Monday, December 31, 2007

Joseph Cornell vs. Mr. Wilson

So continues documentation of my eclectic vacation...

Today I finished reading a most intriguing book: Mr. Wilson's Cabinet of Wonder. This fantastic non-fiction narrative is a pseudo-biographical account of David Wilson and his Museum of Jurassic Technology written by Lawrence Weschler. It is an excellent window into the subculture of museum quality pseudo-science similar to the kind forwarded by the Athanasius Kircher Society.

The other thing I accomplished today was a visit to the San Francisco Museum of Modern Art. There I made a beeline for the Joseph Cornell exhibit (in the last stop of a traveling exhibition). In many ways, he is the chief influence for my Wunderkammern creations (albeit via David Francis). I spent about 2 hours in the 1000 square foot exhibit, and was thoroughly impressed. This show only lasts until January 6 and SFMOMA is the last stop.

In summary, my New Year's Eve can be summarized as Joseph Cornell vs. Mr. Wilson. To those of you familiar with this art and work (or with the interest in following up on them): which do you prefer?

Sunday, December 30, 2007

Christmas Lights

Do you live in the Bay Area? Have you not yet had your fill of Christmas Lights?  Do you have a tank full of $3.50-a-gallon 87 octane anxious to be incinerated?  If your answer to these questions is yes, consider driving to 2724 Ascot Drive; San Ramon, CA.  This writer (known to some in my family as "Mr. Cynical Christmas") drove there twice.  Add hypocritical to that moniker.  Anyway, once you are there, tune in to 100.7 FM.  If you want to surprise yourself, read no further.  If you are actually thinking of going, don't worry - it's much cooler in person!  If you only want to take a virtual trip to this fantastic display, please enjoy the following videos from YouTube.

First, you will need to check your processor speed.


Act One: 34th Street Overture


Act Two: Carol of the Bells

Act Three: Illuminations


If you want to do something like this using a commercially available controller unit, look no further than the Light-O-Rama.  And since you will be able to afford the extravagance of the several thousand dollar computer, the lights and the energy bill, consider offsetting some of your carbon.  Two companies that will take you money to invest in methane and wind projects are terrapass and NativeEnergy.   I have a gut feeling that planting trees is a better idea; the Carbon Trust devotes much of its donations to tree planting and conservation (and it's a non-profit).  Check out this Grist post for more of the gory details of carbon trading.

In the end, I was just as happy with a failed attempt to find the two western screech owls hooting in the trees above my parents' house.  In the process, I only scared one of their neighbors. 

I hope this post was random enough for you.  

Goodnight.

Thursday, December 27, 2007

Book Review: Saturday

Today I read an excellent novel and feel like transcribing a response before I retire for the night. This is a mini-review that includes two quotations and a few comments. My intent is to reveal only whether this would appeal to you: a prospective reader. Attention to the diverse tags at the footer of this piece should clue you to this story's complexity.

The review and summary of Ian McEwan's Saturday you'll find at your favorite online bookseller calls this book "post-911 fiction." While I am uneasy about this label, I suppose it is appropriate. The story wraps itself around the events undertaken by one man in a single day in London. The man happens to be a neurosurgeon and the day happens to be Saturday, February 15, 2003 - the day 2 million Brits marched in Hyde Park against the impending Iraq war.

The protagonist - Henry Perowne - continually analyzes his own emotions and his own perspectives. Reflective and introspective are not common descriptors of neurosurgeons. They have a reputation (an unfair caricature, to be sure) as cocky brutes who see the entire hospital as an enterprise to support their masterful handiwork. I suspended belief for this element of plot, but needed not forgive other shortcomings. McEwan accurately (by this med student's appraisal) incorporated both the complexities of numerous neurosurgeries and the uncertainties of neurodegenerative disease.

The contemplative neurosurgeon is hardly unbelievable. His two children are artists: his son a blues musician; his daughter a poet. His pensive musings frequent upon his inability to understand them. By the time I reached this passage on page 54, I had committed to finishing the novel today.
Once, on a walk by a river - Eskdale in low reddish sunlight, with a dusting of snow - his daughter quoted to him an opening verse by her favourite poet. Apparently not many young women loved Philip Larkin the way she did. "If I were called in / To construct a religion / I should make use of water." She said she liked that laconic "called in" - as if he would be, as if anyone ever is. They stopped to drink coffee from a flask, and Perowne, tracing a line of lichen with a finger, said that if he ever got the call, he'd make use of evolution. What better creation myth? An unimaginable sweep of time, numberless generati0ns spawning by infintesimal steps complex living beauty out of inert matter, driven on by the blind furies of random mutation, natural selection and environmental change, with the tragedy of forms continually dying, and lately the wonder of minds emerging with them morality, love, art, cities - and the unprecedented bonus of this story happening to be demonstrably true.
This prose is just my style, the modernist presentation suits my taste in literature and the subject matter is not too far from my everyday life to disorient me on this simple restful vacation I find myself on. A lot of other people said good things about this book, so now I've put my hat into the mix.

I leave you now with verse selected from the climax of the story:
Ah, love, let us be true
To one another! for the world, which seems
To lie before us like a land of dreams,
So various, so beautiful, so new,
Hath really neither joy, nor love, nor light,
Nor certitude, nor peace, nor help for pain;
And we are here as on a darkling plain
Swept with confused alarms of struggle and flight,
Where ignorant armies clash by night.
Bonus points will be awarded to my readers who recall the author of these words.

Monday, December 24, 2007

Mele Kalikimaka

Merry Christmas from the windward side of Oahu!

I am taking some much needed rest from the toils related to finishing graduate school and transitioning into medical school. My comments and entries (if you haven't already noticed) will come a little more slowly in favor of boogie boarding and sunrises on the beach.

By the way, I highly recommend having in-laws that live in Hawaii.

Thursday, December 20, 2007

End of Days

Okay, so final day (as in day of the final) doesn't exactly count as 'end of days.' None-the-less, it is nice to be almost finished for the year. In about 15 minutes I log on to a web exam for my family medicine clerkship. All over the Pacific Northwest, nervous little medical students (or big ones) will be holed up for three hours in some corner of a hospital or doctor's office answering questions about blood pressure, diabetes, earaches and depression.

At least this exam is a pass-fail test. You have to pass the first time to get 'honors,' but as I understand it, the score is not fed into an algorithm. This is good for me, because as I get older, I do less and less well on standardized exams... More on that later. I have to go complete an academic integrity statement!

