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.


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.


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?


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!


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.


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 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.


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 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

Tuesday, November 13, 2007

We're Not in Seattle Anymore, Toto

This is what I saw this morning while eating breakfast:

Three black-tailed deer strutted through the backyard of the house I am living in while studying family medicine in Anacortes, WA. I took this picture from my bedroom window. Next time I'll be better prepared to get a clear shot of them. If only I would see or hear coyotes, it would be just like home... (in Seattle...)

Tonight Only: Science and Blues Revue

Last Thursday I had the privilege of watching a preview of NOVA's Intelligent Design on Trial at the Pacific Science Center. The director (Richard Hutton) presented about an hour of the two hour documentary of the Kitzmiller v. Dover Board of Education court case two years ago. If you haven't heard, the special airs tonight at 8:00 PM on PBS.

I want to get this post up before the big event, but don't have the time for a complete analysis. Here are some bullet points:

  • Judge John Jones is prominently featured.
  • We weren't shown the whole thing because it was not finished yet (on Thursday).
  • There was a bit more of the warfare theme than I thought was necessary.
  • I sat next to Carl Bergstrom of the UW Biology department.
  • They used actors to portay the court proceedings; Behe's double is excellent.
  • The basic introductions to the philosophy of science are adequate.
  • I thought the presentation of the science was too simplified.
  • I am thinking of using a mousetrap as a tieclip one of these days.
I look forward to the special tonight. I hope you are too.

Thursday, November 08, 2007

Eeesy as Pie

This is my first post as an Eee User. I must say, I am hooked. And look how cute it is next to my monstrosity of a laptop! I'll post more here after I take it for a spin... By the way, I turned both of these compy's on at the same time. Eee is ready to go, while HP is still flying the Windows flag.

T's Crossed

You can tell that I took this photo before the dissertation clerk realized that my dissertation's signatory page was printed in size 14 rather than 12 because she has that big smile on her face. It only took one puppy-dog face to convince her that it was actually okay. It's a good thing I didn't have to use the Force; my Jedi mind tricks probably wouldn't have worked on her.

I only had to reprint two pages and re-copy all of my tables. But it is over. I earned my Ph.D. just in time to rush over to Children's Hospital to take my pediatrics clerkship final. I passed the multiple choice part on the first try, but could have done better. I hope my subjective reviews come back stronger.

I am going to celebrate by attending a special screening of Judgment Day: Intelligent Design on Trial at the Pacific Science Center. This is one of Paul Allen's pet projects, and if you read ScienceBlogs, there's a bunch of good buzz (and plenty of ads) for it. I'll give you my take this weekend.

Graduate Ethics Education

This weekend, I'll be heading to Lexington, Kentucky to represent the University of Washington at the National Conference on Graduate Student Leadership. I'm giving a talk about how ethics education should and can be better incorporated into graduate school. I have 8 minutes... Naturally, I'll be speaking a bit about the Forum on Science Ethics and Policy, but I'll also lay out a case for why providing formal and informal training in ethical reasoning makes for better graduate students.

I had hoped to take my new EEE PC, but it seems as though UPS got confused and shipped it to Ontario, California instead of Seattle. I've already weaned myself down to checking email once a day. I think I can cut the cord for a whole weekend...

Wednesday, November 07, 2007

Playing With Kids

I will miss working in an environment that permits (dare I say, encourages) interactions such as:
Me: "Would you prefer me to listen to your heart with or without my batman mask?"
Kid: "With it, please." (Said in all seriousness)
Me: "What color is your pee?"
Kid: "Green."
Me: "When is it green?"
Kid: "At school."
Me: "When you go to the bathroom at school, is the water in the toilet blue before you use it?"
Kid: "Yes."
It's hard to believe that my 6 week rotation is over. I take my pediatrics final tomorrow. Then I am off to Anacortes, WA to study family medicine. Hopefully the families there have kids.


There are some pretty good carnivals up this week that typically have some really nice articles. If you are looking for something to read, check out:

Carnival of the Liberals
Medical Grand Rounds
Christian Carnival

There are also two new carnivals up that I hope I can check out this weekend:

Linnaeus' Legacy
The Trauma Center

These are all free links (That means I don't have any entries!)

