Podcast #3

The latest edition is up at iTunes and Feedburner. Once again, I’ve failed to deliver the product I intended due to some difficult circumstances, but I promise some kind guests and some controversial guests in the future.

I’m proud of ScienceBlogs

You know, we catch a lot of flack around these parts for being too “political”, and for straying away from “science”. Well, that’s a big load of crap, and two posts by Isis show why. It is impossible to separate politics from science from personal life, at least on one level. Now, perhaps I’ve become more conservative with age (although I doubt it), but certain parts of the discussion really disturbed me.

The rhetoric turned to some classical 70s-80s feminist themes, which can be rather useful, but as with most ideologies, trying to hard to cram all the facts into the theoretical framework leaves neither undamaged. Of course, I’m writing as a male who has experienced many of the benefits of the so-called patriarchy, but folks, it just ain’t that simple.

We all need to keep utopian ideas in mind. It give us hope, something to strive for. But in our real world, there will be no revolution, no turning-on-its-head of our society and its norms—and that’s a good thing, as dramatic revolutions never seem to work out quite the way they are intended. Change—change that is acceptable to individuals, and not forced upon them in re-education camps—comes incrementally.

Let me tell you the first thing that made me nauseated (from Isis):

[A prominent scientist] was visiting the MRU I was attending to give a seminar and I heard it casually mentioned that she had four children. After her talk I had the opportunity to attend a group lunch with her and during a lull in the conversation I asked how she managed to raise four children while managing a large lab and holding down a slew of research funding. She told me quite abruptly that her children and her work were separate entities. She keeps no pictures of her children in her office and does not display their artwork. She told me that she does not want people to walk into her office and immediately identify her by her family instead of her science.


A few years later I met a very prominent female physiologist at a seminar, except this time I was about 12 weeks pregnant. Again, it was mentioned that she had children and during a group meal I brought up the issue of raising children as a scientist. She told me that the only way her career worked was because she was able to send her children to live with her parents during the school year. I was devastated and seriously doubted my decision to become a mother or continue as an academic scientist. Then again, I had already sealed the deal, as it were.

What a crappy role model. This is the real world, and in the real world every family, every individual is different. Financial needs often determine which parent is staying home more, and this is not just the influence of patriarchy. My wife and I chose careers whose earning potentials are very different. You could argue that she was pushed toward hers because she’s a woman, but she like it and she’s damned good at it and it’s important work. You could argue that mine is paid better because it’s male dominated, but you’d be wrong. In my profession, about half of medical students are female. They face different challenges than their male colleagues, but there here and there stampin’ out disease. They’re also becoming mommies. As physicians, we work together intimately enough that it would be very hard to hide the fact that you’re a parent, and we’d all think it quite strange if you tried.

What kind of message would it send to my female residents if the female attendings “hid” their motherhood? Who’s the oppressor now?

Life is work. It’s hard. And finding balance, for both parents, in a world where we all have to earn a living and put food on the table, and have time to cuddle and care for our kids is sometimes nearly impossible. But nothing about that is ever going to get better if we tell our younger colleagues that it truly is impossible.


My father-in-law wore his nickname without irony. His was the kind of nickname that would be tough to bear on the playground, but despite being a teacher for decades, any juvenile thoughts wouldn’t have crossed his mind. I don’t think he knew how to be insulted.

And while he may not have been easy to insult, he did have pride, and as he became more and more disabled by chronic illness, his frustration grew. His attitude and that of his wife was remarkable. Sure, he complained about being dependent on others, but when he needed to start dialysis, he took it in stride. When he became more and more physically unable, his intellectual life continued to flourish. He continued to be a film and theater maven, and read plays for a local theater group.

But certain things he just could not bear. When he became incontinent, when he could no longer lift a book or turn its pages, he began to lose hope. There are certainly some people who can go on living with dignity and vivacity, despite being locked in an uncooperative body, but Dick wasn’t one of them. The insult to his dignity was too much, and being deprived of his intellectual pursuits by weakness and delirium was too much. He was miserable, although he still had a smile for my daughter. He was afraid—afraid of being alone while unable to do for himself. He couldn’t even push a call button for a nurse.

But there was some hope. Despite his poor health, surgeons tried to decompress his spinal cord, and he was set to go to rehab, but recovery, such as it was, was slow, and medical complications kept him away from physical therapy.

