Thursday, July 24, 2008

Some personal notes

I am leaving later this week with my family for a trip to Krasnodar, Russia, my wife's birthplace and where she grew up. Although I have traveled to Canada and the Caribbean in the past, I have never traveled overseas. So, I am quite excited about this trip, as all of us are.

I don't know how much blogging I will be able to accomplish, but I am planning on keeping a journal during the trip, and if I can come up with something interesting to say, I will certainly post it here, probably when I get back.

On another note, my wife is pregnant! A little unexpected, but we are all thrilled; even the girls seem happy with the prospect of a little brother or sister. The delivery will probably take place here at home (hence the post about home births); at least that is the general plan as of now. We are trying to link up with a midwife, and I am trying to be a supportive husband and not the anxious dogmatic doctor.

Wednesday, July 23, 2008

Home Births

For a variety of reasons, this post is about home births.

I ran across this post (courtesy of the folks at MedBlogs Grand Rounds). I was hoping to find something concrete to reinforce my grudging acceptance of home birthing, as there does not seem to be very much that is scientifically unfavorable out there. Well . . .

Louise (the blogger here) cites an article that shows that outcomes for low-risk women who deliver at home are just as good as those for low-risk women who deliver in a medical setting. I tend to agree with some of what Louise says in the post, like the fact that"medical doctors are a vital part of health care. But they are not the only piece of the puzzle, especially when it comes to childbirth." It makes me think of the countless times I have attended a woman who had the "misfortune" (that's sarcasm, folks) of delivering outside of the hospital; better yet, for how many deliveries does the doctor arrive late?

But there are a couple of points that I can't agree with.

"A long, painful birth in an of itself is not a medical problem." For you, Louise, perhaps, but not for every woman. Painful birth does not harm the mother, although the Scientologists might argue about its effects on newborns. You know, you can go to the dentist and have your teeth extracted and filled without anaesthetic, too, but it's not how I would choose to spend my afternoon. Some women are highly motivated to deliver naturally, but to imply somehow that it is superior to a hospital birth is a bit much to swallow. Not even the study which she cites claims as such.

The study does seem to be well constructed, but I find it interesting that the vast majority of the women were white (89.4%), middle class (59.9%), and non-smokers (94.1%); I suspect that this does not reflect a typical mix of patients in the United States (the study was Canadian-based, but supposedly drew patients from North America). It would be prudent to know what the statistics would be for a more realistic mix of patients. I was also surprised that in the paragraph "Outcomes," the authors mention an actual total of 18 intrapartum and neonatal deaths, but excluded 7 of those 18 (38.8%) in their calculations, for reasons that I am not sure are methodologically valid. And even though the authors admit that "Breech and multiple births at home are controversial among home birth practitioners," there were still 80 planned breech deliveries at home, and 13 sets of twins delivered at home. How did these pregnancies get assessed as "low-risk"? I agree that this study is an important one in actually elucidating the risks and outcomes involved in home births, but it is not the definitive answer.

Louise is not a fan of ACOG. "Unfortunately," she states, "ACOG would like to impose artificial time frames on a natural process that was never set up around a clock or a doctor’s schedule." Whoa--there are no time frames imposed on the birth process. There are practice guidelines that are set up (some proposed by ACOG, some by other entities) that serve as suggestions in improving patient care and outcomes. They are based on actual, peer-reviewed research and studies on patients in labor and what happens when certain events occur in certain time frames. ACOG is not a bunch of old guys sitting around making up numbers to torture women with.

Louise continues: "The conflict of interest for ACOG and the AMA is glaring like a neon sign." How is concern about women's health and childbirth a conflict of interest for ACOG? Oh, wait, she explains it to us: "Every woman who chooses to give birth at home with a midwife means one fewer patient for ACOG. That’s pretty much the whole story."

Huh? ACOG isn't in the business of taking care of patients, doctors are. A woman who gives birth at home, or in a car, or at the hospital probably has no idea who ACOG is or what they do. "So ACOG and the AMA have chosen to take the undeniably sleazy route of hiding their primary interest (money) under the thin disguise of being concerned about the safety of mothers and babies." This statement is so ridiculous that I don't know what to say. Maybe she equates ACOG with BigPharma and the whole military-industrial complex run by the Rothschilds. Exactly how does ACOG make money when a woman delivers?

According to Louise, "each woman should be able to labor and birth where she is most comfortable, and have access to competent, licensed caregivers, regardless of where she chooses to give birth. It seems that ACOG and the AMA do not want to offer me that same measure of respect."

