Archive for: July, 2009

No, I'm not tipping over

Jul 22 2009 Published by under Narcissistic self-involvement

If you look to your left, you may notice me paddling a black and white cedar-strip and canvas canoe. I am not about to dump into the water---the "lean" is proper solo canoeing posture. A few years decades back, I was the canoeing director at a Canadian summer camp and taught hundreds of kids how to paddle a canoe. Since this is a "science blog", I'll explain this awkward-seeming posture to you.
The proper position for traditional Canandian-style solo paddling is half-way between the bow and the stern, leaning to the side you paddle on, preferably on your knees. The lean itself accomplishes two things: it brings you closer to the water, making paddling easier, and it lifts a substantial portion of the hull out of the water. Less hull in the water means less resistance to forward motion and to turns. You kneel, rather than sit on the (decorative) seat so that you have a low center of gravity and wide base of support---canoes are rather tippy vessels.

Once seated thus, paddle in hand, you can achieve complete control of the canoe. The position described puts you at the fulcrum of the canoe, and your paddle is a powerful lever. To pull your paddle straight into the canoe is called a "draw" (the opposite of a draw stroke is often called a push-away). If you draw right at the fulcrum, you will move (approximately) sideways. If you reach behind you and draw, you will pivot the stern of the canoe toward your side, turning the canoe to the "outside" (away from your paddling side). Reach forward and draw, and your canoe pivots the other way. You may wish to refer to my well-rendered schematic.
canoe mechanics.JPG
Understanding the pivot allows you to move forward in a straight line without switching sides. A standard forward paddle stroke (known as a "bow stroke") turns you to the outside and makes you look rather silly if your objective is forward motion. A deceptively simple twist of the paddle at the end of a bow stroke turns it into a J-stroke. The end of the J-stroke is a "push-away", so the first part of the stroke turns you to the outside, the last part pivots you back to the inside. When executed well, the result is smooth, forward motion.

While achieving perfect control of the canoe may take a while to master, the basic concepts are reasonably simple and easy to build upon. For example, when paddling into a strong wind, it often helps to move yourself forward in the canoe, allowing the bow to "cut" through the waves (also increasing the drag so that the wind doesn't push you around---a sort of "flag in the wind" phenomenon). With the fulcrum moved forward, however, you must reach much further backward with your J-stroke in order to go straight.
With just a wee bit of science, you can figure out how to make a canoe do what you want it to. How cool is that?

18 responses so far

What's up with Michael Jackson's doctor?

Jul 22 2009 Published by under Medical ethics, Medicine

Since I abhor the entombment of real news beneath the Michael Jackson story, I didn't think I'd be posting about it, but here I am. You see, Jackson was reportedly under the "care" of a privately hired physician when he died, and was being treated with medications not normally used outside the hospital. I have a problem with this.

According to the Times
, authorities are looking for records at the doctor's Houston office. That's not a bad idea.
I'm not a lawyer, and I don't know if: 1) the doctor was licensed to practice in California, or 2) if a doctor from Texas may practice in California on a Texas license (doubtful). Certainly, a doctor may render emergency care to someone, one human being to another, but the use of injectable medications such as propofol and merperidine in an unmonitored setting seems pretty outside the norm no matter where your license is from.
In order to practice medicine legally in my state, I must hold a valid physician's license, a valid controlled substance license, and in order to prescribe medications, a valid DEA license. In order to avoid disciplinary actions, I must also practice in a way congruent with standard medical practice, for example, maintaining proper documentation. The specific section of the Public Health Code says:

An individual licensed under this article shall keep and maintain a record for each patient for whom he or she has provided medical services, including a full and complete record of tests and examinations performed, observations made, and treatments provided.

If this doc was treating Jackson, he should have been recording Jackson's complaints, his own physical exam findings including vital signs, medication administration including amount, route, and timing---really, everything. This is Medicine 101. Of course, if he was practicing without a valid license, who knows what kind of paper trail he would or would not wish to have.
In the news crapnami that is the Michael Jackson story, one useful lesson might be learned; that of the fatal intersection of power, fame, and medicine. It's not a new lesson, but one that may require quite a bit of repetition. Unfortunately, I think we will have many future opportunities for review.

5 responses so far


Jul 21 2009 Published by under Fatherhood

Having a daughter in my late 30's, I began my fatherhood journey a bit later than many. I don't have much to compare it with, but I do wonder how I'm going to keep up with the little princess. Mrs. Pal got us a Trail-a-Bike for Father's day---that's one of those "half bikes" you hook up to your own, effectively creating a tandem bike. PalKid can hold on and peddle if she feels like it. That's a serious workout. When we were up north, I dragged her everywhere (and vice versa) and she dropped off too sleep nice and early every evening (which I wish I could have done, but 7:30 is pretty weak for a grown up).
Yeah, for now, I'm still physically her better (aesthetically, not so much), but I know she'll pass me pretty soon, and it'll be me whining about climbing up the hill to the cabin.
But I'll never ask her for "uppie".

