Tales from the helicopter

Tales from the Helicopter: A really crappy way to start the week

oracknows — Fri, 10 Mar 2017 08:30:06 +0000

Tales from the Helicopter: A really crappy way to start the week

[NOTE: As I mentioned yesterday, our power outage continues, and, thanks to having to decamp to a hotel last night, I didn't have time to produce new Insolence. So I thought I'd repost a "classic" from 11 years ago that I don't believe I've ever reposted before during vacation or otherwise. It represents a sort of blogging that I haven't done for years, just a personal story with nothing to do with my usual topics, such as pseudoscience, quackery, clinical trials, and basic science. This story is based on a real patient encounter from around 25 years ago, but details have been changed.]

I don't recall if I have mentioned this before on the blog, but for about two and a half years when I was doing my graduate work in the laboratory back in the early 1990's, I moonlighted as a flight physician with a helicopter medical transport service in Cleveland. This is probably about the most interesting thing about my life, and it never fails to cause listeners' ears to perk up when I mention my brief time trying to make like Tom Cruise in Top Gun (you know, before he went all mental on us) and swooping in to rescue patients. Of course, the actual experience wasn't exactly like that (although most of the helicopter pilots were ex-military, many with combat experience in Vietnam, and, on occasions when we had to go out for public relations runs (kids just love checking out a real helicopter), they would be sure to do an impressive swoop over the crowd both before landing and after taking off but before leaving, a maneuver which had a tendency to cause my face to turn a rather sickly shade of green. Most unlike a fighter pilot. Those were good times.

But in reality, this job was usually 80-90% boredom (sitting around the call room waiting for calls, often killing time reading journals or playing around on Usenet--believe it or not, this was before Netscape and before the wide availability of access to the web), 10-20% drudgery (routine runs transporting patients who weren't unstable, runs that made me feel more than anything else like a glorified babysitter in a spiffy flight suit), and 1-2% sheer terror. Let me tell you docs out there: You haven't lived until you've tried to do chest compressions in a cramped helicopter in the middle of flight on a windy day, just you and the flight nurse, without the usual crowd of helpers that descend upon codes in the hospital. Shifts were typically 12 hours long from 7 AM to 7 PM or 7 PM to 7 AM, and, because I was the moonlighter, I usually got the night shifts. The level of activity ranged from not getting a single call (and, bliss of bliss, getting to sleep all night) to going on a run shortly after arriving for my shift, going on run after run without making it back to base until quitting time or even later. The worst runs of all, the ones that I always dreaded, usually came in near the end of a shift, at 5 or 6 AM. They were almost always very bad, and not just because they'd guarantee that I wouldn't be getting off work on time and making it back to the lab by a reasonable hour in the morning.

This run was definitely that.

It was early on a Monday morning in late summer. I hated doing Sunday night shifts, mainly because right after finishing the shift I'd have to go straight to the lab and work another 12 hours or more with no break. This was long before the days of 80 hour work weeks. I learned things going out on helicopter runs that I'd never have learned otherwise. I also learned things about myself that surprised me, not the least of which was the very fact that I actually could do the job, something I doubted when I first signed up to do it because it was the thing that nearly all the surgery residents did when they were in their lab years. There had only been one run that shift. Fortunately, it had been a routine cardiac run. We had picked up the patient at a small community hospital and transported him to the cardiac Mecca down the street from the hospital that was home base to my residency program, deposited him safely in the CCU, and headed back without incident. I had plopped down on the less-than-plush bed in the physician's call room and promptly started sawing logs.

Only to have my blissful sleep shattered by the shriek of my pager. I fumbled for my glasses and looked at the clock. 5:30 AM. Shit. That means I'll be late getting back. I grabbed my bag and hat and stumbled out the door to be met by my nurse, the pilot, and his copilot, all of whom were making their shambling way towards the helipad. We all got in, and soon the engine fired up, the rotors started spinning, and the bird started to shudder as it strained against gravity. Over my headphones, report was coming in. Apparently this was a single car MVA (motor vehicle accident), with a single victim, a young female, who was reportedly unconscious at the scene. That's all we knew as we roared off into the pinkness of the just pre-dawn sky. In the back of my mind, I thought about my fellow residents back at the County Hospital and how grateful they would be for my bringing them a new customer right before their shift change at 7 AM. (There were two trauma teams, and switchover time between the two of them was 7 AM; again, this is before the days of the 80 hour work week. When we did trauma, we did 24 hours on, 24 hours off, for up to two months at a time. And it wasn't exactly 24 hour on, but more like 30, because we had to round and make sure all our patients were tucked in before we could leave for the day, and once a week there was a 4 PM conference that we were expected to stick around for, even if it was our "day off.")

As we circled the site, which was a parking lot near the two lane road on which the crash had occurred, we learned more. Apparently, the car had gone off the road and hit a tree at high speed. Usually, given the time of day, a crash like this occurs because the driver fell asleep at the wheel. We also learned that her blood pressure was very low, and she was unresponsive. All exhaustion left me. In fact, I was keyed up so high that I had to briefly talk myself down and remind myself that my being that nervous would do no one any good, least of all the patient. The entire flight took less than 10 minutes, as we were not far from the scene, and I knew from experience that it would probably take about 10 minutes to get back to the County Hospital, the regional Level I trauma center.

The helicopter landed on a section of the parking lot that EMS had marked off. We were out before the rotors stopped spinning, heads held low as we ran awkwardly towards the ambulance, the wind pushing down on us hard. EMS pointed to the ambulance, meaning that they had already gotten the patient into the ambulance and were working on her there. We headed that way. Out of the corner of my eye, I saw the car, a small vehicle that I could not identify, so twisted it was against a tree.

We arrived.

There, in the back of the ambulance, two EMS workers were a blur of action. I looked at the monitor. Not good. BP 70/40, pulse 120. Two large bore IVs were in and fluid was pouring in. One of the workers was at the head, trying to intubate the girl, who had been immobilized on a backboard with a cervical spine collar and whose face was covered with blood from an enormous scalp laceration. Her clothes had been partially cut away to allow the placement of EKG leads and a blood pressure cuff.

"I haven't been able to get it," he informed me.

"Let me try," I said, and jumped into the back of the ambulance, not feeling at all confident in my ability to do an intubation under such conditions. Around there, most paramedics in units trained to do it were pretty good at intubating, and if they couldn't get it I had serious doubts that I could do it. I sincerely hoped that I wasn't forced to do a surgical airway (cricothyroidotomy. Fortunately, they were still able to bag her, and her oxygenation was acceptable.

I could see why he was having problems. She had swallowed a lot of blood and had facial fractures, and the suction wasn't working well. I swallowed, grabbed the laryngoscope, and gave it a go, while my nurse did her assessment.

"Crepitus on the right, muliple rib fractures. Heart sounds weak. Breath sounds decreased on the right."

Even as I was working to secure an airway I instructed her to get a chest tube setup ready. Given the blood pressure, though, I realized that the patient might be better served by us just getting her intubated and getting her on the helicopter, our version of a "scoop and run." Putting a chest tube in in the helicopter to drain the blood and reexpand her lung would be a pain, but if she was bleeding from other sites the delay to get the chest tube in could mean the difference between life and death.

Under ideal circumstances, intubation is not that difficult. You take the laryngoscope and gently lift the base of the tongue and epiglottis to reveal under the light of the scope the vocal cords, doing so without cranking on the teeth. When you see the vocal cords, you take the endotracheal tube and put it right between them into the windpipe and then gently blow up the balloon to seal the space between the tube and the wall of the trachea. Under conditions like these, where you can't bend the neck for fear of causing paralysis if there's a cervical spine injury, there's blood all over the place pooling in the back of the mouth, and space is limited, intubation can be a major challenge.

Fortunately, and much to my relief, this time it was a challenge that I was up to. I had had my doubts.

Once it was clear that the tube was in the right place and that we were able to ventilate the patient, I decided that we should get her on the helicopter. We were gathering our supplies and preparing to move her when it happened.

"Doc," one of the paramedics said. "I can't get a pulse or blood pressure."

We all looked at the monitor in unison. No rhythm. Shit.

We began chest compressions, and one of the paramedics charged up the defibrillator while another one quickly cut what clothing remained covering her torso and placed conductive pads on her chest. I grabbed the paddles.

"Clear!" Everyone moved back momentarily.

Electricity caused the girl's body to shudder, as if she were plunging her chest at the life-giving electricity.

Still no rhythm. I turned up the juice slightly according to ACLS protocol and charged up the paddles again. Shock. Still no rhythm. I did it a third time. Nothing. Double shit.