This is an admirable sentiment; I trained alongside midwives as a resident in Texas, and I found them to be knowledgable, competent and compassionate caregivers. But each woman should be offered appropriate info about the benefits as well as the actual risks of home birth, and I am not sure that this is being done. The statement that "midwives generally don’t accept unhealthy women or high risk pregnancies" made me cringe. As opposed to the midwives that I associated with during my training, many of the midwives (licensed and unlicensed) that I have encountered in private practice have seemed unwilling or unable to correctly assess high-risk conditions such as a previous C-section or diabetes.

I could go on and on. What's the bottom line? Louise presents one well-done study suggesting that outcomes in low-risk patients are comparable (not superior) for homebirth and hospital birth. Much of her post is spent demonizing two influential medical organizations, without backing up her opinions. And that's pretty much her "whole story." I was hoping for something a little more constructive.

I am not a fan of ACOG (nor a current member). I have become more open to the idea of home birth as a result of my lovely wife, and her experience with the process. She delivered at home 4 years ago, attended by a midwife. Her older daughter was born at Charity Hospital in New Orleans (I tell Nika that a lot of famous people were born there, but I'm not sure she believes me), and although it was not a bad experience, she much prefers the home birth experience, which for her was extremely positive and healthy. I no longer argue the point with her; who am I to argue with that success? Even though I haven't run across any negative studies comparable in scope and construction to this positive one, I still have some misgivings about it, but I think I deserve some credit for being very open to the idea.

I won't even go into the issues of depth of training, or the malpractice issue (hey--you want to jump in the water, maybe you should swim with the malpractice sharks just like us docs have to do). It's a neat idea to be able to categorize patients into high-and low-risk categories, but it can also be dangerously misleading, for a simple "low-risk" patient can turn into a obstetrical catastrophe very quickly.

I'd like to see more studies like this one. I'd also like to see less posturing by both sides; we don't need ACOG talking about the need to "legislate" the issue, and we don't need Louise or Ricki Lake generally bashing the medical establishment. The word of the day is evidence-based medicine, and not anecdotal-based medicine, something that has been practiced for far too long. More evidence, less rhetoric.

Sunday, July 20, 2008

Free Speech

Yet another example of the chilling effect that the Bush administration has had on free speech.

Wafaa Bilal is exhibiting his videogame, "The Night of Bush Capturing," at the Freedom of Speech exhibition at FLATFILE Galleries in Chicago. In the game, players are sent on a mission to kill President Bush. "This is to raise awareness about the civilian toll in Iraq, and how a lot of them have been forced by the consequences of the invasion to become suicide bombers," Bilal said.

As Instapundit would say, they told me if Bush was elected, artists would feel intimidated in expressing their creative viewpoints.


Of course, this kind of thing is totally different.

Loaves and Fishes, a Minnesota-based community action group, is protesting the display of a combat simulation videogame at the Duluth Air Show. The Virtual Army Experience, used by Army recruiters, demonstrates what life could be like as a soldier. In one scenario, participants transport aid to threatened humanitarian aid workers while using machine guns and a missile launcher to wipe out terrorists who stand in the way.

Michele Naar-Obed, spokesperson for Loaves and Fishes, is outraged that a military-sponsored video game would be featured as an exhibit at an air show. She is quoted as saying, "I’m very upset over this. I think this is just insane that they would use this kind of venue to train our youth to kill people. . . we find it to be unacceptable and inappropriate."

Apparently, she is unaware that it is a military air show; the headline act is the US Navy Blue Angels. Most of the planes there are military planes. The Duluth Air Show is not a bunch of old guys in shorts standing around in a field, comparing Cessna stories.

Lileks has a good summation:

Inappropriate? At an air show? One can understand their anger if the simulation was mandatory, and children were herded into vast rooms, drugged up, forced to ride the Humvee sim then marched into a recruitment office and told they were signing up for a free trip to Disneyland, but that’s not the case. Somehow a sim about saving relief workers by blowing up terrorists is BAD, but a game in which one plays a criminal who drives around town running over pedestrians is okay.

The Army removed the same game at the request of Summerfest officials in Milwaukee.
“We’re determining it’s probably not something that we want to have shown at Summerfest,” John Boler, vice president of sales and marketing, said before the decision was made to request removal of the game.

The game drew criticism from Peace Action Wisconsin, which called it “totally inappropriate and offensive.”

“War games should NOT be presented as entertainment,” the group wrote in a press release. “War is NOT a game. Summerfest is meant to bring people together for a good time in peace, not to present opportunities to practice shooting people.”