Tuesday, November 06, 2007

ScienceBlogs Loses One

ScienceBlogs' founding member of the "don't hate the religious" clique, has moved on from blogging and resigned his position as ScienceBlogger. Rob Knopp has never been careful with his words; he writes what he thinks and makes no excuses for it. Evidently, the ScienceBorg (who are very good at generating conversations about science, and I applaud them for it) is not interested in assimilating his posts into their archive now that he has left. This is a shame, since some of his posts shed new light on my own position as a scientist and a Christian. My guess is that Seed (they are the folks who manage ScienceBlogs) wants to extinguish any evidence that scientists and science bloggers can consider religion an important part of life.

Thanks Rob. You will be missed. I hope to see you around someday.

Adsense Payday

Last week, I received my first Google AdSense payment. The electronic statement reads:

10/29/07 REVENUE SHGOOGLE ADSENSE 1454684 $105.81

For those of you not familiar with how having ads on your web site makes money, here's the scoop: Google mines the text of my blog and picks out ads that it thinks might interest you, the reader; then, anytime you click on an ad, the site owner earns 10 to 50 cents. Sometimes the surfer has to sign up for something or buys a product for the blogger/webmaster to get the payment- those ads usually bring in more money. For example, if you do not have the awesome Firefox browser, you can sign up for it on this site through the ad a couple of frames down at the bottom of the light blue banner to the right. If after clicking on the ad, you install the software (with Google toolbar), I get a fat $1.00.

But I don't see the cash right away. Anyone who has AdSense ads embedded into his or her blog or website knows that the paycheck is not cut until the website's total revenue exceeds $100. For me, that took about seven months. I get about 1500 readers on my blog a month, most of whom find me by Google searches. I would bet that about half of my revenue comes from those folks, and half comes from people that are more regular readers. Many of my ads (if your browser does not block them entirely) are intriguing; they hawk stem cell banks, evangelical sites, abortion (pro- and anti-) related organizations, and lately, medical equipment companies. I invite you to click on them if they look interesting to you. Is inviting you to click on my ads working the system? All of this information can be found in the AdSense informational pages. Furthermore, Google has built-in algorithms to determine whether I click on my own ads. Though Google prohibits this activity, sometimes I am just too curious about these offshore stem cell companies to resist the lure. Because of Google's anti-fraud software, those clicks never have counted toward my revenue; I tend to post from the same 3 or 4 ISP addresses. When it comes down to it, most people (>99%) just overlook my content-driven ads. It's just as well.

In the end, $100 once or twice a year for only a little time up front seems like an okay thing to me It almost covers the cost of the ComCash cable internet I am using right now. Is this selling out? I think not - first and last write to better myself and society. (I can really only measure the former.) Those three or four ads in the sidebar: do they scare you away? I hope not. Let me know if they do. I value readers and comments more than candy money. Anyway, if you want to try your hand at AdSense, click on the sign-up button at the very bottom of my blog.

(If it's after November 2007, chances are good you found this through a Google search, anyway, and want information about signing up for AdSense!)

Ethics of Medical Training Vol. 1

You're a patient at your local university hospital. Chances are good whatever is wrong with you is complex enough that you have traveled further than most people do when they go to the doctor. But then again, maybe you live just down the street! In any case, you come to the UXMC for the reputation, for the expertise, and to get an answer for what is wrong. It's your first visit. You've filled in the forms, the nurse has taken your vitals, and you're sitting in the cold, fluorescent bulb-lit exam room waiting to be seen, and who is the first to walk in? A twenty-something wearing a poorly-fit white coat grasping a clipboard like a security blanket. "Who is this?" you wonder, and "why does he look so nervous?"

Congratulations. You have just experienced a critical component of the graduate medical education complex. Shifting uncomfortably in front of you is the first rung of the ladder known as the medical hierarchy. Immediately you think, "How is this spring chicken going to heal me when all of the other docs were puzzled?" The answer is a little complex.

Hopefully the medical student in front of you is a little more comfortable than the way I've described him. Unless it's the month of July (when all of the residents and medical students are new), the student has already interacted with hundreds of patients, so he shouldn't have problems conducting an interview. At the foundation of your observation is a critical tension at the base of medical education and professional ethics: How are we to balance what is in the best interest of the patient with what is in the best interest of society? A byline of this tension is the medical student's concern about evaluation. While we students should be focusing on doing the right thing for the patient, many of us also want to do the right thing for our grades. That usually means thinking inside the box and being conservative with answers. Such thinking is not, however what doctors usually order at tertiary medical centers, and it's not what you need to solve your problem.

