Tuesday, April 28, 2009

Grand Rounds is Posted

Six until me is a cool blog by a cool person who you should check back with after today. She puts A LOT of effort into the site, and I'm definitely a reader,

Go see.

Saturday, April 25, 2009

Kennedy's Tumor SNL Weekend Update

All the Health News Fit to Stink:

Kennedy's Tumor (KT) Sorts the Trash:

This Week's Health Headlines:

Reuters: U.S. lawmakers eye Medicare in Health Reform Drive

Max Baucus :
"Everybody here wants to address quality and reimbursements based on quality," Baucus said.
KT: So let the guys from Harvard and Columbia charge more.

If you are interested in quality educate the people, give them choices, and let them choose with their pocketbooks

WebMD (shame on u guys): About 2% of U.S. Population Is Paralyzed, New Survey Shows

Look around you. Are 2 out of every 100 people in wheel chairs? No. Why are they trying to redefine paralysis? Think about what "paralyzed" means; now read what they say in this article:

The survey defines paralysis as having "difficulty or inability" in moving the upper and lower extremities because of a condition affecting the central nervous system

Difficulty or inability? Are they nuts--or eating walnuts?
Question: Why do they define this so narrowly?
Answer: To include more people in their statistics which enables them to apply for bigger grants from the government....to waste your money. Sinful stuff.

Walnuts may prevent breast cancer

Speaking of eating walnuts, THIS is from Britain...a social health care system. They don't want to do MRI's to find your breast cancer and they don't want to pay for monoclonal antibodies to treat it. What's easier? Chiropractic adjustment. Eating walnuts: OFF YOU GO THEN:

Mice fed the human equivalent of two ounces (56.7g) of walnuts per day developed fewer and smaller tumours.

So eat walnuts. Or be a mouse. Or live in the land of postmodern medicine.

USA TODAY: Study: Video-game-playing kids showing addiction symptoms

Nearly one in 10 children and teens who play video games show behavioral signs that may indicate addiction, a new study reports (the stoopid parts of this article are italicized by me).

OK they may show behavioral signs (a red octagon or a yellow triangle?) that may indicate addictive behavior -- I'll give you that totally vague and poorly defined slop of suppositions-- to this activity which is fun, exciting, improves motor skills and is infinitely better than sexting, sniffing glue or running with scissors.

What do video gamers need? Proper parents with proper supervision (oops)...not nannies and housekeepers. You need a good mom and dad who know how to balance things.

Breastfeeding Cuts Moms' Heart Risk

Breastfeeding cuts a woman's risk of heart disease and diabetes long after her infant has grown up, new data strongly suggest.

Soooo...what's the point? I mean, how important could this be

Why do they study this stuff?

The Obama administration is sharpening its scalpel, about to vivisect and put at risk the best health care system in history because it is too expensive to give away for free.

I have a better idea...why don't we just stop funding these studies? Why don't we establish a national board of research approval and evaluation. You get no money for feeding walnuts to rats and no money trying to further or establish a social agenda...like video games are bad or we need to have more people qualify as disabled...and every penny we save on these circuitous nonprogressive counterproductive pseudoscientific wankfests will go towards....health care! That would be radical, eh?

Thursday, April 16, 2009

If Texas Leaves the Union, I'm Following

Secede and Conquer

Texas Governor Rick Perry is saying he wants his state to secede from the Union.
I have personally filed for a license in Texas; and, God bless them, if they secede, I'm going to take my considerable talents there, with glee.

I hope they do it.

According to The Examiner:

Speaking at a Republican "tea party" event yesterday, Perry said Washington has abandoned the country's founding principles of limited government and is strangling Americans with taxation, spending and debt.


As America's leadership continues to punish the successful by taking more of their profits I firmly believe that eventually someone somewhere will open a tax-free zone for the smart and creative. The SAC (Smart and Creative) will then move to that area in order to do WHAT THEY DO without punitive taxation to support the listless and effete...and THAT'S WHERE I'M GOING.

I hope it's Texas, because that's so less far to travel then China.

Kournikova and the Moscow Tennis Clones

Here are 8 female tennis players -- all in the top 100 women (except for Anna at this moment) -- born in MOSCOW in the 1980's. Coincidence? Would you bet on the number "1" to come up on a thirteen million number roulette wheel 8 times in 10 years?

Oh....and you can only spin the thirteen million number wheel twice in any given year...

