PhRMA Two-Step Dance

As part of my practice I conduct research studies for pharmaceutical companies. In order to get medications approved by the Food and Drug Administration, companies need to do studies to prove the medications are safe and effective. Studies are often conducted by multiple physicians around the world in order to get a sufficient number of patients, and to help them get the drugs approved in many countries.

The kinds of studies I do are mostly big and fairly complex endeavors. They usually have an investigator meeting prior to starting in order to explain the study, how to enroll patients, ship blood samples, order supplies, and many other details. It’s also a chance to ask questions and meet others involved in the study.

Pharmaceutical companies pay a certain amount of money to each practice for helping them do a study. That money is used for a number of things, including paying for staffing, and usually a small stipend to patients to cover their transportation and time. The budget includes money for investigators, such as myself, to attend investigator’s meetings, but unless it’s a local meeting, I make less money than I would just seeing patients in my office. A trip to the East coast takes about 3 days including the travel time each way, but I only get paid for the one day. It’s a nice change of pace, though, and it’s fun if I get to go to a city I’ve never been to before, or enjoy visiting.

Recently I was invited for the first time to an international meeting, in Vienna, Austria, by Novo Nordisk. I’d never been there so I figured I’d go a few days early to see the city. I called to book my flight but was told I could only travel the day before the meeting and return the evening of the meeting, or at most the next day. I explained that I intended to pay for the extra hotel nights and food expense, and it wouldn’t cost them any additional money. They said that they could not because of PhRMA guidelines which I’ve discussed before. They said if I arrived early they would not pay for my flight there. The concern was that they would violate the guidelines because if I spent more time at the destination than necessary, they would essentially be paying for a vacation. I pointed out that arriving early would be to their benefit as I’d be less jet lagged while attending the meeting. I also said that if I was taking a vacation, I would bring along my wife, stay for a couple of weeks if going that far, and I wouldn’t visit Vienna in the middle of the winter.

Going to Vienna I want to waltz, but PhRMA wants me to do the two-step, straight there and back. Well I have better things to do with my life, so they will need to find another dance partner.

A Vacation to China

The Great Wall
The Great Wall

Last November I went on vacation to China. In a subsequent post, I’ll write about health issues in China, but for now I’ll just talk about the trip for those interested.

Why China, you might ask? Well I’ve always been curious, and had only been to Hong Kong about 20 years ago, and when a great deal came up, I couldn’t pass it up.

Through Travelzoo I learned of a tour from SmarTours. For an incredible $1099 per person, we had airfare on Air China from San Francisco to Beijing, 5 nights in a nice and well located hotel, a flight to Shanghai, 3 nights in a nice Holiday Inn, also well located, western and Chinese breakfast buffets in the hotels, the flight back to San Francisco, via Beijing, and all airport transfers with an English speaking guide. Additional tours were all optional, but I later learned that the trip was so cheap because it was subsidized by the Chinese government. The tours most people took stopped at government owned stores (silk factory, jade store, pearl store, etc.). As the guide told us, the Chinese government has lent a lot of money to the US, and they hoped us tourists would spend some of it in China!

In Beijing we opted to go with another tour company, recommended by a flight attendant we know, www.chinatour.net. I actually emailed them what I wanted just before getting on the plane. When we arrived at the hotel and I could get on the internet, I confirmed the email they had sent while we were in the air. Our guide called at 10:30 pm and we agreed to meet in the lobby at 8:30 the following morning. We took a private tour for the first 3 days. For a cost of ¥3000 ($484) for two people, we had a driver and tour guide, lunch and most admission fees. The first 2 days events lasted over 12 hours, with the driver waiting to drive us back after acrobatic and Kung Fu shows. For lunch the second day we paid a small surcharge to have a higher quality meal as we had them modify one of their itineraries.

The first day our guide and driver met us at 8:30 am. We went to Tiananmen Square and the Forbidden City. Because the 18th National Congress of the Communist Party of China was about to start to select the new president, security was tighter than usual, and some

Silk and larva after separating cocoons.
Silk and larva after separating cocoons.

buildings were closed to the public.  Our guide helped us get through lines faster. Next we went to a demonstration silk factory and store, then the Temple of Heaven.

