60 years ago today: The end of the Führer

Sixty years ago today, the capital of the thousand year Reich, Berlin, was in ruins, after only twelve years of the Nazi regime. For months, it had been pounded from the air by Allied bombers, and now it was being pounded relentlessly by Soviet artillery, bombers, and tanks. Berlin was completely circled by its enemies, who even now were advancing to within artillery range of the Reichstag itself, lobbing shells that were exploding close enough to shake the building. Remnants of the German forces fought a desperate, last ditch defense, even though they were outnumbered and outgunned, with no hope of doing anything more than slowing down the inevitable onslaught by a few days or hours. Adolf Hitler's dream of creating a Reich that would endure for a thousand years, obtaining Lebensraum in the East for Germans to expand into, enslaving the "inferior" Slavs of that land, and destroying Bolshevism, a dream that had plunged the world into war and led to the deaths of millions, both in combat and in the planned slaughter of six million Jews that later became known as the Holocaust, had backfired spectacularly, plunging Germany into nightmare. Not only had he failed to destroy Bolshevism, his gamble in launching a two-front war had led to the destruction of Germany, the deaths of hundreds of thousands German civilians and soldiers, and the mass rape of German women in the East by soldiers in the advancing Red Army. His most hated enemy had allied itself with nations that he had only half-heartedly gone to war with, Britain and the United States, and the combination was too much to overcome. Although Hitler could not know it at the time, his folly had not only delivered the eastern half of Germany into the hands of his most hated enemies, but that domination would last 45 years, nearly four times as long as the Third Reich had endured.

In the bunker below the Reichstag, it was becoming increasingly obvious that it would not be very long at all before the Russians would reach the grounds of the Reichstag itself; within days, if not hours. In the days and weeks leading up to April 30, the mood in the bunker had become increasingly surreal. Hitler issued orders for counterattacks and attempts at breaking the stranglehold the Soviets were developing on Berlin to armies that no longer existed. He pondered models of the intended postwar rebuilding of his hometown of Linz, to which he said that he wished to retire after the war. When news of Frankin D. Roosevelt's death reached the bunker on April 12, Hitler had become jubilant, seeing the death of his enemy as a sign that the Reich's deliverance was at hand, that his enemies would collapse. It wasn't.

On April 20, Hitler's 56th birthday was celebrated, but the atmosphere was more funereal than celebratory. Hitler clearly saw the celebration of his birthday with his enemy well into the maneuver of completing its encirclement of Berlin as profoundly embarrassing, as did the few remaining loyalists in the bunker. Hitler did emerge from the bunker, climbing the stairs to the Reich Chancellery park. Greeting him with the raised arm "Heil Hitler" salute were soldiers from the SS-Division "Berlin" and twenty boys from the Hitler Youth who had distinguished themselves in combat. The whole scene reinforced the hopelessness of the situation. The defense of the Reich capital, relying on boys? However, it was a natural consequence of Hitler's all-or-nothing thinking. To him, it would be either victory or utter destruction, and if that meant throwing boys into combat against battle-hardened Soviet troops with vastly superior firepower, so be it. As he had raged before, if Germany failed then to him it deserved utter destruction. Two days later, at a briefing, Hitler learned that Soviet troops had broken through the inner defenses and were now moving through Berlin's northern suburbs. Hitler was told that an ordered counterattack had never taken place at all. At this news, the reality of the situation finally seemed to sink in, and Hitler snapped. Hitler screamed that he had been betrayed by all whom he had trusted, railing against the treachery of the army and claiming that the SS was lying to him. The troops refused to fight, and all defenses were down.

And then he stopped. He slumped in a chair and cried. The great dictator, the man responsible for starting a world war and who had callously ordered the murder of millions of innocents, sobbed. The man who had expressed no concern over the suffering of his people, and whose "scorched earth" war orders designed to resist at all costs and destroy infrastructure rather than let it be used by the Soviets (some of which had been secretly undermined by Albert Speer and various industrialists, who did not want to increase the suffering of the German people more) cried. He sobbed that the war was over. He vowed that he would stay in Berlin and lead the defense of the city. Then, rather than allow himself to be captured he would at the end kill himself. All urged himself to change his mind, to make an attempt to break out and retreat to his mountain redoubt of Berchtesgaden, there to continue to lead the resistance. His apocalyptic Wagnerian vision of Gotterdamerung would be fulfilled.

The situation continued to deteriorate, and several in the bunker left, preferring to take their chances trying to escape capture or to die in the open, rather than being trapped in the bunker. When Hitler learned on April 28 that one of his most trusted deputees, SS Chief Heinrich Himmler, had made peace overtures, it was the final straw, and Hitler went into one more monumental rage. On April 29, Adolf Hitler had married Eva Braun, exchanging vows in a simple ceremony. She had vowed to stay in the bunker with him, and would soon die with him. His last will read:

As I did not consider that I could take responsibility, during the years of struggle, of contracting a marriage, I have now decided, before the closing of my earthly career, to take as my wife that girl who, after many years of faithful friendship, entered, of her own free will, the practically besieged town in order to share her destiny with me. At her own desire she goes as my wife with me into death. It will compensate us for what we both lost through my work in the service of my people.

What I possess belongs - in so far as it has any value - to the Party. Should this no longer exist, to the State; should the State also be destroyed, no further decision of mine is necessary.

My pictures, in the collections which I have bought in the course of years, have never been collected for private purposes, but only for the extension of a gallery in my home town of Linz on Donau.

It is my most sincere wish that this bequest may be duly executed.

I nominate as my Executor my most faithful Party comrade,

Martin Bormann

He is given full legal authority to make all decisions. He is permitted to take out everything that has a sentimental value or is necessary for the maintenance of a modest simple life, for my brothers and sisters, also above all for the mother of my wife and my faithful co-workers who are well known to him, principally my old Secretaries Frau Winter etc. who have for many years aided me by their work.

I myself and my wife - in order to escape the disgrace of deposition or capitulation - choose death. It is our wish to be burnt immediately on the spot where I have carried out the greatest part of my daily work in the course of a twelve years' service to my people.

Given in Berlin, 29th April 1945, 4:00 a.m.
[Signed] A. Hitler

In another document, his last political testament, he dictated to his young secretary, Traudl Jung:

It is untrue that I or anyone else in Germany wanted war in 1939. It was desired and instigated exclusively by those international statesmen who were either of Jewish descent or who worked for Jewish interests. . .Centuries will pass away, but out of the ruins of our towns and cultureal monuments the hatred will ever renew itself against those ultimately responsible whom we have to thank for everything, international Jewry and its helpers.

Regarding the Holocaust, he obliquely but chillingly wrote:

I also left no doubt that, if the nations of Europe are again to be regarded as mere blocks of shares of these international money and finance conspirators, then that race, too, which is really guilty of this murderous struggle will be called to account: Jewry! I further left no one in doubt that this time millions of grown men would not suffer death, and hundreds of thousands of women and children not be burnt and bombed to death in the towns, without the real culprit haivng to atone for his guilt, even by more humane means.

The remainder of his testament was devoted to ramblings about a "renaissance" of National Socialism and the charade of nominating a successor government. His final charge to the successor government:

Above all, I charge the leadership of the nation and their subjects with the meticulous observation of the race laws and the merciless resistance to the universal poisoner of all peoples, international Jewry.

[Source: Hitler 1936-1945: Nemesis by Ian Kershaw]

Even there, at the end, he could not release his hatred and wanted his successors to continue his persecution of the Jews.

Finally, in the afternoon of April 30, after taking lunch as usual with his secretaries, Hitler retired to his study with Eva Braun. Hitler's followers waited. And waited. No one heard a shot. Finally, according to accounts by Major Freytag von Loringhoven, Traudl Jung (Hitler's staff secretary, and subject of the documentary Blind Spot: Hitler's Secretary) and SS Staff Sgt. Rochus Misch, one of Hitler's bodyguards, Hitler's vale, Heinz Linge, got up the courage to look inside the room, and found Adolf Hitler and Eva Braun dead, Hitler having shot himself as he bit on a cyanide capsul, and Braun having taken a cyanide capsule. His remaining followers carried the bodies into the courtyard of the Reichstag, doused them with gasoline, and set them ablaze. In the meantime, Magda Goebbels poisoned herself and her six children with the help of SS doctor Helmuth Kunz.

Thus ended the life of one of the scourges of the 20th century. Rumors that Hitler had never died continued for decades, mainly because the Soviets never acknowledged that they had found Hitler's remains until relatively recently, when they put a fragment of Hitler's skull on display.

In the 60 years since today, Hitler has come to take on many meanings, with different meanings to different people. To many, he is the utter embodiment of implacable hatred and evil. Indeed, to some, he is almost not human, and books or movies that portray him as anything other than a monster cause controversy, even today. For example, consider Downfall, a recent German film based on Joachim Fest's book The Downfall: Inside Hitler’s Bunker. This film portrays the last days in the bunker and has been criticized for "humanizing" Hitler, who, as portrayed by Bruno Ganz, comes across alternately as kindly and raving.

Is it wrong to "humanize" someone who was responsible for so much death and destruction.

I don't know the answer, but Hitler was human, and denying it or criticizing portrayals of him as anything other than a raving monster contributes nothing to understanding how one man could perpetrate such evil. Obviously, he was a baby at one time. Indeed, there is a photo of him as a baby on the cover of Ron Rosenbaum's book Explaining Hitler: The Search for the Origins of His Evil, perhaps the best book written thus far to examine what Hitler means to different people and different explanations for the origins of Hitler's evil. It is rather haunting. In Ian Kershaw's biography Hitler 1889-1936: Hubris, there is also a photo of a 12-year-old Hitler with his class at Leonding school, standing in the center of the back row, with his arms crossed, a rather haughty look on his face, almost looking like the future dictator he was to become. As a young man, he witnessed the painful death of his mother from breast cancer and was very fond of the opera, spending nearly all his spare money on tickets to see Wagner. He dreamt of being an artist and was even a bit of a dandy. When he failed to gain entrance to art school and his money ran out, he lived in a men's shelter and barely got by selling postcards of paintings of famous Viennese landmarks. It may have been at that time that the seeds of his later radicalism were sown, as there were a number of anti-Semitic agitators, particularly Karl Leuger, whom Hitler greatly admired. Hitler later served as a courier (a dangerous job) in World War I, by most accounts admirably. It was only after the war that he became involved in radical right wing politics and eventually the Nazi Party, as many did in the wake of Germany's defeat and the myth of the "stab in the back" that lead to defeat.

Oh, yes, Hitler was human. He, along with other great scourges of the 20th century, such as Stalin or Pol Pot or any other monstrous dictator, demonstrate the depth of the human capacity for evil. As Oliver Hirschbiegel, the filmmaker responsible for Downfall, said:

There have been a few voices worried about depicting Adolf Hitler as a human being. But it is ridiculous to regard the Nazis as sent by the devil. There is evil in all of us.

Indeed there is. And, like him, I ask:

How was it possible for a whole nation to fall into barbarism, following this absurd vision of the world and turning loving fathers into vicious killing monsters who felt no pity for their victims? As a civilized nation we have to do that, because no matter how painful, we have to be able to look into each other’s eyes right.

Indeed we do, particularly as Adolf Hitler fades into the mists of time and those who were alive to witness his deeds disappear from the earth.

A final word on Teron Francis

Teron Francis, the unfortunate 13-year-old Bronx boy who developed meningitis from a dental abscess and was declared brain dead last week, leading to a legal battle by the family to prevent the hospital from disconnecting him from the ventilator was finally taken off the ventilator yesterday afternoon, after which his body died. Apparently, his body had begun to deteriorate physically (which is what bodies do once the brain dies). Unfortunately, the news coverage still got it wrong, with headlines like "Brain Dead Bronx Teen Dies" (no, he was already dead) and mush-brained quotes like this from the family's lawyer Robert Genis, who was all over the news last night:

It was like watching an execution. You're watching the doctors and nurses disconnect everything, then you are just waiting for him to stop being a human being.

No, it's not anything like an execution. I know from personal experience of having had to do the disconnection that it's very sad and painful for the family and staff, but it's nothing like an execution. It is the acknowledgment of reality, that Teron passed on over a week ago. Tragically, that is when Teron stopped "being a human being," not yesterday. Genis' ill-advised legal intervention and Judge McKeon's bad decision only prolonged the agony of the family and served to muddy New York case law with regard to brain death. It would not surprise me in the least if several more similar legal actions ensue.

Thanks to Vanessa for pointing out the above quote to me.

Get me a barf bag!

Frank Peretti, writer of Christian novels, has decided to take on evolution in a horror novel he has written, entitled Monster. Quoth he in an interview he gave while promoting his book in Alabama:

My goal is to make them think about evolution. Evolution as a philosophy makes monsters out of all us. It removes all that makes us human - morals, virtue, love, honor, self-sacrifice. All those become illusory. I'm trying to raise some questions. Who is the real monster here? I do it through a monster story.

"Evolution as a philosophy"? What the hell is he referring to? My best guess is that he's confusing social Darwinism and eugenics with biological evolutionary theory, but who knows?

Even worse, look at what he says in this interview:

There are two themes that are in the book that come through strongest. Evolution walks on two legs. One is beneficial mutation, purely random, and the other is natural selection. The whole idea is that some organism, purely by accident, has a mutation in his genetic structure and purely by accident that becomes beneficial because it helps him survive better. So he survives better than all of his other compatriots that don’t have that mutation. Then over billions of years, and billions of mutations, you end up with every living thing on the planet.

Well, I am presenting a thesis in this book that there is no such thing as beneficial mutation. And in weaving this whole story together, that’s what propels the story because this particular scientist decides he is going to prove that beneficial mutations really work. So he starts messing around with the DNA of some animals trying to prove how evolution works. And of course, as in most of these pretty cool monster stories, it is the old pattern of this scientist is messing around with things that are best left. You’ve seen that in all the great horror movies.

So one thing I want to do in the book is just get people to ask questions, to say, ‘Wait a minute, do mutations really work? Is that a really viable pillar for evolution?’ We’ve been told all of our lives that it is purely through mutations that this happens. We’ve even seen it in the movies. Look at X-Men, they were all these mutants with all these special powers. The whole thing was built off the premise of evolution.

When he brought up the X-Men, I knew he had no clue what he was talking about. As for there being "no such thing as a beneficial mutation," obviously he hasn't heard of the CCR5 receptor mutation that makes T-cells far less susceptible to infection with certain strains of HIV than wild-type--and that's just one example. But he's not content to stop here:

I want people to ask questions about evolution, but there is a deeper philosophical theme here too. The logical outcome of evolution is that it makes monsters. We turn into monsters because evolution takes away everything that makes us human in the sense of our moral accountability, our moral absolutes, and our idea of being distinct from the animal kingdom. The prime directive becomes survival. It’s not a matter of what is right or wrong, what is virtuous, what is honest, what does God think, it is all a matter of survival. When that is your prime directive, then virtually anything is possible.

"The logical outcome of evolution is that it makes monsters"? I realize it's only a work of fiction and that bad science is common in horror novels, but such mind-boggling ignorance is hard to fathom. But hang on, it gets even worse. When asked if he wanted to have his book gain crossover success among the general public, here's what Peretti said:

Oh, absolutely, because the secular audience more than anybody is the one that is brainwashed by evolution. They have been told it all their lives. They believe it. If I can get them to ask just one question, I’ll be happy. “You know, I wonder if mutations really do work? I’ve been told that all my life, but I’ve never seen any. They don’t happen on a regular basis; they are not observable in nature now. If we don’t observe them in nature now, how can we know they ever happened in the past?” I’d like to just get them thinking instead of just swallowing all this stuff.

"Brainwashed by evolution"? "I've never seen any [mutations]"? (Well, whoop-de-do! Just because you haven't seen them doesn't mean that scientists haven't.) "They don't happen on a regular basis"? "They are not observable in nature now?" This is creationist drivel of the worst magnitude! I'm not even sure that William Dembski would sink to this level.

Get this man over to Talkorigins.org, STAT! Not that it'll do any good; he's clearly too far gone. But hopefully some of his readers aren't.

As I was getting ready to post this, I just noticed that PZ has already commented on this clown as well, but fortunately for him he wasn't aware of the true--shall we say?--horror of Peretti's additional comments about beneficial mutations.

60 years ago today: The liberation of Dachau

Sixty years ago today, the Third Reich was collapsing. British and American forces were advancing from the West, and had met at the Elbe River four days prior on April 25, cutting German forces in the north off from those in the south. The Soviets had completed their encirclement of Berlin and were well into the final assault, advancing slowly through the outskirts of the ruined city towards the Reichstag itself. From his bunker, surrounded by sycophants (as well as connivers desperate to avoid capture by the Russians), Hitler gave grandiose orders for elaborate counterattacks to armies and divisions that no longer existed, and Berlin's defenders desperately threw untrained and poorly armed 14 year old boys from the Hitler Youth into the fray to take on Soviet tanks, artillery, and Red Army soldiers battle-hardened from years of savage warfare on the Eastern Front.

As Allied forces advanced from both the East and the West, they encountered evidence of Nazi brutality towards their enemies. In January, the Soviets had captured Auschwitz (and here) as they stormed through Poland, but it would be almost three more months before American and British forces started to see firsthand evidence of Nazi atrocities in the name of their war on the the Jews and any enemy of the Reich they perceived. In April, in rapid succession, U.S. and British forces liberated Mittelbau-Dora, Buchenwald, Bergen-Belsen, Flossenbürg, and other camps.

60 years ago today, the U. S. Seventh Army entered Dachau.

Dachau was the oldest of Nazi concentration camps. It was officially opened for business on March 22, 1933, a mere seven weeks after Hitler had become Chancellor on January 30, 1933. Its opening was preceded by notices in major newspapers that enemies of the new regime could end up there. By May, there were well over 1,000 prisoners in the camp; by the end of 1933, over 4,800. In June 1933, Theodor Eicke was appointed commandant of Dachau and over time developed organizational methods and plans that later became the template for future concentration camps. But Dachau was the prototype, the "granddaddy" of all Nazi camps. Indeed, it later became a major training site for SS concentration camp guards. In the early days of Dachau, those imprisoned there were mostly political prisoners, including political opponents of the regime, Communists, Social Democrats, trade unionists, and occasionally members of conservative and liberal political parties who spoke out too vigorously against the Nazi regime. The first Jewish prisoners were also sent to the Dachau concentration camp because of their political opposition. In the following years new groups were sent to Dachau, including more Jews, homosexuals, gypsies, Jehovah's Witness, and Catholic priests who would not accommodate themselves to the Nazi line to the satisfaction of the regime. In the wake of Kristallnacht, more than 10,000 Jews were sent to the Dachau concentration camp. Once war broke out, Dachau became a prisoner of war camp, as well. Over time, German prisoners, once the vast majority of inmates at Dachau, were outnumbered by Poles, Russians, and various other types of prisoners. From 1933 to 1945, over 200,000 prisoners from over 30 nations were imprisoned at Dachau, with a total death toll of at least 30,000. However, this is almost certainly an underestimation of the true death number, given the large numbers of Soviet prisoners who were summarily executed there in 1941. Deaths in Dachau resulted from starvation, disease, overwork, shooting, hanging, lethal injection, and (although there has been controversy over whether the gas chamber at Dachau was ever used in the manner of the one at Auschwitz or other death camps, or how often) occasionally by gassing.

And, like the case at Buchenwald, there were also twisted medical experiments, mainly conducted by Dr. Sigmund Rascher, including low temperature experiments, in which prisoners were immersed in freezing water to determine how long humans could survive in frigid water and high altitude experiments in which patients were subjected to low atmospheric pressure until they died. Another set of experiments were conducted in which prisoners were given only salt water, with the goal of determining how long they could survive.

On the morning of April 29, 1945, U. S. forces entered Dachau. In the weeks prior to the arrival of U. S. troops, the Germans had been transporting concentration camp prisoners out of camps close to the front to camps in Germany proper, and thousands of prisoners had arrived at Dachau, emaciated, ill, and dying, to be added to the thousands of similarly ill prisoners remaining at Dachau and its subcamps, and at the time U. S. forces arrived there were approximately 30,000 prisoners remaining. Indeed, according to some accounts (and here), the horror that greeted U. S. forces at Dachau was even worse than that at Buchenwald or Bergen-Belsen, as hard as it is to believe. The stench of death was everywhere, and scenes like this greeted American soldiers as they explored the camp. Most of the guards had fled, but a few remained, and, unfortunately, although accounts of the circumstances surrounding the incident vary, between 20-30 SS guards were reportedly gunned down by American troops after surrender, so disgusted were the American forces that entered the camp, while a few were killed by former prisoners. One particularly horrific find was a string of over thirty railway cars filled to capacity with the emaciated corpses of men, women, and children, many in advanced states of decomposition. So debilitated were the remaining prisoners that, despite the best efforts of American forces to help them, over the two months following the liberation of Dachau, 2,400 inmates died of starvation and disease. However, given the desperate conditions that greeted American forces, it is actually probably amazing that more didn't die. (An interesting account of the administrative and logistical nightmare that the Americans in charge of post-liberation Dachau had to deal with can be found in this Masters thesis.)

