Monday, February 28, 2005

New on my sidebar

I usually don't mention it when I add or delete sites from my sidebar. Sites and links usually just disappear and appear without my commenting whenever I happen to find a new site, notice that one of my links is dead, decide I don't like a site as much as I used to, or decide that I don't like a site as much as a new site I want to add.

But, given that I'm a big World War II buff, this site is just too cool not to plug. Most of us recall seeing World War II only in black and white pictures. Here, see World War II in Color.

The deadly power of denial, part 3: Fear

I've been thinking about denial yet again.

As regular readers of this weblog know, I've had more than my share of experience dealing with patient denial, as I've described. I've also had enough experiences with denial to realize when it's not denial. A while ago, I dealt with a patient that demonstrates yet another permutation of denial. As always, to protect patient privacy no names are given and some of the details have been altered without changing the heart of the story.

The woman came into my office, accompanied by her daughter and son-in-law. She had come to see me because she had recently undergone a breast biopsy at another institution. Unfortunately, the results were cancer. Even more unfortunately, the surgical margins were involved with tumor, meaning that there was probably still tumor left behind in her breast. Yet more unfortunately, the surgeon who had done the biopsy had failed to orient the specimen with stitches, meaning that we had no way of know which margins were positive. (Generally, it is considered a good idea to mark the specimen with sutures so that, if any of the margins are positive for tumor, the surgeon can know which margin(s) are positive and therefore have to reexcise just those margins.) And, worst of all, even though the size of the woman's tumor was less than 2 cm, that same surgeon had recommended a mastectomy. Fortunately, the woman's family had had the good sense to persuade her seek out a second opinion.

When I saw her for the first time, she seemed reasonable enough. I did the history and physical examination, as I usually do, and nothing indicated to me the difficulties that lay ahead. She was calm and, to observation, seemed to comprehend that she had cancer. She even seemed relieved when I told her she very likely did not require a mastectomy. I explained to her that her tumor could be treated with a re-excision of the area, although it would be a fairly extensive re-excision, mainly because the specimen hadn't been oriented and I couldn't be sure which margin was positive. I further explained that we would have to check the lymph nodes under her arm for tumor using a technique called sentinel lymph node biopsy, in which we inject a dye near the tumor and use it to find the first lymph node(s) to which the tumor drains. I added that, if there is tumor in the lymph nodes under the arm, that she would require an axillary dissection, which is an operation in which most of the lymph nodes under the arm are removed. Finally, I explained that she would need postoperative radiation therapy and possibly chemotherapy and/or estrogen blocking agents. She seemed agreeable and I wrote the orders for surgery. Another life saved--or so I thought.

A few days later, I got a frantic call from our surgical scheduler:

"Mrs. X is telling me she's canceling surgery."

"What?" I said.

"She says she's decided that she'll just get chemotherapy."

"Give me her number," I replied.

I then called Mrs. X. Trying to remain calm and reassuring, I told her that my scheduler had informed me that she was canceling surgery and I was hoping she'd tell me why.

"I just decided that that's no way to live, that I don't want the surgery, and I don't believe I have really have cancer anyway."

I was puzzled. I affected my most reassuring, nonjudgmental posture and asked why and whether she had found another doctor to do this for her. She told me that she had been told that the surgery would "mess her up" and that maybe she didn't need it. She went on about how she didn't think she really had cancer at all and that we all just wanted to operate for the money. I told her that most assuredly she did have cancer and did need the surgery. I explained that no medical oncologist worth his or her salt would give her chemotherapy (or any other therapy) if her surgical management was incomplete. Oncologists need to know the margins are negative and what the status of the axillary lymph nodes are before they can determine what the best postoperative adjuvant therapy is. After a period of my explaining some more, she finally agreed not to cancel the surgery.

A few days later, the date for which her surgery was scheduled rolled around. I was doing a couple of operations before hers. When I was doing the operation before Mrs. X was scheduled, I got a call in the room from the preop area informing me that Mrs. X had not showed up. I relayed a message not to cancel her yet.

When I got out, I immediately called the phone number on Mrs. X's chart.

No answer.

After some searching, the nurses helped me find the number of one of her daughters. I called and asked if she knew what was going on. To my surprise, I got an angry response.

"She did this to me on purpose!"

"What?" I asked.

"She gave them my number on purpose!"

I managed to calm her down, but it took a few minutes. From her, I learned that her mother screened her phone calls with her answering machine and was almost certainly at home, refusing to answer--but listening. I also learned that her mother had "gotten consults" from "people on the street" about her surgery. She had been told that she would be "messed up" by the surgery and was deathly afraid. I must admit to becoming a bit angry (to my shame) and mentioning that this was a slot that could have been used for another patient with cancer who would have jumped at the chance to take this slot. It was too late, even if she hit the road right that second, because another surgeon had booked the room after me. The daughter told me she'd call her mother. I later learned through the social worker that this woman was very suspicious of doctors. She thought that we only wanted to operate on her for the money.

I decided that we had to get this woman back into the office for another discussion. To this end, my nurse was resourceful and enlisted her son-in-law and other daughter to bring her in. After a long, grueling session, I thought I had managed to persuade her of the necessity for surgery and further treatment. Her family was on board and would make sure that she showed up. The social worker had gotten a support group of African American women with breast cancer to contact her and try to allay her fears.

But it wasn't yet over.

The morning of the rescheduled surgery finally rolled around, and she did actually show up.

But she wasn't exactly agreeable to surgery.

In the preop holding area, it was necessary to explain yet again in great detail yet again why she needed more surgery. She once again told me she was afraid the surgery would "mess her up" and that that was "no way to live." Finally, as if a light went on over my head, I asked her why she thought that.

It turns out that she thought that (1) she would lose the use of her arm after surgery and (2) that she might still lose her breast. It occurred to me that perhaps she had been told horror stories about axillary dissection (the removal of most of the lymph nodes under the arm). It is true that there can be one rather nasty complication from this procedure known as lymphedema, in which the lymph drainage is interrupted and the arm swells up badly. There is no cure, and severe forms can interfere greatly with quality of life. The problem is, lymphedema is almost unheard of after a sentinel lymph node biopsy, because only 1-4 lymph nodes are usually taken. After a prolonged explanation yet again that she would not lose her breast and that lymphedema was exceedingly unlikely after sentinel lymph node biopsy, she finally just admitted that she was terrified. She couldn't bring herself to admit she had cancer because she was afraid of the surgery that would be required.

After that, she actually signed the surgical consent. The surgery was somewhat difficult, mainly because she was not a small woman, but it went well. We located the sentinel node with only moderate difficulty, and the patient did well postoperatively. It turns out there was indeed residual tumor left behind in the breast, but fortunately, the sentinel lymph nodes were all negative for tumor.

I realize that it's probably fairly obvious to all that this patient was probably not really in true denial. Her "denial" was more likely a convenient reason to refuse surgery, rather than a true belief that she didn't have cancer. On the other hand, she was extremely suspicious of doctors, and it took a great deal of work to allay those suspicions and convince her that she truly did need treatment. She had been told that she needed a mastectomy when clearly she did not. A consequence of that extreme distrust may have been denial that she had cancer.

Thinking about this case, it occurs to me that we doctors too often become rather blasé about cancer. As mysterious and implacable a foe it is to us, we nonetheless treat it as fairly routine. We have to, particularly if it's our business to treat it. However, to the patient it is most definitely not routine. There are few things more terrifying to anyone than to be told that she has cancer. And, if that patient happens to live in an area where "people on the street" give "consults" about her diagnosis, that fear can be magnified 100-fold by the misinformation she will get from those "consults." Dealing with such patients can be a major challenge. In this case, it was a challenge that I almost failed to meet. Fortunately (for both me and the patient), I did not, at least not in this case. Next time, I (and, by extension, the patient) might not be so fortunate.

I don't forget that.

Tangled Bank #22-1/2

Some people, myself included, noticed that last week's Tangled Bank at The Scientific Indian was a bit thinner than usual. The articles that were there were of the usual very high quality, but there were fewer of them than usual. It turns out that the reason wasn't that there was any less great science blogging over the preceding two weeks than usual. The reason was a gmail gremlin that decided that all the e-mails being forwarded from PZ Myers to Selva were spam, presumably because they all had URLs in them! Those articles were lost, a great tragedy.

To right this wrong, yesterday PZ mounted a search expedition to find the lost articles at Tangled Bank 22-1/2: The Quest for Lost Articles.

Sunday, February 27, 2005

An atheist on "If I Were a Christian"

It's sad indeed when an avowed atheist is able to articulate Christian values more convincingly than the fundamentalists who have hijacked the Republican Party, but that's just what DarkSyd did on Unscrewing the Inscrutable.

Highly recommended reading.

Weekend fluff, part 5

beerrun 4morewars lookit-poppy

I love the Patriotic Poster section of Whitehouse.org, a fine parody site of the White House Website. Be sure to check out the rest of the site as well.