Sunday, December 16, 2007

Movie Review: I am Legend

I'm no film connoisseur, but I am a scientist and physician. Well, almost a physician. So it is from a biomedical perspective that I present my review of I am Legend, starring Will Smith. This is the first film I have seen on opening weekend in as long as I can remember, and the first I've seen in a theater since Arctic Tale. This article won't be a true spoiler, but I will address several critical plot elements. Stop reading if you don't want to ruin the surprises. First, it was nice to see the movie without knowing any of the story. (Will Smith got me in the theater.) Other reviews point out Smith's excellent acting, the weak CGI monsters and how much the story strays from the original novel by Richard Matheson. And Popular Mechanics assesses the verity of the 'junk science' built into the plot. I take a broader view. In sum, I was pleasantly surprised that not only was science important to this film, but it was the co-star. Enough with the preamble! Here's the review:

How many times have you seen a cocky scientist on TV extolling the unlimited cures science has to offer society? If you lived in California a few years ago, you probably met professor Irv Weissman and others promising that stem cells will cure diseases. (They were actually just hinting at it, but does that really matter now that CA is well on its way to funding $3 billion of stem cell science?) I am Legend opens with a smug blond scientist admitting on local TV that yes, she has cured cancer. Note #1: Scientists, if you want to get visibility for science, you need to get on the local news! Evidently, this scientist has built a virus that prevents either tumorgenesis or malignancy. Fortunately, the film did not get into that detail, because I would have something significant to critique! What is notable is that the plot plays on the public's lingering fear of gene therapy. And of course, the worst nightmare comes true. The virus mutates into a lethal strain that results in symptoms part rabies, part ebola, part bird flu. The virus first requires physical contact for transmission, but soon aerosolizes and crosses species boundaries. I am skeptical that viral evolution could actually occur as quickly as in the film, but perhaps such a trait is what enabled one virus to cure every type of cancer in the first place.

Speaking of curing cancer, our mad scientist (who had a vaguely European accent), indicated that of 10,009 clinical trials, 10,009 people were cancer free. This is likely a consistency flaw instigated by the script writers, since later, Will Smith's character tests his "compound 6" and calls one experiment a clinical trial. Note #2: A clinical trial includes hundreds, if not thousands of patients. This was a little mistake, but could misrepresent the process of evaluating safety and efficacy to the millions of people in the theater this weekend. By the way, this flaw was my infectious disease researcher wife's biggest beef with the film.

Speaking of infectious disease, we need to talk about immunity. If 1% or the world's population was immune to the film's virus, Manhattan should have been left with 15,000 people. It took 70 minutes or so for an explanation of why Will Smith's character was the only human remaining. It turns out that 30% of those who survived turned into zombies. These (poorly animated) zombies ended up killing the rest of the people. How likely is it that a virus could cause a devolution (or evolution) of humans into zombies? Greg Bear offers a pretty believable mechanism in Darwin's Radio. If this little viral beastie was a certain type of retrovirus, aggressive zombies could be the next step in evolution, and this could even occur in one generation. I am guessing that this is the part of the film that the audience is supposed to suspend its belief about...

What about the basement laboratory? Smith's character used a fancy eyeglass-mounted video camera to record his experiments on various compounds to reverse the virus's symptoms in sewer rats. The writers got some things right here. Only "compound #6" worked; this was one of twenty he tried in this series, in what we assume was a long string of trials. This brings us to Note #3: Only a small fraction of science experiments 'work.' Of note is that only one rat was tested with #6 before moving to human trials! I guess this paucity of pre-clinical data can be excused when civilization is at stake. While we are on the topic of animal experiments, the presentation of animal research in this film was well done. The rabid rats were clearly animated, so no beef could be made about living conditions for real rats (and the fact that they were injuring themselves on the cages). The cages, by the way, were appropriate for animal size and were not overcrowded. Smith's character didn't need to get IACUC approval for his work, but he was mostly in compliance for many rules about animal care. Some notable lapses: no dedicated facility, interventions that were terminal, minimal personal protective equipment.

The treatment of the bench science was appropriate. There were no unneeded CSI-styled eye-candy closeups of pipetting or tube shaking. (You know the shot: when one of the attractive lab techs flicks an Eppendorf tube up in front of his/her face instead of using the vortexer.) This workshop looked like a well stocked lab crossed with an intensive care unit. There were QPCR machines, vital signs monitors (just like those at the UW hospital!), and med supply carts along with an appropriate amount of clutter. Conveniently for the plot, there were also bullet-proof glass doors. Except for the dim lighting, this looked like a great place to do science.

In my opinion, the ethical land mine in this film was not the fact that some crazy scientist unleashed a deadly virus - that occurred off screen. I worried about the ethical use of human subjects. Smith's character has a wall packed with photos of zombies that he unsuccessfully cured of their zombieism. The viewer is asked to overlook the fact that these zombies have the potential to be fully human. At one point in the film, Smith's character reports that these creatures have lost all semblance of human nature. This is a fine trick to make it okay for experimenting on them. (That is how some scientists justify animal research.) However, the observant audience member will note that the zombies have clear emotional responses to stimuli, exhibit abstract planning and operate in a social manner. One (the chief zombie) even seems to show an attachment to the zombie subject Smith's character is trying to cure. Note #4: If a cure occurs only after sacrificing hundreds of zombie-humans, is the research ethical? Is exterminating the zombie way of life genocide?

Finally, over the course of the film, the protagonist shifts from a Christian to an atheist to an agnostic. First, he prays with his family before all Hell breaks loose. Later, he reasons that God would never permit such a catastrophe, therefore does not exist. The final resolution depends on a near-death and perhaps spiritual experience in which Smith's character adopts a perspective that things 'happen for a reason.' I did not appreciate (nor would my atheist readers) how his suicidal ideation occurred in the post-religion period, while the noble savior surfaced after reconsidering a religious perspective. Apart from that flaw, I was pleased that this portrayal of a scientist encompassed religious, agnostic and atheist perspectives, therefore illuminating Note #5: Science can be done by individuals from diverse belief spectra.

In the end, my wife and I agreed that this was an entertaining movie and worth the $8 after a day of studying. The plot was creative enough to get me thinking about some interesting research ethics and science in society issues. Hopefully it got some others thinking as well.

Wednesday, December 12, 2007

A Very Test Tube Christmas

Seattle's Colors have transformed into something a little more festive than their previous incarnation. This is a living installation, in that each tube may be cleaned and refilled with specimens found near my home. These items were all collected from Magnuson Park on a Saturday stroll with my wife. 'Tis the season for red and white berries. The previous incarnation grew a variety of mold in the months between Seattle Colors V1 and V2, further emphasizing the living nature of this piece.

Here are the same berries - red, orange, yellow, green, blue, and violet - after growing mold and being submerged in dilute bleach. I wonder what the next phase of Seattle's Colors will be? If you have any ideas for me, here's a fun craft: Download the image below, color it in and emailit to me. (Or just post a comment below.)

Merry Christmas! And please don't go out and buy stuff just for the sake of it. Consider crafting something personal, giving a gift of an experience or assembling a creative alternative to a store-bought item.

Monday, December 10, 2007

So Blue

(or why I'm a Democrat)
The world is globalizing, nuclear weapons are proliferating, the Middle East is seething, but Republicans are still arguing the Scopes trial.
-Maureen Dowd

Sunday, December 09, 2007

Keeping Track

What a Day. Today in the ER, I diagnosed the following:
  • New onset temporomandibular joint (TMJ) syndrome in a 29 year old woman.
  • Phimosis and otitis externa in a 10 month old boy.
  • Hip bursitis in a 72 year old man.
I participated in the care of:
  • Man vs. table saw: the loser was a finger (unless the hand surgeons at Harborview can work a miracle).
  • A young man with periodic familial hypokalemic paralysis.
  • 51 year old man with suicide ideation and a plan. (See photo below.)
The currents are deadly enough without having to deal with the impact. I have first hand experience (with the current, not the impact). Let me tell you: going through at slack tide is a much better idea than trying any other time. The current gets up to 8+ knots at flood and ebb. My wife once diagnosed me with suicidal ideation for trying to take this tidal rapid in my now deceased aluminum Grumman canoe.