A few firsthand accounts of the horror and chaos that greeted American liberators follow.

Brigadier General Felix L. Sparks, AUS (Ret.):

The scene near the entrance to the confinement area numbed my senses. Dante's Inferno seemed pale compared to the real hell of Dachau. A row of small cement structures near the prison entrance contained a coal-fired crematorium, a gas chamber, and rooms piled high with naked and emaciated human corpses. As I turned to look over the prison yard with unbelieving eyes, I saw a large number of dead inmates lying where they had fallen in the last few hours or days before our arrival. Since all the many bodies were in various stages of decomposition, the stench of death was overpowering.

During the early period of our entry into the camp, a number of Company I men, all battle hardened veterans became extremely distraught. Some cried, while others raged. Some thirty minutes passed before I could restore order and discipline. During that time, the over thirty thousand camp prisoners still alive began to grasp the significance of the events taking place. They streamed from their crowded barracks by the hundreds and were soon pressing at the confining barbed wire fence. They began to shout in unison, which soon became a chilling roar. At the same time, several bodies were being tossed about and torn apart by hundreds of hands. I was told later that those being killed at that time were "informers." After about ten minutes of screaming and shouting, the prisoners quieted down. At that point, a man came forward at the gate and identified himself as an American soldier. We immediately let him out. He turned out to be Major Rene Guiraud of our OSS, He informed me that he had been captured earlier while on an intelligence mission and sentenced to death, but the sentence was never carried out. I sent him back to regimental headquarters.

Within about an hour of our entry, events were under control. Guard posts were set up, and communications were established with the inmates. We informed them that we could not release them immediately but that food and medical assistance would arrive soon. The dead, numbering about nine thousand, were later buried with the forced assistance of the good citizens of the city of Dachau.

1st Lt. William Cowling:

A man lay dead just in front of the gate. A bullet through his head. One of the Germans we had taken lifted him out of the way and we dismounted and went through the gate into a large cement square about 800 squares surrounded by low black barracks and the whole works enclosed by barbed wire. When we entered the gate not a soul was in sight. Then suddenly people (few could call them that) came from all directions. They were dirty, starved skeletons with torn tattered clothes and they screamed and hollered and cried. They ran up and grabbed us. Myself and the newspaper people and kissed our hands, our feet and all of them tried to touch us. They grabbed us and tossed us into the air screaming at the top of their lungs. I finally managed to pull myself free and get to the gate and shut it so they could not get out. Then I felt something brush my shoulder and I turned to the left of the two block house guarding the gate to find a white flag fluttering square in my face and on the end of it inside the house eight Germans.

I looked around the house and entered. I got the same question, are you an American Officer and said Yes. They turned over their arms, pistols and rifles to me and I told them to sit tight. I then went back outside and sent my driver to get the Jeep. Then I went back into the Germans and took their arms and sent the pistols to my Jeep (I gave all away but two). When I came back out the General was there and the people inside the enclosure were all in the large square shouting and crying. Then a terrible thing happened. Some of them in their frenzy charged the barbed wire fence to get out and embrace us and touch us. Immediately they were killed by an electric charge running through the fence. I personally saw three die that way. Our troops arrived about that time and took the rest of the guards, Germans (who during all this time had remained in the towers around the prison.) A number of them and I sincerely regret that I took the eight prisoners that I did after a trip through Camp which I shall describe in a minute.

Well the General attempted to get the thing organized and an American Major who had been held in the Camp since September came out and we set him up as head of the prisoners. He soon picked me to quiet the prisoners downs and explain to them that they must stay in the Camp until we could get them deloused, and proper food and medical care. Several newspaper people arrived about that time and wanted to go through the Camp so we took them through with a guide furnished by the prisoners. The first thing we came to were piles and piles of clothing, shoes, pants, shirts, coats, etc. Then we went into a room with a table with flowers on it and some soap and towels. Another door with the word showers lead off of this and upon going through this room it appeared to be a shower room but instead of water, gas came out and in two minutes the people were dead. Next we went next door to four large ovens where they cremated the dead. Then we were taken to piles of dead. There were from two to fifty people in a pile all naked, starved and dead. There must have been about 1,000 dead in all.

1st Lt. Chuck Ferree, USAAF (For personal reasons, I conclude with this account, noting that Chuck died in 1999. I had carried on an e-mail correspondence with him for several months before his death and knew him as an ally on alt.revisionism, where he was a staunch fighter of Holocaust denial. He brought to the table his firsthand accounts of the horrors that Holocaust deniers were trying to minimize. Sadly, I never got to meet him in person.):

Leaving the gas chamber we found further proof of the Nazi claim to everlasting infamy---human bodies heaped hodge-podge filling two rooms and sprawling out the doors. It was here that the cold weather worked to the advantage of the witnesses. The stench of the bodies and the accompanying filth would have been unbearable under other conditions. The odor permeated right through my heavy leather jacket.

Between these crowded morgues was the creamatorium where four yawning doors stood open and eagerly consumed more victims. Outside there was much evidence of bones and ash where the furnaces had been emptied many times of their gruesome contents. Beyond this scene was a stall which had been used as an execution chamber where many had met death by the firing squad.

This death farm was separated from the main stockades by a high wire fence and a moat. Swarming along the fence were hundreds of the more fortunate prisoners who were now liberated and expressing their gratitude.

Beneath the murky waters of the moat were the features of several SS guards and on the opposite bank was a fitting monument to the depth of the Nazi culture. Frozen on the ground were the bodies of several SS troopers who had been slain by their liberated captives before they could surrender to the Americans. At the bottom of each of the many high watch towers, more bodies lay. SS guards who had tried to put up a fight and were killed by the Infantrymen of the 45th. Division. After seeing many more horrors of Dachau it was small wonder that the only superman who still held his head up high was the larger-than-life-sized statue of the SS trooper on the wall.

After 3-4 days touring Dachau, the SHAEF officer and the others in our group flew back to Frankfurt. My passenger commented to me as we settled into our seats: "Jesus Christ, I wonder how many more of these fucking places we're going to find."

Unfortunately, there still remained a few more such "fucking places" to be discovered, but, even if not another concentration camp had been found, Auschwitz, Buchenwald, Bergen-Belsen, and Dachau alone were far more than enough to show the depths of depravity to which humans could sink. Fortunately, the author of this horror had only one more day to live, and the totalitarian nation he had created only slightly more than a week.

Debunking cancer myths

Here's a nice article debunking a number of cancer myths. It's good to see the mainstream press occasionally publishing such interviews, rather than the usual glowing puff pieces they all too often like to publish about various alternative medicine "cures."

It makes some nice additional reading to check out after this week's Skeptics' Circle!

(Thanks to St. Nate for pointing this one out.)

Another Skeptics' Circle is here

The Seventh Skeptics' Circle has been posted at Thoughts from Kansas. Once again, we admirers of the Amazing Randi have tried our hand at reinforcing the master's work and inoculating the blogosphere against all forms of credulity and magical thinking. Check it out!

And, two weeks hence, PZ at Pharyngula will host the Eighth Skeptics' Circle. So, skeptical bloggers, start writing, so that you can strut your best skeptical stuff. Maybe if I'm lucky another apparition of the Virgin Mary will appear to give me ideas for my contribution!

A sad end to a sad tale

[A NOTE BEFORE STARTING: In the media accounts cited, I've seen the name of the unfortunate boy in this case spelled both "Teron Francis" and "Taran Francis." I do not know which spelling is correct.]

I've been commenting (also see the update) on the Taran Francis case this week a bit more than I had planned (in fact, it's kind of muscled out the other science-related posts I had been planning, but that's OK). Today, the sad case will finally come to an end, and I hope that the family will finally be able to find some peace. To recap briefly, Taran Francis is a 13-year-old boy who went into a coma from an untreated abscessed tooth and developed meningitis, which ultimately progressed to brain death. When informed of this diagnosis, the family got a lawyer and won a ruling that prevented the hospital from removing life support.

My initial take on the matter was that this was a horrible ruling, both bad law and bad medicine, because it distinguishes between brain death and death and, worse, forces the hospital, in effect, to keep a corpse alive indefinitely as long as the family wants. I speculated that the family would eventually realize the futility of this course of action and that they were only prolonging the agony of everyone involved who loved Taran. Thankfully, my speculation turned out to be correct. Even more thankfully, the family came to this realization sooner, rather than later. The family is scheduled to appear in front of Judge McKeon (the same judge who issued the injunction that prevented the hospital from disconnecting the ventilator), where they will ask him to remove the injunction. Later today, the ventilator will be turned off. What happened? The family brought in an outside doctor, who confirmed the diagnosis of brain death, but--more importantly--explained the significance of the diagnosis (that Taran is dead) in a way in which the family could understand and accept. According to this account:

The last minutes of 13-year-old Taran Francis's life will be today. He's been brain dead for a week now, an agonizing week in which his family fought to keep him on a respirator. But last night, an independent doctor examined Taran and changed their mind.

Robert Genis, the family's lawyer: "He was polite, he was respectful of her. He spoke to you the way you'd want a doctor to speak to you and when he explained to her, her child condition she understood"

I had always suspected that this conflict was due to a problem with communication more than medicine. They almost always are. These are among the most difficult situations to deal with and explain to a patient's family, particularly when that patient is a child. One particular mistake I perceive was that last week someone from the hospital apparently mentioned that state law permitted the hospital to remove Taran from the ventilator 24 hours after the diagnosis of brain death. Whether it was intended that way or not, it was clearly perceived by the family as a threat to remove the ventilator in 24 hours. Even worse, if the family account is correct, they were told that the only reason the hospital was keeping Taran alive was in case they wanted to donate his organs. It's usually not the attending doctor who points this out to the family, in my experience, but rather residents (who are much less experienced in these delicate matters) or other ancillary staff, sometimes even in passing. Also, the rhetoric coming from the hospital on the news media didn't help. Although the frequent statements in the media that Taran is "dead" and "has been dead for a week" were without doubt 100% medically correct, they were delivered in manner that came across as rather harsh on TV and the radio, even to me, someone who is inclined to be sympathetic to the hospital's point of view and the problems inherent in dealing with such delicate situations. Such statements probably contributed to a "circle-the-wagon" mentality in the family, confirming in their minds their worst suspicions about the hospital.

However, it might not have been entirely the hospital's fault. Clearly Taran's family is very religious (the frequent quotes by them in the media "hoping for a miracle" and the frequent references to prayer). Although Catholicism, most sects of Protestantism, and many other religions accept that brain death is death, there are fundamentalist Christian sects, Buddhists, orthodox Jews, Buddhists, and a variety of other religions that do not accept brain death as "real" death, insisting that death doesn't occur until the heart stops beating. Also, in poor communities, particularly African-American communities, it is not uncommon for there to be prevalant an extreme mistrust of doctors and medicine (a distrust that I've experienced myself in dealings with patients). This distrust, often exaggerated even when justified, makes it all too easy for quacks to prey on poor people in these communities, and I'm guessing that it was one factor that made it easy for the family to be convinced that the doctors have no interest in Taran, other than as a source for organs. (Never mind that in this particular case it is highly unlikely that this is true, given that Taran's systemic infection probably ruled him out as an organ donor.) Mix fundamentalist religious beliefs and unrealistic hopes for a miracle with a pre-existing distrust of doctors and hospitals, and even a perfect handling of the delivery of the bad news to the family might not have prevented this conflict. However, letting the family get the message that the hospital was threatening to turn off the ventilator and was interested only in Taran's organs was disastrous. It reinforced the preexisting mistrust, amplified by questions about whether Taran's dental abscess was handled appropriately that probably led the family to be suspicious that the hospital had screwed up.

Fortunately, the outside doctor was able to overcome these problems. I recall hearing on the radio a statement from the family's lawyer along the lines that, if only the original doctors had discussed Taran's situation with the family in the first place in the manner that this outside doctor did yesterday, then the family probably would never have opted for legal intervention last week. (Of course, I still think he should have told the family that they have no case, but people will accuse me of lawyer-bashing when I say that.)

I will remember this case (and, hopefully learn from it) as an example of what can happen if communication breaks down between doctor and patient or patient's family. It has often been said that behind most malpractice suits is bad communication between the doctor and patient, regardless of whether malpractice actually occurred. It's equally true that communication failures can result in other kinds of ugliness, like the legal battle over the Taran Francis case. Fortunately, intervention with better communication kept this case, and the agony of Taran's family, from dragging on too long.

A field guide to biomedical meeting creatures, part 2: Poster time!

Since I've started blogging, I notice things that I probably wouldn't have noticed before. I suspect it's because blogs are a voracious sink for writing and require feeding with a regular infusion of new ideas. Fortunately, the AACR Meeting provided a veritable cornucopia of ideas, and I even had the foresight to jot many of them down.

So it was at the session at which I was presenting a poster.

For those who don't know how poster sessions are run at such meetings, I'll give a little primer. First, you must understand the hierarchy of presentations at these meetings. The best abstracts get chosen for plenary session talks (like the one I was fortunate enough to be chosen to give last month, which partially inspired me to write this). Plenary sessions are often the only session going on at the time they occur, but even if other stuff is going on they are always the biggest sessions. The second best abstracts are chosen for smaller talks in smaller, parallel sessions. The third best are chosen to present posters. The fourth best are deposited in the circular file after a rejection letter is sent to the authors. Oh, there are variations, depending upon the size of the meeting. Because AACR is so big, there are in essence three different levels of parallel sessions called Symposia (bigger guns--but not Plenary Session big guns--giving talks), Mini-Symposia (usually graduate students, fellows, and junior faculty), and Poster Discussion sessions (basically a poster session in which the presenters are allowed to give a five minute talk). But they all break down into specific levels of prominence, a veritable pecking order, if you will.

My abstract happened to be chosen only for a poster session. (Ah, well, win a few, lose a few, I guess, given that I was just one notch above rejection.) Unlike some other meetings, that's not so bad a thing at AACR, for the simple reason that, at the AACR Meeting, it's quite rare for any but the heaviest of heavy hitters to be invited to give plenary talks. Heck, this year even Judah Folkman (my angiogenesis hero, whose work I'll write about sometime in the near future) and Max Wicha (I plan on writing about his work on breast cancer stem cells in a future post, along with a bit about of my skepticism about the concept) were giving talks at Symposia, rather than Plenary Sessions (although the organizers badly miscalculated how many people would want to see Max Wicha, even at 8 AM, leaving those of us who didn't get there 10 minutes early either standing along the walls or sitting on the floors straining to see the slides, much to the annoyance of many).

Poster sessions come in many shapes and sizes. At the core of all of them is the presentation of your data in a concise (an hopefully attractive) form on a poster, and during the session the presenters are expected to hang out by their posters for some period of time, in case attendees want to ask questions. At their best, poster sessions are a chance to schmooze with more prominent scientists, many of whom actually like to wander around and check out various posters. At their worst, they are a chance to stand or sit forlornly by your poster as sparse attendees wander by, briefly glancing blankly at it. In that aspect, they are not at all unlike high school dances. (Indeed, I've decided that I will never present a poster at one meeting in particular again because the sessions were so poorly attended and there was so little interest in anything of a basic science nature, like much of my work.) The AACR is amazing in that the poster sessions are absolutely enormous (just check out the pictures I posted along with this piece), and there are seven of them, each lasting four hours, one in the morning and one in the afternoon of every day of the conference except the last. There are easily several hundred posters per session in the biggest hall in the convention center, for a total of over 5,000 posters presented over the course of the meeting. Presenters are expected to stand by their posters for the first three hours of the session, which can get really boring really fast if you don't have a lot of traffic by your poster.

One of the potentially biggest bummers about taking part in a poster session occurs if you happen to be unlucky enough to be stationed next to a high traffic poster. I've had this happen to me a couple of times at AACR. You stand there, with no one looking at your poster, while an overflow crowd of 20+ people is milling around the poster next to you, bumping into you, giving you annoyed looks because you have the audacity to stand next to your own poster, blocking the spot that they wanted to use to look at the poster next to you! Fortunately, that didn't happen to me this year, but unfortunately the traffic by my poster was only moderate. It probably didn't help that I happened to have drawn a spot just north and east of Siberia, as far as the convention floor goes.

Like the types of questioners at scientific talks, there are different styles of poster presenters, which you will come to recognize rather quickly if you ever get the opportunity to present a poster. They include (but, of course, are not limited to):

1. The Schmoozer. This guy (or gal) wants nothing more than to make as many contacts as possible and will do whatever it takes to achieve that aim. If you show the least bit of interest in his or her poster, the Schmoozer will sidle up to you and try to chat you up. (Characteristic quote: "Can I have your card? Here, please take mine.") Of course, once the schmoozer finds out that you're merely junior faculty or a fellow, his or her reaction to you will be similar to what you would experience if you showed up with skin lesions characteristic of the bubonic plague or, if you're a guy, the reaction you got the last time you tried to hit on that gorgeous model-quality beautiful chick at a bar. How do I know this one, you ask? Don't ask.
   
2. The Ghost. This presenter doesn't like the whole poster thing. The Ghost will disappear shortly after the poster is put up and will be nowhere to be found at any point, until the end, when the poster has to come down. (Sometimes the Ghost will not even show up then and will let the cleaning staff throw the poster away.) Too bad for the Ghost if a heavy hitter or a department head looking for faculty happens to wander by and likes the ghost's poster. The Ghost will have just blown his or her chance at that job at Harvard or M.D. Anderson Cancer Center that he or she craves.
3. The Carnival Barker. Perhaps the most annoying presenter of all, even more so than the schmoozer, the Carnival Barker will stand in front of his or her poster, beckoning people to "come on in" and check out the poster. Worse, you're not safe even if you're in the middle (or even on the other side) of the aisle, because the Carnival Barker will come out and get you. His or her behavior is not unlike that of a carnival barker or of the people strip clubs in the French Quarter in New Orleans hire to try to get people to "come on in." How do I know about that, you ask? Don't. (A less racy example comes to mind. If you've ever been to Mulberry Street in Little Italy in New York, you know that there are so many restaurants in such a small area there that the restaurants have people who stand in the streets and try to lure passers-by in.)
   
4. Impervious. Impervious doesn't like the poster thing any more than Ghost, but feels obligated to follow instructions and stay by the poster until the bitter end. That doesn't mean impervious has to talk to anyone or acknowledge anyone's existence. Impervious may be pissed off that his abstract didn't get accepted for a talk or may believe that sitting by a poster is below him. Whatever the reason, the key characteristic of Impervious is his ability to study closely the meeting program, never making eye contact with anyone who looks at his poster, and/or to carry on multi-hour-long conversations on the cell phone while sitting by his poster. (Impervious sometimes even brings along an extra charged cell phone battery, just for this purpose.)
   
5. The Pointer. This presenter comes complete with a pointer (either the old-fashioned kind or a laser pointer). And he knows how to use it--much to the annoyance of anyone who happens by his poster.
6. The Poser. The Poser will be dressed to the hilt (a very stylish suit if a man or a very attractive dress--with just a tasteful bit of cleavage showing or a hemline that's just slightly shorter than one might consider appropriate--if a woman) and will look as though he or she is literally striking a pose by the poster. It almost makes you want to get out a camera. snapping pictures, and start yelling, "Oh, yeah! The camera loves you, baby!"
   
7. Lost Little Boy (or Girl). This is the saddest poster presenter of all. Lost happens to have a poster that not very many people are interested in. Consequently, during the time no one is looking at the poster, Lost will sit around and look, well...lost. When the rare meeting attendee shows the slightest bit of interest in Lost's poster, he or she will focus a gaze on the attendee not unlike that of a puppy who wants to go out and play. How do I know about this one, you ask? Don't. Really. Don't.
   

Of course, the people wandering by and checking out the posters are an equally eclectic bunch. There is considerably overlap between these people and the people I previously describedwho come up to ask questions after a scientific talk. Indeed, you can encounter almost any of them, with the exception of the Moderator, because there is no Moderator. It's also unusual to encounter Pontificator, Show-off, or Me-Too. (Mainly because there is no real audience for them to try to impress, so what's the point?) However, in the poster session, there's a huge difference inherent in it because of its structure. In the poster session setting, certain of these creatures can be much more of a threat that they normally are at any scientific talk you might give, because there is in essence unlimited time for them to torment you and no way for you to escape. There's no Moderator to keep Conniver or Rival from pumping you for as much information as he can about how far along you are compared to him; to keep Clueless Wonder from wasting huge swaths of your time with idiotic questions; or to keep Nonsequitur from asking interesting but largely irrelevant questions. But worst of all, there is no time limit and no escape from Oh Shit!, who can spend as much time as he or she wishes tearing at the flaw he or she's discovered in your work and convincing you what a careless scientist you are. It is a true poster warrior indeed who can disarm these fierce foes, who are but annoyances in most scientific talks but can be determined destroyers of your sanity in the very different setting of a poster session. Your only hope (and only escape) is for your poster to be so popular that you can quite correctly tell any of them that you have to be fair to the others there and talk to them too. If your poster is not sufficiently popular and you're stuck one-on-one with any of them, you're royally screwed.