Pee boy
Pee boy

We hadn’t asked, but our guide then brought us to an enjoyable tea ceremony where we were served five different kinds of tea. There was a “pee boy” to test the water temperature.  If you pour cool water on top of the head, nothing happens. But if suitably hot, the ceramic boy pees.Then we went to a Chinese acrobat show. Our guide purchased the tickets then took us to the entrance. The ticket taker tried to direct us to the 2nd floor, but when our guide said, ‘what?!’ he pointed us to much better first floor seats near the front.

Rather than go to the chain Quanjude for a Peking duck dinner, as part of the company’s tour, I opted for DaDong, which was well worth the extra cost. In addition to roast duck with condiments, we ordered peas, soy soup, and pomegranate salad.

One of the best places for Peking Duck, DaDong restaurant in Beijing.

One of the best places for Peking Duck, DaDong restaurant in Beijing.
Pomegranate salad at DaDong Restaurant in Beijing.
Pomegranate salad at DaDong Restaurant in Beijing.
20121107_SF-China_0240
Our guide.

Without us ordering they also brought persimmon and candied crab apples.  This was epicurean Chinese food fit for a foodie. At ¥288 ($46) for two, it was a bargain. Our guide sat across the table waiting for us as the driver had already left to park the car. It seemed a little strange, but she helped with ordering and explaining things.

On our second full day, our guide and driver took us to the Cháng Ling tomb of the Ming Tombs.We then stopped at a jade store, followed by lunch. Then it was off to the

Jade horse carving.
Jade horse carving.

Great Wall at Badaling. Despite being off season, it was pretty crowded, but definitely worth seeing. We were lucky with the weather. It had snowed a couple of days earlier, which prevented some tour groups from going, but it was nice and sunny for us. Afterwards I went to use the toilet before leaving. I pressed what I thought was a peddle on the floor to flush the toilet. When I heard a loud sound I looked again at the peddle and realized it said “SOS”. I then found the real flush handle and made a hasty retreat!

On the way back our guide had us stop at the Derun Pearl Gallery. They have the distinction of being located at the National Olympic Sport Center, apparently because the owner or developer owned some of the land before it was turned into the center.

szechuanNext it was time for spicy Szechuan food before attending the Legend of Kung Fu show. The story was a little campy, but it was enjoyable.

We asked our guide about housing. She said most people pay off their house or apartment in 2 or 3 year, longer if it’s a real expensive place. They don’t take loans for cars and pay cash.

The following morning it was off to the picturesque Summer Palace. In the afternoon we strolled down the Fuxiang Hutong. That evening we walked around a mall near our hotel.rink I was surprised by temperature extremes. On the bottom floor was an ice skating rink, yet in the stores it was much warmer than typical American malls. I felt hot with my jacket off, yet most Chinese kept their coats on and appeared comfortable.

We went to dinner at a restaurant near our hotel. As we found at most of the restaurants we went to, the waitress stood waiting to take our order as soon as they brought us to the table, before we had even removed potatoour coats, much less looked at the menu. The menu had many pages, and it was not always easy to figure out what a dish consisted of with their English translations (Heavenly dragon meat, anyone?).  One dish I was surprised to see was sweet potatoes with blueberry sauce. It was kind of bland, but it sure looked good.

The next day we spent most of the day at the Hongqiao (Pearl) Market. That was more time shopping then I bargained for, but it was interesting and we obtained some good deals. You do have to bargain aggressively. One saleswoman grabbed my wife’s arm to prevent her from leaving, and I literally had to pry her fingers off!

The following day a bus took us to the airport, and it was off to Shanghai. After checking in at our hotel, we went to the People’s Park then the Shanghai Museum.

The next morning we took the metro (subway) to see the Yùyuán Gardens and nearby stores. From there we took a taxi to the Bund. The distance was not far, but the man at the hotel desk suggested not walking as he said that area has a lot of pick pockets. The Bund is an elevated walkway by the water, which gives a great view of the Pûdong New Area financial district across the water, and an amazing skyline. To get across we took the Bund Sightseeing Tunnel. It was not nearly as fantastic as they made it out to be (unless perhaps you’re an 8-year-old boy), but it got us there. We stopped at the Apple Store there before going to the Shanghai World Financial Center, where we went to the 100th floor observatory for a stupendous view.