No mention is made of whether any other activities (like a Grand Theft Auto demo) or performers at the festival drew the wrath and ire of Peace Action Wisconsin.

But I'm pretty sure they would have welcomed Wafaa Bilal.

Friday, July 18, 2008

So sad

I guess we are supposed to feel sorry for this kid.

I don't.

Omar Khadr was captured in Afghanistan in 2002. He was imprisoned at Guantanamo Bay, a guest courtesy of the United States, who captured him after he allegedly tossed a grenade that killed Special Forces Sgt 1st Class Christopher Speer of Albuquerque, New Mexico and permanently blinded another.

In the video, he complains that he is not receiving proper medical attention, and that he can't move his arms. In the segment that I saw, he moved his arms without any difficulty.

Navy Lt Cmdr William Kuebler, Khadr's US military lawyer, said the video shows "a frightened boy." "What you see in the video is a teenager begging for help," said Wells Dixon, a lawyer for the New York-based Centre for Constitutional Rights. That's right--Omar was 15 years old when he was captured.

15 years old. When I was 15, I was excited about the prospect of being able to drive a car. I certainly wasn't tossing grenades at the Special Forces. I think that the day you decide to juggle explosives and trade rounds with the elite of the US Army, you kind of forfeit your "child" status, don't you?

Khadr was born in Canada, but raised in Afghanistan (what's up with that?). His family, according to a Canadian report, is quite chummy with Al Qaeda, inviting them over for barbeques and summer trips to the beach. Well, okay maybe not, but the report does say his Egyptian-born father, Ahmed Said Khadr, and some of his brothers fought for al-Qaeda and had stayed with Osama bin Laden. Just the kind of people you want to kick back with a few cold ones you know, watch a little ESPN.

"During his last interrogation, according to the Canadian government report, Khadr is shown a picture of his family. He denied knowing anyone shown, but when left alone with it later, he urinated on the photograph." Marking territory? A new way of expressing filial devotion?

Nah. I think he's just a really creepy kid.

Remember--this "child" fights on the same side as these folks from the Religion of Peace. I am going to bet that the captured (now dead) Israeli soldiers didn't get lawyers or visits from the Red Cross. And guess what? I win!

"The soldiers' Hezbollah captors had withheld any information about them since they were taken, refusing to release pictures or allow the Red Cross to see them. It was not clear if Regev and Goldwasser were killed in the original raid or if they died in captivity."

International outcry? UN denunciations? Congressional calls for impeachment? Nope--all I hear is crickets, endlessly chirping . . .

Back to Khadr: Lt. Cmdr Kuebler says 'when this very scared 16-year-old boy finally figures out that the Canadians aren't going to do anything for him and are going to leave him there . . . he is devastated."

As devastated as the family of Sgt Speer? Or as devastated as the one who was blinded?

15 years old.

Thursday, July 17, 2008

An Inconvenient Iceberg


Kind of like the old bumper sticker that said, "Nuke The Whales--Keep 'em Guessing."

Wednesday, July 16, 2008

It's not just a cracker

This is not the face of a nice, rational person.

I first ran across PZ Myers' blog a few years ago, and was immediately disturbed by the anger and the acidity towards all thing religious displayed there, not only by Myers but also by his loyal commenters. For example, he referred to the recent death of a Baptist minister (someone he didn't even know) as "futile" and that he had dedicated his life to a lie. You have to read it (and sample some of the comments) to grasp how unfeeling and disturbing it is.

This is the kind of writing and mindset that is a complete turnoff to me as someone who considers himself to have a skeptical mind. I don't even like to think of myself as a "skeptic" any more; I have certainly become more open-minded and more spiritual in my everyday life, and I believe it is at least in part a response to these kinds of attacks.

So there is this hoo-ha over a Communion wafer. Seems that Myers is incensed that some college kid who absconded with a Communion wafer may be in hot water with his University. Catholics believe the unleavened bread, once it is consecrated by a priest, is transformed into the substance of Christ's body. Myers doesn't buy it. He wrote that if readers of his blog send him a consecrated host, "I'll show you sacrilege, gladly, and with much fanfare." Myers' plan to support the kid is to get someone to swipe some Communion for him, so that he can engage in some sort of desecration and film it and post it on YouTube.

What a cool guy, eh?

It's kind of like hating Bush---unoriginal, boring and tedious. Look at me! I'm edgy and brash and rebellious! Christians--especially Catholics--look how stoopid they are! I'm telling truth to power! Silly Pope, dressed in his silly robes!