Weekend fluff, part 4

Do y'all think Respectful Insolence reads better like this? (Shout out to my homie Brent for this one!)

Saturday, February 26, 2005

Weekend fluff, part 3

This speaks for itself.

Weekend fluff, part 2

Capitalist Pig vs. Socialist Swine posted a rather amusing take on "emo" rock and its adherents. I may add him to my sidebar...

Weekend fluff, part 1

Regular readers (all two dozen of them) of this blog know that on weekends I tend to prefer to stick to lighter (even frivolous) material, with the exception of days that have special signficance and on which I want to post more serious material, such as two weeks ago.

In that spirit, here we go. I still don't know if I believe this, but apparently I'm a shameless seeker of fame. I suppose it's possible, given my shameless promotion of my blog, which has resulted in its staggering success and massively increased hit count compared to, say, its hit count in November. (Hint: This blog didn't exist in November.)

Friday, February 25, 2005

Update on the smackdown: Pharyngula appears to be down

Yesterday, I described a little smackdown between PZ Myers of Pharyngula and Deacon of Powerline over PZ's comments taking Deacon's fellow Powerline blogger Hindrocket to task for an arrogant and downright ignorant pontification in which Hindrocket blithely dismissed evolution on a "scientific basis." Just as the flood of hits to PZ's site was dying down after Deacon fired back in defense of Hindrocket, wouldn't you know that Atrios linked to PZ, as more evidence supporting Atrios' low opinion of Powerline.

Now Pharyngula appears to be down. At least, I haven't been able to get to the site all morning, and as of now I still can't. I'm guessing the site is getting way more hits than its server can handle right now. Hopefully it's not a DDoS.

In any case, I guess that's the price of successfully debunking one of the big boys. Here's hoping Pharyngula is back up again soon.

The History Carnival #3

Speaking of blog carnivals, the History Carnival #3 has been posted at detrimental postulation. Good stuff for your weekend blog reading pleasure.

My favorite entry of this week: Harry Truman and the Vulcans.

Time flies...and another Skeptics' Circle approaches!

It seems like just yesterday that it was my turn to host the Skeptics' Circle. It was a lot of fun and turned out far better than I had hoped. I plan on doing it again someday, perhaps in several months, to let others have a chance to show what they can do with it. But the baton has now been passed to Radagast, who will host the Third Skeptics' Circle on Thursday, March 3. So help Radagast keep the Circle improving. Send him an example of your best skeptical blogging at rhosgobel2 at comcast dot net.

And if you're interested in hosting sometime, check out the Skeptics' Circle Archive Site to see what dates are open and contact St. Nate, the Founder of the Skeptics' Circle at saint_nate at hotmail dot com.

Satisfaction

A couple of weeks ago, I reported an incident in which a flier that was sent to my office advertising a seminar on chelation therapy. In that post, I expressed my irritation and proceeded to debunk the claims of chelation advocates. I promised to report back on the response to a complaint I said I was going to send. Well, yesterday I got the response:
Dr. ORAC (you didn't think I'd really give up my real name here, did you?):

Thank you for your feedback.

Due to similar comments and feedback from the professional clinical
community we have decided to cancel this program at our Center. Please
note that [FACILITY] offers several, much needed community seminars in all
of our communities each month intended to educate the general public on
care options that individuals may find beneficial. These
seminars/programs include topics such as Understanding Alzheimer's
Disease, Caregiver Support Groups, Arthritis Seminar's, Elder Care
Informational Seminars, etc.

Our goal is to educate, we never endorse. I do understand, respect and
in this instance, agree with your opinion, thus the cancellation. As a
health care provider that serves over 3000 seniors in [STATE] daily
in our Centers, please know that [FACILITY] has invested significant time,
financial and human resources aimed at redefining standards of care in
skilled nursing and assisted living facilities. I would hope that you
consider this primarily when considering the care your patients would
potentially receive with us, and not on the topics we present to the
community.

I would be happy to discuss the quality initiatives our company has
implemented to demonstrate our commitment to excellence to clarify any
doubts you have regarding our dedication to quality of care.

Once again, I appreciate your feedback and letter, and can be reached at
them number below if you would like to discuss this further, and we
apologize if we have offended you - I can tell you with full confidence
that was not the intention of this program.

Sincerely,

Mr. "Smith"
Vice President
[FACILITY]
I must say, I rather expected this. I'm just disappointed that I wasn't the first to complain, as the program appears to have already been canceled by the time "Mr. Smith" received my message. I'll try to do better next time--really. I was busy getting the Skeptics' Circle together and being on call, which delayed my complaint for several days. Mea culpa. Fortunately, my colleagues in the state apparently picked up the gauntlet.

In any case, I really hate it when people like "Mr. Smith" try to weasel their company out of responsibility for choosing to sponsor a talk like this by saying something as mealy-mouthed and bureaucratic as, "our goal is to educate, never endorse."

Oh, really?

Somebody from his company decided to pick this particular speaker, rather than other speakers who don't advocate therapies with no clinical or scientific support for the claims made for them. Somebody must have approved that first somebody's choice of speaker and the use of the company's facility. Somebody from "Mr. Smith's" company decided to mail out a flier to physicians, presumably all over the state, to advertise the talk. Letters like this give the impression that little gremlins must have somehow sneaked this speaker onto the company's "educational" program and mysteriously sent out all those fliers. Would the company have picked a speaker for their educational program whose viewpoint on treatment its officers strongly disagreed with? I doubt it.

But what pisses me off even more is this:
I would hope that you consider this primarily when considering the care your patients would potentially receive with us, and not on the topics we present to the community.
Give me a break. He's been burned by a foolish decision that demonstrates a lack of ability to distinguish between treatments based on evidence and those not so based, and now he's trying to convince me that it's OK to send patients to his facilities. I'm sure "Mr. Smith" would argue that what they present to the public in their educational programs does not necessarily reflect on the quality of care they offer their patients. Maybe so. I don't entire buy it, though, and here's why: These "educational" sessions are almost certainly in reality marketing tools for the facility designed to build good will among the public, and for these marketing purposes, they chose a speaker pushing pseudoscience. If "Mr. Smith's" company doesn't even care enough to verify that the topics being presented to the public for "education"/marketing purposes on its premises meet minimal standards of scientific evidence, why on earth should I believe that his company makes sure that their care for patients meets those same standards? After this, how do I know they aren't giving chelation therapy to the elderly in their nursing homes? After all, they're letting some altie present totally unrealistic and unproven claims for chelation therapy to the public using their facility.

I recognize that it's possible (even likely) that this was nothing more than a mistake by someone putting together the educational program who did not have adequate knowledge and critical thinking skills to recognize pseudoscience and the obviously bogus claims contained in the flier. (Whenever someone claims the same therapy can treat many different diseases, it's a sure sign of pseudoscience or quackery, after all.) My rejoinder would be to ask why the company put someone in charge of the educational program who didn't know enough to recognize bogus claims to begin with.

I can only hope that "Mr. Smith" and the company have learned from this incident. I'll be watching. Next time, I might even sign up for the seminar and give the speaker a rather nasty surprise.

Thursday, February 24, 2005

Tangled Bank XXII is here

The Tangled Bank XXII, the biweekly Wednesday compendium of the best posts from the science blogosphere, is being hosted by the Scientific Indian. Check it out! (And not just for my humble contribution, because--let's face it--if you're a regular reader here at Respectful Insolence, you've already seen my contribution.)

A smackdown to be enjoyed

Science blogger PZ Myers at Pharyngula has taken Hindrocket of the very popular conservative blog Powerline to task for his rather silly statements regarding evolution from a couple of years ago.

Money quote from Hindrocket that raised PZ's ire:
Professor Volokh seemed to assume that someone who doesn’t believe in evolution is a harmless crank, who should not on that account be barred from pursuing a career in, say, medicine. My own view is different. I think that Darwin’s theory of macroevolution is plainly wrong, on strictly scientific grounds. So to bar a student from progressing in his career because he refuses to sign on to what is, in my view, a rather obvious fraud, which cannot withstand the mildest scrutiny, is really an outrage. It is no different from the practice in Soviet Russia of promoting only biologists who believed (or pretended to believe) in the theories of Lamarck, who argued that acquired traits could be inherited. But Darwinism is the official religion of the biological (and more generally, the scientific) establishment, and as such is rigorously enforced.
Yikes. I haven't seen such a bunch of grossly ignorant statements on evolution in, oh, say, a day.

And I used to kind of like Powerline. It's even on my sidebar. I must have somehow missed such idiotic posts about something they clearly know nothing about (evolution). It's downright mortifying and embarrassing to those of us who are scientists and tend towards the right side of the spectrum in our politics.

Well, wouldn't you know, but Powerline actually noticed PZ and Deacon, another member of the blog, responded, leading to PZ's rejoinder, which further led to a large number of rather heated comments at Pharyngula. Now, I fully understand that PZ is not necessarily the most subtle or forgiving of commentator, particularly when it comes to dealing with creationists (in fact, he can be downright nasty at times), but the Powerline boys are big blog boys. You'd think they'd have a thicker skin when it comes to being challenged, but apparently they don't.