Also see:
Clone Wars: The Impossible Reality of Moscow's Female Russian TennisPlayers
Maria Shapapova, Anna Kournikova, and the Russian Tennis Cloning Scandal

Wednesday, April 15, 2009

Clone Wars: The Impossible Reality of Moscow's Female Russian Tennis Players

What are the Chances?

Over at the Women's Tennis Blog I found this feature that describes 17 all-Russian women tennis finals. The most recent of these match-ups was this past January, in Aukland where these two players met:
That's Elena Dementieva on the left and Elena Versina on the right. In the finals. Both were born...in Russia.

This Can Only Be Genetic Meddling
So who are these next two? Want to take a crack at it? Two more female Russian players in the top 100. Blond. Same ground stroke game. Right now, eleven women born in Moscow -- a city of 6 million -- are in the top 100 of the WTA tennis tour; and, twenty of the top 100 women come from a small geographic area including Moscow, all of which are former members of the USSR... And they are almost all blond, skinny, around the same age, and have identical ground strokes. Does that bother you? Why not? Is it a statistical possibility or probability?

What if there were 11 women born in New York City in the top 100? What if most of them looked alike? Would anyone say: "Whoa--that's not statistically possible?" Because it's not.
Approximately 1 in 13 million tennis players can expect to make the top 100 in professional tennis. So if there are 6 million people in Moscow and one out of fifty play tennis, you might expect less than 1/2 of one tennis player to make the top hundred in a generation. So are 11 possible? 11 blonds with the same game? No way.

Put it in Perspective

There has been no time in history when so many people from so constricted a geographic area have numbered so heavily in the top of their sport.

In all of women's professional sporting history, can you name two or three women from the same country who have achieved the top of their sport who look alike, have the same "game" and are around the same age? No. It is simply unprecedented.

Tennis is an international sport whose competitors come from everywhere; competition is year-round, and the chances of "making" it on the professional tour are infinitesimal. The Chinese, Japanese, Koreans, Europeans, Australians, and Americans produce tens of thousands of tennis pros every year all of whom receive the top training, instruction and support, yet only a very small percentage of whom make it to the top 100. So could 11 girls born in Moscow between 1981 and 1992 be in the top 11 just by good luck or even with superior training (most Russian girls train overseas anyway)? NO.

And don't forget who we are talking about--the former USSR. These are the same people who championed the secretive use of professionals when the Olympics were an amateur event; and the same people who created hoarse-voiced female champion weightlifters by pumping them full of steroids. Now they have messed with the genetics of these girls, because mathematically there is no explanation. It can't be nurture so it has to be nature.

Messing With the Eggs
These women are genetically similar. Either they've been cloned or are related to the same sperm donor or egg recipient...or whatever the explanation; it is not up to me to explain how they did it but there is no doubt that we are looking at DNA evidence of a deception...or a crime.

And just like in court, if the DNA evidence is positive (= overwhelming statistical evidence) then you are GUILTY AS CHARGED....unless you can tell us why not, convincingly.

So let's ask Russia for their rationale. Let's ask them a whattssup wit dat!

Because now that the Russians know the game, who knows where they will use the knowledge next; I assure you it will be something less benign than in professional tennis.

Also See:
Maria Shapapova, Anna Kournikova, and the Russian Tennis Cloning Scandal
Kournikova and the Moscow Tennis Clones

Thursday, April 9, 2009

Farrah Fawcett's Anal Cancer--Can You Prevent Yours?

Angel on the Rocks

This isn't a topic on the top of every one's blog list but WHY NOT? Cancer is cancer, whether it occurs in the jaw, breast, kidney, or anus. Former "Charlie's Angels" actress Farrah Fawcett, 62, is back in the hospital this week reportedly with metastases from her anal carcinoma, diagnosed in 2006.

Last September, P.J. O'Rourke was diagnosed with anal cancer. According to CNN:

"The numbers of anal cancer cases are rising, although experts haven't been able to pinpoint why."

ANAL CANCER--Time to Talk

OK, thankfully it's rare -- 1 in 100,000 people -- but with over 6 billion people in the world...do the math. It's significant, and growing in incidence, especially since the advent of the acceptance of anal sex--a fact that needs addressing.