There are, however, a few questioners who are more or less unique to poster sessions. They include:

1. Don't Talk to Me (a.k.a. "I Vant to Be Left Alone"). This variety of poster browser is the counterpart of Impervious. He will stand in front of your poster for many minutes, apparently drinking in every word of your brilliant prose and studying every figure with great interest, sometimes even making little "uh-huh" noises, but will ignore you completely. If you try to ask him if he has any questions, it's no different that talking to a rock.
2. James Bond. Usually affiliated with a pharmaceutical or biotech company, James Bond walks around with his digital camera and takes pictures of the posters, sometimes blatantly, but sometimes in a rather furtive manner. Of course, he could be afraid of getting caught, given that the rules against photography or audio recording of posters and talks are posted everywhere, but they are rules that don't ever seem to be enforced, in my experience. Sadly, the stereotype is not entirely incorrect here, as most James Bonds I've seen are Asian.
   
3. The Clueless Wonder. OK, he's not unique to posters, but no one (and I mean no one) can waste more of your time or make your poster presentation experience more miserable than a clueless wonder cornering you. Pray that he doesn't find your poster early in the poster session.
4. Tell Me All About It. Perhaps the most annoying (and unfortunately probably the most common) of the unique poster warriors, Tell me's characteristic opening line is, "Please, take me through your poster," or "Please, tell me the story." It's not as if you didn't spend hour upon hour carefully crafting your figures and text and arranging them carefully on a poster to, oh, tell your story in a succinct and interesting (and hopefully visually attractive) way, but this clown wants it all spoon-fed to him or her! After about the tenth time leading someone through my poster, I've been know to swear that the next person who comes up to me and asks me to "tell me all about it" will die a horrible, slow, painful death. Unfortunately, I don't have the courage of my convictions, and they never do. I suppose that it helps to remember that they are actually showing an interest in your work, even if they're too lazy to actually read your poster.

And there you have it, the poster warriors. As you can see, as is the case for giving scientific talks, there is more to presenting a poster than just standing there. However, forewarned is forearmed, as they say, and if you know what kinds of curveballs might be thrown your way, you have a much better chance of hitting them out of the park (or at least not striking out). You might even have fun.

Unless you happen to be Lost Little Boy (or Girl).

I wonder how many of my colleagues will recognize these creatures and whether they can suggest more. The floor is once again open!

I'm not worthy, I'm not worthy!

I was going over my Sitemeter logs last night when I noticed a bunch of referrals from Majikthise and Kung Fu Monkey (whose tagline, "Because your monkey's Kung Fu is not strong," I happen to really like and whose post I Miss Republicans I mentioned a while back as being right in line with how I became disillusioned with today's Republican Party). It looks like both have plugged humble Orac, Kung Fu Monkey in his new links (although I'm not sure I'm as much of a "smart guy" as he says) and Majikthise in reference to my posts on the Taran Francis case. Where I dwelt on the medical and patient care issues of the case, specifically the medical and legal implications of brain death and how ill-advised I thought the legal action taken by the family was (even though I realized how devastated the family must be), Majikthise focused on a different aspect, wondering whether the hospital would have treated Taran's family better if he hadn't been poor. (It's an aspect I didn't address specifically, mainly because, having been involved in a few cases like this as a resident on the trauma service, I know that it can be hard to figure out whether the hospital was truly that insensitive or whether the family is in denial because of the tragedy. But she does make a good point, if the account in the New York Post of how the hospital delivered the information to the family is accurate.)

Anyway, thanks to both, and I like your blogs, too.

I'm not worthy! I'm not worthy!

Damn! How could I have missed this?

Apparently yesterday was DNA Day. It marks the 52nd anniversary of Watson and Crick's description of the DNA double-helix, and the national day has been officially recognized since 4/25/03.

How on earth could I have not known about this?

Oh, well, happy belated DNA Day.

Grand Rounds XXXI

Grand Rounds XXXI has been posted at Dr. Tony's blog. Once again, the best of the medical blogosphere has been condensed into one succinct package, and once again you should check it out forthwith! (But don't forget to come back here when you're done...)

Another Skeptics' Circle is nearly upon us!

The Seventh Skeptics' Circle is scheduled to be posted at Thoughts from Kansas on Thursday, April 28. I submitted my entry yesterday. Have you?

If not and you're a blogger, then send your best skeptical blogging to Josh by Wednesday night. Instructions are here. As Josh puts it:

If you're lucky, the Amazing Randi might even read your stuff!

I know he's read my stuff at least once. (I'm hoping to get him to read my stuff again someday.) Maybe he'll even offer to help me get it published in Skeptic. (Hint, hint.)

Nahh, that's probably too much to hope for.

Update on the Taran Francis case

Yesterday, I discussed the very sad case of Taran Francis, the 13-year-old boy who suffered meningitis from an untreated dental abscess that progressed to meningitis and brain death and the motion filed by the family's lawyer to prevent life support from being removed. (I've also seen it spelled "Teron Francis" and am not sure which spelling is correct.)

Although the thought of what the family is going through is heart-rending, my first take on the issue was that the legal action was ill-advised, because brain dead is dead. Keeping the boy's body alive when his brain is dead is a very expensive exercise in utter futility. Also, my guess was that this was probably a matter of poor communication between hospital personnel and the family. My second take (in the Addendum I posted) confirmed this impression, when I found out more information in an account that revealed that hospital officials might have been insensitive in dealing with the family, telling them that they would only have 24 hours to come to terms with Taran's death and implying that the only reason they were keeping Taran's body alive is because the family might want to donate his organs. Whether that is how the hospital actually presented the situation to the family or not is impossible to say from the news reports. Having had a little experience with such situations during the trauma rotations I took during my residency, I know that, on occasion, no matter how sensitive the hospital staff is in relaying the tragic news, the family still doesn't hear. (On the other hand, the story that the family relayed of a member of the staff telling them that the only reason they were keeping Taran's body alive was in case they wanted to donate his organs rings truer than I would like to admit.) Given that additional information, however, I could understand why, if the family had gotten the impression that the hospital was eager to pull the plug (whether correctly or mistakenly), they might have felt compelled to sue, even though I still think the legal action was very misguided and ultimately self-defeating.

Now, I've found out that the Judge Douglass McKeon ruled (and here and here) today that the boy could not be taken off life support without his family's permission. This is a bad ruling. It's bad because it in essence invalidates the law in this particular case, and it's bad medicine. No, I am not saying that the hospital should pull the plug right away, given that they had already come to an agreement not to before the ruling. It is highly unlikely that, in the face of the negative publicity it has received, the hospital would do so anyway. The ruling is also bad medicine, in that it leaves the impression that brain death is not the same thing as death, when such is not the case. Given the timidity of the ruling, I have to wonder if Judge McKeon was afraid of a Terry Schiavo-like controversy, were he to reverse his restraining order. Even worse, he doesn't seem entirely objective, given that he brought his wife to Taran's bedside, where she prayed for him.

But, as I said before, this case is not the same as the Terry Schiavo case. Terry Schiavo was in a persistent vegetative state; she was not brain dead. Terry Schiavo could have lived indefinitely in her persistent vegetative state if her feeding tube had been maintained; without the brain, Taran's body will deteriorate and die regardless of what anyone does. Maintaining his shell "until his heart stops" (as his mother put it) does Taran no good, nor does it do the family any good, prolonging as it does the agony of the family's ordeal. Personally, I had a fair amount of ambivalence about whether letting Terry Schiavo die was the right thing to do before I formed my opinion on that case; I have no ambivalence in my conclusion that disconnecting the respirator from Taran would be the right thing to do, assuming the diagnosis of brain death is accurate.

Unfortunately, some of the same groups that rallied to Terry Schiavo's cause have taken on Taran's cause (see also here and here), even though the two cases are not analogous. They do so based on a flawed understanding of the significance of brain death:

Nor should any one have to meet some arbitrary standard of recovery to justify his life. It is sufficient to survive. Finally, if Taran were truly dead, he would have suffered rigor mortis by now. Would they bury a breathing boy with a beating heart in the ground? Then why murder him?

I'm sorry, but sadly Taran has not "survived." He has already passed on. Unfortunately, his shell remains with the appearance of life, but it is not life. It is not "murder" to accept that the boy's brain has died and withdraw artificial means of supporting the remaining shell of a boy from whom life has already fled (and whose body will not survive for long, even on a ventilator). I think that the family will eventually come to this realization, too. I'm just profoundly sorry that an apparent lack of communication between the hospital and the family allowed an already tragic situation to escalate to such depths of ugliness, regardless of whether the misunderstanding was due to the hospital's insensitivity or the family's inability or unwillingness to let go. Going to court over this served no good purpose and muddied the issue of how brain death is dealt with in New York.

A tragic story

I became aware of a very tragic story yesterday. (Other links here, here, and here.)

Last Monday, a 13-year-old Bronx boy named Taran Francis was taken to Bronx-Lebanon Hospital with a severe tooth infection. A day later, he developed meningitis, slipped into a coma, and deteriorated. He was transferred to Montefiore Medical Center, and on Wednesday the family was told by doctors that he was brain dead. (Note: I've also seen the boy's name spelled "Teron Francis" and am not sure which spelling is correct.)

While I can understand how the family would be utterly devastated by the horrible (and possibly unnecessary) death of their boy and that they might be considering a lawsuit, given that the tooth infection had been diagnosed 11 days before and that he had been turned away from getting his root canal two days earlier because he didn't come with a guardian, I think that their grief is leading them to do something very inappropriate. They are suing the hospital to keep their son on life support:

We are holding on to him," said the boy's aunt, AnnMarie Douglas, as family members continued to hold a bedside vigil at the hospital for young Teron Francis.

"We are not giving up. We believe in God. He has life. I don't care what they say.

"Until that heart stops, we're not letting go of him," Douglas said.

At the risk of seeming callous or insensitive (which I am not, I assure you, having had to deal with brain death in children during trauma rotations in my residency days, experiences that haunt me to this day), I also have to view this as a teachable/bloggable moment. If the diagnosis of brain death is accurate and properly determined and documented (see here also), then, sadly, Taran is already dead. His body can be maintained on life-support for a while, but, without the brain its organs will slowly start shutting down, and there is nothing anyone can do about it. This is not the same as a persistent vegetative state, like the Terry Schiavo case, in which there was still brainstem function and Schiavo could still breathe on her own. In brain death, there is no higher brain or brainstem function. Brain death can be diagnosed on strictly clinical grounds, but most of the time it's confirmed by a cerebral blood flow scan, which will show no bloodflow to the brian or brainstem. Keeping the boy on life-support ("holding on" to him) only prolongs the suffering of the family and wastes huge amounts of hospital resources on an utterly futile gesture. Indeed, in most states (including New York) once the diagnosis of brain death is made, then life support can be withdrawn (usually after 24-48 hours to give the family time to gather) regardless of the parents' wishes. That doesn't mean that every effort shouldn't be made to withdraw support in as sensitive a fashion as possible or that there shouldn't be the flexibility to delay it for a while, if necessary, to give the family some time to come to terms with the situation or so that all the family can be there when the machines are turned off. However, unless there is a good reason to question the diagnosis of brain death, keeping a brain-dead boy on life support indefinitely, hoping for a "miracle" is misguided. (Even the family's lawyer is not challenging the diagnosis of brain death, as far as I've been able to ascertain.)

Even worse is that this lawyer would file such an ill-advised motion. Although I rarely agree with hospital flacks, in this case, I reluctantly have to agree with Montefiore's spokesman, who said: "The case and what this lawyer is doing is atrocious and a disservice to this family." Indeed. The family has just endured a horrific tragedy, one that will cause them pain to remember for the rest of their lives. They can be certainly be excused if they are not thinking objectively, are unable to understand brain death, or can't come to terms with the situation yet. They should be dealt with as sensitively and respectfully as possible. The lawyer, as an objective third party, cannot be excused for pursuing court action in a case like this, particularly given that the diagnosis of brain death does not appear to be in dispute.

I can only speculate here, but I rather suspect that the hospital might not have handled delivering the news to the family in a sufficiently sensitive manner, or that the doctors came across to the family as being too anxious to pull the plug and insufficiently willing to give the family some additional time. (My hunch is supported by the family's claim that doctors told them that Taran was brain dead and that state law allowed them to take him off the respirator after 24 hours.) This whole conflict might have been avoided. When I was training, it was always emphasized that, when talking to a family about the brain death of a loved one, one has to emphasize that the patient is dead; that there is no legal distinction between brain death and death; that we can keep the body alive for a while but inevitably, without the brain, it, too, will die; and that, according to virtually all major religions, there is no moral distinction between the brain death and death. Indeed, some say that we shouldn't even use the term "brain dead," but simply say that the patient is "dead." And, above all, one must be careful never to give the impression of being eager to pull the plug. Finally, in appropriate cases, one should also broach the topic of organ donation (probably not appropriate in Taran's case, because he had had a severe systemic infection). It also helps a lot to have a competent social worker around and (if the family is religious) appropriate supportive clergy, to help them come to terms with the tragedy that has just occurred. It's also possible that the hospital did everything correctly, but that this is just a family that can't let go or won't understand. That happens too, sometimes. It is also not unlikely that they are presently suffering through denial, which can sometimes lead families to behave this way, even when the case was handled perfectly.

In any case, although my heart goes out to the family for what they are suffering, I still have to hope that they will shake off their denial, quickly come to realize that it's over, and let Taran go. If there was evidence of malpractice in the care of their boy, then I have no problem with their filing a lawsuit after they have mourned. But holding on to a boy who has already died will not bring them the peace they crave, nor will it let them move on. What's being kept alive on the ventilator is but a shell. Taran is already gone.


ADDENDUM:

I had had a few misgivings about what I had posted, thinking that perhaps I had been too quick to judge. Then I became aware of this. I think I know now exactly why the family was so quick to sue, and you will too if you read this. So, in my unflinching willingness to admit when I might have done better, I present the money quote from the article:

When a doctor appeared, the two women asked, "Should we be worried about anything?" Douglas said.

"The doctor said, 'Yes. He's literally brain dead.' " Soon after, they were approached by a hospital social worker, who told them, "We're going to give you time to mourn. You have 24 hours," said Douglas.

Asked what that meant, the social worker explained, "Legally, in New York state, the hospital has the right to take a person off life support when he's brain dead," Douglas said.

That's when Marcerlyn called a lawyer.

Douglas noted, "We pleaded with the doctors, 'This child needs time, for Christ's sake. Give him time.' "

In a chilling response, she said, the social worker told them that the only reason the hospital was giving Taran medical attention at that point was "to keep his organs functioning in case you want to donate them."

Ugh!

If that's an accurate account of how the hospital broke the news to the family, then this whole incident is a perfect example of how not to tell a family that their child is brain dead. Although I suspect that the hospital personnel were probably somewhat more sensitive than portrayed, that last statement is almost certainly what pushed the family over the edge. Hospital personnel appear to have broken the cardinal rule in these very difficult situations and given the impression that they were eager to pull the plug (exactly what I said not to do above!). Even worse, the hospital seems to have left the family with the impression that doctors were only interested in the child's organs!

None of this changes the essential fact that Taran is dead (assuming the hospital did evaluated his brain function properly), meaning that continuing to keep him on the respirator is completely inappropriate. However, this revelation (which I should have found earlier--mea culpa) puts the family's decision to sue in a much different light.

How not to win friends and influence people

The question caught me by surprise.

While at the AACR Meeting last week, I was having brunch with a friend I used to work with, whom I hadn't seen in a long time. She and her husband had brought along two of their oldest and dearest friends, whom they had known nearly 50 years, as well as another of my former coworkers. We were idly chatting away and eating, when one of the occupational hazards of being a doctor presented itself. Tthe conversation drifted to medical topics. And then it came.

"What do you think of Dr. Gonzalez?"

Ah, hell.

Blindsided again! Why hadn't I seen that one coming? As a doctor, I find that these sorts of questions hit me when I least expect them. I was half-tempted to play dumb and pretend that I didn't know who Dr. Gonzalez is, but decided against that approach. It doesn't work anyway. I knew feigning ignorance would only result in her telling me who Dr. Gonzalez is. Instead, I asked a single question to make sure we were both on the same page and talking about the same Dr. Gonzalez, "Do you mean Dr. Gonzalez in New York City, the one who uses 'detoxification' to treat cancer?"

"Yes, that's him," she replied.

No escape there. For those of you who aren't aware of who he is, Dr. Nicholas Gonzalez is a physician in New York City who claims to be able to treat incurable cancers with a regimen that includes dietary manipulations, "detoxification" with coffee enemas, and the ingestion of pancreatic enzymes. I've discussed him before in the context of a patient who followed his regimen and paid a price and, indeed, who might even have been treated by Dr. Gonzalez himself. His methods are based on a regimen popularized by Max Gerson. Using this regimen, he claims that he can produce long-term survival in inoperable pancreatic cancer, for which the median survival is usually less than six months. Never mind that his study only had 11 patients who could complete the regimen, had no control group, and, given the rigor of the regimen required, had the potential for serious selection bias (Gonzalez's regimen can sometimes require as many as 150 pills per day). Based on this tiny uncontrolled study, somehow NCCAM saw fit to fund a $1.4 million clinical trial. As I've said before, if I were to submit a grant proposal to the NIH with so little preliminary data, the study section would have a good laugh at my expense before filing my application in the cylindrical file. In fairness, I will give Dr. Gonzalez a modicum of credit for, unlike alties, at least making an attempt to use science to look at his therapy, however dubious the supporting data. Most alties don't make even the pretense of doing that.

I wasn't in the mood. I had just wanted to hang out with some old friends and talk about science, old times, and other topics. Also, I knew that a debunking session would probably not be appreciated (they seldom are, particularly in what was supposed to be a light social situation), and I didn't want to risk offending my friends by being too strident with their old friend. So I tried to discourage her. "You probably don't want to know what I think," I replied, with what I hoped was a self-deprecating smile and chuckle.

"No, I do," she said.

Damn, she's going to be persistent, I thought. Not in the mood for a confrontation, I became more insistent. "No, I really don't think you do."

"Please." She leaned forward.

"You're probably not going to like it," I gently warned her. (If she didn't know what I was going to say now, I couldn't be responsible.)

"Come on."

OK, I warned you. "He's a quack," I blurted out, wincing inwardly at how it must have sounded. "I see no evidence that his 'therapies' do anything for cancer patients." Did you have to use the q-word? Why couldn't you be more diplomatic? I rebuked myself. You know what you normally do in these cases. You normally say that the treatment is unproven, that there is no evidence that it does anything whatsoever to increase long-term survival in cancer patients, but that you doubt it does any harm. (Even if you don't necessarily believe that inside for this particular therapy.) That's how you defuse the situation, avoid unpleasantness, and even possibly educate the people asking about the questionable therapy. You don't use the q-word! (At least, you don't use the q-word with well-intentioned people who just don't know any better. Hard-core alties, on the other hand, are another matter entirely.)

She was silent for a moment. Silverware clinked, but no one spoke. Everyone, my friend included, was looking at me expectantly.

I began a discussion of why I held the opinion I did about Dr. Gonzalez. I was starting to explain that Gonzalez's methods were based on out-dated, faulty, turn-of-the-century concepts of how cancer developed, how there is no good randomized clinical study that shows his methods do anything for cancer patients, and how the only reason his methods hadn't gone the way of Laetrile was because of aforementioned tiny study, which led to the NCCAM study, when my friend's friend interrupted. "You know, my husband and I know one of Dr. Gonzalez's patients."

"Oh, really," I said. So that was why she was so interested.

"Yes, he had melanoma. His doctors told him he should just go into hospice or go home to die. But he went to Dr. Gonzalez, and he's been fine. That was 12 years ago."