We admitted the the man with severe depression. Things are looking good for him. I am glad he came in today and decided to stay; he's also been an excellent teacher so far.

Friday, December 07, 2007

R(eee)view

It's been a month since I first unpacked my ASUS Eee laptop computer, and folks are clamoring for my review. I did promise you a breakdown of my experiences.

If you are thinking of buying an Eee, I would recommend NewEgg.com. They now have several models in addition to the white 4G model I purchased. Either they or UPS screwed up my shipping, but they were quick to admit their error and refunded my shipping costs. Here's me on the airplane last month writing my epic entry about evolution and creationism in Kentucky.


I'll spare you (and me) the specifications. If you are serious about buying one, you probably already know these details. I'm not in the business of sales.

  • Size Matters: I love that it is less than 2 pounds! It can go anywhere. The keyboard is small, but my size 9 1/2 hands do just fine. I do have trouble using the touchpad, so I bought a mini-USB mouse with a retractable cord (no RF devices on airplanes) that does the trick.

  • Battery Life: Don't expect the batt to last more than your other laptop. The longest I had it run was 4 hours, but the wireless card was disabled. The mini-mouse drains the power faster, too. On average, I'd say the battery lasts 3 hours between charges.

  • Screen: For espn.com, the narrow screen makes navigation tough. But for authoring and reading blogs, word processing, and general web use, it's just fine.

  • Start-Up: It's more like 25 seconds to start. And if you connect to wireless networks, it will be about 90 seconds.

  • Connectivity: I've had some frustration with connecting to my current wireless network, but have had trouble with my PC on the same network. I use the hardwire cord to avoid that problem. I've been able to connect to every (other) wireless access point I've encountered in the hospital, the local library and the pub.

  • Social Aspects: I get soooo many comments about how cute my computer is. The Eee has serious potential as a nerd/chick magnet. Seriously. No, really. I mean, I don't (ab)use the Eee that way, but maybe you could...

  • Disk Space: It's pretty amazing to use a compy that has the operating system, all the needed programs and space for your files in 4 GB. I keep everything on an 8 GB thumb anyway, and have interfaced with my 1 TB mother drive. Anything I do on this little guy is small potatoes anyway.

  • Operating System: I can hardly tell it's LINUX. Except that it's faster, doesn't have stupid update messages and has yet to crash. There are some things I wish I could customize, but I am a little afraid of that. Now that medicine is beating the engineer out of me.

  • Name: Eee is hard to explain to people. The name is pretty lame.

  • Role: For my life, this little machine can do almost everything I need in a computer. Honestly, this is not much. I have yet to try and print from it (no printer at my current residence). When my HP PC crashes for good, I will probably buy a desktop and use the Eee as my mobile terminal. Whether that terminal runs LINUX or not, I am not sure. I guess it depends how much of a geek I will need to be to install & maintain it. Because I am getting less geeky by the month.

  • Applications: All OpenOffice applications are installed along with other programs like LTris, pdf Reader, Firefox and a sundry of others I haven't yet used.

Here I am a month later. These pics were taken using the built in webcam. (The direct connect via Skype might come in handy sometime.) For now, it simply offers evidence that I really like this hoody sweater. FYI, the words out of frame say "the unthinkable."

FAMILY Medicine

This is family medicine:

In the ER on Monday night, I injected a steroid/marcaine cocktail into a man's biceps tendon and referred him to an orthopedic surgeon. On Thursday, I saw his wife to renew her Vicodin prescriptions for rheumatoid arthritis. This afternoon, we deliver their 4th grandchild by C-section.

Thursday, December 06, 2007

Socialized Mormons

So, Mitt Romney's a Mormon... This we knew. And he “will serve no one religion, no one group, no one cause, and no one interest. A president must serve only the common cause of the people of the United States.” Okay... That's inclusive (patronizing?) enough for me. And he does "not insist on a single strain of religion—rather, he welcomes our nation’s symphony of faith." Wait a minute... does this assume that all have faith? What about my atheist friends and colleagues? Will they have chairs in Mitt Romney's orchestra?

In the end, I think it is really too bad that Romney is not interested in being a spokesman for his faith. After all, the current President of the Mormon Church, Gordon B. Hinckley "hates war with all its mocking panoply... War is Earth’s greatest cause of human misery. It is the destroyer of life, the promoter of hate, the waster of treasure. It is man’s costliest folly, his most tragic misadventure.” The candidate willing to say this whose name is not Ron Paul, will get my vote. Even if he's from Ohio.
A look at Mitt Romney’s vision for America’s foreign policy reveals little, however, that resembles any of these most basic and central Mormon values. In contrast to Gordon Hinckley’s hatred of war, Romney’s central foreign policy concern, in fact, is a deepening of American militarism and war making. Specifically, Romney advocates drastically increasing American military expenditures, escalating the Iraq war, continuing operations against transnational Islamic militant groups, and preparing for a military assault on Iran.
That's the analysis offered by a little publication a friend recently alerted me of called The Mormon Worker. This was penned a few months ago; perhaps Romney will soon change his mind about Iran.

The Mormon Worker is a strange collection of ideas conflating anarchism, Mormonism, and socialism that highlights some central disparities between the teachings of Mormonism and the way most Mormons vote. Many of the arguments are the same made by Dorothy Day and the Catholic Worker movement. See also the Christians who in the voting booth or policy forum seem to always forget the teachings from the Sermon on the Mount.

Due to the agreements forged by church fathers and the state in the wake of the controversies surrounding polygamy,
Mormons find themselves supporting capitalism and government, and therefore exploitation, imperialism, jingoism, and militarism, considering these things inherent to their religion, despite the many resources within Mormon scripture advocating the contrary. One significant reason Mormons should seek to abolish government and capitalism is the fact that States continually wage war in foreign lands for the sake of economic gain.
To William Van Wagenen (the man behind the Worker) and the other Mormon workers (I wonder if all Mormon workers are stock brokers like Van Wagenan...) out there, I tip my hat. I challenge you to vote your conscience in 2008, even if there's no chance of Utah being a blue state.

Sunday, December 02, 2007

Peds Grand Rounds is Coming to Town

This edition (Volume 2, Edition 12) of Pediatric Grand Rounds is presented in the context of that familiar ode to the jolly fat man. Some readers may bristle at the extent to which I conformed to the hegemony that Christmas has over the month of December, but the truth is that kids love Christmas. What I didn’t realize before compiling these entries is the extent that Santa Claus prescribes prevention in this instructive carol.

Before we strike up the band, Pediatrics Grand Rounds needs a new home. Clark Bartram did a great job initiating the tradition of collecting interesting pediatrics articles, but PGR is now in search of a new administrator. Please consider whether you could host or coordinate future editions. If you are interested, please comment on this post or send an email to Clark or me. Do the same if you would like to host January’s issue. With thanks to Thomas Nast and without further ado...


You better watch out for the greatest threat to kids’ health. Steven Parker brings home a topic that is close to my heart and flies under the radar too often in this country.

You better not cry, or is it actually okay to cry sometimes? Kristen Heinan at The Differential offers a connection between the difficult experiences in the PICU and the world outside.

You better not pout, I'm telling you why: the person responsible for your care, protection and nutrition might forsake you.

Santa Claus is coming to town and he’s bringing a new puppy. Curious about whether new puppies and new babies combine to produce pediatric allergies? Med Journal Watch digests the answer for you...