We began chest compressions again and continued the ACLS (Advanced Cardiac Life Support) algorithm, administering drugs sequentially, followed by shocks. I plunged a 14-gauge IV catheter into the right side of her chest in case she had a tension pneumothorax from all of her rib fractures. There was no rush of air and no change in her vital signs (or lack thereof). We kept working, with chest compressions, interrupted by the administration of drugs and shocks. We ran to the helicopter, doing chest compressions all the way. A cardiac arrest after blunt trauma is almost always not a survivable event. Even for a witnessed arrest after blunt trauma, the odds of reversing it and saving the patient are very small, particularly in the field. We had to try, and try we did, but none of us had any illusions about our chances for success, as the helicopter took off. Even so, getting her to the hospital was the only hope she had of survival, no matter how slim that chance was. We continued CPR and the complete ATLS (Advanced Trauma Life Support) protocol the entire way to the hospital.

When we arrived, we did a rare hot unload (usually we waited for the helicopter rotors to come to a complete stop before unloading the patient) and moved to the elevator, one of the nurses standing on the bottom part of the gurney continuing chest compressions, and straight to the trauma bay, where the assembled team was waiting to pounce.

"How long has she been down?"

"Twenty minutes."

The trauma team took over, and I became mostly a bystander, pushed to the side and no longer needed, having discharged my function. Discarded. I was used to it, though. In this case, I was actually almost relieved. After all, my function was to get the patient to the hospital in as good a shape as I could, after which all that was left was some quick paperwork and then back to the base or on another run. I moved to a counter where I could work on my paperwork and still see what was going on in the trauma bay. (Even the worst human disasters that I saw and transported had to be reported dispassionately on the same form every time.) Meanwhile, a whirlwind of activity swirled about the patient, with shouted instructions rising above the fray every so often. They worked another 20 minutes with no success. 40 minutes without rhythm, even with effective CPR, was hopeless. It was time. Her pupils were fixed and dilated.

"Call it," the E.R. attending said to the trauma chief resident.

"Time?"

"6:40 AM."

The crowd that had been either helping or watching dissolved away, leaving only the girl, blood and discarded wrappings strewn about, and the nurses who had the unpleasant job of cleaning up the body and preparing her for the morgue. It became very quiet. The housekeeping staff moved in to begin to clean up, to make the trauma bay ready for its next occupant, whose outcome, we all hoped, would not be so tragic. I watched as they worked. The girl was so young, no older than college age if that, and so still, the endotracheal tube protruding from her mouth, no longer hooked up to anything. She was so young. Her blood alcohol level had been reported as zero; so this wasn't a case of her having been out partying all night and then cracking up her car. As I later learned from a nurse who had called her parents to come to the hospital while the trauma team had still been working on her, she had been on her way to work at her summer job at a nearby campground. She had been planning on starting college in a mere few weeks. I wondered if she had brothers and sisters. A boyfriend, too, maybe. If not for one moment of weariness, she had every reason to anticipate a long life, complete with a fulfilling career, marriage, and children.

No more. The universe is certainly a cold, uncaring place at times.

It was a hell of a way to start the week. But at least I knew I would be going home later. And my wife would be there. After we got back to base, I loaded up on coffee before daring to get into my car to drive to the lab. No one asked why I was so untalkative that day.

oracknows Fri, 03/10/2017 - 03:30

Categories

Medicine

Good reading, I didn't know this side of you. EMCrit did a similar post recently, good stuff likewise:

https://emcrit.org/podcasts/golden-rule-by-ashley-liebig/

I know that "untalkative" feeling. In a former life, I too dealt with matters of life and death. Keeping a clinical perspective helped, mostly, until one time it really didn't. My significant other could tell that there had been a bad case when I all but went mute. A week went by before I trusted myself to open my mouth about anything other than the most trivial banalities. And then it was good to have that hand to hold, because I did have to say the words and tell the story.

Here's to all the significant others out there who have to listen to the hard and painful tales, even though they didn't sign up for those jobs.

Stories like these need to be told. Partly because the storytellers need to get them out, and partly because the world needs to know that it has people in it who are willing and able to take on this kind of work... even though they're not machines.

These days, my job is much more on the "life" side of those life and death matters, but I remember those times with a kind of fondness. Being the person who steps up to get someone through the worst possible time is rewarding in a way that's hard to describe.

This was well written, Orac, and thanks for putting it out there.

This site needs a better Facebook button than like.

Thank you for the story.

I've said this before and I'll say it again, Orac is the Mark Twain of science blogging.

A copter ride full of emotions.

I believe Travis may have sunk to a new low. Well, it might be a tie with trying to impersonate lilady.

I trained as a neonatologist in the US Army. (in the 1980's when neonatology was relatively novel and had not penetrated far into the community). We had helicopters and were not precluded from serving the civilian community. I remember many helicopter transports to various locales in Washington state (where the weather gan be really grim). I've often said one has only so many helicopter-hours in his lifetime. It is a finite but not knowable number and is not the same for each individual. I know I have used up mine.

Yeah, you'd think a 32 year old man wouldn't be so childish, but I guess it's just Travis J. Schwochert 239 S Church St Endeavor, WI 53930 physical age, not his mental age.

On a hopefully lighter note -

I've had the chance to take several helicopter rides on several different flavors of aircraft, and fortunately, while they were all (mostly) serious, none were as serious as the story told by our host.

The most lighthearted ride (and my favorite) happened in one of those glass bubble helos, also piloted by an ex-military pilot, with combat experience in Vietnam.

I climbed in, . I jumped into a seat that was little more than a lawn chair, shut the door, and "locked" it with a latch more suitable for a screen door, snaped the seatbelt loosely around myself, and said in a cocky voice "show me what this pig can do".

He did.

Can a brother get a preview button?

I believe Travis may have sunk to a new low.

Wasn't he babbling about some sort of 1/t function not long ago?

A pediatric drowning code in ER at end of a 36-hour PICU call shift left me quiet like that. I didn't have anything left in me to go with the attending to tell the family their child had died.

I climbed in, . I jumped into a seat that was little more than a lawn chair, shut the door, and “locked” it with a latch more suitable for a screen door, snaped the seatbelt loosely around myself, and said in a cocky voice “show me what this pig can do”.

He did.

There is a school of thought that claims that helicopters do not fly; they are repelled from the ground by their ugliness. I presume that pilot does not subscribe to that school of thought.

I have a question. I have it on good authority (smarty pants folks on the internet tattling on bad televised medicine - the very best of authorities) that it does absolutely nothing to apply electrical stimulation to asystole and you should never do that, unless you really want to cook the individual in question. However, in this story you talk about the patient having "no rhythm" but still applying regular shocks. Is that different from asystole or have the ACLS protocols just changed that much over the past couple of decades?

Orac. This is doxing. https://en.wikipedia.org/wiki/Doxing

I won't leave this site alone until you substitute my driver's licence number, address, and age with innocuous placeholders.

This is over the line. Johnny and Doug seem to get a kick out of inserting my address, age, and licence plate number whenever possible.

For example this line here from Johnny:

Yeah, you’d think a 32 year old man wouldn’t be so childish, but I guess it’s just Travis J. Schwochert 239 S Church St Endeavor, WI 53930 physical age, not his mental age.

Can be turned into:

Yeah, you’d think a neonatal giraffe wouldn’t be so childish, but I guess it’s just Fendlesworth from Newcastle-upon-Tyne, England physical age, not his mental age.

Doesn't that sound better!

If you just stopped posting, it was cease being a problem.

I've ridden in a helicopter once (scenic flight in Hawaii) and it's an experience I can skip in the future. My uncle (Navy pilot) described landing a Sea King on an aircraft carrier as trying to land on a postage stamp in a bathtub.

My aunt the ER doc has great stories, but she only shares the funny and/or heroic ones (usually). The one about a kid who went to the ER for blue balls was hilarious.

Johnny and Doug seem to get a kick out of inserting my address, age, and licence plate number whenever possible.

I can't speak for friend doug, but, yeah, it's a silly thing that I, in fact, do enjoy. But you have to ask yourself, Travis J. Schwochert, do you enjoy disrupting these blogs more than I enjoy giving you Google-juice?

Of course, if you didn't disrupt this (and several other) blogs with your silly comments, as documented here, http://lizditz.typepad.com/i_speak_of_dreams/2017/02/the-fendlesworth-m… then I'd have no reason to carry on.

If you stop (or our host tells me to stop) then I will stop.

There is a school of thought that claims that helicopters do not fly; they are repelled from the ground by their ugliness. I presume that pilot does not subscribe to that school of thought.

The version I'd heard is that helos don't fly, they just beat the air into submission.

To be honest, I wasn't I wasn't in the mood to discuss the finer points of aerodynamic theory. I was plenty busy trying to cinch up my seatbelt, not grabbing on to the only thing in the cockpit that there was within reach (that happened to be the one thing that the pilot was very clear that I shouldn't touch) and keeping the ear to ear grin off my face (darn it, I was a professional, and it was serious business).