Ah, geez. The dreaded "the doctors sent me home to die" cliché of so many alternative medicine cancer cure testimonials--even worse, the testimonial told second-hand to a friend. You can't effectively fight that one without risking serious unpleasantness, and I didn't want things to get too unpleasant, in deference to my friends. I realized that there was no way I was going to convince these people that Gonzalez was using unproven methods with no evidence of efficacy. They believed he had saved their friend's life when no other doctor could. I also realized that questioning them to see if I could figure out whether their friend really did have metastatic melanoma was probably pointless. I guessed that most likely their friend probably didn't have stage IV melanoma and that surgery probably took care of the disease, as it does for the vast majority of melanoma patients who survive the cancer. But people won't believe that or hear it when you say that. (In my experience, lay people rarely have enough information to let me assess the true severity of their friend's or relative's illness.)

So I did the only thing that was left to me. I explained that a single anecdote does not constitute evidence for general efficacy, using one of my favorite sayings, "The plural of 'anecdote' is not 'data.'" I also explained that spontaneous remissions, although very rare, do occasionally occur for melanoma and that it was impossible to assess whether the Gonzalez treatment really worked or whether conventional surgery had taken care of the melanoma. (Remember, when patients undergo surgery and then decide to opt for alternative medicine for the remainder of their treatment, they almost always attribute their "cure" to the alternative medicine, and not to the surgery.) Finally, I pointed out that my skepticism was rooted in both the lack of evidence that Gonzalez's therapy does any good and the flawed "model" of cancer upon which the Gonzalez therapy is based. I told them that it was being studied in a clinical trial but that I sincerely doubted that it would be shown to have much, if any, benefit. I also explained the concept of selection bias, and how the healthiest patients were the ones who could manage to go through Gonzalez's rather rigorous regimen, which could include as many as 150 pills a day.

"Oh," she said. "You know, I heard of another person that Dr. Gonzalez had turned down because he had had so much chemotherapy and other treatments before."

"That doesn't surprise me and only makes me think selection bias even more," I replied.

Perhaps I had gotten through after all--maybe just a little. It also helped that everyone at the table except them were scientists involved in medical research. I got a little tactical air support from them.

The conversation moved on to other topics. I did see everyone again a couple of more times while in Anaheim, and, to my relief, the topic of Dr. Gonzalez never came up again.

But this encounter reminded me of a few things. First, credulity will hit you when you least expect it. Most people who believe in these things aren't alties. They are regular people who just don't have the background in science and critical thinking to assess claims of "unconventional" practitioners properly. Second, many of these people can be educated, but not by stridency or overly strong attacks on their favored practitioner. That's why I winced when I let it blurt out that I thought Dr. Gonzalez was a quack. That could have turned them off so completely that anything else I said would have been discounted. (Fortunately, it didn't, but it could have.) Finally, if you're a skeptic and a doctor, you have to be prepared at any moment to do your part for evidence-based medicine and against unproven and/or ineffective remedies. And remember, don't resort to bluntness until you've exhausted more diplomatic means of getting your message across--unless you're dealing with an altie, of course.

Even penguins have to go through security

I guess even penguins could be a hijacking threat. You can never be too careful, you know...

Why intelligent design fails

A nice, brief explanation about why intelligent design is not science and why it shouldn't be taught as such can be found here. In about 5,000 characters, PZ succinctly sums up the shortcomings of intelligent design.

The cult of Apple

Having visited the Apple Store in Manhattan (which is very much like the one on Michigan Avenue in Chicago, which I've also visited), I can sort of understand this assertion that we Mac fanatics can sometimes be a bit cult-like. Indeed, when someone switches from Windows to the Macintosh, as one of the faculty at work did several months ago after a particulary bad outbreak of spyware and viruses on his Windows box, it does almost seem religious. Before, he used to mock my love of the Mac, and we would joust in a friendly way over which OS was superior. Now, he's even more enthusiastic about the Mac than I am. (Ah, the fervor of the newly converted!) In any case, for those of us who wouldn't dream of ever using Windows except under duress (for example, I have a cheap Windows box in my lab only because my real-time PCR machine won't run without it), these massive temples to the Macintosh do produce a sense of belonging that we Mac users seldom find in the "real" world. However, I like to think of our devotion as a force for good in the computing world. Can you imagine how crappy Microsoft Windows would be if it didn't have even the single-digit market share competition of Apple to tweak it, if it were an utter and complete monopoly?

I'm particularly intrigued by Umberto Eco's statement in the article that the Macintosh is Catholic, while Microsoft Windows is Protestant.

I bet we could argue about that one for days...

Argh! Not in my home state!

Noooooo!

Even my home state isn't safe from creationists!

I cannot refuse Hedwig either: The Farenheit 451 book meme

Somehow, I've managed to avoid this meme, even though it's been floating around the blogosphere for quite a while. I thought I would refuse it if it ever came my way, but it was Hedwig who invited me a week ago to participate this time, and, as was the case with Majikthise, I cannot refuse Hedwig either. Of course, I didn't see it right away because I was away in Anaheim and not checking most of the blogs that I usually frequent, but that's beside the point. How can one refuse a biologist with such an interest in birds, who names herself after the owl in the Harry Potter books?

So, for those who are not familar with this particular meme, it goes as follows:


You are stuck inside Fahrenheit 451. Which book would you be? [Note: In the novel - because books were burned - to save the content of books, people memorized one in order to pass the content on to others.]

Anyone who knows me well will know immediately what my answer to this question has to be. (Indeed, for me this is the easiest of the questions in the meme.) I didn't even have to think about it before answering. I would be The Lord of the Rings by J. R. R. Tolkien. (And, no, I'm not cheating by answering with a trilogy, because The Lord of the Rings was always intended by Tolkien to be a single novel, even though it ended up being released as three volumes back in the 1950's.) No other book even came close in the consideration.

I first discovered The Lord of the Rings when I was around 13 or so and instantly devoured the book, immersing myself in its world completely. I had read The Hobbit a while before and enjoyed it immensely. However, The Lord of the Rings was on an entirely different level. The mythology, the epic quest, the seemingly impossible task of destroying the One Ring, all of these contributed to its powerful pull on me. In the nearly three decades since then, I have reread the book at least 8-10 times. I don't remember for sure, because I frequently go back and read individual chapters or groups of chapters. My favorites include: The Shadow of the Past, Flight to the Ford, The Council of Elrond, The Bridge of Khazad-dûm, Lothlórien, The King of the Golden Hall, Helm's Deep, The Window on the West, The Battle of the Pelennor Fields, Mount Doom, and The Scouring of the Shire.

In fact, I've read this book so many times that I almost am the book already! I'll probably continue to reread it every so often until the day I die. In fact, now that I'm reminded, it might just be time to crack it open again, given that it's been about three or four years since I last read the whole thing...


Have you ever had a crush on a fictional character?

Not that I can recall, at least not really a crush, although I did rather like Susan Calvin from Isaac Asimov's I, Robot. If comic book characters count, many years ago, I rather liked Sue Richards from the Fantastic Four and Clea (also here) from Doctor Strange. I don't think you could actually call them "crushes," but that's about as close as I can come to answering this.


What is the last book you bought?

Books, actually, because I rarely buy one book at a time. They are:

Armageddon: The Battle for Germany 1944-1945 by Max Hastings.

American Brutus: John Wilkes Booth and the Lincoln Conspiracies by Michael W. Kauffman. (This was an excellent book that I finished a couple of weeks ago.)

The Forever War by Joe Haldeman.


What are you currently reading?

Fast on the heels of finally finishing Harry Potter and the Order of the Phoenix (much of which I read either while I was stranded waiting for a plane or on one of the transcontinental flights I had to take), I just started Rising '44: The Battle for Warsaw by Norman Davies the other day. It's been sitting on my shelf since last fall, and I thought it was time to finally read it. It's a detailed history of the ill-fated Warsaw uprising that started in August 1944 and lasted two months. (This is not the same thing as the Warsaw Ghetto uprising of 1943; it was a more general rebellion that was not confined to the Jewish Ghetto.) As Soviet troops advanced upon Warsaw, Polish nationalists, seeing that the Germans were rapidly retreating, started an armed rebellion, hoping for Soviet assistance. Stalin, realizing that the Polish nationalists could be a problem for him after he had driven the Germans from Poland, held his forces back and offered no aid. In essence, he let the Poles tied down German forces and cause German casualties, while letting the Germans crush the rebellion ruthlessly. Over 80% of the great city of Warsaw was leveled in the subsequent battles, which stretched over two months and caused mass casualties. The Germans also retaliated with mass arrests and executions.


Name five books for your desert island cruise package.

Yikes. Except for the first answer, this one's hard, but here goes:

1. J. R. R. Tolkien, The Lord of the Rings
2. Matt Ridley, Genome: The Autobiography of a Species in 23 Chapters
3. Isaac Asimov, The Foundation trilogy in one volume (only the original story from the 1950's, not the additional stuff Asimov and others wrote later)
4. Robert Graves, I, Claudius
5. Ron Rosenbaum, Explaining Hitler

You realize, of course, that, if you ask me on a different day, any or all of my choices (with the exception of #1, of course) could well be different.


Who are you going to pass this book meme baton to and why? (only three people)

The Cranky Badger, because, given that he's a comedy writer, I think he could make his response funny (that is, if he actually bothers to do the meme), and I'm up for some laughs. (Not too much pressure on you, Cranky.)

St. Nate, because he did a good job with the last meme I sent his way.

Anne, because I'm curious to see what a fine debunker of quackery reads in her spare time.

As an aside, the pictures I'm including are of a rather photogenic pelican that I saw while wandering around Venice Beach on Tuesday night. I was looking for an excuse to post them, and Hedwig's interest in birds is as good an excuse as any. I swear, I think this guy was intentionally posing for the camera!

Stupidity on parade

Here is a story of a woman in Australia who flew a Nazi flag at her house and was surprised to discover that her neighbors didn't approve of her new yard decoration. Actual quote from the article:

Ms. Duncombe had told the Daily Telegraph she did not know what the flag signified until the controversy erupted, but would not remove it because her four-month-old daughter liked its bright colours.

Didn't know what the flag signified?

Won't remove it because her four-month-old daughter likes the colors?

Argh!

I realize that, before the Nazis appropriated it as their symbol in the early 1920's, the swastika was an ancient religious symbol used by Hindus and Buddhists, and was regarded in several cultures as a symbol of good luck. However, since World War II, it has been virtually solely the symbol of the Nazi regime. Even today, it is used primarily by neo-Nazi groups as their symbol and almost never used to symbolize anything else except fascism of the Nazi variety. I find it utterly amazing that anyone alive today could be "unaware" of its history and meaning, particulary since she was clearly flying the very same flag that the Nazis flew, with a black swastika emblazoned on a white circle on a red flag!

The Virgin Mary appears

Unfortunately, Blogger was down for "scheduled maintenance" last night in my prime blogging time, meaning I couldn't access the drafts couple of posts inspired by my recent trip to AACR and finish one of them. By the time Blogger was back up, it was too late to let me finish one of them in a manner that would meet Orac's usual standards. Fortunately, I had started this on the plane on the way home, meaning I had a copy of it in Word, not Blogger. All I had to do is to add the links, clean it up, and I was good to go.

I've been made aware of a rather interesting apparition that has appeared in my favorite city (and here and here), Chicago, not too far from where I used to live. On a freeway underpass for the Kennedy Expressway at W. Fullerton Avenue, there is a stain that has appeared, a stain that is said to bear an uncanny resemblance to the Virgin Mary (more is here and a slideshow is here). Given that I know exactly which underpass this is, having driven by there many times during my three year sojourn in Chicago, I just had to check the story out, even though its entry into the blogosphere is a few days old. Better late than never, I guess (not to mention that, just because several other bloggers have already commented on this story never stopped me from adding my two cents).

Checking out pictures of the supposed apparition, I have a hard time seeing that much of a resemblance. Certainly, not having ever heard of it before or seen it before, I probably wouldn't have looked at that stain and said to myself, "Gee, that looks like the Virgin Mary." (Other things come to mind, unfortunately, which probably says more about me than I'd like to admit.) However, now that the suggestion has been planted by all the stories on the "apparition," I can see a resemblance. But I have to mention that others have pointed out equally plausible things that the stain looks like, one of them quite artistic and another of them quite rock 'n' roll. This particular apparition reminds me of one that happened a few years ago that got a fair amount of play in the media. In the fall of 2000, hundreds flocked to a house in Perth Amboy, NJ, in which a second floor window appeared to show an image of the Virgin Mary. This image, unfortunately, disappeared when the window was cleaned, but that didn't bother the owner of the house, who said, "Cleaning the window didn't remove her. She left when she was ready to leave." Another example is Our Lady of Watsonville, in which an image of the Virgin Mary was reportedly seen in a tree, and a more recent example occurred at a Boston hospital in 2003.

Clearly, as Skeptico points out, this is yet another instance of pareidolia, the tendency of people to see distinct objects in response to a vague stimulus. Pareidolia is usually the explanation for these phenomenon, and psychologists even try to harness this psychological tendency to see distinct objects in vague stimuli as a psychological test, the Rorschach ink blot test (although the validity of this test has been questioned). Having grown up Catholic myself, I never quite understood why Catholics as a religion seem to be particularly susceptible to paredolia, especially to seeing visions of the Virgin Mary in stains, windows, and other objects (although I have seen an amusing story of one who saw a vision of Lenin in his shower, which tells me that anyone can be susceptible to this experience). It seems that, all too often, all it takes is one imaginative person who "sees" the Virgin Mary or Jesus or what-have-you in a window, who then tells others. Add the power of suggestion plus religion and suddenly everybody is seeing the vision!

Not even all religious people think that much of them. For example:

Does it matter? Does it matter what people see, or what they think they see?

The Rev. Al Boyce of the First Unitarian Society on Plainfield doesn't think so.

"I do believe that we are body, soul and spirit, and spirituality is a part of our lives," he said. "But I do not take much stock in apparitions and this type of thing. If someone imagines or sees something through their mind's eye, that's fine with me. . . But if we would only live like Jesus lived instead of looking at images of him, we would be far better off."

Indeed we probably would. However, whatever the source of these "visions," they must be recognized for what they are, not for what we wish they were.

Personally, I consider these "visions" to be no different than looking at the clouds and seeing different objects in them. I myself have seen clouds that have borne resemblances to faces, animals, trees, and a variety of other objects. Sometimes, if I let my imagination go a bit, I can even convince myself that the resemblance is quite uncanny. And, yes, I've even seen clouds that have on occasion reminded me of the face of Jesus or of the Virgin Mary. These "visions" are no different. They would be nothing more than fun diversions if they didn't have the potential to cause so much trouble when used to convince people that it's a "sign from God." Of course, these "signs from God" can then used as a tool for control, a means to convince people that the "sign" means whatever the leader wants to tell them it means. That's one big reason to be skeptical of them, particularly the religious-based ones. Another is that they are often used to "prove" the existence of ghosts, UFOs, the Face on Mars, etc., in the absence of hard evidence.

The bottom line is that we have to understand the psychological tendency to see concrete objects in response to vague shapes and not let it serve as "proof" of anything. It can be fun to let your imagination wander and see what sorts of objects you can "see" in stains, clouds, condensation on windows, or whatever, but don't accept such "visions" as "proof" of anything.

A note to Orac-philes: future topics

Over the weekend and the next week, I'll finish a couple of posts I had started while in Anaheim on but failed to finish due to Blogger's being down for "scheduled maintenance" last night and begin a few more.

Topics presently in the pipeline include a followup to my post on people who ask questions at talks; possibly a word or two about the new Pope and the controversy over his having briefly been a member of the Hitler Youth; a post that I had wanted to post today about how not to persuade an alternative medicine believer that the therapy she is talking about is probably quackery (based on a personal experience--and screwup--at the AACR Meeting); a series of posts on some of the coolest new cancer research; a post or two on my own area of interest, tumor angiogenesis; and, of course, a post or two on the impending 60th anniversary of the fall of Berlin and Hitler's death. I may even briefly muscle in a bit on the territory of Bioethics Dude, given that he's cutting back his posting frequency and that I attended a symposium at the AACR on conflicts of interest, but it could be a couple of weeks or more before I get to that.

Oh, and I still have to do the book meme that Hedwig invited me to do last Saturday. (Sorry, Hedwig, but I was out of town and therefore not checking most of the blogs I usually do. I didn't see it until the other day.

There, that ought to keep this blog filled for at least another couple of months...

I'm back...

I'm backfrom Anaheim. Fortunately, the flight home wasn't as bad as the flight to Anaheim. Unfortunately, my flight got in rather late last night. Because I have a bunch of cases in the O.R. today, I doubt I'll get to post anything other than this today. However, the AACR Meeting did provide me a lot of great ideas for topics to write about with regard to medical research and medicine, as well as a couple of lighter ideas as well. (Even better, I actually remembered to jot them down as I thought of them.) And then there's the issue of the new Pope, and let's not forget that the 60th anniversaries of some very significant World War II events are fast approaching.

I'll get started as soon as I get a chance...

Tangled Bank is one year old!

While bored in my hotel room this morning, having finished packing for the return trip back to the East Coast, I was idly wasting time with some friendly sparring with PZ in the comments sections of two of his predictably critical posts about the new Pope, one in which he makes much of Cardinal Ratzinger's (now Pope Benedictine's) having once belonged to the Hitler Youth and worked in antiaircraft batteries (never mind that every German boy of that age had to join; joining the Hitler Youth was mandatory beginning in 1938, the year Ratzinger turned 11 and never mind that nearly every 17- or 18-year old German boy was drafted into digging tank traps, manning antiaircraft guns, or other war-related activities by 1944 and 1945, as Germany collapsed on both fronts) and another making much of an apparently anti-evolution comment Ratzinger once made (never mind that it's really pretty similar to Pope John Paul II's comments in 1995 that biological evolution is not incompatible with Catholic doctrine; the difference is more in tone, not substance), I realized something.

No, it wasn't that I should be using that time posting pearls to the comments section in PZ's blog to compose more pearls of wisdom to post to my own blog.

It was that PZ's brainchild, Tangled Bank, is a year old, and its 26th edition is being hosted by Circadiana today. So, while I'm spending several hours flying back to the East Coast, head on over there for the best scientific blogging in the blogosphere.

Join the celebration and thank PZ for having set it up and for continuing to organize it!

Grand Rounds XXX

Grand Rounds XXX has been posted at Living the Scientific Life. Although not a physician or medblogger (she's actually a biologist with a strong interest in the study of birds, whose blog template looks mysteriously like mine), Hedwig has done a fine job of aggregating and categorizing the best of the medical blogosphere from the last week, even while suffering through being ill. Check it out!

And let's hope she gets well soon.

Man, am I glad I didn't fall for this!

Daily Kos comments on an ABC News story that interests me so much that, cancer research meeting or no meeting, I had to take some time to mention it briefly. It concerns "Physician of the Year" awards that the National Republican Congressional Committee's Physicians' Advisory Board has been giving out. It turns out that the only qualification necessary for one of these awards is a hefty donation to the Republican National Committee. The problem is, some physicians are posting the award plaques in their office and mentioning the award on their CVs, giving the false impression that they won something that required more than simple cash.

The reason this story interests me so much is that these guys were after me to join the Physicians' Advisory Board for months and months last year. The first time they called my office and left a message I was intrigued but wary. I didn't return their call, but when they called back, my secretary got more information and took a message. What she relayed to me was that they wanted me to join what was described as an advisory board of physicians who would be consulted by Congressional representatives for advice on health policy issues. They did not mention any connection to the Republican Party at all. It all sounded a bit fishy to me. Something didn't add up, but I wasn't sure exactly what it was. So I did a little digging. Although I can't find the original links (mainly because they're buried under the proliferation of links related to the story above), what I found out was that this was a fundraising scam for the Republican Party. Basically, they would invite physicians to join this "advisory board" and then only later, after they agreed to be on this "board," would hit them up for money.

Learning this, I simply ignored all further phone calls. They were quite persistent, though, and always left an 800 number to call back, which actually made me even more suspicious. They called several times over the next few months, with the frequency increasing right before the election in November. It got so bad that my secretary asked me to take one calls and tell them off. I told her what I had learned, and the next time they called she was happy to tell them once and for all (with my approval) that I was most certainly not interested. After the election, the calls stopped just as abruptly as they had begun.

And now this story.

Man, am I glad I didn't let my ego suck me into seriously considering joining this bogus "Advisory Board"! I could have been one of those physicians using the "Physician of the Year" award on my CV and feeling really stupid right now. Instead, I get to savor the pleasure of realizing that I did not fall for this con. I even found out that it's not new. It's been going on at least since 2002.

Meeting archive cleanout: Cancer center bashing

Note: I wrote this a few days ago, but hadn't decided whether or not to post it. But since I'm still in Anaheim, I decided, what the heck.

Last week, I was perusing my usual way too large collection of medblogs, when I came across this post by Medpundit from Wednesday. I just had to respond, given that I happen to be faculty at one of those big NCI-designated tertiary care cancer centers she seems to be taking to task, apparently for abandoning "failures" to be "dumped" back on their primary care doctors or community hospitals.