He's making a list of effective parenting techniques; or at least Dave Munger and his readers at Cognitive Daily are. Scientific studies of parenting are common, but studies linking parenting to morality are scarce. That’s why you should check this post out.

Checking it twice, just like you need to do with those pediatric liquid medicines. Mexico Medical Student helps you out with the not-so-simple math.

Gonna find out who's naughty - I bet you thought internet trolls were just bad for your blog. Sandy at Junkfood Science explains how trolls can turn into killers.

or nice
. The Thinking Mother knows who is naughty and nice at home and in the classroom. She also offers ideas about how to facilitate more nice behavior.

Santa Claus is coming to town, and he’s got great gifts for kids of all ages. And Dr. Gwenn compiled them all into this handy compendium for your holiday shopping.

He knows you when you are sleeping, and Michael Breus thinks we all should be paying more attention to how much our teenagers sleep.

He knows when you're awake, and if you’re in between being awake and asleep, chances are you have yawned recently. Now is that because you’re tired? Dr. Deb thinks not.

He knows if you've been bad or good, but can dear old Santa resolve the dilemma about the 14-year-old Jehovah’s Witness who refused blood transfusion in Seattle and as a result died last month? Several bloggers have offered their perspectives critical of this situation including Beast at Atheist Haven and Orac at Respectful Insolence. Not happy with unbalanced perspectives, I offer my own assessment.

So be good for goodness sake! Sometimes, however a 3-year-old’s conception of good is a little different than yours or mine.

Santa Claus is coming to town! Be sure to email him before it’s too late. That's it for this month. Keep track of the next PGR at this site.

Witnessing Evil?

On November 28 a young man named Dennis Lindberg died in Seattle's Children's hospital. He died because he refused treatment for leukemia. I have personally met many individuals close to this case. I work in Skagit County, WA - the same county where Judge John Meyer made his well publicized ruling. Last week, A Jehovah's Witness who happened to have a deep vein thrombosis taught me about the Winesses' perspectives about blood. His wife shared that she was in the same congregation as this young man. The attending hematologist for this procedure gave lectures about leukemia when I was a medical student at Children's Hospital in Seattle. My wife worked with him for a new diagnosis of leukemia that presented in a kid that came to the Children's ER. I have taken courses with and from some of the professional ethicists on staff at Children's. I would not choose the same path for myself of a child in the same situation, but when you see the story from so many angles, it's harder to be so critical of the outcome.

On top of the complexity already inherent in this case, there are a few distortions, inaccuracies and partial truths about this story gaining traction in the blogosphere - particularly in the atheist community. This post is meant to bring to light some of those lapses in intellectual honesty. We all complain about how science is too-often misused by politicians; when dealing with an issue as controversial at this one, the least we can do is present all of the facts.

Here are some points that if you rely on blogger news, you may not have encountered:

(1) Jehovah's Witnesses were founded in 1872. Any reference to the faith being founded on Bronze Age or Dark Ages thinking is inaccurate hyperbole. The religion is based on 19th Century pre-modern medical thinking.

(2) The treatment denied by the judge was not the stem cell transplant. It was a blood transfusion. Why is this distinction important? Stem cell transplants are the single most expensive procedure in medicine (hundreds of thousands of dollars just to do the procedure). We do them (and many health insurers cover them) because they work, but not all patients facing leukemia choose to be transplanted. Some cannot afford it. Some do not want to go through the pain of the procedure. Others (like this patient) have different reasons. If after providing all of the information, the patient does not consent to a procedure, the medical establishment usually respects this decision. Keep in mind that the legal decision here was related to the blood transfusion which could keep the patient alive for several days, not the stem cell transplant, which has 70% survival at 5 years as reported in the media. It's not as simple as a 750 word article would have you believe. (The Seattle PI printed a good story overall.) The Cheerful Oncologist offers a refreshing perspective on this issue.

(3) There has been some criticism of the words "mature minor." Some say it is a contradiction. The terminology comes directly from Washington State law. Health care providers are very familiar with the term; mature minor is most often applied to pregnant teenagers and to teens who need psychiatric services. The right to make autonomous, confidential (parent-free) medical decisions about reproduction (including abortion) and mental health issues is routinely conferred to 14-year-olds. It has not been previously applied to patients with blood diseases. Joana Ramos outlines some of the issues in a white paper she authored:
Doctrine of the Mature Minor
In most states of the US, 16 is the minimum age for donating blood with parental consent. In a variety of instances, teens are able to consent to, or refuse, medical treatments including surgery. It is customary that 14 is the age of consent for confidential reproductive health services, including elective abortions; substance abuse treatment and counseling; and for consent or refusal of mental health services, even when parents feel that a child’s life may be in danger(1).

The legal concept of the mature minor is well established in case law nationwide(2). It governs such topics the age of consent to engage in sexual activity, to marry, and to make independent and confidential decisions about medical care. The following list of rights extended to teens serves as a good illustration of this concept. Many of these rights involve activities that carry varying amounts of risk, may have both psychological and physical health consequences, and may be neither beneficial nor life-saving. While the laws vary in each state, teens commonly have the right to:

• make decisions as to one’s own guardian or custodial parent at 12
• travel and to purchase a ticket to travel by public conveyance anywhere in the US at age 13 without parental permission
• be employed at 16, but to engage in agricultural work at age 12, in other occupations at 14, with certain jobs being exempt from any age limits
• obtain a license and drive a motor vehicle at age 16
• have one’s body pierced at age 16 without parental consent
• enlist in the military at age 17, with parental consent
• petition the court to become an emancipated minor with cause
• make decisions on behalf of a child parented by one’s self at any age

References:
1. Stenger, RL. ( 1999-2001) “Exclusive or Concurrent Competence to Make Medical Decisions for Adolescents in the United States and United Kingdom”, Journal of Law and Health, 14(2):209-41.
2. Forman, DL. (1998) Every Parent’s Guide to the Law. (pp. 87-154) New York: Harcourt Brace.
The legal precedent in this case is that the 14-year-old was conferred mature minor status for a condition that was not reproductive or psychiatric. In his criticisms of this case, Orac makes the right concession to adult Jehovah's Witnesses regarding decisions about transfusion. He believes a grey area to apply between age 15 and 17. Based on the above examples, I think the range should be 14-17.

(4) Some have written this to be an ignorant backwards, if not abusive decision. To those who think this, I would invite you to seek out a Jehovah's Witness. Ask him about blood. If you don't learn from that individual, every congregation has several experts and health advisers. I bet you will learn things about bloodless surgeries (a few of which are at least as successful as traditional approaches) and artificial blood that you had know idea about.

(5) The newspapers included a fact about this case that most bloggers have left out. The patient's biological parents (who filed the injunction to force the blood transfusion) had a long history of drug abuse. They were in and out of jail, but had been in recovery only recently. They flew to Seattle days before the court hearing and the patient's death. If their son was dying of leukemia, why were they not in Seattle in the weeks and months before this incident?

The bottom line here is that this case is complex. At its center is a 14-year-old's autonomy. Closely related to that is the freedom of religion. The same individuals who value the separation of church and state have called for that wall's dismantling via a court of law. In the end, the judge looked at this young man's ability to make life and death decisions. My suspicion is that Dennis Lindberg was better prepared to make this decision than you or I.

