I played hooky from the office this morning. My hours have really been weighing down on me, and with my recent back injury, I really wanted a break.
Then my wife begged me to take our daughter to school. And stop at the store. And find the shopping list in her car. I was unhappy. I made her cry.
You see, today is my father-in-law's birthday. He was born 70-odd years ago today. He died less than three months ago. It's not going to be an easy day. I apologized and worked on getting my daughter ready.
My daughter has, like most children, traits from both of her parents. From her mother she has a distaste for mornings. When I went to wake her she actually gave me a groggy "talk to the hand" gesture. Everything was a struggle this morning---teeth, hands, asthma medicine, clothes, and finally, coat. Our house is under construction from a horrible ice dam incident, and the coat closet is tough to get to. This answer did not satisfy my daughter's desire to wear a different coat, one thing led to another, and she had lost her TV privileges and shut herself in her room. It was five-to-nine, and I had lost through winning. My wife, trying to claw her way back to sleep, strongly suggested that I learn to de-escalate more effectively, and gave me some specific suggestions. A few minutes later, we were in the car and off to school.
Four-year olds like their routines, and I wandered into the trap of trying to fit a small but willful human into mine. My roll-out-of-bed jump-in-the-shower run-out-the-door routine didn't match hers, and the predictable happened. Hopefully I've learned two good lessons---be nice to my wife, and don't push it with the kid.
Archive for: March, 2009
I played hooky from the office this morning. My hours have really been weighing down on me, and with my recent back injury, I really wanted a break.
I often write about "cult medicine", that is, medical practices that share many characteristics of cults: they are based on faith, they follow charismatic leaders, they separate people from their money---you know, like The Church of Scientology. The COS has everything going for it---a religious arm, a health care arm (the Citizens Commission on Human Rights), and an educational arm. In fact, the more I learn about these wackos, the scarier (and funnier) they seem. You see, it turns out that these folks have a lot of front organizations. Unlike more traditional religions, that are happy to proclaim their identity to all, the volcanosploders seem to think people might be a bit put off by their particular brand of
wackaloonery faith. It's amazing how successful they've been at infiltrating secular organizations under the guise of "public service".
Take public education, for example. There's something called The Concerned Businessman's Association of America which, using various sub-fronts, has infiltrated public schools (that's "state schools" to you Brits) under the guise of "moral education" and drug use prevention. Through the SAGE campaign they claim to have forced over 12 million school children to read a piece of their liturgy, "The Way to Happiness", by L. Ron Hubbard. Now, The Way seems pretty harmless, with nice things like "do not murder", but the fact is that it is a religious text and has no place in public schools.
And if you're thinking, "hey, these precepts don't sound so bad. I don't care who wrote them," remember one thing: these are the same folks who think your soul came from a dying intergalactic empire and was banished to Earth via DC-8, dumped in a volcano, exploded with nukes, and wandered to Earth to inhabit other bodies. Or something like that.
You see, with the DC-8-Wranglers, nothing is too absurd. There is no Poe's Law for Scientology, but there should be. It would go something like this:
"It is impossible to describe, discover, or invent a religious practice more absurd than one already claimed by Scientology without getting locked up in the psych ward."
Hmmm...could that be why they hate psychiatrists so damned much?
How can a seemingly trivial head injury kill you?
To answer this, you need a little anatomy.
Your brain is a pretty important organ, and is well protected. It sits inside a thick armor (the skull) and floats cushioned in a bath of cerebral-spinal fluid. It's surrounded by several layers of tissue, and its blood supply is kept relatively separate from the rest of the body (the "blood-brain barrier"). This separation helps keep out toxins and micro-organisms (but is imperfect). Just beneath the skull is a tough, leathery layer called the dura mater. This picture shows the skull cut away, and the dura peeled back by a forceps.
A frequent commenter on the conscience issue has raised a lot of questions on an recent post. He seems somewhat frustrated that I don't understand his point. What I think he doesn't realize is that I do understand his point all too well---he is just wrong. Here is an example:
You also still haven't cleared up that little inconsistency regarding the matter of whether or not there is a professional obligation to provide elective services. Or is it just physicians, but not pharmacists or other healthcare professionals, who have rights of conscience?