From the reaction to PZ's comments I've learned a couple of things:
  1. Powerline is a bit further out on the fringe than I had previously realized. Given my emphasis on skepticism, science, and critical thinking. I'm now debating whether to remove it permanently from my sidebar. I may leave it there, however, because, like it or not, it is an important conservative blog.
  2. Taking on a big blogger like Hindrocket is liable to be more trouble than it's worth. PZ reports attempted DDoS attacks and foul, profanity-laced e-mails from Powerline readers.
  3. People like Hindrocket, who clearly have little or no understanding of evolution, should avoid shooting their mouths off on the issue (and making pronouncements about it with such utter certainty) and stick to areas that they are more knowledgeable about. Either that, or they should exercise a little humility when commenting on areas about which they are not experts. Actually, that goes for me, too, which is why I tend to stick to what I know on Respectful Insolence, rather than venturing too far afield. (Of course, occasionally, I can't resist, occasionally to my embarrassment.) This is one of the reasons I rarely, if ever, comment on global warming, for example. I just don't know enough about it to comment in much depth. When and if I do comment on it, you can be sure I will make my readers aware of the limits of my knowledge.
In any case, it's a blog smackdown to be enjoyed. The big science dog PZ is taking on the humongous dog Powerline. Even given the size differential, I wouldn't necessarily bet against PZ.

Wednesday, February 23, 2005

A toad is more accurate

Via Improbable Research:

Investigator Robert Bendesky reports that, far more frequently than customer service representatives, a toad produced the correct answer to physicians' questions about Medicare policy. Using a system in which a jump to the left meant "yes" and a jump to the right meant "no," the toad, not surprisingly, scored 50% correct. Unfortunately, the customer service representatives were incorrect 96% of the time, according to a 2004 GAO study described here (warning: link leads to a PDF file).

OK, perhaps it wasn't a fair test, given that the toad only had to choose between "yes" or "no" answers, but sadly I doubt the result would be much better even if the same questions had been given the CSRs. On the toad's side, the report notes that this test was entirely "open book." The managers of the call service centers knew in advance on what days the test calls would be made, and the questions had been intentionally designed to be simple and straightforward questions based on the insurer's own policies as published on their own websites. Indeed, the call center managers had even been informed of the questions ahead of time.

No word about whether the questions for the toads had been designed to be simple or whether the toad had been informed in advance of the test.

The conclusion: Medicare regulations are so ridiculously complex that neither doctors nor even service representatives (whose job it is to explain them) understand them. So, not only does Medicare reimburse physicians at a rate that barely covers their expenses (and sometimes not even that), but it makes it very difficult for the physician to collect even that!

Carnival of the Vanities #127

The Carnival of the Vanities #127 has been posted at PunditGuy. COTV is the grand-daddy of all blog carnivals, and every week it regularly attracts a large number of excellent posts on diverse topics, often so many that I don't have time to check them all out. This week is no exception. It's well worth checking out.

60th years ago today: The flag-raising at Iwo Jima

lflaga
Sixty years ago today, one of the most famous events in the history of World War II occurred, an event that created an image that will resonate forever. Those who have been regular readers know that I have a strong interest in World War II, the Holocaust, and debunking Holocaust denial. However, thus far, you may have gotten the impression that my only interest was the European Theater. In fact, some of the bloodiest fighting of the war occurred in the Pacific Theater. In the early years of the war, before significant numbers of U.S. troops reached England and before significant military action was possible against Nazi Germany, the Pacific was where the worst fighting occurred. In the dark days of early 1942, U.S. forces suffered defeat after defeat before the seemingly relentless advance of the Japanese, until the U.S. Navy handed the Japanese Navy its first crushing defeat at Midway Island in June 1942. After that, nearly three years of brutal "island-hopping" combat finally brought the U.S. to the very homeland of Japan.

Iwo Jima.

Iwo Jima was only 650 miles from Tokyo. Its importance to the U.S. was halfway between the bomber bases of the Marianas and Japan. Although the U.S. had long-range bombers that could strike Japanese soil, as was the case in the European Theater until 1944, they did not have fighter escorts that could accompany them all the way, leading to the bombers' vulnerability to fighter cover. The U. S. wanted Iwo Jima as a fighter base and an emergency landing site for damaged bombers. The Japanese wanted to hold it because it was part of the Japanese homeland and no foreign army had ever conquered any part of the Japanese homeland.

The Japanese defense strategy was simple and consistent with their code of Bushido: No Japanese survivors and each Japanese soldier was to kill 10 Americans before being killed himself. They dug 1,500 rooms into the solid rock of the island, all connected by 16 miles of tunnels in solid rock. Before the invasion, General Kuribayashi, who was in charge of the defenses of Iwo Jima, had been told "if America's casualties are high enough, Washington will think twice before launching an another invasion against Japanese territory." Kuribayashi designed his defense accordingly.
l721flag

On the morning of February 19, 1945, the Navy's big guns opened fire, and, after several hours of bombardment, over 70,000 Marines went ashore under withering fire from the hidden Japanese over the next two days. For 36 days, Iwo Jima became the most densely populated battlefield on Earth, with roughly 100,000 American and Japanese soldiers on an island half the size of Manhattan.

Mt. Suribachi, a 550 foot volcanic cone on the island's southern tip, was the key, as it afforded the island's defenders a panoramic view of the entire island from which to direct fire. After four days of bloody fighting, the men of Easy Company had managed to reach the summit of Mt. Suribachi. There, they raised an American flag. Photographer Joe Rosenthal was on hand. It is actually the second flag raising that was immortalized in the photo at the top of this post. The first flag was a smaller flag and was too small to be seen by the men below. Battalion commander, Lieutenant Colonel Chandler W. Johnson sent a four-man patrol up with a larger flag to be raised. The stories of the men who raised the flag can be found here.

Unfortunately, although the troops were thrilled by this symbol, the battle for Iwo Jima was far from over. Three more weeks of combat awaited, and the island wasn't secured until March 26. Casualties were high, with some units taking 75% casualties. Overall, there were nearly 26,000 U.S. casualties (over one in three), with over 6,800 dead. Approximately 22,000 Japanese died. Approximately 1/3 of all Marines killed in action in World War II died at Iwo Jima, making it the single most costly battle in Marine Corps history.

So, given that, in my occasional discussions of World War II on this blog, I seem to pay inordinate interest to Europe and the Holocaust, I do not forget that the War in the Pacific was just as horrific and required just as much to win. I also take this day and other anniversaries of major events in the Pacific War to remember that my late uncle was a Marine corpsman in the Pacific late in the war. I still have his Navy Corpsman manual, which sits on a shelf in my office. It is one of my most prized possessions.

Tuesday, February 22, 2005

Grand Rounds XXII has been posted

Grand Rounds XXII has now been posted at Catallarchy. Once again, the best of the week from the medical blogosphere is on display.

And those of you who are fans of blog carnivals and happened to have found your way to my humble blog by way of Grand Rounds, may I be so bold as to direct you to the Skeptics' Circle, hosted on this very blog last Thursday? It's a biweekly blog carnival for skeptical thinking about quackery, the paranormal, pseudoscience, and a variety of other issues. The first session was hosted two weeks ago by St. Nate, and the archive and schedule for future Skeptics' Circle sessions can be found here.

And for the skeptics out there who can't wait more than a week for some more skeptical skewerings, The Guardian's Observer kindly debunks The 10 Greatest Rock 'n' Roll Myths.

Common names

I blatantly stole this from Dr. Charles (who had stolen it from Daryl), but it's so cool that I couldn't resist posting it also. If you want to know how common your name was over the decades going all the way back to 1900, check out the Baby Name Wizard's NameVoyager. The interface is unlike any I've seen before. (For some reason it doesn't seem to work correctly on the Macintosh version of Firefox, but it loads and works just fine on Safari. I'm guessing it probably works fine on the latest version of Internet Explorer as well. It does require Java.)

Carnival roundup

Bora Zikovic provided a handy list of upcoming blog carnivals for the next two weeks here. For those of you unfamiliar with blog carnivals, they are periodic aggregations of (usually) related posts designed to highlight the best writing in the blogosphere, usually hosted by different bloggers on a rotating basis.

Interview with Hitler's bodyguard

With the acclaim and attention received by liver Hirschbiegel and Bernd Eichinger's movie "Downfall," which was nominated for a best foreign-language Oscar, about the last 12 days of Hitler's life in the Führerbunker in Berlin as the Red Army pounded Berlin into rubble, advancing relentlessly, Salon.com has published an interview with Rochus Misch, who served as one of Hitler's bodyguards from 1940-1945. With the death of Hitler's secretary Traudl Junge in 2002, Misch is the last surviving person to have spent those bizarre and horrible last days in the bunker.

Unlike Junge, Misch seems relatively unrepentant and reports good memories of working for Hitler. In any case, it's a fascinating piece of history.