In the post, entitled If the Cancer's Gone, Why is Death Knocking at the Door?, Dr. Smith takes issue with tertiary care centers. She starts:

Practicing medicine within easy reach of a renowned tertiary care center has its advantages. Patients can get highly specialized care, such as bone marrow transplants or epilepsy surgery, without completely uprooting the lives of their loved ones. It also has its disadvantages.

OK, so far, no problem, although I sensed she was building up to something.

She continues:

Aggressive public relations campaigns often leave people with the impression that the specialty center can work miracles, even for run of the mill diseases. And so, once in a while, you'll find someone who has landed in the hospital with a routine illness, such as pneumonia or emphysema, who asks to be transferred to miracle-worker hospital with the expectation that they'll get better faster there - even though there's nothing different to be done. The antibiotics don't work faster at a tertiary care center, and they can't transform old, smoke-damaged lungs into pristine healthy ones.

Still no problem.

Indeed, it's hard to disagree with this too much. I myself live and practice (and do my research) near a "big market," where I am subjected to radio, TV, and print ads for huge tertiary care medical centers (one cancer center in particular) all the time. These centers are older, larger, and more established than the cancer center where I practice, and their ads all too often sound as though they are promising the moon to patients. I occasionally even end up accepting patients with routine cancers that could be treated by any competent general surgeon because they wish to be treated at our cancer center. On the other hand, just as frequently patients head to the big city to be treated, because our cancer center, although rapidly growing and gaining a strong national reputation, is still not as well-established or large as the Meccas in the big city. (We hope to remedy that situation within the next 5-10 years.) Patients also go there sometimes to enroll in clinical trials, even though sometimes we have exactly the same clinical trial open at our institution. There's not much I can do about it except keep working to provide the best care and do the best research possible, thus doing my small part to fuel the growth of our institution, so that one day its reputation will be such that patients will feel the pull of the cancer Mecca much less, because we ourselves will be a cancer Mecca on the same order. (Of course, one unfortunate byproduct of that effort is that we ourselves will be forced to join the advertising; I still get an odd feeling when I see ads for our own institution, just as I did when I was in Chicago and Cleveland.)

Dr. Smith continues:

But even worse, is the tendency of the tertiary care centers to leave their failures on the doorsteps of others. They've done such a good job of selling themselves to the public that people do really expect miracles. Go to them with cancer, and you'll be cured, just like the guy in the newspaper or on the television special. I don't know what kind of conversations take place in the privacy of the consultant's office. Maybe they do honestly lay out the odds for patients, and the patient (and their family), blinded by hope, doesn't hear the bad mixed with the good. But, I do know that all too often, when the treatment has been exhausted and the patient ends up in the closer hospital in extremis, the miracle-working specialists are nowhere to be found.

Problem.

Dr. Smith is basically accusing us at the "Meccas" of making unrealistic promises of a "cure" to patients, treating them, and then dumping our "failures" back on the primary doctors and hospitals when they have complications or turn out to be incurable. I take issue with that. She is also implying (see below and note the title of her post) that we at tertiary care cancer routinely tell patients that their cancer is gone when it is not. (It is true that some oncologists will give chemotherapy even when it is unlikely to do any good, but I've yet to see one tell a patient his tumor is gone when it is not.) In every big tertiary care center I've ever worked at as a resident or attending (and I've worked at them in four states now), once we accept a patient from a smaller or less tertiary facility, we own that patient. If the patient is admitted to their original hospital, even for a routine problem like an uncomplicated pneumonia, we get a call wanting to transfer the patient, and we rarely refuse. If that patient shows up at his or her original facility with a hangnail, we get a call. (OK, I admit that I'm exaggerating here, but I think you get the idea.) In fact, if I were to refuse to accept a transfer, I have no doubt that I would end up having a conversation with one of my bosses, who would nicely (but in reality not so nicely) ask why I didn't accept the patient. Telling them it was a routine case that could just as well be handled at the local hospital won't wash, which is why I almost never refuse a transfer that I have the capability of caring for. Also, it is almost absolutely verbotten to refuse a transfer of an existing patient who has recently been under my care. It's an unwritten rule here and pretty much at every other major center where I've worked. It's the culture of the place. (It's also just the way most surgeons are anyway.) Our oncologists also lay out the odds and the clinical situation in great detail to our patients.

Just as I was starting to get worked up into a fine lather going, I kept reading:

As one of the oncology nurses told me yesterday, when neither my patient's miracle working oncologist nor his miracle working gastroenterologist would accept a patient transfer because there was nothing else they could do - "Don't you get the feeling they want us to take the blame for anything that goes wrong?" Then she added, bitterly, "They do this all the time, you know."

Say what?

Believe me, when something goes wrong after a patient is treated at a cancer center, it is not the referring doctors or institutions that take the heat. We get it all the time: "If your cancer center is so fantastic, then why can't you save my father/mother/wife/sister/uncle/aunt?"

To her credit, Dr. Smith didn't quite swallow it, but she bought enough of it:

Well, I didn't know that, but I certainly did get the impression they were reluctant to take responsibility for the complications of their treatment, or to admit to the patient that all was not as well as he had been led to believe. Meanwhile, my patient can't understand why he isn't feeling better. He's been told by better doctors than me that his cancer is "gone," his treatments "successful." And as far as the tertiary care center's records and statistics go - he is one of their success stories. But not because they cured him, only because they won't let him be anything but a success.

Uh oh.

I'm sorry. I really don't like to take fellow medbloggers to task, particularly ones whose blogs I happen to like, but I can't let that go unanswered. I'm guessing that, when she wrote the above, she probably didn't even realize that she was in essence throwing down the gauntlet to docs at cancer centers, like me. It doesn't bother me so much that she has the impression that some docs at tertiary care centers seem reluctant to accept back their complications, as there probably are occasional doctors out there who are like that. Perhaps she could imagine my reaction if she were to think about how she would react it if I were to start complaining about private doctors and community hospitals that send us patients they never should have tried to treat--but only after the patients' management has been made much more difficult by their attempts to manage what they were not equipped to handle.

What does bother me is Dr. Smith's apparent implication that tertiary care cancer centers do this sort of thing in order to protect their statistics, because such an implication relies on a misconception, the misconception that it is feasible to manipulate a cancer center's statistics that way. Her implication is wrong not because of my own experience working in cancer centers that says our patients rarely go elsewhere once they start treatment with us. No, it's because of a little thing called a tumor or a cancer registry. These registries are detailed databases that every NCI-designated cancer center must maintain about every cancer patient they treat and must include survival and incidence statistics by stage. A great deal of effort must be devoted to maintaining these databases, and, depending upon the size of the cancer center, the index may or may not be regional. There are rigorous criteria for these databases, with various bodies that monitor various cancer registries (such as the American College of Surgeons, the Centers for Disease Control and Prevention/National Program of Cancer Registries, or the North American Association of Cancer Registries), all of which require a followup success rate of at least 90% (preferably 95% or better), along with no evidence of bias in the lost-to-followup cases if the cancer center is to be allowed to use its data for survival statistics for publication. Cancer registries often follow state and county death registries, supplemented with a variety of other databases, in order to locate patients lost to followup. If a cancer center's lost-to-followup rate is too high or shows signs of bias in stage or types of cancers, its registry could lose its certification by one of the aforementioned bodies, which could be a big red flag at the next NCI site visit, never mind that a database that could be manipulated that easily would be useless to the cancer center's researchers. Also, because cancer centers are big contributors to state and regional tumor registries, many of these lost to followup patients will be picked up by the bigger registries and reported back to the cancer center that treated them.

Fortunately, it would be quite difficult to make a cancer center's statistics look any more than marginally better by "dumping" its "failures" back on the primary care system and community hospitals. First off, if its lost-to-followup rate is less than 5%, as it should be, then that's a pretty small percentage of patients. Diluting the pool even further, these patients will have a variety of cancers. At most, by pulling the sort of "dumping" Dr. Smith implies, a cancer center might change its statistics for any single cancer by a fraction of a percent. In any case, a patient like the one discussed above would not be considered a "success story" for purposes of the statistics of a major cancer center. Unless the patient moved out of state and did not get captured by a state or regional database, chances are that his relapse and eventual death would still get captured and assigned to the statistics cancer center where he was being treated.

The bottom line is that, while it is certainly possible that some individual doctors at large tertiary cancer centers might be reluctant to take back their complications or patients for whom they can no longer do much, the vast majority are not like that, nor can a cancer center so easily refuse to let a cancer patient it has treated be "anything but a success." It just doesn't work that way.

Air travel rant

Well, I'm finally in Anaheim, and let me just say one thing.

I hate flying.

No, I'm not afraid of flying. I used to moonlight as a helicopter flight physician in the early 1990's and loved going up in the helicopter. I also had a chance to go out on a couple of organ harvest runs during my residency in which they used a Lear jet. Very nice. I just hate flying commercial these days. There are less and less seat space, fewer and fewer amenities, and more and more irritants. It's not even so much the increased security since September 11, 2001. I never much liked flying commercial, but it's definitely even worse these days.

Yesterday was just another fun day trying to get somewhere (in this case, to Anaheim).

It was a beautiful day. A perfect day. You'd think that there would be minimal chance of significant delays, and, indeed, when I arrived at the airport, the flight monitor listed my flight as "on time." Then, just before we were scheduled to board, there was an announcment that there would be a "maintenance delay" of around 40 minutes, which turned into over an hour.

OK, so far, no big deal, although the very term "maintenance delay" always sends a little chill down my spine. (What's wrong with the plane?) We did finally get on the plane and taxi towards the runway--only to sit there for a while and taxi back to the gate. The pilot announced that he wasn't perfectly happy with the readings. OK, fine. I like attention to detail and safety in a transcontinental flight. It's hard to complain too much about that. (It's not like I want to try to fly 2,500 miles in a plane that isn't in tip-top shape.) Such attention to maintenance is a good thing in an airline.

What wasn't such a good thing was the way they handled the situation after we had to deplane and wait. And wait. And wait. Two or three other flights to L.A. (our airline) took off while we were waiting, not counting other airlines. Few announcements were made, and our delay stretched to well over four hours. People were getting testy at the increasing delay, but even more at lack of information. A few first class passengers were quite incensed that they had been strung along so long, with no attempt to try to rebook them for one of the later flights that were leaving for L.A. from nearby gates. (One of these guys, with his gold watch and chain, was a bit of an arrogant twit, but I had to admit that he did have a point.) Also, given that the airport we were at is one of the biggest hubs for this airline, I was wondering why the airline couldn't come up with a different plane. I was just considering seeing if I could get on a very early morning flight the next day and then heading home, when they finally let us board. At least they did give us vouchers for free drinks and a discount card for future flights. Yippee.

Fortunately, the flight itself was uneventful, but baggage claim at LAX is really annoying, and there was a huge line to pick up a rental care where I had reserved one, and then I still had to face the 35 mile drive to Anaheim from the airport. (Nothing like navigating the freeways of an unfamiliar city at night, trying to find your way.) Fortunately, I had gotten Mapquest directions before leaving. Also fortunately (or unfortunately, depending upon your view of these things), there was a Burger King right next to the car rental place. I stopped there, got a slider, and chowed on it while driving. At least I found a really cool radio station to listen to during the ride; the DJ was playing everything from punk to surf musing to Velvet Underground. By the time I got to the hotel, it was close to 11:30 PM local time (or 2:30 AM "my" time). Fortunately, the hotel didn't lose my reservation, which would have made this the perfect travel experience. Even worse, I ran into a woman whose flights had been delayed twelve hours. Geez, I couldn't even claim the only good thing about a horrendous travel experience--the right to bitch about it and have people who have also come to the meeting acknowledge it as the worst.

As you can see, Orac is a bit cranky right now. Not as cranky as the Cranky Badger, but at least he's in Anaheim. With such an inauspicious start, I hope the meeting goes better.

Thus endeth the rant.

Off to Anaheim

I'm off to Anaheim for the AACR Meeting, along with around 15,000 other cancer researchers. It's my favorite cancer meeting, because there's usually a good mix of basic and clinical science and almost everyone who is anyone in the world of cancer research will be there. (I just wish it weren't in Southern California, as I hate the long flight it takes to get there.) Unfortunately, I won't be giving a talk there, but I will be presenting a poster (along with around 3,000 others).

For those of you who may have gotten used to my rather frantic blogging pace over the last week (a bit of an aberration from my usual), my trip means one of two things. Either blogging will be light to nonexistent until later next week (if I run into a lot of people I know and hang out with them every night) or it may be more or less normal (if I end up spending a lot of boring time in a hotel room in a strange city after the daily meeting sessions). I guess you'll just have to keep checking back periodically to see which it is. I do have a couple of things in the hopper that I've already written, though, which I'll probably post while I'm in Anaheim. One thing that could be good for the blog is very likely though. The meeting should provide me with some good raw material for medicine and science blogging to use when I get back. (I'll take notes.) If I'm really lucky, it may provide me with Part 2 of this series, which I started at the last scientific meeting that I attended.

In my absence, feel free to peruse "Essential Orac" (on the sidebar), particularly if you're new to Respectful Insolence.

I cannot refuse Majikthise

Majikthise has invited me (and a few others) to participate in a blog meme, as she has done. I usually decline these blog memes, with the exception of the Friday random top ten, but how can I resist someone as charming as she, particularly when she takes her name from a character from The Hitchhiker's Guide to the Galaxy?

The meme states:

Behold, the Caesar’s Bath meme! List five things that people in your circle of friends or peer group are wild about, but you can’t really understand the fuss over. To use the words of Caesar (from History of the World Part I), “Nice. Nice. Not thrilling . . . but nice.”

I obey, O Majikthise! Here they are, in no particular order:

1. Techno-thrillers of the Tom Clancy variety. They can be mildly entertaining and fun to read, but I'm not addicted to them, as some of my friends are.
2. Lost. I'm sorry, but I just don't understand what everyone thinks is so great about this show. From the few episodes I've seen, it's kind of like The X-Files meets Gilligan's Island. I wasn't a big fan of The X-Files, either (although I was a big fan of Gilligan's Island when I was a kid). It's just OK (or, as we sometimes say, it doesn't suck). But I can't see myself getting addicted to Lost, the way I'm addicted to the exploits of Jack Bauer on 24. Oddly enough, I feel the same way about the other big hit Desperate Housewives. (Oh, wait, I just did a two-for-one on the meme, didn't I?)
   
3. George W. Bush. As a center-right conservative myself (of the deficit hawk, somewhat more libertarian-leaning variety), I can't understand why so a fair number of my conservative friends and acquaintances are still so crazy over GW, who has turned out to be a very un-conservative President. He passed massive tax cuts, failed utterly to control government spending, and now, as the deficit balloons out of control, wants to privatize Social Security in a way that will balloon the deficit even more. I don't actually hate G.W., as as a fair number of people appear to (although I most definitely do not support him any more), but I sure don't see him as some sort of conservative savior, either.
   
4. Skiing. A fair number of my coworkers and friends love to ski. I just don't see the attraction of sliding down a steep hill or mountain slope at high speeds on two thin wooden sticks in freezing weather, with the possibility of broken limbs as a reward. Get me back to the lodge for some Bailey's by the fire.
   
5. Low carb diets. At the risk of directing derision my way, I'll admit that I'm very fortunate that I've never had to diet in my life to stay thin. (When I did put on a few pounds a few months back, giving up my nightly glass of beer and cutting back from potato chips and other snacks for a few weeks got me almost back to fighting weight.) But if I ever did, I don't understand the attraction of this one. It's worked for one friend of mine. But I like bread and pasta too much.
   

Of course, if you ask me another day, I might give different answers.

I now must pass this on to three more people. I therefore choose St. Nate, The Socratic Gadfly (who did a fine job of hosting the Sixth Edition of the Skeptics' Circle), and Bioethics Dude.

The History Carnival #6

The schedule and abstracts for the History Carnival #6 have been published at Cliopatra:

History Carnival #6: Conference Program

Speeches (opening and closing) will be in the Droning Auditorium. Panels will be in the Alumni Donor Memorial Classroom. Poster Session will be in the big Theory Hall; Mini-Panels will meet on the left end of Theory Hall, unless the participants refuse to appear together. Papal Working Group will meet in secret. Titles are approximate (as are names, in some cases) and subject to change without notice; liberties have been taken, mostly for the sake of clarity. The vast majority of conferees who did not submit abstracts in advance are hereby ordered to attend anyway, by the power vested in me....

Check it out.

Unfortunately, my latest abstract was submitted too late for consideration.

60 years ago today: The liberation of Bergen-Belsen

As the Allies marched east across Germany, they encountered more and more evidence of Nazi brutality. A few days ago, I chronicled the liberation of Buchenwald. 60 years ago, today, another Nazi camp, Bergen-Belsen was liberated, this time by the British, with equally horrific scenes. A detailed account is here; a survivor's account is here; and the account of one of the liberators, who was a young medical student at the time, is here. I also note that Bergen-Belsen is the camp where Anne Frank ultimately met her doom in a typhus epidemic not long before the British arrived. For the British and American public, this was the camp that provided the first detailed account to them about the true horror of the Holocaust, brought home to them by their own forces and own reporters, rather than the Soviets, who had liberated Auschwitz two and a half months before.

More evidence of Nazi brutality was to come, as Allied troops would find more such camps. Unfortunately, as the survivors with first-hand experience of these horrors inevitably age and die off in increasing numbers, Holocaust denial by those who either shared Hitler's anti-Semitism or who have other reason to want to rehabilitate the image of fascist political belief systems is becoming more and more of a problem. I wish I could be as optimistic as eminent historian Sir Martin Gilbert, who believes that "the tireless gathering of facts about the Holocaust will ultimately consign the deniers to history." According to Sir Gilbert:

The number of deniers and the amount of denial literature is miniscule compared with the serious literature, not only the memoirs but the history books, the specialist books, and books which cater for every age group on the Holocaust.

There is a tremendous range of stuff and some of it is written for young people and teenagers - in that sense the Holocaust deniers have totally lost out.

He's absolutely right about the enormous amount of serious literature about the Holocaust that utterly overwhelms the weak and distorted attempts at "historical revisionism" by Holocaust deniers. I hope he's right that this literature will ultimately consign Holocaust deniers to a status as historical oddities. However, I fear that it is more likely that, as survivors inevitably die, there will be fewer and fewer with the personal commitment to refuting their lies and more people who do not know enough about the Holocaust to recognize their lies for what they are. Given how poor the average American's knowledge of history is, most people don't have the background to recognize denier lies for what they are. To them, unfortunately, the lies can seem plausible.

The Skeptics Circle #6: Thanks, I needed that!

The last couple of days have been rather eventful here at Respectful Insolence. Logical fallacies, like the post hoc ergo propter hoc fallacy, have been floating through the comments of one of my posts in a vain attempt to "prove" that giving women the right to vote leads to the loss of freedom and an "accelerated shift towards socialism" (as one anonymous commenter put it) or, as the anonymous commenter's inspiration Vox Day had put it, an "obvious connection between the female franchise and the West's continental drift into socialism." (Never mind the pesky possibility that women's achieving suffrage could just as well have been an effect, not a cause, of increasing liberalization.) Not satisfied, Vox launched another broadside at me and others, this time using a strawman and a false analogy when he talked about the Swiss and pretty much every other Western nation not letting resident aliens vote as "evidence" that universal suffrage doesn't necessarily make a nation more free. Never mind that nowhere did I make the claim that universal suffrage did necessarily make a nation more free (although that could be an interesting argument) and never mind that there is a huge difference between excluding resident aliens from voting and excluding full citizens from voting on account of gender!

But I tire of Vox, as (no doubt) do you. Apparently he's decided to ignore me without ignoring me, by trashing me but not bothering to link me, perhaps in response to my sarcastic thanks to him for pumping up my hit count the other day. As a self-proclaimed Mensa member, he's proof positive that intelligence tests don't measure reasoning ability very well. It's hard for me to imagine that he's in the same organization that a very old and dear friend of mine is.

Fortunately, there is finally relief for all this bad reasoning and credulous acceptance of dubious assertions right here: The Sixth Edition of the Skeptics' Circle has finally been posted at Socratic Gadfly! After dealing with Vox, I need a dose of reasoned and rational (and--dare I say?--skeptical) blogging, given all the logical fallacies that have washed over this blog from outside sources over the last couple of days, and the Circle is just the place to get my fix. In fact, if there are still any stragglers coming over here referred from my first post lambasting Vox, please stay and check out the Circle. Then go and check out earlier editions. They may even teach you how to recognize some of the fallacies in Vox's "reasoning" with respect to women's suffrage.

And then come on back in two weeks, when the Seventh Edition will be hosted by Thoughts from Kansas on April 28.

