Sunday, December 27, 2009

Winter Grocery Shopping

Winter is now upon us. With last week’s great snowfall through the eastern seaboard, I got a glimpse of human irrationality. For the two or three days before the weekend weathermen have been predicting at least five to seven inches of snow in most areas. Then as the weekend came closer, that forecast jumped to twelve plus inches. When the snow did finally hit, it ended up being an easy sixteen plus inches. But just as easily and quickly as it came it swept right through, leaving a clear and sunny Sunday. People may have selectively forgotten that fact, but the weathermen also predicted a short-lived snowstorm.

You would like to think that with the accuracy of weather forecasting these days, especially looking only seventy two to ninety six hours ahead and not this ten day voodoo, people would have more faith in the forecast. When I see that a foot of snow is coming my way, I’m preparing to get up early to start shoveling. If I had a snow blower I would get up two hours later, but $500 can buy a lot of Big Macs. However, I also saw that the snowstorm was only going to last a day, so I also knew that I had to shovel once in stopped snowing, lest it melt some and then freeze into an ice rink. What I did not think was that I would be trapped in my house for a week and possibly consider cannibalism like a mountaintop plane crash survivor.

That sentiment is apparently no shared by at least half the public. Mind you, I am talking about the current scenario—a one day large snowfall. Not some four day blizzard marathon. One day of snow. One. And it was on a Saturday. Granted, it was Super Saturday, typically the busiest shopping day of the year, but still, a weekend day. I thought people would be relaxing at home or trying to get out and finish Christmas shopping. And perhaps they did do that. But they also went to grocery stores trying to stock up on milk, bread, and eggs. I know, I know. You think that it is entirely possible that these people were simply shopping for Christmas dinners and Christmas cookies. And I would assure you they were not. There were no components of Christmas dinners in those multitudes of shopping carts I crashed by on Friday. Nor were there bags of chocolate chips or sugar accompanying these kitchen staples. People were out to stock their pantries and refrigerators in case they got snowed in by a one day snow.

Why is it that this mentality exists? I find it very hard to believe that it has trickled over from olden times of war and the Depression. I would believe that people are worried about price gouging after the gasoline fiasco from Hurricane Katrina. Yet you cannot explain the behavior when it was clearly not going to be a blizzard. I think the best explanation for this is the same for the irrational run on banks. All it takes is a few people with unfounded fears to start talking up stocking their pantries and refrigerators. Then that scares more people and more people after that. Soon you have a packed grocery store and no milk on the shelves.

Now me, I was at the grocery store because I planned to make cookies that weekend and just happened to be out of milk, butter, and eggs. Really.

Monday, December 21, 2009

The 'Burbs

I was downstairs in the kitchen today when I happened to look out the window and saw my backyard neighbor Steve outside. He was with three other people, a woman and two men, and they all looked very sad. One of the men was wearing a t-shirt and shorts, not unusual given the unusually warm November afternoon. The other man wore a polo and slacks, while the woman wore a white blouse and black slacks. Each of them took turns patting my neighbor on the back and hugging him. Instantly, I called out to my wife, “Gloria must have died!”

Now obviously I’ve gotten ahead of myself, so perhaps I should start from the beginning. When my wife and I moved into our current house several years ago, one of the first things we noticed was that our backyard neighbors, whom I will call Steve and Gloria, seemed to be very good friends with our next door neighbors, whom I will call Joe and Carrie. We used to see Gloria and Carrie walking back and forth between each other’s houses all the time, knocking on each other’s sliding doors and letting themselves in. They would have outdoor barbeques throughout the summer and hot cocoa in the winter. We met Gloria not long after we had moved in and she told us all about how close she and Carrie were, how their families took vacations together and had dinner all the time. And they seemed to be the best of friends because for the next two years we would always see from our kitchen Gloria walking over the Carrie’s or Carrie walking over to Gloria’s. In retrospect, it seems that Gloria went over to Carrie’s more than the other way around. There were also several other things that seemed to suggest more tension between the two, such as the fact that Gloria did not work while Carrie did. Gloria would spend many a summer day sunbathing in her backyard. Carrie would spend many a summer day mowing the lawn. Given that Gloria and Carrie were likely in their late thirties and were clearly not childhood or even high school friends, you could tell their friendship had an expiration date.

Perhaps a year later my wife and I were in the kitchen and we had a realization. We had not seem Carrie go over to Gloria’s house or vice versa for some time. Was it weeks? Was it months? We surmised the two must have had a falling out. Over what was anyone’s guess. I did remember one day seeing Gloria walking hand in hand with Joe, Carrie’s husband. I didn’t make anything of it at the time, but it came back to me as we pondered this seemingly failed friendship. Not too long after Carrie and Gloria stopped hanging out, we saw Carrie and Joe having drinks with our other next door neighbors, Mark and Cathy. They did not seem to be close before, but now seemed quite chummy. We believed that Carrie and Gloria must definitely have had a fight, and that Carrie had moved on, and Gloria wanted nothing more to do with her backyard neighbors.