@Brian Seller: it's always been that you don't shock asystole, and technically you still don't. The defibrillator doesn't start the heart rhythm it STOPS the lethal heart rhythm. . . . with the hope a healthy or at least functional rhythm will then start. Something that will perfuse the organs.

Problem is, it can sometimes be difficult to tell the difference between asystole and fine V fib. . . and that you DO shock.

Shocking asystole probably won't hurt, after all there is no rhythm to interrupt. And we're giving drugs along with this that have a chance of working whether they're in asystole or V fib.

Bottom line is, asystole is a fatal non-rhythm. If you do nothing, the patient is dead. So we very often do see practitioners shock it, especially in young people for whom we pull out ALL the stops.

Orac, thanks for sharing this story. It was moving.

@Chris Hickie: I was the primary nurse for a 19 year old illegal migrant worker who got stabbed in the heart. We cracked his chest in the ER, sewed up the hole in his heart, pumped him full of fluids and blood but we couldn't get his heart going again.

We didn't even know his name. He didn't speak English.

After the surgeon called it, I told the charge I was on break and went and sat outside the ambulance bay for 20 minutes. No one said anything to me about it; they just picked up my patients and let me decompress.

I was very glad later to find out the police had found out who he was and contacted the family. It bothered me to think they would never know what happened to their son.

@Johnny, you've not truly flown in a helicopter until one is helping to pick foliage from crevices in the undercarriage.

And yeah, the version I heard also "Helicopters don't actually fly, they beat the air into submission", it was also on tee shirts worn by UH-1 pilots.
Aircraft that had many, many holes that were epoxy patched in the floor, caused by incoming AK-47 rounds in Vietnam.

We also flew a lot in Little Birds (OK, on benches outside of the bird) and Blackhawks. The latter, imbuing me with great faith and trust when we were given a totaled bird for extraction training, which had survived (even if totaled) an RPG round to the fuel tank.
You trust any fuel cell that can take that kind of punishment and the crew still gets to land and walk away from!

Autorotation: Something that is rarely an available option in a military helicopter. No altitude to trade for rotor velocity.

Thanks for sharing that Orac; it does show another side of you.

I'm glad to see that Travis Schwochert is getting irritated over the blowback for his heinous comments and other "hobbies" like stealing usernames and following me around the interwebz making disgusting comments. Travis you are a vile nob and only getting a fraction of what you richly deserve.

I won’t leave this site alone until you substitute my driver’s licence number, address, and age with innocuous placeholders.

You're in no position to make demands sweetpea. Get lost and no one will give you a second thought or mention.

Out of curiosity, I did a patent search using the key words "David Gorski" and "inventor".

There were zero (0) hits.

Surprisingly, there were 5 patents granted to a gentleman whose last name was Orac.

@ Orac (David H. Gorski),

Have you ever attempted to patent something?

If you have, I'd like to read about that "crappy" experience.

You clearly don't know how to search, then. If I'm feeling generous, maybe I'll send you the patent number.

OTOH, it was a gene patent in the 1990s; it was might have been invalidated by the recent Supreme Court decision that ruled that genes were not patentable.

Now that I have Panacea's and Johnny's attention, I'd like to share an introduction that I've created for my upcoming book titled, Healing the Mind - Alzheimer's Disease - Thinking Patents (2008 - 2016).

The brain is an extremely complex organ that defines your uniqueness. As you age, though, your brain may be susceptible to a terrible disease. Alzheimer's disease is the third biggest killer in the developed world after cancer and heart disease. It is considered an irreversible, progressive brain disorder that slowly erases memories and thinking, and eventually eliminates the ability to carry out the simplest of tasks. Medical science continues to make substantial progress in the search for therapeutic interventions and a cure. Since 2008, hundreds of Alzheimer’s-related patents have been granted by the United States Patent and Trademark Office in an effort to eradicate this deadly disease. To better understand these inventions, Michael J. Dochniak has written this informative book to provide an easy-to-read summary of these patents. Within the summaries are inventor-profiles and news articles that are insightful and pertinent. Pioneering and worldly inventors originate from Australia, Chile, England, and Hawaii. At the beginning of several chapters, you will read about one of the early signs and symptoms of Alzheimer’s. Most important, Healing the Mind - Alzheimer’s Disease -Thinking Patents (2008-2016) is about keeping your brain at peak performance as you age.

Any suggestions?

Um, why are you pimping your book here?

Why, I most certainly do have a suggestion for your book, MJD.
Use it as a suppository.

@ Orac,

I forgot, Orac's minions rarely read books unless it's about brewing beer or it's the lasted AARP magazine.

Because RI's major audience is +60 years old there may be interest?

Also, I need to show Panacea that I'm not a cheater and Johnny doesn't have a clue.

OTOH, it was a gene patent in the 1990s; it was might have been invalidated by the recent Supreme Court decision that ruled that genes were not patentable.

They're still listed, though.

Gene patents, eh? Probably be MJD's next book. It'll probably be out next week, unless the USPTO site goes down.

You, or someone you love, may die because of a gene patent that should never have been granted in the first place. Sound far-fetched? Unfortunately, it’s only too real...

Why? Because the holder of the gene patent can charge whatever he wants, and does. Couldn’t somebody make a cheaper test? Sure, but the patent holder blocks any competitor’s test. He owns the gene. Nobody else can test for it. In fact, you can’t even donate your own breast cancer gene to another scientist without permission. The gene may exist in your body, but it’s now private property.

http://www.michaelcrichton.com/patenting-life/

Well, Travis J., I sat in a courtroom a couple of days ago as a Crown prosecutor said "Choice have consequences ...". It applies here.

You have repeatedly come to Insolence as sock puppets, knowing full-well that Orac prohibits that. You have made a nuisance of yourself. You have impersonated other commenters, and attempted to impersonate a much-liked and respected long-time commenter who has passed away. That latter act alone has earned you a huge measure of contempt. You have harassed others. You deliberately set a trap to try to obtain IP addresses from other commenters. You've put our host in a position where he may have blocked legitimate new commenters as a side effect of sparing all of us from you. You've wasted a lot of his time. In short, your conduct has been despicable. If you attempted similar things in physical space, you would very likely find yourself in a courtroom, and on the reserved seat, not in the gallery.

You came back over and over again after I and others began to name you explicitly in comments and others began to both name you and include your address. You didn't protest, but instead made childish replies and still you came back again and again. Why you are now protesting will remain a bit of a mystery, but I'm guessing you have discovered that if you sow a crop, eventually it will be ready to reap. If you plant pot in your own front yard, you can't be too surprised if someone who takes a dim view of such agricultural exploits notices. Choices have consequences.

Your solution, as others have suggested, is simple: stay away. If you really want to come back, knowing full well that the types of arguments you will likely try to make will most probably be refuted most ever time, you might try asking Orac to allow your return, either under your own name or a once-and-for-always pseudonym. If I were in his position, I'd blow you as raspberry and banish you forever, but it most certainly isn't up to me.

I’d blow you as raspberry

Everywhere you dang go -- Promiscuous Pokemon furries.

Suggestions? Why yes! (said in the peculiar voice of the character from The Simpsons

I see Wzrd1 beat me to making reply, but I'll still quote from a 1961 song by Alex Comfort (an actual published author of some repute)

If you really want to know where we think it ought to go,
Well, we'll tell you where to put it if you like.

Quotes, unlike myself, age well.
Notable, the quote doug made was from the year of my birth.

Gilbert@30,

Since when does owning a gene patent turn the owner of the patent into a psychopath?

Alain

When one either has a child rapist as a character, who also has a small penis or one is a journalist of the same name as the character in the literary work and is in a dispute with the literary work's author.
https://en.wikipedia.org/wiki/Small_penis_rule

Also, I need to show Panacea that I’m not a cheater and Johnny doesn’t have a clue.

Hey, we all got needs.

I freely admit that there are times I don't have a clue. In the words of Scott Adams, "Everybody's stupid about something", or if you prefer Dirty Harry "A mans got to know his limitations".

You, on the other hand seem to think that copying Alzheimer’s patents and half a day on Google makes you an Alzheimer’s expert.

He relies upon the fallacy that everything patented is actually useful or effective.
Ignoring things like this:
http://www.museumofquackery.com/devices/devindx.htm

Wzrd1@36,

ouch :)

I will leave Crichton's fertile imagination about doomsday scenarios for his book and instead focus on reality. Psychopath will be psychopath, a$$h*le will be a$$h*le and troll will be troll; no need for gene patent to turn into one of these.

Alain

It was a hilarious episode of literary history.
Or something.