Monday, February 21, 2005

Jim Holt deconstructs intelligent design

The New York Times published a rather nice deconstruction of intelligent design creationism by Jim Holt in its Sunday magazine. I wonder if the editors were feeling a bit foolish for giving Michael Behe a forum to defend intelligent design two weeks ago.

A pet peeve

"23 is asking to speak with a doctor."

I turned. The nurse was addressing me, waiting expectantly for an answer. "Who?" I asked.

"Room 23."

"Who?" I demanded more insistently. I knew exactly which patient she was talking about. In fact, I was being a bit of a jerk on purpose, to make a point. You'll see why in a minute.

"Mrs. Smith," she finally said. ["Mrs. Smith" is, of course, not the patient's real name.]

"Thank you. Tell Mrs. Smith I'll be there in a few minutes," I replied.

I was on call last weekend. Normally, most of my practice is outpatient visits and outpatient surgery, but about once every month or so, for a week at a time, I'm on call for new consults. Part of that duty is to come in and round on the group's patients over the weekend. During these call weeks, I'm suddenly immersed in the hospital lifestyle once again, sometimes after being a way for a few weeks or longer. Last week, I was on call again after an unusually long stretch of time not being on call. Consequently, I had forgotten one of my pet peeves about hospitals, something that's irritated me about every hospital I've ever worked in (and I've worked in hospitals in four different states now). Can you guess what it is?

Yes, indeed. It's the tendency of nurses and hospital personnel to address patients not by their names but by their room numbers. Nurses, ward clerks, orderlies, and just about all the other staff do it. People who have been patients have no doubt heard variations of these kinds of statements by nurses and others:

"15 needs the bedpan."

"Room 54 needs his pain medicine."

"27 is throwing up."

Now, such terminology can serve a legitimate purpose when it's used for an overhead announcement. It protects the privacy of patients. I'm not saying that ward clerks should make announcements that every can hear in which patients' names are used. Also, I realize that nurses are assigned rooms. Unfortunately, it permeates every other interaction in the hospital, even those that happen behind the ward desk or even in the nurse's lounge. I've heard people justify such a habit using HIPAA (regulations that govern patient privacy), but this is a long-standing custom in hospitals that has irked me ever since I was a medical student in the 1980's. HIPAA took effect less than two years ago.

Don't get me wrong. This is not nurse-bashing. We doctors are just as guilty of dehumanizing patients by not using their names, perhaps even more so. It's just that we tend favor a different style of dehumanization. We tend to refer to the patient by his or her disease or surgical procedure, rather than room number. We'll refer to "the choly [short for "cholecystectomy"] in room 10," "that pancreatitis patient," or "that lower GI bleed in the unit." These sorts of usages irk me just as much as the nurse's telling me that "23 wants to talk to me." No one is immune to using this sort of terminology in medicine, even me (although I do try to stop myself when I find myself starting to use it).

When I was a second year medical student, my preceptor for Physical Diagnosis (the course in which we learned the basic techniques of physical examination) warned me about this tendency. He reinforced strongly that each patient was a person, an individual. The patient is not just a disease and is certainly not just a number. That patient has hopes, dreams, and fears, just as we do, and that patient deserves always to be treated with respect. He was correct. However, once a young medical student (or nursing student, orderly, or technician) is immersed in the culture of the hospital, rare is the individual who doesn't find him or herself occasionally (or even frequently) slipping up and referring to patients as numbers or diseases. In fact, during residency, when I was frequently overwhelmed by work, dog tired from spending 36-40 hours straight in the hospital, and all too often cranky, I found it very difficult indeed not to just "go with the flow." It's also particularly difficult for surgical residents on the trauma service, where the patients are all too often alcoholics, violent, or otherwise very unlikeable. In such situations, the patient becomes the enemy. Samuel Shem's House of God is still relevant today, even though it was written decades ago. I could speculate on how such dehumanization could serve a psychological purpose, protecting health care professionals from emotional reaction to the disease and death they see around them or how exposure to such suffering can dull one's senses to the humanity of even the most obnoxious patient (who might be obnoxious precisely because he/she is suffering and being obnoxious is the only way to get attention). But that doesn't make it acceptable.

As those who've been reading this blog a while know, one of my major themes is a critical (or skeptical) examination of alternative medicine and the science (mostly, sadly, the lack thereof) behind its claims. Indeed, my first substantive post to my blog after my manifesto was a post about why otherwise intelligent people choose alternative medicine over conventional medicine. In that article, I pointed out that one reason was the people with diseases for which conventional medicine doesn't have particularly effective treatments are desperate for any hope and will grasp at straws. That's not the only reason though. Certainly one other reason is that alternative medicine practioners, for good or ill, often give the patient the human touch they crave. They listen to their patients and take the time to explain their treatments, probably more so than "conventional" physicians. That their explanations are scientifically implausible or even obviously erroneous does not matter, because most lay people don't have the background in science to recognize the scientific and logical fallacies in their treatment rationales. Indeed, such alternative medicine practitioners are only rarely sued when there is a bad outcome, because they have developed a bond with their clients.

I don't claim to know how we in the medical profession can go about reclaiming the human touch for our patients. Certainly there are individual doctors who do a fantastic job of doing just that, and I highly doubt that any doctor wants to be perceived as impersonal and uncaring. But individual efforts not enough. The problem is systemic in modern medicine, and has been so for a long time, at least as long as I've been in the field. I may not know how to change the system, but I do know how I can change my little part of the system.

Here's what I can do. I can refuse to address patients as diseases or room numbers and insist that the nurses, medical students, and residents who deal with me do likewise. I can do so even if it means being a bit of an asshole sometimes, as in the example with which I started this post. I can hope that this example teaches or inspires. Whatever my other personality faults may be (and, as those who know me best know, there are many), I can hope to follow this one precept. It's not much, but it's a start.

Sunday, February 20, 2005

Dresden redux

One week ago, I posted a rather lengthy piece about the 60th anniversary of the firebombing of Dresden. In it, I mentioned that there are many myths about the firebombing (inflated death tolls, that Dresden had "no military significance," etc.). Lest anyone think I was exaggerating the emotions that Dresden still provokes today and the persistence of some of the myths about it, I became aware that my article had been linked to in the comments of a recent entry in Matt Yglesias's weblog by someone trying to debunk one myth being propagated in the comments thread. (Tip o' the hat to Andrew for using my blog to debunk myths on high traffic blogs!) In the original post, Matt points out an article that uses a particularly hyperbolic and offensive comparison to Dresden with regards to the educational system. Check out some of the comments. Most are about the educational system or the appropriateness of the analogy, but the ones about the Dresden raid itself are very heated, some even vitriolic. One caught my eye first, as he was repeating exaggerated claims as though they were fact:
Dude, in a half day, a half million people, mostly civilians, were killed. How is that not "the worst single event massacre of all time"? It tops both Japan atomic bombings and the Tokyo fires. If you can come up with a similar event on a similar time-scale, I'm all ears.
There it was, an estimate more than ten-fold higher than the highest credible estimates of the death toll, stated as fact. It was more than twice the highest exaggerated death toll I had ever heard.

Also, here was another fallacious statement (albeit by a person remonstrating with the person who posted above):
No one really knows how many people died in Dresden, Hiroshima, Tokyo, or Nagasaki because the bodies were completely burned it's all estimates.
No, this is incorrect as well. There are actually very good estimates of how many died in Dresden, compiled by the Germans themselves and intentionally exaggerated by Goebbels for propaganda. Later, the Soviet rulers of East Germany considered it convenient to allow Goebbel's exaggerations to be propagated, in order to make the British and Americans look brutal. This person is correct, however, when she says:
...by any metric Hitler's extermination programs and their side projects were worse.
Definitely. The reason fascists equate the Dresden bombing with the Holocaust is to downplay the scope of the Holocaust.

Finally, part of one comment in the thread was simply so spot-on that I have to include it:
Can we please, perhaps, just agree that invoking Hiroshima, The Holocaust, Dresden, The Rape of Nanjing, The Cultural Revolution, The Trail of Tears, The St. Bartholemew's day Massacre, Rwanda, The Black Plague, or The Extinction of the Dinosaurs are all rhetorically excessive when compared to just about any domestic social issue?
Amen.

Such rhetorical excesses shed much heat but very little light. Their usual purpose is to demonize the subject of the attack without actually having to bother to do the heavy lifting of justifying the attack with, oh, say, actual persuasive evidence. Usually, when you see this kind of rhetorical excess, it is a sign that the person using it either has a weak argument, is intellectually lazy, or is just interested in polemics. Unfortunately, all too often these days, polemics work.