11 responses so far

Open Letter to Fred the Pool Nazi

Jul 21 2009 Published by under Narcissistic self-involvement

Dear Fred:
First, I'd like to thank you for guarding the integrity of the swimming pool in my folks' neighborhood. I know they feel safer because of you.
On that proud day twenty years ago, the day they handed you the thin cotton t-shirt with the banded collar and sleeves that reads "Pool Monitor", who could have known the proud years of service that would follow? I know I couldn't have because I was in college writing a paper on The Authoritarian Personality (classic Adorno, you should read it).
Your recent service is to be especially praised. When my wife fell asleep in the sun by the pool, enjoying a brief moment of peace away from family, work and other worries, you made sure to check on her. You made sure that a man she's never met came up to her, woke her up, and interrogated her, which, I'm sure, was for her own good.
I must say though, that I'm a bit disturbed. You asked her, as she rubbed her eyes and looked around to see if anyone else was nearby, her name, where she lived, what car she drove, whether she had kids---you asked all that but you forgot to ask her social security number. I'm fairly certain you can do better.
When she asked to be left alone, when she was clearly nervous about a strange man approaching her and wagging a finger in her face, you made sure to reassure her of your status as an authority finger by standing over her, wagging your finger more vigorously, and showing her the now-tattered shirt that is your badge of office.
I'm sure it was only a small oversight on your part that, when she could not get you to go away and had to make up a story about being pregnant, you didn't ask for a copy of the lab report, or better yet, take a look at her cervix. Fred, I know you can do better.
I feel bad that I could not have been there to see your performance, as I would have had some specific words, and perhaps actions, in response to the service you performed, and while some might have considered these potential actions to be a bit of an over-reaction, I can assure you that they are less than you deserve.
So, Bravo! Fred. Well done. My wife now feels uncomfortable at my parents' pool, especially when alone. Keep up the good work---it would make my day.

9 responses so far

DSHEA: a travesty of a mockery of a sham

Jul 20 2009 Published by under Absurd medical claims, Medicine

In 1994, Congress enacted the Dietary Supplement Health and Education Act (DSHEA). This act allows for the marketing and sales of "dietary supplements" with little or no regulation. This act is the work of folks like Tom Harkin (who took large contributions from Herbalife) and Orrin Hatch, whose state of Utah is home to many supplement companies.
DSHEA has a couple of very important consequences (aside from filling the pockets of supplement makers).

Continue Reading »

38 responses so far

Caritas, tzedakeh, etc.

Jul 19 2009 Published by under meta-blag

One of my Sciblings, one Ethan Siegel has issued a charity challenge. If one hundred commenters head over to his place and leave a comment assuring him that they will donate 10 USD to the charity of their choice, and name the charity, he will cut off his luxuriant locks.
Please, do it. His hair has, like, its own zip code or something.

No responses yet


Jul 19 2009 Published by under Narcissistic self-involvement

Yes, this post is a repeat from long ago, but I was reminded dig it up after reading a piece at a friend's blog. Thanks for indulging me. --PalMD
If Bob Dylan provides the soundtrack for much of my life, then coffee provides the "smelltrack". I did not start to drink coffee until I was about 20. My best friend of 18 years told me I should learn to, as I might need it. He also told me to drink it black, because I might not always have cream and sugar, but I still might need the coffee. So, I started to drink it. Now, this was terrible coffee...institutional, stale, sour, just generally bad. And the coffee revolution of the 90s had not yet hit. I had nowhere to go but up.

Continue Reading »

13 responses so far

PalCast 13: Medicine, Communication, Quackery, and Death

Jul 19 2009 Published by under PalCast

Yes, the new PalCast is finally up. Get it through the feed or on iTunes. Perfect for 18min30sec car rides!