According to statistics, the odds of anal cancer are 35 TIMES HIGHER in men who have sex with men (MSM). MSM is the current euphemism for anal sex, and I don't have any problem with the acronym, except it isn't just MSM but also WHASM (women who have anal sex with men) who need to be aware! BE AWARE that condoms are essential. So men or women who are having unprotected (or even protected) anal sex need to understand--you are at 35 times higher risk.

In addition, MSM who are HIV positive are twice as likely to get anal cancer than MSM who are HIV negative. Likewise then, WOMEN with HIV+ partners need to be EQUALLY VIGILANT.


Why is that?

The most common manifestation of this disease may very well be propagated by the Human Papilloma Virus. At least that is the leading theory. So just like women can get cervical cancer from HPV and we believe that uncircumcised men can get penile cancer from HPV; probably, both sexes can get anal cancer from HPV. Who gets HPV? Who gets these? Individuals with a history of multiple sexual partners, anal receptive (read anal) intercourse, and genital warts are at an increased risk for infection.

Genital warts are one of the few visible manifestations of HPV. Anal warts are, basically, a sexually transmitted disease, mostly transmitted through anal sex. I'm gonna show you a picture of them right now, so gird your loins:

These are anal warts. Bumpy, cauliflower-like appearance. Probably due to the association between HPV and anal cancer, women with history of cervical cancer are at increased risk of developing anal cancer. This is what you want to look for and act on. People with these are at an increased risk for cancer.

Take Home Lessons: Wear condoms. Avoid people with warts in the genital area. Avoid sex with HIV+ individuals unless you are REALLY well informed and quite well protected. And a far as I am concerned, you should get the HPV vaccine if you are in an at risk group.

At Risk:

1. Unprotected Sex

2. Anal sex -- protected or not, male or female

3. Male-female vaginal sex if the male is uncircumcised

4. Many sex partners over the course of a lifetime, vaginal or anal or oral sex

5. History of genital warts--exposed to genital warts

Why worry about many partners? Because HPV is transmitted with increasing likelihood with an increasing number of partners; in addition, the virus will often cause no symptoms. It's frequently silent, and you'll never know you got it. As for women, given the frequency of cervical cancer and the implication of HPV in the origin of that disease, unless you intend to have very few partners --get the vaccine.

And let's not forget the legend as she was:

Tuesday, April 7, 2009

Mammography Faces A New Foe: NNT

This Door is Closed
DATA IDENTIFICATION AND ANALYSIS: Literature search of English-language studies reported from January 1966 to October 31, 1993, using MEDLINE, manual literature review, and consultation with experts. A total of 13 studies were selected, and their results were combined using meta-analytic techniques based on the assumption of fixed effects

CONCLUSION: "Screening mammography significantly reduces breast cancer mortality in women aged 50 to 74 years after 7 to 9 years of follow-up"
--JAMA Vol. 273 No. 2, January 11, 1995

The efficacy of screening mammography in reducing breast cancer mortality is not really any longer statistically debatable; unless you have a new meta-analysis or multi-center trial with tens of thousands of patients to refute what has been a done deal for quite a while. So why would Kevin, M.D., a notable and widely-read blogger title a post: "How Much Do We Really Need Mammograms." And why would he attempt to validate this proposition by adducing the "Number to Treat" statistical evaluation, saying that NNT is "a statistic that is gaining increasing relevance in mainstream health reporting." ?? Sheesh.

Market Tops
A wizened investor analyst once told me that at market tops, when people no longer have a rationale for explaining the market distortions that lead to overvalued assets, they invent new definitions for value. So when Internet stocks rose to the heavens on vapor profits, analysts began to tout the theory that the standard of value measurement, the price to earnings ratio , was no longer valid. Instead we would look at a new valuation method: price to sales ratio. Of course, sales were an estimate (as opposed to earnings); and, when sales failed to materialize as predicted by overzealous and greedy stock analysts (duh), millions of people lost billions of dollars as the Internet stock bubble exploded.

Lets not even talk about real estate.

Measuring Out Your Life

The Number Needed to Treat is the "price to sales" ratio of this debate. It's how we are going to redefine your life in the era of nationalized health care and how the coming regime intends to measure out your care with coffee spoons. According to Wikipedia, the NNT:

... is an epidemiological measure used in assessing the effectiveness of a health-care intervention... The NNT is the number of patients who need to be treated in order to prevent one additional bad outcome (i.e. to reduce the expected number of cases of a defined endpoint by one).