OK, I'll clarify it for you. It's not that doc's have a "right of conscience", it's that they cannot be unreasonably coerced to provide services. This does not mean that a physician or other provider is never required to provide a service. In other words, if some random person walks in the door of my office, I don't have to see them. If I am an ER doc and someone walks in the door with a life-threatening condition, I DO NOT have the right to refuse them care, whatever my beliefs. I am required by law to stabilize them and if I am unwilling to continue to care for them, transfer them appropriately (the transfer doesn't happen much in practice). Of course, no one can hold a gun to my head. If I refuse to serve the patient, and no one else is available to do it, I have committed a highly unethical act. If someone else is available, I can be fired for failing at my job. I am welcome to follow my conscience all I want, but as with conscientious objectors throughout history, I have to be willing to accept the consequences of my actions.
This whole idea of "elective services" is a straw man invented by the commenter. He has also frequently used the term "medically indicated". The health professions each have their own responsibilities. There exist in medicine standards of care, which guide the way we take care of patients. We provide preventative services, and we treat diseases. We follow the science-based guidelines of our professions. Not everything we do is a directly life-saving intervention. For example, if someone has a backache, I can choose to tell the patient to take a motrin, or I can tell them to suck it up. Neither recommendation will change the course of their illness---the back will heal in a few weeks with either approach. One of these may in fact provide more comfort, so it is the better choice in most instances. Was it "medically indicated"? Was it "elective"?
But those who argue for conscience clauses don't usually want to deprive people of motrin; it is almost about women's health---contraceptives, Plan B, abortion. All these things are "medically indicated" in that when used properly, they are part of the standard of care. If I prescribe an oral contraceptive to a male, that is most definitely NOT medically indicated.
Now, some folks would like to dodge this whole ethical issue by simply making any medications that they aren't comfortable with available over-the-counter. This way, a woman can simply walk into the drug store and buy contraceptives without any interference. This is a terrible idea. Dodging ethical questions rarely solves them, it simply creates more layers of problems. If we were, for example, to make OCPs over-the-counter so that pharmacists wouldn't have to be bothered dispensing them, we would be depriving women of the crucial counseling and advice that they can get from their physician. OCPs are not all the same; patients are not all the same. Further, the patina of discrimination raises the bar on justification---if you are going to act in a way that disproportionately affects a particular group negatively, your actions deserve special scrutiny.
When encountering an ethical problem in health care, you have to look it right in the face---dodging it only creates more problems. The most important needs in health care are those of the patient. That isn't to say that providers don't have needs, simply that their needs are of a lower priority than those of patients. And if you wish to exercise your rights of conscience at the expense of your patients, you can do so---but not without consequence.
I've written a number of times how blindingly stupid and irresponsible Deirdre Imus has been. Now, Don Imus has revealed he has prostate cancer, and he is apparently surprised. According to ABC News, "he was surprised by the diagnosis because he had been following a healthy diet for the last decade." He also stated that, "... it was all the stress that caused this."
I'm not nearly as surprised as Mr. Imus. Prostate cancer is the malignancy most closely correlated with age (and of course, gender) and estimates are that between 14-70 % of men his age may have prostate cancer (occult or apparent). As to his healthy lifestyle, studies have failed to show any strong correlations between prostate cancer and "lifestyle". One of the largest studies to date on dietary supplements and prostate cancer (SELECT) failed to show any reduction in prostate cancer with vitamin E and selenium supplementation.
Imus's surprise at his diagnosis is a common feeling. When someone is diagnosed with cancer, they often feel the world falling away around them. It doesn't really matter if it's a "good" or a "bad" cancer--the emotional effect is usually the same. So, Imus's surprise doesn't, er, surprise me.
Hopefully (and I'm not counting on this, mind you), he will do a little reading and communicate to the public the facts about prostate cancer. It is a disease of age, and it is often said that any man who lives long enough will have it. It is also often said that most men will die with it rather than from it. Still, it is an important cause of morbidity and mortality, and since we don't have a great way to screen for it (meaning we don't know what PSA results necessarily mean) more research is being done.