This was a man who worked hard, and whose intellectual curiosity took him all over the globe, before diabetes and vascular disease robbed him of his ability to travel widely. Early in his life, when his country called him to duty, the Army made an uncharacteristically wise decision and assigned him to military intelligence. He seemed much less conflicted about his service than many others—while being a dedicated liberal, and strongly anti-war, he served his country proudly, although I think he was genuinely puzzled as to how such a bizarre institution as the U.S. Army could function without recourse to logical thought.

Dick taught high school most of his life, including history, social studies, and drama. He was proud of his students, and of his work with them. He loved to brag when a student “made it”—Sanjay Gupta, my fellow physician, was a former student, as was one of my medical residents. His students said wonderful things about him, and I presume this is because he was visibly fascinated by history and politics, and loved to share his knowledge and thoughts.

He and his wife adopted two children in the late sixties, when adoption wasn’t quite the common practice it is today. I was lucky enough to marry one of them.

Last night, when the hospital called to say he was in cardiac arrest, we rushed to his bedside. It was clear he never had a chance—whatever did him in happened quickly and efficiently. Earlier in the day, my wife was spending time with him, listening to his confused moans, and when she got up to say goodbye, he said, “you have a beautiful smile. Where did you get such a beautiful smile?”

Dick, she got her smile from you, her passion from you. How could you even wonder?


Over the last few years, as he became sicker, he was always cold. He wore a sweater even in the heat of the Midwestern summer. I’m reminded of nothing so much as the Robert Service poem “The Cremation of Sam McGee”, where a man, stranded in the Arctic cold, enjoins his friend to cremate him, no matter how impossible the task. And while our family’s cultural tradition calls for burial, I can’t help but think of Sam McGee, dead for days in the Arctic cold, finally delivered to warmth by his friend:

And there sat Sam, looking cool and calm, in the heart of the furnace roar;
And he wore a smile you could see a mile, and he said: “Please close that door.
It’s fine in here, but I greatly fear you’ll let in the cold and storm–
Since I left Plumtree, down in Tennessee, it’s the first time I’ve been warm.”

Dick, when I escorted you to the hospital morgue, you looked so small. I can’t believe that hours earlier, you were such a tall, imposing figure. But on this ice-glazed December morning you looked peaceful and warm, and for that, you and I are both grateful.

Merry Xmas!

As many of you may know, I’m not a Christian. That’s right, the whole Jesus thing kinda passed my by. It’s not that I have anything against your Lord, I just don’t give him much thought.

Except now. This is the time of year when people wish me a Merry Christmas, then back peddle, embarrassed, as if they had just told me to perform some anatomically unlikely act on myself.

So, I’m telling you all right now:

It’s OK to say “Merry Christmas” to this Jew. I realize that I’m a minority around here, and while there are certain things about being in a religiocultural minority that are problematic, having someone wish me a practically secular holiday greeting just doesn’t rate getting me annoyed.

Trust me when I tell you that people manage to find far more offensive things to say at any time of the year.

Now let’s remember that on this federal holiday (declared by President U.S. Grant along with New Year’s Day and Independence Day to give federal employees some days off), there are a whole lot of people still working. We may enjoy an easier drive to work (absent snow and ice), but we work just the same. In my little bit of life, it’s hospital employees who deserve special kudos. Most of them are, as my daughter would say, “Christmas people”, and have sacrificed important time to take care of sick people.

Many of us doctors aren’t Christian, but “other”: Jewish, Muslim, Hindu, Jain, Druze, Ba’hai—really, you name it, we’ve got it. Sure, some of the doctors are Christian, but medicine is a world-wide fellowship whose identity often supercedes, or at least rests hierarchically near, religious identity. While I’d love to spend the day watching the snow fall with my daughter, there are people at the hospital who need me, who need the nurses, techs, cooks, environmental workers, all of our hospital family. As a non-Christian, I’m pleased to be able to give my time so that my colleagues can be home on what for them is a special day, and many of my non-Christian colleagues feel the same way.

Please, on this holiday, remember that many of us are taking calls, auscultating chests, lancing boils, and otherwise tending to those occurances that, like me, don’t recognize Christmas.

But don’t be afraid to wish me a Merry Christmas. I know you mean it in a nice way. And cookies—I like cookies.

Science-free holiday post–FOOD!

OK, this is a meme that I’ve always wanted to do (at least since this morning). It will involve no tagging, no involuntary contributions, just some cool info sharing.

We all have favorite restaurants, places we can drop in for a favorite meal. What I’m interested in is not the best gourmet places, but the best everyday places. So, I’ll share with you some of my local favorites from the NW Detroit metro area (leaving out some from earlier in my life, as I can’t verify their continued existence).