A church that even atheists could love

In my constant quest for ecumenical understanding between atheists, agnostics, and theists, I may have found a church that even atheists like PZ might not detest. I'm not sure if it's on the up-and-up or if it's some sort of joke, but if it is a joke, it's an elaborate one. In any case, it's a rather interesting concept. It's called the Church of Reality. Its saying: "If it's real, we believe in it."

The Church's thoughts on "Does God Exist?":

The standard for reality in the Church of Reality is that for us to declare something is (probably) real - it has to be something that is objectively observable in the real world by any observer. Personal revelation does not meet this test. So - even if I were to personally believe in God - that isn't good enough for the Church of Reality. We are committed to believing in reality the way it really is.

It is therefore the official position of the Church of Reality that God does not exist until such time as God chooses to reveal himself to all Realists and come out into objective reality in the real world. Should God come out into the real world then we as Realists will instantly become theists and will do whatever God commands us to do. Until that happen then either God does not exist or it is God's will that Realists don't believe in him. Either way - this is the correct choice.

I don't think that even Brent or PZ would have a problem with that. The Church of Reality has 15 Sacred Principles. My favorite:

The Principle of Bullshit: The Principle of Bullshit recognizes that things that aren't true just aren't true. It doesn't matter how many people believe it - it doesn't matter that people have believed it for thousands of years - it doesn't matter if you want to believe it - bullshit is bullshit - and if it isn't true - it isn't true. There is a difference something being true and something being not true.

The Principle of Bullshit is all about refusing to live the lie; to be able to call something the way it really is. It is the ability to face the reality of being wrong so as to create a starting point to make a better choice. It is to accept that you can't truly pursue reality if you continue to believe in things that aren't real. You may have made a mistake - or millions of people might have made the same mistake for thousands of years. But when you know it's all bullshit then you have to call it - accept it - and move in the Sacred Direction. If you're a Realist then by definition you are supposed to give up what's not real - or at least admit your denial if you aren't ready to face reality.

There are those who would twist the truth, be misleading, tell half truths, hide the truth, use double meanings and distort definitions, be deceitful and deceptive, and to lie. This is not the way of the Church of Reality.

The Tree of Knowledge is built on what is real and what is true. Bullshit that is passed off as reality pollutes the Tree of Knowledge and creates a weakness in knowledge itself. It inhibits growth and holds back our development as a race of humans. It keeps us from developing in a positive direction. Part of the Sacred Duties of the Church of Reality is the purification of knowledge. We choose to expunge the bullshit and replace it with what's real. The Principle of Bullshit asserts a duty to resist the powers of bullshit and move towards reality the way it really is. It requires courage and strength of character to go against the herd mind and refuse to live the lie.

You don't even have to be an atheist to agree with this particular sacred principle. All skeptics and scientists should accept it, even those who are religious. For example, we shouldn't be afraid to call creationism and intelligent design what they are: bullshit, at least as far as the claims that either are science rather than religion.

Unfortunately, the Church stumbled very badly in its choice of "saints," picking Jack Kervorkian and Larry Flynt (which is one reason that made me wonder if this is all some sort of elaborate joke). Sorry, Mark Perkel (The First One, or the Founder of the Church), but I think that Jack Kervorkian is anything but a hero of reality. As anyone who grew up in the Detroit area knows, he's a creepy old guy who has always been obsessed with death from his earliest days as a pathologist. I've always suspected that his "assisted suicide" bit was just another way for him to indulge his obsession. (He also seemed to get way too much pleasure out of offing the poor people who wanted to die.) Fortunately, he's in jail, where he belongs. Larry Flynt, for all his battles for "free speech" in the name of pornography, is (and always has been) a digusting slimeball. Surely, O First One, you could have come up with better examples of people deserving of sainthood who (as the Church of Reality's requirements for sainthood say) put themselves "in a position of grave personal risk in order to promote an idea that is real in the face of a public who refuses to face reality." Hello! How about Ignaz Semmelweis, who spent decades trying to convince doctors that washing hands would decrease infection in the obstetrics ward and ultimately died in an insane asylum?

Sadly, this may not be too far from the truth

You don't have to be a liberal to realize that this may not be too far from the truth:

Awaiting the Skeptics Circle

I was rechecking my tax returns last night in preparation for mailing them out on Friday. (I believe in doing my return the old-fashioned way when I owe money and sending in a paper check by mail on the last possible day.) So I didn't have time to write anything last night to post on the blog this morning. Consequently, today's blogging will be light, with no further comments on Vox Day's reactionary advocacy of denying women the right to vote (at least not now). But do look forward to later today, when the Socratic Gadfly will post his turn at hosting the Skeptics' Circle (at which point I'll post a plug).

In the meantime...

Even though I'm not a big fan of cats, I do like kittens; so even I couldn't resist this.

Even though I tend to find militant radical animal rights activists laughable, I find this tasteless in the extreme, even if (as I suspect) it is meant as a hoax to tweak them. It doesn't help that it sounds like a scam. If it were funny, that would be one thing, but even my sometimes sick sense of humor doesn't allow me to laugh at this.

The Orange Man

The first thing that struck me about him was that he was orange.

It wasn't a shade of orange I had ever ever encountered before in a patient. It was a yellowish orange, an almost artificial-looking color. At first I wondered if he was suffering from liver failure with jaundice, but this orange was not the right color, and his sclerae were not yellow. I also considered whether he was suffering from renal failure, but the orange color of his skin didn't quite match the rather coppery color that some patients suffering longstanding renal failure necessitating dialysis sometimes acquire. I was puzzled. His chart said that he was being admitted for surgery for rectal cancer. So I sent the intern in to get the story, do the history and physical, and get him all plugged in for his bowel prep. (Yes, believe it or not, there was a time when it was not all that uncommon for patients to come into the hospital the night before their surgery in order to undergo a preop bowel prep, rather than being forced by their insurance companies to undergo the torture of drinking four liters of the purgative known as Go-Lytely--a misnomer, if ever there was one!--at home and spending the next several hours having to rush periodically to the toilet, waiting in vain for the liquid exploding out of their hind end to run clear.)

Ten years ago, I was in my chief resident year in general surgery. I was doing a rotation as chief of one of the general surgery services back at the mothership (the University Hospital). This particular service had a lot of colorectal surgeons on it. Consequently, we saw a lot of good, solid general surgery involving the colon, one of the organs a lot of general surgeons like to operate on the most. Naturally, a lot of this surgery was colorectal cancer, given how common this variety of cancer is. It was while I was doing this rotation that I first encountered the Orange Man, as I dubbed him in my mind (although I never called him that out, not even to the other residents, who might have found it amusing).

When rounding with one of my surgery attendings, I learned the sad tale of the Orange Man. He was a man in his early 50's, who had first seen my attending over a year before. He had suffered BRBPR (which, non-medical types, stands for "bright red blood per rectum") and been referred to a gastroenterologist, who examined him and did a colonoscopy. This revealed a rather low-lying rectal cancer. He was referred to my attending, who evaluated him, found that there was no evidence of metastasis to the liver or elsewhere on CT scans, and recommended surgery. Although the tumor was relatively low, the attending thought there was a very good chance he could do a sphincter-sparing procedure, known as a low anterior resection, possibly with either a very low anastomosis or a coloanal anastomosis. However, the patient would have to be prepared for the small possibility that it might require an abdominoperineal resection (APR) to remove the tumor. (An APR involves taking not just the rectum, but the anus as well. It necessitates sewing the anus shut and leaving the patient with a permanent colostomy. APRs are necessary for very low-lying cancers or cancers that can't be removed with an adequate margin of normal tissue between the tumor and the anus or tumors low enough to involve the anal sphincter mechanism.

Scary news indeed. I can only imagine the reaction of the Orange Man upon hearing the news. He was probably terrified. Certainly, I'd be scared if it were me. Certainly, I wouldn't want to have a permanent colostomy if it wasn't possible to get the tumor out with a clean margin and still save my anal sphincter. No one, and I mean no one, does. But, if it had been me, I'd still have undergone the surgery, because I know it would be my best shot at long-term survival. I'd take the small chance that it might be necessary to have a permanent colostomy.

The Orange Man, unfortunately, made a different choice. Convinced that he could find another way, he sought "alternative" medical treatments. He somehow ended up in New York City, where he undertook a regimen that involved coffee enemas and megadoses of carrot juice. There he returned periodically for over a year, all the while purging himself with coffee enemas, consuming megadoses of carrot juice and vitamin supplements, and undertaking various other "alternative" treatments for a potentially curable cancer (and, I guess, trying to ignore the increasingly orange tint his skin was developing).

Coffee enemas? I couldn't believe it. I had never heard of such a therapy before. What possible use could coffee enemas have against cancer, I wondered. The only use for them I could imagine at the time was possibly as a more rapid (and highly disgusting) method of delivering caffeine into the bloodstream.

I didn't know about it at the time, but now I can speculate that the "therapy" the Orange Man had chosen was very likely some variation of the Kelley/Gonzalez treatment. The basis of this "therapy," developed first by Max Gerson, MD back in the 1940's and 1950's, then continued by William Kelley, DDS in the 1960's, and still practiced today by Nicholas Gonzalez, MD, is a belief that all cancers come from a deficiency of pancreatic enzymes, which supposedly allows cancer cells to grow. By the "concept" behind this, cancer grows and metastasizes because there is lack of cancer-digesting enzymes in the body. The solution is, supposedly, is to get pancreatic enzymes to the place where cancer is growing, in a concentration high enough to stop growth, but not so high as to cause too rapid production of "toxins" from tumor breakdown. Consequently, the treatment consists of "detoxification" with coffee enemas, which supposedly help flush the waste products of tumor cell breakdown out of the body; dietary manipulations; ingestion of pancreatic enzymes; and megadoses of supplements and vitamins, like carrot juice. The original Gerson diet required more than a gallon a day of juices made from fruits, vegetables, and raw calf's liver, but there are many variants.

Looking back on the incident, I now wonder if the Orange Man was treated by Gonzalez himself, given that New York is where Gonzalez has operated.

The Orange Man was finally forced to return to my attending when it became clear that the coffee enemas and megadose carrot juice therapy were not working. His rectal tumor continued to bleed intermittently but with increasing frequency. It continued to grow slowly and started to interfere with his ability to defecate. Finally, it began to produce a horrible sensation of tenesmus (the intractable sensation of having to move one's bowels that rectal cancer patients sometimes get and which can at times be almost unbearable). Finally, the Orange Man had had enough.

Unfortunately, the cancer hadn't yet had enough the Orange Man. By the time he returned to "conventional" doctors and surgeons, his tumor had grown considerably. It was now intermittently bulging out of his anus and may have been growing into his anal sphincter. Fortunately, CT scans showed that it did not appear to have metastasized to the liver or elsewhere yet. Fortunately for him, the tumor still appeared to be operable. But he would require an APR and a permanent colostomy for the tumor to be excised with curative intent. There was no chance of sparing the anal sphincter and no chance that he would avoid a permanent colostomy. There was also a very high chance that the Orange Man would be left permanently impotent, as well.

The Orange Man was the first to teach me that alternative medicine that is ineffective is not harmless.

I still remember his operation. It was one of the last ones I did before I had to move on to another service. The Orange Man had a bulky rectal tumor that was very difficult to remove. He had numerous hard, suspicious lymph nodes in the mesentery, going all the way up to the root of the aorta. He clearly had node-positive disease, a negative prognostic factor. The tumor had clearly invaded all the way through the wall of the rectum, another negative prognostic factor. All I can remember thinking is: How on earth could this guy have chosen not to undergo surgery a year before, back when his tumor would have been much more easily removed, and he would have had a good chance of not needing an APR (with its attendant permanent colostomy), not to mention a much better shot at long-term survival? Why? What did the "alternative" medicine practitioner tell the Orange Man to convince him to forsake proven effective therapy? Did the practitioner promise him he could be "cured" without surgery, radiation, or chemotherapy, without pain? Did the practitioner scare him with horror stories of the complications from such therapies? Did he or she do a little of both?

I don't know what ever happened to the Orange Man. I felt very sorry for him. He had clearly been taken in by a quack and was very likely to pay the ultimate price. And he knew it. A few days later, before the Orange Man was discharged, I had to move on to another service in another hospital. I never saw Orange Man again. Given the extent of his disease, there's certainly less than a 50-50 chance that he is still alive today. If he is still alive, however, there is a 100% chance that he has a permanent colostomy that he probably didn't have to have.

Alternative medicine that is ineffective is not harmless.

When I hear advocates of alternative therapies claim that their therapies are harmless, I think of the Orange Man. When I hear advocates of alternative therapies claim that their therapies are harmless, I also think of women like Patti Davis, who underwent a breast biopsy and was told that she had breast cancer. Her cancer would have had a high probability of being cured (oncologists hate to use that word, but in this case it is not entirely inappropriate) with conventional therapy, but instead she, like the Orange Man, opted for a variant of the Gerson therapy, driving to a clinic in Tijuana, undergoing "detoxification, and eating 7-8 pounds of carrots a week at one point. Her mother, who had had breast cancer at age 47 and survived 22 years after surgery, radiation, and chemotherapy, urged her daughter to finish her surgical therapy and a course of conventional therapy, to no avail. Mrs. Davis ultimately did return to conventional therapy when she felt a lump under her arm that had developed while she was undergoing the Gerson therapy and finally realized her mistake.

By then it was too late. She later died at the age of 39.

And she has company: Debbie Benson, who eschewed conventional therapies for a treatable cancer; Lucille Craven, who went so far as to hide her diagnosis from her husband for many months while she sought treatment from various "alternative" practitioners; and many others.

Alternative medicine that is ineffective is not harmless.

I think of the Orange Man and Patti Davis, when I read or hear alties crowing about how the Gonzalez regimen is being tested by an NIH-funded trial. Although I support the rigorous testing of alternative medicine therapies in clinical trials to determine whether they have any efficacy, as I have said before (see here and here), dubious trials like the Gonzalez trial highlight the problems of the National Center for Complementary and Alternative Medicine (NCCAM), too many of whose studies are based on pseudoscience and supported by preliminary data that is shaky, at best. A prime example, the Gerson/Gonzalez therapy trial was funded on the basis of a single uncontrolled and poorly designed clinical study of 12 highly selected patients with pancreatic cancer. R01 grant applications for conventional medical therapies usually require considerable preliminary data from basic science, preclinical animal experiments, and often preliminary clinical trials if they are to have a shot at being recommended for funding. Where was the in vitro data to support the Gonzalez protocol, showing activity against pancreatic cancer cell lines? Where were the preclinical animal studies showing activity in models for pancreatic cancer (or any cancer)? Where were the animal studies that support the supposed mechanism by which the therapy is postulated to work? Not in the scientific literature or in the grant application, as far as I can tell. If I were to submit a grant application to the NCI for funding for a clinical trial based on so little data, the study section would deposit my application in the circular file; that is, if they didn't pass out from laughing so hard first! Yet NCCAM funded this one for over $1.4 million. That's $1.4 million that could have gone to fund a trial that might actually have taught us something, just like the more than $1 million that has gone to funding a trial to test chelation therapy, despite randomized clinical trials showing that it does no better than placebo for atherosclerotic cardiovascular disease. Worse, both of these studies lend credibility to these dubious therapies, because they have the imprimatur of the NIH. Because I still believe that some alternative therapies that show promise need to be tested by rigorous science (green tea as a chemopreventative agent for cancer, for example), I wouldn't go so far as Dr. Sampson, who believes that NCCAM should be completely defunded. On the other hand, it is unclear to me why NCCAM's budget continues to rise, while the NIH budget proposed by the administration for fiscal year 2006 is the tightest in more than a decade. With paylines for NIH grants falling like a rock last year and poised to fall just as much farther next year, I have to ask: Are these sorts of dubious studies the best use the NIH can find for the increasingly limited pool of taxpayer money for biomedical research?

Alternative medicine that is ineffective is not always harmless. It's not just the patients who choose them in preference to proven treatments who suffer. It's their families friends, who watch them die from potentially curable diseases (often draining their life's savings along the way), and all of us, who fund these ineffective treatments or end up paying more through taxes and insurance when a patient who might have been treated more effectively and inexpensively requires much more difficult and expensive treatment because of a delay caused by the pursuit of ineffective therapies and false hopes.

Someone noticed me

Someone noticed me, thanks to this.

I was rather surprised, given that I'm such an itty-bitty blogger.

However, as an itty-bitty blogger, I have to offer my thanks to Vox for pumping up the hit count of my blog yesterday. I'm actually rather surprised that such a "big-time" Worldnet personality actually noticed my humble little blog, much less deigned to take a few minutes from writing his rants for Worldnet to trash a post of mine. Such are the rewards and perils for calling 'em like I see 'em, I guess. In any case, I hope that some of his readers might actually like what they see here, his negative "recommendation" of me notwithstanding. Maybe some of them read Vox for the same reason some liberals listen to Rush Limbaugh or Sean Hannity. (Of course, as regular readers know, I'm not liberal, but more center-right, but for some reason I seem to annoy far right-wingers more than left-wingers. Maybe I need to write a bit advocating a flat tax.)

And thanks to PZ for pointing Vox out to me.

I think.

Given some of the scary comments (see the one with the timestamp of 10:54 PM--the direct permalinks to individual comments don't always work right on Blogger), I'm not entirely sure I should be thanking PZ. Read that comment, contemplate Vox's calling women "fascists at heart" (without presenting a shred of evidence to support that contention other than a questionable historical reference to Mussolini), and then wonder at how the anonymous commenters drawn here by Vox's response to my original post accuse me of using emotion and demagoguery over reason! Sheesh.

Ah, well. Glutton for punishment that I am, I can't resist making one last (I hope) comment on the matter. Unlike what was said in one of the comments to my post, it is not I who misunderstand libertarianism. It is Vox. No libertarian principle that I'm aware of justifies denying the right to vote to a whole segment of the population on the basis of gender (or, for that matter, race) alone. If Vox really believes women should not vote on the basis of some defect ("fascism" I guess) he attributes to them because of their gender, then he's a sorry excuse for a libertarian and a Christian. I also can't help but wonder why on earth he totally undermined what could have been a potentially valid point about government interference in private enterprise and private life in Norway and Spain with an utterly idiotic assertion that women are "fascists at heart," which he fails to back up but then uses as a basis for his "argument" (if you can call it that) that women should not vote.

Vox seems to think I'm a woman, too. I can only guess that he can't imagine why a man like myself or PZ would disagree with his apparent advocacy of disenfranchising women simply because of some vague "fascistic" tendencies he seems to perceive in them. Either that, or maybe he thinks that calling me woman is an insult, given that he seems to consider women "fascists at heart," as he so quaintly put it. If the latter is the case, then his calling me a woman as a form of insult says far more about him than it would about me. And this quote, cut and pasted without change from an anonymous commenter, says a lot about the mindset of some of Vox's supporters: "Orac, yes, I am very judgemental. I just didn't want to have to see the contempt I have for you now that I know you're a man. It's understandable that a woman would use emotion and demegoguery to make her points. That a man would is astonishing. Vis a vis."

I'm sure the complete irony of that statement totally escapes the man who posted it.

The smackdown as a blog carnival

A while back, Paul at Wizbang started posting a bunch of broadsides at "evolutionist oozers" and in general making an utter fool of himself, provoking righteous smackdowns not just from liberal and science bloggers, but from a few of his fellow conservatives. He and his Wizbang buddies later claimed that it was just an April Fool's joke. Maybe it was indeed planned. Even if it was, Paul ended up looking like a scientifically ignorant (and proud of it!) anti-intellectual twit, all the while disingenuously claiming he wasn't a creationist. Well, now the very conservative blogger The Commissar at The Politburo Diktat has resurrected the issue and taken blog thrashing to a whole new level, in essence declaring war on Paul with an opening broadside he calls his Carnival of the Coward, where he has gathered a large number of criticisms of Paul's behavior from a wide variety of bloggers.

I have mixed feelings about this. On the one hand, I do feel a guilty sense of schadenfreude seeing someone of Paul's arrogance get yet another round of what he himself sowed (and given my that my average daily hit count is actually slightly less than Dan Riehl's I can certainly like seeing his broadside against Paul's arrogant dismissal of him because of "pathetic stats" on his blog ). In a similar vein, as a conservative-leaning type, it irritates me to see people like Paul make the rest of us look bad. On the other hand, I'm beginning to think that The Commissar has let this grudge match get out of hand. It's become a bit unseemly, albeit still somewhat entertaining. (Of course, one could claim that I'm only saying that because the most unseemly thing of all is that The Commissar neglected to mention my take and followup on Paul--but that would be wrong. . .)

Personally, I think it's time to let it go, unless Paul resurrects it. I don't think I want to see a Carnival of the Coward #2.