Friday, February 18, 2005

The Aftermath

Well, I took my turn hosting the Second Meeting of the Skeptics' Circle yesterday. Despite some initial trepidation on my part that my somewhat unusual style of organizing the submissions might put some people off, the response has been quite gratifying. In fact, yesterday, the response shattered all previous one day hit total records for Respectful Insolence, exceeding the previous record by well over two-fold! (I realize the numbers aren't all that impressive compared to the big sites, but it impressed the heck out of me.) I'm quite grateful to all the supportive bloggers who linked to the Circle and helped bring in more traffic, creating more buzz and hopefully directing some traffic to the First Meeting of the Skeptics' Circle as well. The response tells me that there really is a "market" (if you will) for high-quality skeptical blogging, and I see this thing continuing to grow from here on out. Radagast, the next host, should keep the ball rolling quite nicely on March 3. Send him your skeptical blogging by the evening of March 2.

Given how much time I spent putting the Circle together in some sort of coherent form (and the fact that I was on call yesterday, a sad fact that will continue through the weekend and the pain of which became apparent over the last couple of nights), blogging will be light and possibly nonexistent until Monday. Also, I don't want to distract unduly from the Skeptics' Circle for at least a couple of more days by cluttering up the top of my blog with multiple posts that necessitate a lot of scrolling (hence the handy link to the Second Meeting of the Skeptics' Circle in the first paragraph of this post). In the meantime, in the spirit of blatant blogger self-promotion that I have pointed out to you in the past, I would urge those new readers who've discovered the joy that is Orac's Respectful Insolence for the first time through the Skeptics' Circle to check out some of the blog posts contained in Essential Orac (on the sidebar). Hopefully you'll like what you see and become a regular here. There's lots more where that came from. I promise.

But probably not before next week.

To my regular readers, I beg for patience. Followups to my Wearing Two Hats and Denial Parts I and II posts will be forthcoming, as will the usual assortment of posts about surgery, alternative medicine, science, skepticism, Holocaust denial, and random other musings.

Thursday, February 17, 2005

The Second Meeting of the Skeptics' Circle will now come to order!

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Away from the revelry of the main bar, in a dark, wood-paneled meeting room in the back of an old tavern frequented by scholars and scientists, the smell of beer and hamburger mixed with the musty odor of the old wood paneling as the gathered members of the Skeptics' Circle murmured among themselves. The air was ripe with anticipation, as St. Nate, Founder and President of the Skeptics' Circle approached a podium set up at one end of the long table around which everyone sat.

"Let the second meeting of the Skeptics' Circle come to order!" he said, banging the gavel with a flourish. "As you know, the first meeting of our Circle was a great success, due mainly to your hard work and fine skeptical blogging!"

"Here, here!" Interrupted Radagast and Orac, raising their glasses in unison, as the Circle cheered and clapped.
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"A toast to our President, whose vision and hard work organizing this club has made this all possible!" Radagast cried, leaping to his feet. The assembled Circle all raised their glasses in unison and drained them as one. As the servers wended their way among the crowd bringing additional pints to the thirsty skeptics, along with an assortment of appetizing pub fare, St. Nate continued.

"But we are not content to rest on our laurels! I want this Circle to endure and to keep getting better and more popular. I want to expand our membership! The blogosphere still remains a cesspool of the paranormal, pseudoscience, and quackery! We've had one success--a good start--but we must not let up now! This week, Orac, who volunteered to organize this week's meeting, will take his turn conducting the meeting. He has worked tirelessly to gather the best skeptical blogging and to publicize the Circle for all to see. Orac!" He motioned to Orac, who, clutching his second beer carefully in order to avoid spilling even a drop of the precious amber fluid, approached the podium, as the Circle applauded.
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"Let's get right down to business," Orac said, grasping the sides of the podium and carefully setting his beer down. "When trying to decide what topic to lead off this meeting with, I had a conundrum. As a doctor and surgeon, personally I have an affinity for debunking quackery and questionable medical claims. I had therefore originally planned on leading off with that topic. However, ten days ago, an article"--he paused and drew himself up for dramatic effect--"was published in the pages of the New York Times"--he paused again--"an article that so roiled the skeptical blogosphere--and, most of all, the biologists among our membership--that it's impossible for me as a scientist also not to lead off with it. "

A murmur of boos and hisses rose from the assembled Circle, particularly from the biologists (and especially from PZ Myers, whose smile had turned to a scowl and who was now darkly muttering under his breath something that sounded like "pseudoscientific crap"). The members of the Circle all knew exactly of what Orac spoke. On February 7, Michael Behe, author of Darwin's Black Box: The Biochemical Challenge to Evolution (a favorite tome among creationists), had somehow gotten his defense of intelligent design published on the editorial page of the New York Times, provoking a firestorm of reaction in the science blogosphere. Before anyone else could rise to take the challenge, PZ practically leapt to the podium to deliver a devastatingly logical point-by-point rebuttal of Behe's article. When he finished, there was a brief moment of silence, and then the Circle burst into heated discussion. Orac tried to regain control of the group, but everyone was so anxious to interject their opinion on this controversy that they didn't listen. Comments flowed more freely than beer in the minutes after PZ's blog piece (many questioning why the New York Times would foolishly devote such a high-visibility and high-credibility platform to such pseudoscience), topping out at over 200 before the insistent pounding of Orac's gavel finally managed to restore order.
02

When things finally settled down, inspired by PZ's example, a new member of the Circle, The Socratic Gadfly, weighed in, calmly pointing out the logical fallacies contained in Behe's article. He was followed by Joshua, who carefully made his way past his fellow skeptics up to the podium, where he proceeded to read aloud (with his own comments interjected) his scathing letter to the editor in response to Behe's piece, in which he pointed out that, using Behe's criteria, one could just as well argue that the Old Man of the Mountain was "intelligently designed." Not to be outdone, another new member, Joe McFaul, echoed Joshua, pointing out that Behe's use of Mt. Rushmore as an example of how a scientist could potentially distinguish intelligent design from from natural processes is fallacious. Joshua's and Joe's complaints were then reinforced by yet another new member, Carryon Williams, who tried to expand further upon the same concept but was stymied by the poor design of the Microsoft connection he was using (which forced Orac to explain gamely that members who don't have or want an MSN Passport account might have to go here and scroll down to the February 11 entry of his blog to read the full text of Carryon's excellent writing). "Damn Microsoft and its attempt to pretend that the rest of the world doesn't exist!" Carryon muttered as he returned to his seat, to have his place at the podium taken by Jason, who explained how creationists use many of the same rhetorical tricks and logical fallacies as those used by a cranks in general and a particularly nasty breed of cranks in particular.

After the presentations, another free-wheeling discussion ensued, highlighted by Joe's pointing out how intelligent design itself can "evolve" (and perhaps even--dare one say?--"speciate") and the Socratic Gadfly's wondering how creationists can so easily get a sympathetic hearing from the press about their claims of being "persecuted." "It's just as bad as the sympathetic hearing the Lobster Liberation Front gets when they claim that lobsters feel pain in the same way humans do!" interjected Brian, whose passion (and area of expertise) was the debunking fallacious scientific claims often made by radical animal rights activists.

The Circle agreed wholeheartedly that it must redouble its efforts to confront the insidious pseudoscience known as intelligent design creationism and the efforts of fundamentalists to misrepresent it as "science" in the classroom.

"Next topic," Orac interjected. "Now, it's time to discuss our skeptical inquiries into claims of medicine and quacks. Because alties are always claiming that we skeptics don't give them a fair shake, I've decided to begin this session with skeptical examinations of issues in conventional medicine. Then we'll move to questionable claims about conventional medicine that are often made by alt-med advocates and others. Finally, we'll save the skepticism about alternative medicine for last. Radagast?"

Radagast approached the podium. His pet peeve was a study that had received a lot of press recently claiming that fruit juice causes obesity in children. With a cold calculation that belied his previous boisterousness, he dissected the conclusions of the study with a surgical precision that Orac approved of and left it in tatters. He then continued, disbelieving that the media could pick up the story again, and launched into an even more detailed deconstruction of the study's conclusions, to the awe of the assembled skeptics. He was followed by Mark, who wanted to debunk a story about an actress going blind after using colored contact lenses. Next, Revere, ever the contrarian, approached the podium and carefully proceeded to question conventional wisdom about something most people rarely think about, the fluoridation of water, without falling victim to the usual paranoid claims voiced by the anti-fluoridation crowd. After he sat down again, Dr. Sydney Smith, apparently even more the contrarian than he, surprised the Circle with a speech asking whether the recent trend towards mandatory chickenpox vaccination for children might actually be putting adults at risk for serious cases of chickenpox and concluding that laws making this particular vaccination mandatory in some states might well be more a victory for Merck than for public health. A few of the physicians in the crowd muttered in disagreement, but others seemed to approve.

Sensing tension in the Circle and not liking it, Dr. Charles, who was known as the cut-up (non-surgical, of course) of the Circle and who had obviously consumed exactly the correct amount of beer to have gotten into the mood for some lighter skepticism (without affecting his wit one iota, it should be noted), began to expound in great detail about why thongs are such a grave danger to women's health. The Circle erupted in laughter. The tension dissipated.