Fortunately, the medical hierarchy comes to the rescue. The residents, fellows and attending physicians who are actually liable for patient care benefit from the constant discussion, questioning and brainstorming (all lumped into that unfortunate term, 'pimping') that a teaching environment affords. You benefit from the system that brings you the medical student.

On a lighter note, keep in mind that medical students usually only take care of 2-3 patients at a time in the hospital. This means that they have more time to sit in your room and ask questions, catch overlooked relevant physical exam findings and pore over books (paper or electronic) to learn about your condition. And if you are a kid, maybe the student will take you over to the playroom to use the finger paints!

In many ways, you are the best teacher for medical students (especially those tired of sitting in class). Thanks for working with the medical student. Society thanks you, too.

Monday, November 05, 2007

Advice To Those Who Follow

So let's say you are one of the 400 or so MD/PhD students out there planning on restarting medical school next year. Please give yourself more than 10 days between your defense and your first day on the wards. Trust me on this. No matter how little sleep you need, every day will drain your energy to the extent that the only science you could even consider doing after you get home is the variety served on CSI. And even then, it's a safe wager that you'd be asleep before the killer confessed in light of the evidence.

These days, I've been spending too much time on figures and edits and not enough reading about fever in the newborn or asthma.

I guess that is how it always will be.

Sunday, November 04, 2007

We're on a mission from...

The next time (the late, great) James Brown asks, be sure to remember that, yes, you have seen:and you saw it at the Science Creative Quarterly. What else have you seen?

For a refresher on my second Blues Brothers reference of the weekend, consider watching this clip. Abbreviated start points at 1:00 or 4:00 will get you up to speed.

Saturday, November 03, 2007

Perils of Biking

Two incidents in the past month involving have reminded me just how unprepared America is to move forward as a society responsible for its health and environment. One of my friends has been carping on this issue for a while, and for once, I will join his refrain.

The bicycle is increasingly considered a legitimate mode of commuting; many employers provide showers and secure lockers for staff. As the environmental, health and cost benefits of biking are realized by more individuals, there is more contact between bicyclists and automobile commuters. This fact rears its head in some ugly ways. The first is that case of a Seattle commuter who was shot with BBs at point blank range this past week. He blogged about this and his situation described in a local paper. The thing was that he kept riding with a pneumothorax, got home, and told his wife in private so as not to concern his kids! One of the BBs lodged near his aorta, but he is okay and will be able to bike again soon. My other example doesn't have such a happy ending (yet).

When I first started working in the Murry lab (where I completed my dissertation work), I was drawn to certain of the experimental techniques used there - namely murine cardiac surgery. That a mouse heart the size of Roosevelt's head on a dime could be used to approximate human heart function was amazing to me, and that we could surgically induce heart attack was unbelievable. I learned how to do heart surgery from the skilled hands of Jitka Virag. Now an assistant professor at East Carolina University, Jitka was a post-doc in the Murry lab. When she left, I inherited her desktop computer, through which all of my science was done. On October 19, while bicycling home from work, she was struck by a motorist who was traveling as fast as 50 mph. Her helmet may have protected her head, but it could not prevent a T4-5 spinal cord transection. She has been recovering in the hospital since then. A community of support has formed around her, reaching across the country and around the world. Some of the updates on the blog her husband keeps are in Hungarian for family members over there to keep up with the news. I am thankful that she is alive, but hope she can come off the ventilator soon.

Incidents like these make it hard for me to oppose groups like Critical Mass. Some of their tactics are belligerent, but they are not as belligerent as BBs shot at point blank. Their behavior may be irresponsible, but not as irresponsible as clipping a bicyclist at full speed.

Miraculous or Mundane?

One of the most miraculous plays in the history of college football is just another day in rugby. Surely, you've seen this one by now:

Medical school places you a little out of the loop on some things. For example, I heard about this play on NPR's Weekend Edition... The sort of response this single play received suggests to me that rugby, if given a chance, could be really popular in the US. My bias is that I played rugby for 3 years in Pittsburgh and never played American football. But seriously folks: this is what rugby looks like! And really, it only takes a season to learn the rules and strategy.