1) Mr. Kabob, in Berkley, MI. This place rocks. It’s in a damned gas station, but they cook up some wickedly good and cheap mideastern carry out (and you can eat there if you don’t mind the comings and goings of the gas patrons).

2) Redcoat Tavern, Birmingham, MI. This cramped, dark, smoky spot is well-known for one of the best burgers in Michigan.

3) Juilleret’s, Charlevoix, MI. I dare you—I double dog dare you—to find a better breakfast. The french toast is incomparable.

4) Steve’s Deli, Bloomfield Hills, MI: Detroit has great delis. Really, New York, you guys are pitiful. You must have a #4 (corned beef, swiss cheese, coleslaw on rye with russian dressing)—it’s a classic Detroit deli sandwich. (Yes, Star Deli is better, but it’s takeout only.)

5) Athens Coney Island, Birmingham, MI: Coney Islands are Detroit diners. They are often Greek-owned, and have lots of classic Greek specialties, but what they all share in common is the Coney, a natural casing hot dog in a steamed bun with chili sauce (not chili). You gotta do it. (Yes, Lafayette and American are the classics, but how often do you really go to downtown Detroit, even if you live here?)

So go ahead and tell us your favorite hometown eateries—we want to know.

Smackdown, please (yes, Egnor, I’m talking to you)

Arrogance. It’s always about arrogance. Arrogance is the Great Distractor in science. It is a half-a-dozen logical/rhetorical fallacies rolled into one—argumentum ad ignorantium, non sequitur, tu quoque, ad hominem, straw man (yes, that’s not six yet, but I gotta give myself some flexibility here). These fallacies aren’t just rhetorical toys to play with in the blogosphere. They can be simple mistakes made when discussing an controversy, or they can be weapons used in place of a valid argument. They are particularly important when dealing with reality.

Reality. I’m not talking about a stoned, midnight bull session about whether dialectical materialism accurately describes the relationships between groups of people, or other such (sometimes interesting) nonsense. I’m talking about this table, this PC, this cup of coffee. Reality. Truth.

There’s a great blogger out there who is fond of repeating the fact that “the truth is consistent with itself.” Sure, we can argue the philosophy of reality, truth, perception all day and night, but in the end, in the real, practical world (the one doctors deal with), the truth is consistent with itself, and reality is that which we can observe. Reality is, by definition, everything.

Continue reading “Smackdown, please (yes, Egnor, I’m talking to you)”

Hi, Mom!

i-717d70581118215cee135ee2f56bf332-DSCN0336.jpgIt’s another cold, snowy day in Michigan, and while I was busy stamping out disease, PalMom was looking out her window at the snow. Perching on a branch was this beauty, which I believe to be a red-tailed hawk. Please correct me if I’m wrong.

i-d9e2e5cef17eb7e6f31c4699c88e5893-DSCN0337.jpgThis raptor is no dummy. There’s a bird feeder a few yards away, which, in addition to attracting the LBJs, also brings the little mammals.

i-22d03b3632ac9af14b27ab1b478ec176-DSCN0339.jpgApparently the LBJs aren’t too stupid either. There were none at the feeder while brother hawk was there, but according to PalDad, the hawk is now gone, and the birds have returned to their feast.

Podcast update

OK, we’ve got a second episode up, with much better ones to come, including, hopefully, some rather heated discussions with a few interesting guests. Interestingly, if you click on the link above in Firefox, you are taken to the rss feed. If you do it in IE, you get an error. So, either use iTunes or FF.

The iTunes feed is up and running—you can see it on the right sidebar—it’s the white coat thingy.

I’ve found that I’m not compulsive enough to write code, but if I have to update an xml file once a week, well, I’ll dig deep for my inner compulsive self.

What is an internist, and why should you care?

A (long) while back, I gave you a brief explanation of what an “internist” is. I later gave you a personal view of primary care medicine and some of the challenges involved in creating an infrastructure of primary care (only 2% of American medical grads are going into primary care). We also had a little chat about medical mistakes and medical training.

No matter what changes we ultimately make in the way we train internists, one of the lessons that residency teaches is to identify who is truly sick. I don’t mean who is faking it, I mean being able to look at someone briefly and decide whether or not they need your immediate attention. It may seem obvious, but it’s not. Objective factors can sometimes be deceiving. For example, an asthmatic may have perfectly normal vital signs, including a normal oxygen level, and yet be moments away from needing a breathing machine. For an asthmatic, a normal respiratory rate may indicate fatigue rather than health, and absence of wheezing my indicate such severe airway obstruction that wheezes aren’t even possible. The ability to recognize severe illness is one of the critical goals of residency.