A few more months later my wife and I came to another realization—we had not seen Gloria for some time. Where had Gloria gone? What had happened to her? We theorized reasonable possibilities, morose possibilities, and even ludicrous possibilities.

“Maybe she went back home to take care of her sick mother.”

“Maybe she left him and moved back home with her parents.”

“Maybe he killed her and buried her in the backyard mulch line!”

Every once in a while we would look out our kitchen window and into the sitting room of Gloria’s house, as if expecting to see her walk across the room. Steve would come out and mow the lawn every week just like clockwork, but one late spring day we saw him pull up everything in the mulch line. And as the holidays went by, we looked across the yard to see if any decorations had gone up. It wasn’t that men don’t put up decorations, but that men usually don’t put up decorations and especially not if a woman is not around. All of our observations told us that Gloria was not living in that house. This was very concerning. Where does a thirty-something stay at home mother of two children go all of a sudden? We figured Carrie must know, but since we weren’t very close with her we decided it would be rather callous to ask about Gloria.

But then I saw Steve outside very sad with people that must be friends and family also very sad. And everyone including Steve talking on their cell phones every five minutes. This and the fact that Steve had just mowed the lawn yesterday told us that something must have happened to someone close to him. I believed that one of the women was his sister, who seemed to be offering him comfort rather than the other way around, which would make it unlikely that it concerned one of his parents. Though I didn’t see both his children around, without Gloria it also seemed unlikely that it concerned his children. That would only leave Gloria. Something had happened to Gloria.

“Gloria must have died!”

It’s hard to imagine what could have happened to a thirty-something woman who looked healthy enough to sunbathe in her own backyard in a bikini not one year ago, but the list of suspects isn’t very long. I didn’t really know Gloria at all, and I keep thinking I’ll look across the backyard one day and see her walking through her sitting room. Deep down I know I won’t though, and I’ve been reading the obituaries to see if Gloria will show up there. One day I’ll have to ask Carrie what happened to Gloria. Otherwise I’ll be talking the kids treat or treating around the block to Gloria’s house one year to see if she’s there.

Sunday, December 13, 2009

Medicine: SNAFU

Have you ever wondered about the medicines in your medicine cabinet? All those pills that come in different shapes and colors. In tablets and capsules and liquids. Do you ever stop and really think about them? After all, they are in essence chemicals. Synthesized molecules meant to perform certain functions. To a chemist there is pharmacokinetics to be considered. To the public there is only, “what dose will work?” and “what side effects are there?” After all, how complicated is acetaminophen or Tylenol? Or loratadine or Claritin? Most of us learned how to dose these medicines either from our family and friends or by reading the bottle. So what’s the big deal? Apparently, the FDA and bandwagon jumpers would have you believe there is a big deal that concerns your health. And because you are such an ignorant fool, they have to protect you from it.

Pharmaceutical companies spend billions on research and development of medications. It exceeds even that spent on marketing, though not by much. As part of the research, different doses are tested, and efficacy, metabolism, and adverse reactions are all tracked, so that a dose that optimizes all three factors can be determined. It is this dose that is ultimately seen on the shelves of your pharmacy. Take Tylenol, for instance. After much testing, it was determined that doses of 325mg was enough to allow treatment of pain. For pain that is more severe, a 500mg dose was also created and marketed as “extra-strength”. In the medical world, as “extra-strength” Tylenol was not always available, 2 regular tabs were used for pain, giving 650mg Tylenol. And for severe fevers, 1000mg, or 2 “extra-strength” tabs were used. Eventually, this practice trickled to the public, and it became commonplace to take 2 regular Tylenol for pain, resulting in 650mg of Tylenol. In the same way, doubling the “extra-strength” dose also became commonplace.

Now fast forward to today. Given some newfound concern over Tylenol toxicity, someone had made it his or her personal mission to bring the dangers of Tylenol to the forefront of medicine. And because of those efforts, the FDA has decided to remove the “extra-strength” dose of 500mg Tylenol from the shelves. It will still be available, but only by prescription. Now what in the world is the point of that? And more importantly, what sort of commentary is that on the American public? If you needed pain control and chose to use Tylenol, and decided to take 500mg because that is what has worked for you in the past, you would find that 500mg is no longer available. Would you then take 325mg of Tylenol? Of course not. You would take two 325mg tablets for a total of 650mg of Tylenol, effectively increasing your ingestion of Tylenol overall. How does that help to prevent toxicity?

Do you remember anything other than a news snippet about Tylenol this year? I don’t. But yet there will be a paucity of “extra-strength” Tylenol at your local store next year. What does that tell you? It tells me that the FDA thinks the American public is composed of 60% morons and 40% idiots. They truly believe that the best and perhaps only way to alter human behavior is to change the environment in which they live. The problem is that people can do simple math and realize that 325mg Tylenol will not cut it for pain control, so the next best thing is to double it. The best way to have handled Tylenol would have been to educate the public about it’s potential for toxicity, so that taking 650mg of Tylenol is not such an easy reflexive decision.