The importance of "the number of patients who need to be treated" translates to COST. This is what all you Obamaphiles should get through your heads. We intend to make the measure of health care what it costs to get it done, not how many fewer people die. What does it COST to save a life? It is not a measure that is used in our courts where the Tort system projects the value of life into millions; obviously. See my previous post here.

So, theoretically, even if screening mammography reduces deaths from breast cancer, if you have to do too many mammograms to prevent one death, then...it isn't worth it to the system

Who is the system? Whoever pays the bills.

Who make s the rules? Whoever pays the bills.

Who's paying the bills in the future of your heath care? The government.

So, if they want to question the value of mammography not in relation to death reduction but rather on how much it costs to actuate as compared to the eventual cost to the system...as Arnold Swartzeneger says in almost every movie he makes: "GET DOWN!"

Maria Shapapova, Anna Kournikova, and the Russian Tennis Cloning Scandal

The Girls From Russia

This past weekend, in Key Biscayne Florida, another young tall, blond, pig-tailed Russian girl with devastating ground strokes won a major tennis tournament.

Was it Anna Kournikova? No. Maria Sharapova? No. Elena Dementyava? No. Vera Zvonareva? Daniela Hantuchova? Dinara Safina? Nadia Petrova? Anastasia Pavlyuchenkova? Maria Kirilenko? Dominika Cibulkova? Anna Chakvetadze?? No, no, no, no, no, NO!

Those would all be good guesses, though, because those are all top female tennis players with remarkably similar appearances and games. And they are all Russian, or very close to it. It was none of these top players. It was yet another eerily similar female seemingly popped out of a mold: Victoria Azarenko:

Just the Facts, Ma'am
What is going on here? Has not anyone stopped to take note that an impossibly large number of young, blond Russian teenagers are now within the top 100 female tennis player? And they are, for the most part, tall, skinny and sport pulverizing forehands -- all manufactured with a severe Western forehand grip--and two-handed backhands that rip through the court like steam through a samovar...

Has anyone not said: "What are the chances?" No? Well let me ask you this: can you think of any 3 female tennis players in the history of United States tennis that were look alikes? Tracy Austin, Pam Shriver, Chris Everet, Mary Carillo, Lindsay Davenport, Mary Joe Fernandez...? No. Not even close. Even the Williams sisters -- who are indeed sisters -- look less alike than say, Maria Sharapova and Viktoria Azarenko; or Hantuchova and Cibulkova:

Say It IS So
It really cannot be. It really is impossible. There is simply no way, statistically, that so many similar appearing women with nearly identical tennis games could all come from Russia, or very close to Russia--basically all from that part of THE FORMER USSR

Remember the USSR? Remember them? The original sports cheaters. The first country to use professional athletes disguised as amateurs. The first country to use performance-enhancing drugs on their athletes--the ones who must have put together the genetic material for this cloning experiment in the 1980's!

Here are the Russians in the TOP 100 with their birthplaces and dates:

Sharapova former #1--: Nyagan, Siberia, Russia 1987
Dinara Safina #2--Moscow Russia 1986
Elena Dementiava #4 --Moscow Russia 1981
Svetlana Kuznetsova #8-- St. Petersburg, Russia 1985
Nadia Petrova #9--Moscow 1982
Victoria Azaranka #10--Minsk, Belarus 1989
Dominika Cibulkova #16-- Bratislava, Slovak 1989
Alisa Kleybanova #17 -- Moscow, Russia, 1989
Anna Chakvetadze #23-- Moscow, Russia. 1987
Anastasia Pavlyuchenkova #27--Samara Russia 1991
Alona Bondarenko #38 --Krivyi Rig (Ukraine),1984
Maria Kirilenko #39-- Moscow Russia 1987
Maria Daniela Hantuchova #43 --Poprad, Slovakia 1983

And don't forget the queen bee. The original. The model from whom the others seem to have begotten:

It all started with Anna Kournikova, born in 1981; where else? Moscow Russia.


Also See:
Clone Wars: The Impossible Reality of Moscow's Female Russian Tennis Players
Kournikova and the Moscow Tennis Clones

Saturday, April 4, 2009

British Still Resist Screening Mammography--Why?