Saturday, December 01, 2007

Continuity

Today is the midpoint of my family medicine clerkship. For the past three weeks, I have seen kids with coughs, guys who want Cialis, dislocated joints, pregnant mommies, runny noses, depressed senior citizens, strep throats, Caesarian sections, annual physicals, lots of funny skin spots, uncontrolled diabetes... the list could go on.

You know what I have liked the most out of my experiences so far?

Continuity. It is rewarding to see a women who formerly had oxygen saturations of 85% on O2 nasal cannula walk into clinic (from her home) and have no problem finishing a sentence. It is nice to be able to pick up a skin color change from mild jaundice to something to be concerned about. It is heart-wrenching to see an 80 year old man deteriorate from a compassionate caretaker for his demented wife and palsied son to a fetal position writhing in pain from a pelvic bone infection. (I hope and pray he recovers.)

These are all aspects of medical care I would miss out on by pursuing the top two specialties I've been considering recently: emergency medicine and hospitalist.

We shall see about this!

Wednesday, November 28, 2007

Unearthing Truth in Northern Kentucky (Part 3 of 3)

This is the third part in a series of posts describing a recent visit to two of northern Kentucky's attractions: the Creation Museum and the Ordovician fossil beds. Part 1 outlined my perspective on the science and religion debates. Part 2 narrated a span of 3 hours when I visited both the Creation Museum and the birthplace of American vertebrate paleontology. Part 3 offers the conclusion to my journey: an exercise in unearthing truth. If you have stuck with me this far, you don't have to worry about verbosity in this entry. This one is mostly pictures.

UNEARTHING TRUTH

After finishing my conference in Lexington at noon, I had three hours to make the 80 minute drive to the airport. That left a little bit of flex time to following up on a rock hound's tip from a few days previous. There was a new Wal-Mart in Fort Wright, KY that was built into the side of one of the areas river hills. The naturalist at Big Bone Lick State Park told me that folks had been finding trilobites over there. Given that the store is 10 miles from the airport (CVG), I hedged my bets that I could find something good if I sought out that beacon of American consumption. I was hoping for something like I bought as a 10 year old from the Field Museum of Natural History. I wasn't disappointed with the 45 minutes I spent scrambling over clay-slickened rocks behind the bargain center's loading dock. Here are some pictures of my specimens, and my attempt at identifying the items. More knowledgable readers are welcome to correct me! The trilobite in the center is about as big as a nickle.

Clockwise from the top are: monticule ornamented bryozoan coral, conglomerate crinoid slab, fossil coral stem, trilobite, individual crinoid stem, brachiopod (perhaps Rafinesquina), Hebertella brachiopod, and in the center another trilobite.

I had to pick and choose from numerous slabs like this one. Packed into this 7 inch piece are numerous intricate details of organisms from the large inland sea that covered much of middle America in the Ordovician Period.

In under an hour, I had unearthed ample evidence of life extinct for more than 500 million years. I could have stayed there for hours (although it would have been nice to dig with someone who knew what he or she was doing!) As if to remind me to head to the airport, the sky opened up with one of those Midwestern thunderstorms I have grown to miss since moving to Seattle (land of perpetual mist). I got quite a bath running back to my car. Perhaps that was God's way of baptizing me in the truth of an Earth formed billions of years ago.

Tuesday, November 27, 2007

Equal Time in Northern Kentucky (Part 2 of 3)

This is the second part of a three-part series detailing some of my experiences on a recent trip I made to Lexington, KY. Part 1 outlines my resistance to the warfare thesis, that is that religion and science are not reconcilable. By that position, as long as they both exist as prominent components of society, S&R will be at war with each other. Unfortunately, this perspective is often used to frame media representations of science and religion – most notably in the conversation about evolution and creationism. Even though I firmly deny the legitimacy of selecting one creationist scientist as an equal opponent to a shouting evolutionist who defends all of science, I recognize that we humans like to categorize our arguments. Therefore, today I will grant equal time to my science and religion experiences in northern Kentucky. Should you be accustomed to presentations in the form of a scientific reports, think of this post as field research composing the methods and data sections for this paper.

EQUAL TIME

Yesterday, I hinted that I was considering a visit to the Creation Museum in Petersburg, KY. This decision was not without its dilemmas. First, there is principle. How could a God-fearing scientist such as myself justify the blasphemy of setting foot in a temple of wrongness? Please see the figure at left for a summary of my gut reaction to the museum. My regular readers know that I am a Christian and a scientist. One of the ways I reconcile this is to approach both theology and scientific empiricism with intellectual honesty. I previously alluded to my view that young earth creationism is at worst dishonest, and at best fanciful. Why would I then be willing to step inside? Many out there (6th Century BC Chinese military strategist, Sun Tzu, for example) would contend that we need to know the enemy so as to not be imperiled in battle. But wait a minute – I'm no fan of the warfare thesis. So why visit? Well, there's the curiosity of it all. According to the traffic director in the museum's parking lot, more than 500,000 people have visited the museum since it opened six months ago. That's a whole stink of a lot of people to see a little animotronic cavegirl feeding velociraptors carrots. Maybe I don't see them as enemies, but if ever I am going to be an informed contributor to the dialogue on science and religion, shouldn't I have visited the crown jewel of creationist science? The guy (Matt) who checked my paperwork as I left the Alamo rental car lot told me that the museum was totally worth my time. Museums are, after all, the place where (insert topic here) comes alive. Just when curiosity nabbed me, I was deflated by: 1) The lines – it was to take 30 minutes just to get in to the place! and 2) The price tag – on a graduate student's budget, $19.95 is a steep price to pay for an hour's amusement. Rental car Matt saw the museum for free because his brother worked construction there - I forgot to ask him whether the visit was worth my money. I am guessing that $19.95 goes toward anti-science propaganda. Even though I didn't buy a ticket, the people at the museum were nice. They let me check out the gift shop, look at some of the dinosaur animatronics and didn't prevent me from documenting my visit.

My pilgrimage was handicapped from the start. I needed to get to Lexington by 7:00 PM for the first meetings of the conference I was attending there, and I heard that there was nice scenery between Cincinnati and Lexington that I wanted to enjoy before dusk. I headed south on I-75 and quickly encountered a sign that jogged memories from more than a decade ago. In my eleventh grade American history class, each student adopted the personality of one historical figure. I was Lewis and Clark. (Some of the personalities were schizophrenic.) Naturally, I was drawn to the scientific missions the two pursued in the midst of their cross-country adventure. I also remember reading about a scientific collecting expedition William Clark led after the Corps of Discovery returned from their adventures. The destination of the voyage was a little valley now designated Big Bone Lick State Park. Native Americans knew for ages of the place with big bones and French trappers discovered it in the middle of the 18th Century. The place soon became a well guarded outpost – for nearby salt springs, not the fossils. When Thomas Jefferson heard of the enormous fossils being recovered at the site, he sent Gen. Clark to recover the bones. I think that some mastodon teeth are still at Monticello.