But the little devil on my shoulder can't help wondering if, like Mrs. Imus, he will bring the stupid. I wonder if he will opt for "alternative" therapy, and when his cancer doesn't kill him, give credit to the herbs rather than to the fact that most prostate cancers won't kill you.
By the way, you can start reading about prostate cancer here.
Over at Neurotopia, Scicurious has been doing some terrific writing about depression. Mental illness is a topic I've written about many times, so I was inspired to look into the vault and see what kind of goodies I had back there. Well, since I truly loathe people who dole out dangerous medical lies, I figured it was time to dust off this little bit on Scientology and mental illness, rework them a bit, and share them with you again.
Depression, in the medical sense, is not a mood...it is a severe
disorder originating in the brain, and affecting the entire body. Major Depressive Disorder is the leading cause of disability in the U.S. for ages 15-44,
but can begin at almost any age. Depression affects health in many
non-obvious ways. People with depression have a higher risk of suicide,
but the disease may also lead them to take poor care of their health.
Depressed patients may forget or chose not to take medications, see
doctors, and eat well.
There are plenty of online resources for depression, especially at the NIMH,
so I won't go into details of diagnosis and treatment. What I find
disturbing is that there is a small but significant movement that
denies that mental illness is "real", whatever that means. There seem
to be many flavors of this denial.
Bringing the stupid
Perhaps most influential of the denialists are the Scientologists, who have
utterly insane unusual beliefs about mental illness. For those of you who don't yet know, mental illness, according to Scientology, is caused by "the reactive mind and its engrams."
That is, unconscious, unpleasant memories, that must be purged via the
expensive system of "auditing". Sounds a little like traditional
Freudian psychology, right? Um...not so fast.
What is the great theory behind this? Neuroscience? Well, no. It has
been discussed so thoroughly elsewhere, so I won't belabor it, but
Scientology's beliefs are based on the idea that extraterrestrial
tortured souls possess us and cause mental illness. Really. Just google "Xenu".
Of course, this process is not only good for mental illness:
I had asthma, and it was actually pretty traumatic.
I woke up in the middle of the night and couldn't breathe at all. Then
I learned about Dianetics and I read the book. My friend and
I did it on each other and it wasn't too long before I realized I
wasn't having any attacks. It was GONE. It's now been fifteen years and
I haven't even wheezed. It's a miracle.
Woo! A testimonial!
So, if you buy their books, follow their program, you can be, well,
pretty much perfect. I'm sure everyone is lining up at the Church of
Scientology to be cured of their maladies, mental and physical, right?
Umm..well, no. Why not? It turns out that Scientologists are persecuted world-wide, by governments and the "psychiatric community".
But in a bizarre turnabout, these poor, persecuted (and asploded) souls will sue you. Really.
Scientology has a long history of suing people for revealing their
"secrets" and mocking them.
Those sneaky Scientologists!
OK, so Scientology seems like an easy target, and with all the publicity you'd think their views on mental illness would have been laughed off the planet (on a DC-8?) for good. But those Scientologists are crazy, not stupid, so they created a front organization.
It's called the "Citizens Commission on Human Rights". It's motto is "investigating and exposing psychiatric human rights abuse". Who is this "commission" and what is their beef?
A good place to start is on their info page. Hardly a paragraph goes by without a falsehood or logical fallacy.
First of all, I'll skip the cute SciFi-ish adds on the margins of
the page with headlines like "Psychiatry: Industry of Death." Hyperbole
of that degree should be, well, discouraged.
The Citizens Commission on Human Rights (CCHR) is a
non-profit, public benefit organization dedicated to investigating and
exposing psychiatric violations of human rights. It also ensures that
criminal acts within the psychiatric industry are reported to the
proper authorities and acted upon.
It starts out as a simple statement of fact (non-profit, etc.),
then, makes a subjective statement about their purpose which suffers
from the logical fallacy of "begging the question":
it assumes that there exists significant psychiatric abuses and crimes.
Nowhere on their site can I find actual evidence of widespread crimes
by psychiatrists, nor do they link to any specific "report[s] to...proper
authorities". This paragraph may be a lie, or it may be making truthful
claims, but failing to support them.