Another metro took us to the French Concession part of town. We walked a fairly long distance to go to the Bâoluó Jiûlóu restaurant. My Lonely Planet guide said it was a large soupand lively place. When we got to the address all we saw was what looked like a small, dumpy restaurant. We almost left, but then walked in and asked for a table. We were taken around the corner only to discover a very large room full of people. I enjoyed a thick pea or soy (?) and coconut soup.

The next day it was off to the town of Suzhou. The train station was close to our hotel, but we wasted a half hour in the wrong building before finally finding the place we had to go to buy the tickets. Fortunately they had a line for English speakers. Unfortunately we found out that we needed to show our passports just to purchase a ticket, though it wasn’t needed to board the train. So we had to go back to the hotel to get our passports. It was a fast train that took us to Suzhou, and the landscape blurred past. When we arrived at the station, we weren’t sure where we were in relation to the town, and our guidebooks made no suggestions. At the “Information” booth the attendants barely spoke English. They suggested a 30 minute bus ride. We and two others in our group decided to take a taxi. It turned out to be a 5-10 minute ride that only cost less than $2!

We went to the zen-like Suzhou Museum, designed by architect I.M. Pei. It contained modern art (some paintings were labeled with dates such as, “2011 AD” just in case you thought it might be 2011 BC), ceramics, jade, textile, and other pieces.

20121113_SF-China_0758Afterward we went to the Humble Administrator’s Garden. This is a very large, and not so humble, garden, with lots of water features and Asian buildings. We had lunch at a noodle shop then wandered down the colorful Píngjiang Lù road. One had to watch out for the numerous bicycles and motorbikes.

In the evening we took the metro to East Najing Road and walked down the heavily  neon-lit road. We were surprised to see a large group of mostly women doing a form of a line dance, as well as some smaller groups ballroom dancing.

We had dinner at the Lost Heaven restaurant, a large and delightful place serving Bai, Dai and Miao folk (Yunnanese) cuisine.   We ate tofu with eggplant, a shrimp dish, Burmese chicken curry, and a pumpkin truffle soup. This was the most expensive restaurant of the trip at about $100 per person. But the rest of the meals were cheap, and if you’re a foodie, it’s worth it to try a delicious, and hard to find cuisine.

We ended our sightseeing with another trip to the Bund to see it at night. We took our photos just in time, before discovering that they turn off many of building lights at 10 pm.

The SmarTour itinerary showed us flying from Shanghai to San Francisco. On the bus to the airport we learned that although that was true, it was not the whole story. We actually had a flight to Beijing with a 3-4 hour layover first, which made for a long day of travel. It took a long long time to get through security in Beijing. They did not ask people to take off belts, so almost everyone set off the metal detector. They subjected most people to a pat down and having a metal detector wand passed over them. Water bottles were confiscated, even if bought past security in Shanghai, and again just before boarding in Beijing, even if purchased after passing through Beijing security.

If you’ve made it this far, I think you will enjoy seeing more of my photos at http://www.danielginsberg.com/Travel/China-2012/27271654_z6ZLck#!i=2291644664&k=FqnMv9X. To reward my faithful readers, I’m offering 70% off those photos for this month only on all prints and merchandise, using the coupon code WBSChina. Feel free to just look, however.

Cruise Health

As I wrote about last time, I attended the ACP Internal Medicine 2012 meeting in New Orleans. Afterwards my wife and I took a cruise on the Carnival Conquest ship that left from New Orleans and stopped at the ports of Cozumel, Jamaica and Grand Caymen.

On the first day of the cruise there is a mandatory safety briefing on deck where they discuss such things as how to board the lifeboats in the event of an emergency. The announcer appropriately discussed the importance of washing hands, but incorrectly said, “the hotter the better.” When it comes to washing your hands, cold water works as well as hot water, except that if it’s cold, people won’t wash their hands as long because it’s uncomfortable. The same is true if the water is too hot. Thus warm water is recommended.