Back to my story. It was still light out, and I decided that interstate driving was not fulfilling my quest for local scenery. I took the 7 mile detour to the birthplace of American vertebrate paleontology. Call it providence, but I happened to run into the park's naturalist in the visitor center parking lot. Todd Young is an anthropologist by training and is an expert in Native American sign language. State Parks are notoriously understaffed, so he wears many hats at Big Bone Lick. One of which was to teach a curious traveler a little about local geology. I am still on the lookout for a personal copy of the local geology field guide he recommended. Thumbing through it at the University of Kentucky library provided me with a profound connection with the place I was visiting. It also pointed to the great irony that the Creation Museum is built on one of the most fertile fossil beds in all of North America. The Ordovician strata is the remnant of the great inland sea that inundated much of the Midwest 500 million years ago. It is the purple region on the map from yesterday's entry. The rock strata are so close to the surface that just about every road cut, stream bed and construction site offers an opportunity to discover fossils. At these disrupted sites, you can expect to trip over corals, crinoids, brachiopods, nautiloids and trilobites. Todd and I scrambled through a creek bed and found some crinoids and brachiopods. Before I hit the road, he pointed me in the direction of a recently built Wal-Mart. Evidently, folks had been finding some nice trilobites there recently. Growing up, the trilobite was a symbol of fossil hunting for me – I always hoped to find one 'in the field,' but had to settle for one purchased from a museum shop.

In the end, I was happy with my decision to drive to, but not pay for entry at the Creation Museum. That decision enabled my encounter with the naturalist at the birthplace of American vertebrate paleontology. In a way, viewing the mammoth skull and scrounging for some little fossils was cleansing. It balanced out the queasiness I felt standing in the Creation Museum's bookstore.I hope you will find your way back here tomorrow for a final installment of my three part series: Unearthing Truth in Northern Kentucky.

Monday, November 26, 2007

Warfare in Northern Kentucky (Part 1 of 3)

This is the first entry in a three part series that examines science and religion in the context of a recent trip I made to Northern Kentucky.


People who know me well are aware that I'm a little proud of the fact that I have been to every state. (Although my dad contests my claim on Oklahoma.) Do you count states? Whether you count the Bluegrass State while passing through Delta's hub depends on your counting rules. For this trip, I decided to fly direct into Cincinnati/Northern Kentucky airport and drive the 80 miles or so south to Lexington where I was to present about graduate student ethics education. (Carbon auditors: what's the verdict on this? I drove a compact car.) In cutting out the labile factors of airline strikes, delays and weather that could strand me somewhere in middle America, I increased the chances of returning to Seattle and Anacortes in time to get some sleep before the first day of my family medicine clerkship. As a bonus, I got to drive through some scenic countryside during daylight hours.

Some readers might recall something else about northern Kentucky. Back on Memorial Day there was a big splash in the blogosphere and beyond about the grand opening of the Creation Museum. Tara and Michael each wrote good reviews of this spectacle and there are rather extensive photo-documentaries of the place around the web. Since the museum happens to be just a few miles from the airport, I had been considering checking it out, and several folks suggested I would regret being in the neighborhood and not visiting.

Since my presentation was about graduate ethics education, it is reasonable that I formally outline the dilemma I faced. As I got to typing this entry, it quickly blossomed into a thesis on science and religion. I present it here in three parts, titled “Warfare,” “Equal Time,” and “Unearthing Truth.”

Who knew that northern Kentucky could be so stimulating?

WARFARE

When it comes to science and religion, I am no fan of the warfare thesis. After all, how could I reconcile my own beliefs regarding science and God? My view is that the folks who ascribe to warfare are either comfortably camped with their own tribe, or indifferent to the extent that they buy in to the barrage on the airwaves about science and religion as polar extremes. The hour or so footage that I've seen from the recent NOVA special, “Intelligent Design on Trial” perpetuates the warfare thesis, and evidently in Dover two years ago, it felt like war. Science and religion are well entrenched, but like certain other kinds of war, that people fight does not make it right. When it comes to conversations about religion and science, I prefer a diplomatic approach. That's why I am a member of the American Scientific Affiliation and the Metanexus Institute.

What does all this have to do with the Creation Museum? A lot, actually. I am a Christian and a scientist who understands Earth to be billions of years old. I am an evolutionist who believes that the Universe exists in the context of Divinity. For me, that's a Christian divinity. I do not believe that Earth was created 6,000 years ago. Like the majority of Christians, I am not a Biblical literalist. As someone who prefers diplimacy over warfare, I am interested in meeting people where they are and seeking a common ground. This part of me strongly endorses a visit to the Creation Museum. I think that several science bloggers and atheists who visited the museum when it opened took this position as well. They sought an understanding of this foreign worldview, if only to better mock it.

That's not the end of this story. I've been around the conversations involving evolution, young earth creationism (YEC) and intelligent design (ID) long enough to know that there are some folks genuinely convinced that there is scientific proof of an earth less than 10,000 years old. These people are confused. Take for example, LOLCreationists: earning a PhD in geology requires acceptance of billion year old principles. How then can the earth be only 6,000 years old? I have to give the YECs credit for their earnest puzzle-solving. Cramming geologic research from the better part of two centuries into a worldview derived from ancient peotry takes a great deal of skill. Most folks on the Creationist side of this 'debate' are more disingenuous. They do not understand science or else openly disregard it, for they select certain facts and misuse them to 'prove' their own agendas. Science requires a complete assessment of all known facts, not a selective assortment of convenient truths.

So if there is a war, it is not between science and religion. It is between the honest immutibility of fact and the confused selective interpretation of fancy. That is not to say that all scientists are honest and all persons of faith are fanciful. On this particular issue, I think that there is a basic misunderstanding that will require both education and relationships to overcome. At the center of the creationism debate is not the science, but Biblical literalism.

Tomorrow in Part 2, I'll provide some elementary field work to examine the state of creationism and evolutionary theory in northern Kentucky. Of note to the folks who hung around for the entirety of this post, that entry will have more jokes, too.

Sunday, November 25, 2007

Faith in Science

Until science comes up with a testable theory of the laws of the universe, its claim to be free of faith is manifestly bogus.
These be fightin' words!

The general idea offered by Paul Davies in a NYTimes editorial yesterday is that science is actually based on faith - specifically that scientists mus adopt a belief that the universe is ordered and has special conditions that enable life. You can expect there is another another side to this story. Actually, many other sides. I appreciate the concluding statement in PZ Myers' lengthy rebuke:
Maybe Davies has faith in science, but I don't. I take it as it comes. I have expectations and hypotheses, but these are lesser presuppositions than what is implied by faith—and I'm also open to the possibility that any predictions I might make will fail.
Of all the responses that I have read, I most appreciate Dr. Free-Ride's distinction between metaphysical commitments and methodological strategies. When discussing the perspectives of scientists in action (Latour reference intended), it is important to consider what the practitioners recognize as the foundation of their activities. In the trenches of wet labs, field plots, and modeling suites, there are many more scientists willing to accept the utility of empiricism than a theory of universal existence. Don't get me wrong: many scientists do nurture their own metaphysical understanding of the universe, but my guess is that the color of those beliefs varies widely between individual. When it comes down to it, I think that most scientists do experiments and leave questions of metaphysics to the philosophers and theologians.

I think that my resistance to Davies' article is founded on the comparative comfort that cosmologists have in talking about origins, faith and world-views relative to other scientists - especially biologists. Maybe I am jealous that cosmologists can write in the New York Times about science and faith, while in the current setting, most biologists must pick a side: science or faith. Some readers are not willing even to grant cosmologists the right to seek common ground between science and religion.

I applaud Davies' efforts to point out an important understudied element of existence - origins - but agree with many other blogs that he was clumsy in his attempt. Anyway, is science even capable of studying origins?