Wzrd1@41,

I agree, the lit critique was found to be at the short end of the stick...

Alain

Hello Team,

Today, I faced an impending disaster in that my oldest brother needed urgent help and has been since weeks (this the reason I'm not as active as I used to here). My brother was getting homeless this Wednesday and I had to involve a bunch of social workers in Quebec's psycho-social hotline to take care of him temporarily while my cousin (who I am living with) will take a work truck tomorrow morning to move out all his furniture here while I prepare the bedroom.

The key point is that, he's been on the move since forever and never lived in a place more than 4 months except a single place where he lived 1.5 year under the most stringent supervision I've witnessed him to submit to (the owner of said place was a cop married to a lawyer and the cop had a good idea of what he underwent into).

Given what I know about his issues, behavior and his psycho-social well-being, I am thinking about possible solutions and their constraint and one of them is that, I have to spend the major part of a day, with him, always available, to help. Yet, I will need to take care of my life, and goals. Given these two opposing constraint, there is one solution: he will have to do the same daily activities as I do. One thing that make it easy is that he submit every minor and major decisions to everyone else because he's afraid to make a mistake and he do make some huge ones from time to time.

I'll be checking this Wednesday (my weekly day off from work) with McGill university's legal clinic to have a contract made that we can sign but the main gist is that, I'll be bringing him to work every day, at least this week and later on, we'll both get back to school (I still need to finish high school despite having went to an university in the past but after high school, we'll both go to a French language university to get a bachelor in the very same field; that'll be part of the contract).

I'm open to suggestions, inputs, questions and ethics related venting but please be aware that I'm 40, he's 43, same disability as me and his situation has been a work in progress for over 100 persons since all of our life.

Alain

To kind of bring this back on topic: My oldest child was a frequent flyer to emergency department of the Children's hospital from his second day of life to just before his third birthday. Twice for seizures (the latter due to a now vaccine preventable disease) and about four times for croup, where he would come in with a oxygen level less than 90% (one time he was examined with some kind of light and camera down his throat to check for epiglottitis, one of the two who examined remarked they were seeing much less after the introduction of the Hib vaccine, which my son was just a few months too old to have received).

During one of the croup trips there was commotion in the ED while we waited for our son to be checked after getting medication and assignment of a room (back then the meds required a minimum of an overnight stay, with him it was usually three days). I stood at the exam room door, but backed away when I saw a gurney being rushed by with lots and lots of blood on the covers that were over a small body.

A couple of years later we moved from our tiny house to the larger one we live in now (location was dictated by real estate prices). It just happens to be under the helicopter flight path to that hospital which is about six blocks away. Every time one flies over I think about the family who is going to have a bad week, month, or years.

Alain, I wish I could help you. I do not know the laws of Quebec, but if they are like they are here there is not much one can do unless they are a danger to others.

If he does not pay the rent for his housing, someone may need to take over his finances. But if it is his behavior, that is another matter... and it gets a bit sticky. Unfortunately my extended family had to deal with this. I am not privy to the details, just to the reactions and comments at family gatherings. Good luck to you.

To all who work in emergecy medicine, in whatever capacity,
I would like to say thankyou.
I very much appreciate the insight the author has given here.
Thanks for reposting it after all this time.

Im gunna put a link up to a video ( actually a historical montage of several
ads specific to motorcar accidents ) that many Australians watched and ( hopefully ) learned
from.
As a commenter above notes, pain and grief often
continue for years.

https://youtu.be/Z2mf8DtWWd8

I’ll still quote from a 1961 song by Alex Comfort (an actual published author of some repute)

Words cannot express my delight in discovering that someone else remembers Alex Comfort (gerontologist, historian of medicine, anarchist, author, poet, general all-round good guy).

Notable, the quote doug made was from the year of my birth.

Get offa my lawn, youngster.

Chris,

Behavior.

Chris,

Furthermore, he's way belong excellent with finance.

Unfortunately unless he is a danger to himself or others, you most likely can do nothing. Our extended family desperately tried to get a family member to use the county outpatient psyche clinics after she was released from the psyche wards in two states... she refused. There was no legal way to get her to take her meds or visit those clinics.

Though she did seek help from a naturopath who used homeopathy. That did not work. The details are not important, but she is buried next to her stepfather. Le sigh.

There is this odd balance between incarcerating a person with mental illness who is harmless versus determining a person with behavioral issues is dangerous. Then the question is who is in danger from this person. Themselves or others, like strangers. No one in our extended family knew our relative was in danger of herself!

Though, if your brother's behavior is such that he poses an issue that caused him to be evicted several times, you might have an argument. Those behaviors need to be documented, and make sure it is not from just one person. This is very important when you need to get help from social services agencies.

I am not a lawyer. I am just part of an extended family that has dealt with this. Plus I have an adult autistic child who got yet another weird letter about his disability benefits today. Oh, wow... just when I think we have all together I get another wrinkle in the system! AAAARH!

My reply is to Alain.

Why is Darrell pimping a Vinu article? Is he a sock puppet? Seriously? I am sorry, Darrell, but Vinu is not a qualified medical researcher and his papers are not worth the electrons used to store them on any server.

Darrell was a Travis/Fendlesworth sock. He has been taken care of. Dude had to reach back to 2007 to find someone to impersonate.

Hi Darrel,

Yes I've read it and the research it cites, it suffers from major flaws:

1) English isn't Vinu's first language, he badly translates sentences to alter their meaning and won't be told.

2) He only selectively reads what he wants to read, ignoring history and denying reality.

3) There is no evidence that the vaccines on the schedule cause food allergies. Bleating about IgG4 levels doesn't translate into actual allergies:

"American Academy of Allergy Asthma & Immunology practice parameters do not support the use of any determination of IgG4 levels in the diagnosis and management of food allergies."

4) The long term impact of vaccines are obtained via such things as the Vaccine Safety Datalink. Something Vinu just can't see when he sticks his head in the ground screaming "there's no evidence".

Orac ... I've been on the ground waiting for a chopper, and there is no more beautiful sound in the world than the noise of those rotors in the distance.

there is no more beautiful sound in the world than the noise of those rotors in the distance.

I think the standard guerrilla gardener would disagree. That and countries with only a marginally effective air defense where the rotor sound is then punctuated by people standing on rubble piles and ululating.

Johnny writes (#37),

You, on the other hand seem to think that copying Alzheimer’s patents and half a day on Google makes you an Alzheimer’s expert.

MJD says,

Sick humor:

Old Johnny goes back to the hospital and the doctors say, "Johnny, you have two serious problems and one is worse than the other. Which one would like to hear first?"

Johnny bravely says, "Give me the worst news first, I can take it."

The doctor sadly says, "You have advanced cancer and less than about a year to live.

Without hesitation Johnny loudly asks, "Is that it?"

The doctor quickly replies, "No, you also have Alzheimer's disease."

Johnny smiles and says, "Geez....I'm sure glad I don't have cancer!"

there is no more beautiful sound in the world than the noise of those rotors in the distance

Count Bruce Cockburn among the people who would disagree.

Orac,

Thanks for your story. I work in a hospital in your state now, and I appreciate learning more about the critical care side of things. In my role, it's seldom that my ability to remain calm and efficient will directly affect a patient's chances of survival, but that did happen yesterday, and it made me reflect on how glad I am that there are so many people, doctors, nurses, EMTs, pilots, and others, who can master their emotions and anxieties well enough to provide care in those situations. Good on you and on every other professional and paraprofessional for accepting that stress.

Strengthened my resolve to go back to school and get more knowledge and training so I can do the same.

The Cleveland Clinic: Promoting dubious diet advice on Twitter and beyond

oracknows — Fri, 26 Aug 2016 01:04:27 +0000

The Cleveland Clinic: Promoting dubious diet advice on Twitter and beyond

I’ve mentioned on quite a few occasions that there’s a quote attributed to philosopher Arthur Schopenhauer that is much beloved of cranks:

All truth passes through three stages. First, it is ridiculed. Second, it is violently opposed. Third, it is accepted as being self-evident.

I also like to point out that Schopenhauer probably never said this and just how silly the thought behind this quote is when you think about it. Unfortunately, as I was perusing Twitter yesterday, I couldn’t help but think of this quote, but not in the way quacks and cranks usually intend. Rather, I was thinking of a modified version of it to describe my feelings towards quackademic medicine.