We took an excursion to see the Mayan ruins of Tulum near Cozumel, Mexico. Before leaving the ship we were warned not drink the local water. Near the ruins in a tourist shopping center I was tempted to eat at a Häagen-Dazs ice cream stand. I figured the ice cream was safe, but I worried about the water used to clean the scoops. It was probably safe, but I didn’t want to take a chance.

Obesity is a common problem in the United States and elsewhere, and is particularly a problem in the South. This was reflected in the passengers having embarked in New Orleans. Although people understandably eat excessively on a cruise, to which I’ll take the 5th Amendment, there are opportunities to do some healthy things on a cruise. I took advantage of their gym and exercised every day, though few did. Most of the time half the people exercising were crew members.

While looking for something else, I happened to walk by an ongoing talk on Secrets To A Flatter Stomach. I sat down and listened. The speaker was a personal trainer, certified by the Australian Institute of Fitness. He was buff, which automatically makes one feel he knows what he’s talking about. In fact his advice on exercise and nutrition was sound, and he did a great job explaining things. He then talked about detox and the need to get rid of toxic water trapped around fat. They invited people to sign up for a 1 hour personal analysis and consultation at a 2 for 1 special of $35. I spoke with the speaker’s colleague, a man from Scotland, and also buff. I asked if they would be repeating the lecture as I thought my wife would enjoy hearing it. He said he would cover the same material at the consultation, and more, and do an analysis with equipment not available in the United States (this model is available in the US and seems close to the 310e V8.0 they used). I was skeptical about the detox, but the cost was pretty low so I signed up.

At our meeting he first had us fill out questionnaires about our health, including what medications we were taking and why. I purposely didn’t answer the question about occupation, but admitted I was a physician when he later asked. He then went on to tell me he had a BSC degree in Sports Science from the University of West of Scotland, which he said was about equivalent to a physician in the United States. It’s not. He ran a bio-electrical impedance test attaching an electrode to the ankle and wrist. Running a very low voltage and current, that you cannot feel, through the body, it calculates body fat, lean body weight, body water and metabolic rate. The calculations require the body weight, which he asked about, but did not measure (towards the end of a cruise the actual weight is likely to be significantly higher than the stated weight!). Although the equipment he used may not be available in the US, it’s similar to the Tanita bathroom scale I have at home. My device calculates body fat, though you have to do your own calculations to derive the other numbers, and the results he obtained were very similar to my results at home.

He said I needed to lose 6.1 lbs of fat, and admitted I was among the healthiest he had tested on the cruise, but that I also had  12.5 lbs of toxic water to remove. According to his handout, that put me in the level of, “High levels of accumulative toxic waste circulating the cells of the body. Damage to Liver and Kidneys apparent. Weight gain is inevitable. Degeneration of joints and muscle tissue. High Blood Pressure / High cholesterol.” He recommended a 3 month detox program for $300. Most people, “needed” a 6 month program, which consisted of two 3 month cycles, and some needed a year’s worth. They would then do a 3 month cycle every few years or so depending, less often if following a healthy diet. My credit card would be charged that day, and the product shipped the next, so we could get started on it as soon as we returned home. The products are supposed to cleans the digestive tract, kidneys and liver. They contain various herbal products, algae, plantain seeds for fiber, and a low dose thyroid product of some sort, and one is also supposed to eat alkaline forming foods. I was naturally skeptical. He claimed that his analysis showed that I needed detoxification because I had problems with my cholesterol. He said that with his device he didn’t need to do blood tests. How did he know about my cholesterol problem? Because I told him! Actually it’s not that much of a problem, but I try to be proactive.

He said that evening there would be a nutrition class, but only for those who signed up. He encouraged me to sign up for the detox, but said he wasn’t worried because they get 60 people per week to sign up. While we were talking he was interrupted by someone asking if a person could be signed up for a consultation, even though his schedule was full.  He said he would let us think about it while he took care of something. The class was later held in the gym in a glass walled off section. I counted 19 attendees. To show the legitimacy of the program, he said his company contracts with Carnival and other cruise lines to offer the program, and has been in business for years. I asked for clinical study references to support detoxification. He said he could give it to me, but not until after I signed up. I declined.

If you take a cruise, try to get in some exercise, if nothing more than some extra walking. I advise you to save your money and not spend it on a detox program, and don’t forget your sunscreen.