It is noteworthy, I believe, that Myers uses the word "Frackin" instead of the coarser Anglo-Saxon version that he actually means. Why? Was he worried that he was going to OFFEND SOMEONE?

Can we say, “perpetual adolescent?”

C'mon Myers--grow a pair! I don't foresee Myers taking a goat into the next Islamic prayer service. He probably won't be shouting "Sieg Hiel!" at synagogue. Why not video yourself desecrating a Koran? Why not take on those Scientology folks? Tip over some headstones at the local cemetery? Or is that too edgy for you? Or maybe you're just chicken?

He's got an answer for that, actually. In this interview, Myers states "I don't favor the idea of going to somebody's home or to something they own and possess and consider very important, like a graveyard -- going to a grave and desecrating that. That's something completely different. Because what you're doing is doing harm to something unique and something that is rightfully part of somebody else -- it's somebody else's ownership. The cracker is completely different. This is something that's freely handed out."

The "logic" doesn't really work for me here. I am glad that he respects someone else's property. And the Eucharist is freely handed out; in a sense, you could do with it whatever you wanted to do. But a tolerant, rational person wouldn't behave so uncaringly. Although an aggressively intolerant person would, I suppose. Does one's tolerance stop at some imaginary property line?

Myers (who was once an altar boy) admits that the majority of the angry emails he has received threaten nothing but to "assault me with prayer." But Myers seems genuinely surprised that his proposed actions have disturbed some people; he is clueless as to why some have even threatened violence. I am always amazed at those who loudly and sometimes crudely exercise their right to free speech, but seem unable to understand that others have that right also, and that others will respond to them, loudly and sometimes even crudely.

There is this exchange in the interview, beginning with the ex-Catholic interviewer:
". . . While I was taught to be reverent with Catholic symbols and artifacts, I also learned of a powerful god, totally unlike this fragile one that can be damaged by a non-believer's mishandling of a communion wafer.

Myers: It's actually kind of sad. I grew up in a church, although I'm, of course, no longer a member of a church, but it is kind of weird to see this going on right now. The messages I've been getting in my email have just been insane. People who say this cracker is literally and physically the body of their god and that I'm doing this great act of heresy and sacrilege and horror -- even though I didn't actually do anything to it -- is disturbing. It's like discovering there are witch doctors lurking in your community and they've been doing weird practices."

Again, it has nothing to do with God being fragile, or whether you or I or Myers actually believes that the Communion wafer is God's body or not. It has to do with tolerance; it's as simple as that.

It is this kind of intellectual arrogance and intolerance that has turned me off of so much of what the skeptical community has to offer. It is one thing to be pro-science and pro-rational thinking; the world often seems short of such ideas. But I believe it can be done without the hubris and arrogance that Myers displays. I believe that in a rational world, there is more than enough room for tolerance.

Friday, July 11, 2008

Taking fitness to a (w)hole 'nother level

I had heard briefly about this, um, special spa, you know, for women; no, it's not Curves--it's a really special spa.

It's a spa for your vagina.


The New York Times article is titled "A spa for those women concerned about pelvic fitness," which is a growing constituency, I guess. The pelvis has become a marketable area for modification, ranging from the Brazilian bikini wax to genital surgery referred to as vaginal “rejuvenation.” Doctors have even coined a term for such genital “beautification”: cosmetogynecology or cosmogynecology. The ads for doctors who specialize in vaginal rejuvenation, and for courses that you can take to learn the techniques ("YOU can become a licensed vaginal rejuvenator--IN YOUR SPARE TIME!") are rampant in the OBGYN periodicals.

Let's see what they say about this place, shall we?

Dr. Laura Romanzi is opening "the first medi spa in Manhattan wholly dedicated to strengthening and grooming a woman’s genital area. Phit — short for pelvic health integrated techniques — is to open this month on East 58th Street." Apparently, for $150, you can go in and tighten your vaginal muscles around Dr. Romanzi's fingers so she can assess your, eh, personal fitness. Perhaps Dr. Romanzi seeks to return to those halcyon days back in the late 1800's, when it was fashionable for society women to visit their gynecologist who would perform "uterine manipulations" to relieve their neurasthenias and hysterias, so to speak.

She's got a website, too.

Some of the services offered include Lazy Susan ("Painless electrical stimulation--for an effortless Kegel muscle workout"), Lip Sync (for those with asymmetrical labia), and The "Other" Face Lift (go on--guess what that's about--I dare you). There's even a Gifts and Packages page, for that special someone in your life! "Honey, the kids and I wanted to get you something really nice for Mother's Day . . . "

I couldn't make this stuff up if I tried.