6 responses so far

Unscientific America: When being right isn't enough

Jul 17 2009 Published by under Book reviews

If you've dipped even one toe into the science blogosphere lately, you've seen discussion of Chris Mooney and Sheril Kirshenbaum's new book, Unscientific America: How scientific illiteracy threatens our future. I have very little interest in the arguments currently raging but not because I don't care. The book makes interesting arguments, some of which I agree with, and some of which I don't. More important, however, is that the authors have a track record of being listened to (cf The Republican War on Science). In a crisis that involves communication (i.e. of scientific knowledge), it would be foolish to ignore people who have proved themselves in that realm.
M & K make a convincing argument that scientific information is not being communicated effectively to "real people". I will stipulate that scientific knowledge is at least as important now as it has ever been, and that there is a gap in understanding between scientists and the lay public. For their thesis to have any utility, this must be true. Whether this gap is unique to our culture and our time is less clear to me, but the basic problem remains.
I agree that there is a, "need for scientists to communicate their knowledge in ways that non-scientists can relate to and understand." I also agree to an extent that, "scientists [often] fail to connect with top decision makers" (which intersects with, but is different from, the lay public). Where they lose me, but only a little, is with the assertion that we must, "break down the walls that have for too long separated the "experts" from everybody else." For better or for worse, we need experts, and some barriers are insurmountable. Not everyone (including me) can understand how to design a microprocessor. I must in some way trust those that do. Those that investigate and design our world must be trustworthy in the eyes of the rest of us, and to the extent that this is the "wall" they are writing about, I'm with them.
In medicine, this idea of "expert-ness" is critical. It is a constant frustration for some lay folks and others that medicine requires special knowledge, and quacks capitalize on this by sounding "expert-y". But doctors--and scientists--have special knowledge, special skills, and special creativity not possessed by all the rest of us, and to pretend that it isn't so is dangerous. Still, we could put some portholes in that wall, dig some tunnels, create effective communication. But I'll always have to trust the astronomers if they tell me object "x" is made of neutrons or whatnot, because I'll never have the skills to see for myself.

Continue Reading »

17 responses so far

Are we insane?

Jul 16 2009 Published by under Medicine

An old medical joke goes like this:

An oncologist goes to check on his patient, a 90 year-old man with Alzheimer's disease and metastatic pancreatic cancer. The doc is about to start him on a new round of chemo, but when he goes to the patient's room, he's not there.
He demands of the nurse, "Where's my patient?"
"He took a turn for the worse and was transferred to the ICU. He looks like he's reached the end."
"My patients don't just die!" he says as he picks up the bag of chemo and marches to the ICU. When he gets there, he asks the charge nurse where he can find his patient.
"I'm sorry, Doctor, but he's gone. He was just at the end of his road."
"But where is he?"
Thinking the doctor wanted to pay his last respects, the nurse told him, "Connell Brothers Funeral Home."
The doctor picked up the bag of chemo, got in his car and drove to the funeral home. When he arrived, he marched up to the funeral director and said, "Where's my patient?"
"He's in the viewing room, sir."
The oncologist marched into the viewing room with the bag of chemo, ready to hook up his patient...but the casket was empty.
"Where's my patient?" he asked of the man in the suit.
"I'm sorry, sir, he's in dialysis."

Americans are, in general, people of faith. We believe in certain principles, such as freedom, liberty, and equality. Most Americans even believe in an unseeable, unknowable being in the sky. But there is one thing most Americans do not believe in---death.
Death is as foreign to Americans as sub-compact diesels, siestas, or socialized medicine. Anyone who works in a hospital knows that the intensive care unit is full of patients who should be dead. They are hooked up to breathing machines, kidney machines, machines to pump food into their stomachs, etc. They have a near-zero chance of meaningful recovery. Still, families often demand of doctors that we "do everything".
But "everything" is a pretty vague idea. No one wants to feel responsible for the death of a loved one. If you ask someone, "do you want us to do everything or to let them die," the answer will usually be, "do everything." End of life issues need to be addressed early and often. We need to impress upon our patients that death is where we are all headed, and it can only be evaded for so long.
I had a patient once who had a history of kidney cancer. She was supposed to get yearly CT scans to check for recurrences. At the age of 76, she also had severe heart failure, but it rarely bothered her. Still, heart failure like hers carries a high risk of dropping dead. On one visit I asked her when her last CT for the cancer was. She said, "do you really think I need it?"
"Well, if you have cancer in there, the scan will find it. Removing it early can give you a lot more time."
"Doctor, you do realize that I'm not going to be alive to worry about it, don't you?"
No one likes to face mortality, but it's still there. Part of health care reform must be "culture reform". We need to remind ourselves that just because we can do something doesn't mean we should. But how do we make these decisions? How do we decide to withhold dialysis from someone? Based on life-expectancy? Quality of life? Religious preferences?
None of these questions has easy answers, but other countries have some pretty simple approaches. They recognize that no matter how much you spend, no matter how much you do, everyone dies. The death can come at home surrounded by family, or in the hospital sucking up resourced for futile care. These choices aren't really as hard as they seem. We have data to guide us, and quite honestly, if more Americans saw what goes on at the end of life in a hospital, we'd have a lot more empty beds.

28 responses so far

« Newer posts Older posts »