Let’s look at another “mission” for healthcare reform. Take Dennis Quaid. His story was quite popular this year. If you do not remember, his twins received an overdose of heparin after birth in the hospital. It would seem that the nurse either drew up too much heparin solution either by visual error or by calculating the amount incorrectly. (Heparin comes in solution of so many thousands of units per milliliter.) Fortunately, no detrimental effects resulted, but because of it he used his celebrity to “raise awareness” of the dangers of heparin. Now rather than spawning an inservice educational wave across the country about heparin and calculating its dosage correctly, the FDA decided that the potency of heparin should be reduced by 10% in order to reduce toxicity risks.

You can guess what happened next. The FDA issued a statement to patients and healthcare providers that heparin will be made less potent, and that a higher dose of heparin may need to be prescribed in order to maintain therapeutic efficacy. I kid you not. So not only will people still have to titrate the dose of heparin, they will now have to correct for the 10% loss of potency. There will already be some medical errors from miscalculation of heparin. It is a fact of life. But now you are adding another calculation and expecting that it will reduce medical errors. Really? It is far more likely that while you might reduce the adverse outcomes when heparin is actually overdosed (which is not that common), you will introduce far far more adverse events from patients being underdosed with heparin. It takes a really ignorant medically untrained celebrity to come up with that brand of logic.

I am not really sure what the FDA will try to screw up next. Perhaps they will remove the gallon size of milk for fear of calcium intoxication. Or they will cut all table salt with flour in order to better treat and control hypertension. This is standard operating procedure for a government agency, but perhaps best described as SNAFU.

Monday, December 7, 2009

Joys of Shopping

Another holiday has come and gone. Halloween was a burp at the end of October, and Thanksgiving was a blur. And before you have a chance to say “turkey again?” your next-door neighbors have their Christmas trees up and decorated. Or menorah. Or aluminum pole of Festivus. Either way it becomes time to shake off the Thanksgiving dinner coma and go winter-holiday-of-your-choice shopping. And it is a veritable free for all melee come Friday after Thanksgiving. There are so many peculiar nuances to this yearly ritual that aliens to Earth observing us must think we are all raving lunatics.

First, for what is supposed to be one of the greatest days for shopping in the entire year, when shoppers get deep deep bargains while retailers sell lots of merchandise, we have named it Black Friday. Now many believe it is because retailers go from being “in the red” to being “in the black”, but this is certainly the minority theory. It is more likely that the term “Black Friday” was created pejoratively to indicate the madness and chaos that ensues with the disruption of supply and demand by discounts. And the term likely originated in Philadelphia, currently the fattest and rudest city in the United States. Be proud, Philadelphians.

We will either stay up all night or get up at three in the morning to drive to the stores to get the best deals on whatever is up for sale, whether it is a Zsu Zsu pet, a Shop Vac, or HDTV. And the economics of Black Friday are atypical. If retailers are cutting prices by such large margins, you must wonder how they are making a profit. Microeconomics tells us that even though they profit less per item sold, they are selling far more items. So cutting your profit in half but selling three times as many items nets you one and a half times more profit. This then begs the obvious question, if this works for Black Friday, why not use this strategy the entire year? The answer, of course, is that it does not work well for the vast majority of retailers, but for different reasons. One reason is that retailers need the demand for their good to be so ridiculously high that by the time Black Friday comes around, people will go bananas and buy up every last piece of good, including items they really do not need. But if they kept it on sale all year round, demand would fall precipitously because people associate low cost with low quality or novelty and vice versa. (This is one reason why people think goods are expensive at Target even though the prices are some of the lowest. More on this another day.) They will also have too much time to think about buying and end up not buying at all. Another reason is that most of the goods purchased on Black Friday are not as personal items but as gifts. Since people are generally short sighted in terms of their future, they will generally not buy a Christmas gift in April, no matter how much it has been marked down. (This also helps explain Americans’ low savings rate and inability to save adequately for retirement. Again, more on that another day.)

Now the latest development in Black Friday sales is the opening of store at midnight or all night long. This came about after several trampling deaths from people rushing to get items before they sold up. The popular example last year was a trampling death of a Walmart employee. This was not even a raving lunatic shopper but an employee who had to work Black Friday. Could it then be any surprise that we get very little done as a society? Rather than simply behaving as civilized people should, we have to alter the environment in order to achieve a different result. Sound familiar? It is a very American concept. We blame the fast food industry for our obesity, cigarette manufacturers for our lung cancer, and television for our children’s bad behavior.

Now we have CyberMonday, the biggest online shopping day of the year. Far safer for all retailer employees to say the least. But I would bet that if the study was done, CyberMonday would be the least productive day of the year for most businesses. Even though the online stores are open 24/7, inventory is finite, so it’s still first come, first serve. And that leads to a lot of people shopping on company time, even with a lot of companies restricting internet usage.

Me, I will never be out there on Black Friday, fighting for parking spaces, standing in lines, and trying to get the last of whatever is going to be popular for one month before the next fad sweeps through. I will do a little shopping on CyberMonday, if I can find a good deal that includes free shipping. Most of my shopping, however, will be done on the classic busiest shopping day of the year—the Saturday before Christmas—when desperation and embarrassment increase your tolerance for traffic, lines, and every-man-for-himself behavior.