The article does include some skepticism from a Dr. Abbey Berenson, who states, “If this is being recommended to women who have no symptoms, then there are no medical organizations or literature that support that that is necessary.” Indeed, the American College of Obstetricians and Gynecologists has issued a statement noting that "vaginal rejuvenation, designer vaginoplasty, revirgination, and G-spot amplification, are not medically indicated, and the safety and effectiveness of these procedures have not been documented. No adequate studies have been published assessing the long-term satisfaction, safety, and complication rates for these procedures."

Dr. Romanzi says that she only wanted to teach women the proper way to do Kegel exercises. She does grudgingly admit that the idea of pelvic fitness is based more on her own experience than on clinical evidence. However, she believes all women might benefit from such exercises. “If you can vote and you have a vagina, you should do these,” she said. “It’s the dental floss of feminine fitness.”

I'm not sure what your voting rights have to do with your G-spot; nor am I sure that women will necessarily appreciate the flossing analogy. Indeed, The Anchoress commented, "My voting vagina rejects the analogy to dental floss - it makes her wince into a stern and metal-bending Kegel."

Only a woman could say that.

Thursday, July 10, 2008

Food Police

I liked this example of political correctness run amok. For the upcoming Democratic Convention in Denver, "Democratic National Convention host committee guidelines for caterers suggest serving mostly organic fare or Colorado products, and avoiding fried foods. The guidelines even suggest color schemes on plates."

DNC host committee meal guidelines:

* Half a meal made up of fruits and/or veggies

* At least three of the following five colors on a plate - red, green, yellow, blue/purple and white (garnishes don’t count)

* No fried foods

* At least 70 percent of ingredients (based on precooked weight) certified organic and/or grown or raised in Colorado

* Use of reusable serviceware

* No bottled water, use pitchers instead

* Encourage staff to use alternative modes of transportation

As a commenter noted, the staff is encouraged to use alternative modes of transportation, not the attendees. Alternative transport is for the "Little People."

What I wonder is: will you be able to use more than one square of toilet tissue?

I had previously talked a little about this other kind of food hypocrisy in regards to the UN Food Summit. I guess it just keeps popping up. PM Brown of Great Britain is urging his citizenry to reduce food wastage, which is not an unadmirable idea. Apparently, "mountains" of food are wasted each year--up to 40% is lost due to poor processing, transport and storage. Among the solutions: bulk-buying will be discouraged. Excessive packaging will also be forbidden, somehow.

Exactly what these measures will achieve is not clear. Eliminating food waste is a good thing, and eliminate excessive packaging is another, but it is not clear that there is a relationship between the amount of packaging thrown away, and the amount of food thrown away. The relationship between the mountains of food being thrown away and world starvation is also a bit murky to me. Noble efforts to be sure, but to what end?

Of course, this was almost immediately followed by a story about the G8 food fest, I mean, Summit, which Brown is attending in Hokkaido, Japan. Some Summit trivia: the Summit itself cost close to $400 million. Also, the International Media Center cost almost $50 million, and will be dismantled after the Summit is completed (this is somehow consistent with UN and Japanese visions of eco-greenness and enviro-friendlyism).

The menus in full:

Corn-stuffed caviar
Smoked salmon and sea urchin "pain surprise" style
Hot onion tart
Winter lily bulb and summer savoury
Folding fan modelled tray decorated with bamboo grasses
Kelp-flavoured cold Kyoto beef "shabu-shabu", asparagus dressed with sesame cream
Diced fatty flesh of tuna fish, avocado and jellied soy sauce and Japanese herb "shiso"
Boiled clam, tomato, "shiso" in jellied clear soup of clam
Water shield and pickled conger dressed with vinegar soy sauce
Boiled prawn with jellied tosazu vinegar
Grilled eel rolled around burdock strip
Sweet potato
Fried and seasoned Goby with soy sauce and sugar
Hairy Crab "Kegani" bisque soup
Salt-grilled bighand thornyhead with vinegary water pepper sauce
Milk fed "shiranuka" lamb flavoured with aromatic herbs and mustard
Roasted lamb and cepes and black truffle with emulsion sauce of lamb's stock and pine seed oil

All in all, it sounds like a really long episode of "Iron Chef." I would definitely steer clear of the Hairy Crab (sounds like something that should be treated rather than eaten). Also, I suggest you skip anything that includes a "pain surprise."

Wednesday, July 9, 2008

Obama on Language

In today's world it just makes sense to be able to speak more than one language--no question about it. Here's Obama at a townhall meeting in Georgia yesterday:

You know, I don't understand when people are going around worrying about, "We need to have English- only." They want to pass a law, "We want English-only."