Quackademic medicine, as you might recall, is a term first coined (as far as I can tell) by Dr. R. W. Donnell to describe the infiltration of outright quackery into academic medicine in the form of “complementary and alternative medicine” (a.k.a. CAM), which is now more commonly referred to by advocates as “integrative medicine,” the implication being that integrative medicine provides the “best of both worlds,” alternative medicine and real medicine. In actuality, it does nothing more than “integrate” pseudoscience and quackery into real, science-based medicine. In any case, in the world of quackademic medicine, one of the quackiest of the quackademics, a veritable bastion of quackademic medicine, is the Cleveland Clinic. It’s an academic medical center that has always had a lot of woo in its integrative medicine department, but in 2014 it surpassed itself by being the first academic medical center to host a traditional Chinese medicine (TCM) herb dispensary and clinic, run by a naturopath. Not satisfied with that, later that same year, it started a functional medicine clinic run by the founder and guru of all that is functional medicine, Mark Hyman, who also wrote an antivaccine book with Robert F. Kennedy, Jr. himself. Functional medicine, of course, is basically quackery gussied up to look like scientific medicine that is basically making it up as you go along. Unfortunately, that hasn’t stopped the Cleveland Clinic’s functional medicine clinic from being wildly successful.

So basically, my version of that fake Schopenhauer quote applied to quackademic medicine tends to boil down to: All quackery passes through three stages. First, it is ridiculed. Then it is violently opposed. Then it is "integrated" into medicine by credulous academic medical centers like the Cleveland Clinic.

What got me thinking about this was an incident yesterday where I happened to see in my Twitter feed responses by people I'm following to the Cleveland Clinic's Twitter account. It wasn’t pretty. The reason it wasn’t pretty is because of what the Cleveland Clinic’s social media people were Tweeting. Mixed in among the usual self-promotional Tweets designed to promote the institution were some real howlers. For example:

Eat spinach for a firm bottom. This leafy green contains the #collagen boosting nutrient vitamin C, which keeps your skin tight and firm.

— Cleveland Clinic (@ClevelandClinic) August 23, 2016

My first reaction to this was that this sounds like something I would find being promoted by Dr. Oz’s or Oprah’s or—dare I say it?—Gwyneth Paltrow’s Twitter feed, not the Twitter feed of a respected academic medical center. What actually brought my attention to this particular Tweet were the reactions though, reactions like:

@ClevelandClinic it also has large amounts of vitamin k which can cause headaches and thicken blood

— dlmcbrayer (@dlmcbrayer) August 23, 2016

And:

@ClevelandClinic and if you believe that we have a bridge to sell you in Antarctica!

— Rjeff (@rjeff48) August 23, 2016

And:

@ClevelandClinic stop embarrassing yourself. Eating spinach is great. It will NOT give you a "firm bottom".

— Dr. Nimigan MD FRCSC (@DrNimigan) August 23, 2016

And perhaps my favorite:

@ClevelandClinic Get an #RDN to review your nutriton tweets.

— Emily Kean, MBA, RDN (@Keannutrition) August 23, 2016

Indeed. As was pointed out, spinach is great stuff from a nutritional standpoint, but it won’t give you a firmer bottom because of its vitamin C. It might help you get a firmer bottom if you eat more green leafy vegetables and exercise, but that’s less popular a message.

There’s more where that came from, unfortunately:

Eat these #superfoods for smoother skin:
- Kiwi
- Pineapple
- Guava
- Papaya

— Cleveland Clinic (@ClevelandClinic) August 23, 2016

OK, the term “superfood” is a marketing term, not a term that has anything to do with medicine or science. It is a term that should never be seen on the Twitter account (or on other social media) of a reputable academic medical center. There is no such thing as “superfoods.” The term “superfood” implies, well, something “super” in the food, that the food is somehow far superior to most other foods or has some sort of nutrient that allows it to improve or bolster health or cure disease. Let’s listen to a real professor of nutrition:

“There’s no such thing as a superfood. It’s nonsense: just one of those marketing terms,” says University College Dublin professor of nutrition Mike Gibney, throwing on the garb of Ireland’s superfood Grinch. “There is no evidence that any of these foods are in any way unusually good.”

Yet here’s the Cleveland Clinic claiming that kiwi, pineapple, guava, and papaya are “superfoods” that’ll give you smoother skin. It’s antiaging woo combined with nutrition woo, and it’s all over the recent Twitter feed of the Cleveland Clinic. For example:

Vitamin E can be a powerful #antioxidant that helps your body fight off infection. Find it in almonds, broccoli, peanuts and spinach.

— Cleveland Clinic (@ClevelandClinic) August 24, 2016

Of course, the benefits of antioxidants aren’t nearly as clear as the Cleveland Clinic would lead you to believe, and there’s a paucity of evidence that antioxidants do anything like that. Worse, one almost gets the feeling that Oprah now owns the Cleveland Clinic:

Broccoli provides a good source of riboflavin (vitamin B2), which may help keep your lips super-smooth. pic.twitter.com/RagjaZ7gkc

— Cleveland Clinic (@ClevelandClinic) August 25, 2016

And:

5 foods that fight wrinkles:
- Apricots
- Broccoli
- Citrus Fruits
- Sweet Potatoes
- Tofu

— Cleveland Clinic (@ClevelandClinic) August 20, 2016

Either that, or a fashion magazine has taken over. As a friend of the blog put it:

@ClevelandClinic have you given your twitter password to a snake oil peddler? Citation direly needed.

— (((Catherina+SM))) (@justthevax) August 20, 2016

In any case, is there anything more inane, from a medical standpoint, than these Tweets from the Cleveland Clinic? A significant fraction of recent Tweets seem to be pushing vegetables more as a source of substances that’ll rejuvenate a woman’s skin, giving her a tight bottom and smooth lips and:

Chia seeds are one of the best sources of omega-3 fatty acid, and can help turn your snakeskin hands luxuriously soft.

— Cleveland Clinic (@ClevelandClinic) August 25, 2016

Seriously, who has snakeskin hands? Is that anything like snakeskin cowboys?

I suppose I shouldn’t be surprised. If you had taken a look at the webpages for the Cleveland Clinic Center for Integrative & Lifestyle Medicine, you wouldn’t be surprised either. Take a look at the services offered:

Acupuncture
Chinese Herbal Therapy
Chiropractic Services
Guided Imagery
Holistic Psychotherapy
Lifestyle U
Massage Therapy
Reiki Therapy
Yoga

Take a look at what it says about reiki:

Reiki is a form of hands-on, natural healing that uses universal life force energy. The term comes from the Japanese words “rei,” which translates into universal, and “ki,” which means vital life force energy that flows through all living things. This gentle energy is limitless in abundance and is believed to be a spiritual form of energy. It is not tied to any specific religion or nationality.

The Reiki practitioner is the conduit between you and the source of the universal life force energy. The energy flows through the practitioner’s energy field and through his or her hands to you. The energy does not come from the practitioner; it comes through the practitioner from the universal source. There is no energy drain on the person giving the treatment. You may experience the energy as sensations such as heat, tingling, or pulsing where the practitioner places her hands on your body, or you may feel these sensations move through your body to other locations. This is the energy flowing into you. Some people may not perceive any change at all. Most people feel very relaxed and peaceful. Many clients even fall asleep while receiving Reiki treatment.

Elsewhere, the Cleveland Clinic asserts that it offers reiki for:

Cancer
Infertility
Parkinson’s disease
Psychological illnesses
Chronic pain
Digestive problems
Stress-related diseases

Every time I go back to the section about reiki on Cleveland Clinic’s website I keep hoping that I won’t find that passage. I’ve been hoping in vain for several years. This is the same text I found on a pamphlet from the Cleveland Clinic at least seven years ago. Of course, as I’ve explained time and time again (more times than I can remember, but it’s worth explaining briefly again), reiki is nothing more than mystical magical wishful thinking. Think of it this way. Its adherents claim reiki “works” by allowing the reiki master to channel “energy” from what reiki believers call the “universal source” through him and into the patient in order to heal. Now substitute the word “Jesus” or “God” for “Universal Source.” Now what are you dealing with? That’s right. You’re dealing with faith healing. The only difference is that reiki bases its faith healing on Eastern mystical beliefs instead of the Judeo-Christian god.

And the Cleveland Clinic has been featuring a credulous description of this superstitious belief on its website for several years now, at least.

That’s not all, of course. the Cleveland Clinic also offers the Esselstyn Program, which is a plant-based diet program to “reverse heart disease” developed by Caldwell B. Esselstyn Jr., MD. He’s a former surgeon who’s become a vegan evangelist. According to his book, Preventing and Reversing Heart Disease, to reverse hear disease you must follow the following rules:

you may not eat anything with a mother or a face (no meat, poultry, or fish)
you cannot eat dairy products
you must not consume oil of any kind
generally you cannot eat nuts or avocados

As the Skeptical Cardiologist has pointed out, Esselstyn’s program is based on incredibly bad science. For example, he points out that the best randomized controlled clinical trials that we have for diet to prevent heart disease “have shown that supplementing diet with olive oil and nuts substantially lowers CAD.”