Wednesday, November 21, 2007

Giving Thanks in Anacortes

On call in the emergency room this evening, I encountered my first homeless person in the city of Anacortes, WA.

This coastal town of 15,000 didn't strike me as a likely destination for homeless folks. A good number of people work at the local Shell Oil refinery. The health care industry employs many to care for the aging population. There are also a number of suburban-looking communities springing up in the gateway to the San Juan Islands. I figured that this hamlet would have its share of low income families given the depressed state of the shipbuilding and fishing industries here, but homelessness? Where are the services? In my ten days here, I just haven't encountered any signs. And it's not like I don't know how to look... I don't imagine that there are civic resources like might be found in the larger urban centers. The staff in the Island Hospital ER helped me understand my misjudgment. Tonight, I was the a civic resource.

Adult homelessness is often confounded with mental illness, substance use and malnutrition. This is very apparent in America's urban ER's. Tonight's case featured mental illness, but not a particularly severe type. I learned that the homeless here either live in cars or are "walkers." Walkers follow routes to keep them awake when personal safety is involved or the elements are an issue. In Seattle, this could include frequenting 24 hour grocery stores, night owl bus lines and busy streets like the Ave. or Broadway. In Anacortes, it's the Safeway and the hospital. My first brush with homelessness here happened to coincide with one of the first nights the temperature dipped to 25 degrees F. (That's frigid for the Pacific Northwest!) Our walker arrived after the frost had already tinged the windshields in the parking lot.

It actually doesn't matter why this individual presented to the ER, just that it is our job to provide care. The attending physician said something that really resonated with me. "About the most humane thing we can do for these folks is to provide a meal and a safe place to eat it." We may not have been able to provide a medical solution for this patient tonight, but I could heat some food and sit to chat with our guest. Was that chicken parmesan Thanksgiving dinner?

I'll soon be returning to my wife in Seattle knowing that today and every day, I have much to be thankful for.

Middle Ground For Stem Cells?

You've probably already seen the headlines: "Top Scientists Generate Stem Cells From Cloned Skin." My local Seattle paper has a story. So does the NYTimes. Not surprisingly, the Times article is really good. They tend to get it when it comes to stem cell science and politics. The articles there represent the science well and give a good breakdown of the political context of the announcement. But for a better breakdown, read Matt Nisbet's post on his Framing Science blog. He points out that middle ground in the stem cell debate is murky, if it even exists. I think the potential for middle ground would be greater if we could get away from the polarizing environment that make a presidential "I told you so" possible. I'll get to that in a minute. First the science:

Tonight I passed on reading about chronic pain to get the dirt on the research in the Cell and Science articles. And what do I get? Well at first it was a bunch of freakin' press releases and 'digested for the lay public' news articles. I started to think that this was just a ruse to provide a reason for me to give thanks tomorrow when the currency of science - the paper - was released. But then I found the Sciencexpress paper (you need a subscription, of course).

What do I think? These stories look pretty good. Okay, really good. The teratomas look a lot better than the sorry examples provided by the Yamanaka group in July of '07. (The Yamanaka paper in Cell also looks much better this time around.) The pathologist in me wants more than the H&E tissue sections the Thomson group provided. I want to see definitive lineage markers by histology. But none the less, I am pretty impressed. They set out to create a stem cell line that could produce all three germ layers. It looks like they did. The next question is whether these pluripotent cells are as pluripotent and as controllable as the embryonic stem cells. The only way we will know is by doing the experiments. My former dissertation adviser, Chuck Murry, has already put an order in for these cells and should have some in Seattle by January 2008. Can they be coaxed into beating human embryonic stem cell derived heart cells?

(By the way, if you are looking for a more detailed take on the science, please refer to Pharyngula, The Scientific Activist or Dear Science.)

Moving on to the political situation, there is plenty of hot air out there to get indigestion about. Fortunately, there are some level heads to provide the TUMS needed for me to get a good night's sleep.

From the New York Times article.
Karl Zinsmeister, a domestic policy adviser to Mr. Bush who kept the president apprised of the work said, “I don’t think there’s any doubt that the president’s drawing of lines on cloning and embryo use was a positive factor in making this come to fruition.”

Mr. Bush’s critics say he should not be so quick to take credit. They note that the reprogramming method has some kinks to be worked out and say the research would never have proceeded without the initial embryo experiments. The critics say that far from encouraging research, Mr. Bush has stood in its way.
I got queasy reading the first paragraph (the aforementioned presidential "I told you so"). If you will allow me to continue with disease/treatment metaphors, its follower provided the anti-emetic I needed to keep my keyboard vomit-free.

Let's not overlook the quote from the only Republican senator I ever voted for:
“I really don’t think anybody ought to take credit in light of the six-year delay we’ve had,” said Senator Arlen Specter of Pennsylvania, the lead Republican sponsor of the bill that Mr. Bush vetoed in July 2006. “My own view is that science ought to be unfettered and that every possible alternative ought to be explored.”
Yeah! I think I would vote for him again!

[tirade]

What's not being brought to the table here is the notion that most of science is not about designing cures! It's about asking questions and answering them. Goal-oriented science and translational research is what pays the bills because it captures our imagination. But when it comes down to the bottom line in biomedical research, we need to understand mechanisms and systems before we go and use some new-fangled therapy in the clinic. Why is this important? I need only cite the unfortunate example of Jesse Gelsinger. Viral gene therapy was not ready for prime time, and a sick kid paid the price. Where do we begin to understand stem cell differentiation?

The thing is, embryonic stem cell researchers have always contended that the goal is to generate stem cell lines that don't need to come from blastocysts. After all, it's a good chance that ES cell-derived tissue replacements would need immune suppression to prevent rejection. If stem cells could be derived from other cells, that would obviate the side effect-prone rejection medicines. Embryonic stem cell research teaches us about cell reprogramming so that maybe there will be a clinical application in the future. Indeed, the same interventions that were used in these (what I think will amount to) monumental papers to generate these ES cell-like cells were studied in embryonic stem cells.

Science is and relies on progress. To say that the shortsighted policy made by George Bush and his puppet show of a Presidential Bioethics Committee is anything but a hindrance to science is not just disingenuous, it's an outright lie.

[/tirade]

And I wonder why we can't all just get along. Let me tell you (and myself): It's because crazies like me are tired of the political misuse and misrepresentation of science.

Tuesday, November 20, 2007

Laparoscopic Supracervical Hysterectomy

This morning I scrubbed in for my first surgical procedure. It was a Laparoscopic Supracervical Hysterectomy. Doesn't ring a bell? Visit www.laparoscopicsupracervicalhysterectomy.com/ I am not kidding. I wonder if every procedure has its own website. That sure would be handy for junior medical students!

Anyway, the general process is to inflate the abdomen with air, separate the uterus from the abdominal wall, cut the body of the uterus from the cervix, cut the organ into little pieces and suck it out of the abdominal cavity through the belly button. The machine used to cut and suck is called the morcellator. This is really quite remarkable. Instead of being in the hospital for weeks, the woman can go home in a few days. She also retains important abdominal wall support and mucus producing tissue to prevent drying.

My attentive readers may recall that I am doing a family medicine rotation. What am I doing scrubbing in? My preceptor is a family med doc who takes obstetrical cases - these folks are becoming a rarity - and this was all in a day's work for her. My role in the operation was to dilate the cervix to an extent that an indwelling probe could be inserted to manipulate the uterus during the procedure. Then I watched the rest of the show from the anesthesiologist's station.