Now, I agree that immigrants should learn English. I agree with that. But understand this. Instead of worrying about whether immigrants can learn English -- they'll learn English -- you need to make sure your child can speak Spanish. You should be thinking about, how can your child become bilingual? We should have every child speaking more than one language.

Okay--I don't think we need to have English declared as our National Language (whatever that would mean); I also agree that immigrants should and probably do learn English. But you need to make sure your child can speak Spanish? Why Spanish? Why not Chinese--the third most commonly spoken foreign language in the US? It's pretty obvious to me that the Chinese will be playing a much more major role in economic affairs in the future than any of our Latin American neighbors.

According to the Census Bureau, of the 20 non-English languages spoken most widely at home, the largest proportional increase in the 1990s was (drum roll, please)-- Russian! (Way cool!) Speakers of this language nearly tripled, from 242,000 to 706,000. (I am trying my darndest to increase that number to 706,001.) The second largest increase was among French Creole speakers (including Haitian Creoles), whose numbers more than doubled, from 188,000 to 453,000.

Perhaps learning to hable espanol may be politically expedient, but a little short-sighted.

It's this next bit that has most people disturbed:

You know, it's embarrassing when Europeans come over here, they all speak English, they speak French, they speak German. And then we go over to Europe, and all we can say [is], "Merci beaucoup." Right?

Stoopid, embarassing Americans, clinging to their guns and their religion. Is there any stereotype about Americans that Obama doesn't subscribe to? We're just a bunch of loud-mouthed, arrogant, English-spouting rubes, stumbling through the flowerbeds, yanking on the tapestries, right? How 'bout those French? A lot of people hoped that Obama was beyond this sort of cliched thinking, you know, about "typical white people."

I'm pretty sure that if I found myself stranded on some backroad in Greece or Alsace-Lorraine, I would not be surrounded by smiling locals cheerfully quoting Keats and Dickens. And I am sure that some tourists here are often surprised that sometimes us provincials can understand their "furriner talk" purty good. According to the American Council on the Teaching of Foreign Language, nearly one-third of students in grades 7-12 are taking a foreign language; not great, could be better, but not exactly the picture of xenophobic Neanderthals that Obama seems embarassed by.

In the immortal words of Senora Obama:

Usted sabe, esta conversación no ayuda mis niños.

Tuesday, July 8, 2008

Robots in medicine

Sometimes I feel like an old man. Hey--no snickering back there. When I trained in my residency the laparoscope was just gaining general acceptance in gynecological surgery. Even in the 4 years that I was training, the indications for using the scope expanded dramatically, as we became more comfortable with its use, and in hand with technological advances in lenses and other equipment.

It was about 10 years or so ago that the laparoscopically assisted hysterectomy became widespread. The "advance" that it promised was shorter hospital stays, and less discomfort to the patient. It certainly has shortened hospital stays; most patients undergoing LAH go home within 24 hours. But, most traditional hysterectomy patients go home in 24-36 hours anyways (gone are the days of the 4-5 day post-operative hospital stays for the majority of surgeries). And, I think for the most part, scope patients have less post-op pain for shorter durations of time, and usually return to work sooner.

There is a cost, or course. Most of the equipment used in laparoscopic surgeries is disposable, and hence quite costly. And scope procedures take considerably longer to perform compared to the traditional, "open" procedures. So a lot of the cost advantages are offset by the increased operating costs and times. Most studies in general do show a slight advantage overall for laparoscopic surgeries compared to traditional methods, but the advantage for the most part is small.

Of course, MD's (including gyn surgeons) love technology, and the race has been ferocious in coming up with new laparoscopic devices and increasingly complex procedures to do with them. The latest "advance" in gyn surgery is the use of robots to assist the surgeon. With the da Vinci system, the surgeon sits at a console outside of the OR, viewing the operative field through a viewer attached to a remotely controlled set of "robotic" surgical instruments. This article summarizes the experience of 20 patients in Ohio who underwent a radical hysterectomy for early stage cervical cancers. A radical hysterectomy as the name implies involves a significantly more extensive dissection of the pelvic tissues, and in general takes a bit more operative time; where a regular, old-fashioned hysterectomy takes about 30-45 minutes to do, a radical hysterectomy done via the "open" method (with traditional abdominal incisions) takes anywhere from 2-3 hours.