Longtime readers know that I did my general surgery residency at University Hospitals of Cleveland back in the late 1980s and early 1990s and that I got my PhD at Case Western Reserve University in the early 1990s. I know Cleveland. Even though, back in those days, the Cleveland Clinic was the bitter rival of University Hospitals, there was always respect. When I moonlighted as a flight physician for Metro LifeFlight for two and a half years, the Cleveland Clinic was a frequent destination for the transport of cardiac patients. Its cardiology and cardiac surgery programs were world class then, and they’re still world class. That’s why it’s so depressing to me to see what the Cleveland Clinic has become.

oracknows Thu, 08/25/2016 - 21:04

Categories

Medicine

Schopenhauer's quote is : "To truth only a brief celebration of victory is allowed between the two long periods during which it is condemned as paradoxical, or disparaged as trivial". Which is not very different from the other quote, and not silly at all. And has very few to do with the Cleveland Clinic.

Actually, that quote is quite different from the quote attributed to him that I discussed because there is nothing about these "truths" as inevitably being accepted as "self-evident." That's the part of the quote that makes it very silly. Actually, go back and read my discussion of the quote. The whole quote is silly because many truths aren't violently opposed or condemned.

OT:
I've just read the JAMA article "Unintended consequences of expensive cancer therapeutics—the pursuit of marginal indications and a me-too mentality that stifles innovation and creativity: the John Conley Lecture."
It's a lot to digest, but first thing I thought was 'altmed loons are gonna love it'... Water to their mill.
What do you think about this analysis? I'm slightly confused, tbh.

I won't mention where I practice. The acute pain service has received and I am already resisting the offer of assistance from some local reiki practitioners. Also on a recent OB anesthesia call lets just say- epidural 1, essential oils 0 !

Oral # 2
Truths and untruths are violently opposed or condemned if they threaten some interests. Otherwise, they are simply ignored.

@ Amaria
There is no innovation and creativity in alternative medicine, just a different kind of conformism.

I won’t mention where I practice. The acute pain service has received and I am already resisting the offer of assistance from some local reiki practitioners. Also on a recent OB anesthesia call lets just say- epidural 1, essential oils 0 !

Yeah, it's everywhere. There's a common progression. First reiki practitioners offer their services for free. Some hospitals fall for this and reiki masters get a foothold in those hospitals. Then, if the program is popular, the hospital considers hiring a reiki master or two. Then the program gets entrenched.

The Cleveland Clinic is just among the worst.

I guess fermented food is out on the Esselstyn Program. (For non-cooks and bakers, "Mother" is a common term for an already fermented portion added to a new batch to start it fermenting),

The discussion thread on the previous post about the fake Schopenhauer quote mentioned the quote from Carl Sagan:

They laughed at Columbus, they laughed at Fulton, they laughed at the Wright brothers. But they also laughed at Bozo the Clown.

That last item neatly encapsulates the fallacy to which people offering the fake Schopenhauer quote succumb. Just because a proposition goes through the first two stages doesn't mean it's actually true. Often a proposition will go from being ridiculed to being violently opposed because somebody did the experiment and found that the proposition was not only wrong but dangerously so. Orac has discussed several such cases in previous posts.

I do have a couple of nits to pick with the Sagan quote. One, it's not entirely fair to Bozo, who was one of the best in the world at his chosen profession (i.e., he wanted people to laugh at him). Two, Columbus's critics actually did have a point. They didn't doubt that the earth was round (that myth seems to have been invented in the 19th century); they correctly objected to his claim that the Earth's circumference was about 30,000 km, rather than the 40,000 km that Eratosthenes measured in ancient Greek times. Columbus was lucky that there turned out to be a previously unknown continent about as far west of Spain as he claimed Japan would be.

. . . There’s a common progression. . . . services for free. . . . Then the program gets entrenched.

Ack. That sounds like how drug dealers work. Well, at least they offer something that has an effect.

It's times like these that I'm tempted to open a Twitter account...fortunately, the temptation passes.

Dear Cleveland Clinic,

If I eat pineapple, I will have smoother skin. The mortician's staff will see to that. I eat broccoli 4 or 5 times a week because I love it. I still have old lady skin and lips - possibly because I'm an old lady. I don't even know where to go with spinach = firm bottom. But, it certainly gave me a much needed laugh!

I think this is the marketing department at work.

What twenty-five year old is going to eat more vegetables and fruits to prevent long term chronic disease, but if it improves one's appearance today.... now there is a great argument.

There might even be something to this (with a lot of YMMV), Eating healthy food can make one feel better, and if you feel better (or lose weight) you can look better.

Between the perplexing ingredient selection and the poor knife technique in that image, I can only imagine that the outcome is not going to be good.

@ Eric
Maybe the worst fallacy is in the idea that truth eventually wins. What about religions, astrology, homeopathy, acupuncture and so on ?

I can't swear that eating lots of spinach will give anyone a "firm bottom" but it's well established that eating lots of spinach will give some folk an increased risk of kidney stones.
If you want a firm bottom, get off of it and move it around.

they correctly objected to his claim that the Earth’s circumference was about 30,000 km, rather than the 40,000 km that Eratosthenes measured in ancient Greek times. Columbus was lucky that there turned out to be a previously unknown continent about as far west of Spain as he claimed Japan would be.

I had never heard that, Eric Lund #9. Public education sux; We were taught the myth. Though, 'Japan'?? I was taught India thus the native americans became called 'Indians'.

@Eric #9, @Gilbert #15

It was known in Colombus' time that the Earth was round, but that knowledge was mostly kept away in ancient Antiquitiy knowledge. Copernicus and Galileo were persecuted by the Church, which had much more power and message control than they. The problem was not the flat/round Earth per se, but more of the Earth/Sun/Center of Universe relationship, and what orbits what. The fear of sailors of falling off the edge of the world, and sea monsters, was real, because the lay man did not get to know the scientist's view very often, but went to Church every Sunday.

Colombus didn't start on his journey with only just his hunch that the Earth was round, and he got financed because the theoretical knowledge existed too. The Americas were not really known and recognized then in Europe (only the Norse had been there, but the Basque had visited the coastal waters too, and both knowledge source were mostly oral and disregarded/unknown), and Colombus' big mistake was that he hadn't reached the Indies but thought he had. Europeans who had known the Indies from the other way around knew immediately they were not at the same place. Magellan's trip was more precise, and even then, he misjudged the size of the Pacific Ocean which was way larger than anyone thought. His slave, Enrique, who could speak to the tribes in the Philippines but was bought in Malaysia, is probably the first man to circumnavigate the globe in history. But that expedition did reach its intended destination.

Sorry for that long OT posts...

Often, much of woo-fraught ( so-called) health/ diet advice amounts to appearance-centred hacks for women who have feelings of inferiority.

All truth passes through three stages. First, it is ridiculed. Second, it is violently opposed. Third, it is accepted as being self-evident.

Even if Schopenhauer had said it, and even if it was broadly true of "great truths" ...

It still wouldn't say that only truths are ridiculed and opposed - stupidity and lies can be and often are ridiculed and opposed, but never accepted.

("They laughed at Einstein!" ... "They also laughed at Bozo.")

The foods that come closest to having the set of nutrients needed for healthy skin are the skins of other animals. Which skin to eat depends on your own skin problems. If you have oily or scaly skin, for example, you should not eat fish skin. If you have bumpy skin, you should not eat chicken or goose skin. For most people, pig skin comes closest to the ideal of a healthy smooth skin. This is widely available as fried pork rinds, sold in the snack section of supermarkets everywhere.

But Mark!
Many of the woo-enticed would never eat anything which had a face or a mother!
And pigs and chicken do!

My usual response to the quote at the top of the post is, "Sure they laughed a Galileo. They also laughed at The Three Stooges."

I was taught India thus the native americans became called ‘Indians’.

Usage of geographic terms, like other aspects of language, evolve over time. In Columbus's day the Indies were the islands to the east and southeast of the Asian mainland--e.g., what we now call Indonesia. The modern country of India was then known as Hindustan; its current name is derived from the Indus River, which ironically is in Pakistan, not India (the British Raj included those two countries plus Bangladesh).

My memory is hazy, but I have a recollection of Columbus circling an island he thought was Japan. It was actually Cuba.

I didn't know where else to put this.
http://www.knowable.com/a/23-medical-professionals-share-the-worst-advi…

This is a related quote: "A new scientific truth does not triumph by convincing its opponents and making them see the light, but rather because its opponents eventually die, and a new generation grows up that is familiar with it."

-Max Planck (Nobel Prize winner)

"The Reiki practitioner is the conduit ....... There is no energy drain on the person giving the treatment."

Just a drain on the finances of the Reiki con's victims ("patients).