This is one area in which the so-called alternative medicine folks can really be dangerous.
Continue reading “What is an internist, and why should you care?”

Skeptics’ Circle 102 at Happy Jihad’s House of Pancakes

Please check out this week’s skeptics’ circle at Happy Jihad’s House of Pancakes.

Of note, I liked Dr Austs’ post on the human toll of HIV/AIDS denialism, it is stirring. I also found the Skeptic’s field guide particularly interesting. I would have two suggestions. One would be to prioritize by frequency of use or rhetorical appeal rather than alphabetical, and second would be to include a section on conspiracy (like the ones the Lay Scientist and Dubito Ergo Sum describe in this issue ), which I believe is the hallmark of all denialist arguments. If you need a non-parsimonious conspiracy theory to explain your beliefs, well, you should re-think your beliefs.

And speaking of conspiracies, I forgot to blog the hysterical interchange between Rolling Stone contributor Matt Taibbi – author of The Great Derangement, and David Ray Griffin, 9/11 truther crank. The whole thing is instructive in the lesson of not arguing with cranks, but it doesn’t get interesting until part II when Taibbi starts to figure this out for himself.

As you’ve noticed, I struggled for quite some time with the question of how to answer your responses. Mainly this was because I was unsure of whether to treat this exercise like a comedy (because it’s certainly hard to take seriously any “debate” with a person who believes that Rudy Giuliani would conspire to blow up the densest slice of taxpaying real estate in the world, the New York City financial district, in order to save his city the cost of an asbestos cleanup) or whether to aim higher and treat it like a serious political argument. I tried it both ways and neither way seemed to fit. Treating this like an absurdist comedy, I realized, I’m making it hard for readers to see how monstrous and offensive your arguments are — but then again, when I take you seriously, spending paragraph after crazed paragraph grandstanding against you and your book, suddenly I’m the one who looks ridiculous.

Then it hit me, and probably far too late: the correct play here is to ignore you and your arguments entirely. There are many things about your work that are outrageous and offensive, but the very worst thing about you and other 9/11 conspiracists — and, I guess, lately anyway, me — is that you’re/we’re a distraction from the real problem.

It gets better. Taibbi really nails the fundamental problem with all of the false-flag arguments the truthers always lay out against reality:

This same public — the same public that stood meekly by when its manufacturing economy was exported overseas, that cheered when our government pledged to “get tough” with China by demanding that it allow us to weaken our currency vis a vis the Yuan, that twiddled its thumbs when Wall Street played Keno with the nation’s homeowner savings, that has consistently voted overwhelmingly to deprive itself of its right to litigate against powerful companies — this is the public you think George Bush and Dick Cheney needed to blow up downtown Manhattan for, in order to get them on board with a war against Iraq, the Patriot Act, and whatever else.

All of this 9/11 Truther stuff, it’s a silly distraction. A country whose economy is about to go down the shitter, to the brink of depression, thanks to three-plus decades of routinely-ignored Wall Street deregulation just can’t afford to be wasting its time arguing about thermite reactions and “morphing technology.” Captivated by the comic possibilities of Truther literature, I realized this too late. As you’ll see below, I even spent a lot of time pulling what’s left of my hair out over your answers to questions that even I admit now go beyond inane. I admit in advance to looking silly for doing so, and hereby make a promise to God that I won’t do it again, at least not as long as we have other things to worry about. All the same, some of the stuff you came up with, Professor sheesh! And I thought I was loony!

Freaking awesome. I’m sorry I didn’t write about it when it came out. His final diagnosis of Griffin’s writing was beautiful:

In the end it all comes down to what you believe. If you believe that events in life tend to have simple explanations, then you’re not going to be very impressed by Griffin’s arguments. If on the other hand you think that the people running this country spend their days plotting to create phantom civilian jet-liner flights, disappearing whole fuselages full of passengers, and then shooting missiles into the Pentagon in broad daylight in order to cover up embezzlement schemes if you think, in other words, that our government is run by the same people who cook up second-rate French spy movies or your mind instantly produces the word “crossbow” when asked to produce A MURDER WEAPON by a Mad Libs script well, then, you’re probably going to enjoy Griffin’s books.