The next several talks debunked bogus indictments of conventional medicine. At this point, it was Andrew's turn to approach the podium. Concerned about the misinformation regarding the MMR vaccine and autism, he launched into a blistering rebuttal of the anti-vaccination activists who claim MMR causes autism. Joshua agreed about the mendacity of the anti-vaccination activists, pointing out the fallacies of another vaccine myth, that of a supposed link between the polio vaccine and AIDS. Andrew couldn't resist adding that fear of the polio vaccine due to unfounded rumors may be leading to a resurgence of polio in Africa.

Now came the time in the program for a skeptical examination of alternative medicine, a favorite topic of Orac's, as the membership could tell from the gusto with which he introduced the next series of talks. Dr. Henochowicz began by expressing his skepticism about alternative medicine in general and his wonder at how people could so easily fall for claims about herbs that are so obviously medically fallacious. Shrinkette shook her head in disbelief and then took the podium to contribute an anecdote about her attempt to educate a patient who chose not to buy her needed medications in favor of purchasing "oxygenated" water instead. All the doctors in the Circle nodded in sympathy. (They had all seen variations of the same story in their own practices before, just with different "alternative" medicines.) Indeed, Dr. Charles lamented that sometimes, even when a physician does exactly the correct thing for a patient, it can be difficult to convince the patient of the correctness of the doctor's course of treatment, mainly due to misconceptions patients all too often harbor. For the last word on this topic for this meeting, Paul Lee fired up the Circle with a scathing debunking of one of the rationales that chiropractors sometimes use to justify their claim to being health care professionals.

Finally, with everyone fired up by the great skeptical blogging thus far in the meeting (not to mention the great food and drink), Orac introduced everybody's favorite part of the meeting, blogging about the paranormal, urban legends, and pseudoscience. Making this session even more fun was the number of new members contributing. Wolverine Tom, seized this chance to introduce himself to the Circle by debunking one of the most sacred of American myths, Punxsutawney Phil's prognostications on Groundhog's Day about the duration of winter remaining. Next, Bora Zikovic demanded that the credulous give him a break regarding claims that we have a "sixth sense," to which Majikthise couldn't resist adding her demand that Lawrence Summers give her a break from his simplistic comments about supposed biological differences between the sexes, and neither could Tim Lambert resist adding his demand that anti-environmental writers give him a break from their misrepresentations of the history of why Sri Lanka stopped using DDT. Bill Adams then expressed his annoyance at the lack of critical thinking in the reporting devoted to a strange incident of animal slaughter in England. Hedwig, however, was slightly more sympathetic to the credulous reporter, pointing out that even the most skeptical might, when their guard is down (early in the morning, for instance), be more susceptible to obvious scams or urban legends than they normally would be. Orac agreed, admitting to his fellow Circle members his recent embarrassment that he himself had been forced to question his own skeptical qualifications to host this very meeting, because he had once credulously reported on an incident that turned out to be most likely an urban legend--without even the excuse of having been sleep-deprived. This admission led to some good-natured ribbing from the group, which Orac deflected with his characteristic wit (at least he liked to think that's what did it).

Finally, it was time to close the meeting. As Founder of the Skeptics' Circle and the previous host, St. Nate was given the honor of the last speech. He had decided that he wanted to investigate a strange incident that sounded like an urban legend to him. He confronted head-on the "If Your Child is a Gothic, Reform Through the Lord" story, in which, it is said, certain Catholic Churches posted dire (and ridiculously over-the-top) warnings about Goth culture. He considered the story likely to be an urban legend (although a few members considered it possibly credible, given the documented strange things fundamentalists have said about rock 'n' roll, even recently). Orac could not help but suggest that perhaps St. Nate should counter this probable urban legend with the comprehensive analysis of Jesus' Gothness, Jesus Was Gother Than Thou. St. Nate drily replied that this was an excellent idea. He wasn't done yet, though. He finished by expounding upon modern day alchemists and the quest for immortality.

The Circle rose and gave him a standing ovation, leading to his taking many deep, exaggerated bows. "Only three more things remain," St. Nate announced, as he waited for the applause to die down. "First, we must congratulate all the presenters for some fantastic skeptical blogging and urge them to keep it up! Give them all a round of applause." The membership of the Circle responded to this plea, congratulating the bloggers with great enthusiasm. "Second, we must redouble our efforts to combat the credulity with which the blogosphere all too often greets claims of pseudoscientists, believers in the paranormal, and quacks. Keep that skeptical blogging coming!"

"Lastly, we must agree on who shall host the next meeting of the Skeptics' Circle, to be held two weeks from tonight on March 3. Any volunteers?"

"I'll do it!" shouted Radagast and approached the podium, before anyone else could say anything, narrowly edging out Bora and the Socratic Gadfly, both of whom were rising from their chairs as Radagast's cry cut them off. (This was much the same manner in which Orac had claimed the honor at the last meeting.)

"Will anyone second the nomination?" said Nate.

"I will!" said Orac.

"Then let's vote," continued Nate. "All in favor of Radagast's hosting the next meeting, raise your hands and say 'Aye!'"

"AYE!"

"All opposed?" Utter silence answered, except for the distant murmur of the crowd in the main bar area.

"The ayes have it," shouted Nate. "Radagast shall host the next meeting of the Skeptics' Circle! Everyone, send your entries to him by March 2." A cheer arose from the Circle.

Orac gently elbowed Radagast. "You really have no idea what you're in for, you know," he said quietly. He then smiled, "By the way, I hope there's a good restaurant or tavern in Rhosgobel where we can hold the meeting. Skepticism is hungry work."

"And thirsty work, too," added Radagast, continuing, "Don't worry, there is..."

The Circle broke up into smaller groups and continued its boisterous fellowship and debate more informally. Over the next couple of hours, members filtered out one by one, until there remained only three stragglers (St. Nate, Orac, and Radagast) who lingered, united by their common experience of having been chosen to host this great event and their search for ways to make it better and more widely known in the blogosphere (not the least of which included the hatching of wild schemes to get their little fellowship noticed by their heroes, especially famous skeptics like The Amazing Randi, Michael Shermer, or even Penn & Teller). Orac happened to glance at the clock and noticed it was past midnight. He was grateful that he didn't have to operate or see patients the following day, but realized that he needed to get home anyway. He was no longer as able to tolerate sleep deprivation as well as he could in his younger days during his surgical residency.

So, saying their goodbyes, the remaining skeptics dispersed into the winter night, secure in the knowledge that they were doing their small part to promote reason, science, and skeptical thought in the blogosphere. It was enough.

For now.


[Note from Orac: Thanks to all who contributed, and particularly to St. Nate, the Founder of the Skeptics' Circle. It's been a blast. If I somehow forgot anyone's article, e-mail me and I will, besides apologizing profusely and abjectly, forward it to the next host. And thanks to the Madhouse Madman, who provided the inspiration for this particular style of organizing the posts. Finally, if you're a newcomer to the Circle, the first edition is here. If you're interested in hosting a future edition of the Circle, the archive and host schedule is here.]

Wednesday, February 16, 2005

Last call for The Skeptics' Circle!

The Skeptics' Circle will be appearing here tomorrow. So far, I've received some really good examples of skeptical blogging on intelligent design creationism, questionable medical claims, pseudoscience, credulous reporting of the "paranormal," and other topics. However, there's always room for more! The deadline for submissions is tonight at 9 PM EST. Please send your entries to orac_usa AT hotmail.com. What we're looking for is described here. (Late entries will be included this time at my discretion only if I haven't finished putting the Circle together at the time I receive them. Otherwise, I will forward late entries to the next host for inclusion in the next Circle.)

Also, if you've submitted an entry and haven't yet received a confirmatory e-mail from me, please let me know today, to make sure I didn't somehow miss it or overlook it.

Join me tomorrow for the best skeptical blogging around!

Tuesday, February 15, 2005

Great idea!

Joshua from Thoughts from Kansas has proposed a wonderful idea. Quoth he:

Following up on an idea at Pharyngula (starting here), I want to document the following statement.
'Creationists like to say that evolution’s influence is dying and that it is of little importance to doing biology. They take advantage of the layperson’s lack of familiarity with the scientific literature to argue that evolution has little relevance, or that Dobzhansky’s aphorism that “nothing makes sense in biology except in the light of evolution” is false. Anyone who actually reads the biological literature, though, will come away with exactly the opposite impression: the journals are full of references to evolution, even in disciplines and journals that don’t have “evolution” in their title. The concept is central; it’s as ubiquitous as references to “genes”.'

Actually, I'm lazy, so I want you to help.

I've set up a new blog, The Evolution Project. I've also, for completeness, set up The Non-Evolution Project. People can add comments here, email me, or leave comments at those sites.

Submissions can be brief, and refer to either a news item, or a journal article. The Evolution Project will classify this research in two categories:
  • Research that is explicit in its discussion of evolution, proposing evolutionary connections or even testing evolutionary hypotheses. The evolutionary aspect may not be the major point of the paper, but it is discussed.
  • Research treating evolution as implicit; it may work with molecules homologous between different species, but without specifically address evolutionary ideas. This is not to say that they have a lesser commitment to evolution, but more that they take it for granted.
The Non-Evolutionary Project will, if such research comes into existence, document research that that directly discusses Intelligent Design or other anti-evolutionary ideas about science. I encourage submissions to both.