Thursday, November 01, 2007

I Hate Washington Racists

The title above is a bad reference to the 1980 classic movie: The Blues Brothers. In one scene, Jake and Elwood (by that point, well entrenched in their "mission from God") encounter a traffic jam caused by a parade of Illinois Nazis. They ask an officer what is going on; he says the Illinois Nazis got a permit for a parade. Elwood scoffs, "Illinois Nazis!" to which Jake replies, "I hate Illinois Nazis." They promptly accelerate through the parade causing the uniformed Nazis to jump from a bridge into a small river. (Was the bridge in Peoria?) For a refresher, see:

I cite this example of intolerance because of something more relevant to 2007: Islamo-Fascism Awareness Week. This was a nationwide series of events sponsored by David Horowitz from the Los Angeles-based Freedom Center, a conservative think tank. I was annoyed about this issue last week when I read that the event was occurring on the University of Washington campus, but Robert Jamieson really got me (and at least one other person) riled up in a recent well-thought column in the Seattle Post-Intelligencer. Chances are good there were events in your city.

Such ignorance as this makes me want to find a 70's vintage police cruiser and drive it through my school's quad (also called Red Square) during one of the events. It's a good thing 1) the 'awareness' week is over, 2) I don't know where to find old police cruisers, and 3) due to medical school, I don't have time for such tomfoolery.

Married Classmates

Today, an interesting discussion ensued while I rode in a shuttle with some of my medical school classmates between clinic and our teaching didactics. There are a couple of things that medical students who do not know each other very well can talk about easily. At the top of the list is the location of your next rotation. (UW folks have five states where they can be assigned.) My pediatrics clerkship is coming to an end, and soon I will be off to Anacortes, WA to learn about family medicine. When my colleague learned I would be heading up to Anacortes, he inquired if my wife would be able to join me up there. I almost turned to her and asked, "What do you think, honey?"

You see, currently, my wife is one of my classmates and was sitting right in front of me. None of my other classmates are aware of this. My outpatient clinic attending physicians know it (we bring the same food in for lunch); the folks in administration know it (we did put each other as emergency contacts); even my supervising intern knew (sometimes you have good conversations that can only go so far while concealing such a big component). But none of the 9 other students know about us. I bet that they just think we know each other well because we are both MD/PhD students... I think keeping this secret is a fun, harmless game that keeps things interesting for us. Anyway, that fact would just get in the way of the already isolating effect of being an MD/PhD kid.

Anyway, I am pretty sure I pulled off the answer to my classmate's question in a straight face with a simple, "No, she's going to stay in Seattle. Hopefully, we will see each other on the weekends." Susan pitched in with, "How long a drive is it? Two hours?"

Actually it's one and a half.


I'm willing to bet that many medical students in their third year think that they should be provided with classroom-style teaching as part of their clerkship education process. Medical $chool is, after all, really expensive. One might think that an education that keeps you in debt for many years should have a good amount of structured teaching. Many still think it is important to pull you away from hospital learning to sit in a class with four to fifteen other students to view some Powerpoint slides about the differential diagnosis of pediatric cough or the role of sleep apnea in pulmonary medicine. (My clerkship director thinks this, for example.) Five years ago, I may have agreed with the need for structured lectures.

These days, I much prefer learning in small groups in the care provider room, in patients' rooms, in the halls of the clinic, or even over dinner when on call. The thing about the medical training system, is that MOST people are in the process of learning and teaching. There is an adage in medicine called, "See one, Do one, Teach one," and while this may not be appropriate for some complex procedures, everyone should be in this mode. The residents teach each other and the medical students; students absorb experience from nurses and other providers; everyone learns from attending physicians. That's how teaching hospitals work. And don't just rely on others to teach you! If you are light on heart malformations, ask for some teaching from a cardiology fellow or the sub-intern on the cardiology team! Look up a paper, and present the tetrology of Fallot to your team. Chances are good that several others could use a brush up on that.

I know that the medical school wants to standardize its education so that everyone sees the same thing, or that some people just learn better in the classroom. I am pretty sure that the practice of medicine does not have didactics very often. If you cannot learn on your own or on the fly with and from your colleagues, good luck keeping up. I wish I didn't have to waste a good chunk of my days commuting to the lectures and figuring out ways to keep interested in them.

I mean no disrespect to the lecturers at my medical school, and specifically in my clerkship. It is clear that the administrators pay close attention to students' feedback - the lecturers are hardly ever boring, speakers generally use A/V aides appropriately and they often engage the students - I just think that time is better spent in clinic. We sat in the same chairs for almost 2 years absorbing info in classrooms. I wonder if these 5-10 hours of classroom learning are just a way to wean medical students from the structure of a classroom.

I'd rather go cold turkey.

Grand Rounds

I am a little late in posting this - all of my electronic correspondance are behind - but you should still head over to Running a Hospital for this week's Grand Rounds carnival.