Those tweets remind me a lot of the ridiculous things I see in the tabloids and magazines at the checkout line at the grocery store (lose 20 pounds in 2 weeks!). And based on those statements, I am disinclined to believe anything else I read in those publications.

And it's the same way for the Cleveland Clinic. Sure, it used to be super respected, but all those tweets make me concerned that the quality of *all* of their care has gone down, not just that they've adopted nonsense. How is the average patient supposed to know if they will still be offered good, evidence-based, science-based medical treatment?

Eat spinach for a firm bottom. This leafy green contains the #collagen boosting nutrient vitamin C, which keeps your skin tight and firm.

So out of the thousands of plant foods that contain Vitamin C, only spinach is mentioned?

If spinach gives you a firm @ss, then I wonder what the Pauling Therapy can do? (Ever watch Death Becomes Her?)

@JustaTech #27:

ridiculous things I see in the tabloids and magazines at the checkout line at the grocery store (lose 20 pounds in 2 weeks!).

The only way they can get someone to lose twenty pounds in two weeks is if that person spends £1.43 a day on those stupid magazines!

@ Rich Woods
You can lose more than 20 pounds in less than two weeks, but it costs an arm and a leg.

The Cleveland Clinic's tweets are fairly innocuous and easily ignored. But almost everything from @MarkHymanMD makes me want to gouge my eyes out. Mostly because I don't consider him a crank, but a woo-peddling opportunist. I try, but it's pretty ineffective to troll on Twitter :(

Which vegetables will make my boobs bigger?

#13 Narad
I missed the knife technique. Scary to say the least.

#22 justawriter

usual response to the quote at the top of the post is, “Sure they laughed a Galileo. They also laughed at The Three Stooges.”

Well yes, Galileo was being an idiot but no one laughed at him.

If he had a theory that held water then he was probably fine; a theory that is palpably false, well he is in trouble. Cold fusion anyone?

This is my usual response to the Galileo crap. Galileo was taken seriously until it became obvious that his "theory" was nonsense. Any theory that predicts one tide a day is not likely to be endorsed by clerics who grew up on the western coast of Europe.

And let's see, clerics from western France, Spain, Portugal maybe present day Netherlands? Probably laughing like mad.

And remember the Jesuits in Rome ( at the Pontifical College) were among the most leaned astronomers in Europe at the time. And they had problems with his theory.

There is no doubt that he was a brilliant experimental but some of his later theories were a bit dicey.

Still, for a man in his 60'sm with arthritis and failing eyesight, house arrest in his own home does not seen a real persecution.

And reportedly he published another three books ( in Amsterdam to be sure) before he died.

My god, he really was persecuted.

Eat spinach for a firm bottom. This leafy green contains the #collagen boosting nutrient vitamin C, which keeps your skin tight and firm

Hey it works for me. I love spinach.
Err, combined with the 4--12 KM cycling every day but I did get a complement the other day.

Vaccine Truther, no vegetables, but the cheapest milk you can find. That's made by dairy cattle that are given hormones which increase udder size and capacity. That's what you want.

@ jkrideau
"If he had a theory that held water then he was probably fine"
How can you know? Galileo was persecuted not because he was wrong , but because he was a threat to Aristotelian order.

Well, if it works for Popeye's forearms, I'd say spinach might firm your gluteals. If you're a cartoon character.

#37 Daniel Corcos

Galileo was persecuted not because he was wrong , but because he was a threat to Aristotelian order.

Oh definitely, sorry I did not mean to imply otherwise. That was why he was summoned before the Inquisition but if his theory had worked he almost certainly been okay. Aristotelian order was not fundamental Church doctrine. The Church could, fairly easily, adjust to it.

He had already been censured for suggesting that a heliocentric solar system theory was “true”. The Church didn't seem to mind if he wanted to present the idea as a "thought experiment" but they wanted "very" solid proof before they would question Aristotle.

He claimed that his new theory was true. The theory did not work properly and he presented it in a way that seemed to imply that the Pope was an idiot or, at least, that's how the Pope interpreted it. Apparently Galileo was not always the most tactful or politically astute person.

@ jkrideau
"Aristotelian order was not fundamental Church doctrine"
Actually it was very important:
https://en.wikipedia.org/wiki/Transubstantiation

"Aristotelian order was not fundamental Church doctrine”
Actually it was very important

It may very well have been very important, I'm not at all conversant with its impact on Church thought but, again, I'd argue not fundamental. Aristotle was a pagan philosopher not a church father or something out of the bible.

Actually the Bible's statement that the Sun stopped was probably a more serious issue but the Catholic Church never insisted on a literal interpretation of the Bible if solid conflicting evidence showed that a certain bible passage should be interpreted as allegorical. See recent Popes stand on evolution.

It might have taken a lot of hair-splitting and theological footwork to switch to a heliocentric theory but that's one of the reasons for keeping theologians on the payroll.

The Church was not anti-science but having a very important, if not really fundamental, piece of doctrine challenged meant that one needed really strong evidence. One, probably, need to be a good salesman too. Galileo seems to have failed in both and he was very lucky not to have been convicted of heresy.

Try denying the Virgin Birth or the Trinity and then you are in real trouble. Those were/are very fundamental to Catholic doctrine. I believe these were some of the many things that got Giordano Bruno burned at the stake. These were real heresies.

One of the many charges against Bruno seems to have concerned his astrological (?) theories but here again it seems it was not his heliocentric theory so much as his denial that the world would never end. That was/is heresy.

There are many less politicized examples of scientific heresy. Take Gilber Ling's theory on the Association-Induction Hypothesis.

This seems like a better theory than the Membrane-Pump Hypothesis, yet it is dismissed by the orthodoxy. I have this seminal book in the mail (first edition) and will be able to talk more authoritatively on the matter in the future.

Look at the history of scurvy and Vitamin C if you want to see how the obvious can be ignored for decades by scientists intent on finding a bacterial cause.

At this time, heresy consisted in saying that the host could not contain the body of the Christ, and the Catholic Church found support in Aristotle writings to declare it possible. Everybody who was against Aristotle was heretical. You could challenge the writings in the Old Testament, but not Aristotle.
https://en.wikipedia.org/wiki/Host_desecration
https://en.wikipedia.org/wiki/Transubstantiation

@ Ted Striker
The association-induction hypothesis has been cited 104 times from 1973 to 1991, which seems to indicate that it was not so heretical. After this date, it was cited only 5 times. Maybe this has to do with the identification and cloning of the membrane pumps....

# 43 Daniel Corcos

As far as I am aware saying that the host could not contain the body of the Christ, still is heresy.

I think you are underestimating the mental agility of the Church theologians. I am pretty sure that they would be able to make an exemption for a heliocentric model if the evidence was good enough.

If I am reading that Transusbstantian wiki correctly it looks to me while Aristotelian philosophy was important in supporting the concept of host as the body and blood of Christ it was not essential.
Certainly the belief seems to have been held long before the Western Church adopted Aristotelianism and the wiki points out that one did not need it formally.
In Roman Catholic theology

The distinction between "substance" and "accidents" - the latter term is not used in the Catholic Church's official definition of the doctrine but has been used in the writings of theologians - arose from Aristotelian philosophy, but in Roman Catholic eucharistic theology is independent of that philosophy, since the distinction is a real one, as shown by the distinction between a person and that person's accidental appearances

Still, I probably should grab that new bio of Galileo by David Wooton and see if he has any new information on the issue.

Take a look at what it says about reiki:

Reiki is a form of hands-on...

Not even ten words in and they're already getting it wrong.

Membrane pumps. You keep using this word Daniel, but I don't think it means what you think it means.

Identifying a protein and calling it a pump does not necessarily make it so.

@ Ted Striker
I acknowledge that the "pump" is a protein that transports molecules across the membrane, and not a real pump, but does it change anything?

Pedantic point... The original quote far upthread has now been revived by the Great Pumpkinhead in a recent speech and was incorrectly attributed to Gandhi: "First they ignore you, then they laugh at you, then they fight you, then you win." There is apparently no evidence that Gandhi actually said it.

@ Sara
There is some truth in this quote, which may seems quite general but is biased. Another statement “First they ignore you, then they laugh at you, then they fight you, then you lose." is also true.

You can't "fight" wrinkles, you prevent them by using sunscreen and wearing a hat in the sun. This also helps protect against skin cancer. You'd think a clinic would want people to know this.

The only certain way to prevent wrinkles is to die young. Not many clinics seem to recommend that.

@rs -- or you can get fat. As ZsaZsa Gabor supposedly once said, " As a woman, you have to choose between your fanny or your face."