One of our own has died

On the way to work this morning, I heard the sad news that Dr. Jeanne Petrek, a prominent breast cancer surgeon/researcher at Memorial Sloan-Kettering Cancer Center in New York was struck and killed (also here and here) by an ambulette while crossing the street near 2nd Avenue and 64th Street on her way to work.

I never met her, but she was very prominent in the field, particularly in research about quality of life issues related to the therapies used to treat breast cancer. Breast cancer patients will be the worse off for her loss.

Grand Rounds XXIX

It's Tuesday, which means it must be time for Grand Rounds.

Grand Rounds XXIX has been posted by one of my favorite Emergency Medicine bloggers, Gruntdoc. Go forth, and peruse the best offerings of the medical blogosphere this week. (And I'm in there too, but, please, don't let that keep you from checking it out.)

Naturally, being the Emergency Medicine doc that he is, Gruntdoc has featured a post by a nursing student about a rather disgusting incident that happened recently, variations of which have also happened to many of us doctors, including me, at one time or another. (Hey, I thought blogging about feces was something for a surgeon--like me--to do.) It almost inspires me to blog about similar things that have happened to me over the years, but, for the sake of my readers, I think I'll restrain myself--for now.

I thought the Taliban only existed in Afghanistan

I thought the Taliban only existed in Afghanistan, but I was wrong. We apparently have our very own aspiring Taliban wannabes right here in the U.S., even in a state as liberal as Minnesota.

Don't believe me?

Read this disgusting tidbit from a "conservative" blogger calling himself Vox Popoli. Some of the comments are even scarier.

But don't read it unless you have a strong stomach.

(Via Pharyngula.)

60 years ago today: The liberation of Buchenwald

Sixty years ago today, on April 11, 1945, elements of the U.S. Third Army reached Buchenwald. It was two and a half months after the liberation of Auschwitz, and less than three weeks before Berlin would fall to the Russians. What they found when they arrived there were approximately 20,000 remaining prisoners, most of whom were starving, ill, or dying.

And stacks upon stacks of bodies.

As described by some of the liberators, the scenes that greeted the American liberators of Buchenwald and other camps in April were as horrific as the one the Russians encountered when they liberated Auschwitz in January, with skeletal prisoners staring weakly at their liberators, the dying, and stacks of bodies. Dwight Eisenhower wrote in a letter to Chief of Staff George Marshall:

I have never felt able to describe my emotional reaction when I first came face to face with indisputable evidence of Nazi brutality and ruthless disregard of every shred of decency...I visited every nook and cranny of the camp because I felt it my duty to be in a position from then on to testify at first hand about these things in case there ever grew up at home the belief or assumption that the stories of Nazi brutality were just propaganda.

While inspecting Buchenwald and other camps, even hardened warriors like General George S. Patton felt themselves becoming sick to their stomachs. Imagine the soldiers who first found the camp, most of whom were kids between the ages of 18 and 22.

Unlike Treblinka or Sobibor, Buchenwald was not primarily a death camp. It wasn't a combined death camp and concentration camp, like Auschwitz. It was primarily a concentration camp, like Dachau, for political prisoners, who were used for slave labor in nearby armaments factories. But that didn't mean that mass killings didn't happen there. It didn't mean that, in its own way, Buchenwald wasn't a place of unspeakable cruelty.

Nine years before the Third Army entered, the Inspector of Concentration Camps, SS General Eicke, had proposed to transfer the concentration camp of Lichtenburg to Thuringia. The field of Ettersberg was chosen, and on July 16, 1937 three hundred prisoners arrived at the camp (at this time, the camp was called "Konzentrationslager Ettersberg"). The prisoners built the camp up in their "spare time," being forced by the SS to carry huge stones from a nearby quarry, and on August 6, 1937, the name of the camp was officially changed to Buchenwald. The name "Buchenwald" means "beech forest" in German, because of the forest that surrounded the site. It was initially designated as a place to hold political prisoners, particularly those whom the Nazis considered social misfits, Jehovah's Witnesses, those who spoke out against the regime, homosexuals, the homeless, and, of course, Jews. Given the cramped conditions of the camp, the overcrowding, and the inadequate nutrition given the prisoners, many sentenced to Buchenwald would not return. After the invasion of the USSR in 1941, the camp was also used to house Soviet P.O.W.'s. The population of the camp rapidly swelled from around 1,000 prisoners in the fall of 1937 to nearly 40,000 by 1943 and 80,000 in early 1945, with an estimated 250,000 prisoners passing through the camp during its existence, one-fifth of whom died, either through execution, overwork, starvation, or epidemic disease. Indeed, the SS even built a special chair to place Soviet prisoners in a position that made it easier to shoot them in the back of the head. Many of the surviving prisoners remaining in March 1945 were evacuated east as part of a series of "death marches" that the SS undertook as the Allieds advanced into Germany. Buchenwald was one of the places where the Nazi philosphy of destroying its enemies through overwork in service of the war machine was implemented." All the while, life was not unpleasant for the SS running the camp, who enjoyed a zoo, a riding hall and a brothel.

Although Josef Mengele at Auschwitz is the best-known Nazi who did horrific experiments on humans, many such experiments were also performed at Buchenwald. The most notorious of these included large-scale testing of vaccines for typhus. The prisoners were first injected with the vaccine and then injected with live typhus, with large numbers of fatalities. Similar experiments were carried out with spotted fever, as well as to serve as a source for the virus. Prisoners were also injected with phenol in order to kill them, first intravenously but then later by direct intracardiac injection. Last of the more famous atrocities was the testing of various compounds to treat phosphorus burns after inflicting painful and disfiguring phosphorus burns on hapless prisoners.

But perhaps what Buchenwald is most remembered for is one person: Ilse Koch. She was the wife of Karl Koch, the first Commandant of Buchenwald. Dubbed the either the "Witch of Buchenwald" or the "Bitch of Buchenwald" by the prisoners for her sadism, she and her female overseers were responsible for a reign of terror over the prisoners. In 1943, her husband was arrested for embezzlement and removed from the camp, but, after a trial for embezzlement during which she was acquitted, Ilse remained at Buchenwald, where she continued to terrorize female and male prisoners. Perhaps what produced the most infamy was her predilection for taking souvenirs from the skin of murdered inmates with distinctive tattoos. She is one source of the famous but disputed claim that she made lampshades from this human skin. There is no doubt, however, that she collected pieces of human skin with distinctive tattooes and that her family dinner table was decorated with shrunken human heads (also here) of murdered inmates. Although cruel and murderous, Ilse could appear to be mild-mannered when she wished to be. When U. S. soldiers went to arrest her, they were surprised that she didn't appear to be the sadistic monster described. Ilse was tried and sentenced to a life term in 1947, which was commuted to four years because of doubts about some of the testimony against her, but was re-tried by a German court for killing German nationals, and sentenced to a life term. Since then, besides being the very vision of the sadistic female prison matron and proving that women are just as capable of cruelty and murder as men, she has also unfortunately served as the inspiration for disgustingly bad campy movies, like Ilsa, She-Wolf of the SS.

Although less famous than Auschwitz or Treblinka, Buchenwald was every bit as much a cog in the machinery of the Holocaust as any Nazi camp. Thousands of Jews and political prisoners perished there, and hundreds of thousands were imprisoned under horrific conditions. It is therefore appropriate that the anniversary of its liberation be commemorated.

Other links:

Frau Ilse Koch, General Lucius Clay, and human-skin atrocities
Harry J. Herder, Jr.'s firsthand account of the liberation of Buchenwald
Orr Iverson's firsthand account of the liberation of Buchenwald
Informational site on the Buchenwald Concentration Camp
Buchenwald from The Forgotten Camps
Wikipedia entry on Buchenwald

Go get 'em, Peter!

Peter Bowditch is not happy about the claims of a certain woman who believes in homeopathy and is opposed to vaccination, and he tells her so in an open letter, written in his usual inimitable fashion.

From my perspective, in order to lend some tactical air support to criticisms of anti-vaccination fanatics, I suggest that people peddling exaggerated and erroneous anti-vaccination rhetoric read this recent article. It's about the last generation that ever had to worry about polio and some of its now aging polio survivors. Thank heaven, the development of the polio vaccine has essentially eradicated the disease from this country; unfortunately, the very success of the vaccine in eradicating this formerly dreaded disease is the very thing that allows anti-vaccination advocates to seem reasonable to the uninformed.

One reason I miss Chicago

I don't know if I've ever mentioned it here before, but I used to live in Chicago.

I love that city. In fact, it was my favorite place that I've ever lived. When work brought me east six years ago, it was really hard to leave Chicago, even though I had lived there only three years. I had developed an affinity for the city and our neighborhood in Lincoln Park near DePaul University, as well as our frequent haunts in Wicker Park, Bucktown, and downtown. I loved going to a Cubs game on a summer afternoon. It's arguably the purest baseball experience there is anywhere, sitting back, drinking an overpriced beer, and watching a game on a sunny summer afternoon. I loved the lakefront, and, well, just the entire vibe of the city. (OK, the winters were rough, but I could deal with them; and navigating the Kennedy Expressway at rush hour is one of the most frustrating driving experiences anywhere, period, but I put up with it.) In any case, Chicago is different than the big cities on the East Coast (it's a lot friendlier, for one thing); maybe it is just my Midwestern upbringing that made Chicago such a good fit for me compared to cities like New York, Philadelphia, Baltimore, or Washington. Fortunately, I still have family there to bring me back. Also, there are fairly frequent medical and surgical meetings there that I like to attend, and I rarely miss a chance to go back, if even for a couple of days. Even so, I don't get back to Chicago nearly as often as I would like.

Yesterday, my sister, who lives near a church in a heavily Polish neighborhood in Chicago, told me that she was working at home one day last week, when she was startled by the roar of many motorcycles. She looked out the window, and what did she see? A large contingent from a Polish biker club arriving at the nearby Catholic church to pay their last respects to Pope John Paul II. How cool is that? Fortunately, she had her digital camera and knew how to use it. I can't think of any place else in the country, if not the world, where you would be likely to see something like this. From the pictures, it appears to be the Legacy Polish Motorcycle Club.

This is what it looked like:

The bikers gather. Note the statue of Pope John Paul II in front of the church on the left.

More bikers. Note the many Polish flags and flags with the Polish national emblem (the Polish Eagle)

The motorcyles are taking up the entire block!

Another view.

A prominent Polish flag with the added Polish Eagle on the motorcycle, of course!

Police directing traffic. Again, note the prominent statue of John Paul II.

The last view

Damn, I'm missing Chicago right now. No, not because I'd like to have a couple hundred Polish bikers firing up their motorcycles outside my window on their way to pay their last respects to the late Pope, but rather because Chicago is the sort of place where a couple hundred Polish bikers would gather at a church to pay their respects to the late Pope. If you don't understand what I'm talking about, I don't know if I can explain it any better than that. The suburbs where I live now are just plain boring in comparison.

By the way, if you're ever in Chicago, be sure to check out my favorite neighborhood Italian restaurant, Club Lucky. It's in Bucktown, away from the tourist traps, and serves up some great Italian food.

Thanks to my sister for the pictures...

New blogs

Thanks to the Hospice Blog, I was pointed to an interesting medblog called Joe Oncology. The post of his that caught my attention is about radiation overdoses at a very prestigious Florida cancer center. I'm adding it to my sidebar.

Also, my favorite blogging oncologist of all, Dr. Hildreth (a.k.a. The Cheerful Oncologist) has announced the new URL for his blog. Update your bookmarks accordingly.

Curse you, Blogger! Part III

A while back, when Blogger was really acting up and annoying me, I posted a couple of rants that I called "Curse You, Blogger!" parts one and two. At the time, I had lost a big chunk of a fairly sizeable post I had been working on and needed to vent. Trying to get Blogger to let me have access to my list of posts and pending posts was an exercise in futility, as Blogger would chug away for minutes. . . then many minutes. . .and then even an hour or more before finally coming up with a "Page has no data" message. It was frustrating as hell. Since then, Blogger has improved its service to the level of tolerable. Although it's never been spritely, it's at least letting me on the system in a (somewhat) reasonable amount of time. Also, I haven't lost a post since then, and only a couple of times in the last three or four weeks have I had to give up trying to post with Blogger due to prolonged waiting times for loggin in, looking up my list of pending posts, saving drafts, or to publishing. One caveat is that I have a day job and, with the exception of vacations, usually don't blog during work days; so I had no idea what Blogger was like at what are presumably peak times.

While I've been toying with the idea of switching, either by picking another free service or paying for a blogging service (TypePad being the main service I'm considering in order to be rid of Blogger), it appears that more and more people are recognizing the deficiencies of Blogger. One of my favorite medical bloggers, whose wonderful essays helped to inspire me after I first dipped my toes in the blogging pool (and upon some of whose posts I tried to pattern a couple of my early efforts), The Cheerful Oncologist, has announced that he will soon be moving his blog to Live Journal. And now, I've come across an article on Wired! that discusses the recent problems with Blogger. Most of what's in that article is right on, and it made me think again about whether I've outgrown Blogger. Others gave me some suggestions the last time I wrote about this, and I'm still considering them, too.

In a way, I'm a bit torn about his. After all, Blogger is a free service. Consequently, if it has problems, I have a hard time complaining too much about the service because I'm not paying a penny to use it that I wouldn't be paying anyway for broadband Internet access. (What do I expect for free, anyway?) I also don't have to worry about bandwidth at all (not that I get enough traffic yet for it to be much of an issue, even if I were to pay for my blog), whereas with paid services I might. And some pretty high-traffic blogs still use Blogger, like Hullabaloo, Chrenkoff, Orcinus, Skippy the Bush Kangaroo, The Decembrist, and others. Also, this is just a hobby. Why pay for it if I don't have to? Still, I wonder if, after nearly four months and over 30,000 hits, it's time to remove the training wheels. The number of posts I've made has now grown large enough that it would be very helpful to be able to break them down by category in the archives at the very least, rather than the present scattershot "Essential Orac" list that I have to update manually on my sidebar every time I post what I consider to be a particularly fine pearl of blogging goodness. Another huge frustration for Mac users using blogger is the clunky way of posting pictures that is forced on us. My main concern about switching now, however, is that my hit count has been steadily rising over the last four months and it worries me that having to change URLs might cause a temporary hit in the growth of my blog. I wonder if the benefits are worth the temporary hit in the growth of my blog that would be likely from a switch. On the other hand, the longer I delay, the more difficult the change may be. My other concern is that I'd like a service that would allow me to transfer all my posts to the new address. I could use this address as an archive site, as some have done when they switched, but it would be nicer and cleaner just to move everything over to the new site.

I started this weblog on a whim one cold, dreary Saturday afternoon in December when I was rather depressed, and it turned into quite a fun hobby. It's also an outlet for my latent creativity, which is necessarily suppressed in the copious highly technical writing I do for grant applications and journal articles. At the time I began, I had very modest expectations, but Respectful Insolence has turned out to be more widely read than I thought it would be at this point, and the readership seems to be still growing. I attribute my initial rapid increase in readership to my regular participation in blog carnivals, such as Grand Rounds, Tangled Bank, as well as the Skeptics' Circle, my hosting those carnivals, plus my filling of a niche in the blogosphere that (as far as I can tell) no one else had filled before or has filled yet. I've learned a lot along the way, and (I daresay) have developed into a more than competent blogger. However, even after passing the 30,000 hit mark, I'm not under any illusion at all that I'm anything other than strictly small fry in the blogosphere, or even in the specialty niches of the medical or scientific blogosphere. This remains for me a fun diversion. If the readership continues to grow, great. If not, it would be disappointing, but I'd still forge on. Sooner or later, readership will have to level off, and I'm curious to see at what level it finally does.

On a final note, regardless of what I decide as far as keeping or dumping Blogger, over the last week or so I've been doing some serious thinking about implementing a few changes in Respectful Insolence. First, I am always looking for ways to improve. Second, unfortunately, I have to react to a recent incident involving harassment by a (now formerly) anonymous nutcase. (Please note that I'm remaining intentionally vague for the simple reason that I doubt whether the enormous satisfaction that administering to this idiot the righteous verbal smackdown that he so richly deserves would bring to me is worth the additional annoyance he might cause, no matter how tempting it is to reveal everything right now in detail, particularly his identity.) Suffice it to say that my employers now know my weblog exists. That in and of itself is not too big a deal, as I expected all along that my colleagues would probably find out about my hobby sooner or later anyway. (I was also pleasantly surprised at how they reacted as well, particularly my Department Chair and Division Chief, who were supportive. My initial trepidation appears to have been for naught.) I had just hoped that its existence could have been revealed in a less jarring manner. In any case, the changes that I'm contemplating probably won't be radical, but they might end up being significant. Right off the bat, I have to tell my readers that one of these changes might be to ban anonymous comments. I really hate to take this step, given my long pre-blog history on Usenet and the fact that I myself have chosen to blog semi-anonymously under a pseudonym. Indeed, some of the best comments to this weblog are posted by readers who comment anonymously, and I fully understand why one might not want to leave his or her e-mail address, identity, or even pseudonym. Still, I might ultimately end up having to take this step. On the other hand, a better blogging service might allow me more nuanced methods to deal with this problem than having to resort to a "nuclear" option.

Don't worry, though, about the future of this weblog. I still haven't worked through my backlog of topics, and right now I seem to be adding to the topics to the list at almost the same rate that I'm knocking them off. For the immediately foreseeable future at least, blogging about the odd combination of medicine, science, skepticism, and history (all tinged with Orac's twisted sense of humor), will continue. The core will remain more or less the same as it has been since the beginning. However, as it must, this weblog will continue to evolve and (hopefully) improve.

And, of course, any advice is appreciated regarding ways to improve this weblog.

Farewell, John Paul II

Pope John Paul II's funeral was still going on as I got up this morning to get ready for work. Even though I'm not the Catholic I once was many years ago, his death still saddens me, although in some ways it was a relief, given how frail and ill he had become after having been so athletic and energetic, planting the seeds for the Solidarity movement in his native Poland, hastening the fall of the Soviet Union, and traveling the world. He was elevated to Pope when I was in high school, and I can still remember the surprise that accompanied the election of the first Polish Pope and the first non-Italian Pope in 400 years, a source of great pride among Polish-Americans like myself. For many Catholics, he is the only Pope they have ever known. Although he was conservative on many issues, he was not always loved by political conservatives. They liked his staunch opposition to abortion, but his opposition to war and the death penalty rankled. The scientist in me also can't help but point out that John Paul also stated around 10 years ago that evolution was not incompatible with Christian doctrine. A nice summary of the paradox of John Paul's reign is here. He will be a hard act to follow.

Farewell, John Paul II. You will be missed.

Interesting conference

I had forwarded to me a description of a conference that might be quite interesting to me and to anyone interested in a critical evaluation of the claims of alternative medicine, Curing the Ills of Alternative Medicine and Questionable Mental Health Practices on May 21 in Amherst, New York. Although unfortunately I can't attend (too far away and other obligations), anyone who has an interest in the scientific and critical evaluation of alternative medicine practices who lives within striking distance of Buffalo should consider attending, particularly if this introduction gets your attention:

It’s taken centuries and the work of countless doctors and researchers to move clinical practice onto sound scientific foundations. Countless millions alive today owe their lives and health to science-based therapies. Yet, there is a growing effort now underway to tear those foundations down. That effort is richly supported by the nutritional supplement and alternative medicine industries. These industries have been aggressively challenging the need for rigorous standards for medical and mental healthcare research and healthcare products, practices, and education. This assault on medical science poses a public danger that goes beyond the marketing of unproven and potentially harmful products and techniques.

The conference, sponsored by the Commission for Scientific Medicine and Mental Health (CSMMH), will investigate what’s driving the assault on science-based medicine and mental healthcare and will explore what can be done to stop the erosion of healthcare standards.

While pharmaceutical and medical device manufacturers are required to establish the safety and efficacy of their products in well-controlled clinical trials, alternative medicine companies have been exempted from such requirements. As a result, the public is being increasingly exposed to products that are hyped with unproven and even fraudulent claims. Studies have shown that many of these products don’t have the ingredients as described in their labeling. Much worse, some are laced with dangerous prescription drugs or are adulterated with lead, mercury, or other toxic substances. In the realm of psychotherapy, there has been precious little interest in scientific quality control. Many clients are still being urged to “recover” purported memories of early abuse, and children are being seriously abused and even killed by “therapists” who are using pseudoscientific practices to “treat” behavioral problems.

Aftermath

There will be minimal or no blogging today. At the moment I'm too busy, and putting together Tangled Bank took up too much time.