In this study, the median operative time was 6.5 hours, more than double the usual operating time. The study authors congratulated themselves in getting that time down to 4.5 hours for the last 5 cases (although I suspect that the "learning curve" is a bit steeper than that). Still, I don't really see a great advantage here. The article specifically mentions two advantages. One is the system uses some sort of dual-lens scope which "provides vivid 3-dimensional images." You know, I've got a dual-lens system that I've been using for over 48 years; even with some corrective optical devices, I think my system works pretty darn good. The other advantage they mention is some sort of articulation at the tip of the microinstruments that "serve the same function of the human wrist." But that's not really an advantage, serving the "same function." The authors do grudgingly acknowledge that there are no studies showing that robotic surgery is superior to laparoscopic surgery. So what's the point? "We believe that the goal of robotic surgery is to perform the same procedure laparoscopically that would have been performed during laparotomy."

I remember at one laparoscopic conference I attended, a "learned" professor solemnly intoned, "Just because you can see something through the laparoscope, doesn't mean you have to operate on it through the laparoscope." Alas, I am afraid his advice goes unheeded.

Friday, July 4, 2008

Happy 4th!

Happy 4th of July! I love this country, warts and all. It is the far from perfect, but by far and as a whole, it is the greatest country on this planet. As this article notes, "After all, since humans climbed out of the trees and began surveying the lion-infested Savannah, none have ever lived in a period more prosperous, secure and stable than Americans do today. The U.S. is not only the wealthiest and most powerful country on earth now, but in all of history. There's never been a better time and place to be alive than America in the 21st century." The whole piece is an interesting read about the current spate of America-is-in-decline books.

There does seem to be an interesting dichotomy on how the two sides of the aisle view America, and specifically, their views on American patriotism. It really comes down to looking at the glass half-full or half-empty. It seems that the left always takes the more pessimistic view regarding this country. As Joe Klein writes in Time magazine, "This is a chronic disease among Democrats, who tend to talk more about what's wrong with America than what's right." Even among the blogs, you can tell who you are reading by the tone of the posts and comments. This piece exemplifies my point:

"A mother of a heroin addict, for example, is critical of her child's drug abuse and wants it to stop. The mother wants only the best for her child. Does the mother's criticism of the child's actions in any way illustrate that she does not love her child? On the contrary, it is because the mother loves her child and is devoted to her child that she wants her child to be better, greater than he/she is."

Yeah, that's it--let's think of America as a heroin-addict! Works for me!

As Jonah Goldberg notes, " . . . at the end of the day the patriotic American believes that America is fundamentally good as it is." Does that mean that my government can do no wrong? Does that mean I should never question my government? No, not at all. I think this is the nub of the argument--America is a great country, whether or not we have had a great government, and sometimes in spite of it.

James Lileks hits the nail on the head with this one, pointing out the smugness with which a lot of critics look at this nation. In their world,

". . . we will never be a great nation until we all realize how much we suck, and then we will also realize it is wrong to be a great nation. For that matter, nationhood are overrated. (The only nation that gets to be a nation is France.)Nations are bad enough, but we’re something else:the only nation that has ever fought a war, acted in self-interest, had a good opinion of itself, permitted slavery, elected leaders who lacked a certain Olympian quality, had a popular culture that included simple catchy melodies and bright pictures, harbored racist attitudes, had a strong religious element, and contained a sizable amount of stupid people."

But this is what is so difficult about Obama, and his patriotism. Again, from Jonah Goldberg,

"I am absolutely certain," he proclaimed upon clinching the Democratic nomination, "that generations from now, we will be able to look back and tell our children that this was the moment when we began to provide care for the sick and good jobs to the jobless; this was the moment when the rise of the oceans began to slow and our planet began to heal." So wait, America never provided care for the sick or good jobs for the jobless until St. Barack arrived? That doesn't sound like the country most Americans think of when they wave their flags on the Fourth of July.
The notion that what America needs is a redeemer figure to "remake" America from scratch isn't necessarily unpatriotic. But for lots of Americans who like America the way it is, it's sometimes hard to tell when it isn't.

I want to emphasize a few things here. America is not above reproach; no one is claiming that. And criticism of America does not make one unpatriotic. At all. But it's okay to love your country, even if it's only once in a while.

And even if it's every day.

Thursday, July 3, 2008

Critical thinking, lack thereof

Joy Johnson, and her husband, Rev. Joseph Craig, were arrested in Durham NC recently, on charges of rape, torture and kidnapping. The rev was contacted by a couple who were interested in Satanism; he promptly instructed them in the finer points of Satan worship, with Ms. Johnson's consent.

Okay--so what?