Tales from the Helicopter: A really crappy way to start the week

oracknows — Mon, 14 Aug 2006 06:16:12 +0000

Tales from the Helicopter: A really crappy way to start the week

Here's a feature I've been meaning to start almost since I started this blog, a series along the line of Dr. Bard Parker's Tales of the Trauma Service. Oddly enough, it only took me over a year and a half to get around to writing the first entry, for reasons that, quite frankly, I don't know. It just sort of got away from me. (And, believe it or not, there is at least one more series idea I've had floating around just as long.) It's not scientific, but it is medical, and in particular surgical.

I don't recall if I have mentioned this before on the blog, but for about two and a half years when I was doing my graduate work in the laboratory back in the early 1990's, I moonlighted as a flight physician with a helicopter medical transport service. This is probably about the most interesting thing about my life, and it never fails to cause listeners' ears to perk up when I mention my brief time trying to make like Tom Cruise in Top Gun (you know, before he went all mental on us) and swooping in to rescue patients. Of course, the actual experience wasn't exactly like that (although most of the helicopter pilots were ex-military, some with combat experience in Vietnam, and, on occasions when we had to go out for public relations runs (kids just love checking out a real helicopter), they would be sure to do an impressive swoop over the crowd both before landing and after taking off but before leaving, a maneuver which had a tendency to cause my face to turn a most sickly shade of green. Most unlike a fighter pilot.

But in reality, this job was usually 90% boredom (sitting around the call room waiting for calls, often killing time reading journals or playing around on Usenet--believe it or not, this was before Netscape and before the wide availability of access to the web), 8-9% drudgery (routine runs transporting patients who weren't unstable, runs that made me feel more than anything else like a glorified babysitter in a flight suit), and 1-2% sheer terror. Let me tell you docs out there: You haven't lived until you've tried to do chest compressions in a cramped helicopter in the middle of flight on a windy day, just you and the flight nurse, without the usual crowd of helpers that descend upon codes in the hospital, to the point where on occasion I've had to kick some of them out of the patient's room. Shifts were typically 12 hours long, and, because I was the moonlighter, I usually got the night shifts. The level of activity ranged from not getting a single call (and, bliss of bliss, getting to sleep all night) to going on a run shortly after arriving for my shift, going on run after run without making it back to base until quitting time or even later. The worst runs of all, the ones that I always dreaded, usually came in near the end of a shift, at 5 or 6 AM. They were almost always very bad, and not just because they'd guarantee that I wouldn't be getting off work on time.

This run was definitely that.

It was early on a Monday morning in late summe, a day not unlike today in fact. I hated doing Sunday night shifts, mainly because right after finishing the shift I'd have to go straight to the lab and work another 12 hours or more with no break. This was long before the days of 80 hour work weeks. Indeed, residents in the lab at my institution aren't allowed to moonlight. In some ways, that's a good thing, in that it forces them to concentrate on their lab work, but in other ways it's not so good. I learned things going out on helicopter runs that I'd never have learned otherwise. I also learned things about myself that surprised me, not the least of which was the very fact that I actually could do the job, something I doubted when I first signed up to do it because it was the thing that nearly all the surgery residents did when they were in their lab years. There had only been one run that shift. Fortunately, it had been a routine cardiac run. We had picked up the patient at a small community hospital and transported him to the cardiac Mecca down the street from the hospital that was home base to my residency program, deposited him safely in the CCU, and headed back without incident. I had plopped down on the less-than-plush bed in the physician's call room and promptly started sawing logs.

Only to have my blissful sleep shattered by the shriek of my pager. I fumbled for my glasses and looked at the clock. 5:30 AM. Shit. That means I'll be late getting back. I grabbed my bag and hat and stumbled out the door to be met by my nurse, the pilot, and his copilot, all of whom were making their shambling way towards the helipad. We all got in, and soon the engine fired up, the rotors started spinning, and the bird started to shudder as it strained against gravity. Over my headphones, report was coming in. Apparently this was a single car MVA (motor vehicle accident), with a single victim, a young female, who was reportedly unconscious at the scene. That's all we knew as we roared off into the pinkness of the just pre-dawn sky. In the back of my mind, I thought about my fellow residents back at the County Hospital and how grateful they would be for my bringing them a new customer right before their shift change at 7 AM. (There were two trauma teams, and switchover time between the two of them was 7 AM; again, this is before the days of the 80 hour work week. When we did trauma, we did 24 hours on, 24 hours off, for up to two months at a time. And it wasn't exactly 24 hour on, but more like 30, because we had to round and make sure all our patients were tucked in before we could leave for the day, and once a week there was a 4 PM conference that we were expected to stick around for.)

As we circled the site, which was a parking lot near the two lane road on which the crash had occurred, we learned more. Apparently, the car had gone off the road and hit a tree at high speed. Usually, given the time of day, this means the driver had fallen asleep at the wheel. We also learned that her blood pressure was very low, and she was unresponsive. All exhaustion left me. In fact, I was keyed up so high that I had to briefly talk myself down and remind myself that my being that nervous would do no one any good, least of whom the patient. The entire flight took less than 10 minutes, as we were not far from the scene, and I knew from experience that it would probably take about 10 minutes to get back to the County Hospital, the regional Level I trauma center.

We arrived.

"I haven't been able to get it," he informed me.

"Crepitus on the right, muliple rib fractures. Heart sounds weak. Breath sounds decreased on the right."

Fortunately, and much to my relief, this time it was a challenge that I was up to. I had had my doubts.

"Doc," one of the paramedics said. "I can't get a pulse or blood pressure."

We all looked at the monitor in unison. No rhythm. Shit.

"Clear!" Everyone moved back momentarily.

Electricity caused the girl's body to shudder, as if she were plunging her chest at the life-giving electricity.

Still no rhythm. I turned up the juice slightly according to ACLS protocol and charged up the paddles again. Shock. Still no rhythm. I did it a third time. Nothing. Double shit.

We began chest compressions again and continued the ACLS algorithm, administering drugs sequentially, followed by shocks. I plunged a 14-gauge IV catheter into the right side of her chest in case she had a tension pneumothorax from all of her rib fractures. There was no rush of air and no change in her vital signs (or lack thereof). We kept working, with chest compressions, interrupted by the administration of drugs and shocks. We ran to the helicopter, doing chest compressions all the way. A cardiac arrest after blunt trauma is almost not a survivable event. Even for a witnessed arrest after blunt trauma, the odds of reversing it and saving the patient are very small. We had to try, and, believe me, try we did, but none of us had any illusions about our chances for success, as the helicopter took off. Even so, getting her to the hospital was the only hope she had of survival, no matter how slim. We continued CPR and the complete ATLS protocol the entire way to the hospital.

When we arrived, we did a rare hot unload (usually we waited for the helicopter rotors to come to a complete stop before unloading) and moved to the elevator, one of the nurses standing on the bottom part of the gurney continuing chest compressions, and straight to the trauma bay, where the assembled team was waiting to pounce.

"How long has she been down?"

"Twenty minutes."

The trauma team took over, and I became mostly a bystander, pushed to the side and no longer needed, having discharged my function. Discarded. I was used to it, though. After all, my function was to get the patient to the hospital in as good a shape as I could, after which all that was left was some quick paperwork and then back to the base or on another run. I moved to a counter where I could work on my paperwork and still see what was going on in the trauma bay. (Even the worst human disasters that I saw and transported had to be reported dispassionately on the same form every time.) Meanwhile, a whirlwind of activity swirled about the patient, with shouted instructions rising above the fray every so often. They worked another 20 minutes with no success. 40 minutes without rhythm, even with effective CPR, was hopeless. It was time. Her pupils were fixed and dilated.

"Call it," the E.R. attending said to the trauma chief resident.

"Time?"

"6:40 AM."

The crowd that had been either helping or watching dissolved away, leaving only the girl, blood and discarded wrappings strewn about, and the nurses who had the unpleasant job of cleaning up the body and preparing her for the morgue. It became very quiet. The housekeeping staff moved in to begin to clean up, to make the trauma bay ready for its next occupant, whose outcome, we all hoped, would not be so tragic. I watched as they worked. The girl was so young, no older than college age if that, and so still, the endotracheal tube protruding from her mouth, no longer hooked up to anything. Only just now I could perceive that, even with the trauma suffered, she was pretty. Her blood alcohol level had been reported as zero; so this wasn't a case of her having been out partying all night and then cracking up her car. As I later learned from a nurse who had called her parents to come to the hospital while the trauma team had still been working on her, she had been on her way to work at her summer job at a campground. She had been going to start college in a mere few weeks. I wondered if she had brothers and sisters. A boyfriend, too, maybe. If not for one moment of weariness, she had every reason to anticipate a long life, complete with a fulfilling career, marriage, and children.

No more. The universe is certainly a cold, uncaring place at times.

oracknows Mon, 08/14/2006 - 02:16