However, I did come across a post on a blog called Kung Fu Monkey that interested me. It's a few months old, but it caught my attention because it almost perfectly encapsulates why I became disillusioned with the Republican Party. He exaggerates a bit (remember, it was Kennedy who made the push to go to the moon), but I think his basic points are pretty sound. Selected excerpt:

Remember Republicans? Sober men in suits, pipes, who'd nod thoughtfully over their latest tract on market-driven fiscal conservatism while grinding out the numbers on rocket science. Remember those serious-looking 1950's-1960's science guys in the movies -- Republican to a one. . . How did they become the party of fairy dust and make believe? How did they become the anti-science guys? The anti-fact guys? The anti-logic guys?

Discuss while I recover from yesterday.

The Tangled Bank XXV: Dear Journal Editor, It's Me Again

In the relatively brief time I’ve had a weblog (around a week shy of four months now), I’ve managed to acquire a reputation for using creative (some might say bizarre) formats for arranging blog carnivals, based on the two previous carnivals I've hosted. Given my love of science, I could hardly wait for my opportunity to host Tangled Bank back in January, when I first discovered it and immediately volunteered to do it.

But what format?

I didn’t want to repeat myself. So a raucous meeting of scientists or a TV Guide of geeky scientific programming was definitely out of the question. I didn’t want to repeat anyone else either if I could avoid it; consequently, I couldn’t do a menu or a tabloid. Given the diversity of the submissions (plus a couple of articles that I appropriated using the host's perogative), certain ideas I had thought of going into this just wouldn’t work. Frankly, I was stymied. Even a call to the Cranky Badger for some comic advice on whether my ideas were hack didn’t help.

Then it hit me.

Tangled Bank is about science. So what do scientists do? Well, they do research and experiments. But what do they do after they do their research? They submit articles reporting the results of their research to scientific journals, of course, hoping to get published in a high visibility journal. It's publish or perish! And, sadly, their articles get rejected. A lot. All too often with nasty comments from the reviewers. I had my organizing principle!

With that inspiration, I knew what I had to pattern this week's Tangled Bank after: Roy F. Baumeister’s famous comic diatribe against an intransigent journal editor and the journal’s bloodthirsty reviewers. I hereby present to you, blatantly (but lovingly) stolen and altered at will to my own nefarious ends:

Tangled Bank XXV: Dear Journal Editor, It’s Me Again

Dear Sir, Madame, or Other:

Enclosed is our latest version of MS# 85-02-02-22-RRRRR, that is, the re-re-re-revised revision of our paper (oh, hell, I've lost track of the number of times we've revised and resubmitted our paper!), entitled The role of homeobox genes in dinosaurian angiogenesis as new paradigm for evolution and the antiangiogenic therapy of dinosaurian cancer.

Choke on it.

We have again rewritten the entire manuscript from start to finish. We even changed the goddamned running head! Hopefully we have suffered enough by now to satisfy even you and your bloodthirsty reviewers. Besides the fact that we included five new figures of brand new data (with six panels each, yet), we still cannot believe that you were unable to see the merit of our work, especially given the recently published the description of the ways different tissue-specific promoters driving the homeobox gene Pitx1 can drive evolution in fish by Science Boy et al; the description of preserved dinosaur blood vessels by Myers et al, which proves once and for all the feasibility of dinosaurian antiangiogenic therapy; the report on the roles of transcription factors Zic2 and islet-2 in the control and evolution of binocular vision by gaw3 et al; the recent discussion of positive and negative evolution by Jeff et al; and a proposed rebuttal of the recent report of the genome-wide non-Mendelian inheritance of extra-genomic information in Arabidopsis by Cartwright et al. (Fortunately, these researchers didn’t write off their results as an error or anomaly, as your reviewers seem to be trying to do with our results.) All of these, plus our additional data, solidify support for our hypothesis about the role of homeobox genes and dinosaurian angiogenesis in evolution and the prospects for developing an effective dinosaurian antiangiogenic therapy. We even took the advice of one of your senior editors, Girlscientist, who told us how to format our submission for your journal. Not that it helped any. One of your earlier reviewers even went so far as to take a great deal of issue with our proposed new meme, indeed even the whole concept of a meme. (I suspect you've switched reviewers since three versions ago, as he was actually one of the more reasonable of the twenty or so reviewers we've had during the multiple resubmissions you've forced upon us.)

I shall skip the usual detailed point-by-point description of every single change we made in response to the critiques. Analyzing and re-analyzing the data in response to your reviewers’ ignorant comments, rewriting the entire manuscript from scratch, and then justifying our changes (most of which we consider unnecessary and ill-advised in the first place) yet again to you gives me a brainache, not unlike the one described by Young Female Scientist. After all, it is fairly clear that your reviewers are less interested in details of scientific procedure than in working out their personality problems and sexual frustrations by seeking some kind of demented glee in the sadistic and arbitrary exercise of tyrannical power over hapless authors like ourselves who happen to fall into their clutches. Either that, or they are like demented old patients that harass hospital staff, as described by my colleague Madhouse Madman. Or perhaps they have been infected with the Borna Disease Virus, exacerbating their depression or bipolar mood disorder, leading them to take it out on hapless authors (or not, given that the authors report that there may be no connnection). We do understand that, in view of the misanthropic psychopaths you have on your editorial board, you need to keep sending them papers, for if they weren't reviewing manuscripts they'd probably be out mugging old ladies or clubbing baby seals to death. They probably even rejoice over the death toll in Angola due to Ebola, as described by Wilson et al or enjoy watching the indiscriminate slaughter of wild birds in Asia in a misguided attempt to contain the Avian flu. (OK, clearly Girlscientist wouldn’t enjoy that, as she wrote about it, nor would another of the editors listed on your masthead--Mike--enjoy it, given his journeys to see 10,000 species of bird—but the rest of your sadistic editors and reviewers would!)

Still, from this batch of reviewers, C was clearly the most hostile, and we request that you do not ask him or her to review this revision. Indeed, we have mailed letter bombs to four or five people we suspected of being reviewer C, so if you send the manuscript back to them the review process could be unduly delayed. In any case, we refuse any longer to kowtow to your tyrannical reviewers in the manner that medical students try to write what they think prospective residency directors want to hear. We fart in your general direction. Your mother was a hamster, and your father smelt of elderberry.

Some of the reviewers' comments we couldn't do anything about. For example, if (as reviewer C suggested) several of my recent ancestors were indeed drawn from other species, it is too late to change that. It is indeed fortunate that, as my colleague St. Nate has told me, paleontologists are not as close-minded and hidebound as Reviewer C; if they were, we would never have changed our perception of dinosaurs or even found the soft tissue reported by Myers et al. (If Reviewer C were the only source of knowledge we had on dinosaurs, we would still believe they were all large, cold-blooded thundering lizards with brains the size of a walnut.) Given Reviewer C's pathetic understanding of angiogenesis and evolution, I'm thinking of sending him/her Myers' comprehensive list of books on biology and evolution.) Leaving that aside, however, other suggestions were implemented, and the paper has improved and benefited. Thus, you suggested that we shorten the manuscript by 5 pages, and we were able to accomplish this very effectively by altering the margins and printing the paper in a different font with a smaller typeface. We agree with you that the paper is much better this way.

One perplexing problem was dealing with suggestions # 13-28 by Reviewer B. Maybe you were too busy cavorting with models, or maybe you don’t even bother reading the reviews before doing your decision letter, but that reviewer listed 16 works that he/she felt we should cite in this paper. Two were by the same author, about the quietest room in the world and how you some have used the room to make music based on the sounds of the human body. These articles were indeed very fascinating reading, but we fail to see what they have to do with evolution, dinosaurian angiogenesis, or homeobox genes. There were also fascinating articles on marsupial wolves and Emperor Penguins by Bums et al; on defoliation in Massachusetts by the invasive European winter moth (Operophtera brumata) by Orth et al; on gastropod blogging by Wolverine Tom et al; a discussion of artificial biodiversity by RoguePundit et al; the crystal structure of birnavirus by Syaffolee et al; a heavy-duty (and I mean heavy-duty) serious discussion of invasions and exotics and natives by Clarke et al, none of which had anything to do with homeobox genes or dinosaurian angiogenesis. The reviewer even suggested citing an article on making methane from nonorganic sources and fuel from organic waste, by Dresner et al and about a trip to the National Museum of American Indians by Insert Name Here et al, for crying out loud! They're enjoyable and informative reads, but they have nothing to do with dinosaurian angiogenesis or evolution. We could not find a common thread between these articles at first, but apparently Reviewer B greatly admires these authors and wants to promote their career and the number of times their papers are cited in the literature. Then a colleague pointed out that all of these investigators trained in the lab of a certain scientist. I suppose it is an admirable trait (certainly more admirable--and less obvious--than demonstrated during the last review cycle, when Reviewer B cited 16 articles, all by the same author, presumably someone whom Reviewer B greatly admires and feels should be more widely cited; at least this time he/she restrained him/herself and limited the suggestions to only 10 articles). To handle this, once again we have modified the Introduction and added, after the review of relevant literature, a subsection entitled "Review of Irrelevant Literature" that discusses these articles and also duly addresses some of the more asinine suggestions in the other reviews.

We hope that you will be pleased with this revision and will finally recognize how urgently deserving of publication this work is. If not, then you are an unscrupulous, depraved monster with no shred of human decency and you clearly meet the litmus tests to be considered a pseudoscientific hack. You ought to be in a cage. May whatever heritage you come from be the butt of the next round of ethnic jokes. If you do accept it, however, we wish to thank you for your patience and wisdom throughout this process and to express our appreciation of your scholarly insights. We expect that, like any good biologist, you ought to be able to do many things well, and your acceptance of our paper will prove prove that you might actually be a good biologist. To repay you, we would be happy to review some manuscripts for you; please send us the next manuscript that any of these reviewers submits to your journal.

Assuming you accept this paper, we would also like to add a footnote acknowledging your help with this manuscript and to point out that we liked the paper much better the way we originally wrote it, but you held the editorial shotgun to our heads and forced us chop, reshuffle, restate, hedge expand, shorten, and in general covert a meaty paper into stir-fried vegetables. We couldn't or wouldn't have done it without your input.


Sincerely,


Orac

Well, that's it. I had a great time hosting, and I hope you liked the results. For anyone whose entry was presented in a way they might not have expected (or might not approve of), just remember that I meant it all in good fun. I am grateful to everyone who took the time to contribute and help make this session of Tangled Bank (I hope) a success (and to the two or three bloggers whose works I decided to appropriate even though they weren't submitted). I also abjectly apologize in advance if I forgot or missed anyone's post. Let me know and I will amend the text to include it. Either that, or send it to the next host.

The next Tangled Bank will appear two weeks from now by Bora at Circadiana. So, start getting your posts ready and show Bora the same love you've all shown me. Also, the godfather of Tangled Bank, PZ Myers, tells me that he's looking for more bloggers to host. So, if you have an interest in science and want to host, let him know.

In fact, it was so much fun to be your host that I may even volunteer to do it again myself--but probably not for several months. Doing three blog carnivals in less than three months turned out (almost) to be biting off more than I could chew in my very limited spare time. Chalk it up to the excessive enthusiasm of a new blogger.

Grand Rounds XXVIII

Grand Rounds XXVIII is now posted at Polite Dissent. Once again, the best of the medical blogosphere is gathered into one nice package. Remember, what would (Dr.) Doom do?

He'd check out Grand Rounds, that's what, even though he might not really be a doctor.

Of course, I always wanted to be Reed Richards.

Last call for Tangled Bank!

This is the last call for submissions to Tangled Bank, the biweekly opportunity for science bloggers to showcase their best. I like what I've received so far, but there's always room for some more good science blogging. I'm guessing that most science bloggers out there tend to be procrastinators like me and wait until a day or two before Tangled Bank to submit their work. (Yes, I admit that I have been guilty of this myself not infrequently, as some past hosts know.)

Well, time's really running out now, with less than a day to go until the deadline. So, please, no more procrastinating. Lay those submissions on me today. Or, if you like, you can send submissions to host@tangledbank.net or PZ. The deadline will be 9 PM EDST tonight. (I don't want to be up too late getting the carnival all ready to post before I leave for work tomorrow morning.) Late submissions (if there are any) might be incorporated at the discretion of the host (me), but only if I haven't finished putting the carnival together yet when I receive them and can find a way to work them in. More likely they will be forwarded to the next host.

Kentucky zombie update number two

While I was enjoying my parents' visit last week--and more or less neglecting the Internet and my blog, other than taking a few minutes a day to post stuff I had written before for just such an occasion, brief link and comment posts, my monthly EneMan pictures (again, prepared the weekend before), and plugs for two of my three favorite blog carnivals (the Fifth Skeptics' Circle and Grand Rounds XXVII)--it appears I missed an update to the William Poole case in Kentucky (a.k.a. the "Kentucky zombie" story), which I had commented on before here and here. I guess that's what I get for being mostly unplugged from the blogosphere for a few days. Fortunately, Zero Intelligence and James Bow (and here) both picked up the slack for me. Nonetheless, being the pontificator I am (otherwise why would I enjoy blogging so much?), I still can't resist sneaking in one more post of my own about this issue before my turn at hosting the Tangled Bank two days from now. I guess the question is, now that this update is nearly a week old, is there anything that your humble blogger Orac can add to the issue?

Of course there is! There always is. Of course, no one may care, but since when did that ever stop me (or any other blogger) from commenting on an issue before? Although I did blame myself for an initical lack of skepticism, I found the whole affair disturbing because the story was so easy to believe. If there weren’t such a post-Columbine paranoid climate of fear and “zero tolerance” in our schools, I thought that my B.S. detector would almost certainly have immediately told me not to take this story at face value. Certainly, when I first commented on this case and then revisited it, I never expected the level of attention my posts managed to engender. This may have been one of the first times my blog ever produced a reaction outside of the medical or scientific blogosphere and I got all sorts of comments, some claiming to be from people in Winchester County who also claimed to have first hand knowledge of the case. Given that they chose to remain anonymous and never even gave me an e-mail address that I could try to verify their stories with, I chose to take what they posted with a big grain of salt. The whole thing ended up taking on a bit of a surreal air.

In any case, before I go on, a brief recap is in order, for those who don't want to click on all the links above. In late February, a young man from Kentucky named William Poole was arrested for making “terroristic threats,” based on his writings. Poole initially claimed that his arrest was because of a story he had written about zombies taking over a school. This story got wide play in the blogosphere, but a little more digging showed that it was more complex than I had first realized. In essence, the story that had gotten Poole into hot water was about a group of "soldiers" (called in the story "True Soldiers" or "No Limit Soldiers") who planned a violent takeover of a school. The most disturbing part of the story was read in court:

They stood at the yard carrying bags full of weapons and tools. They yelled kill them. All of soldiers of zone two started shooting. They are dropping every one of them. After five minutes all the people were laying on the ground dead.

On the basis of this story and some vague claims that Poole had actually contacted other students to ask them to join this "Brotherhood of NLS Soldiers," police arrested him and charged him with "terroristic threatening."

Now, it appears that, after having had his bond apparently paid by a donor with an interest in civil rights, Poole has been arrested again. This time it appears to be a result of his own poor judgment, which he originally showed in abundance by making the fanciful claim that the stories that got him into trouble were about a zombie attack on a school. He had been ordered as a condition of his parole not to go near any county schools but apparently went with a friend to an elementary school, where his friend needed to pick up his sister. He has been sentenced to six months in jail for violating a judge's order.

Like Mr. Bow, I do not consider the people of Kentucky to be a bunch of rednecks or ignorant. Certainly, since my first post, damaging additional information came out that hurt Poole's case and made me wonder whether my position was the correct one after all. If other evidence comes out to show that Poole was actually acting on a plan to attack the school, I'd be all for throwing away the key. However, I do think the people of Kentucky and Winchester County have been badly served by how their lawmakers have written and now police and prosecutors are interpreting their terroristic threatening law. In the post-Columbine and post-9/11 world, it is hard to blame them too much for believing that they needed vague new laws to protect their children while in school. But leave aside Poole's apparent inability to comprehend or obey a simple judicial order for a moment. I still think this case raises serious civil liberties problems and anxiously await the trial, where, hopefully everything the police has will become known. What people often forget when laws like Kentucky's terroristic threatening law (or the Federal government's Patriot Act) are passed is that creative police and prosecutors will almost always test their limits and see how far they can go in using the law. Even now, we see the Patriot Act being used to prosecute non-terrorism crimes.

The key problem is that, even if everything the police have said about Poole's writings are true, in the absence of other evidence showing that Poole was actually acting on a conspiracy to attack the school (by, for instance, recruiting students), it is hard for me to support their response to Poole's poorly written violent story. No police or prosecutor that I have yet been able to find has stated that the writings were anything other than a story. Until his recent re-arrest, the sole offense Poole has been charged with so far, as far as I can tell, is "terroristic threatening" and then only on the basis of what is, from the few exerpts I have seen, obviously a poorly written story. In essence, he was arrested for what appears to be a work of fiction. Consequently, I stand by my opinion that the Kentucky law on "terroristic threatening" is disturbingly vague in what it proscribes. It in effect criminalizes speech that is not clearly connected with specific planned incidents of violence and seems to give schools a special privilege with respect to such speech. I can see all sorts of potential for mischief from a law like this and have a very hard time supporting throwing Poole behind bars--even if his writings contain exactly what you claim they contain. Even in that case, I rather suspect that Poole is more in need of psychological care rather than imprisonment.

Once again, I will try to keep an eye on this case, as I fear it is yet another indication that we are trying to trade essential liberties for a little temporary safety, as Ben Franklin put it. As he also reminded us, that doesn't work. I don't know when the trial is scheduled yet, but I'll try to find out, so that I can find out what happens. My one fear is that there will be a plea bargain that allows the court to seal the actual story, so that we can never see it and never judge for ourselves if the police overreacted.

A sad day

Pope John Paul II has died. I was afraid his recent bout with the flu several weeks ago that necessitated a tracheostomy was the start of a downward spiral, and, unfortunately, it was. As a Polish-American and a Catholic, I always admired him, although his rigid conservatism when it came to doctrine were frustrating. He will be a very hard act to follow.

Interesting site for skeptics

This new web-based discussion forum for Skeptics looks potentially interesting. It's run by The Skeptics' Society. I'm adding it to my sidebar. I hope other hosts of the Skeptics' Circle and past contributors will do the same.

It also may be another good place to let people know about the Skeptics' Circle when it comes out every other week.

Yikes! And I thought some of Shatner's singing was bad...

Leonard Nimoy actually did him one better by making a video!

Even as a rabid Lord of the Rings fan, I can't countenance this.

The Traveling Story

Check this out, from The Examining Room of Dr. Charles:

I’d like to introduce a fabulous story, written by seven authors. About a month ago I had an idea – how fun would it be to start a fictional story, then send it out to a chain of waiting writers to add their own creative spins to it! I asked seven medical bloggers who frequently write some imaginative posts to build the first “traveling story” with me. I believe it may be the first of its kind on the internet. I hope you all enjoy!

Never mind that I had a hand in this craziness...

Sorry, Dr. Charles, for not linking yesterday. Parents in town and all that....

Your monthly dose of EneMan...on April Fool's Day

Once again, it's time for me to indulge my strange obsession with EneMan. I don't know how it started, but I can say when it started. Way back near the very beginning of Respectful Insolence, I posted about strange things doctors get from pharmaceutical companies. Featured prominently was EneMan, the Fleet Pharmaceutical Company mascot who's supposed to somehow promote colon health. Little did I know then that it would be the start of a regular feature on this blog. Since then, on the first of every month, I've been posting pictures from the EneMan calendar (and here). It's a strange obsession, and I shudder to think what it says about me. But I find EneMan very amusing, and these calendars particularly so (although I do feel sorry for the unfortunate people who have to dress up in the EneMan costumes at surgical meetings, such as the American College of Surgeons Meeting in 2003). And April 1 is so perfect, given that it's April Fool's Day. It's doubly perfect since my parents are in town and I don't have time for lots of blogging. On the other hand, I'm always a little hesitant when there's a blog carnival I've contributed to (such as the Skeptics' Circle yesterday), because I'm afraid that the first thing some brand new visitors to the site may encounter is EneMan. Oh, well. For better or for worse, this little bit of weirdness is part of the package that is Respectful Insolence. Try not to judge the entire blog by it.

This month, we have a special treat, because, via my parents, my sister loaned me back the EneMan calendar from 2004 for me to scan pictures from. (My own copy is lost; I don't know what happened to it.) What that means is that I have not one, not two, but three years of calendars to post the April picture from. So, if you are one who is annoyed with Orac's weird sense of humor on this matter, ignore this post. However, if you, as I, find EneMan oddly hilarious, check it out. You know you want to. It's like a train wreck...

April 2005

April 2004

April 2002

There. That should do it for another month. Don't worry. I won't forget next month.

No matter how much my readers might wish that I would...