Well, there is the obvious angle related to Mike Nifong, the disgraced ex-DA who was involved in the scandal involving false rape charges brought against some Duke lacrosse players. Ms. Johnson was a local Democratic party activist, and was closely involved with the Durham People's Alliance, a group which was a major supporter of Nifong. A headline which reads "Nifong supporter charged with sex crimes' certainly catches my eye.

That angle is too obvious and easy. Instead, I thought it was cool that the couple also ran Indigo Dawn, a New Age "resource for spiritual growth." Here's their website.

Wow. More woo than you can shake a stick at. "Our intent and purpose is to lead the way and help others rise to a higher level of existence, quality of life and increased spirituality in preparation for this coming age of enlightenment." Apparently, you can get increasingly enlightened by being shackled to a bed and kept in a dog cage. Who knew?

The Rev. Craig is described as a "devout student of magick"---that's magick with a "k", folks, so you know it's Crowley-good! Ms. Johnson "has devoted her life to peace activism and searching for proactive means to bring about world peace." By worshipping Satan--of course!

Got some politics too. Did you know that "Iraq did not have problems with cancer until about three or four years after the Gulf War"? It says so in her essay "Recollections of a visit to pre-war Iraq." She met with a Dr. Yacoub, dean of a medical college in Baghdad, who specializes in depleted uranium, a component of some of the weaponry that was used against Iraqi forces. Dr. Yacoub's investigations found that cancers had increased by "300%" since 1993 in Basra. No mention is made of Dr. Yacoub's research into the health problems among the Kurds exposed to nerve gas, or how all those people got into those mass graves--just to embarass Sadaam, no doubt. Apparently, Ms. Johnson (when she wasn't scrawling pentagrams on the floor and invoking Beelzebub) spent a few weeks in Iraq in early 2003, lapping up with great gusto whatever her Iraqi hosts spoon-fed her. Her article/essay is gripping in its total lack of critical thinking applied to a complex situation.

But then, the whole of Indigo Dawn is devoid of critical thinking. And in light of these charges, the question no longer is where is their ability to think logically, but just what the hell were they thinking at all.

I am trying to keep in mind that this is Durham County, after all, and a charge of rape in this locality becomes, let's say, suspect. Nifong has long since departed office in disgrace; one can only hope that the new prosecutor is honest and decent.
Rev. Craig might be a formidable opponent; as the website bio says, "Do not judge this young man by his age, for his soul goes far beyond this."

Oh, indeed it does.

Tuesday, July 1, 2008

Marriage and equal pay and hypocrisy

Obviously, gay marriage is an inflammatory subject right now. So much so that there is a move afoot to amend the Constitution to recognize marriage exclusively as a union between a man and a woman. The latest version of this idiocy is sponsored by two senators who are all about the sanctity of marriage. Yep, that's right--the amendment is being sponsored by Sens. Larry "Wide Stance" Craig and David "Diaper Boy"* Vitter. These two are not exactly poster boys for family values; why they feel that they should be the ones to get behind something like this makes absolutely no sense at all.

I also ran across this article about Obama and his support for equal pay for women.

I firmly believe that men and women should be paid equally for equivalent jobs. I do believe that gender discrimination exists. But, the wage gap measures inequality, and not necessarily discrimination. And there are many reasons that explain the wage gap that do not involve discrimination, such as family and time constraints.

Obama, according to the article, believes that there is a clear difference between himself and McCain on the equal pay issue. "Mr. McCain is an honorable man, we respect his service. But when you look at our records and our plans on issues that matter to working women, the choice could not be clearer," Obama told the audience in New Mexico, a voter-swing state. "It starts with equal pay. Sixty-two percent of working women in America earn half or more than of their family's income. But women still earn 77 cents for every dollar earned by men in 2008. You'd think that Washington would be united it its determination to fight for equal pay."

Yet, the article points out that Obama's female staffers are paid significantly less than the male staffers. This is completely opposite of what is found among McCain's staff, where the average pay for the 30 non-intern women on McCain's staff was $59,104.51. The 16 non-intern males in McCain's office, by comparison, were paid an average of $56,628.83.

Maybe there is a good reason why Obama pays the women who work for him less than the men, I don't know. He was speaking in support of the Lilly Ledbetter Fair Pay Restoration Act, which would extend the limit on how long an employee can wait before suing an employer for pay discrimination. As Obama noted, "Lilly Ledbetter's problem was not that she was somehow unqualified or unprepared for higher-paying positions... Her problem was that her employer paid her less than men doing the exact same work."

Well, I guess there's enough hypocrisy to go around today.