Grand Rounds XXI is now available

I have to admit, when it appeared screwed me up a little bit, but Grand Rounds showed up yesterday, many hours early, as Sumer is posting it from India. That means my Grand Rounds plug is later than usual relative to when Grand Rounds was actually posted. (As a surgeon, I tend to pride myself on getting a link to Grand Rounds up very early in the morning on Tuesdays, usually before most others.) The good news, though, is that those of you who frequent Sumer's blog could enjoy the best of the medical blogosphere many hours before the normal time it is usually posted.

In the meantime, because this week is rather busy and I haven't composed much (damn my day job for interfering with my blogging!), I'll think I'll post a few more photos from my foray into NYC over the weekend to see The Gates. Don't worry, Respectful Insolence isn't going to turn into a photoblog (I'm not a good enough photographer that people will want to see me posting photos every day anyway, although my father probably is); the more substantive blogging my readers crave--nay, demand from me--will recommence shortly. It's just that I don't feel I'm truly blogging if I don't post something every day, even if it's a short link/quote plus comment. I won't go so far as to post crap rather than nothing (well, not most of the time, anyway); but I do try not to let a weekday go by without posting something... It can't always be scintillating pieces of prose like my recent Dresden post, my recent submission to the aforementioned Grand Rounds, or even my discussion of cancer denial. No, sometimes even I, Orac, must recharge the batteries.

Fortunately, I have the beauty of these additional pictures. I hope you like them too...

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Billowing in the wind

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A single gate

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A row of gates

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More gates

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View from across a pond

Monday, February 14, 2005

In honor of Valentine's Day

What not to do... courtesy of Joy of Tech.

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Cristo and Jeanne-Claude's The Gates

There will most likely only be light blogging this week. This is true for a couple of reasons. The main one is that I'll be dedicating a lot the free time I usually dedicate to writing longer posts for my blog to promoting and putting together this Thursday's edition of The Skeptic's Circle, which it happens to be my turn to host. Most likely there won't be much time leftover for anything other than relatively brief posts, at least until next weekend or early next week. I'm gratified that we got several more fine submissions over the weekend, but there's still room for some more. If you're a blogger and want to submit your work, drop me a message containing the URL and a one- or two-sentence description of the post. The deadline is 9 PM Wednesday, February 16. The guidelines, as suggested by St. Nate, are here and here.

I took a break from blogging this weekend to make a foray into New York to check out Cristo and Jeanne-Claude's The Gates in Central Park. I had been skeptical of the entire concept, but, if you have the opportunity to see something like this, which will only be around a little more than two weeks, it's foolish not to take it. My wife and I weren't disappointed. Seeing the whole project in person, I found it quite impressive and beautiful. I took a bunch of pictures. I'll post a few today. I may include additional pictures with every post I write for a while (at least until I exhaust the good pictures). Unfortunately, it was overcast on Saturday, making me wish we had gone yesterday instead, when it was sunnier. My wife thinks that the overcast skies made the Gates stand out more from the background, but I'm not so sure. In any case, here are the first few pictures I plan on posting:

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A view from the rooftop garden of the Metropolitan Museum of Art

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A confluence of gates

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Behind the Met

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By the fountain

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Staring straight up at a gate

If you live close enough to New York that it's feasible to make a day trip into the city by February 27, to see this spectacle, go! It's well worth it.

More pictures to come...

Sunday, February 13, 2005

The Carnival of the Godless #3

The Carnival of the Godless #3 is now posted at Science and Politics. You don't have to be "godless" to appreciate the blogging going on there, although if you're a fundamentalist you might want to stay away. I've always had mixed feelings about this particular carnival, but so far it's been quite good.

60 years ago tonight: The Dresden Firestorm

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60 years ago this evening, Dresden was destroyed. It is an event that has had profound political ramifications even today and poses difficult moral questions that I will try to address, because, given my interest in debunking Holocaust denial, Dresden is a topic that all too often comes up, with Holocaust deniers trying to claim a moral equivalence between the Nazis and the Allies. Before these questions can be addressed, however, it is necessary to describe what happened that fiery night and dispose of some of the myths that persist about the bombing. What happened was awful enough without these myths. Indeed, it can be argued that the destruction of Dresden was the result not of any one act, but a consequence of total war.

Dresden had been oddly fortunate up until this date in 1945. While other cities, particularly Berlin and the industrial cities of western Germany, suffered bombing raid after bombing raid and the city of Hamburg had suffered a monumental firestorm a year and a half earlier, as of mid-February 1945, even with the Red Army a mere 75 miles to the east and advancing, somehow Dresden had avoided this fate. True, it had not completely escaped damage. and scares. As early as August 1940, air raid sirens had sounded over the city. It was a false alarm. In October 1940, three high-explosive bombs had actually fallen in a field just southeast of the city. After that, in 1941 there were seven air raid warnings and in 1942, four. Despite the fact that its sister city Leipzig, located a mere 60 miles away, was bombed multiple times during 1943 and 1944, despite having 203 air raid warnings over the course of these two years, in early 1945 Dresden remained largely untouched.

Indeed, this escape from the destruction other cities endured time and time again contributed to a false sense of security among Dresdeners--that, and its location in the far eastern reaches of Germany and its reputation as a cultural center of great beauty of "no military importance." ("Why would anyone want to bomb Dresden?" was a frequent refrain.) This confidence was so great that parents refused to send their children to the countryside for safety, as parents in so many other German cities were being forced to do, leading a rather weak "order" in December 1943 for parents to send their children out of Dresden. This order was was widely ignored, leading to a stronger order in January 1944 warning parents that children who did not go to the countryside would not be entitled to schooling in Dresden. Parents found ingenious ways to get around this order, to the point that official documents spoke with a sense of resignation regarding efforts to relocate the children. In August 24, 1944, the first Allied bombing raid that actually caused casualties within Dresden occurred. The USAAF targeted the Rhenania Ossag hydrogenation works--which made oil used in the Wehrmacht's tanks--in the Dresden suburb of Freital, during a daylight raid. 241 people died. However, little damage occurred in the city of Dresden itself. On October 7, 1944, Dresden was hit again by the USAAF, but only because its Friedrichstadt marshalling yards happened to be a secondary target of a larger raid, to be bombed only in the event that the primary target could not be found. This raid should have caused serious concern, because it was an improvised raid with fewer than 30 American bombers diverted from other targets and it still had resulted in the deaths of 270 people. But it didn't. Most Dresdeners considered the raid an anomaly. The city was subjected to one more raid before the end, a raid that occurred on January 16, 1945. Once again, Dresden was a secondary target, but this time 127 bombers attacked the city, killing 376
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people and spreading intermittent areas of destruction over a four mile swath of the city.

At this point, even though it should have been clear that Dresden's "special status" among German cities was an illusion, Dresdeners still clung to this illusion. They did not know that, on January 1, 1945, Colonel General Heinz Guderian, Chief of the Army General Staff, had designated Dresden a military strongpoint, a "defensive area" (Verteidigungbereich). Dresden was to be one of several strongpoints to be used in a last desperate effort to slow the relentless Russian advance into Germany. Even if the citizens had known that their city was in Allies' sites, there was not much that could have been done anyway. By February, the German defenses were utterly collapsing, and the Red Army was rapidly advancing from the East. The air raid equipment and antiaircraft batteries from Dresden had been mostly removed and taken to places where they were more urgently needed. The city was largely defenseless.

And then, on Tuesday, February 13, 1945, with Hitler's death and war's end less than three months away, Dresden's luck finally ran out. On the night of Shrove Tuesday, in two raids, a total of nearly 800 RAF bombers dropped 2,690 tons of incendiaries and high explosives on the capital of Saxony. 244 Lancaster bombers hit the city center between 10:13 PM and 10:28 PM, pummeling it with 881 tons of bombs, 43% of which were incendiaries. By 11:00 PM, the early stages of the firestorm were becoming evident. But worse was in store. 550 more bombers were on their way, guided to their target by the light of the fires raging in Dresden, which were visible 50-100 miles away. As Bomb aimer Miles Trip, quoted by Frederick Taylor, in his excellent book Dresden: Tuesday, February 13, 1945 described it:
Although we were forty miles from Dresden, fires were reddening the sky ahead. The meteorologic forecasts had been correct. There was no cloud over the city.