The Empire Strikes Back
The British always want to do less than the Americans (just ask Barak Obama), especially as regards breast cancer screening. Once again I picked up the the New York Times to read another article in which the Brits question the value of mammography. I guess since they lost the statistical and factual debate that mammography actually does save lives (which they resisted for years), they will now draw their limp straws and swing away with anecdote and opinion. The American press continues to support these ruminations as if they have validity which seems odd, doesn't it?

The Hundred Years War
In case you don't know, this argument used to go on constantly. The British have been kicking and screaming and resisting mammography for the better part of thirty years. As late as the 1990's their mammographic screening policy was: one view of each breast every three years! When the data finally settled the case that mammography saves lives they begrudgingly capitulated and now recommend two views of the breast every two-three years. But they still resist. You have to ask your self: Why?

The title of the most recent handmaid tale from Britain in the NYT: Benefits of Mammogram Under Debate in Britain. I'm won't bore you with all the details, but you can trust me on this summation of today's controversy: A woman (let's call her Anecdotal Lady Agatha) underwent a screening mammogram which was positive for cancer.

"She had a lumpectomy but was offered such a confusing array of treatment options that she realized doctors knew little about how aggressively to treat this kind of cancer."

This woman turned out to have a low-grade tumnor (DCIS -- which is not always low-grade)and basically, hers and the the British complaint is that we (Americans) find too many women with breast cancer and some of these women (they admit there is no way to tell which ones before a biopsy) do not need full-on breast cancer therapy, and it is difficult to know how aggressively to treat this particular subset of breast cancer. The British solution? Don't look so hard, and you won't find so many low-grade cancers (nor high-grade cancers I might add).

To ameliorate this "problem" a British mammogram expert,Dr. Peter C. Gotzsche,rewrote a "letter" provided to British women regarding mammography screening:

“It may be reasonable to attend breast cancer screening with mammography, but it may also be reasonable not to attend.”

The Objective of Mammography
The British doctors worry about too many biopsies which result in extra cost, stress to the women, and extra radiation during repeat mammographic imaging. Don't they sound like nannies?

What about cancer? They don't mention that.

The object of mammography is to find cancer. That's the prime directive: FIND CANCER. If a mammogram finds a cancer, it's done its job. If the surgeons and pathologists and oncologists have yet to sort out which cancers need treating, that's just the state of their art; however, to look less hard for cancer clearly in inimical to what we, in the U.S. want. We want to find all the cancer possible -- and if you don't believe me consult the Tort system which has the accuracy rates sighted on infinity. Or ask any breast cancer advocate.

Socialist Mind Set
In the British health care system, the individual is less well regarded than the group, which is the state. This is the system we are moving toward. It therefore makes sense that the British want to do less when doing more is costly. In the United States our health care system has always done everything it can all the time despite the cost. It's a mindset.

Are we ready to change mindsets? Are we ready to understand that you can't try to save everyone all the time? That it may not be worthwhile to save one person if the cost incurred is deemed to be asymmetrical to the system?

And if we are, then are we ready to abandon the Tort system that penalizes the failures to each individual--because some individuals are going to the graveyard (or worse)-- because the system cannot afford to respond individually.

One thing the reformers of our health care system are not accounting for is the American mind set. If people wake up and understand that "health care reform" means the government has to make funding choices that pit the individual against society, then maybe even all the false hue of crisis will not cover the fundamental changes being proposed out of Washington in the name of hope.

Thursday, April 2, 2009

Keeping Smokers Alive to Take Care of Children

Night of the Living Smoker

The government has finally declared its intentions to the cigarette smoker: KEEP SMOKING BRO!

BHO just engineered an increase in the federal excise tax on cigarettes so that yesterday, the tax on every pack jumped from 39 cents to $1.01!

This represents the largest federal tobacco tax increase ever. In some cases, smokers will be coughing up $9-$10 for a pack...

For years health officials have claimed they hope that tax-price increases will motivate smokers to quit, and perhaps at one time that sentiment was real. But now the government--like the desperate smoker-- is also addicted, but addicted to cigarette tax money, which nowadays is viewed as a way to raise funds for federal programs.

Who What When...Teddy Kennedy

In 1997 Teddy Kennedy sponsored an expansion of Medicaid (SCHIP) in order to provide insurance for families that were not poor enough to qualify for Medicaid. An expensive proposition. This February, one of BHO's first acts as president was to expand this program (stimulus shmimulus) to include millions more people, even those who are not traditional families, including immigrants.

