churchill had no idea what ‘lick’ means and FDR had to explain it to him.

Gettysburg Battle (July 1-3, 1863) was the turning point of the Civil War, but Lincoln was disappointed that General Meade failed to pursue the retreating Robert Lee to finish him off.  Lincoln told his son, Robert (who was home visiting from Harvard), “If I had gone up there I could have licked them myself.” (Lincoln was right in my view; there were more casualties in both sides after than that before the Gettysburg Battle.)

General Grant

The battle of Shiloh (fought April 6-7, 1862) was the first major victory of the Union.  At the night of the first day, Union army suffered a terrible loss; Sherman said, “Well, Grant, we’ve had the Devil’s own day, haven’t we?”, to which Grant responded, “Yes, Lick them tomorrow, though.”  Licked them they did next day.  

General Bradley and Patton also used ‘lick’ on numerous occasions, I think Patton said, “I feel that we will lick him [Rommel] so long as the Lord stays with me.

Even Scarlett O’Hara said at the end of Gone with the Wind, “As God

is my witness, as God is my witness they're not going to lick me. I'm going to live through this and when it's all over, I'll never be hungry again. No, nor any of my folk. If I have to lie, steal, cheat or kill. As God is my witness, I'll never be hungry again!”

This is the difference between American language and English: Churchill didn’t understand the favorite use of ‘lick’ by famous Americans.