Six miles from the target, other Lancasters were clearly visible; their silhouettes black in the rosy glow. The streets of the city were a fantastic latticework of fire. It was as though one was looking down at the fiery outlines of a crossword puzzle; blaxing streets stretched from east to west, from north to south, in a giagantic saturation of flame. I was completely awed by the spectacle.
From 1:20 to 1:45 AM, Wednesday, February 14 (Ash Wednesday, appropriately enough), the remaining bombers dropped their deadly cargo on the city. By the time they were through, Dresden, the victim of perfect weather, no air defenses, bombing far more accurate than the crude methods of World War II usually produced, and the most horrible of luck, had been engulfed by the rarest of things: The perfect firestorm. Victor Klemperer, one of the few Jews to have survived in Dresden through the entire war (mainly because he was married to an "Aryan") and whose memoir, I Will Bear Witness, is an indespensible account of the gradually increasing persecution of Jews by the Nazis that culminated in the Holocaust observed:
Within a wider radius, nothing but fires. Standing out like a torch on this side of the Elbe, the tall building at Pirnaischer Platz, glowing white; as bright as day on the other side, the roof of the Finance Ministry...the storm again and again tore at my blanket, hurt my head.
Dresden suffered one more punishment that day. The USAAF followed up with a previously planned followup daylight raid in the early afternoon of February 14. The fires burned for more than a week, and an estimated 35,000 people died, many in the air raid shelters, from which the firestorm sucked the oxygen. Many died in the boiling waters of fountains in the mistaken belief that the water would protect them. It didn't. It boiled away.

Since the firestorm, several key myths have been repeated and become "common knowledge." Frederick Taylor, while not justifying the Dresden raid, has debunked at least three of them:

  • Inflated death tolls. Death tolls were inflated for propaganda purposes at the behest of Josef Goebbels. These "estimates" ranged to as high as 250,000 (and even 300,000+) people. Noted Holocaust denier and self-proclaimed historian David Irving touted an estimate of 100,000. However, the most recent research on the topic suggests that the toll was between 25,000 and 40,000, horrible enough without exaggeration.
  • Dresden was a city of "no military importance." This is also untrue, at least by the standards of the time. There were a large number of precision engineering companies headquartered in Dresden, many of which made instruments for the Wehrmacht and Luftwaffe. Zeiss-Ikon manufactured precision optics in Dresden, much of which went in the later years of the war to sights for antiaircraft batteries. There was the previously mentioned hydrogenation plant. Many of these plants used Jewish slave labor in the later years of the war, when worker shortages were accute. Next, Dresden was an important rail transportation hub for all of Saxony and eastern Germany. Finally, there were a number of military barracks in and around the city. By any criteria used at the time, Dresden was a legitimate military target.
  • Allied planes strafed survivors fleeing the city. There is no evidence that this happened. In fact, it would have been irresponsible, because the escort fighters were operating close to the limit of their range, and undertaking strafing runs would have used fuel they could ill afford. There were some strafing runs far to the west of Dresden, but against railroad targets. Also, there was a brief low-level dogfight near and over the city, which may have contributed to such stories. To people on the ground, they may have appeared to be strafing and it is possible that some civilians may even have been hit by the fire.
Not surprisingly, soon after the bombing, the German propaganda machine went into high gear. Surprisingly, it got a boost from the Allies, many of whom were horrified by the freak firestorm that had been created, which was worse than the Hamburg firestorm. Even Winston Churchill, an enthusiastic supporter of the bombing of German cities, backpedaled a bit in a now-famous memorandum on March 28, in which he stated: "Dresden remains a serious query against the conduct of Allied bombing." Chuchill's memo infuriated Air Marshall Arthur "Bomber" Harris, the architect of the British bomber war against Germany, and Churchill did follow it up with a somewhat less provacative memo. After the war, the Soviet occupiers of East Germany found it convenient to continue the myths and denounce the bombings as "barbaric" and evidence of the brutality of the Americans and British, a particularly ironic charge given the well-documented brutality of the Red Army committed on the Eastern Front and the mass rapes it committed as it swept through eastern Germany. No doubt 45 years of Soviet propaganda helped nurture these myths about Dresden.

In considering the moral questions involved in the Allied bombing campaign, it helps to remember how it was started. The possibility of aerial war was contemplated nearly 40 years earlier and even regulated in the Hague convention, which prohibited attacks on undefended towns and villages. Mainly because the technology didn't exist, there were few such attacks on towns in World War I anyway, other than German zeppelin raids on London and occasional highly ineffectual attempts at bombing. Between the World Wars, there developed a contingent of military men who became fervent believers in the concept that air power alone, specifically strategic bombing, could win wars. In fact, some went so far as to claim that air power would ultimately render ground forces necessary only to move in and take over territory after strategic bombing had defeated the enemy. Thus was born the "bomber's dream," which, boiled down to its essence, is the belief that wars could be won by bombing alone.

Although there were attempts at strategic bombing before, the first serious sustained strategic bombing occurred in 1940. In August 1940, Germany bombed London. The British retaliated with bombing raids on Berlin. This so enraged Hitler that he ordered a massive sustained bombing campaign on Britain, which became known as the "Blitz" or the Battle of Britain. Over 40,000 British civilians were killed in the fall of 1940. The bombing campaign nearly broke the back of the RAF, but somehow Britain held out.

The Blitz probably explains much of why the British were always more enthusiastic for strategic bombing than the Americans. They understandably viewed it as payback, having experienced first hand the horrors of aerial bombing themselves. Nonetheless, when they first started their bomber campaign, they concentrated solely on strategic objectives, such as dockyards, military installations, and munitions factories. However, the accuracy of their bombing was woefully lacking. Indeed, in 1941 an analysis of the effectiveness of British bombing based on 100 separate raids on 28 targets over 48 nights in June and July 1941 observed: Of those aircraft recorded as attacking their target, only one in three got within five miles. Over the French ports, the proportion was two in three. Over Germany as a whole, the proportion was one in four. Over the Ruhr [the heart of industrial Germany] it was only one in ten. Because of the high casualty rates among bomber crews flying unprotected by fighter escorts in the daylight, the British came to favor large night-time raids on cities, while the Americans advocated daylight "precision bombing" raids from very high altitudes against factories and other military targets. However, for both, low accuracy meant relatively low success at destroying the intended target and a high likelihood of "collateral damage." Lack of fighter escort meant very high bomber loss and casualty rates among the crews, so much so that there was concern in 1942 and 1943 that the casualty rates were higher than what could be replaced by training new crews. However, it must also be remembered that, in the early years of the war, the British and Americans really had no other means of engaging Germany in Europe, and political forces were such that British leaders didn't want to be perceived as "doing nothing." Over time, the momentum favoring bombing grew and grew, so that it continued even after Germany was clearly losing. The bomber's dream still drove it, and still lives today (for example, in the war on Kosovo in 1998, in which nearly no ground troops were used until after Serbia surrendered).

So how to answer the Holocaust denier's charge that bombings like those of Hamburg or Dresden (or, in the Pacific, Tokyo and the atomic bombings of Hiroshima and Nagasaki) were morally equivalent? One answer obviously presents itself. Whatever its results and intent, the bombing campaign was not (at least until late in the war) directed solely or even primarly against defenseless people. Indeed, the high bomber crew casualty rates that caused so much concern about the sustainability of the bombing campaign were due to highly formidable German air defenses. Casualty rates among bomber crews remained very high until well into 1944, when long-range fighter escorts became available. The bombers' intent was not to eliminate an entire race of people from the face of a continent, as the intent of the Holocaust was, but rather to destroy infrastructure and military targets and and to "demoralize" the populace into demanding surrender. (It succeeded at the first aim and almost utterly failed at the second aim.) Second, there was a military rationale for the bombing campaign, in fact a rationale that seemed very compelling to a great many military and civilian commanders at the time, most prominent of which were Winston Churchill and "Bomber" Harris. That the rationale may has been questioned and may have been incorrect is something that we can see now in hindsight but that was not readily apparent 60 years ago, although some did question the wisdom of this campaign. As James Woudhuysen puts it: If, for instance, we search for a military rationale for the Nazis' Holocaust, in which a whole industry had to be built to kill six million Jews, we will search for a long time. Once Germany was engulfed by fascism, all kinds of irrationality were possible. (To that I would add: In fact, the Holocaust actually decreased Germany's war-fighting ability, as the personnel and enormous resources retained late in the war for maintaining the camps for killing Jews could certainly have been better used to defend Germany.) In addition, as Frederick Taylor points out: It is rarely mentioned that almost exactly the same number of Soviet citizens died as a result of [German] bombing during the Second World War as Germans: around half a million. However, it is still clear that the Allied bombing campaign against cities, both in Germany and Japan, is perhaps the single most morally difficult question that is asked about the conduct of the war by the Allies. Once the relentless logic of total war takes hold, it allows the justification of things we would normally consider abhorrent and may consider abhorrent later. I am not sure that there is an good answer to this question, but I emphatically point out that, whatever other things the bombing campaign may have been, it was not morally equivalent to the Holocaust. Another thing I do know is that claiming moral equivalency of the Allied bombing campaign to the Holocaust will not justify the Holocaust or diminish its horror. World War II was the bloodiest war in history, and, as the distance of time allows more perspective, I hope that we will be able to use what we have learned to try to prevent anything like it from ever happening again. If that sounds like a copout, it probably is to some extent. But it's also about as close as I can come to the truth right now.

(Note: Other articles are here, here, here, here, and here.)