When pressed for a funding solution to support this new expansion of the government program, BHO and someone really clever (maybe Robert Reich?) came up with the idea that they could add another tax on cigarettes (who can argue against that?) and use that money to fund SCHIP. So now cigarette smokers are taking care of kids, at the cost of their lives.

The federal government has come to rely on cigarette taxes -- as states rely on lottery income-- to fund their social programs, so if people stop smoking...that would be bad. This approach is obviously contradictory. If the government discourages tobacco use with taxes then people will stop smoking. However, if the government uses the tax money to fund its pet projects then if people stop smoking, pet projects will suffer.

Looking for Volunteers

One could foresee a day when people quitting smoking may seriously jeopardize something important, like climate change research or digital TV converter coupons, and this administration in its inestimable cleverness would be looking for new solutions. For change.

One idea is to have young people, when they turn 21, to volunteer as smokers for 1-3 years. This would be seen as public service, a Marlboro AmeriCorps.

Or maybe the government could keep people alive, on smoking farms--which could be erected adjacent to windmill farms-- and let their breathless bodies shift from foot to foot in search of oxygen, but addicted to cigarettes while BHO funds his support of future smokers by maintaining their health as children.

Sounds good to me.

Why Worry About Pistachio Recall When Poison Fish Can Ruin Your Sex Life?

Ugly Fish, Painful Sex and a Bad Bug

Possibly, two people are sick from contaminated pistachios. Nonetheless, the whole country is on red alert with grocers busy pulling bags of nuts off shelves while housewives search their cupboards for the wandering lost shell...

Meantime, an actual threat with an ugly mug is swimming offshore in your local subtropical coral reef zone. There he is, on your left. The amberjack: a rough and tumble little guy hanging with his posse -- groupers, red snappers, eel, sea bass, barracuda, and Spanish mackerel -- who together sicken as many as 50,000 people every year. Take that pistachios!

Loves Labor Lost

In a new report, public health investigators describe a cluster of cases of painful intercourse associated with eating one of these fish. You heard me right. It makes one wonder what questions our public health professionals are asking their subjects during investigations...but as it turns out these fish ingest algae contaminated with a bad bug, a protozoan -- dinoflagellida to be exact -- from the class PHYTOMASTIGOPHORA.

The bugs make a poison, ciguatera, which, when ingested, can cause some pretty weird and alarming symptoms like:

Paradoxical temperature reversal (cold objects feel hot and hot objects feel cold)
A feeling of loose teeth
Painful intercourse (for both the man and the woman)
Ataxia, vertigo
Respiratory paralysis

In the group reported with painful intercourse the men had painful ejaculations and the women complained of burning, and some of these problems persisted for a month.

Fish Rabies

Since fresh fish--like the baracuda you see here-- gets flown all around the world nowadays, don't think for one minute that you are safe from ciguartera poisoning by living in Iowa or Uzbekistan. This illness strikes everywhere. And ciguatera poisoning is the most common nonbacterial, fish-borne poisoning in the United States.

So how will you know if you've been poisoned?

First, you will have eaten fish. Maybe a fish sandwich or the daily special which was grouper provencale...Well, after about 6 hours your mouth and lips will feel numb and you'll start to vomit and get a bad case of the runs. Then your hands and feet will start to tingle...makes you wonder how anyone actually got to the point where they might experienced painful sex, doesn't it?

The room starts to spin right before you begin panting to catch each breath. You feel exhausted, yet your heart is beating faster and has a jumpy feeling.

That's when you go to grab the ice-cold can of Coke...AND IT'S BURNING HOT!

That's the classic finding: temperature reversal. If this happens to you send yourself straight to the local ER and demand several hours of a Mannitol infusion -- an IV with heavy molecules in it which serves to "flush" out the toxin. This seems to reverse the neurological problems and from that point on have your doctor treat you symptomatically.

Don't Be a Hog (Snapper)

If you want to avoid ciguatera, make sure you identify any fish you eat anywhere. No mystery fish allowed. Next, if the fish is from a tropical or subtropical zone, ask how big it was. Really. Because the chances of a fish accumulating significant ciguatera poison are proportional to its size and if the fish was greater than 2 kg--have the lasagna.

Now can anyone remember why the hell we are rushing to throw away 700 thousand tons of pistachios? The only painful intercourse resulting from eating nuts is when you accidentally roll over the shells.