CCHR was founded in 1969 by the Church of Scientology
and the internationally acclaimed author, Dr. Thomas Szasz, Professor
Emeritus of Psychiatry at the State University of New York, Syracuse.
The Church of Scientology, as we've seen, is a bizarre cult that believes human
suffering originates in "engrams" implanted on Earth by an evil
galactic overlord named Xenu, so that pretty much eliminates any
credibility this organization might have. Then they use the inevitable "appeal to authority".
Dr. Szasz is known not for his positive contributions to the field of
psychiatry, but for his incoherent rants that fail to propose a viable
alternative to current practice.
The entire premise of the organization is bizarre, and it is a poorly masked front for the morally indefensible anti-mental health activities of the Church of Scientology. Most of us have seen the bizarre behavior of Scientology's most public adherents, and I can't help wondering if this whole mental illness denial is a convenient position for these meshuggeners to take. I'll leave further speculation to you.
According to Operation Clambake, it's not a bad idea to say the following: All
quotations of copyrighted material herein fall within Fair Use
guidelines. Note: The Scientology organization is commonly referred to
as the Church of Scientology. The reader should be aware that, in
reality, global Scientology is a complex international legal structure
of multiple corporations, some of which are nonprofit and some of which
terms "Scientology" and "Dianetics" are trademarks and service marks
owned by Religious Technology Center (RTC), Los Angeles, California,
USA. For a detailed explanation of Scientology's copyrights,
trademarks, and other legal issues involving the names and symbols used
by the organizations collectively known as "Scientology" and
"Dianetics," see the Trademark Section of the Official Scientology Web Site.
I woke up yesterday morning feeling almost rested, but something was missing. During the week, I don't have time to have coffee at home, but on the weekend, I love to brew a pot and slowly enjoy it while reading my Sunday feeds, writing, or putting together the PalCast. On this morning, I was to be disappointed. Our kitchen is no more, having been fatally wounded earlier by water damage, and now having been completely removed in preparation for rebuilding. As a consequence, I have nowhere to grind and brew my coffee. Not to be deterred, I brought PalKid her breakfast and took off for the cafe. I love going to cafes, something that has become rare for me. I sat down with a mug of joe, took out my laptop, and started working on my podcast.
Two hours later, I realized my daughter was probably ready for lunch (no, she was not home alone; it was my wife's turn to sleep in). I came home and found her comfortably settled in front of the TV. She had managed to dress, in a way---she was wearing brown wool tights with various designs on them and a black and white "peace sign" t-shirt. I felt terribly guilty, having let my child sit in front of the TV for several hours, brain slowly melting. I felt I should take her for one of our hikes, but I was so damned tired. We cuddled for a while, and it was wonderful, but my guilt grew. Finally, her cousin came over to play. At that point, she noticed how nice it had become outside (she reminded me that it was only six more days until Spring). The neighbor's kids came over, and she ended up playing tag, swinging, and running around for hours (without a coat!).
I think I can deal with my guilt now. I hate being so tired that I can't take my daughter for a hike. There's nothing like watching your kid discover the outdoors, especially on the first nice day of the year.
Thankfully, I don't receive all that much blog-related mail. But this weekend I received several communications about a piece in popular liberal blog. The piece is (ostensibly) about Lyme disease, which coincidentally happens to be one of the topics of my first post here at SBM. In fact, I've written about Lyme disease a number of times, and Dr. Novella has a very good summary of the controversy at one of his other blogs. Since we've discussed this so many times, I won't be reviewing the entire controversy, but looking at this particular blog post to examine how our personal experiences and errors in reasoning can distort our view of reality.
The topic of Lyme disease has come up recently in the press, and as the weather improves, cases in the northeastern U.S. should start to increase soon. Just as a reminder, so-called "chronic" Lyme disease is not Lyme disease at all. Lyme disease can have early and late manifestations, none of which correspond to the vague, protean symptoms labeled as "chronic" by some. The disease is often diagnosed without resort to objective evidence, such as reliable, positive lab tests. But let's look at the blog post in question and see what's there.