By the way, he was doing the New York Times crossword puzzle during the procedure.

Graded?

I don't know how it works at your medical school, but here at the University of Washington, eons pass before the clinical clerkship evaluations make it back to the student. It's been only a few weeks since I moved on from pediatrics to family medicine, but my current roommate - he finished his first clerkship in mid August - still has not heard about his marks. This is a good reason to ask for feedback real time during the rotation.

What gives, UWSOM???

Sunday, November 18, 2007

10,000th visitor!

This morning at 6:06 AM Pacific Standard Time, a Macintosh-using Londoner used google.com to search for "articles about carbon footprint cellphones." Being the upstanding internet user that she or he is, our surfer followed the first link shown. A single click dumped the unwitting individual into Hope for Pandora, thereby accounting for my blog's 10,000th visitor. Given the equivocation offered in that article, chances are good our friend will not return to this fair web venue ever again.

Of possible interest to you is that my own visits to the site over the course of authoring and editing probably account for one of every 35 counts. This means that I have visited my site more than 300 times in the last 6 months. It is a good thing that I like to blog, 'cuz I've been spending more than a little time typing away...

Saturday, November 17, 2007

Pediatric Grand Rounds

I'll be hosting Pediatric Grand Rounds on December 2, 2007. If you have written any posts about kids and health, pediatric practice, child safety, or pediatric medical policy, please submit them to me by November 30. There are still 2 weeks before then - consider writing a piece and submitting it to me. Given the context of the holiday season, I'm thinking of categorizing the posts using the framework of a popular carol. If you have kids, care for kids, or write about kids, send me an entry. I'll work yours into a collection of this month's best of pediatric blogging. Please send your posts to scienceandmedicine at gmail. Last minute shoppers: you don't have to wait until Grand Rounds Eve. Send me something now.

$3 A Gallon? Try $10!

A lot is being made of the increase in cost for auto fuel. The national average is above $3 a gallon. It's $3.29 here in Anacortes, WA, and there's a Shell refinery just across the inlet. Two summers ago, I was in Grand Rapids, MI at a conference of the American Scientific Affiliation. There, one of Congress's only scientists (PhD in physics), Vernon Ehlers (R-MI), gave a keynote address about the science and policy of energy. You know what he said? He thinks gasoline should cost $10 a gallon. That way, folks would actually change consumptive behavior, industry would put alternative energy as a top priority, and the government would not be so reliant on foreign powers. This is a Republican! From Michigan, home of the US auto industry!

I think I could buy into this, as long as the $$$ doesn't go to the oil companies or foreign regimes. Maybe it could go to the National Park System or to local schools. Or fancy this: the extra cash could finance developing viable alternative fuel sources. Of course, something would need to address folks around the poverty line - maybe something like gas stamps - but apart from that, we need to wise up.

The Descent of Posts

Back in late September I was tagged by Mike for an evolution-themed meme. This meme provided an opportunity for the tagged bloggers to dive back into the vault and contemplate the evolution of their blogs. Since I was tagged in the midst of finishing my dissertation, submitting several papers, and starting the third year of medical school, it has taken me a while to put everything together in a way that makes sense to me and might be interesting to you.

My very first post consisted of one version of a story about my blog's namesake. Long story short, after Pandora unleashed evils into the world, she also had the sense (or luck) to release hope as an antidote to the ills. Pandora's box is an often used frame in conversations about science and society, particularly surrounding technology and ethics. So I thought it was reasonable for my blog to start out with the following goals:
1. To generate a conversation about science and society.
2. To contribute interesting and meaningful content to the digital community.
3. To improve my own writing and argument skills.
4. To learn more about what others think about science.
5. To encourage scientists to think critically about how their work fits into society.
I am happy to say that more than a year later, I am sticking with these objectives.

My first posts were personal - I had been quarantined by the King County Department of Health for mumps. It turned out I had a salivary stone, but because I had traveled recently through some cities with mumps cases, I was to keep out of public places. Here is one reflection inspired by my quarantine:
This brings me to another point: economic productivity. I wonder what the effects of a widespread quarantine for H5N1 avian flu would have on the economy. I'm no economist, but I would imagine that any effects from lost work would hit the poor first and hardest. Do employers make any allowance for workers on quarantine? Is that something the government is prepared for in the reports recently issued about the possible pandemic? Who's responsibility is it to keep food on the table when the breadwinner is quarantined?
I even wrote some bad poetry about the experience That's a path you may not want to travel.

Which brings me to my next theme: carbon footprint. In the interest of contributing content to the web (and attracting readers), I started writing a weekly column about how to reduce your carbon footprint. Each of my posts was personal. I was motivated by what seemed to me shaky science and imaginary economics to pick areas of my own life that I could improve on. This came back to bite me when I wrote about cell phone chargers. I still think I did my calculations correctly, given what I knew. Even the experiments to test the idea that chargers use power when plugged in seemed rigged and misinterpreted. Anyway, my favorite post from that series featured some of my local farmers' markets and added a splash of color to the site.

Speaking of flashes of color, as I grew more comfortable with the blog, I posted more entries that revealed my sense of humor. Many of these fun entries were collected from other sites. Some I embellished or inserted into my own context. Others were enough to stand alone. When I encountered a video of surfing rats, I could not help but point out the link between one Australian animal trainer and the laboratory experiments I conducted at the time.


But it's not all fun and games at Hope for Pandora. As I had the ideas and energy, I would ponder some serious issues. Occasionally, I would rail against how some new stem cell study had been overhyped. Sometimes, I would comment on issues related to science in religion. My most viewed entry (thanks to a link from PZ Myers) was one where I supported the atheist Out Campaign. Go figure: a Christian supporting 'the other side.' I guess that was my way of denying the tenability of the warfare thesis in the science and religion debates. One quote from that post is:
My conversations with atheists about science, politics or religion are as interesting and meaningful to me as discussions on the same topic with Christians. In many instances, my agnostic and atheist friends are more likely to be open to thinking about new and different ideas. In the kinds of discussions I like to have about science, society and social justice, it doesn't matter what people believe in. It matters that they are respectful, honest and open to conversation.
Finally, I recently made a transition in my 'real life' from graduate student to third year medical student. With that comes different blogging patterns - weekend heavy and sporadic. I use my blog these days to record and explore experiences from medical school. It is easy to move from one day to the next without pausing to reflect on the significance of what filled the day. My favorite medical post so far describes my first delivery. When the difficult delivery was at a critical stage,
We were patting and rubbing him, sticking tubes down his throat, and forcing air into his lungs. All we wanted in return was for him to scream at us. After 4 minutes, he took a breath; 30 seconds later we heard a weak cry. The intern kept imploring Seattle's newest baby boy to tell us how angry he was. When he did, I wasn't the only person in the room with wells for eyes.
That about does it. Hope for Pandora is an evolving entity that closely reflects its author's evolutions. It is a tool for me to express myself and a way to develop a voice.

In the interest of keeping this meme alive, I will tag a few blogfriends. Mostly because it would be fun to hear about their sites' evolution. I don't want to be pushy about it, so they will have to discover on their own if they've been tagged. The worst that can come of it is that I send a few new readers to those sites.

Mark of blogfish
Kate of Anterior Commissure
Ben of nosugrefneb
Noel of Constructive Procrastination